Key Takeaways
- Advancement to senior leadership requires shifting from task-oriented execution to strategic oversight by challenging the 'why' behind operational objectives.
Operational strategy in healthcare is facing a crucible moment in 2025. As the sector navigates post-pandemic workforce attrition, ballooning administrative overhead, and patient access challenges, the difference between survival and obsolescence lies in the effectiveness of operations leadership. Yet, the pathway from clinical practice to the C-suite remains opaque for most. That’s why this episode of The American Journal of Healthcare Strategy podcast—featuring Gaurai Uddanwadiker, MHA, MSc, Senior Vice President, Operations at Daybreak Health—matters now more than ever.
Gaurai’s story is one of navigating multiple healthcare systems, adapting to the U.S. market, and driving results by relentlessly questioning the “why” behind every operational objective. From his roots as a therapist in India to leading broad operational portfolios at disruptive U.S. mental health startups, his perspective bridges the clinician’s empathy with the operator’s discipline. This article distills the top insights from the episode, translating Gaurai’s journey and expertise into actionable lessons for today’s—and tomorrow’s—healthcare leaders.
Why would a successful clinician pivot into healthcare operations, and does a foreign background add or subtract value in the American system? Gaurai answers directly: it’s about impact and adaptability.
After nearly a decade as a therapist and behavioral health entrepreneur in Bangalore, India, Gaurai faced a crossroads upon relocating to the U.S.: “My entire clinical background did not make any sense here,” he recounts. Rather than start over as a clinician, he leveraged an Executive MHA from the University of Washington to bridge his expertise into the U.S. system.
Key drivers for Gaurai’s transition:
Bureaucracy-fatigue in academic healthcare motivated his initial shift to entrepreneurship.
The U.S. market’s insurance-based complexity demanded “a greater understanding of the system… the executive MHA program just made a load of sense to me.”
Adaptability: “If I step back and give [a problem] a little bit of time, maybe a week or two, I can solve it. That’s the value that the MHA gave me.”
What’s the real lesson? For professionals with international or clinical backgrounds, U.S. healthcare rewards those who combine humility with curiosity—and are willing to translate, not simply transfer, their experience.
Despite an impressive resume abroad, Gaurai’s U.S. job search began with rejection and humility. How do you move from “overqualified outsider” to the C-suite? Gaurai gives a playbook:
Accept the Learning Curve: “It was an incredibly humbling time… I had no U.S. healthcare experience, and no one was really interested in my [past] experience.”
Reframe Your Story: He realized his challenge wasn’t only experience, but “how I translated my experience for the interviewer was not going down well.”
Network Relentlessly: Meeting Larry Angel, Chief Product Officer at 98.6, was pivotal. “Would you be open to doing an informational meeting?” became his mantra, ultimately landing him a Practice Operations Coordinator role.
Outwork and Outlearn: Gaurai credits his rise—Coordinator to Manager in five months, then Director and VP roles—to two things:
Hunger for growth: “I was hungry for more and willing to put in the hard work to do what needed to be done.”
Supportive leadership: “My managers…were incredibly supportive but also recognizing I was willing to put in the work.”
The direct answer: Breaking in requires humility, targeted networking, and reframing of international or clinical experience into operational language. Rapid advancement is possible—but only if you out-hustle and out-learn everyone else.
Even high performers get stuck. How did Gaurai move past a stalled promotion, and what changed his trajectory?
When he was passed over for a Director role after years of exceeding targets, Gaurai hit a wall: “I have done everything I could do and if they can’t see what I’m doing then…there’s no point.” But quitting wasn’t the answer.
Seek feedback, not validation: “My manager told me, ‘Yes, you are achieving all the goals but I’m not sure you’re stepping away from what the goal is to question the goal.’”
Challenge assumptions: Gaurai was a _“dog with a bone”—hitting KPIs without asking if the KPIs mattered. This was his blind spot.
Executive coaching: “We did some assessments…where truly I was very task oriented and needed to take the broader picture view.”
Don’t quit—evolve: Within 8-10 months, after intentionally shifting to strategic thinking, the promotion came.
Direct lesson: Advancement to senior leadership requires not just delivering results, but stepping back to challenge objectives and think systemically. Task mastery is the price of admission; strategic perspective is the ticket forward.
What actually changes when you become a Senior Vice President in healthcare operations? Gaurai explains it’s about both breadth and altitude.
At Cerebral, his focus was behavioral health clinician operations—at scale. At Daybreak Health, the portfolio exploded: “I’m responsible for customer support, health plan operations, expansion operations, clinical recruiting, capacity management, workforce management, clinical care quality, clinician accountability…It’s much more broad.”
