I recently went one on one with Sylvana Sinha, Founder and CEO of Praava Health.

Adam: Thanks again for taking the time to share your advice. First things first, though, I am sure readers would love to learn more about you. How did you get here? What experiences, failures, setbacks or challenges have been most instrumental to your growth?

Sylvana: I am very lucky to have had a lot of different experiences that led me to entrepreneurship - it might appear a bit meandering, but a common thread that's woven through my career has been a desire to do impactful work, and to build the skills needed to be best positioned to achieve impact. I have had some incredibly rewarding experiences ranging from suing governments for corruption, to advising the Afghan government on legal reform and working for then-Senator Obama’s campaign. I spent several years abroad working for both the World Bank and the US Institute of Peace in Afghanistan, which were fascinating experiences. My plan had been to get this in-country experience and then come back and join the Obama administration. But ultimately I realized that while I really admired the work of diplomats and bureaucrats, they need to play, by necessity, a very long game. I wanted to focus on outcomes that were more immediately impactful. I definitely struggled with the idea of turning my back on years of study and professional experience that had led to a career path dedicated to law and policy. But I realized it wasn’t the right path for me.

Adam: How did you come up with your business idea? What advice do you have for others on how to come up with great ideas?

Sylvana: As I mentioned, I had a yearning to create and do something more directly impactful. Around this time that I was reconsidering my professional direction, I was visiting Bangladesh for a family wedding, and my mom had a health scare that necessitated an emergency appendectomy. This was my first up-close experience with the challenges of the healthcare system in Bangladesh. And while my mother was treated in one of the fanciest hospitals in the country and had the means to pay for whatever care was needed, we had extreme difficulties in accessing quality care, and then there were a lot of medical complications that could have been avoided. We ended up having to airlift her to Bangkok, where she had another surgery, and a year later a third surgery in the United States.  It struck me that despite the tremendous progress I had personally observed in Bangladesh during my lifetime - which now has one of the fastest expanding economies in the world, with GDP per capita consistently exceeding India’s, and a huge growing middle class driving the growth – no amount of money could afford you access to excellent quality healthcare. As a result, every day, thousands of Bangladeshis, and every year billions of dollars, were leaving the country to access better healthcare. I thought that there had to be a better way. That's how I decided to start Praava Health. 

Adam: How did you know your business idea was worth pursuing? What advice do you have on how to best test a business idea?

Sylvana: I used every resource available to me to find out more about what would be the best way to approach improving healthcare in Bangladesh, and I continue to try to leverage every networking angle, connection, and resource that comes my way. 

Before starting, I spoke with as many potential consumers of the product as possible. I spent about a year on a global listening tour, starting in Bangladesh, on the ground there, particularly because I'd never lived there before. I met patients. I learned about the real pain points in Bangladesh’s healthcare system. I also spent time in other markets, especially in Asia, but all over the world, learning what worked and what didn’t in different healthcare systems. I wanted to see what we could learn from other models and how we could take the best from each system. 

I knew that there was an issue in Bangladesh in terms of quality diagnostics. I had family members who had been told they had cancer, but they did not, and others for whom their cancer had been overlooked. And that was just the tip of the iceberg. At the time we entered the market, there were only 4 international standard labs in Bangladesh, for a population of 170 million people. Most testing was happening at small, substandard labs, where diagnostic error rates are high; so doctors were often misdiagnosing patients based on poor quality diagnostic testing. So initially I had this hypothesis, maybe what I should do is set up a quality lab. But as I dug in, and talked to more patients, and learned more about healthcare systems, I realized that the healthcare problem was broader and more nuanced. I wanted to try to create more systemic change. I was really interested in the middle-class segment of the population, which is now more than 40 million people.

Every day you have thousands of medical visas being issued to go to neighboring India. The people traveling to India to access quality healthcare were largely from the middle class and they were selling property, doing whatever they needed, to access quality care. This was a really fascinating data point for me. I actually showed up at the Indian embassy in Dhaka. There's a separate line for the medical visas because you have so many people applying for them. And asked patients who were standing in line, "What is it about your healthcare system that's failing you? Why is it that you're leaving your country?" And across the board, none of them talked about this diagnostic error rates issue. They all said, "We just don't trust the system. We don't feel our doctors answer our questions, smile at us, even look us in the eye." And that's where I started getting excited about building an integrated outpatient healthcare system that was really grounded in trust, and patient-centric care.

Adam: What are the key steps you have taken to grow your business? What advice do you have for others on how to take their businesses to the next level?

