Rami Elghandour’s 18 year career spans technology, venture capital, and entrepreneurial management. Most recently, Rami served as President and CEO of Nevro, where he joined in 2012. Under his leadership, Nevro grew from a small private company of nearly thirty people to a disruptive player approaching one thousand people, transforming a market and earning recognition for both business results as well as an innovative and diverse culture. Rami was responsible for fundraising $750M through venture capital, IPO and follow on public markets, orchestrating one of the most successful product launches scaling to $320M in 3.5 years through a differentiated brand and model, and forming the company’s long term strategy through a combination of new market identification, creation of new research functions, and R&D pipeline and strategic investments. Nevro increased over 10X in value since Rami joined in 2012 and was valued over 450% above IPO pricing at over $3B during his tenure as CEO.
Prior to joining Nevro, Rami was an investor with Johnson & Johnson Development Corporation (JJDC), where he led several investments, including Nevro’s Series B Financing. During his tenure, Rami served on the boards of directors of several private companies and led strategic initiatives in the development and management of JJDC’s portfolio. Prior to joining JJDC, Rami worked for Advanced Neuromodulation Systems, Inc. (acquired by St. Jude Medical, Inc.), where he led firmware design and development on several products receiving 2 patents.
Rami has been a guest lecturer at Stanford, Wharton, and UC Berkley, a TEDx speaker, a keynote speaker, and an advisor and board member to start ups. Rami earned recognition as an EY Entrepreneur of the Year for Northern California and as a National Finalist, as one of the top CEOs in the U.S. and notable recognition as one of the top CEOs for women and diversity nationally. Rami is a recipient of the Bill Campbell award by Watermark, a leading women’s organization, for his influence, impact, and advocacy in promoting women and women’s issues. Additionally, under Rami’s leadership, Nevro garnered recognition as a Silicon Valley Top 10 company, a best place to work in the Bay Area, and nationally receiving best company culture, best company leadership and best companies for women and diversity awards. Rami currently serves as a national judge for the EY Entrepreneur of the Year program.
Rami received an MBA from the Wharton School of the University of Pennsylvania and holds a BS in Electrical and Computer Engineering from Rutgers University School of Engineering.
In my spare time, I’m into photography, writing, art, and music so stay tuned for a mixture of some of my work
Over the past nearly 2 years I’ve had the privilege of reconnecting with my family and friends, working to make an impact on gender equity, and exploring new ideas and learning. I knew I wanted to focus the next adventure of my life on something that will change the world. In my view over the next decade there are a few things that can and have captured my interest. Autonomous driving, virtual reality, artificial intelligence, next gen consumer/internet, cell and gene therapies, and Fintech/crypto. I was fortunate to be able to explore a number of opportunities across these spaces and find one that checks all the boxes for me. Working to create a world where cancer is curable is incredible. And within that world finding something that’s truly disruptive and working with a Board and team who have shared values is all I could ask for.
I’ve been fortunate in my career to identify disruptive innovations and develop the strategy, people, culture, and execution to maximize their impact. I can’t wait to do that at Arcellx, Inc. and look forward to partnering with the team for a fulfilling journey!
Last week I had the privilege of attending an event with Supreme Court Justice Stephen Breyer. It was an incredibly inspiring experience at a remarkably challenging time for our country and the world. One of the most resonant things Justice Breyer shared was that the best thing you can ever say about a judge is that their decision is “sound”. A reflection of a thoughtful and deliberative approach independent of bias or politics. With that, Justice Breyer shared the 6 principles that constitute his interpretative philosophy or the method by which he makes decisions. I couldn’t help but contemplate how these same principles apply outside our highest court and discovered in my reflection that his principles work incredibly well for business and life. Enjoy this bit of wisdom from one of our wisest elders coupled with my perspective and experience.
The 6Principles of Sound Decision Making
Text: Text in a judicial sense is of course the constitution. The constitution serves as a Framework for interpretation and decision making. Frameworks can help us simplify and apply data and focus on how best to organize it to make the best decision. When making a decision, applying the right framework can be a critical help to choosing the right path. Frameworks range from the decision making type like the Eisenhower matrix, to behavioral like game theory or strategic like Christensen’s disruptive innovation. Identifying the right framework can lead to faster, clearer, and more consistent decisions.
