One of the many conundrums about cancer biology is why the body does not recognize abnormal, mutating cells as foreign and eliminate them. Biotech companies are starting to unravel the mystery and cancer immunotherapy is hot.

However, we have a much better understanding of the corporate immune system that has developed, over many years, the ability to sniff out innovation, troublemakers or those who pose a threat to the status quotidiens and nip it in the bud.

For intrapreneurs-employees trying to act like entrepreneurs in their organizations- they need to learn how to evade this highly developed and regulated corporate immune mechanism. Here are some tips:

1. Become a Trojan horse

2. Innovate your heart out. Just don’t let anyone know you are doing it until just the right time. Be sure you know when to ask for foregiveness instead of permission.

3. Intrapreneurship is guerilla warfare, not a full on frontal assault, so pick your weapons and strategy carefully,

4. Be sure you have good intelligence assets on the ground

5. Have Plan B

6. Be sure to give as many other people credit for your ideas as possible

7. Use words carefully. Call something by a name that does not raise the hair on the back of people’s heads, particularly in a different culture, like using “entrepreneur” or “marketing” in a clinical environment

8. Find a sponsor who can provide you with political cover

9. Bootstrap your idea for as long as possible. Asking for money puts you on the radar screen

10. Hide as many innovation surface receptors as possible so the corporate ligands can’t find you.

Here are some other survival tips for physician intrapreneurs.

Corporate anti-immunotherapy is evolving,but very slowly. It will take a long while before investors start throwing the same kind of money at it they are throwing at cancer immunotherapy. Keep your head down.

The most frequently asked question most inexperienced physician entrepreneurs ask is, “How do I find investors?”. The facts are that, according to the Angel Capital Association, only 2 percent of entrepreneurs are able to pry much-needed cash from the tight hands of angel investors, and less than a half of a percent raise money from venture capitalists, according to Price Waterhouse study.

Structural changes in the venture capital industry makes it harder to find seed stage money and investors who are willing and able to lead deals. The result is a seed stage gap.

Further complicating the issue is that investor ecosystems and funding requirements vary depending on the type of product or service you are building. For example, finding the amounts of money you will need to develop a drug, device or diagnostic product will vary significantly from how you find money for your digital health app or care delivery or service improvement. The time horizons and follow on round required are also different.

So, what’s a biofounder to do?

Here’s are the stages of funding.

Obviously, there is a lot of advice on how to raise seed stage money, but here are some recurrent themes concerning the strategy and tactics involved:

Strategy

1. Be sure your idea is ready for investor prime time–i.e. you have the pieces in place and have validated most of the elements of the your business model. The ultimate validation of your model will be if you have paying customers already.

2. Fight the right kind of investor who identifies with your idea during the right stage of development. Not all investors are the same. Some favor certain industries or products, some have personal connection, some want early stage, some want later stage. Do your homework. Here are the various stages of startup funding.

3. Explore alternative and new forms of funding, such as investor, charity or product/service crowdfunding, corporoate venture, state andlocal grants and university based endowments and investment funds.

.4. Network, network, network.

5. Fail early, often, and for as little cost as possible.

6. Self-fund or bootstrap for as long as possible. Build as much value into your idea as possible before shopping it to investors.

7. Consider customer-funded business models if possible.

8. Have a fundraising plan, just like a marketing plan or financial plan, and execute it

.9. Get the right people on the bus as soon as possible.

10. Find the cheapest, smartest capital (not necessarily money) to get to your next critical success factor.

Be sure you have a fundraising plan and follow these steps.

Tactics

Now that you have some strategy, here are some nuts and bolts:

1. Network, network, network.

2. Create a one-page executive summary, a 3-minute video, a website with a button “for investors” and a 10-slide Powerpoint presentation.

3. Sell to the heart, not to the head and be sure your pitch is investor ready.

4. Be sure you have the right story teller on the team.

5. Create social media buzz about your product or service as part of your plan. You know you are successful when an investor says, “Oh, I’ve heard of you.”

6. Apply for non-diluting sources of capital like SBIR/STTR, state and local eco-devo grants, international research, and development collaborations, etc.

7. Explore accelerators, generators, and incubators that have the right model for you.

8. Find out who funded your competitors and contact them.

9. Think big, but start small demonstrating customer traction with pilots.

10. Network,network, network. Even when you are networking, you might be mingling with the wrong people. There are 15 sources that you should cultivate who can make introductions or ease the way to meet investors.

11. Here is your angel investor contact to do list

Here are 10 other places to look for money:

You should also look into investor crowd funding. Here are the pros and cons.