Multiple domains: No longer just clinical ops—now, customer support, plan ops, workforce, and more.
Depth to breadth: “You can’t just focus on one area for an extended period. You have to focus on seven or eight different KPIs and metrics.”
Managing up: “What do I need to do to prove my value to the rest of the executive team that I am a worthy leader?”
Takeaway: Moving from director to SVP is not “more of the same.” It demands system-level vision, the ability to manage across domains, and the political skill to contribute at the executive table. Delivering results is assumed; building influence and cross-functional trust is now essential.
Why do some leaders grow while others stagnate? According to Gaurai, it’s how you handle adversity—and failure is non-negotiable.
“Challenge is a part of every career irrespective of how much experience you have. You have to constantly be focused on am I learning from this experience or not.”
Don’t get emotionally attached to either success or failure—focus on replicating what works and learning from what doesn’t.
Example: On his fourth day at 98.6, the CMO asked him to scale a small 9-4 clinic to a nationwide 24/7 model. “I had no experience in the US Healthcare System… but I dug in and did it over the next 16 months.”
Key mindset: If you’re comfortable, you’re not learning. Seek out new, intimidating assignments; view feedback as data, not judgment.
If you hate networking, can you still succeed? Gaurai says yes—if you treat it as a skill to master, not a social performance.
“My Mantra: If I am saying no to something, I need to figure out why. Am I scared of it or is it not interesting? If the answer is I’m scared, that’s where I need to go.”
He systematized networking: “I had a spreadsheet, targeting reaching out to 10 people—cold call, email, LinkedIn. My conversion rate was 1-2 out of 10, which meant one informational interview per week.”
Actionable tactics for the reluctant networker:
Track outreach: Keep a spreadsheet and calendar reminders.
Batch process: Set quotas (e.g., 10 new contacts per week).
Measure conversion: Focus on quality of connections, not just quantity.
Reframe the discomfort: Use fear as a compass for growth.
Direct answer: Networking isn’t optional in U.S. healthcare. But you can engineer it as a process, not a personality contest.
What’s the fastest way to “grow out” of your job and prepare for the next role—even before you need one?
Gaurai’s approach: “The first thing that I’m trying to do is laying out a plan…what do I need to do in order to fire myself from the job? How can I coach my team, ramp them up so they can take on my responsibilities? Creating a career trajectory for them—and for myself.”
Creates internal promotability: Your team is ready to backfill you, which reduces risk for leadership when moving you up.
Signals strategic thinking: You’re seen as a multiplier, not a bottleneck.
Expands your scope: Frees you up to seek out new challenges.
Summary: Constantly plan your own obsolescence—if you’re indispensable in your current seat, you’ll never get out of it.
The U.S. healthcare market is starved for leaders who can blend empathy, operational rigor, and strategic foresight. Gaurai Uddanwadiker’s journey—from clinician-entrepreneur in India to SVP at Daybreak Health—demonstrates that technical skills, relentless learning, and process-driven networking are the key differentiators.
“If networking is what scares me…that’s where I need to go. That’s where I’m going to learn.”
“The value the MHA gave me: I can be handed any problem, and if I step back and think, I can solve it.”
“Don’t get so disappointed with failure that you can’t learn from it.”
If you want to rise in healthcare operations today, stop chasing titles—chase learning and system-level impact. Make networking a process, not a personality trait. Build your replacement. And when you get feedback that stings, don’t quit—evolve. As Gaurai Uddanwadiker exemplifies, the difference between being stuck and getting ahead isn’t luck or lineage; it’s your willingness to step outside your comfort zone and reframe every challenge as the next rung up.
