GUEST POST from Arlen Meyers

Leadership is in crisis and the command and control model is bankrupt. In healthcare, we will need a cadre of physicians to lead us to the promised land. However, doctors don’t seem interested and are pre-occupied mostly with keeping their heads above water or putting them in the sand.

Physician executives are not necessarily physician entrepreneurs.

Knowledge technicians are different from managers who are different from leaders who are different from entrepreneurs.

Coping, let alone thriving , in this turbulent sick care environment will require an attitude change. Consider:

1. Doctors need to evolve from technicians to managers to leaders to entrepreneurs to leaderpreneurs to thrive. Some call it practicing at the top of your license. In addition, filling the C-suite with more physician managers just makes it harder to innovate and adds further clutter to the organization.

2. Millenials have no interest in leading.

3. The large majority of “leaders” are managers with no leadership skills and are examples of the Peter Principle. At best, most are managing process, safety and quality improvement, not significant and meaningful sick care innovation.

4. Leadership is about communicating vision, direction and inspiration. It is not managing. Entrepreneurship is the pursuit of opportunity with uncontrolled resources with the goal of creating user defined value through the deployment of innovation. Innovation has both a qualitative and quantitative component and is measured by user defined multiples of both.

5. Most leaders fail because they have poor communications skills. They have poor communication skills because they don’t know how to listen, engage and motivate followers.

6. Listening fails for many reasons, not the least of which is not ignoring your internal conversation and changing the lenses through which you see and hear people.

7. Who is “the leader” is not something determined by the org chart. Get rid of it and take advantage of the leadership potential of those without the titles on their office door. Navy Seals do. Israeli army officers do. You can too and it won’t be nearly as dangerous but it usually involves having as much courage.

8. Require every manager to go to leadership boot camp before they can assume any leadership position. Assign them a mentor and get them coaching.

9. Value is the coin of the realm. Leaderpreneurs have to evolve and adopt an entrepreneurial mindset. In the new world of robotic infested work, everyone has to be an entrepreneur or run the risk of losing their jobs. Just ask Watson.

10. Hire, develop, promote and reward for innovation.

Leaderpreneurship development isn’t creating leaderpreneurs whether it be those who deliver are or those who manage and lead it.

Leadership development expert, Alan Patterson, describes the four stages of leadership at it applies to technical experts like physicians:

Stage 1: Expertise derived from technical competence

Stage 2: Credibility derived from people skills

Stage 3: Execution, alignment and engagement, derived from teaching, coaching and inspiring other people , focusing on the now

Stage 4: A strategic mindset focusing on the next (making existing products and services better) and the new (making existing products and services obsolete)

One key difference between management and leadership is that the former is about you and the latter is about coaching and teaching the people you lead.

Here are 10 principles of strategic leadership:

Leadership styles depend on the situation. Here are the six leadership styles Daniel Goleman uncovered among the managers he studied, as well as a brief analysis of the effects of each style on the corporate climate:

The pacesetting leader expects and models excellence and self-direction. If this style were summed up in one phrase, it would be “Do as I do, now.” The pacesetting style works best when the team is already motivated and skilled, and the leader needs quick results. Used extensively, however, this style can overwhelm team members and squelch innovation.

1. The authoritative leader mobilizes the team toward a common vision and focuses on end goals, leaving the means up to each individual. If this style were summed up in one phrase, it would be “Come with me.” The authoritative style works best when the team needs a new vision because circumstances have changed, or when explicit guidance is not required. Authoritative leaders inspire an entrepreneurial spirit and vibrant enthusiasm for the mission. It is not the best fit when the leader is working with a team of experts who know more than him or her.
2. The affiliative leader works to create emotional bonds that bring a feeling of bonding and belonging to the organization. If this style were summed up in one phrase, it would be “People come first.” The affiliative style works best in times of stress, when teammates need to heal from a trauma, or when the team needs to rebuild trust. This style should not be used exclusively, because a sole reliance on praise and nurturing can foster mediocre performance and a lack of direction.
3. The coaching leader develops people for the future. If this style were summed up in one phrase, it would be “Try this.” The coaching style works best when the leader wants to help teammates build lasting personal strengths that make them more successful overall. It is least effective when teammates are defiant and unwilling to change or learn, or if the leader lacks proficiency.