Here are some tips on how to find angel investors:

1. Use personal networking. The best angels you will find are the ones who know you personally, or know a member of your team or advisory board. If a potential investor gets to know you BEFORE you are asking for money, your credibility and investment probability will be improved by an order of magnitude.
2. Entice angels to play along. Of course, angels are really mortals. They want to make a difference. Asking an angel to work with your company in an advisory role is a great way to establish a relationship that may lead to a cash investment. If you impress the angel, it will likely make her at least an archangel (advocate) when it comes to funding.
3. Court local angel groups. Since angel investors most often focus only in their own geographic area, it’s most effective to court the local group, or even make a guest appearance with an archangel. If you can earn an archangel’s confidence, he or she will invite you to pitch the group, and you’ll have an edge in the voting.
4. Mine national databases. If you are still alone, submit your application to the leading online website national databases of angel investors, Gust (USA) and National Angel Capital Association (Canada). These sites have arrangements with hundreds of local groups and individual investors that you might otherwise have missed. You might also check angel funds that target bioscience or digital health ideas or raise money from doctors for doctors.

Gust (formerly AngelSoft). This is perhaps the most widely-used source of information on angel investor groups across the world, run by the “Father of Angel Investing in New York,” David Rose. This software platform is used by many local angel organizations for managing deal flow.

Gust claims to have facilitated over $1 billion of investments in 500,000 startups to date, via connection through their platform to over 70,000 angel investors in 190 countries. As an entrepreneur, you simply use their investor search engine to find appropriate investors for your business according to location, industry interest, and other relevant criteria.

AngelList. This is another very popular website for raising equity or debt investments for startups. It was founded back in 2010 by Naval Ravikant and Babak Nivi of Venture Hacks, which is also a great place to visit for startup advice.

AngelList has featured over 3 million businesses for potential investors in a format that is, effectively, a social network for entrepreneurs and angels. They claim to have already raised over $560 million for 1400 startups, primarily in the US and Europe. In addition, they serve as a jobs available site for 24,000 startups.

Keiretsu Forum. This one claims to be the world’s largest single angel investor network, with 2500 accredited investor members throughout 52 chapters on 3 continents. Since its founding in 2000, its members have invested over $800 million dollars in over 800 companies in technology, consumer products, healthcare/life sciences, real estate and other segments with high growth potential.

The Founding Chapter is in Silicon Valley, California, (naturally). A caveat is that this is a for-profit organization, so fees to present may be significant.

USA Angel Investment Network. This group claims to be the largest angel investment community in the world. They have already raised $300 million for startups in the US and across the world. A caveat is that this network doesn’t offer a personal touch, as it only facilitates the exchange of contact information, so the matchmaking is left up to you.

The reach is very broad, with a network has 30 branches extending to 80 different countries. They have over 785,000 registered members with 140,000 investors and 650,000 entrepreneurs.

Angel Capital Association (ACA). The ACA is the angel industry alliance, which now includes a directory to more than 240 angel groups and 13,000 individual angels across North America. ACA member angel groups represent more than 10,000 accredited investors and are funding approximately 800 new companies each year, and managing an ongoing portfolio of more than 5,000 companies throughout North America. Here are some facts about angels:

• Angels are still predominantly men, but the number of women angels has been increasing – 22 percent of angels are women and 30 percent of new angels are women;
• Angels are based everywhere, not just in the Silicon Valley, Boston and New York;
• Most angels are experienced entrepreneurs;
• Median investment size is $25,000; and
• A typical angel has a portfolio of 11 companies, with large variation depending on how long the angel has been investing.

1. Remember angels beget angels. That means that once you get the first one, he or she becomes your best advocate for finding more. Investment angels don’t like to travel alone, so they will bring in others if they can (it’s called share the risk).
2. Don’t forget passive angels. These are angel investors who are private, meaning they don’t go to meetings, but will invest if someone they trust brings them an attractive opportunity. Find the right investment advisor, or member of your advisory board, and the “match-making” will happen.

The VIC Investor Network helps develop and commercialize biomedical technologies that originate in academic research centers and government labs.

Apply for an SBIR/STTR grant for non-equity diluting funding. If you are successful, then apply for matching grants if they are offered in your state.

Apply to be part of an iCorps team.

Be sure you have a financial model is credible

Here are some ways to be sure you are ready for fundraising prime time.

Finding seed funding for your idea is as much about when and if as where and how. It takes planning, preparation and practice and having realistic expectations about how few companies actually are funded by VCs, angels and crowd funding platforms. Be sure you have done your homework, crafted, and validated your business model canvas and done some experiments before giving up control to investors. Good luck with your venture.

