In conversation with Sharmila Nebhrajani OBE, chair at NICE

Sharmila Nebhrajani OBE is chair at the National Institute for Health and Care Excellence (NICE) and a NED at ITV, Severn Trent, Halma, and Coutts Bank. She’s a World Fellow at the University of Yale and is on the Governing Council of Oxford University. Here, she shares advice for chairs, her experience joining NICE as chair at the start of the pandemic, and how you get the right thinking skills and values on your board.

Having initially studied medicine, your career path is somewhat atypical. Are there any defining moments that stand out for you?

Three stand out to me:

1. Learning never to be afraid of “taking a left turn”. In my early 20s I realised that, although I loved medicine, I didn’t want to be a doctor and was lucky to find a company that would take a punt on a medic who didn’t know anything about accounting or finance. Reflecting back on this, I call this kind of thing a “left turn” to the young people I mentor today. And I embrace the left turn to this day!
2. Discovering the great value of holding non-executive and executive roles simultaneously. The learning opportunity is immense as is its re-energising effect which enables you to go back to your day job with fresh perspectives.
3. Purpose-driven business opportunities come in all shapes and sizes. So, look at the opportunities that come your way carefully. Health is perhaps one obvious area, but public service broadcasting, providing clean water to customers or even running an industrial company focused on safety and the environment are all highly purposeful endeavours that really make a difference.

Which female leader has inspired you, and why?

I’ve been lucky enough to have several mentors, but one that stands out is the late Professor Lisa Jardine, a wonderful scientist and chair of some of the most complicated ethical conversations and a wonderful mentor of young women. She told me there are two things you need to know about being a female leader:

1. If you’re on a male-majority board, the ambient conversation round the board table is at male pitch. The first intervention by a woman raises that pitch and it’s easy to come across as sounding quite shrill as people adapt to the higher-pitched female voice. So, speak early in the meeting to help the room get used to female as well as male voices.

   “Speak early in the meeting to help the room get used to female as well as male voices.”

2. “Get on the pitch early” — a different take on pitch but just as important. If you wait until 45 minutes in to speak, the pressure builds as you tentatively wait for the ideal opportunity to intervene; you can choke yourself and run the risk of not speaking as fluently as you might.

How do we get the right thinking skills around the board?

You need cognitive diversity. It can be tempting to think you need a board full of subject matter experts. Guess what? The executive team are subject experts, and they don’t need to be duplicated by non-executives. I really appreciate the contribution of gifted generalists, who take the essence of their experience and can apply it creatively to a different area.

“Guess what? The executive team are subject experts, and they don’t need to be duplicated by non-executives.”

Do you have any advice for fellow chairs?

1. I think as much about the choreography of the discussion as about the paper. And I encourage board members to understand not everyone has to talk about everything. We don’t all need to make all points — as chair, I know that person A will likely talk about these two points, and person B will talk about this one, so I can make sure I raise the missing point.
2. Encourage your brightest colleagues to comment on areas that aren’t their subject matter expertise. I love it when the publishing expert makes a brilliant point about financial strategy for example. People often have a higher risk appetite and strategic insight in areas outside their natural expertise.

“Encourage your brightest colleagues to comment on areas that aren’t their subject matter expertise.”

You joined NICE as chair a few months into the pandemic in May 2020. How did you navigate that?

I was a new incoming chair in a virtual environment, I had little personal capital and we had a virus we hardly knew about. We were very task focused — as medics that’s how we’re trained, but we’re trained to look at evidence and facts and Covid had few of either. We had to really increase our risk appetite, and work in new ways. The challenge now is to sustain that agility in “business as usual”.

At a personal level, I had to work out how to build trust and personal capital with a board I had never met in person, yet who all knew each other, whilst working at a challenging pace. The answer was a significant investment of my time, more so perhaps than if we have been able to meet in person.

What’s the main thing you see that needs to be done to improve board information?

As a non-executive, you only really know what you’re told about the organisation usually via the “paper”. Great papers really distil the “So what?” and clearly separate out the “show and tell” from the key questions for the board to think about.

But great papers cannot do all the work. Walking the floor, meeting informally with key folks in the business are really important for soft intelligence and of course, build that trust and personal capital that are so important for board members.

“Great papers cannot do all the work.”

What role can boards and nomination committees play in choosing leaders whose values match those needed to ensure that business is a force for good?

I would say recruit for attitude as well as expertise. High intellectual curiosity and low ego humility are key.

“Recruitment is a long game.”

Recruitment is a long game. I’m surprised when I see a panel with tightly drafted questions in advance not able to follow the thread of the interview conversation. I want to get under the skin of their motivation to join the board. Understanding what drives people, what their scars are and what they have learnt gives the best insight into how the chemistry will work. So I’m in favour of several meetings, individually and as a committee, also in recognition that it’s a two-way street — it’s not just about us picking the right people, it’s about them picking us too.