Why William Paiva chooses the middle seat on purpose

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William Paiva 

Most travelers go to some lengths to avoid the middle seat. William Paiva has chosen it on purpose. Sitting between two strangers, he reasons, doubles his chances of meeting someone who could change his life, personally or professionally, and that is worth far more to him than a little extra elbow room.

For Paiva, a molecular biologist turned healthcare venture investor and innovation center director, the habit is the most literal expression of the idea at the center of his work, which he calls Life in the Middle Seat. In his words, it is about “deliberately placing yourself where people, ideas and possibilities intersect,” then staying prepared and curious once you are there and acting when an opportunity appears. He distills it into a single line, Life in the Middle Seat: Put Yourself Where Opportunity Can Find You.

What ‘life in the middle seat’ means

But more broadly, the Middle Seat is the space between people, disciplines, or perspectives that do not naturally understand one another. Occupying it means learning their different languages, earning trust, and staying with the tension long enough to turn their differences into useful possibilities. It can feel uncomfortable: a person may belong fully to neither group yet be responsible for helping both move forward.

Putting yourself in that space creates potential. Curiosity and preparation help you recognize what could happen next. Action turns that potential into progress.

His name for that second step is “Sure, why not?” He uses it to describe the attitude behind many of the decisions that shaped his career. The phrase sounds more impulsive than the thinking behind it. In Paiva’s view, saying yes to a conversation, a dinner, or a meeting commits a person only to finding out what comes next, which is what makes the habit safe enough to practice again and again.

The idea took shape over time. During the COVID-19 pandemic, working from home, Paiva brought two whiteboards into his office and listed the traits of the successful CEOs and management teams he had backed on one and the traits of those who had struggled on the other. The patterns he found became the first chapters of a manuscript. The title grew out of his habit of choosing the middle seat, which began as a metaphor for improving the odds of meeting someone who might change your life. The longer he worked on the book, the more that metaphor described his entire career, and the manuscript became the book he is now developing, Life in the Middle Seat.

From molecular biology to healthcare venture capital

Paiva describes his career as one spent in the Middle Seat, between science, healthcare innovation, and venture capital. It began in the lab. He earned an undergraduate degree in microbiology at the University of Oklahoma, went on to a Ph.D. in molecular biology, and spent time as an academic researcher before he decided to complement scientific depth with the business skills needed to move discoveries toward practical use.  

Making that move meant confronting what he calls walls: beliefs about what a person can and cannot do that feel structural but often are not. A house has load-bearing walls that hold up the floor above, along with others that can come down without consequence. Paiva had assumed an MBA would have to come from an in-state school. His Ph.D. advisor pushed him to apply to the country’s top programs instead and encouraged the career change itself, even as one member of his Ph.D. committee told him he was making “the worst mistake of your life.” Paiva describes what his Ph.D. advisor, Dr. Philip Silverman, gave him as “mentorship through subtraction,” the removal of a constraint that had never been real.

He enrolled at Dartmouth without having taken a single business class, then worked in healthcare investment banking at J.P. Morgan and in product development at Merck before returning to Oklahoma to help care for his parents. There, he launched his venture fund. For 26 years, he has invested in early-stage healthcare companies through OLSF Ventures, where he is a Founder and Managing Partner, backing 28 companies along the way. He is also Executive Director of Oklahoma State University’s Center for Health Systems Innovation, which focuses on rural and Native American health. As an investor, he works between entrepreneurs and the capital markets that fund them, and at Oklahoma State he leads a center that sits between the university’s business school and rural health care.

One night in Dallas shows how that plays out. After a 12-hour flight back from China, Paiva landed to find his connection to Tulsa canceled and a friend’s invitation to join a group for dinner. He was exhausted and tempted to stay in, but he went. A conversation at that dinner helped open the path to funding from MPM Capital and Novartis for a Phase 2 trial of a sickle cell drug his fund had backed. Novartis later acquired Selexys for $665 million. He traces an important connection back to that dinner, though most evenings like it lead nowhere. As he puts it, “Did I get lucky? Maybe. Did I do what I needed to do to put myself in a position to be lucky? Yes.”

Turning different perspectives into practical work

At CHSI, the framework has a practical application: improving rural care requires business, clinical, and technology perspectives to work together. A technology vendor may focus on what its product can do, while a clinic must consider staffing, patient needs, and its daily workflow. Connecting those groups is the beginning. The work is translating their priorities into an approach that can be implemented and evaluated. That is why Paiva emphasizes workflow improvements and technology as ways to extend the capacity of existing care teams in rural markets. The Middle Seat becomes useful when it helps people move from an interesting idea to a workable next step.  

The middle seat between humans and AI

That same tension provides a way to think about the relationship between human teams and artificial intelligence. An organization may want the productivity AI promises, while employees want to understand how their roles will change. Managers occupy the Middle Seat between those expectations, responsible for making the technology useful and helping people contribute as the work evolves.

Paiva applies the framework by asking how human perspective, experience, and judgment can work with machine capabilities. An AI system might prepare a customer response; an employee may recognize that the complaint reveals a relationship problem requiring a different approach. The opportunity lies in designing work that draws on both, with clear responsibility for the outcome.

For leaders, that starts with understanding the work before choosing the tool and involving the people who know its exceptions and demands. They need to decide where AI can help, where human authority remains essential, and what support employees need to adapt. This is the question behind Middle Seat AI, a further application of Paiva’s philosophy: how can leaders turn the tension between human strengths and machine capabilities into an opportunity for the organization and its people?

For Paiva, the value of the Middle Seat is that it makes opportunity something a person can make more likely rather than simply wait for. That applies to a scientist considering business school, an executive weighing an unfamiliar partnership, or anyone at a point where the familiar path and a new one diverge. None of it requires certainty about the destination. It requires curiosity, judgment, and a willingness to take a manageable next step.

That is the thread connecting the scientist, the investor, and the university leader, and it is the idea he now wants to carry beyond his own career. The Middle Seat is available wherever different perspectives meet. Paiva’s argument is that possibility tends to find the people who have made room for it, and that the decision to make room is one almost anyone can make.

Readers can follow William Paiva’s work on Life in the Middle Seat, including updates on the book, on LinkedIn. More about his venture investing is available at OLSF Ventures.