The coercive leader demands immediate compliance. If this style were summed up in one phrase, it would be “Do what I tell you.” The coercive style is most effective in times of crisis, such as in a company turnaround or a takeover attempt, or during an actual emergency like a tornado or a fire. This style can also help control a problem teammate when everything else has failed. However, it should be avoided in almost every other case because it can alienate people and stifle flexibility and inventiveness.

The democratic leader builds consensus through participation. If this style were summed up in one phrase, it would be “What do you think?” The democratic style is most effective when the leader needs the team to buy into or have ownership of a decision, plan, or goal, or if he or she is uncertain and needs fresh ideas from qualified teammates. It is not the best choice in an emergency situation, when time is of the essence for another reason or when teammates are not informed enough to offer sufficient guidance to the leader.

Here is another way to slice the pie.

There is a growing acceptance of the practice of formally developing physician leaders to help navigate the increasingly turbulent health care landscape. Research points to the important role that clinical leadershipcan play in improving the performance of health care organizations. Growth in compensation for physician executives, particularly those with postgraduate management degrees, signals higher demand and appreciation of their value.

While satisfaction scores might be high, unfortunately, only about 10% of leadership development programs are successful. They fail for 3 basic reasons:

“The first is a gap in motivations. Organizations invest in executive development for their own long-term good, but individuals participate in order to enhance their skills and advance their careers, and they don’t necessarily remain with the employers who’ve paid for their training. The second is the gap between the skills that executive development programs build and those that firms require—particularly the interpersonal skills essential to thriving in today’s flat, networked, increasingly collaborative organizations. Traditional providers bring deep expertise in teaching cognitive skills and measuring their development, but they are far less experienced in teaching people how to communicate and work with one another effectively. The third reason is the skills transfer gap. Simply put, few executives seem to take what they learn in the classroom and apply it to their jobs—and the farther removed the locus of learning is from the locus of application, the larger this gap becomes. To develop essential leadership and managerial talent, organizations must bridge these three gaps.”

Politicians,whether in your company or in the upcoming elections, promise change. Leaders make it happen. They lead innovators, they don’t manage innovation. There just seems to be fewer and fewer of them wearing white coats and physician leadership and MBA programs are not working.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Every entrepreneur who has succeeded or failed (is there a difference?) has advice about how to get the right people on the bus. What questions should you ask at the interview? What character traits should you seek and how do you do that? How much is science and how much is just going with your gut and whether you click?

What Google found was that interview scores had no correlation with performance, of those who got hired.

Likewise, advisors or potential employees want to find the right fit as well. The rules are somewhat different when it comes to the board of directors, the management team, employees, consultants and advisors.

Maybe flipping a coin or a job lottery would save a bunch of time and money and get the same results.

I’ve been on both sides of the table so allow me share my two cents on how to staff your startup:

1. Hope for the best and expect to fire fast. Give yourself lots of wiggle room.

2. Don’t hire hood ornaments (doctors with fancy credentials that you parade on your website and pitch deck) unless you simply need one for credibility and really don’t expect them to do much more.

3. Clarify expectations, timelines and benchmarks

4. Rent advisors, don’t buy them

5. Barter, don’t rent, if possible

6. Expect most people to put a hand up, not show up

7. Define your next critical success factor (like raising 2M dollars in seed money) and find people who can help get it done. Once it’s done, stop and empty the bus, and reload. For example, suppose your company has achievements to date that include FDA 510(k) submission, provisional and non-provisional patent filing (there is no such thing as a non-provisional patent granted by the USPTO), and patent attorney freedom-to-operate letter (here’s what that is). You have raised $200,000 from angel investors and are currently raising $1.5M in the current seed round with a valuation of $10M. Who do you want to help, how and how much will you compensate them and for how long?

