GUEST POST from Arlen Meyers

Business plan. Those two words have been used a lot to kill a lot of innovative ideas. Yet, it persists in the entrepreneurial consciousness. It’s a mainstay in the manager’s tool box. Sure, it you are going to ask for money, you will in all likelihood need to write a business plan. But, so few entrepreneurs actually get to that stage, that it’s putting the cart before the horse. I’m not the only one who thinks so. There are lots of reasons why writing a business plan, or even worse, telling someone to write a business plan, is a bad idea. Here are some more:

1. Business plans are usually smoke and include financial projections that, at the most, are guesses without valid underlying assumptions on which they are based.

2. There is little evidence that business plans are related to business success.

3. Few successful businesses wind up doing what they said they would do in their initial business plan

4. Few investors or sponsors want to see a business plan first. They want a concise pitch that generates further interest.

5. As Guy Kawasaki points out in ” The Art of the Start: 2.0″, business plan competitions are really pitch competitions. It would be a whole lot easier for BP judges to watch submitted 3 minute videos than have to plow through pages of business plan submissions.

6. Business plans are used by dull managers to dissuade innovation. Have an idea that could kill our cash cow? Go write a business plan and get back to me. It’s called triage by inconvenience.

7. Most intrapreneurs don’t know how to write a business plan so it’s another way to kill ideas.

8. Planning is different from writing a business plan

9. Most of what you would put into a business plan anyway can be validated before and if you get to that stage.

10. Better to create and test a business model canvass than a business plan

Distracting you and hoping you’ll get discouraged is but one arrow the in the anti-innovative bureaucrats quiver. There are many more:

Deflection: turfing you to the death committee

Delay: Maybe some other time

Denial: We don’t have a problem

Discounting: It’s really not that big of an issue

Deception: They make up facts that discredit you

Dividing: Divide and conquer

Dulcifying or appeasing: Making meaningless concessions

Discrediting: Sniping

Destroying:Trying to ruin you and your reputation and get you to quit or retire

Dealing: Compromise and give you just enough to make you go away.

There are alternatives to writing a business plan based on :

Prototype: Sketch out your idea quickly with the Business Model Canvas and Value Proposition Canvas.

Question: Ask yourself what needs to be true for your idea to work, i.e. define the underlying hypotheses.

Test: Test the desirability (will customers want it?), feasibility (can I build it?), and viability (will it be profitable?)

Iterate: Adapt your initial rough Business Model and Value Proposition Canvas and refine with increasing evidence from testing.

Still not convinced? Here are some more innovation killers – try these too.

Look out for killer phrases that start with “That’s a good idea, but…”

1. It’s against company policy
2. It’s not practical
3. It’s not necessary
4. We don’t have the resources
5. It will cost too much
6. We’ve never done it that way
7. Our customers (or vendors) won’t like it
8. It needs more study
9. It’s not part of your job
10. Let’s make a survey first
11. Let’s sit on it for a while
12. That’s not our problem
13. The boss won’t go for it
14. The old timers won’t use it
15. It’s too hard to administer
16. Why hasn’t someone else suggested it before?
17. Let’s form a committee
18. We should wait until the economy improves
19. Who else has tried it?
20. Is it best practice?

No business pllan survives the first customer, and it is definitely helpful to plan. However, writing it as the first step is another story and just discourages innovators. Stop it.

Maybe those two words will help.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

There’s No Better Time to Be a Doctor

Victor Fuchs and Mark Cullen published an article in JAMA questioning the impact changes in health care systems have on doctors. The authors argue that the medical education establishment should respond to such changes with curriculum reform that includes, among other things, health economics and population health. They further provide a short history of health care policy and structure and discuss how it has evolved from an unregulated industry to one that is now increasingly corporatized. They note the rise in employed physicians and state: “Physicians might become less professional, but their professional role could increase as their entrepreneurial role decreases.”

It seems to me there is confusion about physician entrepreneurship, its definition, and whether it represents a threat to professionalism. I’m not alone in my speculation. Is a physician entrepreneur someone who starts and runs a business, or is it something more?

