GUEST POST from Arlen Meyers

The economists tell us that labor productivity is a measure of the amount of goods and services that the average worker produces in an hour of work. The level of productivity is the single most important determinant of a country’s standard of living, with faster productivity growth leading to an increasingly better standard of living. Given recent stagnation in wages, however, some are re-examining the link. It turns out if you make more things or produce more services, you don’t necessarily make more money.

As noted in a recent WSJ article, perhaps we are experiencing a kind of Solow Paradox 2.0, with the digital age more around us than ever except in the productivity statistics. There are several reasons for this lag. First of all, we’re in the early deployment years of major recent innovations, including cloud computing, IoT, big data and analytics, robotics, and AI and machine learning. Notes McKinsey: “The challenge of adoption in the current digital wave may be even harder because of the broad range of uses of digital that not only help improve current processes but fundamentally transform business models and operations.”

While leading edge companies are already leveraging these advances, most are still in the learning stages. The most sophisticated companies have been pulling far ahead of everyone else in deploying these advanced technologies. According to McKinsey, “Europe overall operates at only 12 percent of digital potential, and the United States at 18 percent, with large sectors lagging in both. While the ICT, media, financial services, and professional services sectors are rapidly digitizing, other sectors such as education, health care, and construction are not.”

Given all the changes and demands on the sick care system, many experts are suggesting ways to increase sick care worker productivity. If you are a clinician, the measure now is straight forward i.e. the number of relative value units you can generate and how much revenue and reimbursement that translates to for you or your employer. Some are trying to move the goals posts or change how we keep score, but, for now, most doctors are being measured and compensated by how many points they put on the board. One of these days, though, CFOs are gong to have to figure out what to do with all those doctor cash cows.

On the other hand, some doctors think we should abandon measures of doctor productivity.

Healthcare is a key component of the US economy, but healthcare spending increases consistently outstrip GDP growth. Improving productivity in healthcare delivery could change this dynamic without harming patient care.

Charles Duhigg has written about what makes people productive in his book, Smarter, Faster, Better. For those of you who just read the conclusions sections of scientific and medical journal articles, here are the takeaways as they could potentially apply to sick care workers:

1. Make people feel like they are owners, not renters. Expand their locus of control, constantly reminding them about how the work they do is about something they care about. Remind yourself and co-workers that you are building a cathedral, not just laying stones. Suppose doctors and other employees were owners instead of cogs?

2. Many say you should choose a stretch goal and break it down into SMART (specific,measurable,achievable,realistic,timeline) objectives. When it comes to innovation, though, some think DUMB goals make more sense than SMART goals. Taking it one step further, HARD goals are better motivators:

Question #1: Animated. “Think about where you want your career to be, and describe to me exactly what you’re doing (what kind of work you’re doing, who you’re working with, what your days look like, etc.) one year, three years, and five years from now.”

Question #2: Heartfelt. “Describe at least three reasons why you want this goal (note: the reasons can be intrinsic, personal, and/or extrinsic).”

Question #3: Difficult. “What are the three to five most important skills you’ll need to develop to achieve this goal? How will you develop those skills?”

Question #4: Required. “What do you need to have accomplished by the end of the next six months to keep on track toward achieving this goal? What about by the end of the next 90 days? The next 30 days? What’s one thing you can accomplish today?”

3. Start with the end in mind, create a retrograde pathway, and focus. Ask, “what next and by when?”

4. Envision multiple futures and open yourself to multiple options

5. Make teams more effective by focusing on the how (give everyone a chance to speak and are safe) instead of the who.

6. Push decision making to the person closest to the problem. Rule makers , managers, bureaucrats and many physician executives have a very hard time with this one.

7. Innovation is mostly about doing old things in new ways. To connect the dots and harvest institutional history, become an “innovation broker”. Innovation brokers don’t just build network pipes and pumps, but instead accelerate the flow of information and fix the pipes that are clogged.

8. Customers buy emotionally and justify rationally. Inventors and innovators should do the same. The user defined value of an idea or invention is often more aptly measured by how it makes you feel, not what you think about it.

9. The productivity curve maxes out at some mean level of stress. Something that is boring or a task that is overwhelming does not drive productivity. In fact, excessive stress, change fatigue and administrivia crush productivity. Some seem to think that the way to make doctors more productive is to make them conform to rules and mandates telling them how to be more productive.

