GUEST POST from Arlen Meyers

Michael Gerber , in his book The E-myth Physician, says that doctors can assume three basic roles: technicians, managers or entrepreneurs.

A 2013 AMA report notes that 53.2 percent of all physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians. Less than half of practicing physicians own their own practice, according to 2016 data collected in a nationally representative survey of 3,500 U.S.-based physicians who provide at least 20 hours of patient care per week and are not employed by the federal government.

2016 marks the first year in which physician practice ownership is no longer the majority arrangement. According to data drawn from the AMA’s Physician Practice Benchmark Surveys, 47.1 percent of physicians are practice owners. The same percentage of physicians are employed, while 5.9 percent are independent contractors.

More and more doctors are becoming employees of hospital systems. Most of the latter will be technicians. Most of the former, independent physicians, will have to move up the value chain, being entrepreneurs, to thrive,let alone survive.

Technicians are doers who play by the rules and are concerned with generating revenue by doing things to solve problems. Given the evolution of medical cyberintelligence, knowledge technicians are a dying breed.

Managers are resource optimizers who make the rules and are concerned with maximizing efficiency. They do things right.

Leaders provide vision, direction and inspiration. They do the right thing and are guided by personal values and exhibit emotional intelligence to succeed.

Leaderpreneurs lead innovators, not manage innovation systems.

Entrepreneurs innovate, making the old rules obsolete by creating new business models and are concerned with building equity. They create user defined value through the deployment of innovation using a VAST business model.

Any of the above five can be leaders, but their focus and objectives are different and require different skill sets and aptitudes. Unfortunately, since few physicians have an entrepreneurial mindset, let alone a leaderpreneurial mindset, those dwindling numbers who elect to go into private practice without an entrepreneurial mindset will continue to struggle and have a hard time adapting to a rapidly changing and challenging healthcare environment. Innovation starts with mindset.

The entrepreneurial mindset is different from the clinical mindset.

Knowledge technicians are an endangered species and must evolve from domain expertise to credibility to leading execution, engagement and alignment to strategic thinking, leading organizations that have organizational ambidexterity i.e. simultaneously creating the now, the next and new.

Thoughts drive emotions and emotions drive behavior. It is the basis of cognitive behavioral therapy. The key to survival in today’s private practice is not in squeezing another nickel out of your overhead. It’s adopting an entrepreneurial mindset. Most likely you won’t learn that in your formal training.

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GUEST POST from Arlen Meyers

Biomedical or clinical entrepreneurs are not just doctors, scientists and engineers who create businesses.

Instead, they are those who pursue opportunity with scarce resources under conditions of uncertainty with the goal of creating user defined value through the deployment of biomedical or clinical innovation. As such they can assume many roles in the value creation pipeline such as technopreneurs, intrapreneurs (employees acting like entrepreneurs) ,social entrepreneurs, investors or small-medium size business owners.

Almost every health professional, scientist and engineer has a good idea. Unfortunately, that is all it will be because they don’t know what to do with their idea and the are unlikely to learn how during their formal training. Here are some tips on what to do next.

Here are some thoughts about who they are and what it takes.

Some key attributes are :

1. Mindset Innovation starts with the right mindset.

2. Talent

3. Opportunity

4. Luck

5. Knowledge, skills and attitudes. Unfortunately, doctors get duped into thinking that getting an MBA gives them the right to call themselves physician entrepreneurs. More often, they are trained to be managers.

6. Networks and becoming part of the expanding network universe

7. Mentors and sponsors and knowing the difference and how to find them

8. Resources

9. Experience. Here are some tips on how to get started as a physician entrepreneur.

10. Emotional internal motivation

11. Social and emotional support networks

12. A sandbox where they can play and experiment

13. Humility

14. Coning down off the mountain. What got you to where you are now won’t get you to where you want to go.

15. Finding your blind spots.

16. Making it personal but not taking it personally.

17. A personal brand

18. At first, be a problem seeker not a problem solver

19. Entrepreneurial habits

20. Strategic thinking

Learning this “hidden curriculum” should start in elementary school and continue as part of lifelong learning.

Very few medical schools or resident training programs, if any, teach medical students or residents the business of science and medicine and that is a big mistake, since learning how to create user defined value is as important and difficult as practicing state of the art medicine. The curriculum is the traditional one, guided by learning objectives and the secret one, including network development, people skills and learning how to play the game, which, in my opinion, is a bigger determinant of success than the grades on your transcript.

Unfortunately, few doctors, scientists or engineers have the package. But, those that do are creating great things for patients, themselves, their regional economies and US global competitiveness.

