Credit: Courtesy Salesforce

As chief medical officer at Salesforce, Dr. Ashwini M. Zenooz used to spend most of her time focused on Salesforce’s clients and offerings in the health care and life sciences area. But Dr. Zenooz now spends much of her time on how the company itself is navigating the pandemic and its own practices around workplace safety and employee health. 

The crisis has highlighted the role of chief medical officer at the companies other than health care companies that have one. To get a better sense of what the role does and whether more organizations should hire one, this week I spoke with Dr. Zenooz, who is also a practicing radiologist and previously worked in the Department of Veterans Affairs. Here is a transcript of our conversation, edited lightly for clarity.

What does a chief medical officer do?

It depends where. When you think of a chief medical officer, I think you traditionally think about [health-care] provider organizations. It’s a very traditional role where you’re working with other clinicians, frontline providers to organize your policy and delivery of care etc. There are some chief medical officers that are in the employee health—like occupational health—space traditionally that you’ve seen at large companies. But that has changed since the pandemic. So when you say today what does a chief medical officer do? I think that looks very, very different today.

I imagine there are differences in the role between manufacturing and service companies, for example. It depends on the type of company as well?

Yes, absolutely. We’ve had medical personnel in different places. They may not necessarily have been elevated to the chief medical officer level in different organizations like you’re talking about, whether it’s in a manufacturing company or an auto company or technology company. But I think when the pandemic hit there was clear need for understanding of what was happening with this pandemic—a lack of information, the rapid spread, the changing landscape of the spread, people dying, restaurants closing. There was just so much going on that the c-suite in each of these types of companies recognized that you need to have somebody who is a focal person that can be the lead. Maybe they have a team, but they need to start looking at how this impacts not only their employees, but others that company touches.

If you’re in a company that produces canned foods, you want to make sure that your people are healthy and the people that are processing the food and packaging and transport etc. are also healthy because there’s an entire line of communication. Also if one or two people in that process get ill and it’s not recognized, it changes the entire team that works on that. It shuts down operations. So it has broader implications of not just your employee base, but the people it’s impacting around you, the teams. There’s economic impact. There’s impact into the community where they’re going out and interacting with others. Companies started to recognize that they need to have people who actually understand public health. If they had people inside the system who had clinical background, they said, ‘Hey, can you help us understand and help translate what’s happening out there?’ Suddenly during this pandemic, when I talked to other chief medical officers in different companies, the roles have been elevated and they’re talking to a whole different group of people that they didn’t really talk to on a daily basis or weekly basis before.

The different group of people is the c-suite and the board?

That’s right. Or other public health officials, representing the company. Talking to government officials, trying to understand the data, sitting in on CDC calls. These are not things that, for example, a person who sits in a technology company traditionally does outside of understanding regulatory and compliance, if you’re going to sell something as a medical software product. There are people on my team that are now actually talking to folks in these organizations trying to understand what are the types of vaccines that are coming out, how does that impact? Where’s the regulatory authority, what’s the EUA [emergency use authorization] process? How is it different globally? How is this going to impact our employees? So it’s a much broader conversation. You’re talking to people that you traditionally wouldn’t talk to, like all of those other people in government.

Your role prior to the pandemic was focused on the health sciences practice of Salesforce and serving customers in that area much more than general employee health and wellness, right?

Yes, that’s absolutely right. My role here has been to work on the customer side, to understand the customer needs, work with our customers across payer providers, medical device, pharma, public health companies to say, what are the solutions that Salesforce can provide and then working with the product teams and looking at a strategy for software. Now does that mean that I never interacted with our employee benefits and HR folks? That’s not true. At the end of the day, if you’re going to give out a mental health benefit or they have questions or maternity benefits, you’re going to engage with somebody in the field. But I think the collaboration has drastically changed now where we’re on weekly calls rather than ad hoc.

Can you give a few examples of specific things that you’ve been involved with this year in terms of workplace safety and mental health?

Mental health is a great example. We definitely saw that there are many reasons why people are more likely to get depressed or have exacerbation of mental health issues. These were conversations that we started having, and saying are the benefits that we have appropriate. How do we engage certain populations around the globe where we see more of that happening at a population level, and what are the type of benefits we should be focusing on you know, in a market? Those were very targeted conversations where we said are the things that we’re offering clear for our employees and how do we make it more clear for certain populations more at risk?