<p>hello everyone this is Cole from the American Journal of healthc care strategy and we are joined by an incredible operations leader this evening GTI please go ahead and uh introduce yourself hey folks this is ganik here uh I'm the vice president of care operations at Daybreak health I come from a clinical background I was a therapist for many years before I transitioned into an operations role and started working on the business side of the house but really excited to be chatting with you Cole and thank you for inviting [Music] me I'm so happy to be chatting with you and and thank you so much so you were a therapist for quite a while as you mentioned what made you uh change your path and then decide to get that Master's the executive Masters in healthcare administration what was that change yeah it's been an interesting journey I started off as a therapist in an academic Medical Center in Bangalore India worked there for approximately 2 years before deciding that the bureaucracy in an academic brickin water was probably not my cup of tea and started my own Behavioral Health company and was involved in direct patient care as well as in expansion and growth of the business to sort of multiple physical locations as well as services in a virtual setting after about I think at at year 10 or 11 I want to say we relocated to the us as a family and the right Next Step uh seemed like moving moving into the direction of either doing an MBA or an mha primarily because I think coming here meant that my entire clinical background did not make any sense uh here which means I needed to go through the education system again I wasn't sure I was keen on doing a master's and a PhD uh again and sort of again starting at the bottom most drunk so you know and and I I I love operations I I have absolutely a lot of fantastic experiences but you know just ideas around what we can do to make Healthcare better and I said okay I need to get a little more trained and a little and have a greater understanding of the US Healthcare System and the executive mha program at the University of Washington just made it unload of sense to me that makes a lot of sense and so with that mha because you were so educated and experienced beforehand did you find that it was still valuable for you since you know the American Healthcare System is quite convoluted and and probably quite different and were you able to gain any skills in that program that you found useful I think that is exactly why that program is is so valuable right having come from in a fee for service primarily a fee for service environment which is in India to a much more Insurance based system here yes it is convoluted but yes it is also you know interest interesting it's exciting and I think the program the program did give me an understanding of the US Healthcare System you know through multiple perspectives through the classes that I took but I think what was much more valuable from that program was that it sort of prepared me to just be handed any problem and then it gave me the confidence to say you know if I step back and give it a little bit of time maybe a week or two and think about it I can solve it I think that's that was the value that the mha program gave me besides the technical SK skill and the knowledge and the experience Etc so then after you got that you I believe it looks like you became a practice operations coordinator that was the first role you had gotten yeah in the that's right that's right then you became a manager after five months and it looks like and then after a couple years you became the director and then since then you've had you know directorship and then now vice presidency but what's interesting is it's all within a fairly short per period of time so you really have been able to continue to get promoted again and again and again and that's something that a lot of people are interested in especially some people who maybe have been stuck at that coordinator level or that manager level even with good education they've been there for five to 10 years how have you been able to get those promotions and continue to expand your you know autonomy and your Authority in such a short period of time fantastic question coal when I got the coordinator the practice operations coordinator role at 98.6 I was at a point where I was on one hand networking I had no I had zero Healthcare experience I did have the executive mha degree or or sort of was getting to that point where I would get that degree I really wasn't getting any interviews because I had no us Healthcare experience it was an incredibly humbling time for me having gone from uh leading a particular business in India and kind of being being good at it to then moving to the US and finding that no one is really interested in my experience but more importantly also being humble enough to accept that my narrative my story and how I translated my experience for the interviewer was not not going down well so there was something that I needed to learn from that that's when I met Larry Angel and I called him out because he has been instrumental in my career Larry Angel was the first Chief um product officer for 98.6 and I I met him and I said hey would you be open to doing an informational meeting we did there was an interview that that there was a role that was posted it was a coordinator role and I said you know what this company seems very exciting I really would love to work for this person and I went for it and I and I got the job once I got the job I think I met a lot of people in the company including my chief medical officer Brad youngren Rob schweer who was who then became the chief product officer they were all extremely supportive Tommy Rainey you know Laura gum um Lauren gums these were all my managers while I was there and they were incredibly supportive but also recognizing that I was hungry for more and that I was willing to put in the hard work to do what needed to be done in order to get there it was definitely a steep learning curve there were new things there were lots of failures there was learning from those failures and sort of picking myself up and moving forward um and yeah so it's a bit of it is um me just constantly being intensely focused on growth and learning potentially also harassing my my managers for wanting more on my plate sort of taking on more projects than sometimes even I felt I I could take on but I I I wanted that and I think they they saw they saw my hunger and they fulfilled it so it was a bit of it bit of it was support from them and a bit of it was my hard work one of the things I you mentioned that I really am interested in is you have experienced of course many years working but also you've experienced running your own company founding your own company you know you're you're coming from a place of so much experience