GUEST POST from Arlen Meyers

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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.

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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.

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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?

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GUEST POST from Arlen Meyers

The IHI Triple Aim is to lower per capita costs, improve the quality of outcomes and improve the patient experience.Add the doctor experience and you have the quadruple ain. Some patient engagement and experience experts say there are 5 steps to making it happen:

1. Establish vision

2.Create a culture of engagement

3. Employ the right technology

4.Empower patients

5. Be ready to evolve.

Others have outlined how to get it done.

It’s been demonstrated over and over again that happy employees make happy customers. Likewise, burned out, unhappy doctors make unhappy patients. The key to the patient experience is the doctor experience, yet employers and organized medicine have dropped the ball and don’t seem to see the link. Physician burnout is now a public health crisis with more than half of doctors feeling the sting. What/s more, no one has a lasting cure.

In 1981, the psychologist Christina Maslach, working with several colleagues, set out to create a test to measure occupational burnout. Eventually termed the Maslach Inventory, the scale assessed the risk of burnout by testing subjects along three basic dimensions: emotional exhaustion, depersonalization and personal accomplishment. The first set of questions, nine in total, measured the feeling of being chronically overextended or emotionally fatigued in the workplace. The second, with five items, tried to capture the feeling of becoming detached or disconnected from the recipient of your services: toddlers in the case of kindergarten teachers, or patients in the case of doctors (“I haven’t even touched a patient,” as the resident put it). The final dimension that Maslach identified, through eight questions, was a loss of personal accomplishment, a feeling that nothing was being achieved.

The AMA’s STEPS Forward collection offers free online modules that help physicians and system leaders learn their risk factors for burnout and adopt medical practice solutions to reignite professional fulfillment and resilience, including modules that focus on how to change key workflows and processes, such as pre-visit planning and synchronized prescription renewal.

In 2016, Carilion Clinic conducted a survey encompassing physician burnout and employee engagement. The survey was distributed to all physicians, residents and fellows, advanced care practitioners and medical students in the system.

The results were sobering. Fifty-nine percent of Carilion physicians were experiencing high burnout. Half of medical students, physician assistants and nurse practitioners also reported burnout, with burnout being worst among residents. The survey renewed Carilion’s focus on efforts to rectify widespread burnout. Leaders came up with these seven innovative ideas and initiatives, as outlined in an AMA STEPS Forward™ module.

Burnout takes not just a human toll, but a financial one as well.

If nothing were done to address burnout, two Stanford researchers estimated, almost 60 physicians would leave Stanford within two years. The cost of recruitment for each physician—depending on the specialty and rank of faculty—would range from more than $250,000 to almost $1 million. And, for those 58 physicians, Stanford’s economic loss over two years would range from a minimum of $15.5 million to a maximum of $55.5 million.

EMRs have become the burnout scapegoat, but there are 5 main sources of burnout ,which mostly have to do with the loss of control and authority and not having the right tools and support to do your job.

1. The practice of clinical medicine.

2. Your specific job.

3. Having a life.

4. The conditioning of our medical education

5. The leadership skills of your immediate supervisors.

To address the problem we need to PISS on it:

1. Prevention. Burnout prevention interventions are effective but tend to fatigue. They need to reinforced periodically.

2. Innovation: We need better ways to intervene and prevent relapse. For example, peer-to-peer network support systems provide peer supporters to those who have experienced an adverse medical event and need someone to talk to them.

3. Surveillance: Few health service organizations or academic medical centers monitor burn out or employee disengagement and usually depend on self reporting or flushing out the bad apples. It does not work. Doctors, like military personnel, have a warrior mentality that places stigma on those who won’t man up.

4. Stewardship: We need better ways to shield harried doctors from adminstrivia and anything that prevents them from practicing to the top of their license.

Members of a recent AMA summit issued this call to action:

They committed to:

1. Regularly measure the well-being of our physician workforce at our institutions using one of several standardized, benchmarked instruments.
2. Where possible, include measures of physician well-being in our institutional performance dashboards along with financial and other performance metrics.
3. Evaluate and track the institutional costs of physician turnover, early retirement, and reductions in clinical effort.
4. Emphasize the importance of leadership skill development for physicians and managers leading physicians throughout our organization.
5. Understand and address more fully the clerical burden and inappropriate allocation of work to physicians that is contributing to professional burnout.
6. Support collaborative, team-based models of care where physician expertise is maximally utilized for patient benefit, with tasks that do not require the unique training of a physician delegated to other skilled team members.
7. Encourage government/regulators to address the increasing regulatory burden that is driving inefficiency, redundancy, and waste in health care and to proactively monitor and address new unnecessary and/or redundant regulations.
8. Encourage and support the AMA and other national organizations to work with regulators and technology vendors to align technology and policy with advanced models of team-based care and to reduce the burden of the EHR on all users.
9. Encourage and support the AMA and other national organizations in developing further initiatives to make progress in this area by compiling and sharing best practices from institutions that have successfully begun to address burnout, profiling case studies of effective well-being programs, efficient and satisfying changes in task distribution, and outlining a set of principles for achieving the well-being of health professionals.
10. Continue to educate our fellow CEOs as well as other stakeholders in the health care ecosystem about the importance of reducing burnout and improving the well-being of physicians as well as other health care professionals.
11. Support and use organizational research at our centers to determine the most effective policies and interventions to improve professional well-being among our physicians and other health care professionals.