Sylvana: It’s critical to listen, especially in the early days, to the consumers and data points that are guiding you toward the business model you are building. Too often I find, especially in the digital health space, that some innovations are solutions looking for problems. A company will only succeed if it is solving a critical problem that consumers have, and it is doing so in a manner that is 10x better than the current status quo alternative. 

Listening continues to be a core part of our business since we started serving patients more than 5 years ago, for example, patient feedback has always been a fundamental component of our work. We collect feedback and measure NPS for every patient interaction, and on a weekly basis, I, our entire management team, and many next-level managers join our “weekly feedback call” - it’s intentionally one of the most resource-intensive meetings we have, in which we review all the feedback we received in the previous week, positive or negative, and what we can learn and adapt about our processes based on what we have learned. All of this helps us to continuously improve Praava patient experiences. 

The listening skill must also be embedded to help you to become aware of the pivot points that might be critical for your future success. During the pandemic, for example, demand for our services fell dramatically, and we faced sobering cash flow challenges, like so many startups. But we had critical human resources that we knew could help our community - so we volunteered our team’s services, becoming the first private provider to partner with the government on telemedicine, and also volunteered services to collect COVID test samples, providing crucial aid at a time when resources were stretched in the public sector.  We also made the government aware of our world-class lab, which had one of the only PCR labs in the private sector. All of this goodwill and awareness raising are responsible for the fact that we were one of the first private labs in Bangladesh to receive approval to do COVID testing for the general public in May 2020. This became a game changer by presenting us the opportunity to serve our community in a critical moment of need and helped to accelerate the brand value we enjoy today as a name of trust for Dhaka’s 30 million residents. 

Adam: In your experience, what are the defining qualities of an effective leader? How can leaders and aspiring leaders take their leadership skills to the next level?

Sylvana: For me, leadership is about inspiring my employees to be individual ambassadors for our mission and our work, and the best leaders they can be within their own domains. My responsibility is to help define and then embody our company’s mission and values - from day 1, the founding team spent time defining the key values that continue to govern our work and our culture. We call these our “SMILE” values - S is for Service, M is for My Praava (the concept of ownership), I is for Integrity, L is for Listening, and E is for excellence. Every Praava employee knows and is impressed with the importance of these values, and is empowered to apply them to their work. I personally conduct the hospitality training for every single person who comes to work at Praava, so that they can learn directly from me about our values, and I can also stay connected to our team. We always emphasize that every single employee plays a role in creating an amazing patient experience - whether they are a security guard, a nurse, or a procurement officer - and these values play out in each professional’s role in different ways. 

Having set the mission, vision, and values for the organization, it’s the responsibility of the leader to embody all of that, and to guide the team in execution. To that end, I always say my job is about accountability and inspiration. 

A big part of the inspiration piece of my role and what I enjoy about my work is creating and living a learning culture. This includes educating myself constantly - through consumption of books, podcasts, conversations with other executives and founders - to self-reflect and improve. Another thing I often say to my team is that in order for our company to 3x revenues in a given year, for example, that means we each have to grow our own skills too!

Adam: What is your best advice on building, leading, and managing teams?

Sylvana: I have to say when I first started out, I was wildly underestimated. I was a foreigner in Bangladesh, I am a woman, and I was considered young (although I was 37!). And I'm really grateful for having been underestimated because it meant people were less likely to feel threatened by Praava and create roadblocks to stand in my way. But there were other challenges to being underestimated. There are people on my team who were told not to join, because what I was trying to do would never happen. I've always been very honest about my vision, and also honest about my values. And I think it helped me to attract the right kind of people to our team. 

All of this was possible because I have always been authentic and transparent about what drove me to start the company, and my dream to create the best patient experience and restore trust in Bangladesh’s healthcare system. This also means being honest and direct during the hard times, when we have to deliver disappointing news to the team. This is true for communicating both with our internal team as well as external stakeholders, such as investors and advisors - and even patients. This authenticity has helped us to build an army of people who are now earnestly committed to building the best healthcare system in Bangladesh and across other emerging markets.

Adam: How can leaders best engender innovation?

Sylvana: For me, the answer to that question is inclusion and empowerment. As I shared previously, I believe a big part of my role as the founder and leader of Praava is inspiration - connecting each of our individual colleagues to the mission and dream of our company. When each employee takes ownership of delivering amazing patient experiences and restoring trust in healthcare, she/he will inevitably be inspired to innovate to achieve those goals. I try to be very engaged with the employees as well - just last week I took out a group of some of our younger colleagues for a meal. Whenever I get the opportunity, I like to have these gatherings, in addition to skip-level meetings, where I ask team members at every level of the organization 2 questions: 1) what is the one thing we are doing at Praava that we should never stop doing? 2) what is the one thing we are doing at Praava that we must stop doing?  

