As a leader, we are handed with situations where we find ourselves helpless, challenged, and overwhelmed. What do we do in those scenarios? How do we overcome adversities and deal with the unfamiliar? Ahmad Zbib is the CEO of the Canadian Rheumatology Association, the national professional association for Canadian rheumatologists. Ahmad spent most of his career at mission-based, non-profit organizations in diverse roles. He has hands-on experience in managing technology projects which brings a unique perspective and expertise. In this episode, he shares his professional journey and emphasizes that throughout his life he has worked with a lot of fundraisers so he is collaborative in nature. Listen to this episode as he shares valuable insights on the great measure of being a great leader.
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Our guest is Ahmad Zbib. He’s the CEO of the Canadian Rheumatology Association and we are pleased to have him on the show. Welcome, Ahmad.
Thank you for having me, Doug. I’m looking forward to this discussion.
Not everyone knows about the work of the Canadian Rheumatology Association. I’m going to ask you to tell us about that. Before you do that, having had the opportunity to do a little bit of work with you and your board, you have, as an organization, set very high standards for performance but also, for governance. I’m looking forward to the lessons that you can share with our readers. Tell us a little bit more about the CRA.
Thank you for saying that. It’s reassuring. The CRA, we are not what everybody thinks about when they think about the CRA. We are the Canadian Rheumatology Association. Basically, doctors are a professional medical society of rheumatologists in Canada. Our mission is to make sure that we help our members deliver the best care possible. We do that through education, research and networking.
Thank you for sharing that. As an eight-year-old boy, you always wanted to be the CEO of the Canadian Rheumatology Association. This is your life’s dream. Congratulations on achieving that. Walk us through how you came to be the CEO and tell us a little bit about how you came to Canada and how you’ve got into healthcare in the Canadian context.
I always say that I’m a physician. I’m a non-clinician. I’m trained as a doctor but haven’t practiced in Canada, and my years of practice are the months of practice as an intern at a hospital, ER and OR department. I have always wanted to be an orthopedic surgeon growing up. That was the dream. I went to med school and I decided to come to North America, but in the States, the heart wants what the heart wants. I met my wife now, girlfriend then online. She was living in Canada. She’s like, “Why don’t you come to Canada?” I came to Canada and got stuck in the medical system here because it’s not very friendly for international medical graduates.
I passed my first evaluation exam and I was starting to work on the exams, which were required me to do the residency because I came fresh off the boat of university graduating in General Medicine. As I was applying, I needed a job. I started working at Future Shop selling TVs. Before I knew it, they are offering me a management stream position. I was like, “No, I want to stick to healthcare.”
I’ve got my first job at Heart and Stroke. It was in research implementation special project on managing high blood pressure in multiple and primary care sites. I was responsible for developing the relationship and managing it with those sites and also creating some standardized clinical flow sheets to help doctors implement clinical guidelines in their practice.
We gave them back some practice outercourse to show them how they are doing. I have always been very technical. I used to put computers together in med school. When anything failed, they came to me. I leveraged that part of my role as well. I managed the implementation of this EMR connected database, feedback reports and whatnot.
I’ve got into the world of digital health and eHealth. I decided to join COACH Canada. It used to be COACH, now they are called Digital Health Canada. I’ve got my certification in Healthcare Information Management. I started doing different roles at Heart and Stroke. Because of my skills, they moved me into a patient and public education role developing apps and behavior change tools to help people live a healthier life.
At one point, we had Canada’s most downloaded health app. We developed this app in collaboration with a group at UHN in Toronto. It’s an innovation group. They do amazing stuff. I slowly started to get into working with the marketing folks at Heart and Stroke. I’ve got pulled into the strategy team and at one point, even the CEO is telling me, “Why are you still here?”
It was a time to start thinking about other opportunities. I’m chatting with a friend of mine who made the move to our Arthritis Society saying, “We could do somebody in business development.” I said, “I have never done business development other than selling TVs at Future Shop.” He said, “I have taken you with me to discovery meetings and whatnot. I think you will be great.”