8. Don’t give away the store early in the game. If you are successful, you’ll have to give it away to get the money anyway so keep your powder dry

9. Hire people who are card carrying members of the Get Shit Done Club  

10. Evolve as fast as you can from a knowledge technician to manager, to leader, to entrepreneur to leaderpreneur i.e. work on the company, not in it.

11. Be careful about hiring interns since there are practical and labor law issues that can make your life more complicated than it already is or is going to be. Internships are supposed to be about helping the intern. You want people who primary purpose is to help your company as much and as soon as possible

12. Don’t overhire for quality or quantity. Do you really need to hire that expensive CFO when what you really need is someone to keep the books and do payroll at this stage of the game? What about business development, sales and marketing?

13. Figure out whether you are hiring someone, or joining someone, to help with strategy or tactics. At the beginning, it is usually a cacophany of both. As the company validates its model, though, there is the risk of the distraction of traction. For a surgical benefits management company, for example, you need to focus and define your SCOPE.

14. The single most important question you can ask yourself is, “Do I like and trust these people?” The second is, “Can I deliver what they want, or am I just doing this to stroke my ego and make some bucks?”

15. If you had one more day to live, would you spend it in a co-working space wearing a hoodie? How about training and hiring felons?

16. Promote intergenerational collaboration

17. Don’t hire doctors to sell your products. They don’t know how to do it.

18. Here’s some advice on who should be on your board

Here are some tips on hiring sales people and avoiding the mistakes.

This on-demand talent model, dubbed SPEED by the author (Success, Plan, Execute, Evaluate, Decide), is good for the company, and good for all specialized, dedicated, and high performing people in the workforce today. Your company gets the flexibility to adapt quickly to the needs of a rapidly changing marketplace, and workers get to broaden their experience in the work they love.

One empirical analysis shows that companies that are equipped with both business and technical skills are disproportionately more likely to introduce new-to-the market innovations than firms that have only one of these skills. However, not all firms that are equipped with both types of skills are able to profit from them. Firms profit disproportionately from a mix of business and technical skills when the founder has technical knowledge and employs additional business experts. By contrast, we find no evidence of complimentary either when business and technical skills are balanced within a founding team, or when a founder with business skills hires employees with technical skills.

Entrepreneurial startup success is about entrepreneurial startup TEAMwork i.e.finding the people:

1. Who have Talent
2. Who can Execute
3. Who can Articulate a vision, mission, values and strategy
4. Who know how to raise, manage, protect and make large sums of Money

That means you will have to find people who play some skill positions like problem seeker, problem solver, money finder, score keeper, product developer, business builder, dot connector, risk manager and story teller.

The startup lineup should also have people in it with these skills and abilities.

How do you compensate these people without breaking the startup bank? Here are some ideas.

Hiring the right people makes the difference between fun and misery. Plan to make lots of mistakes and fire fast. Pivoting often means taking casualties.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Disrupting sick care is the new parlor game. Of course, even the guy who coined the term “disruptive” now feels he has to defend himself, so I guess the good news is that we are becoming the victims of our own success. Most of the talk has been about changing patient/customer/consumer/prosumer/client behavior. The assumption is that engaging patients will create better health and insurance IQs. thus making patients better consumers, and that will translate into behavior change that will lead to cost savings. Many entrepreneurs, hospitals and doctors are spending billions to validate that assumption and most will be surprised when they get the results. So will investors. The hypothesis could be the Achilles heal of many business model canvases.

It’s time to look at physicians and surgeons through the same lens.

Here are 10 things I would like to change about how doctors think, feel and act and how to do them as a starting point to get us to the brave new sick care world:

1. How doctors make decisions about technology adoption

2. Adherence and compliance with clinical guidelines

3. Diagnostic decision errors and second opinions

4. Hand off errors

5. Emotional intelligence errors

6. Adopting an entrepreneurial mindset

7. Failure to recognize the socioeconomic and behavioral determinants of health disparities

8. Uncounscious bias when making medical decisions

9. Managing or mitigating conflict of interest

10. How medical educators treat students, residents and fellows

Engaging physicians to transform operational and clinical performance is a tough task. You must understand the barriers as well as what matters most when it comes to changing a person’s behavior and, then, have a strategy that is sustainable.