10. Just because you have realized a creative breakthrough does not mean it will create user defined value. Be open to the fact that your baby might, in fact, be ugly. Statistically, most are.

11. Get rid of the SHIT in your life. Mitigate technofatigue.

12. Use these AI tools to streamline your day

13. Do a better job of coding

14. Minimize no shows

15. Use the OKR system to measure your results.

Here are six more keys to improving physician workflow.

Of course a much easier way is to make doctors wear performance-monitoring wearables.

Virtual and face to face mentors help too.

Sick care labor economists debate whether productivity is increasing or decreasing and whether it is contributing to an increased standard of living. If you want one answer, ask your neighbor, the pediatrician. Or, maybe we should just all learn from Leicester City to solve the Solow paradocs.

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

One of the best ways to reduce your tax burden and save for the future is to maximize contributions to your Individual Retirment Account (IRA) early and often, create the proper asset mix and periodically doing an asset allocation rebalance at the right time.

Similarly, the future of most companies, organizations and universities depends on their ability to put innovation in the bank as part of 3 horizon planning. Just like individual accounts, it requires structure, a process, people (leaders, champions, teams), strategy,execution,discipline, creativity ,imagination and the tools to measure results.

Harvard Professor Gary Pisano claims that the reason companies often fail in their attempts to become innovative again or to keep their innovative capacity is due to three factors. One is strategy. For a larger company with an existing business, you need an explicit strategy around how you allocate resources to the new versus the old.

The second is getting the right systems in place. Very different kinds of innovation and problem-solving processes go on when you’re trying to do something transformative versus routine innovation.

The third element of that DNA is their culture. There’s got to be the right kind of culture and has the courage to innovate.

Here are the six steps in the innovation life cycle:

Identifying a Problem to Solve. Successful innovation programs are not only great at generating solutions, they excel at identifying problems. Identifying problems requires that organizations take these four steps to prepare for problem solving: gather & organize existing information, reframe and ask why, set expectations, and identify what success looks like.

Identifying a Process that Works For You. Should I use design thinking or six sigma methodology? Having a process for sharing, identifying and selecting great ideas is what makes innovation a repeatable (even predictable) practice. Get an overview of the different options available to you and figure out which one works best for both your organization, but also for this unique innovation initiative.

Engaging Others in the Process. Employee engagement, open innovation – the future of innovative thinking requires that you reach out to the collective intelligence surrounding you. But how do you get people to share their ideas? How do you keep them coming back to build on the ideas of others? What sorts of incentives motivate creative participation? Every innovation push needs to include a communications plan.

Empowering Groups of People to Build Ideas into Projects. When it comes to turning great ideas into great projects, it’s important to build teams of people that will help steward it through to completion. They need to refine ideas, do research, find collaborators, and more.

Evaluate and Prioritize. Your organization has lots of great ideas, but you only want to move forward with the best ones, the ones most in line with your organizational goals. How do you funnel ideas through a process that helps you evaluate and identify the ideas that will deliver the highest ROI?

Idea Implementation. The best programs have been anticipating this step from the beginning. You’ll need to have buy-in, organizational allies, and creativity in marshalling resources. This is the most important step, of course, in your innovation program.

Every financial planning and retirement site has a calculator to tell you whether you will have enough to retire. But, few firms have done an organizational Innovation Readiness Assessment (IRA) to see if they are on the right track.

Giffford Pinchot, who originated the term “intrapreneur”, has suggested that you rate your organization in several domains to see whether your innovation future looks bright or bleek:

1. Transmission of vision and strategic intent
2. Tolerance for risk, failure and mistakes
3. Support for intrapreneurs
4. Managers who support innovation
5. Empowered cross functional teams
6. Decision making by the doers
7. Discretionary time to innovate
8. Attention on the new, not the now
9. Self- selection
10. No early hand offs to managers
11. Internal boundary crossing
12. Strong organizational culture of support
13. Focus on customers
14. Choice of internal suppliers
15. Measurement of innovation
16. Transparency and truth
17. Good treatment of people
18. Ethical and professional
19. Swinging for singles, not home runs
20. Robust external open networks

If you ask a sample of people to rate these in your company on a scale of 1-10, don’t be surprised if the average equals somewhere between 2-4. Few organizations, you see, are truly innovative or have a truly innovative culture. Most don’t even think about how to bridge the now with the new, let alone measure it.