1. Entrepreneurship is the pursuit of opportunity with scarce, uncontrolled resources. The goal of all entrepreneurs, including physician entrepreneurs, is to create user-defined value through the deployment of innovation using a VAST (click here for more info) business model.
2. Innovation has both a qualitative and quantitative component. It refers to doing something new, or something old in a new way, that creates user-defined value that is a significant multiple of the competitive offering. Sick care sorely needs innovation that is not incremental or sustaining, but rather significantly adds at least 10 times the present value to have an impact.
3. Physician entrepreneurship is not the same things as private practice nor is it fundamentally about practice management. The increasing rate of employed physicians should not be interpreted, as Fuchs and Cullen imply, as decreasing the professional role of doctors . To the contrary, when entrepreneurism is done properly, it enhances medical professionalism.
4. There are many different goals and roles for physician entrepreneurs (a category that includes small- to medium-sized business owners in private practice, technopreneurs, social entrepreneurs, intrapreneurs (i.e., employed physicians acting like entrepreneurs), freelancers and consultants, and physician investors). Social entrepreneurship has a long history of physician involvement, and business school courses in social entrepreneurship are expanding. (Here is an example of how one doctor can make a difference.) Roles can vary as well. Some physician entrepreneurs are problem seekers, others are problem solvers. There are also storytellers, money finders, scorekeepers, social connectors, risk managers, and business developers.
5. Employed physicians, whether academic or non-academic, have the potential to be as entrepreneurial as their colleagues who are in independent practice.
6. While medical education reform is necessary, expecting medical students to master health economics and population health is unrealistic. Medical schools need to be part of entrepreneurial universities, with the goal of instilling an entrepreneurial mindset in all graduates, including health professionals. To that end, medical schools and their affiliated graduates schools should rethink how they teach. They should practice technology transfer and commercialization, and give faculty innovators the tools, incentive, and recognition to pursue innovation scholarship.
7. Physician entrepreneurship enhances medical professionalism. It does not degrade it, so long its practitioners understand and resolve the conflicts between the ethics of medicine and the ethics of business. Violating the patient or public trust by self-dealing or not disclosing conflicts of interest degrades any profession that has a fiduciary relationship with its customers or clients.
8. Physician entrepreneurs create value for patients in many ways outside clinical care. The upcoming generation of medical students, residents, scientists, and engineers understand that better than graduate school faculty and administrators—and they have engaged in bottom-up efforts to fill the gaps in their education and experiences.
9. Every threat to the existing practice of medicine represents an opportunity for physician entrepreneurs to help patients by adding value.
10. Every industrialized country is grappling with how to provide its citizens with health services given scarce resources. Innovation and entrepreneurship, fostered by rules that catalyze them, will be the solution. Physician entrepreneurs are making a difference. This non-profit group that is trying to eliminate the stigma of mental illness in Nigeria is just one of many examples.

The “golden age” of medical practice is being replaced by the “golden age” of physician entrepreneurship. Entrepreneurship offers another way to help patients—arguably, there is no better time to be a doctor.

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GUEST POST from Arlen Meyers

In 2004, Stanford Professor Robert Sutton published “More Trouble Than They’re Worth” in the Harvard Business Review. His subsequent book, The No Asshole Rule, expanded on the theme and described how toxic the syndrome can be and whether you are one or not. Are you one? Here is a test to find out and the accompanying survival guide for assholes.

Prof. Sutton now has a new book that offers some ideas on how to dealt with assholes.

Taking a page from that book and others like it, medical schools are confronting the issue of medical professionalism and issues that derive from student abuse and mistreatment. They are creating Offices of Professionalism that offer guidance, counseling, dispute resolution alternatives and education to faculty,staff and students to address and prevent unprofessional behavior that interferes with education.

So how do you know one when you see one? Prof. Sutton offers two tests:

1. After talking to the alleged asshole, does the “target” feel oppressed, humiliated, de-energized, or belittled by the person? In particular, does the target feel worse about him or herself?

2. Does the alleged asshole aim his or her venom at the people who are less powerful rather than at those people who are more powerful?