 
Image credit: So Tyred

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GUEST POST from Arlen Meyers

There are many reasons why your startup will fail, but the main ones are 1) you create a product or service no one wants to buy, and 2) you do not have a profitable and VAST business model.

Likewise, there are many reasons why your corporate or organizational innovation initiative will fail. Most of the time it’s due to a mismatch between the innovator’s entrepreneurial mindset and the organization’s innovation culture.

Some have described the Innovator’s DNA.  Others note characteristics of the entrepreneurial mindset:

1. Personal growth relates to the size of the challenge, not the size of the kingdom. What motivates real innovators is the more exciting challenge, not the number of people reporting to them. The ‘size of the difference’ they will make is more inspiring than the ‘size of the business.’ They relish getting out of their comfort zone, and into the unknown.
2. The new direction is the challenge, not the destination. The challenge is the transformation vehicle for true innovators, and not a performance goal. They focus on legacy creation, not legacy protection. They ignore failures and are constantly looking at the progress made. They treat innovations reviews like performance reviews.
3. Be an attacker of forces holding people back, not a defender. Real innovators start by questioning the world order rather than conforming to it. They begin by confronting the forces holding everyone back, rather than living with it. The forces include mindset gravity, organization gravity, industry gravity, country gravity, and cultural gravity.
4. New insights come from a quest for questions, not a quest for answers. This discovery mindset searching for new questions drives real innovators away from more of the same. They fundamentally become value seekers; they look for value in every experience, in every conversation. They don’t seek prescriptions, they seek possibilities.
5. Stakeholders must be connected into the new reality, not convinced. True innovators tip stakeholders into adopting and even co-owning the orbit-shifting idea. They go about tipping the heart first, assuming the mind will follow. They seek smart people, who openly express their doubts, and then collaborate to overcome them.
6. Work from the challenge backward, rather than capability forward. Overcoming execution obstacles is combating dilution, not compromising, for these innovators. Their mindset is not ‘if-then’ but ‘how and how else?’ They convert problems to opportunities, and often the original idea grows far bigger than the starting promise
7. Getting rid of your victim mentality.
8. Having the discipline to practice the discipline
9. You relish the role of leading the charge. Being a visionary or an idea person is not enough; you have to be anxious to jump in and get your hands dirty. Most success stories in business are not about envisioning the next big thing, but about making that change happen. Investors and strategic partners look for entrepreneurs who can execute.
10. Able to balance right-brain and left-brain activities. Most technical entrepreneurs are left-brain logical thinkers, even perfectionists. Yet every business today needs a focus on visualization, creativity, relationships, and collaboration, which are normally in the domain of right-brainers. Successful and happy entrepreneurs have that rare whole-brain focus.
11. Enjoy being outside your comfort zone. New businesses are an adventure into the unknown. You need to be mentally prepared to enjoy the roller coaster ride, rather than face it holding your breath with your teeth gritted at every turn. Only then can you enjoy the thrill of victory when you survive a major turn, and be energized for the next one.
12. Proactively seek input, but make your own decisions. Great entrepreneurs seek out critical customers and industry experts, and actively listen, but are not afraid to trust their own judgment as well. Ultimately they accept the responsibility of “the buck stops here,” meaning they live by their own decisions, and never make excuses.
13. Willing and able to do a little bit of everything. Technology experts tend to have a very deep level of knowledge, but not very wide. If your real interests are not very broad, then building a business will likely be frustrating and expensive. Startups have limited resources, so the founders have to enjoy trying things, and learning from their mistakes.
14. Viewed by others as a successful problem solver. The best ideas for a new business are solutions to a real customer problem, rather than great ideas looking for a market. Creating a new business means tackling one difficult problem after another, until success suddenly appears. Entrepreneurs see problems as milestones to success, not barriers.
15. Don’t demand or expect immediate gratification. Seth Godin once said “The average overnight success in business takes six years,” and he is an optimist. For some entrepreneurs that success is financial, and for others it is a legacy of good deeds. Because it takes so long to get there, it is important to be happy with the journey.

Creating a culture of innovation must include SALT and PRICES

Strategy

Alignment

Leadership

Teams

Process

Recognition

Incentives

Champions

Encouragement

Structure

When these two are in synch, like two hands shaking, great things happen. When they are not, things get ugly and, in some instances, people lose their jobs. Or, at least they should and be replaced with effective leaderpreneurs.

 
Image credit: So Tyred

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GUEST POST from Arlen Meyers

Doctors do three basic things. In their role as healers, they make decisions, they do procedures and they communicate with patients as a source of information and guidance.