I moved as the Director of Business Development. I’m primarily responsible for fundraising within the industry. I did, in a short timeframe, raise quite a bit of money. At the same time, there was a vacancy in the Ontario division for an ED role. The CEO tapping on my shoulder said, “I would like for you to take that on.” That’s when I made the move. It was several months after I joined the Arthritis Society.
A few years later, I’ve got a call from a recruiter. He came from the Rheumatology Association and they are looking for a CEO. I said, “I’m not interested. It’s too small.” It’s a small organization. He said, “Before you make that decision, the board wants something big out of this. They want to transform the organization. They may have some other dreams.” I said, “I’m listening.” That’s how I’ve got into that conversation. I had a discussion with the board. Now, I’m having this discussion with you as the CEO of the CRA.
It’s a remarkable story from what you described. I’m sure a lot of the pieces that you left out through that friend that tapped you on the shoulder from the Arthritis Society. Paul Haddad is a friend of mine that introduced us. Heart and Stroke, you are coming in. Your medical expertise and background are important in the work that you are doing there.Be eager to learn a lot from different people and experiences. Be open to new knowledge by reading a lot. Click To Tweet
Your aptitude to technology aside, you are able to speak to patients and for patients on that side of it as you move into the Arthritis Society. You are much more into organizational leadership and in the fundraising side of things. What was that transition like to move from being the medical expert to being the organizational lead? How did you think about that as you are making that transition?
What helped was the fact that I am collaborative in nature. Throughout my work on Heart and Stroke, I worked with a lot of fundraisers, marketers, strategists and whatnot. I’m like a sponge. When I work with somebody, I like to learn a lot from them and read a lot. The transition wasn’t that hard because my medical expertise also comes in handy.
One is people think of you higher when they know you have a Medical degree, which I have a problem with that because I have encountered people with Medical degrees and I don’t want to talk to them ever in my life. Most of them are awesome people, don’t get me wrong. People are of different shapes and forms. The other thing is as a commission or as somebody who is trained to be a commission, you are a critical thinker and that helps a lot.
When you are fundraising in healthcare and you understand the disease mechanism and the implication on the patients, it makes you a better fundraiser as well. There was a saying that I’m sure every charity has that is, “No mission, no money and no money, no mission.” You will have to understand the mission. Having that background helped me understand the mission quite a bit.
What was it like making that transition particularly in that second role you had as Head of the Ontario Division at the Arthritis Society? You are leading a large team of people responsible for raising millions of dollars a year. It’s quite different than a clinician in-clinic or even working in a team of physicians. How did you approach that leadership challenge where you are now the boss?
It wasn’t easy. It was uncomfortable and I like uncomfortable because this is where I developed the most, especially since we have an advisory board and I didn’t know what to do with them. To be honest with you, neither did the organization. It bothered me because I felt like I’m wasting the time of these people. We bring them in, “We want your opinions.” Sometimes we cannot act on these things and sometimes it feels like, “Check the advisory board meant,” there’s that.
The second thing is every new leader or manager, you have to go through the process of feeling or getting that imposter syndrome a bit but that pushes me to learn, talk and reach out to people. The way I approach it is by being as humble as possible and recognizing what I know, what I don’t know, and letting my team know. “I have never done that before. Let’s bring that up together.” I’m sure I made a ton of mistakes and bothered people but that was not my intention. I tried as much as possible to get to know the team and what are their pain points. I always put myself in their shoes.
I remember when I used to work in Future Shop, my manager comes to me and said, “There’s a new corporate policy that says this and that.” I didn’t agree with it. The last thing I tried to do when I became that person who could put these policies in place is to develop policies that are detached from reality. I tried as much as possible to get feedback. I talk to people to understand what they are going through without forcing them to do things that I felt were the right things to do.
I’m curious as a first-generation Canadian, as someone who moved to Canada as an adult, how did that factor into your responsibilities as you went through these two very large national health organizations?
This wasn’t my first big move. It was less of a culture shock. I went to med school in Lithuania and that was a culture shock.
You went from Lebanon to Lithuania.