and then you're saying that you know you faced struggles in a learning curve and in failures and challenges can you share what what that looked like for someone of your experience yeah yeah um such an interesting question and um I think Challenger is a part of every career irrespective of how much experience you have and you have to constantly be focused on am I learning from this experience or not and sort of not being super involved with um if it's successful then you know kind of taking it as the biggest positive thing thing that has happened versus sort of looking at it as okay so how can I replicate it and then on the other hand if there's failure not getting sort of so disappointed with it that you can't learn from that failure and kind of not repeat it the next time but to sort of give you some examples I started at 98.6 in June in 2017 and I think it was probably my third or fourth day when I had my meet and greet one-on-one with my chief medical officer 6'4 tall guy you know um I am I am I tiny I'm petite I am barely about 5ish feet probably not even that much and I was sitting next to him I was I was intimidated and then I think after a first few sentences of sort of introducing myself and him introducing himself he said to me gay I want us to go Nationwide and I want us to take the clinic you know to an on demand 24/7 model at that time it was a small weekday only 9 to4 clinic in Washington with six Physicians and he was asking me to do something me who had no experience in the US Healthcare System definitely nothing nothing around understanding you know the variety of State specific lure regulations what does credentialing mean here in the US Etc and he sort of trusted me on that and I was taken back and I'm like this is this is this is going to be hard I have no idea and then you know I sort of dug in uh and did that over the next 16 months um and then you know then things started flowing good for you that that's uh an incredible an incredible thing to have been put on your plate at that point wow so when you became a director there was it a challenge to get that position you had been doing a lot for them for a while in their manager role you had expanded to that 247 365 model how did you keep it from them not just keeping you in that manager role or or getting complacent what did you do to keep growing you know what were your aspirations at that point what did that look like it's interesting you ask me that question because I almost did not get that promotion there was I think I was a manager for a couple of years and I expected to be moved into the next role and I was sort of running clinical the entire clinical operations for the company and I remember me and my my manager was the director and the VP sort of sat down in that review feedback annual feedback with me and they they did not see me as the person who could take on that role they gave me some feedback around you know what I needed to do and you know that I needed to potentially look at another larger program and sort of deliver there before they could look at me for that next role so that year passed and and the year after I still did not get it and at that point I was reporting now to the to the vice president and I remember her her saying to me that that yes you are you are achieving all the goals goals but I am not sure you are stepping away from what the goal is to question the goal A and B to even figure out how do we need to approach it meaning I was sort of like she looked at me and you know maybe that that's how I was at that point that I was a dog with a bone if there was an objective there was a Target there was a kpi that I needed to hit I would give it my 100% my team would give it 100% but then there was no conscious thought around is that goal even important I was not asking the question why and I think that is what my manager was telling me it was uh even when that feedback happened I remember there I me going back to the chief product officer of the company he was he was my mentor at the time and saying that you know what I I think I'm going to leave because I I have spent so much time here and I feel like I've given so much to the company and I'm not sure I'm being respected and then one thing one thing led to another we had another meeting with the CMO and the and and my VP and they sort of coached me through this and they are like that's not the way to handle feedback you don't quit you sort of fig you sort of figure it out and at this point I I was disheartened I was like I am I have done everything that I could do and if they can't see what I'm doing then you know what there's no point I'm not going to you know bang my head against the wall constantly but I also went to an executive coach at that point and I said and I and I told her that you know this is this is what I'm dealing with and I think she walked me through we did some assessments she walked me through some of the blind spots that I had where truly I was very very task oriented and I needed to step away be a combination of relationship orientation task orientation but also sort of take the broader picture view sort of you know take a 10,000 foot view of where the company was heading what do I need need to do in order to get there versus a particular project a particular program that was handed to me and I have I don't know what Chang has happened I I truly don't know they didn't happen consciously but the coaching helped you know being desirous of that growth and being desirous to learn constantly also helped and I think 8 10 months later I was given the promotion an amazing lesson to me as well that um not to give up because it's tempting sometimes when you encounter those issues and then so you stayed in that role for a little over you know a bit over a year and then you moved to cerebral um cerebral is interesting because that's a more of a I mean yeah that's a startup and then that was in the mental health space which you had experience with in the past too what was the reason for moving there honestly I wasn't necessarily um actively looking for opportunities but one thing that I had promised myself after I got the director role and this is part of the you know sort of the self- review that you do in your Performance Cycle where I had um told my boss at 98.6 I'm not good at networking it's not something that I enjoy I'm an introvert so I would rather not network not go out for a drink with people not go out for these large group dinners I'm I'm good with one-on-one I just don't necessarily enjoy or let me put it this way my energy sort of drains off much more faster when I'm in a large group setting so networking is yeah so um but that so that was I said okay so if this is something that is scaring me then I absolutely have to do this so that was part of what I was doing during that year and during