The 4th industrial revolution and the digitization of sickcare, powered by the technologies and forces of global cyberintelligence and the emerging cyber nervous system has radically altered how doctors do their jobs.

Clinical decision support systems (CDSS) powered by artificial intelligence and other data science techniques significantly improves outcomes in several specialty areas. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Robotics, AI, virtual reality, augmented reality and smart ORs are transforming the operative experience for both surgical teams and patients.

Even communicating medical information, expressing empathy and guiding patients towards the right decision for them and their family members has become digitized towards more high tech and less high touch.

That said, forces are creating a counter movement of patient customers craving trusted intermediaries.

1. Clinical care is increasing in complexity making it more difficult to sort out the details
2. The pace of change is happening faster than the ability of people to cope with it causing change fatigue and diseases of despair
3. Social media has contributed to the death of expertise
4. Clinical care has evolved from one on one to a team collaborative effort whereby medical care teams work with patient and family support teams and communities
5. Sick care is migrating gradually to health care and disease prevention
6. Both patients and doctors are struggling to become data literate to understand the meaning and and avoid the pitfalls of what comes from the internet of medical things
7. Customers are fed up with the lack of personalized service and terrible user and purchasing experiences while, the same time, having to do more the work to create more profit for the seller.
8. While personalized/precision medicine is the latest techno-rage, the corporatization and consolidation of BIG MEDICINE leads to more impersonalization of small care
9. The invisible hand is a cruel one, creating significant inequalities in outcomes and health opportunities, leaving many stranded and reaching for a hand up, even when they are too young or small to do so.
10. Social isolation, behavorial disorders, frustration, violence and burn out are pervasive

Despite being able to buy or research almost any service or product on the internet, people still use wealth managers, plan trips using travel agents and hire service professionals. Some even still trust regular taxi drivers and doctors to safely transport them on their care journey.

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GUEST POST from Arlen Meyers

Health entrepreneurship is the pursuit of opportunity using scarce resources under conditions of uncertainty. The goal is to create user defined value through the deployment of health innovation using a VAST business model. Those who embrace the entrepreneurial mindset and practice entrepreneurial habits hold the keys to the kingdom when it comes to improved sick care and health outcomes. In fact, it is unlikely that any independent practitioner or group can survive, let alone thrive,without moving to an entrepreneurial role from a being a knowledge technician. That does not mean you have to start a company. It means that everything you do has to create user defined value. No move should be wasted.

The space between the data and the doctor is being filled quickly with navigators, advocates and “infomediaries”. As responsibility for health outcomes increasingly shifts from doctors to patients, they become, in a sense, patient entrepreneurs, in possession of an asset-their data- creating value (better disease management and prevention) through the deployment and adoption of innovation. The result will be more DIY medicine and all that goes with it.

Think of APIs as tunnels into the clinical data warehouses that have been created by EHRs. Think of third parties as new and existing IT powerhouses — including the likes of Apple, Amazon, and Google — that have been authorized by patients to act as data stewards on their behalf.

We are not only democratizing care. We are democratizing and decentralizing value creation and funding. We are creating prosumers and accidental entrepreneurs.

What the result will be is anybody’s guess, but what is clear is that the rules, ecosystems, business models and technologies are inevitably facilitating more patient involvement, engagement and responsibility.

Amedzon has recently announced a service that will allow AI based algorithms to be applied to EMR data. Would you charge someone a fee to do that and place restrictions on its use if you owned your data?

Silicon Valley startup Open Health Network, which develops AI-based applications for healthcare organizations like UCSF, Sanofi and Cornell University has launched a new product meant to use blockchain technology to allow patients to manage and monetize their medical data. If successful patients will be able to sell their assets on the PDX. a NASDAQ for patient data.

The Institute of Medicine (IOM) has proposed a streamlined set of 15 core measures that they say represent the most vital signs for tracking progress toward improved health and healthcare in the United States.

They are:

• Life expectancy
• Well-being
• Overweight and obesity
• Addictive behavior
• Unintended pregnancy
• Healthy communities
• Preventive services
• Care access
• Patient safety
• Evidence-based care
• Care match with patient goals
• Personal spending burden
• Population spending burden
• Individual engagement
• Community engagement

Like all entrepreneurs, to succeed in sick care entrepreneurship, patients will need education, resources (low interest loans or seed stage funding), networks (connected to sick care professionals to inform their thinking and design), mentors, experience and peer to peer support. While is it nice to see more and more health professionals and educators embracing biomedical innovation and entrepreneurship, most patients are still standing on the sidelines or recovering in the ICU. However, things are changing and we need to remove the barriers to patient entrepreneurship so they can, like health professionals, get their ideas to other patients.

