Operational Strategy in Modern Healthcare: Lessons from Gaurai Uddanwadiker, SVP, Daybreak Health

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.

From Clinical Care in India to U.S. Operations Leadership: What Drives the Transition?

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.

How Do You Break Into—and Move Up In—U.S. Healthcare Operations?

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:

1. 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.”

2. 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.”

3. 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.

4. 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.

What Does It Take to Keep Advancing When Promotions Stall?

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.

The Turnaround Process

• 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.

How Does Leadership Scale from Director to SVP?

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.”

Differences at the SVP Level

• 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.

What’s the Role of Failure and Challenge in Growth?

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.

Networking for Introverts: Gaurai’s Tactics

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:

1. Track outreach: Keep a spreadsheet and calendar reminders.

2. Batch process: Set quotas (e.g., 10 new contacts per week).

3. Measure conversion: Focus on quality of connections, not just quantity.

4. 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.

How Do You Avoid Career Stagnation and Build a Leadership Pipeline?

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.”

Benefits of This Approach

• 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.

What Does All This Mean for Healthcare Strategy Leaders in 2025?

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.”

Actionable Takeaway

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.