Happy employees make happy customers. If you want to change things, worry aboutchanging the doctor experience  instead of changing patient/consumers/customers/prosumers/clients.

The only thing harder than herding cats in trying to get them to change their spots. Try changing the rules, not people.

BTW: When was the last time you were able to change someone’s behavior? Here are some things to consider.

Hint: Data rarely does.

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GUEST POST from Arlen Meyers

Digital health refers to the application of information and communications technologies to exchange medical information with the goal of improving outcomes, lowering costs, increasing access and improving the doctor and patient experience.

For digital health entrepreneurs, those who pursue opportunities under conditions of uncertainty and uncontrolled resources with the goal of creating stakeholder defined value through the deployment of digital health innovation using a VAST business model, the digital health innovation road map has several critical stops and the pathway to success is hard and brutish.

Stage 6 involves sales, marketing and postmarket surveillance that is required to achieve dissemination and implementation as scale such that it becomes the standard of care. What is your digital marketing strategy and how will you execute and measure it?

The 7-step sales process

1. Prospecting
2. Preparation
3. Approach
4. Presentation
5. Handling objections
6. Closing
7. Follow-up

The result of this process means you will have to hit some major benchmarks:

1. Product design and development
2. Technical validation and verification
3. Commercial business model validation
4. Clinical validation by end users
5. Product launch
6. Inplementation and dissemination
7. Post dissemination surveillance i.e.digitovigilence
8. Continuous quality improvement

Much has been written about how to get, keep and grow customers using digical strategies i.e. a combination of face to face, physical and online techniques.

However, most startup and scale up entrepreneurs lack sales skills, knowledge, attitudes and competencies. For example, if patients are becoming customers more and more, how do you sell to them? Here are some reasons why doctors don’t do sales and marketing.

Here are some tips on how to sell your digital health product or service:

1. Know your customer and the quality and quantity of their market pain, jobs to be done, persona and customer journey map
2. Prepare for a long sales cycle
3. Sales depends on your not just demonstrating technical verification and validation, but solving a business problem as well as a clinical one
4. Be open to feedback about changing your strategy and stay customer focused
5. Know the difference between education, engagement, experience and enablement. Here is how to treat doctors like customers.

6. There many reasons why their innovation initiative, whether it is internal (intrapreneurship) or external (entrepreneurship) will fail.

Here are some ideas that might help.

If patients are customers, how do you sell to them?

The three levels of branding

The 7Rs of content marketing

Things doctors don’t get about sales and marketing

What is your digital marketing strategy?

Why digital health startups fail

Why your innovation initiative will fail

The sickcare intrapreneur innovation roadmap

What to know about value propositions

What you need to know about innovation

The difference between and improvement and an innovation

How to create user defined value

How to creat a strategic marketing and communications plan

Crossing the chasm and lean startups: meet digital health

How to screw up online medical practice marketing

7. Focus on the why, the what and how of sales

8. Find the right people to do marketing, sales, business development, sales operations, sales enablement and servicing clients after the sale. The roles and skills required are not the same

9. Figure out the right sales compensation scheme and sales management strategy

10. Integrate your sales operations into your entrepreneurial operating system

Sales is a critical part of the path from failing to nailing to scaling to saling. Be sure you find the right people, create the right structure and processes and measure success with the appropriate key performance indicators. Everyone should have a number and be held accountable. Otherwise, your app will be deleted, no one will use your disease management tool and no one will buy your product regardless of how valuable you think it is.

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GUEST POST from Arlen Meyers

Startup CEOs face a dilemma. Their focus needs to be on creating and validating a value proposition and business model by finding their first few customers that will create a sustainable revenue stream. They do it with limited people, money and resources and, thus, have their picture in all but a few of the boxes in their organizational chart. Some would say every CEO, not just startup CEOs, have the same conundrum to one degree or another when market share drops, competitors eat your lunch or the environment radically changes and someone moves your cheese.