French and Raven described 5 sources of power:

1. Legitimate – This comes from the belief that a person has the formal right to make demands, and to expect compliance and obedience from others.
2. Reward – This results from one person’s ability to compensate another for compliance.
3. Expert – This is based on a person’s superior skill and knowledge.
4. Referent – This is the result of a person’s perceived attractiveness, worthiness, and right to respect from others.
5. Coercive – This comes from the belief that a person can punish others for noncompliance.

In medicine, these sources are not much different and there are three main power imbalances that play out in practice and during training : the faculty-faculty imbalance, the faculty-student imbalance and the doctor-patient imbalance. If not managed properly, these interactions can have significant organizational, legal and educational implications.

The syndrome is even more pervasive in entrerepreneurial circles, where, in many instances, being labeled a toxic, bullying, annoying troublemaker is a badge of honor, when , in fact, you might simply be an asshole. Silicon Valley has made a cottage industry helping assholes via the radical candor movement.

Discovering you are an asshole can create existential questions that go to the core of your being. But, sooner or later, you will have to deal with your demons. If you don’t, you will be destroying your personal life and career, living in the veil of marginalization and career suicide. You choose. Good rebel or bad rebel.

Here are some words others might use to describe you: annoying, troublemaker, arrogant, bully, direct, hot-headed or, you are an asshole. Like crafting a value proposition, it really does not matter whether you think you are an asshole or not. . The only thing that matters is how others feel about being around you. So, if you finally admit that you are an asshole, here are some things you can do about it:

1. Practice being considerate and caring. You might need to fake it ’till you make it. Start with using these five tricks to remember people’s names.
2. Stay away from toxic assholes at work and in your personal life
3. Do something that scares you every day and learn from it
4. Ask for help
5. Stop comparing yourself to others
6. Give people the right to show you the yellow card or red card whenever they think you are acting like an asshole
7. Listen more and don’t interrupt. Don’t say all that stuff in your mind that you want to blurt out when others are talking. Instead, write it down and either forget it because it wasn’t all that important anyway, send it someone who might be interested in your ideas, or wait for the right time to chime as long as you have not already talked more than anyone else.
8. Use “we” not “I” and “us’ not “me”
9. Like a contagious virus, quarantine yourself periodically until you have mutated into a less harmful form. Spend time in nature. She is forgiving.
10. Jerks can be effective in organizations. Just don’t step over the line.
11. Learn better feedback techniques.

Here’s how to survive a jerk at work.

Most people think power is a dirty word. However, it is an i nevitable part of organizational behavior and managing to use or not use power in the appropriate way is a core skill for doctors and teachers. Refusing to work with assholes is important. So is recognizing one in the mirror.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

A friend and colleague physician entrepreneur was recently lamenting the fact that , in business, being disruptive is a good thing , but, in medicine, it can result in , among other bad things, losing your license to practice. Despite that, the AMA wants you to be disruptive.

In business, disruptive innovation, a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.

Medicine sees it a different way.Patients identify being confident, empathetic, humane, personal (ie, viewing the patient as a person, not a disease), forthright, respectful, and thorough as ideal physician behaviors. Valuing teamwork, handling stress, punctuality, and self-motivation to pursue professional and personal growth are also ideal physician behaviors. On the other hand, the American Medical Association, in its Code of Medical Ethics, states that “personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care constitutes disruptive [physician] behavior.” Such behaviors include inappropriate language, yelling, gossip, facial expressions and other mannerisms as well as physical boundary violations.

Unfortunately, the line between the two is not so clear and some doctors are branded as disruptive, not because they cause patients harm, but because, through their efforts and actions, they are disruptive to the existing sickcare business model. Those that dare to tell truth to authority are branded as provacateurs, naysayers, grenade-throwers and “just not team players”.

Those who threaten the status quo in any industry at any time are outsiders and run the risk of suffering from the full force of those seeking to resist change. Physician entrepreneurs are no different. Being disruptive in pin-stripes is one thing. Being disruptive in a white coat is another. Few vested interests tolerate either in the clinic, the bedside or the OR.

So, what differentiates a disruptive from a disruptive doctor? What’s the difference between a good rebel and a bad rebel? Here are the differences.