By now, if you have anything to do with taking care of patients, you have been bombarded with posts, blogs, white papers and seminars on customer service. The customer experience is not just about the patient, but also includes anyone who interacts or touches the patient in their care journey, including clinical, administrative, clerical and support staff.

More and more, doctors and other medical staff are being measured, held accountable for and compensated, in part, on their customer service skills, and, for good reason.

A study of nearly 35,000 online reviews of physicians nationwide has found that customer service is patients’ chief frustration, not physicians’ medical expertise and clinical skill.

The study, published in the current issue of the Journal of Medical Practice Management, reveals that 96 percent of patient complaints are related to customer service, while only 4 percent are about the quality of clinical care or misdiagnoses.

In summary, the study found that fewer than 1 in 20 online complaints cite diagnosis, treatments and outcomes in healthcare as unsatisfactory, whereas more than 19 of 20 unhappy patients said inadequate communications and disorganized operations drove them to post harsh reviews.

Despite assertions to the contrary, digital health interventions aren’t helping.

The problem, like so many other other demands placed on the clinical staff, like being expected to innovate, is that they are not taught how to do it. The result is frustration, push back and burnout. Here’s how to piss off your patients.

If you are like most, you probably hate customer service and companies seem to be doing little or nothing to make it better.

A recent article explains why and stresses that the experience should derive from your brand identity, the defining values and attributes that distinguish a brand.

Like building a house, the author suggests that you need to build a blueprint and a customer experience architecture in 7 steps:

To develop a customer experience architecture, follow these steps:

1. The brand platform — First, define or reaffirm the overarching ideas that represent the brand. REI’s brand platform is the excitement and adventure of the outdoors; Chick-fil-A’s is exceeding customers’ expectations with a servant’s spirit.

2. Customer experience strategy — Then describe the desired customer feelings and perceptions of the brand across all interactions with the organization. An electronics website might want to create a “place” for customers to discover and be delighted by innovations. A hotelier might want customers to feel pampered by legendary service. Most patients simply want to feel like caregivers care and that they are safe.

3. Business segmentation — The next step is to break down the business into discrete units. For a new brand, segmenting the business by traffic vs. trial vs. transition might be an illuminating approach; a restaurant company might segment by service mode, e.g., eat-in vs. drive-thru vs. carry-out; and a product-line segmentation might be appropriate for a manufacturer. The objective is to identify the different experiences the organization delivers and to articulate the requirements and objectives of each.

4. Customer segmentation — Different target segments have different needs — some customers may value convenience over price, others may be looking for an entertaining experience — so their desired experiences vary. Describe each segment with a profile and a needs inventory, including key drivers of purchase decisions and brand perceptions.

5. Prioritization — Create a grid with the business segments as columns and customer segments as rows. Each business/customer intersection represents a discrete experience to design and deliver. They should be prioritized in order to focus design and management. Prioritization criteria include profit potential, fit with long-term strategy, competitive advantage and differentiation, resource requirements, and how the experience affects and/or reinforces brand values and brand position.

6. Experience design — Determine how to meet the segment-specific needs in each business segment, either by improving existing approaches based on new insights from the architecture or by developing entirely new ones. All the levers of customer experience — product, service, content, channels, touchpoints, pricing, facilities, sensory engagement, etc. — should be considered and described in the design.

7. Assessment and integration — Now the architecture is ready to be inspected for integrity and coherence. Is the brand platform expressed throughout every experience? Do the discrete experiences contribute to the overall customer experience strategy? Do experiences complement and enhance each other, or do they conflict or detract from each other?

Some argue that the hospitality industry is not the appropriate model for the sick care systems business and that we need to fix how we do care coordination and communication and teach pathetic doctors how to be empathetic.

Here’s a test on patient experience at your place:

1. Was it easy to find a place to park?

2. How many times were you handed a clipboard?

3. How long did you have to wait to get an appointment?

4. How long did you sit in the reception area/waiting room?

5. Was there free WIFI in the reception area ?

6. How long did it take for you to get your test results? Did someone send them to you or was it your responsibility to get them?

7. Was the coffee in the lobby overpriced or free?

8. Were you charged to get a copy of your records and was it more than what it would cost at Staples?

9. Were you able to find your doctor’s office easily or did you have to ask someone for directions?

10. Do you remember the names of the people who took care of you?

11. Does everybody really care or, are they too burned out to do so?

So, if doctors are expected to improve their customer service skills, how should we do it?