Example: When making a decision on whether or not to preemptively initiate a lawsuit against a competitor who was larger and better resourced than us and one that would have a massive impact on our company, I stopped to teach our lead attorney about game theory and specifically the prisoner’s dilemma. It was a great exercise to map out all of our possible moves against our competitors to determine what the right course of action is. Applying the framework allowed us to quickly determine that the lawsuit was the right course of action amongst all the possible scenarios. That right decision combined with great execution by Peter led to protecting our core technology and preserving the strength of our business.
History: Those who fail to study history are doomed to repeat it. History can always be a guide. What have similar circumstances and actions yielded in the past and can help us evaluate our decisions. It’s important however to note how things relative to current circumstance and make sure the other history related axiom doesn’t take hold: Historical performance isn’t indicative of future results! The world is constantly changing and while being a student of history is important, it’s important to note as the rate of change in technology and business continues to accelerate, history is informative but not decisive.
Example: When it came time to decide what our brand positioning would be on a product launch we had to consider history. The market we were launching in operated on two metrics that weren’t very relevant for us: technical features and relationships, neither of which we could win on. In this case following history puts us at a disadvantage. By choosing a differentiated positioning based on our strength, we were able to shift the field towards a world that was better for us and for the patients and customers we served.
Tradition: Until Westworld becomes a reality, we live in a society composed of human beings and all human beings have expectations. Whether making a professional or personal decision tradition can weigh heavily on how that decision is perceived and ultimately how successful it can be. Going against tradition needs to me managed and messaged carefully helping people see why the future is better for that departure from the past.
Example: When I was an engineer, we were hit with a surprise. One of our competitors launched a product about a year earlier than we anticipated instantly obsoleting a recent product launch. So we had to get cracking! We had to essentially do in 6 months what typically took us 18-24 months of design and verification work. What made it more challenging was our VP of R&D was an old school engineer, and insisted that all firmware design be done in assembly language vs the more modern language C. Now I loved assembly language as much as the next guy or gal but there was no way to get this project done on this insane time scale without using C as assembly took orders of magnitude more time to code. So I proposed we write the code in C and convert it later in assembly. With the safety of that back stop we got to work and as at the project progressed our VP gained confidence in C and we never went back. Acknowledging tradition rather than fighting it while finding a path to move forward was critical. It took a lot of late nights ending at 2am but we achieved our goal and launched our competitive product in record time!
Precedent: One of the most under appreciated things about decisions is precedent. If we do this what precedent are we setting and does that create other problems down the line? This is especially true when it comes to people related decisions like promotions and parenting. Precedent also matters quite a bit if you’re part of a public company. When you announce revenue, do you choose to pre announce ahead of a conference, what metrics you share sets a precedent. And any deviation from that precedent is taken as a sign by analysts and investors. It also matters when you’re establishing a culture. In fact precedent is the essence of culture in that every action can reinforce or undermine a value.
Example: Culture is a reflection of the values you value as a leadership team and as a company. Ultimately those values are exhibited as people decisions. And with each people decision you make you’re setting a precedent. Does work ethic matter? Does integrity matter? Does teamwork matter? Every time you hire or promote someone who exhibits those values you’re establishing your culture by setting a precedent. This is what it takes to succeed in this company. Every time you fail to hold accountable someone who does not exhibit your values, you’re also setting a precedent. People decisions are ultimately that precedents that people monitor to learn the culture and operate within it, make them thoughtfully.
Purpose of a Statute: What is the objective we’re trying to achieve with this rule? This is perhaps best captured by the classic elevator problem. You own a building and get frequent complaints that the elevator is too slow. If you focus on the letter of the feedback you would need to rip out the elevator and install a new, faster one at great cost and inconvenience as elevator capacity would be reduced. But what if you focused on intent. What are the complaints telling you at their core? They’re telling you people are bored while waiting for the elevator. When understanding the purpose alternative solutions become a reality. Installing a mirror can reduce boredom and address the problem without the costs of the alternative. Purpose is a powerful tool in solving the right problem.
