How to Get Leadership Right, According to the CEO of the Bill and Melinda Gates Foundation

The name Susan Desmond-Hellmann may not have the same household recognition as those of her bosses, Bill and Melinda Gates, but that could change. Correction: That should change.

As the CEO of the couple’s eponymous foundation, Desmond-Hellmann runs the show that keeps their billions of charitable dollars—and that of other billionaires, including Warren Buffett, a foundation trustee—working toward the loftiest possible goal: reducing disease and inequality around the world. That’s significant enough, but long before she joined the foundation, Desmond-Hellmann, a physician and oncologist by training, worked at Genentech, a pharmaceutical company, where she led the development of two landmark, life-saving cancer drugs, Avastin and Herceptin. She later became the first woman named chancellor of the University of California at San Francisco.

Nearly five years ago, she was recruited to the Bill and Melinda Gates Foundation, drawn to what she calls its founders’ beautiful vision: the concept that all lives have equal value. On Dec. 13, the foundation released its year-in-review report for 2018. Among the victories it cites: thanks to the foundation’s work with partners globally, the first new drug to treat relapsing malaria in 60 years got approved, and more children in India were immunized against pneumonia than in any year in history. The foundation spent hundreds of millions improving opportunities for the world’s poorest women and children, making birth control more accessible, and, in the U.S., backing a new approach to supporting college-bound high school grads from America’s black, Latino, and low-income families.

In a recent conversation with Quartz at Work, Desmond-Hellmann discussed her leadership style, the global forces that shaped progress at the 1,500-employee strong foundation, and why she took the CEO job, despite an initial lack of interest. The interview has been condensed and lightly edited for clarity.

Quartz: How would you describe your leadership style?

Desmond-Hellmann: One of the things I’ve been known to say—apparently, like a broken record—is everyone deserves a great manager. It’s a tenet for me, something I’m very focused on, and a big part of how I lead.

Another through-line of every role that I’ve had is that I’m very drawn to work that provides meaning, and one of the things I think is required of great leaders is to make sure that the culture and the working environment brings out the best in people, and that people find joy and meaning and purpose in the work they’re doing. And, happily, working at the Gates Foundation, I find a lot of opportunities to celebrate, and to make visible for staff, the meaning and the purpose of the work that we all do together.

Does it help that meaning and purpose is built into the job at a place like the Bill & Melinda Gates Foundation?

It’s built in, but saying that, I don’t think it’s obvious. Let me give you an example. Let’s say you’re in finance and your job is to make sure that the books are closed at the end of the month and we make payroll. That person in finance, I want them to understand that in 2018, the work we funded ended up leading to the first new drug for relapsing malaria in 60 years.

This year, I got to travel to Brazil and I made a little video for staff to really bring to life how important that new medicine was for the people of Brazil, and how excited the caregivers in Brazil were that they were getting ready to launch this new medicine. I think it’s important not to underestimate that there are a lot of people who work in places like the Bill & Melinda Gates Foundation, who, on any given day, might be struggling to understand some areas of Brazil where they’ve never been, and that, as a leader, I can help bring that to life for them, and help them get a little more insight into the importance of the work that they do every day. I think that’s one of the most fun parts of being a leader.

In her new book, Dare Greatly (Avery, 2018), Brené Brown writes that people tend to think of their best leadership traits as “just the way they are,” until they’re asked to think about how they developed that trait. It’s usually because of a lesson learned from someone else. Do you have any examples of habits you’ve learned from others?

I believe, and I know Brené Brown agrees with this, that one way not to forget is to constantly tell stories. And so I love a good story. I actually was meeting with somebody who I manage yesterday and we were talking about being a great manager, and I told a story about working for Art Levinson, when I was at Genentech. [Editor’s note: Levinson, a former CEO of Genentech, is now the chairman of Apple and the CEO of Calico, a research organization focused on aging and lifespan.]  I told this person that one of the things that Art had this wonderful ability to do is, I would walk into his office and the hairs would be up on the back of his neck, but when I left, the hairs will be up on the back of my neck.

I found that inspiring. There’s something really amazing if your manager, tells you, “I know you can do this and you’ll do this really well. I’m counting on you.” It demonstrates respect, and it creates just the right amount of “I’m not going to let you down” [on the employee’s part]. When you really count on somebody and you’re asking them to contribute in a meaningful way—if you have the ability to say, “If I can help you in any way, I’m here for you, but you know, you can do this”—people are amazing.

