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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GUEST POST from Arlen Meyers

Physician burnout is pervasive and appears to be worsening. In fact, in some specialties, residents are burned out even before they have spent their first day in practice. But, they are not alone since burnout happens in many industries other than medicine.

Burnout is considered to have a range of symptoms. There is no agreement which of those are part of it and which ones are not. But all definitions given so far have in common that the symptoms are regarded as being the consequence of stressful activities in or outside the job. One possible source of stress outside the job is caring for a family member, for example.

Three main areas of symptoms are considered to be signs of burnout syndrome:

• Emotional exhaustion: People affected feel drained and exhausted, overloaded, tired and low, and do not have enough energy. Physical symptoms include pain or problems with the stomach or bowel.
• Alienation from (job-related) activities: People affected find their jobs increasingly negative and frustrating. They may develop a cynical attitude towards their work environment and their colleagues. They may, at the same time, increasingly distance themselves emotionally, and disengage themselves from their work.
• Reduced performance: Burnout mainly affects everyday tasks at work, at home or when caring for family members. People with burnout regard their activities very negatively, find it hard to concentrate, are listless and experience a lack of creativity.

Burnout can also be described as “the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results,” and is a stress-related state and there are multiple causes.

Burn out interventions and prevention programs both at the personal and organizational level are successful 80% of the time. However, both personal and organizational interventions are better than either alone, and the results tend to fatigue over time.

Mentors, coaches, sponsors and colleagues might help, but , you need to understand the roles each one plays and when and how to engage them. Here is what to do when your boss refuses to be your sponsor.

Mentors are accountability partners who help you stay on track to meet your goals. They are hard to find and the lack of a mentor is an oft quoted reason for entrepreneurial failure. Many entrepreneurs have a hard time finding the right mentor for various reasons. Mentors help your personal development.

Here are some tips on being a good mentor. It starts with building a genuine relationship.

Sponsors are different from mentors. Their job is to run cover for you in your organization and help you find the scarce resources intrapreneurs need to succeed. They are making an investment in your idea, and, like every investor, they expect a return within a defined time.

They are also called “rabbis” and you should find and be one yourself. Many who consider themselves to be sponsors are acting more like mentors. To claim the title of sponsor, a senior leader should be an active advocate for their protégé — a more junior professional who the sponsor sees as a top performer, with tons of potential, who deserves to move up in their career. A sponsor has three primary responsibilities: to believe in and go out on a limb for their protégé; to use their organizational capital, both publicly and behind closed doors, to push for their protégé’s promotion; and to provide their protégé with “air cover” for risk-taking.

Colleagues are people you work with that you admire and can emulate. They are not friends, but rather a honest sounding board. They set an example by their actions. There are many reasons why colleagues make good mentors or confidantes.

Coaches The goal of the coach is to facilitate learning, focus, and results. Coaches are trained in the strategies for achieving the results specific to their domain of coaching. Although they may not have experience generating the results you are looking for in themselves, they should have experience generating these results in other people or organizations. Coaches teach you a skill.

Many of you who are reading this don’t have a mentor. But, here are some ways to change that.

Here are some best practices for mentors and mentees.

You might be a member of the miserable professional class. Whether you are an employed physician, a community practitioner, a budding CEO of a biomedical or health startup or an intrapreneur, you need help as an antidote to the stress. Take the time to cultivate the right relationship with the right person in the right role and thank your lucky stars you found them.

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GUEST POST from Arlen Meyers

There is no shortage of advice when it comes to tips and techniques on entrepreneurship. Newsletters, blogs, You Tube videos and podcasts could consume the entirety of every day if you’d let it. Most of this advice falls into three categories: 1) how I do it, 2) motivational stories and pieces and 3) advice on how to create entrepreneurial habits. Indeed, there are many myths.

Here are 5 more must have habits.

It turns out that habitology has a physiologic and anatomic basis, residing in your basal ganglia in your brain. The process involves three parts: the trigger, the habit and the reward. If you want to change certain behaviors, you have to change the triggers and rewards. That’s why changing behaviors on a vacation is a good idea-the triggers are gone or different.