Example: One of the core things to focus on while scaling a growth organization is bureaucracy. It creeps in as rapid growth causes things to break and rules are installed to deal with the problems. The challenge is rules accumulate over time creating bureaucracy and driving out top performers. One way to deal with this is to understand the underlying reason something broke, as in the elevator problem, and ensure you address the core issue. An example was early in a commercial launch we had an issue with our commission plan and our sales ops team wanted to create a rule whereby all such issues would be dealt with automatically. But as anyone who knows sales knows, every sales person, territory, quarter, etc. is different. So rather than institute a rule, we created a 30 minute meeting at the end of every quarter to review issues and come up with solutions. That allowed us to manage by exception in an efficient way without being a slave to an indiscriminate rule.
Consequences of Competing Interpretations: What is the long and short term consequence of the interpretation. In law, that is understanding both sides of interpreting the law or statute to ensure you know the consequences of your decision. This works to overcome confirmation bias or the tendency to only look or things that confirm one’s view and ignore anything that counters our views. This is critical to good decision making and it’s no surprise that a Supreme Court Justice ensures they have a principle to help them overcome this bias
Example: Often times in business there’s no clear answer. This is particularly true in venture capital and entrepreneurship where you’re making decisions with very little information and there’s a lot of ambiguity. In my experience in venture, companies rarely fail due to failure of the underlying technology. They often fail due to poor strategy or poor decision making leading to bad execution and ultimately the inability to raise money. And this often all happens due to confirmation bias and not understanding competing interpretations of the future. Making decisions on a business strategy thinking the world would play out one way for it to play another is a recipe for failure. Taking the time to understand the competing interpretation is critical for success.
Conclusion: That is a lot to digest. More than anything ensuring you have a process for making your decision is key. For me it involved a lot of the above on reflection. But perhaps more importantly I’ve always surrounded myself with great people that served as a sounding board and advisors that helped me enormously in every decision I made. That includes my family, friends, colleagues, and mentors. As the proverb says, if you want to go fast go alone, if you want to go far, go together. And Justice Breyer certainly referenced that often times Justices learned a lot from each other in deliberations. So having the right process, incorporating the appropriate framework and coupling that with the right people around you can enlighten your path and lead to sound decision making. Here’s to better decisions.
Looking for a new role or challenge? Want to impress your interviewer? Interested in what makes a great work environment? Interviewing someone? Sharing my top 10 questions to ask during an interview for insights on all the above. I’ve interviewed a couple of thousand people over my career and found the quality of the questions asked of me during an interview often told me more about the candidate than anything else.
This pandemic has brought on the worst joblessness period post World War II. If you’re looking for a new role or considering a career change in this rapidly changing environment, these top 10 questions to ask and why they’re effective will help you make the right impression and make the best decision for your career. I also included a bonus question just for these times.
1. Why is the role/position open?
Why it’s effective? The value of this question is it tells you if this is a newly created position or if there’s been churn in the role. If it’s not newly created a follow up would be why it’s open and why others in the role haven’t succeeded. If it is new, ask why it was created and how committed management is to this new strategy/business segment. Either way you will learn if there’s stability in the role.
2. What level of responsibility will I have?
Why it’s effective? This is a great question to communicate your desire to have an impact and willingness to take on responsibility. It’s also a great question to understand how much autonomy you’ll have in the role which is a critical factor for high performance teams and individuals. You’re looking for a response that encourages you to take on added responsibility. Shy away from places that don’t welcome this question or have keep your head down and do as your told mentality.
3. What is your long term vision for the company?
Why it’s effective? This question helps you understand the higher purpose for the organization. This is important for two reasons: First, you want to know if the company you’re dedicating your life to has a future and if that’s a future you want to contribute to. Second, research shows that purpose is one of the biggest drivers of career and life satisfaction. If you’re sold on the vision of the company you’re more likely to find meaning in your work and life.
4. What does success look like for this role in the first 3 to 6 months?
Why it’s effective: This question helps to ensure you’re on the same page with the hiring manager and the organization and uncover any disconnects in the hiring process. It helps to establish a path for success should you take the role with a clear understanding of expectations. It also communicates that you want to hit the ground running and contribute immediately something your employer will surely appreciate.