Do a cultural audit. Organizational innovation competencies must include:

• Leadership
• Vision
• Strategy and execution
• Alignment and engagement
• Tactics
• Structure, policy and procedure
• Tools and incentives
• Teams
• Champions
• Innovation learning system and knowledge management

Here are some examples of questionnaires you can use to identify innovation opportunities for improvement:

1. INSEAD and Logica model
2. Innovation Excellence Co-Founder Braden Kelley’s Free Innovation Audit (fill out online or use the downloadable Excel spreadsheet)

There are also ways to measure individual/intrapreneur innovation mindset and readiness

Initiator

Ambidextrous individuals take the initiative and are alert to opportunities beyond the confines of their own jobs.

Cooperator

Ambidextrous individuals are cooperative and seek out opportunities to combine their efforts with others.

Broker

Ambidextrous individuals are brokers, always looking to build internal linkages.

Multitasker

Ambidextrous individuals are multitaskers who are comfortable wearing more than one hat.

Theoretically, then, organizational ambidexterity happens when organizations and individuals are ready, willing and able to innovate. For one author, that means the leadership of your organization needs to focus on three core competencies:

1. Start by being a problem seeker, not a problem solver
2. Lead innovators, don’t manage innovation
3. Look for precedents and why they succeeded or failed

The good news is that now you have something to measure and pursue the many opportunities for improvement. Your business depends on your innovation nest egg as much as your personal retirement. Start now and you’ll have a much happier business future.

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

Most sick care technology companies, at some stage of their development, decide whether to hire a Chief Medical Officer (CMO), either part time or full time. However, given that the job description involves a combination of clinical and business domain expertise, there is a shortage of qualified applicants and a war for talent, much like there is for sick care data scientists.

The roles and responsibilities of hospital CMOs are different from biomedical and clinical company CMOs. However, the job descriptions of both are undergoing rapid change.

Since there is no technology CMO school (Sorry, doc, but that MBA won’t get you there), most get OJT with the attendant inefficiencies, role conflicts, waste and dysfunctions. How, then, should we rethink physician entrepreneurship education and training for those interested in a technology CMO career pathway?

1. Start with a needs assessment. Clinical and domain expertise is the price of entry. Beyond that, we need to talk to industry, investors and the various innovation ecosystems to define the needed skills, knowledge, abilities and competencies the market wants.
2. Use the needs assessment to create learning objectives. Those will most likely involve understanding how to translate data into value, dissemination and implementation science,project management, strategic thinking, leaderpreneurship,product management, emarketing, clinical trial design and execution, and and using social media to create stakeholder engagement.
3. Use the learning objectives to design the curriculum that would include not just education and training, but mentors, networks, experiential learning and international knowledge exchange as well.
4. Create rubrics to measure competency metrics.
5. Require each participant to create a personal and professional career development plan
6. Begin introducing medical students, residents and fellows to aspects of the curriculum early in their training
7. Create a network of technology CMOs to encourage sharing best practices and life long learning
8. Develop scholarships, fellowships and other funding models in cooperation with medtech/biopharma/digital health/care delivery companies
9. Introduce potential CMOs to internship opportunities. The good news is that you won’t have to wear white pants and a short white coat. However, on some nights, you might have to sleep in house at the co-working space.
10. Medical specialty societies and associations should offer continuing education for technology CMOs
11. Most universities are not entrepreneurial, nimble or responsive enough to offer this kind of thing. It should be done at the bottom-up community level and most of the faculty should be practicing CMOs
12. The process should be a hybrid model, with a combination of face to face and online experiences.

Filling the CMO manpower gap will take years given the length of the pipeline and the limited supply of doctors with an entrepreneurial mindset. That said, things are changing as more and more medical students choose to forgo practicing clinical medicine for something else.