Apple has changed the game with HealthKit expanding how we do human genotyping and how we do clinical trials. My Retina Tracker, an online registry for patients with retina diseases to store their medial records and provide anonymous data to researchers.

The monetary value of information about a single person’s online and offline activity may reach $10 a month by 2025 in the U.S. For further insights, read “Tomorrow’s Data Heroes.”

Is it unlikely that we will be able to move the needle on most of these without the involvement of patient entrepreneurs , patient scientists and doctors assuming more of their traditional role as teachers, not just healers. Remember, docere is the Latin word for teacher and don’t forget those pediatric patient entrepreneurs.

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GUEST POST from Arlen Meyers

The vast majority of startups will fail and the numbers are even higher in biomedicine due to the numerous risks involved in getting a product or service to patients in a highly regulated industry that involves human subject and clinical trials. Add to that the many barriers to adoption, dissemination, diffusion and implementation and why clinical trial results don’t translate into clinical use, and you can see why things are so risky.

However, Peter Drucker, in his book Innovation and Entrepreneurship (1985) pointed out several common reasons:

1. MARKET-PRODUCT FIT: lack of market focus, the wrong product market fit, poor missing a customer segment
2. MONEY: poor cash flow management not having an adequate plan or a non-viable business model to generate the necessary capital for growth
3. MANAGEMENT TALENT: not having the right people and advisors doing what they do best and who are willing to tell truth to authority
4. MATURITY: A founding entrepreneur who know his or her place in the scaling company and is willing to step away or down from the primary leadership role

I would add:

5. MODEL: the lack of a VAST business model.

6. MARKETING: Not doing what it takes to find the innovators and early majority and crossing the chasm

7. MANPOWER: not scaling the enterprise with the right people on the bus sitting in the right seats who can work in high performance teams

8. MONITORING: Missing a major market, demographic or technological shift

9. MINDSET: Not having an entrepreneurial mindset

10. MISSING YOUR BLIND SPOTS: Not making yourself disappear fast enough

The root causes are 1) you offer a product or service no one wants to pay for, and 2) you don’t have a VAST business model. Examples in sick care include digital health, medical marijuana, medtech, biopharma and care delivery products.

All of these wounds are self inflicted and can be prevented by proper planning and money and people management when you start your company. It starts with understanding your customer, creating a product that solves their problem, and executing a business model that is reproducible and scalable and that adjusts to changing market conditions.

If you begin with the end in mind i.e. a grown up and anticipate the stages of scale up and startup working backwards, you should be able to envision what you will need to succeed from the beginning.

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GUEST POST from Arlen Meyers

Sign up here to join 17,000+ leaders getting Human-Centered Change & Innovation Weekly delivered to their inbox every week.

GUEST POST from Arlen Meyers

Sign up here to join 17,000+ leaders getting Human-Centered Change & Innovation Weekly delivered to their inbox every week.

GUEST POST from Arlen Meyers

Artificial intelligence, like most industries, is diffusing in sick care. Applications in surgery are emerging and can generally be categorized as :

1. Surgical training and education
2. Preoperative assessment and diagnosis and clinical decision support
3. Intraoperative surgical performance and quality improvement
4. Smart OR’s and environment
5. Postoperative care and complication risk assessment and predication
6. Workflow improvement, like OR start time and turnover efficiencies
7. Surgical robotics
8. VR and AR and 3-D printing
9. Telerobotic and teleproctored surgery
10. Human subject trial recruitment and execution

Many of these applications are in the research or demonstration phase and will take a while to become the standard of care or achieve widespread dissemination and implementation.

Biomedical AIntrepreneurhship describes the practice of creating AI products and services to solve bioscience (drugs and devices) and clinical problems. As such, it is the pursuit of opportunity under conditions of uncertainty using scarce resources with the goal of creating user defined value through the design, development and deployment of biomedical innovations that use a predominantly AI backbone, platform or foundation that have a VAST business model. It is a subsegment of digital health products and services.