I just talked about the vaccine component, where Salesforce is a global company. When we’re looking around, we have offices all over the world and we have to follow guidelines of local governments. There are some governments that are going to mandate vaccines and mandate vaccines before you come into the workplace. Where other places you have more of an option whether you want to get the vaccine or not. So we have to understand what the federal rules are in different countries, and then translate that to our customers, to our employees and think through how to work within the regulations of countries, but also maintain some level of safety for all of our employees. These are active conversations that I’m involved in with our leadership, with our benefits teams, as well as outside federal governments.

One more example is as we’re thinking about vaccines another conversation I’m deeply engaged with during Covid is around ethics. We have a chief ethics officer and I’m very tied in, in conversations with her as we think through how this will impact [our workforce.] This was initially contact tracing,. Do we allow people to come into work? Do we contact trace people? Can we get people’s temperature? Can we mandate that? These were all conversations that the two of us would have with the leadership, because we had to think through this and make recommendations. Now with vaccines, we’re having the same conversation. Can we require immunization passports for people to come in? Is it just for employees or do we also mandate it for our customers? Is that legal? How does that work with privacy laws in California? The rest of the country? Europe? You’ve got to tie all that together. That requires somebody who understands public health, privacy, regulation, ethics, leadership. So you need a team of people that come together. And I find that people like me in my company are critical to these conversations.

Where did you land on how to approach contact tracing?

I don’t know if I can talk about specifically how we do it in our company. But in general we provided a contact tracing mechanism as part of our software options that anybody can use, including our company. I want to say half of the us population uses our technology for contact tracing. So it is fairly widespread. We do not use automated contact tracing. That’s one area where we have the ethics, where we talked about whether we want to be a part of that. We chose to work with manual contact tracers and governments to ensure that software and mechanism is available for general public use. Internally in our own company. most of our buildings are closed and we have not required our employees to come in. In places around the world where we have opened up our offices, we’re following federal guidelines. If those guidelines require us to measure temperatures, to give information back to the local government so that they can contact trace, we participated in those.

Have you come to a view on whether, where it’s legally permissible, companies should be requiring employee vaccination once it’s available?

I don’t think we’re there yet. This is still evolving. Clearly at least in the United States, the FDA is looking at emergency use authorization for two of the vaccines. [Editor’s note: The FDA granted EUA approval for the Pfizer/ BioNTech vaccine late Friday, after this interview.] If you follow federal guidelines, you’re hoping that they look at safety measures much deeper than somebody on the outside would, and you’d follow their precautions. But at the end of the day people have a choice in the US, so this is still something that we’re thinking through. I will tell you in general, what I’ve found is if we start mandating that everyone have it, for example, it may impact certain populations disproportionately because Covid has been really clear. It’s been really clear to show that people of color don’t trust healthcare systems, and you have to earn their trust and therefore in general have had reductions in access and poor outcomes.

It’s a vicious cycle. So you have to build people’s trust to come in and get vaccinated, to get therapy, so that you can go back in. When you start mandating things, you have to think about the broader diverse population at large. These are all our employees, and they live in different places in diverse systems. I could see a company saying you can opt to work from home, but if you are going to come into the workplace, we will require that you are vaccinated for the foreseeable future. That way it gives people an option. But I think it would be really difficult until we work through all these issues to think about mandating it for everybody in the United States.

For companies that don’t have chief medical officers, what are the issues that you’d advise them should be on their radar now?

I would say, then get yourself a chief medical advisor. Every company is a health care company today and I don’t see it not being one for the next few years. So I think it’s really important. I’m not saying a person who has a medical background can evaluate all of the complexities of what’s happening today in a pandemic. But at least they have better guidelines. You want to take advice from somebody that can translate some of the information. I’m a radiologist—and I’ve also been in public health before so I happen to have that background—but at least I have a clinical background, and I can liaise with other people who have public health backgrounds and understand, because I’ve trained in this.

So at a very minimum, you want somebody that has this background. Ideally you want people advising you that have a public health background, who understand the implications, who understand the broader implications of just saying this is a virus, you need a vaccination. It doesn’t need to be a chief medical advisor—get yourself an advisor or two that can help you think through employee strategy. What you may find is these folks could be more beneficial than you think beyond just the pandemic. When you’re looking at employee health benefits, employers share a brunt of the burden in paying for insurance for their employees. So there are a lot of other things to think about where there are price transparency rules coming out, insurance companies requiring things. So having somebody with a background in clinical and public health can also help you think through other aspects of how you care for your employees and how to cut down costs, but also provide it in a way that incentivizes your employees to stay with you. There are so many other things that you can work with these folks on.

