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May 11, 2023

Mandy Cohen's Remarks to the Class of 2023

Mandy Cohen, the former N.C. Secretary of Health and Human Services, told the Class of 2023 to be someone others can trust.

Thank you President Farmbry.  Hello Graduates!  Hello family, and friends of the class of 2023, Guilford alumni, professors, and College leadership 

Thank you for inviting me. 

I am so honored to join you today as you celebrate all you have learned and experienced here at Guilford College and prepare for the next chapter.   

I am honored to be here at Guilford College.  Your long legacy of equity is inspiring….and I have such admiration and gratitude for your leadership.  Whether it was one of the first colleges to admit women students or being part of the National Underground Railroad Network to Freedom,  Guilford College has been on the right side of history over and over again – and you continue to lead the way.  In addition, your core values of community, diversity, equality, excellence, stewardship, integrity and justice resonate deeply with me personally and professionally.  

As you heard, I am a physician and spent 15 years working in the government sector – first for President Obama - working on Medicare and Medicaid - implementing the Affordable Care Act.  And most recently, I was Governor Cooper’s Secretary for Health and Human Services for 5 years. Most folks in North Carolina know me from leading North Carolina’s COVID pandemic response.  I was often spotted at one of over 150 COVID press conferences with the Governor talking about the importance of the 3W’s  - remember those – wearing a mask, waiting 6 feet apart and washing your hands.  Or later -- the need to get tested, get vaccinated, and get boosted.  

So, I thought, today, I would share some of the lessons learned from leading the COVID response for North Carolina.  And yes, they are lessons learned in a time of crisis, but they are also universal lessons that you can apply right now in your own personal life or in the professional careers ahead of you. I'll focus on what I learned about trust, and how trust is an essential ingredient for success in your personal lives, your professional lives and is the foundation to making positive change in the world.

I am extremely proud of how North Carolina fared during the pandemic.  There was a recent report that ranked states on the effectiveness of their response and north Carolina ranked #2 out of 50 states. Just behind #1 ranked Vermont, North Carolina had lower rates of death, lower overall COVID transmission, less hospital strain, higher vaccination rates – And during the pandemic North Carolina’s economy grew, we added more jobs than our neighboring states and we continue to be a destination for new companies and are one of the fastest growing states in the nation.

I need to pause here and say thank you to everyone who helped in the COVID response – and that literally was everyone.  Responding to COVID was a huge team effort.  It required sacrifice from everyone, it wasn’t easy and it wasn’t ever ideal.  But thank you – thank you to the Guilford College leadership who worked to keep students and faculty safe, and to you, graduates, who had to alter how you learned and how you played to keep yourself and your community safe.  Thank you.

So - how did we do it?  How did we pull together as a state and largely stay united through the pandemic?  How did I survive all those press conferences? What can be learned from this dumpster fire of a time?    

The central learning for me and the key theme for today is the importance of trust. Trust is the foundation of all relationships, both personal and professional.  

Graduates,  you likely first learned about trust – from the people seated in the audience.  And today, I want to focus on what I learned about building trust with intention.  Planning for it – making it central to how we move through the world.   

I truly believe change happens at the pace of trust.  Change happens at the pace of trust.  And if you want to make change in this world through your professional endeavors – whatever that change may be - making the world safer, more just, more equitable, more beautiful, more resilient, or healthier – you will need to think intentionally about trust.   

Sure, you can scare people into changing in the short-term….but fear will only get you so far.  We saw that exact scenario play out with COVID.  We had decent national cohesion and action in our response to COVID at the beginning of the pandemic – that was when we knew the least and fear was at its highest.  But it was those states or communities that were able to maintain trust that saw the best longer term results.  Unfortunately, trust was not built at the nation level….but I know trust was built here in North Carolina.

I know, because we measured it.   Trust in North Carolina’s health information and services actually GREW during the pandemic rather than declined.  Trust in health information and services went UP for 35% of North Carolinians, with the highest increases among Black North Carolinians increasing by 47% and increasing for Hispanic/Latinx communities by 39%.  And North Carolinians credited my former Department for delivering the health information and services they needed; 82% said that the Department met or exceeded their expectations.

Ok – how did we actually build trust with the public during this crisis when so many others lost that trust?  

First, in order to build trust with others – you must trust yourself.   No one will be ready to trust you if you don’t first trust yourself.  It is important to believe in your abilities, your intuition, and your decisions.  

Trust in myself came from having key people in my life believe in me before I even believed in myself.  

It was my mother believing in me when I thought I couldn’t hack it during medical  training 

Or it was my husband reassuring me I could “lean in” to a big career opportunity at the federal level when we had two super young kids 

Or it was my boss and mentor putting me in charge of a high profile project and merely saying “You’ve got this”  

I also learned how to recover from mistakes – because mistakes will happen – and that took away the pressure to be perfect….because there is no perfect.

All of this helped me hone my belief and trust in myself.  So I could be a confident leader for this state during a crisis.  

So, find your support network, those that believe in you so you can build trust in yourself….I bet some of them are right here in this room with you today.

After trusting yourself, the building of trust requires intentionality.  

In the very early days of the pandemic response, well before North Carolina even saw its first case of COVID,  we called out “building trust with the public” as THE thing that would determine success or failure in COVID response.  We called it out and we named it. We actively managed it every day and as I shared, we graded ourselves on it.