We also continuously engage our patients - the consumers of our product - in our innovation journey, by encouraging them to always provide us with feedback and ideas on how we can improve. We proactively reach out to both NPS promoters and detractors to get their views on how we can do better. Patient feedback is a major source of learning for us as an organization. 

Adam: What are your three best tips applicable to entrepreneurs, executives, and civic leaders? 

Sylvana: The first thing I would say is to make sure you ask a lot of questions. The person who asks the most questions is the one who learns the most. Often, especially in emerging markets, there is a certain stigma around asking questions. People expect others to know everything when they get to the table, or at least want to appear that way. Now, you do need to do your homework before you get to the table, but maybe because I'm a lawyer by training, I do ask a lot of questions, because I think that's how we're going to get to the answers that we need.

It's also really important to have a network of people around you that you trust, who can also help to fill your own skill and experience gaps. We've been very lucky, not only with my incredible management team, and the people that I work with very closely every day but also with a team of global advisors who've worked in different aspects of healthcare all over the world. I turn to them all the time and I trust them for the things that I don't know, or even just to be a supportive sounding board. Entrepreneurship is a lonely journey, particularly for a sole founder, so it is absolutely critical to build a moat around yourself through a strong team of leaders and advisors. 

The last tip is to treat the difficulty with some sense of adventure. Even when you fail, you know that you've done this on your terms and hopefully, you've learned something. In the same way I mentioned to follow every contact to its logical conclusion, follow every aspect of your dream that way as well. And continue to try to be agile and learn from what direction your company is also taking you. With every new team member, and every new patient, the dream becomes bigger than you, and that's the really exciting thing. With a little luck, we are building an organization that will serve generations of Bangladeshis and other emerging market populations with high-quality healthcare, long after each of us is gone. 

Adam: What is the single best piece of advice you have ever received?

Sylvana: When you’re going through hell, keep going!

Adam: Is there anything else you would like to share?

Sylvana: Being a healthcare company on the frontlines of the pandemic in the 8th most populous country in the world has been an extraordinary crash course in healthcare systems change. We’ve had a frontrow seat to the lessons of COVID-19 about how interconnected our world is - and how despite those lessons, emerging and frontier markets remain ignored, even when 85% of the world lives in these markets. 

We must begin to think differently as a global community about these challenges. Global health investments have fallen in recent years and remain predominantly U.S.-focused. Global business leaders and international institutions often talk a good game about investing in healthcare in emerging markets like Bangladesh, but there is little follow-through. Investment firms are not much better – rather than supporting innovation and truly impactful investing, they follow the lead of other larger institutions, so all the funding ends up going to the same types of countries and economies, and doesn’t necessarily promote real innovation or market disruption. The WHO estimates that healthcare in Asia alone - where 50% of the global population resides - remains underfunded to the level of $60B annually. Every dollar invested in healthcare has a direct positive impact on a country’s economy – McKinsey estimates that low-middle-income countries achieve a $4 increase in GDP for each dollar of healthcare investment. Despite all the challenges, the hard work emerging market entrepreneurs are doing - and indeed that my team at Praava is doing - is creating change and impacting lives, even without the support of traditional investors to help us to scale. It’s worth it.


Adam Mendler is an entrepreneur, writer, speaker, educator, and nationally-recognized authority on leadership. Adam is the creator and host of the business and leadership podcast Thirty Minute Mentors, where he goes one on one with America's most successful people - Fortune 500 CEOs, founders of household name companies, Hall of Fame and Olympic gold medal-winning athletes, political and military leaders - for intimate half-hour conversations each week. A top leadership speaker, Adam draws upon his insights building and leading businesses and interviewing hundreds of America's top leaders as a top keynote speaker to businesses, universities, and non-profit organizations. Adam has written extensively on leadership and related topics, having authored over 70 articles published in major media outlets including Forbes, Inc. and HuffPost, and has conducted more than 500 one on one interviews with America’s top leaders through his collective media projects. Adam teaches graduate-level courses on leadership at UCLA and is an advisor to numerous companies and leaders. A Los Angeles native, Adam is a lifelong Angels fan and an avid backgammon player.

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