What are the key things that they should have on their radar now?

I talked through some of that. You need to understand the implications of your own employees, whether they’re able to come in. Most companies are forecasting and you need to be able to forecast whether you’re going to have the workforce or you’re going to have economic implications. So that’s one. You need to really understand what’s happening around the world from a vaccine perspective because generally the way things work in this world is 90% of the medications are available to 10% of the population. If you look at vaccines the same way, you really don’t want 90% to only be available to 10%. If you’re a global company, you really want to understand the other ways I can help participate in getting these vaccines out to everybody, because this is an economy that is a globalized economy.

So I really need to participate in this broader process. You need to understand, beyond the nuances of the vaccine, who is available, what are they getting? How can I participate in a collaborative with the government to ensure that there’s equitable access to this around the world? This is more mundane, but you once the pandemic stuff is done, you need to start thinking about the staying benefit, the longer-term benefits or the longer-term repercussions, like the mental health issues. If you look at data that’s coming out of Japan, there are more people dying by suicide than they are by coronavirus. You need to start looking at the populations that are impacted and thinking through how you help your employees that are in these countries right now. In the insurance stuff, there are other things like benefits. Beyond that, cutting down the costs, where can you focus, how can you make lives easier for your employees, and happier? How can you care for the communities around them? Because it all impacts their well-being and their happiness so that they can come work in your workplace. So you have to take a more holistic view.

You’ve mentioned mental health a few times. From where you sit, are there best practices or specific areas of focus that are particularly meaningful right now?

I don’t know if I would say that it is an employer’s responsibility to care for mental health. I think it’s everyone’s responsibility. Government should be engaged in this and thinking about this. We should be incentivizing people with payments. We should have easy access to tele-mental health. These are all places that employers can work to ensure that their employees have access to these things. But I don’t know if I’d make it their sole responsibility, because that’s not really fair. There’s so much going on right now, I haven’t really focused on any one best practice. But I would say every company hopefully has this, but employee assistance programs are core.

If they’re going through any changes in their life, the pandemic has had other repercussions, with people feeling stressed, divorced, having anxiety. So there are things beyond suicide prevention. Giving the opportunity for employees to discreetly talk about how they’re feeling is really important, whether it’s through employee assistance programs, through tele-mental health programs, giving people time off so that they can rest and recuperate like wellness days. We do a lot of that here at Salesforce where we block off days where we say no meetings on this day, just take it off and be with your family. I think that’s really, really important. We also bring on people from other industries and have events. It’s open to the public, but it’s also open to our employees,. We bring on artists, singers, where they come and entertain for 30 minutes. It just brings joy to your employees and it’s not related to your work, but it’s a great way to give them an outlet to come together virtually .

Post pandemic, how will the role of the chief medical officer will reset? Presumably it’s not going back to exactly where you were at the beginning of the year.

I definitely see that my role has become much more strategic. Within this company I’m involved in a lot of different conversations and I expect that to be the same elsewhere. Whether you’re an employee or you serve as an advisor, the c-suite is going to come to rely more and more on people with clinical background in the workplace, regardless of what type of industry you’re in. If you happen to be inside, you’re going to be critical. I can’t see it going away because there are so many other benefits to having somebody with this skill set inside of a company. If they’re not on the c-suite, at the very least they’re going to be very, very engaged. So I don’t see it just disappearing.

What’s your training and how did you come into this role?

I’m a radiologist by background. I’m still practicing. But I spent a lot of time as a subject matter expert on the Hill while I was practicing medicine. I then spent a year in the Senate working on policy. From there I spent a few years in federal government in the Department of Veterans Affairs, initially working under the Obama administration running clinical programs, policy, research development, etc. Then during the Trump administration I was chief medical officer for digital modernization. We started with EHR [electronic health records] modernization so that we could have more seamless access and provide more seamless access to care and further interoperability. A lot of folks focus on the clinical data and how that’s really important to outcomes for patients. But you spend more time with non-clinical folks than you do with clinical folks [as] the patient. There’s a lot of place there where you can have much more seamless interactions and ease of access to patients. Salesforce was really intriguing to me because I saw a lot of opportunity where I could further that here. I came here to be the chief medical officer. It’s been fun.

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