I was born and raised in Lebanon. I did my undergrad at the American University of Beirut. English was not an issue. I’m privileged that way. I have always had a good background. I went to Lithuania because my parents couldn’t afford to send me to medical school in Lebanon although I was a good student. I’m glad that I couldn’t because I have learned a lot but it was quite a shock from a culture perspective.
Eastern Europe is not North America and it’s not Western Europe. It’s different now. Especially in the city I lived in, it was very hostile for people with my skin color. In general, Lithuanians have been subjected to Soviet occupation and they did not like foreigners. At least, that was my experience. Hopefully, things have changed and different cities probably is different.
That helped me get to know the people and not judge them as much as possible. I formed a ring of good Lithuanian friends. We used to play guitar, drink together, have fun and whatnot. I needed to immerse myself in the culture. As I said, I’m a sponge. I wanted to sponge off that culture and learn what’s good and not good because every culture has its positive and negative. That shift from Lebanon to Lithuania prepared me for coming to Canada.
It made me more resilient. To be in a leadership position, you have to develop a bit of resilience because there are negative days and positive days. I am who I am because of all these experiences that I have gone through. I don’t think you can say one reason per se that made me successful or fail. My character and the way I conduct myself as a leader were impacted by those experiences in moving to different countries.Every new leader has to go through the process of feeling or getting that imposter syndrome event that pushes you to learn, talk, and reach out to people. Click To Tweet
What I love most about Canada is that for most, it’s a very welcoming society. It’s a society that if you work hard, most of the time, you will get something in return. That’s speaking from a position of privilege. I didn’t come with no language skills or no background, whatsoever. I came with a Medical degree and was very fluent in English. I have $200 in my pocket when I came but that’s it. I had other skills that were very transferable.
Thank you for sharing that perspective. I appreciate it. That adaptive, “Let’s figure this out. Let’s make the best of what’s in front of us,” attitude that you exemplified in that story comes in handy as a leader. We often find ourselves in leading organizations and positions where it is unfamiliar or the challenge is something that you hadn’t anticipated or you had anticipated being one way and it’s something very different. Showing up as your best self at the moment is the measure of great leaders versus good leaders is how well we respond to those challenging times.
A measure of a person is how they act in stressful times. What I try to do with most is be true to myself. It doesn’t always work but this is what I tried. I always say, “What is happening on the inside and how can it affect the outside?”
One of my favorite questions to ask leaders who have taken on organizations where the pandemic is featured prominently in the beginning times of your leadership. Take us back to that first day. What was it like to start your first day as the CEO of the CRA?
That was quite the experience because the CRA even pre-pandemic was a virtual organization. I went from commuting for almost three hours a day to go from my bedroom. My first day was at the dining room table because I haven’t set up my office yet. In trying to understand all the systems that were in place, automatically my head is going to, “This can change.” It was like one of those days where a kid in a candy shop or I see all these problems that I can solve.
Another lesson learned is at one point because I started working with a business coach shortly after and she was saying, “Slow down. Not everybody operates at the same speed,” there was that aspect of all that excitement, “I want to prove myself,” and all that. Generally speaking, I operate fast. I like to do things fast. When you are in that position, it doesn’t only implicate you. It has implications on the rest of the team, especially when it’s a very small overworked hardworking team. You come in and you want to change everything. My motto, which now reflecting on it, wouldn’t have been the best. I kept telling my team, “No stone unturned.” Every time I said that they cringed.
There were some lessons in humbleness and making sure that you reassess your environment before you come with a plan. This is what our Secretary, Dr. Wade, keeps saying, “25 years from now.” My few months will be about knowing the people and I want to make sure that it’s obvious about knowing the people. It’s not about transforming the organization.
It’s one of the difficult things, whether it’s the CEO or that first Vice President position. I have seen lots of leaders and I’m guilty of it myself. You go into those positions and you think, “I’ve got to do this. I will look at this problem. I turned over this stone. I can help here. I can do this and change this.” I worked with someone who was a great fundraiser, a great person, and first time as a vice president. He would start fixing a little bit on this project and a little bit on this. At the end of the first few months, every revenue stream was half taken apart and a quarter put back together.
