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.

Despite the noise and groaning, medical school applications continue to grow, driven by many factors. However, the medical school education model dates back to the Flexner report issued in 1910.. Many are trying to address the challenges of how to train the biomedical research and practice workforce to win the 4th industrial revolution, but progress has been slow.

Medical educators will face 5 basic problems in the coming years:

DEMONSTRATING THE VALUE OF MEDICAL EDUCATION AND TRAINING

According to a new AAMC study, 76% of students graduate with debt. And while that percentage has decreased in the last few years, those who do borrow for medical school face big loans: the median debt was $192,000 in 2018. At private schools, 21% of students have debt of $300,000 or more. The average four-year cost for public school students is $243,902. For private school students, the cost is $322,767. Many medical students in debt marry other medical students in debt. Do the math and the implications of career and family planning, housing and specialty choice.

Some are questioning whether it is still worth being a doctor.

ACCOMMODATING THE MARKET DEMAND FOR NON-CLINICAL CAREER OPPORTUNITIES

Medical students are forgoing residencies, practitioners are abbreviating their clinical careers, side gigs and hustles are hot and many want to create patient value other than seeing 20 a day for their entire career. Physician entrepreneurship is finally getting its rightful due, yet few medical schools offer education and training in it, let alone the business of medicine. There are few entrepreneurial medical schools and, arguably, there is a sick care innovation bubble.

Barriers persist:

1. Lack of education about how to get an idea to patients, particularly in the core areas of regulatory affairs, intellectual property, the legal environment, reimbursement, business development and building high performance teams.
2. Lack of seed stage money
3. Poor internal and external networks to find the right people for their startup or development teams
4. Poor mentoring platforms
5. Lack of social support networks
6. Poor relationships with policy and advocacy partners
7. Lack of a structured digital health clinical research infrastructure
8. Inability to find clinical care delivery partners who are willing and able to test digital health products and services
9. Significant barriers to integrating digital health products into the legacy EMR
10. Poor innovation culture, structure, process, leadership and incentives
11. Lack of promotion and tenure credit for academic entrepreneurs
12. Lack of recognition for medical edupreneurs
13. Poor entrepreneurial mindset
14. A toxic, anti-entrepreneurial culture of education and training
15. High switching and opportunity costs of pursuing a non-clinical career track
16. Ignorance about non-clinical career development opportunities
17. Difficulty matching qualified physician entrepreneurs with viable startups and scaleups

18. How to manage a gig economy portfolio

19. Understanding the tax and liability consequences of various compensation schemes

20. Risk management

DECLINING REVENUES FROM RESEARCH GRANTS, CLINICAL EARNINGS AND STATE SUPPORT AND A FAULTY BUSINESS MODEL

Major consolidation and the expansion of academic integrated delivery networks means the rich get richer and poor get poorer. NIH funding uncertainty is pervasive. Some states have withdrawn funding from their public medical schools. Reforms in clinical practice reimbursement will lead to decreasing revenues. Many schools are reaching out to create partnerships with industry with ethical and professional conduct threats. More are relying on philanthropreneurs to put their names on buildings. Many have repacked their technology transfer offices and rebranded them as innovation centers.

Here’s why there is a physician compensation bubble.

DEFINING NEW MARKET NEEDS DERIVED LEARNING OBJECTIVES AND CURRICULUM REFORM AND RESKILLING

U.S. companies are increasingly paying up to retrain workers as new technologies transform the workplace and companies struggle to recruit talent in one of the hottest job markets in decades.

Amazon.com Inc. AMZN 0.54% is the latest example of a large employer committing to help its workers gain new skills. The online retailer said Thursday it plans to spend $700 million over about six years to retrain a third of its U.S. workforce as automation, machine learning and other technology upends the way many of its employees do their jobs.

We need to stop graduating knowledge technicians. Recruiting the traditional triple threat to lead departments is a dead model. Domain expertise needs to be supplemented with communication, creativity, collaboration and complex problem solving to address the social determinants of health and other wicked problems. Here are the principles of medical education reform. Free tuition won’t solve the problems.

The Institute for the Future for the University of Phoenix Research Institute outlines ‘trandisciplinarity’ as one of the ‘Ten Skills for the Future Workforce’ alongside the following: Sense-making, social intelligence, novel and adaptive thinking, cross-cultural competency, computational thinking, new-media literacy, design mindset, cognitive load management and virtual collaboration

Who is the chairperson of your Department of the Future and what are their qualifications?

Here’s how to create a culture of digital transformation.

FIXING THE TOXIC CULTURE OF MEDICAL EDUCATION AND TRAINING AND THE LACK OF DIVERSITY

How many more times do we need to read about physician burnout, stress, mental health issues and suicide? When will we fix how we recruit applicants and faculty to create a more diverse and inclusive talent pipeline?

Medical school graduates are now more racially diverse than before, but they’re still not representative of the general population, according to new research.

Higher education feeds the medical school pipeline and has its own problems that need to be fixed.

There are many parts to the contemporary economic bubble diagram and medical schools could be one of them is they don’t address these problems.

The economists tell us that labor productivity is a measure of the amount of goods and services that the average worker produces in an hour of work. The level of productivity is the single most important determinant of a country’s standard of living, with faster productivity growth leading to an increasingly better standard of living. Given recent stagnation in wages, however, some are re-examining the link. It turns out if you make more things or produce more services, you don’t necessarily make more money. In the case of doctors, the reverse is true. If you make more money it does not necessarily mean you are more productive.