Once you have the knowledge, skills, abilities and competencies to do the job that needs to be done, then you have to find one. That will take mentors, networks, career coaching and peer to peer support. Here are some tips:

1. When you go to meeting and conferences, don’t ignore the vendors or just take their free T-shirts. Do informational interviews to learn more about what they do, whether and how they involved medical consultants and who to contact for more information.
2. Talk to opinion leaders or those who are already in CMO or advisory positions
3. Relentlessly network, particularly building robust networks outside of your field of interest.
4. Build your personal brand directly and on social media
5. Refine your soft skills-communication, collaboration, creativity and complex problem solving
6. Join side gig dating services, like the AMA Physician Innovation Network (you don’t need to be a member), the Society of Physician Entrepreneurs or other jobs boards
7. Find a place in your local biocluster
8. Create a personal and professional career development plan
9. Live in the right place , since tech hubs and jobs are concentrating in fewer and fewer places
10. Think big but start small
11. Think twice about not doing a residency. It’s called “physician entrepreneur” for a reason.
12. No, you don’t need to “grab an MBA“. Instead, we need MBEs.
13. Determine whether the company needs you to be a CMO or something else, like an advisor
14. If part of your compensation is equity, find out whether you are working for a C corp or an LLC and determine the right kind of equity award.

Once you land a job, then the first 90 days are critical to setting the stage for a successful career trajectory. As noted in a recent HBR blog, the biggest challenge leaders face during these periods is staying focused on the right things. You are drinking from the proverbial fire hose while trying to get settled and figure out how to start to have an impact. It’s easy to take on too much or to waste your precious time. So, it helps to have a set of questions to guide you. Here are the five most important ones to ask…and keep on asking on a regular basis.

The sooner, we start, though, the better , at least theoretically, the company success outcomes and that’s good for patients.

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

Entrepreneurship education programs are expanding rapidly and recent polls indicate that 20-25% of B school applicants are interested in starting their own business. Many applicants, including medical school and graduate school applicants already have, but feel they lack the business skills to start and scale their companies. Consequently, there are more Masters in Entrepreneurship programs sprouting up around the world. In addition, bioentrepreneurship education and training programs (BEET) are not far behind and things are changing rapidly:

There are several drivers of international bioentrepreneurship education programs:

1. The biologic revolution and emerging technologies
2. Student demand for education and training that will give them a competitive advantage in the job market where there are shrinking academic research career opportunities
3. The desire to create biomedical new ventures
4. Expanding innovation ecosystems at academic medical centers
5. An understanding of the importance of coherence and how cross-campus, interdisciplinary collaboration facilitates innovation
6. The innovation imperative to stay competitive
7. Digital health creating new products, markets and jobs
8. The need to re-invent sick care and address global health disparities
9. The changing financial, regulatory, legal and intellectual property landscape
10. Faculty innovation champions eager to get their ideas to patients
11. The lack of bioentrepreneurship educational offerings at academic medical centers
12. Higher education, sick care and government resistance to change
13. Philanthropreneurs funding change and demanding a different model.

Since most of these programs are in their early stages, to a large extent, best practices are still in development and many are experiments. Based on our experience, here are some general categories of best practices we should be measuring and sharing:

1. Pedagogy. What are the best ways to teach biomedical innovation and entrepreneurship (BMIE)?
2. Technology. Which educational technologies have the most impact and which do not?
3. Markets. Which students are most attracted to BMIE progams and how do we target them?
4. Prerequisites. How do we define prerequisites, if any, for BMIE, and how do we provide students with them?
5. Early education. How do we integrate k-20 innovation, creativity and entrepreneurship education and training?
6. Defining KSAs. What knowledge, skills, abilities and competencies should graduates have after completing the programs? What should be the learning objectives of these programs that drive curriculum design? What are the market driven soft skills in demand? How about social and international entrepreneurship?
7. Outcome metrics. How should we define outcomes to measure the success of programs both in the short term and the long term? Can entrepreneurship be learned or should those who are interested just go to the school of hard knocks?
8. What is the value added from the programs.?How have the programs contributed user defined value, regional economic development value and enhanced US global competitiveness?
9. Faculty development. How do we recruit, develop, reward and promote BMIE faculty?
10. Knowledge sharing. What are the best ways to share best practices , minimize redundancy and overlap and collaborate with other disciplines and campuses?
11. Innovation. What are recent innovations in BMIE education and training? What should be on the research agenda and where are funding sources to do it?
12. Credibility and recognition. How do we make BMIE a separate academic domain? Should it be or are success factors more domain specific, like engineering, biomedicine, aerospace or energy?
13. Ecosystem integration What are the most successful ways to ingrate these education programs into regional innovation ecosystems?
14. Market demand. What is the market demand for graduates and do graduates have a competitive advantage over those without formal education and training?
15. Business models. How to we create VAST business models for BMIE programs?

1. Validity Regardless or which elements of your model you choose, they have to be valid. In other words, the dogs have to eat the food. When the dog won’t eat the food, you’ll have to change your approach and try again.