I was like, “You’ve got to finish something. Stop playing around with those things.” Knowing where to jump in and put your deep effort and thought, you are fortunate if you get it. Talent factors in there somewhere too but good fortune and where you dedicate the most of your time, rather than trying to fix everything 5%, “Let’s fix one thing, 30%, 40%, 50% or 100% if it’s really broken.”
You came into an organization that had great ambition. You said great ambition from the board, which is what attracted you to the role. You have talked about a small and overworked team that has this new ambitious CEO that keeps flipping the rocks over. How responsive or receptive was the team when you came in with these big ideas to change the organization?
At least what I saw is that they were responsive. They liked the ideas and whatnot. They were exhibiting symptoms of severe corporate dehydration because they were genuinely overworked. Three people are doing all the work that we are doing now with seven. It was not done at the same level of sophistication and whatnot but they were working around the clock. They liked the idea of some of the things that I want to do and doing things differently.
One of the things I started to do is do a weekly team meeting and we switched to virtual. I was feeling lonely. I’m an extrovert. I get my energy from people. Also, I felt that despite us being so small, we are heavily siloed. It’s amazing how an organization that small can be that siloed. Nobody knew what the other person was doing. It’s because the organization has gone through evolutions.
The previous CEO got us to where we are and I couldn’t have picked up the next level had she not done that. In that course of evolution, these people were doing more because they couldn’t afford to do the meetings together because they were so busy. They were digging the deeper silos. It was shortly after I started that I realized that there’s an HR intervention that is required. It’s less about stones on unturned and strategies, and everything else I want to do. There’s a crisis that needs to be addressed.
A few months into the role, I shifted entirely. It’s like, “The primary focus here is twofold.” One is talking to the board about the future, where we want to go but that requires a lot of work and prep. There’s an immediate intervention that needs to happen in terms of restructuring and changing some of the roles and whatnot. This is where I started diving deep with every single team member in terms of, “What are your scope? What are you working on? How many hours a day?” All these things. I’m trying to figure out how we can start adding team members that help us alleviate some of that.
Was there a single moment where you realized, “We’ve got to fix this before we can do this?”If the people are not treated well, this organization will not survive. Click To Tweet
I received a call from somebody on my team who was about to crash. I felt so guilty for not picking up. I had no clue how bad it was. I knew it was bad, I just didn’t know how bad it was. This is where everything else has to wait. This is the most important thing now because if the people are not treated well, this organization will not survive. That phone call, that was it.
Having the privilege and the opportunity to talk to a lot of leaders who are responsible for big organizational change, you either push too far or you realize we are not doing it in the right way because it’s burning people out. Lots of people will receive that phone call, but not everybody stops and says, “We’ve got to address this,” or try to push through it. Those leaders who try to push through it are rarely successful because as you say, it takes the team to get everything done.
Let’s make sure we’ve got what we need. The infrastructure, the positions, and the people in place to do this on a sustainable basis. You turn your attention to that first point you made about the long-term planning with the board. You had a very common experience that a lot of first-time CEOs but a lot of new CEOs, whether they have been CEO before or not, say, “We need to do a strategic plan,” and everyone said, “Yes.” Didn’t they say, “Let’s do this?”
No, they did not.
What happened when you said, “We’ve got to do a strategic plan?” What was the response of your board?
Before I joined, I met with the president then and I asked. It was part of the prep for the interview and I reviewed her strategic priorities. For me, they were not that specific. They were very high level and there were no specific metrics tied to them. We don’t know if we achieved them or not. To give you an example, members are aware of the human resource shortage in Canada. Everybody knows there’s a healthcare human resource shortage in Canada.
Rheumatologists, cardiologists and nurses. You call it whatever you want to call it. That was a pillar. Everything that we can do under that HR can fit easily beyond under. My question to the president, was like, “How open is the board to reevaluate the strategic plan because, for me, it doesn’t seem that specific? I like to draw a map to a destination and I don’t have a destination.”