The use of AI in medicine is evolving rapidly. Here are some updates:

1. Educational platforms, meetings, conferences and magazines
2. Robust investment into development and M/A
3. Coherent applications combining AI, medtech and biopharma
4. Increasing concerns and attention to the ethical, societal, education, manpower development and economic impact of AI in medicine
5. How AI is contributing to the 4th industrial revolution
6. The intersection of AI and robotics
7. The intersection of AI and blockchain
8. The impact and perils of decentralized, DIY medicine
9. Cybersecurity and confidentiality concerns. If you are not worried yet, read this too.
10. Concerns and strategies to make transparent algorithms and mitigate AI bias and “eliminate black box bias”.
11. Stories and organizations about physician AIntrepreneurs.
12. Regulatory, legal and reimbursement challenges

13. Convergence of AI into medical device and biopharma Current emerging applications appear to fall into three main categories:

14. Smart speakers in the OR and examining rooms

Management of chronic diseases – Companies are using machine learning to monitor patients using sensors and to automate the delivery of treatment using connected mobile apps (Example: Diabetes and automated insulin delivery).

Medical imaging – Companies are integrating AI-driven platforms in medical scanning devices to improve image clarity and clinical outcomes by reducing exposure to radiation (Example: GE Healthcare CT scans for liver and kidney lesions).

AI and Internet of Things (IoT) – Companies are integrating AI and IoT to better monitor patient adherence to treatment protocols and to improve clinical outcomes (Example: Philips Healthcare solution for continuous monitoring of patients in critical condition).

As artificial intelligence projects roll out, organizations will need to rethink the definition of the “work” that people will do. The future of work will become one of the largest agenda items for policy makers, corporate executives and social economists, says Sanjay Srivastava, chief digital officer at Genpact, a professional services firm focusing on digital transformation. Here is how doctors and patients can win the 4th industrial revolution.

What is the secret sauce of successful innovators like AIntrepreneurs? They strive to innovate in ways that would have a major impact on markets and society, e.g changing sick care to health care or making the sick care workforce more efficient and effective, and they revamped how their organizations pursued innovation and brought their capabilities together in a single “architecture.” That will mean medtech transforming to techmed will require changing how to collaborate with doctors and patients.

Will AI put society on autopilot? Will surgeons lose their skills in the age of automation?Where is the evidence that robotic surgery adds value and when?

Here are some of the barriers we will need to overcome.

Why is the gap between companies’ AI ambition and their actual adoption so large? The answer is not primarily technical. It is organizational and cultural. A massive skills and language gap has emerged between key organizational decision makers and their “AI teams.” It is a barrier that promises to stall, delay, or sink algorithmic innovations. And it is growing, not shrinking. The problem is that healthcare professionals are from Venus and technologists are from Mars. They have different mindsets and how they communicate.

Here are emerging data security and risk management trends.

Those products and services that add value, particularly those that drive down costs and do not interfere with workflow, have a higher chance of success. Those that don’t will be relegated to the shiny new object pile and red bagged for disposal.

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GUEST POST from Arlen Meyers

Most doctors would agree that medicine, contrary to popular belief, is part science, but mostly art. Most of medical practice is not evidence based.

On the other hand, there seems to be some argument whether entrepreneurship is an art, a science or both.

Based on my experience of teaching and practicing both, here’s my two cents:

1. The underlying foundation of science is a body of knowledge believed to be true. That is until it is proved wrong. Take, for example, the idea that the earth revolves around the sun. Sure, there are many examples and “best practices” when it comes to describing entrepreneurial ventures, but, there are no hard truths when it comes to predicting success, other than you need to make more money than you spend.
2. Science “facts” are used to predict outcomes with a high degree of probability. We use math and astrophysics to figure out how to land a man on the moon. It’s harder to figure out how to use “facts” to land a customer
3. There is a difference between science and the scientific method. Creating a hypothesis, doing experiments to test it, gathering and analyzing the data that results and drawing conclusions is useful both in the lab and what goes on out of the building. However, customer discovery data will only get you so far.
4. The STEM basic science curriculum has been iterated for thousands of years. The entrepreneurship or management “science” curriculum is a relatively recent phenomenon.
5. Using lean startup principles, while useful, is no guarantee of the “right answer”. I can pretty much guarantee that 2 x 2 =4.
6. Biomedical science is about finding “truth”. Entrepreneurship is about finding and creating customers or helping beneficiaries, as in the mission driven canvas.
7. In science, all things being equal, there is a high likelihood you will get the same experimental result. In entrepreneurship, there are no guarantees that doing the same thing twice will give you the same results
8. Science is supposed to be cognitive. Entrepreneurship is mostly about emotions.
9. Bias can distort both
10. The value of scientific discoveries and outcomes are much harder to define than entrepreneurial outcomes and they both have different timelines for doing so.

The art of entrepreneurship relies more on best practices than scientific facts. Even then, the problem with best practices is that they make you average.

 
Image credit: viola.bz

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