5. How would you describe the culture of the company?
Why it’s effective: This question is effective for two reasons: First it communicates that culture is important to you. We spend more time working than doing anything else and you want to be in a positive culture that brings you meaning and happiness. Second, it gives you a way to assess the emphasis the company puts on culture and what it values. That should help you determine if the company is a good fit for you.
6. What type of people have been successful here? Why?
Why it’s effective: This is another way to ask the culture question. By having the company describe what success looks like on the inside you’ll get a great perspective on what the culture is vis a vis what values they value. This is also a better question in the sense that you are likely to get a more candid response. It triggers people to recollect instead of invent and their response are likely to reflect both who they’ve seen succeed and why they’ve succeeded.
7. How does this role contribute to the growth and success of the business?
Why it’s effective: It communicates that you are looking to have an impact while also ensuring that the role is of value to the organization and not extraneous. This latter point is crucial for career growth by ensuring you’re doing meaningful work as well as stability as extraneous roles can be easily eliminated. It also hits on some of the themes described above helping you understand how your work contributes to the mission providing you purpose and meaning.
8. Can I meet more team members?
Why it’s effective: Going back to that culture point, there’s no better way to assess culture than to meet as many people as possible. It’s a bit like getting married. Sure you’re marrying your hiring manager but as they say you’re also marrying the whole family. So the more family members you can get to know during the hiring process, the more comfortable (or not!) you might be with the union.
9. What does career progression look like here?
Why it’s effective: One of the biggest reasons people leave companies is lack of advancement. By understanding upfront how career progression happens and what factors play into it you’ll have a sense of whether this is the right place for you. This question also communicates that you care about career progression and the reaction from the company will signal whether they have the plans, growth, and culture to support your potential for advancement. It’s important on your part to communicate that this isn’t an expectation and come across entitled. Instead communicating that you hope to work hard and contribute and want to know if you do your part there will be corresponding opportunities.
10. What resources/budget will I have?
Why it’s effective: If you’re going to bring your energy and talent to a team, you want to make sure you’ll have the resources to succeed. If there is equipment, resources, or access required for you to be successful it’s important to understand what will be available and if you can work within any limitations. Once you sign up you own it, so getting this information upfront will help you make the best decision you can. It also communicates you’re sophisticated and realistic enough to understand the impact of resources to your and the company’s success.
11. Bonus: Is flexibility available in this role?
Why it’s effective: We’re clearly living in unprecedented times and employers are increasingly offering flexibility to their workforce. That flexibility is wide ranging and so it’s more important perhaps than ever to understand the norms and what’s expected from your potential employer. In normal times, you would also want to understand what level of flexibility they offer. Do they allow work from home typically or is it only pandemic related? What if you had to drop off or pick up a child, have a Dr.’s appointment, etc. How do they view or handle that? Having clarity on expectations will again help you determine if this is the right place for you.
90% done, 90% to go. That’s what I was fond of saying as an engineer. That last 10% of a project was as difficult and took as much effort as the first 90%. The debugging, integration, testing, documentation, operations, everything that went into making the product a success. That last 10% was as challenging as the first 90%.
As a CEO I learned another variant. When we took the company public, the first investor we met on the IPO road show told us, if you’re as enthusiastic in your last meeting as you were in this meeting, you’ll do great. That advice served us well as it helped us focus and overcome the exhaustion of the IPO process and close strong delivering one of the best IPOs of the last decade.
That’s life. The last yard, the last minute of a wrestling match (real wrestling =), the next rung on the ladder of success, the final mile of race, the next leg of market share, all more difficult than the road to get there. And are what determines success vs. failure.
So how do you translate this secret to success? So much of life is about preparation and expectations. Knowing up front that the close is going to be challenging ensures you train for it, you have the resources and time you need, and are mentally prepared for the challenge. And you need to be prepared because that is where success is earned. It’s the mental toughness, the determination, and the commitment to maintaining the highest standard throughout your journey that allows you to close as strong as you started. As the saying goes, don’t stop when you’re tired, stop when you’re done.