2. Automaticity At the very start of planning your venture, you should think about how you are going to work on your business, not in it. Reducing hands on time to manage operations will give you more time to lead the company and create strategies for growth and give you more personal time to enjoy the fruits of your success. Outsourcing, automating or using technologies to ramp up operations, sourcing and distribution is a key part of scaling, and something that investors want to see…which brings us to the next piece.

3. Scalability Your business model is primarily a way to create a business machine that can produce an infinite number of products. Think of it as a device that takes in customers and creates profits out the other end and can do so at quicker and quicker speeds.

4. Time and Traction Finally, your model need to create as much profit as quickly as possible with a growing customer base that is loyal to your brand.

In my view, we are training too many MD/MBAs that don’t add value to the system and that many programs should be terminated or restructured. At the University of Colorado, we intend to offer a Masters in Bioentrepreneurship (MBE), building on our experience offering a certificate program in bioentrepreneurship as a joint program between a business school and an academic medical center graduate school. As a result, we hope to contribute some answers and share experiences about our efforts to provide BMIE education to business, science, engineering, law, arts and humanities and health professional students who are interested in the pursuit of biomedical and clinical opportunities with the goal of creating user defined value through the deployment of innovation.

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

Physician entrepreneurship has changed from a curiosity to becoming mainstream in 5 short years. Defined as physicians pursuing opportunity with scarce resources and conditions of uncertainty with the goal of creating user define value through the deployment of biomedical and clinical innovation, we are starting to see some trends and fault lines forming.

1. The phenomenon affects all physician demographics including the young and the restless (in training or in practice less than 5 years) , the desperados (in the prime of their professional careers (6-40 years in practice) and the old and the grumpy (arbitrarily over 65) but looking to rewire, not retire, pursuing encore careers. 

2.International bioentrepreneurship education programs are evolving and offering various levels of training and platforms. MD/MBA programs , while still being offered, are being displaced by more specific, sick care relevant, market driven offerings that teach moreclinically relevant, market driven knowledge, skills and attitudes. They are growing because almost every health system in the world is challenged with getting better outcomes for less cost. More medical schools are offering education in innovation, entrepreneurship and design thinking.

3. More medical students are electing to forgo residencies to work with industry or create their own companies. While ultimately a personal decision, some think it is an encouraging sign while others question the wisdom of that pathway. After all, it’s called physician entrepreneur for a reason. The market for physician entrepreneurs, either as advisors, founders or employees, particularly in digital health companies, is starting to plateau. Part of the reason is that while the number of startups is increasing, fewer become scale ups that hire people.

4. Digital health is getting most of the attention. Unfortunately, it has yet to demonstrate it can deliver most of the value.

5. Academic medical centers have searched and replaced “research” with “innovation” in their marketing literature and branding communications. Listen to this for some stories about how they are doing.

6. Sickcare employment has dropped for the first time in 10 years. Reading the tea leaves is always hazardous to your health, but some feel the era of “rightsizing” has started as we wean ourselves from inefficient, wasteful, costly medical and business practices. In addition, with the migration of care to non-hospital settings, integrated delivery systems are shedding unprofitable parts and that translates into fewer employed physicians.

7. Consolidation of hospitals and insurance companies are making it harder to innovate and creating hostilities between the administrators,third party intermediaries and the grunts in the trenches. Mergers and acquisitions have moved from horizontal to vertical.

8. Physician employment is plateauing, but significant intrapreneurial barriers persist. 

9. People are finally beginning to abandon the notion that doctors are lousy business people. Even doctors are starting to believe the contrary about themselves.

10. The names of the players and the dramatis personae have changed. The word police have been active.

11. Value based care is driving the necessity for advanced information technologies, like artificial intelligence, do help determine quality and costs and improve productivity

12. Immigration policy is interfering with entrepreneurship

13. International medical graduates who are US citizens are seeing physician entrepreneurship as a viable alternative career pathway, particularly that 50% who do not match into a US residency

14. COI rules are interfering with physician-industry collaboration and new product development

15. Sick care data scientists are in sort supply unless you live on the US coasts

16. Women make up more than 50% of medical school students. However, fewer woman than men stay in the clinical workforce, mostly to take care of family members or find a non-clinical job after burning out.