Here are some guidelines that should inform how we teach and measure doctor customer service:

1. Changing behavior is hard and involves identifying the undesired behavior, targeting triggers, measuring the response and creating carrots or sticks to eliminate or reinforce the behavior
2. Unless the changed behavior becomes a habit through repetition, education and training, there is a high rate of recidivism
3. Many doctors are simply unwilling or unable to change and they need to be “rehabilitated” or fired accordingly. Instead, many just get promoted to the C suite.
4. Delegating the responsibility to managers or department heads to create customer service improvement does not work without following a delegation process
5. The process of gathering feedback and using it to guide improvement likewise must be done correctly to make a difference.
6. There is little or no correlation with patient experience and the quality of medical inputs and outcomes
7. Improving experience is but one step towards engagement and enabling changes into value added modifications of patient and medical team behavior
8. The cost, time and effort of using sophisticated customer experience vendor solutions can be prohibitive and, instead, require some bootstrapped solutions to solve targeted problems eminating from targeted people in certain departments, who, most likely, are the 20% creating 80% of the problems
9. Often times, because managers themselves are not trained or proficient in customer service, the blind are leading the blind
10. It is an unrealistic expectation for a doctor to have the diagnostic skills of Osler, the technical genius of Leonardo, the compassion and empathy of Mother Theresa and the customer service skills of the bartender at the Ritz Carlton. We need to be realistic about setting acceptable standards that recognize individual strengths and weaknesses and how we recruit for them.
11. Establish guidelines and pathways for dealing with difficult patients and chronic complainers. When and how should you inform a patient that they should get care somewhere else if they are so dissatisfied with the service or experience.
12. Manage online complaints and create a reputation management protocol and platform.

We used to tell substance abusers to just say no and that didn’t work out so well.. Unfortunately, just telling sickcare workers to follow the golden rule has not worked either.

When companies like Uber move into an area, some people there are less likely to start businesses of their own. The falloff may reflect a decline in “necessity-based entrepreneurship” by unemployed or underemployed people. If they have no job opportunities, “they’re more likely to act on what’s potentially a lower-quality startup idea” that doesn’t get much support on Kickstarter.

About half of Uber drivers have college degrees. What is the lost entrepreneurial cost?

More and more doctors are getting interested in entrepreneurship i.e. the pursuit of opportunity under conditions of uncertainty with the goal of creating user defined value through the deployment of innovation using a VAST business model. Some are doing it because they think they have to given threats to their incomes, change fatigue and fear. While those factors can be strong entrepreneurial motivators, there are also pitfalls:

1. Getting involved without a clear understanding of the entrepreneurial knowledge, skills, abilities and competencies required to add value.
2. Making decisions based on reflexive emotions instead of reflective decision making
3. Taking short cuts
4. Undervaluing your worth to get a side gig
5. Participating in ventures that have a low chance of success
6. Quitting your day job before you should
7. Putting too many eggs in one basket
8. Over promising and under delivering
9. Making bad investment decisions
10. Making burnout worse by losing even more control

Like Janus, necessity-based entrepreneurship has two faces. While it is said that necessity is the mother of invention, it leaves many ideas, inventions and discoveries as orphans as well.

Which face you show should be something that is by design, not by necessity. So here’s to financial stress and deadline pressure, even if few of us can be Marx or Dickens. To paraphrase Tiny Tim, God bless ‘em, every one.

Pharmacy educators, like other health professional educators, have realized that they need to educate and train graduates with better critical thinking skills, spur more creativity and innovation and graduate students with an entrepreneurial mindset, since, that’s where innovation starts.

Here’s how one panel defines a pharmapreneur and the KSAs and competentices required to be successful.

The entrepreneurial mindset is different from the clinical mindset.

Consequently, pharmacy educators and professional associations are rushing to to meet the need and add value to their members and graduates:

1. Bioentrepreneurship education and training courses
2. Dual degree and certificate offerings
3. Pharmacy entrepreneurs in residence
4. Better seed stage funding mechanisms, including those from pharma philanthropreneurs and corporate venture sites
5. Interdisciplinary Professional Education programs
6. Pharmapreneur pharmacy student groups
7. Pharmapreneur Shark Tank competitions
8. Recognition of the scholarship of innovation for promotion and tenure credit.
9. Preceptorships and apprenticeships with biomedical startups
10. Alternative career development tracks for those interested in non-clinical careers
11. Better mentoring and network development
12. Career fairs
13. Education on drug supply chain management, tracking and security
14. Pharmacy merchandising
15. Asset protection and risk management

We need more primary care pharmacists and interprofessional sick care entrepreneurship

Rapid changes in sick care delivery are creating many new clinical and non-clinical opportunities for pharmacists. When linked with similar programs for medical, nursing, dental and graduates student efforts, synergies and economies of scale will result in a more capable workforce dedicated to creating user defined value through the deployment of biomedical and clinical innovation using a VAST business model.