You might be wondering why the picture for this article is of Usain Bolt. The fastest man alive provides us one last example to power this point through. Did you know that olympic sprinting is not about how fast your run, but how slowly decelerate? In other words sprinters generally reach similar top speeds, but he/she who can maintain that speed the longest wins the race. Of course starts are important, but how you close is what separates gold from bronze. So prepare for that last 10%, maintain your enthusiasm, and go for the gold!
My kids are competitive like their dad and in the before times when we would head to a park they liked to race ninja warrior style against each other on the park play structure. Often times challenges arise. Another kid gets in their way, they fall, they accuse each other of cheating, and ultimately stop racing because they assume due to the impediment the other kids will win.
A few years ago on one such instance I pulled the kids together and shared with them one of my core principles: Always finish the race! I don’t care if you fall, if someone gets in your way, or if someone cheats, you always finish the race, then we can talk about it. Because even if you lose, finishing the race is helping you get better for the next race. Quitting robs you of the practice needed to improve. and equally importantly determination is a habit, you don’t want to develop a habit of quitting or excuse making.
Fast forward 5 years. Yesterday we were doing some swim races. And after beating me a few times in a row, sometimes handily, my oldest turns to me and says: Dad, good job always finishing the race.
A few takeaways from this experience that apply to leadership in life and work
1. Always Finish the Race: The race of life is long and there are a lot of obstacles along the way. But much like racing we can’t get better if we don’t work our way through the challenges and obstacles we invariably face. And our biggest life achievements be they academic, professional, or personal will involve pushing through obstacles. In fact that’s what makes achievement so rewarding, it’s overcoming the challenges along the way.
2. What You Say Matters: It’s incredible to me that this one lesson stuck with my kids from so many years ago. There are similar examples of things I’ve said to colleagues throughout my career that have stuck with them and helped them years later. We forget how impactful we can be on our family, friends, and colleagues and it’s a great reminder to use that super power for good.
3. Preach What You Practice : Words alone aren’t enough. Following through and demonstrating the behavior is key to effective leadership. If your behavior is inconsistent with your words, impact and followership will be hard to attain. Leadership is most effective when you’re preaching what you believe and practice. Being mindful of that is a key to having a meaningful impact.
I once asked a friend how she manages to run marathons and she replied with the old adage, “ I don’t stop when I’m tired, I stop when you’re done!” So set a good example, share your wisdom, and always, always finish the race!
“Privilege is not the presence of an advantage. It’s the absence of an impediment.”
Last night, the first woman of color was selected as a candidate for the Vice Presidency of the United States. Whatever your politics, take a moment to appreciate her path in the context of the above statement. Appreciate what she had to overcome to get to this stage as a black and brown woman, born to immigrant parents, from Oakland.
Oftentimes when we speak about privilege in the workplace there’s a misunderstanding. What advantage do I have some think? It’s not that you are given an advantage per se. It’s that your colleagues are held back by impediments providing you a relative advantage.
Those impediments are many:
They are rooted in our psychology: Unconscious bias prevents us from hiring women and minorities when they’re the best candidate for the job.
They are rooted in our history: The gatekeeper effect perpetuates white men hiring and promoting others who most resemble them as they attribute their success to their likeness.
They are rooted in our society: Socioeconomic backgrounds determine access to education, healthcare, and other determinants of success.
Take a moment to check out the two quizzes below for a window into privilege.
The first is the American Dream score. It a short quiz that asks you a series of questions about who you are and what factors, such as health, education, race or gender, may have contributed to your success ― or created barriers to it. It’s meant to challenge the narrative that our success is only a function of our hard work when in reality a number of other factors play into achieving the American Dream. I know that’s been true for me.
The Second quiz does a better job of giving you a sense of what privilege is. You don’t have to take it (although it’s quick and interesting!) but if you simply read the questions you’ll understand how many factors you might take for granted that are an impediment for others.
I know reflection can seem like a lot of work. But I hope it gives you a few things: Gratitude for what you’ve had to overcome to achieve what you’ve achieved. Empathy for what your friends, family, and colleagues had to overcome to get to where they are. And a mutual respect that while all of our paths are different, what we have most in common is striving for a better life, a better society, and a better world, together. And on that note, here’s a link to my TED talk on gender equity which touches on many of the topics discussed above
Differences matter. Our creativity comes from our culture, our history, our stories. Be brave enough to believe the world can change. Trolls is Trolls.