The disruption lexicon gets even more complicated. Do you want to know what else is disruptive in sickcare?

1. Alarm fatigue

2. Change fatigue

3. Cell phones in the OR

4. Music in the OR

5. Non-ergonomically designed surgical instruments and ORs

6. Shooters in the ER

7. Electronic medical records and workflow

8. Electronic medical records and the doctor-patient relationship

9. Meetings

10. Two words

Here are some tips on how to deal with rule breakers.

• Let employees define their missions.
• Tailor jobs to employees’ strengths.
• Ask “Why?” and “What if?”
• Stress that the company is not perfect.
• Maximize variety.
• Continually inject novelty into work.
• Hire people with diverse perspectives.
• Design processes to include dissent.

Ask, “What information suggests this might not be the right path to take?”

Part of doctors acting badly might be traced to loss of control or threatened masculinity.

Digital disruptors are making their mark in healthcare. The new triple threat is a doctor/technologist/entrepreneur. Many are outside of the industry, some are physician entrepreneurs and , increasingly, many are patients. As more a more doctors shift their attention from the practice of medicine to the business of medicine, the medical establishment will have a hard time distinguishing one disruptor from the other.

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GUEST POST from Arlen Meyers

It’s been said that data is the new oil that is fueling the 4th industrial revolution. Others disagree. However, while the business models and value chains of oil and data might be different, the metaphor is used to describe the increasing value of data. Transforming into the cyberintellingent, mobile, digital economy has created a lot of pain to many people and made old industrial models, and their employees, obsolete or redundant, much like renewal energy is doing to the coal industry and workers.

Now we are hearing rumbles about changing sick care to healthcare , the fee for service model to value based care and the present payor model to “Medicare for all”…whatever that means. However it plays out, the die has been cast and there is an ongoing restructuring of the sick care industry that will cause a lot of pain and make the coal and petroeconomy meltdown look like a mere blip on the labor economy radar screen. Even clusters and innovation districts have a life cycle.

For everything, there is a time to live and a time to die.

The US sickcare system of systems medapocalypse is looking something like this:

1. The future of sickcare work is changing
2. The doctor persona of the future is changing
3. Care delivery business models are changing
4. Patient expectations and demands are changing
5. Biopharma and medtech business models are changing
6. Hospitals and traditional care delivery models are increasingly obsolete
7. The primary care model is being unbundled
8. One on one care is changing to team on team care
9. Medical education is being reformed
10. Biomedical and clinical ecosystems are changing driven by digital health technologies
11. Innovation financing is changing
12. Sickcare policy is changing
13. Intellectural property laws and FDA regulations are changing.
14. Reimbursement models are changing
15. Patient and doctor behavior change models are evolving

The personal computer changed the world. Sustainable energy technologies are doing the same to the petroeconomy as will self-driving electric cars, robots, AI and the other shiny objects on the shelf.

Prepare yourself and your kids now for the opportunities all this presents

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GUEST POST from Arlen Meyers

Suppose you are running a pitch competition and need to create a scoring rubric? Or , maybe you are the head of a technology transfer office or innovation center and need to screen lots of ideas? Or maybe you teach innovation and entrepreneurship and need to clearly explain to your students how their submissions will be graded?

How do you score innovation ideas?

At many companies, the idea evaluation process revolves around detailed Excel spreadsheets, comprehensive PowerPoint documents, and an orchestrated sequence of pre-meetings leading up to a decision meeting. This kind of disciplined approach works very well when companies have knowledge that lets them be precise in their analysis, and executives have the relevant domain experience to make informed decisions.

Applying this same discipline to nascent opportunities in new spaces can be disastrous. People spend days discussing Excel spreadsheets that are nothing more than mathematical relationships between made-up numbers. Managers working on ideas discover that detailed PowerPoint documents are their biggest enemy, because the details act as bait for nit-picking devil’s advocates. Endless pre-meetings crowd out action-based learning.

Here’s how one investment team screens and scores.