She’s like, “Let’s not discuss it now. It was painful to go through that process but if we didn’t do it a long time ago, I don’t think we should do it now.” Instead of that, I was like, “What can I do to start getting the board engaged in what the key issues are?” That was also another development opportunity for me because I haven’t ever done governance board before and I was scared a bit and messing up.
I didn’t want to go with confidence that I know what to do. I was like, “I have no idea.” I was so privileged to the fact that CRA is gone with this governance restructuring process a few years back and brought in an excellent consultant who helped us develop proper governance, structure, governance policies, clear roles for board members and the CEO. It was like a manual. You read it and are perfect. I know how to operate this board. It helps that you have great people on the board, who wanted to trust me and were rooting for me.
Going back to that strategy discussion, I presented a SWOT analysis. I competed it out of the blue, for the board. I said, “These are the issues that we need to keep our eye on.” It was a good discussion. The board liked the information. I said, “How about we build on that? I want to do a gap analysis to understand what the gaps are in the world of rheumatology.
I had done something not long ago on the arthritis side. They are very related fields. We took whatever I have done there and then built on that. I hired an epidemiologist that I have worked with. She’s a researcher, so she’s very helpful in looking at literature and combining your reports. We compiled the report first from the published immigrated literature. We went out and I did find a few opinion leaders in rheumatology, we interviewed them. We shared some of the results with them and we’ve got more feedback and all of that was taken. What I did is I created two pathways.
The career pathway for a rheumatologist from the day they enter med school all the way when they retired and a disease pathway for a patient and where the patch points and the doctors would be. We built all this information that we gathered around these pathways. I presented all that information to the board. I highlighted, “These are the key areas of opportunities. These are the existing programs that we are doing. These are the areas that we are overserving. These are areas as we are under-serving. By the way, meeting the strategy.”
That worked. It was after a few years and after all that research I brought in also a strategy consultant. We did a session on, “What does it need to be to do a strategy? Where would strategy take you? Why do they fail? Why do they succeed?” We asked them, “Should we develop a new strategy?” We’ve got a yes. It was a process. It took about two years to get there but we’ve got there.
When you started, you had your board fully aligned. They were nodding, “Yes, let’s do this.” They understood what the strategic plan was going to be in service to. Those two pathways, the areas of service were required and the investment in those areas that are overserved, which is a challenge that a lot of organizations on the charitable or in the social profit sector more broadly, sometimes missed.
We do a strategic plan because the year has changed in the last strategic plan, didn’t have this year in it. We’ve got to do a new strategic plan. Let’s roll it forward and change some of the KPIs and we are done. What I like about the path that you took with the organization is that you anchored it in the experience of the members and the actual or reality about what’s happening for the members and what it means for patients. They could see, “This is what we need to do.” Everyone was agreeing on what problem needed to be addressed.Show up as your best self. The measure of great leaders versus just good leaders is how well we respond to challenging times. Click To Tweet
The strategy is about, “How we resolve that or how we address that problem,” rather than, “Let’s figure out what we think our problems are and what we might do to fix them,” which doesn’t have much data behind it. That’s when you tend to see strategic plans drift off into the ether or go somewhere to collect dust but you did the work. It’s amazing what hard work will do when you are getting a board ready to do strategic planning.
The beauty of doing this work is that we have preconceived notions of what the strategy should look like when we start, we all do. We have our biases. I understand the system. “The problem is here and the problem is there.” You then find out, it was like, “The problem is not here. Your intuition is not right. You cannot refute data. Data speaks louder than intuition.” It’s easy to think of things as, “That’s my intuition.
I’m hoping that readers can read your approach. You have utilized what I consider to be the CEO’s magic wand several times, which is the phrase, “I don’t know.” As new leaders or CEOs feel like they have to know all of the answers, “I’ve got to show that they made the right choice in hiring me and I’ve got to prove it.” Every leader has that moment of, “What if they find out that I don’t know what I’m doing?” You shared along your journey, that the power of saying, “I don’t know,” and then people help you find the answer. When you have used that, “I don’t know,” what have you found that the response to have been from your board?
