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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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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