Those are the surprising lessons from Trolls World Tour. A film as fun as it is perfect for this moment. And thanks to a certain 3 year old in the house, a movie I’ve gotten to enjoy multiple times a day since we got it =)
The thing about diversity is it’s misunderstood. It’s under the surface due to unconscious bias. It’s lonely due to the small number of diverse individuals in many organizations. It’s ineffective without being pared with inclusion. And It’s under appreciated, in the positive impact it can have on individuals, teams, and society as a whole.
So what can you do to promote diversity and inclusion in your company? Start with education, learning more about unconscious bias and the challenges facing women and minorities is a key first step.
Next comes advocacy. Here are some practical things to advocate for:
1. Ensure you’re evaluating diverse panels with two or more diverse candidates when it comes to hiring, promotions, and team selection for projects. Research shows that we can overcome unconscious bias and choose the best candidate by ensuring we have 2 or more diverse candidates in a panel.
2. Perform an equal pay analysis in your organization and correct any pay disparities. Women continue to get penalized by perpetuating low salaries from previous roles/companies. Break the chain and make the correction. It’s important to look at equity as well as cash compensation.
3. Form affinity groups within your company and/or your industry for women and minoritie. We formed a group for women in our industry in my last role and it was incredibly effective on so many levels. Most notably creating a space where people can share their challenges provides a powerful and reassuring shared experience. Additionally there is power in numbers and knowing you’re not alone.
I had the privilege of giving (virtually) my TED talk on gender equity to a group of female executives last week and it was inspiring to relive some of these dynamics. Experiencing their strength and hearing their challenges was yet another reminder of the potential we have and the work that remains so vitally important.
So definitely check out Trolls World Tour and my TED talk (link below) for some inspiration and take some positives steps towards diversity, inclusion, and gender equity. Together we can change the world.
This past week we picked up a new family game called Fluxx Marvel edition. Super fun and highly recommended. It’s a fast paced game with constantly changing goals keeping everyone on their toes while teaching mental agility and focus. Add Marvel super heroes and it can’t miss.
Playing the game with 3 of my kids offered a teaching moment. The Two younger kids focused on each other, stealing each other’s cards, trying to make sure the other doesn’t win. The oldest focused on the game’s objective and won consistently.
After a few turns of this I showed the kids the picture above. It’s from the 2016 olympics where Michael Phelps edged rival Chad Le Clos to win the gold in the 200m butterfly.
I was sent this picture by Jean Bays after an interview in which she asked me how I feel about everything I built at Nevro. I told her I haven’t looked around, I was too focused on winning and that there would be a day for looking around. That reminded her of this picture and she sent it to me as a follow up to the interview.
Back to the kids. I showed them this picture and asked them what they saw. They needed a little help to recognize that one swimmer, Phelps, was looking forward while the other, Le Clos, was looking at this competitor. One was focused on winning, the other on the competition. The very dynamic that was happening in our game of Fluxx. The kids took the lesson on board and gameplay improved dramatically.
Personally, this is the keeping up with the joneses lesson. Focusing on others instead of our own success and happiness detracts from happiness. Practicing gratitude, helping others, and focusing on our own goals will produce personal meaning and happiness.
Professionally it’s of course critical to be aware of and adjust for competition. But no one is winning by co-opting another firm’s strategy. Focusing on differentiation that’s value adding to your customers as supported by your unique resources and activities is key to strategy. Further it’s been my experience that too many firms focus on short term drivers rather than long term value. Peeking too much in your competitor’s direction is a sure fire way to lose sight of the long term vision for your product and company and drive you to short term reactionary activities. There’s a vast difference between the necessary awareness of the competitive landscape and focus that diverts away from your own strategy and long term success.
So focus on the goal. Don’t get caught looking around. As for me, I finally got a chance to take Ferris Bueller’s advice. Life does move pretty fast and if you don’t look around once in a while, you could miss it. I finally got my chance to look around and I couldn’t be more proud of what I built and more importantly the lives I’ve touched.