Then we also had a tactical framework for creating trust…..that rests on 1. transparency – open and honest communications and 2. competence - doing what we said we would do. 3. Actively building and maintaining relationships.

Let’s dive into transparency and competence a bit more. 

First, transparency.   In our personal lives transparency is about sharing accurate information and giving people in our lives the confidence that they can ask questions or check out if that answer is in fact true.  

Let me give you an example.  Your parent asks you- Where are you going tonight?  You say – to a movie with friends.  They say - which movie theater, what time, with whom?  All of which are normal follow-up questions assuming your first answer is in fact true.

Leading in the pandemic was not much different. 

First, it is really important to be clear about what you know and what you don’t know. Trust isn’t built by having all the answers, it’s built with honesty and access. Again – access to information and the ability to ask questions about that information.  

We had extensive dashboards of data for the public to see.   But information and data needs context and the ability for others to ask questions.  

That is why for the first 18 months of the pandemic, I did more than 150 press conferences (sometimes 3 in a week), with even more 1:1 interviews in different formats.  The press was our way of getting asked the questions needed to build trust with the public.  I would give context to our data and our decision making by going through graphs and charts…..something I NEVER could have anticipated I would ever do on TV…but I would walk the public through the numbers and how they informed our decision making.  

And then the Governor and I would get loads of questions. So, so, so many questions….and I always saw those questions as an opportunity to build trust, reinforcing the “why” behind our decisions.  I actually really liked the questions - but wow, did it take a ton of patience, preparation, and mental energy to be transparent! 

Ok - now over to competence -  doing what you say you are going to do. It’s that simple.  If you told your parents you were going to the movie and would be back around 11pm….did that in fact happen?  When they activated the phone locator for your phone at 9:30 that night….were you in fact sitting in said movie theater.  Did you indeed walk back in the door before 11?

Same thing in leading through the pandemic.  If we said, there will be COVID tests available in a certain place at a certain time….were those tests in fact there.  Did we actually execute on the plan for response that we shared at those press conferences?  

Our test of competence and key trust building moment certainly happened during the roll out of the COVID vaccines.  We need to make sure that vaccines were equitably distributed across the state, that they weren’t sitting on a shelf somewhere and that we were all working with the same rules to prioritize who would get vaccines and when.  We also need to systematically communicate about why it is so important to get vaccinated, and use different mechanisms to make vaccines available to all communities.

We had clear data and metrics to hold ourselves accountable – and everyone could judge our competence.  And - I am very proud of our competence grade –  99% of North Carolinians over age 65 were vaccinated – 99%....with no disparities across our Black or hHspanic communities.

After transparency and competence – focusing on building and maintaining relationships was key.  Remember that trust is not a one-way street.  Trust is a reciprocal relationship. When you trust others, they are more likely to trust you in return. And when you are trustworthy, you inspire others to be trustworthy as well.

Let’s go back to my example about the parent, their kid and the movie…..  Let’s say something goes sideways during the evening.  Maybe you had every intention of going to the movie – and what you told your parent at the time was in fact true….but when you got there the movie was sold out and instead of going home, you changed plans and went to the local diner (or bar) instead with friends.  If you have a foundation of a trusting relationship – no problem - plans change no big deal.  

But if the relationship foundation isn’t there….you can only be judged by that one encounter or one statement.  And you said you were going to a movie….and you didn’t.  So, if your parents find out you weren’t at the movie…..and you didn’t have a baseline relationship of trust….that could go badly.  

For the COVID response, I was grateful that I had three years of building relationships as Secretary of Health and Human Services before COVID happened.  In that time, I was able to build relationships across the state…and in particular with elected members of the North Carolina General Assembly.  During those first three years – folks got to know me and I had opportunities to demonstrate trustworthiness well before we got into a crisis.  I built strong relationships across the political aisle – which doesn’t mean we agreed on everything – but there was a mutual respect and thus a foundation for a strong working relationship.   

In addition to building on existing relationships, I focused on building new trusted relationships by showing up, listening and immediately taking action on what I heard.  In order to truly lead with equity in our COVID response….I did a ton of listening to historically marginalized communities.  And what I heard was anger at first – our black and brown communities were more likely to be essential workers and not surprisingly were seeing an outsized impact of COVID in their communities.  

And even when it was uncomfortable  – I needed to hear where we were falling short for our historically marginalized communities…..and I needed to keep showing up, listening and incorporating what they shared in our planning.  The trust building wasn’t quick – but we built relationships that deepened well beyond the COVID response.

The combination of the transparency, competence and relationship allow us to come through this pandemic with more trust.  And we are able to use that trust to continue work to make north Carolina healthier and safer. 

To recap the takeaways: Trust yourself.  Think intentionally about building trust – make a plan. And then focus on transparency, competence and relationships as you work to build trust and make change in the world. 

And, before I close today, I want to touch on one more aspect of trust.  That is trust is a critical foundation for a healthy society. Trust in institutions, such as government, or media, or business, has been eroding in recent years. This lack of trust has led to polarization and division, and has made it harder to solve important issues facing our world. As you move forward in your lives, I encourage you to think about how you can also contribute to rebuilding trust in institutions and creating a more trusting and united society.

Your education at Guilford College has equipped you with the knowledge, skills, and abilities to make a positive impact on the world.  If you take what you have gained at Guilford College and focus intentionally on trust  –  I know you will make positive change in the world.  I trust you.

Congratulations again to the class of 2023, and I wish you all the best in your future endeavors. Thank you.