There are many ways to screen, score and scale your innovation management system, but, here are some considerations when you do:

1. Should judges do it or should you task the innovator with self scoring?
2. How many ideas do you anticipate and how will you scale the process?
3. How will you communicate the structure, process and criteria to those who enter the process? How will you engage innovators?
4. How will you create fairness and eliminate bias in the selection process?
5. How much money do you have to spend on screening, scoring and scaling?
6. How will you determine the selection criteria that are consistent with your strategic objectives?
7. What will you do with those who have submitted ideas that have been rejected?
8. How many stages of evaluation will you have? Pass-fail or stage gate?
9. What is the most appropriate process for your industry or point of view? Should a new medical practice idea be judged the same way you would judge a digital health idea at a pitch competition or, a technology if you worked at a technology commercialization firm?
10. Should you automate the process?

Most managers and many leaders fail at picking winners, regardless of how they go about picking the jockey and not the horse. The thumbs up or thumbs down approach, with death to the vanquished, creates innovation cultural chaos. “Ave, Imperator, morituri te salutant”  If might have worked for Caesar, but, when it comes to leading innovators, those who are about to die won’t salute you. They’ll leave and compete with you.

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GUEST POST from Arlen Meyers

If you work for a big, established company, you’ve probably been noticing the sudden rise of a new trend: the innovation lab. Companies as diverse as Delta Air Lines, Target, Google, Pfizer, Marriott, Autodesk, Fidelity Investments, Ford, Verizon, and Stanley Black & Decker are jumping on the bandwagon. Most don’t deliver.
 

Open innovation labs like this bring The Garage Experience inside the four walls of the corporate business environment – freely available for everyone to use and experience.

Univerisities have joined the parade, creating undergraduate and graduate innovation and entrepreneurship centers, despite the fact that there is scant evidence that they work.

The new thing in sick care administration is to create healthcare innovation centers, modeled somewhat after other industry R/D and skunk works. Their goal, ostensibly, is to innovate our way out of the sick care and health care mess. They focus mostly on quality, cost, process improvement, patient experience, sometimes doctor experience and access to care and range in size, scope and vision. A recent review identified 50 hospital innovation centers. Steve Blank calls it innovation theater

Here is an example of one that is successful. Some have combined designers and, can you imagine, are also asking patients what they want.

Here is a building dedicated to sick care innovation in Denver.

Now,even the AMA is in the game and has anted-up $15M.

As you would expect, there are now conferences, webinars and white papers about health innovation centers, best practices and their impact to date. Accelerators are changing to accomodate the realities of the sickcare industry.

Corporations are creating innovation outposts to stay ahead of the curve.

Sick care (over 90% of the US “healthcare” spend is for taking care of sick people) innovation center leaders and participants will need to address some issues to be effective and deliver impact:

1. The last mile. All the systems engineering in the world won’t make a difference until we crack the code on how to change human behavior.

2. The rules. Most will have relatively limited impact until and unless the reimbursement rules substantially change. Rules drive ecosystems that create business models that deploy and scale innovation. Right now innovation centers are trying to use new tactics but can only deploy limited innovation strategies without a new playing field. They are living in the no man’s land between the now and the new.

3. Systems thinking overcoming silos. Healthcare is notoriously siloed at almost every level, from department to department to one sick care system to the next.

4. Patient willingness and ability to engage. The assumption is that more patient “engagement” will be mean better outcomes. That needs to be validated and we need to do a better job of targeted patient segments who want to take responsibility for their care and assume the consequences for the results.

5. Shifting value factors. Medical care is becoming commoditized. Patients can’t judge quality and cost since they are so opaque so they use service, speed, convenience and experience as proxies. There is relatively little correlation between satisfied patients and the quality of care they receive.

6. Data integration and interoperability. Resolving the protect but share dictum will be challenging.

7. Measuring and defining innovation. Big orbit change is necessary, not incrementalism. Innovation is a measure of the multiple of user defined value that results when compared to the existing competitive offering.

8. Lead innovators, don’t manage innovation. We need leaderpreneurs and followers with an entrepreneurial mindset willing to fail at low cost.

9. Innovation management systems. There are many ways to foster, package, test, validate, prioritize and deploy components of an R/D portfolio. The process needs to efficient, effective and transparent to the users .