I also try not to forget that I wasn’t capable of doing half the things I’m capable of doing now before somebody gave me a chance to try and even fail the first couple times. Talking about those lessons and talking out loud about failure, and what you learned from it and how you carried on, I think that’s a really important part of leadership. 

One basic question that comes to mind about the head of what the New York Times has called a “global colossus of philanthropy,” with an endowment of $50 billion, is: How do you do it? How do you manage to handle all of these varied programs and projects around the world?

The answer is I don’t do it all. There are a couple things that people in jobs like mine can do that can drive great outcomes. If you look at something like the Gates Medical Research Institute opening, it’s astoundingly exciting. We’re going to try, through this research institute, to translate laboratory discoveries into real medicines for humans. It’s called translation, and it’s one of the hardest things to do in product development, and especially hard when you’re making products for people in low-resource areas.

So, as CEO, what are the kinds of things I can do to ensure that it’s a success? Well, I encouraged the selection of Penny Heaton as the CEO of the Gates Medical Research Institute. I’m not going to know every detail of the Gates Medical Research Institute. There’s only 24 hours in a day. But what I can do is make sure that the leader is an incredibly talented person who has the capabilities of driving that agenda.

Were there changes in the world or political forces that have made your job as the head of the foundation more difficult? Or changes that made your work easier?

Yes. I’ll give you one that’s positive and one that’s challenging.

Let’s start with the positive. One of the things we launched in 2018 was a gender-equality strategy. Boy, was our timing on launching that strategy good, because everybody wants to talk about, think about, and do something constructive and positive to support women and girls playing a key role in society. So, I would say that that has been welcomed and that’s been terrific.

On the other hand, I’ll tell you one that’s been really, really challenging. We are very focused on family planning as a key strategy and making sure that women get to decide when they have their children and how far apart their children are born. We think that women deserve to have access to modern, safe, and effective contraception. But the policies in the United States, and what’s called the Mexico City rule, make it more challenging for us to make sure that women have access to contraception.

How have you handled that?

We have stayed the course. We’re working locally with many communities and nations that want to bring this to women in their communities, and we’re looking at the long term, not the short term.

What advice do you give to women who aspire to a leadership role like yours, especially in scientific fields, where women have famously faced barriers?

One, I serve as a mentor, and I think having a good mentor or a good sponsor is a really important thing for anybody, male or female, as they have aspirations to improve their career.

The other thing that I’ve passed along to people is advice I heard from a colleague at UCSF, Liz Blackburn, who was awarded the Nobel prize in medicine or physiology for her work on telomeres. Liz and I did a really fantastic interview with the female medical students at UCSF. Liz has a son, and someone asked Liz about work-life balance. I’ve never forgotten what she said: She decided not to hold herself accountable for work-life balance on any given day or any given week, but to think of it in parcels of a year.

Her family always had a great family vacation in August—they would take off the last two weeks of August and go to Hawaii. And sometimes she would take a whole weekend and spend it with her son on some science project. But there were times when a grant was due, for example, when she would just be invisible [at home] for a week, and she just didn’t beat herself up about it. She encouraged people to think about the longer term work-life balance, rather than stressing out when you have a deadline or something that requires your energy. That’s when you depend on your partner or other support you have to make it all work. I thought that was really good advice. Have a little self forgiveness. Stop beating yourself up that not everything at home is perfect, or not everything at work is perfect.

How did you know, coming to the foundation, that it would be right for you, that you’d be able to lead there?

When I first talked to Bill and Melinda about coming to the foundation, I was somewhat negative [about taking the role], because I had a really good job at UCSF and I was happy in the job. I was not looking to change. I have to say that the scope of their ambitions, and their conviction that I could help them with their ambitions, drew me to the foundation.

One of the most exciting things about 2018 has been the recognition that vaccines are saving more lives than ever before. At the Gates Foundation we funded and collaborated with others to cause incredible innovation in vaccines: two major HIV vaccine trials started in September in sub-Saharan Africa this year, and a new polio vaccine is being tested. That’s one of many examples of the kind of ambition and the kind of global impact that the Gates Foundation aspires to create.

When I realized how committed and how ambitious Bill and Melinda are, I thought if I can help them, I really need to. It’s as simple as that. And they haven’t let me down.