Continuing a decadelong trend, total cash compensation increased in 2019 for physicians across all major specialty groups, including primary care, medical, surgical and hospital-based specialties. This is driven primarily by a tight labor market — organizations are offering increasingly competitive pay packages as they vie for the same talent.

While pay increases, productivity remains flat, or has even decreased slightly. SullivanCotter notes that primary care physicians have seen a 14.7 percent increase in total cash compensation, while work RVUs, a measure of productivity, have declined 0.2 percent from 2014-19. Hospital-based physicians are the only exception to this trend. They’ve seen 5.2 percent growth in median wRVUs from 2014-19.

As noted in a recent WSJ article, perhaps we are experiencing a kind of Solow Paradox 2.0, with the digital age more around us than ever except in the productivity statistics. There are several reasons for this lag. First of all, we’re in the early deployment years of major recent innovations, including cloud computing, IoT, big data and analytics, robotics, and AI and machine learning. Notes McKinsey: “The challenge of adoption in the current digital wave may be even harder because of the broad range of uses of digital that not only help improve current processes but fundamentally transform business models and operations.”

While leading edge companies are already leveraging these advances, most are still in the learning stages. The most sophisticated companies have been pulling far ahead of everyone else in deploying these advanced technologies. According to McKinsey, “Europe overall operates at only 12 percent of digital potential, and the United States at 18 percent, with large sectors lagging in both. While the ICT, media, financial services, and professional services sectors are rapidly digitizing, other sectors such as education, health care, and construction are not.”

Given all the changes and demands on the sick care system, many experts are suggesting ways to increase sick care worker productivity. If you are a clinician, the measure now is straight forward i.e. the number of relative value units you can generate and how much revenue and reimbursement that translates to for you or your employer. Some are trying to move the goals posts or change how we keep score, but, for now, most doctors are being measured and compensated by how many points they put on the board. One of these days, though, CFOs are gong to have to figure out what to do with all those doctor cash cows.

On the other hand, some doctors think we should abandon measures of doctor productivity.

Healthcare is a key component of the US economy, but healthcare spending increases consistently outstrip GDP growth. Improving productivity in healthcare delivery could change this dynamic without harming patient care.

Charles Duhigg has written about what makes people productive in his book, Smarter, Faster, Better. For those of you who just read the conclusions sections of scientific and medical journal articles, here are the takeaways as they could potentially apply to sick care workers:

1. Make people feel like they are owners, not renters. Expand their locus of control, constantly reminding them about how the work they do is about something they care about. Remind yourself and co-workers that you are building a cathedral, not just laying stones. Suppose doctors and other employees were owners instead of cogs?

2. Many say you should choose a stretch goal and break it down into SMART (specific,measurable,achievable,realistic,timeline) objectives. When it comes to innovation, though, some think DUMB goals make more sense than SMART goals. Taking it one step further, HARD goals are better motivators:

Question #1: Animated. “Think about where you want your career to be, and describe to me exactly what you’re doing (what kind of work you’re doing, who you’re working with, what your days look like, etc.) one year, three years, and five years from now.”

Question #2: Heartfelt. “Describe at least three reasons why you want this goal (note: the reasons can be intrinsic, personal, and/or extrinsic).”

Question #3: Difficult. “What are the three to five most important skills you’ll need to develop to achieve this goal? How will you develop those skills?”

Question #4: Required. “What do you need to have accomplished by the end of the next six months to keep on track toward achieving this goal? What about by the end of the next 90 days? The next 30 days? What’s one thing you can accomplish today?”

3. Start with the end in mind, create a retrograde pathway, and focus. Ask, “what next and by when?”

4. Envision multiple futures and open yourself to multiple options

5. Make teams more effective by focusing on the how (give everyone a chance to speak and are safe) instead of the who.

6. Push decision making to the person closest to the problem. Rule makers , managers, bureaucrats and many physician executives have a very hard time with this one.

7. Innovation is mostly about doing old things in new ways. To connect the dots and harvest institutional history, become an “innovation broker”. Innovation brokers don’t just build network pipes and pumps, but instead accelerate the flow of information and fix the pipes that are clogged.

8. Customers buy emotionally and justify rationally. Inventors and innovators should do the same. The user defined value of an idea or invention is often more aptly measured by how it makes you feel, not what you think about it.

9. The productivity curve maxes out at some mean level of stress. Something that is boring or a task that is overwhelming does not drive productivity. In fact, excessive stress, change fatigue and administrivia crush productivity. Some seem to think that the way to make doctors more productive is to make them conform to rules and mandates telling them how to be more productive.

10. Just because you have realized a creative breakthrough does not mean it will create user defined value. Be open to the fact that your baby might, in fact, be ugly. Statistically, most are.

11. Get rid of the SHIT in your life. Mitigate technofatigue.

12. Use these AI tools to streamline your day

13. Do a better job of coding

14. Minimize no shows

15. Use the OKR system to measure your results.

Here are six more keys to improving physician workflow.

Of course a much easier way is to make doctors wear performance-monitoring wearables.

Virtual and face to face mentors help too.

Sick care labor economists debate whether productivity is increasing or decreasing and whether it is contributing to an increased standard of living. If you want one answer, ask your neighbor, the pediatrician. Or, maybe we should just all learn from Leicester City to solve the Solow paradocs.