Here is more about the neurophysiology of breaking away from habits and getting in touch with your orbitofrontal cortex.

Increasingly, full time clinical practice is not providing personal and professional satisfaction for doctors and they are looking to supplement their patient care work with other interests, including entrepreneurship. Changing gears, however, requires creating new habits and changing patterns of behavior that have been ingrained over 25 years of educational training and have have been reinforced by the medical culture.

Entrepreneurship starts with the right mindset. Once you have the right mindset and get rid of your inner grump, then the next step is to create entrepreneurial habits.

Read why it is unlikely you will meet your goals or won’t stick to your resolutions.

Here are some new entrepreneurial habits that might contribute to your success:

1. Put 5 books on your nightstand that you read for 30 minutes before going to bed. William Osler suggested it for doctors but it should work for entrepreneurs, too. Yes, you can read 50 books a year. The new twist on the concept is the 5 hour rule.

2. Subscribe to 5 newsletters completely outside of your field to find new sources of innovation and inspiration. Most true innovation rarely comes from inside.

3. Write 500 words about anything, anywhere every day. It can be in a journal. It can be on a Pulse post, It can be an evolving book or it can simply be on your iPad. Perhaps the biggest gap in my formal education was in writing. The only way to overcome that deficit is to discipline yourself to practice, practice, practice.

4. Invite at least one person every day to join your linkedin network who you think you can help.

5. Practice social media random acts of kindness when someone asks you to do them a favor that does not compromise your integrity. It’s good for your karmic bank account.

6. Watch children play every now and then. Like Jobs said at Stanford, be playful and stay hungry.

7. Use vacations as a way to create new habits. Change the rewards and cut yourself some slack instead of practicing incessant self denial. Productivity decreases when you reach a certain numbers of hours of work in a day. Try to do more in less time by eliminating unproductive distractions, overconnectedness or finding when your creative, imaginative biorhythm kicks in. Aim to work 20 hours a week.

8. Set goals with your spouse.

9. Have a fun fund. Not an emergency fund. Not a retirement fund, A fun fund you use to reward new and constructive behaviors. Don’t make it too small or too large. Just enough.

10. When your inner voice says no, create a space between the stimulus and your response. Say yes more often and try new things. Say no more often to things and people that are not aligned with your goals.

11. Train your brain to have patience and leave more time for Type 2 thinking (slow) instead of Type 1(fast) that leads to bad decisions based on intuition and bias.

12. Think positively to act positively. Here are 10 ways to do it

13. Keep a daily log of your small accomplishments each day and congratulate yourself. Nothing succeeds like success, not matter how small.

14. See things differently.  Great creators, innovators, and entrepreneurs look at the world in ways that are different from how many of us look at things. This is why they see opportunities that other people miss.

Take advantage of the science of happiness by doing these four things.

Here are 5 more habits to future-proof your brain.

There are no short-cuts along the entrepreneurial journey. There are only habits that take time, repetition and the motivation to develop. You should focus on a few critical behaviors that have:

Implementation criteria include:

• Actionability: Are people able to perform the behavior?
• Degree of visibility: Can people see others performing the behavior?
• Measurability: Can you measure (preferably objectively) whether people are performing the behavior?
• Speed of results: Can people performing the behavior deliver results in the short term?
• Ease of implementation: Given the current organizational environment, how easy/difficult will it be for people to perform the new behavior?

Some of these principles apply to organizations as well. When it comes to turning strategy to action, pay attention to this check list

Here are some ways to turn insight into execution by rewiring your brain and your team’s too.

Part of surgical training involves creating patterns of behavior that are habit forming. While, on the one hand, it helps to standardize care, it also can lead to making Type 1 and Type 2 technology adoption errors and faulty diagnostic thinking because it precludes other possibilities. The same applies to entrepreneurs.

Try to avoid what your basal ganglia is telling you to do when it makes sense. Like the man says, you’ll like how you feel. But, like they say, innovation and entrepreneurship is much easier said than done..

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GUEST POST from Arlen Meyers

We have a crisis in entrepreneurial character. and doctors are not exempt. Justifiable suspicions of physician entrepreneurs result when the halo is cast over the profession by those who commit fraud, double-deal, or don’t prioritize the patient’s interest above others. They can’t reconcile the ethics of medicine with the ethics of business.