that networking I met a few people um well when I say met we this was just post pandemic so I met them virtually and one thing led to another and um yeah then I I landed at cbru so it seems like since you've been in the US it's been only networking that's really for getting the jobs it doesn't seem like you're and this is something that almost everyone else I've interviewed has said the same thing but you've really just been networking meeting people you're not really putting in like traditional applications I'm not uh I have also been fortunate enough that I haven't ever reached a point in my career except that one time when I wasn't getting that director role where I felt like I needed to leave right away right that being said I have always focused on sort of firing myself from the job and that's how I think I feel I grow where if I'm given a job then the first thing that I'm trying to do is sort of laying out a plan almost like a business plan in front of me as to what do I need to do in order to fire myself from the job how can I sort of coach my team train up my team ramp up my team so that they can take on the responsibilities that I am taking on in a way sort of creating a career trajectory for them and not just for myself and then going and looking for another role for myself so either expanding my role or taking a completely different role in the same company or sort of finding it you know finding it elsewhere again the idea is for me is am I learning am I growing and then the then the title and the scope and the rest of it sort of comes as a part of it so after cerebral you you had a lot of things that you did at cerebral and then and you became an adviser for care operations but then you got the vice presidency role of care operations what challenges has the vice presidency role given you compared to the director role I think at a director role especially when I was at cerebral my focus was on the behavioral health clinicians and the behavioral health operations purely right um at as I have moved up into this role it's much more Broad um for example I'm I'm I'm also responsible for customer support um customer support operations I'm responsible for Health Plan operations expansion operations clinical recruiting capacity management workforce management you know clinical care um delivery clinical Care Quality clinician accountability and just generally sort of Performance Management for the clinicians as well um and when you are when you go from a narrower Focus as that was in cerebral but at a much much higher scale for example at cerebral I had about 2800 clinicians at one point reporting uh on my team through of course I mean there was there was a hierarchy of people but that was the depth and the scale of it but then you sort of move away from that and take on a much more broader scope which means you can't just focus your attention on one area and and you also don't have the luxury of sort of focusing your attention on on a area for an extended period of time you sort of have to focus your attention on eight seven eight different areas that are seven eight different you know kpi kpis and metrics and goals and objectives Etc and you also need to be participating now so this is the how should I put this this is sort of the the broader scope and the broader focus on one hand is on is different from what I had at cerebral but then on the other hand it's also about how am I managing up what do I need to do in order to sort of prove my value to the rest of the executive team that I am a worthy leader like this is the first time I'm sort of getting a seat at the table and what am I doing to contribute to the mission of the company what am I doing to sort of learn from you know this esteemed group of people that I am now part of and what am I what value am I providing to the rest of the team the rest of the executive team so that they can learn from me and I think all of this takes a little bit of um sort of Mind shift and yeah so I long long story short yeah no but that's that's intimidating for sure yeah kind of a a very different not just like more more of the same thing but also very different responsibilities and different ways you have to approach the problem than before yeah yeah um one thing I wanted to ask as well you know before we conclude of course is you mentioned that you you didn't like you know I guess tra the traditional networking you know that you think of with the groups and the and that was a bit more challenging for you how did you overcome that how did you because did you get your your current role via networking as well yeah so how did you overcome that and what does that networking look like for you my um my Mantra in life is if I am saying no to something I need to figure out why am I saying no to it am I scared of it or am I saying no to it because it's not really interesting to me and if the answer is I'm scared of it then that's where I need to go because that's where I'm going to learn that's where I'm going to grow so if networking is what scares me networking is what sort of brings out the introvert in me networking is what drains my energy that's where I need to go because I'm not saying that networking is not something that I should do or you know this is not for me I know it's important it's just scaring me so then that's what I'm going to do wow and nice and so you just had the you just put the courage and and you did it you yeah I mean you know one step at a time right I actually I remember you laugh at me about this just right out of the mha um or rather last quarter of the mha program I had a spreadsheet where I was targeting reaching out to 10 people like either a cold call or a cold email or a cold LinkedIn message and then I would look at my conversion rate out of the 10 maybe one or two would sort of reply back and then that would convert into maybe one informational interview so I was targeting at least one informational interview every week by sort of doing this and I had this entire spreadsheet that I had built out so that I could you know that I had to do it I had calendar reminders I had alarms built in so that even if this scared me that is just what I needed to do um and that has sort of become a habit wow excellent advice as well I I have a similar I have a a spreadsheet as well of everyone who I've attempted to contact and everyone who I've met with very very good advice thank you so much for for joining me you have incredible experience hopefully we can stay in touch and we can you know discuss things more in the future as well but I could be more absolutely hey we are networking here so exactly this is this is networking right here yeah yeah yeah you let me know if any if any interesting things open up in the Seattle area for sure absolutely</p>
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