17. Sources of early seed stage money have changed, altering the all aspects of biomedical and clinical startups.

18. Accelerators and incubators continue to evolve as part of their inevitable life cycles

19. AI, robotics, cloud storage, blockchain and mobile devices are having a bigger impact on digital health design, development and launch

20. Many digital health products and services are encountering significant resistance crossing the chasm to widespread adoption.

21. Regulatory and reimbursement rules are shaping the future of new products and services.

22. Burnout continues to claim more and more victims who looking for alternative non-clinical career possibilities

23. Community based innovation networks and ecosystems continue to grow and evolve

24. Medical schools continue to ignore the importance of entrepreneurship and digital health and data science education and training

25. Graduate bioscience and medical school education is in desperate need of reform

26. Outsiders, Google, Apple and Microsoft and the three amigos-Berkshire,JP Morgan and Amedzon- are trying to change the game and then scale it to others.

27. The fourth industrial revolution is changing the future of sick care work.

28. Patient entrepreneurs want a seat at the value creation table.

29. Interprofessional entrepreneurship is growing

Physician entrepreneurship continues to evolve before our eyes. If things go according to plan, physician entrepreneurs will be more and more involved in the innovation supply chain at earlier stages helping others innovate our way out of the sick care mess. If things don’t go that way, we’ll just have lots more people with lots more letters after their names sitting in the corner office of the Innovation Center. Smart medicine has already attracted a lot of smart money. Let’s see if it attracts the smart doctors and students.

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

Q: What are the three most common questions doctors, scientists and engineers ask about their new ideas, inventions and discoveries?

A: What do I do next ? How to I find money? How do I scale my business?

The answers are to 1)set up and fail at conducting the right business model and experiment to find a profitable and scalable business and economic model (fail it), 2)fix what’s broken (nail it) and 3)then feed the machine so that when you put customers in the top, profits come out the bottom ((scale it) or you create value for more and more patients.

Whether you are a for profit or non-profit, here are the benchmarks and KPIs that will define the stage of development of your enterprise as described by your impact model, operations model, marketing and sales, management and team, and financial management and growth plan.

At this point, taking the next step means having organizational ambidexterity and having planning horizons on the now, the next and the new. That takes a different approach and means you’ll need to constantly adjust and lubricate your machine with OILS

Getting your ideas to patients is a risky, laborious process.  In the beginning, most of your time should be spent on being a problem seeker, not a problem solver. The task at had is to understand the industry, your competitors, the markets and the segments you intend to dominate with a unique selling and value proposition. Particularly with sick care ideas, we need substantial innovation, not tinkering, incremental tweaking or solutions chasing problems designed to scale and not heal. That means doing something new or something old in a very new way that generates at least 10x the user defined value of the existing competitive offering or the status quo.

One way to think of the steps along the path is to mark three steps: The 3 stages — Setup, Launch, and Scale — are successive. That means, that one must complete one stage in order to move onto the next one. It’s analogous to a stage-gate® at the end of each stage. It is also 99% about execution.

Here are some tips on how to scale your ideas:

Scaling companies is more important than starting companies, particularly for mid-sized cities trying to create opportunities for their cities. Doing it requires several steps:
1 – Quickly demonstrating new growth, not startups, using scalerators, not accelerators
2 – Broadly communicating growth i.e. marketing
3 – Training stakeholders to support growth i.e growing the ecosystem
4 – Building local capacity and getting out i.e. planning for sustainability

Here is the intrapreneur’s guide to scaling.

Successful startups and regional ecosystems go through three broad phases as they scale, and a startup CEO’s job changes dramatically in each phase. A CEO’s first job is to build a product users love; the second job is to build a company to maximize the opportunity that the product has surfaced; and the third is to harvest the profits of the core business to invest in transformative new product ideas. This blog post describes how to become a great Phase 2 CEO by focusing on the highest leverage tasks that only the CEO can accomplish. As YC’s Continuity team, we’ve seen many Phase 1 CEOs transition successfully into Phase 2, and some who have not. The future of your startup depends on which kind you are.

Finally, don’t forget about keeping the end in mind and planning your exit.

I continue to participate in the growth and development of several biomedical and digital health innovation ecosystems, including those that are community and academically based. Each has grown by demonstrating the aforementioned principles, and include chapters of the Society of Physician Entrepreneurs, Digital Health Colorado, a data science consortium at the University of Colorado and the biocluster in Colorado.

The challenges and processes are the same for non-profits.