The hall of shame adds new members on an almost daily basis, including doctors defrauding Medicare,physician entrepreneurs cutting corners or misreprenting data to satisfy investors and shareholders or “pill pushing”. Add Theranos to the list.

These leading medical figures are among dozens of doctors who have failed in recent years to report their financial relationships with pharmaceutical and health care companies when their studies are published in medical journals, according to a review by The New York Times and ProPublica and data from other recent research.

The World Medical Association (WMA) first adopted the Declaration of Geneva in 1948 as the contemporary successor to the 2,500-year-old Hippocratic Oath. Since then, just minimal amendments were made. But in October—after two years of gathering feedback from WMA member national medical associations, external experts and the public—the WMA adopted the revised Declaration of Geneva at its General Assembly meeting in Chicago.

In addition to the declaration’s being called “The Physician’s Pledge” for the first time, the policy:

• References respecting the autonomy and dignity of the patient, which was not previously recognized in the declaration.
• Adds that the “well-being” of a patient will be a physician’s first consideration, amending a clause to state that the “health and well-being of my patient will be my first consideration.”
• Creates an obligation for respect between teachers, colleagues and students. Previously, it called for students to respect their teachers, but included no reciprocity.
• Establishes an obligation for physicians to share medical knowledge for the benefit of their patients and the advancement of health care.
• Requires physicians to attend to their own health, well-being and ability so they can provide the highest standard of care. This comes at a time when physicians have seen an increase in workload and a rise in occupational stress.
• Augments an existing clause that calls for a physician to practice with conscience and dignity by having physicians pledge to practice with conscience and dignity “in accordance with good medical practice.” This was done to more explicitly invoke the standards of ethical and professional conduct that patients and physicians’ peers expect.

The problem is obviously not new. Why is it so hard to do the right thing?

1. People are inherently flawed, “broken branches” and turn a blind eye to their foibles

2. The world is getting more complicated with intertwined conflicts of interest that often fall in the grey zone

3. Society has become more permissive

4. People think they can get away with it. They are often right, particularly when you have power, influence or money.

5. Rules of civility have become more lax

6. A possible decline in self-disiplinary skills and delayed gratification. More and more people choosing the one marshmellow over two later on.

7. A media and communications culture that showcases the Big Me over the Little Me.

8. Pressure from investors and shareholders at the expense of patients because the stakes are getting bigger.

9. A culture of entrepreneurship that fosters an ethos of win at all costs, short term thinking and creating shareholder value at the expense of employees.

10. The differences between the ethics of business and the ethics of medicine.

Steve Blank offers some reasons on how we got here and why founders need a moral compass.

Despite all this, there are exceptions that display our better angels, like my friend and colleague, John Kelley, CEO of www.cerescan.com, who worked for several high profile execs that eventually went to jail.

Listen to what he has to say here.

Several authors have explained why white collar crime exits, including physical and psychological distance from the victim, pressure , opportunity and rationalization.

•  It’s hard to fathom how lying and deceit permeated organizations. Some researchers point to group decision-making processes or psychological traps that snare leaders into justification of unethical choices. Certainly those factors are at play, but they largely explain dishonest behavior at an individual level ,but these four systemic factors influence whether or not people in organizations distort or withhold the truth from one another1) lack of strategic clarity, 2) unjust accountability systems, 3) poor organiozational governance, 4) weak cross-functional collaboration.

The first step in building your capacity to say no is to recognize some common situations that should raise a red flag. Entrepreneurship education is changing. Students must be equipped with the skills to make values-based decisions.

Once you have to make some hard decisions, here are some things to think about.

Doing the right thing means sticking to your core values and practicing emotional intelligence in the business of medicine.

America has sometimes been referred to as the land of second chances, as if every citizen gets a career Mulligan.

Entrepreneurs live in a world of light and darkness. Some choose one over the other. In medicine, taking the wrong path betrays the society and the patients who have entrusted you with their health and the profession that has made you a member.

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GUEST POST from Arlen Meyers

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.

So, what’s a biofounder to do?

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.

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.

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

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.

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