It depends on the context, if they ask me, “What are the financials for the year?” I say, “I don’t know,” and then I should be on the spot. In general, it’s a good thing. It’s funny because I was reading the book that you and I were discussing, Think Again, by Adam Grant. He’s saying, “The best way to convince somebody is not to be overly confident.”
It’s funny because I was having a conversation with someone who was a tech-smart guy and he’s an investment banker. He’s having his doubts about this whole thing with COVID and vaccines. I said, “You are not going to get anything near confidence from me because I don’t have the confidence first. I’m not an infectious disease expert.” I do read a lot.
The second is science is iterative. It doesn’t happen overnight and what we thought was right in the 1930s, and even in the 2000s, we think it’s wrong now. The problem is not with the scientist. The scientists are not communication people and communication people are not scientists. What happens is the communication people will become overly confident in the message that they are displaying or that they are relaying and that scientists are saying, “That’s not what I’m saying.”
It’s the same with your board, but even with the staff. It’s like, “I don’t know means, I’m honest.” It could be that nobody knows or that we put this as one of the given if we are solving a problem. It’s like, “There’s a lot that we don’t know. Let’s keep that in mind. Let’s figure out how much more we can know.” It reminds people, “I’m human. There’s a lot that I don’t know.” The role of a leader is not to give answers. It’s to ask good questions.
Showing that you are asking questions of yourself, adds a lot of credibility to the questions you are asking of other people. As we come to the end, I was hoping you would share some words of advice. We are here at the beginning of 2022, looking ahead to the year that will be. What advice would you have for CEO colleagues, executive director colleagues, across the country that is feeling a bit restored now but had a pretty tiring 2021? What are you looking forward to and what advice would you give to others?
The advice could be in two categories. One is pandemic-related. One is general. The pandemic-related is to take good care of yourself. You are as good as your mental health. Especially for me, after working that many years from home, I’m making sure that I’m not missing out on my exercise. I am eating healthy and spending as much time as possible with my kids. When you work from home, you don’t leave work. Make sure that you have a routine by end of the day that you shut down, and go out and charge. You can’t drive an electric vehicle if it hasn’t been charging. It’s the same with your mind. You need to recharge.
The second one is with anybody who’s got a board is to have a good relationship with your board. Think of them as your supporters. Think of them as your colleagues who may know more about things or have more experiences and use them as a sounding board. Don’t think of them as your bosses or people who can fire me or they are stepping on my toes.
There are reasons where sometimes boards do step in and sometimes, they shouldn’t. If you invest time, energy, and emotions in a relationship with your board, it pays dividends. That would be my number one advice is to make time to get to know your board members and have a good professional relationship with them.
The best leaders across the sector, follow that as a matter of practice. For leaders who are struggling with their board, often the first place we start with advice is, “Get to know these individuals as people.” You will find that you don’t need to feel quite as defensive when they ask you questions. The questions will be a little bit more based on the content of the meeting and less on the perception of how you are handling things as a leader.
If it helps at all, invest in a business coach. That was transformational for me. I approached the board and I said, “I would like to invest in something like that. Would the CRA support me?” They did. It was amazing because that coach helped with my blind spots and helped me manage situations with the staff, the board, even when my kids and my wife, it was phenomenal.
Ahmad, thank you so much for making time to be on the show and sharing your journey, experience, and your wisdom.
About Ahmad Zbib
Ahmad is healthcare executive with strong interest, certification and many years of experience in digital health. Ahmad leverages his understanding of the Canadian health care system, his medical knowledge and strong technical and executive skills to transform organizations to realize their full potential.
Currently, Ahmad is the CEO at the Canadian Rheumatology Association. He is also in the Global Executive MBA for Healthcare and the Life Sciences at the Rotman School of Management. He has a MSc in medicine and physician qualification as well as a BSc in Biology. Throughout his career, Ahmad had been responsible for various functions including primary care outreach, research implementation, patient and public education, digital health and innovation, business development (fundraising), and executive leadership.
Ahmad looks forward to applying and widening his knowledge, skills and network and unlocking opportunities through which he can deliver a positive impact on a global level in health care.