One of the many reasons why doctors make great entrepreneurs is their training in monitoring clinical outcomes and adjusting treatment based on the results. Do the same for your idea, invention or discovery and watch what happens.

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

The newly elected members of Congress don’t have to worry about working in an open space office environment. Instead, they cross their fingers and hope they get an office with a view. Those who are not running for reelection or lame ducks sit in cubes until the new sesion starts.

Likewise, most employed physicians, including academic physicians, savor their private offices and want to be able to hang all those diplomas, awards and patent plaques on their vanity walls. Of course, the chairperson usually gets the best spot with more space to display all those memorabilia from foreign speaking engagements while you are at home racking up RVUs. They also need a conference table so they can periodically review your productivity numbers in a friendly place and need extra seating for someone from administration to document the meeting for your file when it comes time for an “employment action”. Just in case you were wondering, here’s what to do when your white coat gets the pink slip. There is about a 33% chance you will move on or be made redundant, particularly if you are an assistant professor.

Things are changing, however, and open office design is coming to a startup, coworking or office building near you. That’s not good news for many reasons including the fact that it interferes with productivity of your best, let alone the worst , employees. Sick care productivity is already down.

Another trend is domain specific open working spaces for digital health entrepreneurs,lawyers, women or some other demographic or industry sector.

Most people want to work in solitude during most of the day and writers and philosophers have praised it for millennia. The problem is when solitude turns into loneliness, something that has become a public health crisis and infects entrepreneurs as well.

The other problem is the mistaken notion fostered in domain specific integrators that a given industry can be fixed from inside and that all it takes is better cooperation and integration of the parts. Sick care cannot be fixed from inside and neither can most industries. Changing the rules and models requires open, outside in, inside out collaboration with people from strange and foreign places.

The answer to all this seems to be activity based workplace design. ABW presents a mix of open, semi-private and private spaces in one commercial office to meet employees where they are in the moment, not forcing workers to accomplish their tasks in a specific non-ideal space. In this contemporary evolution of ABW, employees still keep their desks. Think a quiet floor with assigned workstations, another floor of private offices and suites with conference rooms, and a floor with a cafe and social hubs.

Like doctors, Congress people get paid for effort, not results, regardless of where they do their work. Both, arguably, are equally inefficient, non-productive and wasteful. If you want to accomplish something and be a member of the GSD club, it’s better to have an open mind and mindset instead of an open space to work.

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

… and what to do with them once you have them.

Surthriving in the brave new world of sickcare requires not just a new playbook, but players with new skill sets to execute the plans. Knowledge technicians are as obsolete as an NFL team with a running game but without a passing and special teams plan. Unfortunately, HR managers are getting it wrong.

But, do you know how to recruit for creativity and imagination? What will you support creative people once you have?

If you are looking to employ physicians, you need to recruit physician intrapreneurs. not knowledge technicians. Physician intrapreneurship has particular challenges.

Those responsible for hiring and managing the new sick care workforce should factor these things into the hiring decision:

1. Knowledge technicians will eventually be replaced by AI and other technologies, placing special emphasis on a doctor’s comunication and empathy skills

2. There are many reasons why doctors don’t play nice with others and they need to be addressed.

3. Only about 1% of doctors have an entrepreneurial mindset

4. You need to give knowledge technicians the knowledge, skills and attitudes necessary to evolve into managers, to leaders, to leaderpreneurs

5. It is almost impossible to pick identify and select people with a real or nascent entrepreneurial mindset. Most hide their innerpreneurial tendencies for fear of being eliminated by the BIG MEDICINE corporate immune system

6. Creating strategic alignment between the patient and profit mission is a full time job

7. Entrepreneurship or intrapreneurship is not about starting companies. It is about creating user defined value through the deployment of innovation.

8. Doctors matter. DISing them won’t work

9. Intrapreneurs are employed physicians trying to act like entrepreneurs in their organization. They are fighting a two front war. Don’t make it any harder than it already is.

10. You won’t find many who fit the bill, so be sure you celebrate the champions and use them as role models for others. Don’t make these mistakes when it comes to overlooking internal talent.

11. Renters act differently than owners

12. Quality of care is not improved in employed physician organizations.

How change agents respond to frustration is based on 1) whether they feel they have the ability, status or power to change things, and 2) whether they are committed to do so. In other words, depending on whether they are willing and able to engage, they will lead (attacker), follow (defender), get out of the way (disengage or be a sabateur) or quit.