For newcos, once their product gets traction, things start to speed up and several things happen that can cause the leader to lose focus. I call it the distraction of traction.

1. People who ignored you when you were first pitching your idea are now knocking on your door to get involved now that you have some social media buzz or accelerator or investor interest.
2. You have to keep more balls in the air, simultaneously working on customer development, product development, operations management and financing for future needs
3. The CEO needs to work more on the organization rather than in it. Their task at hand is to focus on strategy, marketing, building and leading high performance teams and raising money-money,management and marketing.
4. The product improvement development pathway or service line extensions need to be prioritized given the necessary resources to develop and launch them
5. People start giving you last minute great ideas that can often distract you from your core competency and make you ignore the guy what brung you to the dance.
6. The CEO needs to define and measure short, intermediate and long term key performance indicators, create an appropriate span of control and create a dashboard that will keep him or her informed at the desired time intervals.
7. Clinical trial management takes priority to generate the data necessary to demonstrate clinical, experience and financial effectiveness
8. There is a tendency to ignore the original value proposition and lose touch with the customer segments that are hiring you to do the jobs they want you to do, remove the pains they have presently doing it, and give the gains in product benefits (not features) they want or need.
9. Internal financial controls and managerial finance gets more complicated requiring expensive expertise from accountants, lawyers and financial officers or controllers
10. There is a tendency to bite at every hook thrown into your pool, particularly when dollars are attached.
11. Multiteaming can make it hard to stay on track.

Startups are not the only ones at risk. Companies that are failing and in need of a turnaround and also potential victims.

The distraction of traction is a predictable, manageable disease. The treatment is to:

1. stay customer focused

2. prioritize the things they want you to do that will generate the most revenue or reduce your costs the most

3. prune things that are no longer working or a drag on resources

4. lead innovators, don’t manage innovation.

5. get the right people on the bus, including advisors and consultants, in the right roles for the right amount of time receiving the right amount and type of compensation.

6. Don’t try to scale too quickly. Stepping on the gas when you have an engine knock could result in throwing a piston.

7. Don’t cave into pressure to sale it when you have not yet nailed it

8. Focus on the core components of what Gino Wickman describes in the Entrepreneurial Operating System: Vision, Data, Process, Traction, Issue and People.

9. Avoid these entrepreneurial syndromes

10. Use OKRs: Objectives and Key Results (OKR) is a powerful goal-setting methodology that drives alignment, performance, and results in growing and high-performing companies. At the most basic level, it is a simple tool to align and engage everyone at the company around measurable goals. It is a management goal-setting system and methodology that helps to focus everyone’s efforts on the most important priorities and connects the work of employees to what truly matters at the organization. The OKR methodology is a “Shared Goals” system which creates clarity and aligns your organization, connects everyone to your Top Company Goals, increases performance and drives better results

Here is a description of a process that can streamline your innovation engine once you get traction.

Don’t take your eye off the ball-revenue growth derived from doing the job your customers want or need through the deployment of innovation.

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GUEST POST from Arlen Meyers

I recently found myself in a room filled with in house healthcare lawyers. I was the only doc, let alone physician entrepreneur, there.

After the usual full contact schmoozing, tasty morsels and open bar, two lawyers from large hospital systems answered some questions and made comments about the issues and opportunties these folks face as sick care quickly changes. Dealing with the legal and regulatory challenges of innovation, intrapreneurship and technological change seemed to be on most everyone’s mind. There were few clear answers. That’s because:

1. Innovators are leading indicators and sometimes ask for forgiveness. Regulators and lawyers struggle to catch up and generally ask for permission. That can lead to Therantology.
2. The entrepreneurial mindset is often lacking in both employed physicians and in house lawyers. There are many exceptions, though, to the rule.
3. The barriers to vetting, piloting and deploying technologies, within a large integrated delivery system, particularly digital health solutions, are substantial
4. The rules change often and it is hard to keep up. Take AI for example.
5. Lawyers pay attention most often to those who can fire them or sign their paycheck
6. Lawyers worry about the size of the bill for outside counsel consultation
7. Most are overworked and understaffed. Unlike working in a large group with lots of others with experience, wisdom and judgement, in house lawyers are often on their own.
8. The medical culture and the legal cultures are substantially different so they often don’t see eye to eye of even understand what each other are saying. Doctors don’t play nice with each other let alone lawyers.
9. In the early stages, start up sick care intrapreneurs need help with protecting their intellectual property, creating startup up entities with the appropriate governance structure and raising private money without running afoul of securities laws, rules and regulations. Many of these subjects are outside the expertise of in house counsel , not a priority or outside of their job description. Consequently, they are often turfed to “tech transfer”. Wash. Rinse. Repeat.

10. Sometimes, doctors who are used to unpleasant medicolegal encounters with lawyers, come to the entrepreneurial table with a biased mindset.

Innovation starts with mindset. Physician intrapreneurs need entrepreneurial lawyers to help them navigate the treacherous waters of sick care innovation and entrepreneurship. Otherwise, what might have been an invention or innovation will continue to be merely an idea that never sees the light of day.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

Every CIO, whether in healthcare or not, is confronted with the dilemma of how to balance the now with the new. Whether it is EMR deployment, improving cash flow or plugging holes in the HIT system, the problem is the same: finding the right balance betweenoperational improvement and innovation.

Having a close link between strategy and execution is critically important. Your strategy is your promise to deliver value: the things you do for customers, now and in the future, that no other company can do as well. Your execution occurs in the thousands of decisions made each day by people at every level of your company.

The problem is immediate since we are seeing attempts to rapidly change the healthcare business model from fee for service to bundled payment., with the announced goal of Medicare making 50% of its payments to doctors and hospitals on the basis of the quality of care they provide, rather than the quantity, by the end of 2018. Hitting that goal would mark a big change in a program that paid providers $362 billion for their services in 2014.

Most large companies have a hard time innovating for four basic reasons. BIG MEDCINE has the same problems.

So how does Sickcare USA Inc. bridge that gap? Most docs in private practice are having a hard enough time keeping their heads above water complying with payment and IT regs. Biomedical and digital health entrepreneurs have one eye on fee for service to keep the profits flowing while at the same time have another eye on bundled payments as the model of the future with the need to drive down costs.

Most Chief Medical Information Officers and CIOs spend 99% of their time working on operational efficiency. At the same time, the CEOs are charged with seeing around corners and creating a strategy to bridge the gaps. Unless they are on the same page with clear marching orders, budgets and sponsorship, things move slowly into the future.

Healthcare sorely needs new business models. To survive companies need to run three-horizons of innovation

• Horizon 1 – execute their existing business model(s)
• Horizon 2 – extend their existing business model(s)
• And for long-term survival – Horizon 3 – search for and create new/disruptive business model(s)

While traditional analysis suggests that Horizon 3 disruptive innovations take years to develop, in today’s world this is no longer the case. The three horizons are no longer bounded by time. Today, disruptive Horizon 3 ideas can be delivered as fast as ideas for Horizon 1 in the existing product line.

Unfortunately, very few industry leaders, including sick care, spend much time on the next and the new. For example, the average CIO spends most his or her time getting the EMR deployed, not worrying about a new EMR.

One way to “see” the future is to view it through a parabolic mirror, i.e. look at what you see now and call it the future. No matter how successful you are as a company or a leader, you have to be on alert to anticipate market shifts and adapt your business accordingly.

Here are some ways you can positively anticipate a market shift before the turning point occurs.

Perhaps we have it backwards. Instead of dedicating 95% on operational efficiency and operations management, particularly in medical practice management, an alternative would be to outsource it and focus on taking care of patients and worrying about practicing medical practice entrepreneurship, with a focus on innovation and strategy instead. Here’s how to take advantage of trends, predict them or create them yourself.

However, implementing them will be a painful process for all the stakeholders. After all, the now is a whole lot more comfortable than the fear of the new.

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