10. Execution. Inspiration and perspiration. In the end, no idea, invention, discovery, or process is worth much without a team who can execute or deploy it.

11. Long sales cycles prolonged processes of decision making.

12. Different business models to develop digital health and process improvement products

13.Overcoming the main barriers to physician adoption: a)evidence based safety and effectiveness, b) concerns about liability, c)getting paid to do whatever you propose that d) will not interfere with workflow, take more time and further abbreviate face time with patients.

14. Entrepreneurs outperform intrapreneurs

Here is an example of a “different” model. We need scalerators, not accelerators.

Healthcare innovation centers seem to have a different focus than community based entrepreneurship centers. Yet, they should both be focused on the same thing: transfering value to patients. Physician centered value centers should have the following features:

1. Focus on creating value transfer to patients, not startups

2. Create a separate value proposition for the different kinds of physician entrepreneurs: private practitioners, technopreneurs, intrapreneurs, investors, consultants.

3 Include rapid prototyping facilities

4. Integrate non-MDs from other industries to create a larger, more eclectic community of interest

5. Include patients and others who might help with the customer discovery and development process

6. Include human subjects trial support

7. Accomodate the schedules of practicing clinicians

8. Use state of the art teaching technologies

9. Have an active and effective mentoring process

10. Create a business model that doctors will buy

A recent study provides details for the 10 top success factors for hospital innovation:

1.      Use a clear step-by-step innovation method

2.      Establish an Advisory Group to guide innovation concepts and proposals

3.      Focus on consumer needs, rather than technologies to direct the innovation

4.      Generate Big ideas by focusing on core outcomes, not the symptoms

5.      Minimize early funding by focusing on a minimal viable product

6.      Support projects with innovation experts (design, engineering, business)

7.      Utilize an iterative prototyping to quickly build and test the best product

8.      Nurture publicity and storytelling to raise visibility, excitement and funding

9.      Include industry experts/ vendors/ investors to support commercialization

10.  Develop power users to give hands-on training and coaching for innovations to build key behaviors and practical experience

“What is the source of this hostility to innovation?”, “Is the under-performance in innovation episodic or systemic?” and, “What is causing this value-destroying gap between stated intent and actual reality?” Here are 3 reasons.

In fact, like many industry innovation centers, my guess is that few sickcare innovation centers are creating much impact and should be closed, particularly if they are just high priced, high tech suggest boxes. Here are five reasons why they should be shuttered.

In addition, the establishment of university-affiliated incubators is often followed by a reduction in the quality of university innovations, according to a new study co-authored by a Baylor University entrepreneurship professor.

Here are some reasons why it is so hard for BIG MEDICINE to innovate

Most don’t and that’s part of the reason doctors have been disintermediated and marginalized from the value creation process.

We need to rethink accelerators and incubators given their marginal success record of creating scaleable companies. Scale up expert Sherry Coutu believes that most innovation facilities today are failing in their duty to help startups and corporates work effectively together and bring products to market at scale. Whether in terms of running successful proof-of-concepts, giving access to talent and finance, or even providing the hardware required to scale up their work, these things are traditionally lacking from the modern incubator.

The challenge for enterprises looking to make strides then is to back up their innovation strategy with the organizational capability to scale up the experiment i.e minimally viable pilots.. Hagel and Seely Brown advocate a seven-step process:

1. Locate your edge, which is likely to be an emerging business opportunity that has great potential to scale up rapidly.
2. Identify your changemaker/s who fully understand and will embrace this opportunity.
3. Position this individual/s outside the core of the organization.
4. Take a lean startup style approach and experiment relentlessly in order to accelerate learning.
5. Deprive the team of much in the way of support or resources.
6. Encourage the team to connect and partner with other parties outside of the organization to gain the support they need.
7. The new venture should look to create a new product or service and not cannibalize the core business, at least to begin with

Sick care organizations can also learn some lessons from other industry corporations that are trying to partner with startups.

Sick care innovation centers might be a fad or an important tool for fixing what’s broken. We’ll have to see. In the meantime, enjoy yourself at all those conferences.

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