Here are 7 reasons why your best docs might quit. Here are some danger signs that they are headed for the exits:

1. Their work productivity has decreased more than usual.
2. They have acted less like a team player than usual.
3. They have been doing the minimum amount of work more frequently than usual.
4. They have been less interested in pleasing their manager than usual.
5. They have been less willing to commit to long-term timelines than usual.
6. They have exhibited a negative change in attitude.
7. They have exhibited less effort and work motivation than usual.
8. They have exhibited less focus on job related matters than usual.
9. They have expressed dissatisfaction with their current job more frequently than usual.
10. They have expressed dissatisfaction with their supervisor more frequently than usual.
11. They have left early from work more frequently than usual.
12. They have lost enthusiasm for the mission of the organization.
13. They have shown less interest in working with customers than usual.

OK. Hopefully, I’ve convinced you to hire physician intrapreneurs. Now what should you do next?

1. Provide them with the knowledge, resources, networks, mentors and experiential learning they need to succeed.

2. Create a transparent innovation leadership system. Give them some PEARLS

3. Support champions, facilitate team building and develop Physician Intrapreneurs in Residence (PIIRs) to support peers.

4. Set strategy, define the vision and get out of the way

5. Let them fail without labeling them as “disruptive physicians”

6. Be sure they are integrated into your regional innovation ecosystem

7. Absolutely, positively, walk the walk. Never promise something you can’t deliver. If you do, you will break the trust you are trying to create and never regain it.

8. Be sure you have the structure, process and culture that fertilizes imaginative physician intrapreneurs. Do what it takes, within reason, to make your doctors happy. Happy doctors are safer, more enjoyable to work with, make happy patients , and , according to positive psychologist, are more creative, imaginative and entrepreneurial.

9. Not everyone is motivated by the same things. Some want time. Some want money. Some just want revenge, driven by anger to make things right based on their values.

10. Think big, but seek and leverage small wins.

Pay attention to these 10 reasons why your doctors will quit:

1. They are not respected as people at work. They are viewed as production units, rather than valued collaborators.

2. They don’t have the right tools, equipment, information and basic operational requirements they need to do their job. When they ask for tools or guidance they get yelled at or ignored. What kind of company would impede its employees’ ability to do their jobs, then get mad at them for asking?

3. Their employer disregards their personal life and has no compassion for their obligations outside of work.

4. Their immediate supervisor is a tyrant, unqualified for their job, or both.

5. They are tired of being lied to.

6. They have no visibility into the future and no confidence their leaders will do the right thing, either from a business standpoint or a human standpoint.

7. They are tired of dealing with the politics in their workplace.

8. They are underpaid and overworked.

9. They go to work every day and push a rock uphill, trying in vain to get forward motion on their projects. They’re tired of pushing.

10. They have to watch every word they say and every move they make, because the knives are out and they could get in trouble — or get fired — for almost any reason.

The face of intrapreneurship is changing in many industries other than medicine.

You also need to dial back your corporate innovation immune system.

There is a reasonable chance that the physician intrepreneurs you hired are already looking for another job.

Here are 10 mistakes to avoid if you want to prevent losing our best physician intrapreneurs.However, losing your best is actually good for you for many reasons.

Recruiting, developing and retaining physician intrapreneurs is a difficult task. Here are some ideas on how to recruit for group creativity.

Despite all this, try not to buy into some myths about intrapreneurship. As noted, to start, innovation must be recognized as a permanent function of a successful company, just like other business functions such as accounting, operations, sales, and finance. It’s hard to imagine a large company without a marketing department or division, yet less than 50 years ago marketing as a business function, profession, and department did not exist. The same is true of innovation today. If companies want to be able to consistently innovate, they need dedicated innovation professionals to carry out the functions of discovery, development, incubation, acceleration, and scaling.

But this innovation division can’t be siloed off from the rest of the business. Company incubators and innovation labs that are isolated from the rest of the organization tend to have limited success, because they are disconnected from a larger system. Game-changing innovations require a holistic approach across the organization.

Simply hiring doctors does not improve the quality of care. To thrive, however, HR managers and recruiters need to to have new tarkets in their sights and provide recruits with the tools they need to add value not just to themselves, but to their organizations as well. It’s the only way to get to the playoffs.

What gets you up in the morning?

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