Happy, productive doctors make happy patients and that drives revenue. Plus, the direct and indirect costs of burnout and turnover justify the investments and boosts the ROI.

Organizational behavior experts tell us that the single biggest cause of job stress is lack of control. Rules, red tape, interference, and IT mandates that don’t help doctors take care of patients don’t help and demoralize doctors. Creating a better attitude is about giving employees control, not wresting it from them.

These workplace factors contribute to burnout in family physicians.

Physician burnout can be reduced by interventions at the individual and organizational level.

These burnout risk factors should be measured and addressed at an organizational level to help restore joy to the day’s work.

Workload: The demands of your job exceed the resources available to accomplish it.

Control: You have very little say over how you do what you do—and no one is interested in your feedback.

Rewards: Rewards are less about salary and benefits and more about recognition for a job well done. If the best you can say about your workday is that “there were no screamers today” or “nothing bad happened,” then you and your workplace are in trouble, Maslach noted.

Community: “Unresolved conflicts that fester over time into a socially toxic environment” may lead to anti-social behaviors, such as bullying and rudeness, Maslach said.

Fairness: A perceived lack of equity in the workplace—one in which success “depends on who you know” rather than experience and expertise—can result in anger and hostility.

Values Conflicts: A disconnect between the values that give meaning to your life and your day-to-day work realities can chip away at your sense of self, with long-range consequences.

What is missing is intervention and change at the systemic level or regulatory level.. If anything, top down rules, regulations and constant policy changes from Washington is causing change fatigue and making matters worse.

Here are some organizational strategies to reduce burnout:

1. Acknowledge the problem and measure it.

2. Utilize the power of leadership.

3. Focus on providing job resources

4. Minimize job demands and conflict

5. Promote work-life integration

6. Promote individual resilience

Here are some tips on building personal resilience:

1. To build and work your plan for greater resilience, strengthen your CORE.
2. Adjust your mindset
3. Practice resilience on the small stuff

Be sure you are measuring the right thing with instruments that are valid.

We need to rename the Triple Aim the Quadruple Aim and many professional associations are supporting the movement to restore the joy in medicine.

Note to administrators:Results indicated that organizational commitment had a more persistent influence on performance at the business unit level than vice versa. Consistent with prior research, this suggests that job attitudes may come first, and that practitioners might be well advised to aim to improve job attitudes in order to boost performance.

Employed physician engagement is not as high as their employers think it is, and conceivably, could drop even more in the future.

Health professional burnout will have to be addressed at 3 levels: individual, organizational and systemic. The last one is the most problematic given the conflicting interests and resistance to change. Here is an example. Although most physicians view the delivery of high-quality care as a professional imperative, performance-measurement activities face increasing resistance from physicians and some policymakers who believe that current measures are not meaningful. In a recent survey, 63% of physicians said that current measures do not capture the quality of the care that physicians provide. Yet U.S. physician practices are spending $15.4 billion each year — about $40,000 per physician — to report on performance.

Burnout and depression rates among U.S. physicians failed to improve in 2019, despite growing efforts by healthcare organizations, hospitals, and academic centers to address the issue through wellness programs and other interventions

Did you get the memo?

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GUEST POST from Arlen Meyers

I think “health administration” is an anachronism, since we have a sick care system masquerading as a health care system and the last thing we need is more administrators, rather than leaderpreneurs.

Consequently, those offering programs to students interested in being health systems administrators offer courses and measure competencies designed to fight a phony war.

Instead, they should be requiring graduates to demonstrate the following knowledge, skills, abilities and competencies:

1. How to hire physician intrapreneurs and what to do with them once you have
2. Understand AI and machine learning and what to do with the results of algorithms.

3.How to overcome the barriers to US and international biomedical innovation and entrepreneurship

4.How to lead innovators

5.Success factors for successful organizational innovation

6.How to address the social determinants of adverse health outcomes

7.How to recruit, train, promote and retain a diverse talent pipeline

8.How to win the the 4th industrial revolution

9.How to improve the health professional, health care team, patient family and friends care team experience

10.How to change doctor and patient behavior and transform sick care to health care.

11. How to break down innovation silos in regional clusters

12. How to eliminate sick care worker burnout

13. How to reconcile the ethics of business with the ethics of medicine

14. How to switch from fee for service to value based care

15. How to give white coats the pink slip

Pillay, et al, have defined the healthcare innovation competencies as:

Opportunity recognition pertains to one’s ability to scan and search for new information, connect the dots between incidents that appear to be unrelated with limited cues, and recognize patterns or ideas that suggest potential opportunities in the myriad cues or signals that they receive (Baron, 2006).

Conveying a compelling vision/seeing the future reflects an individual’s proclivity for effective communication where he or she can translate his or her vision into condensed, clear, and intriguing messages to important stakeholders (Chen, Yao, & Kotha 2009).

Ability to maintain focus yet adapt speaks to the entrepreneurial experience. This ccan include considerable ambiguity and uncertainty, significant obstacles, ongoing emergence of new opportunities, and continuous change in circumstances (Morris et al., 2012). The entrepreneur must continuously adapt, change, modify, and switch while maintaining a self-regulated focus in the midst of volatile conditions (Haynie & Shepherd, 2009)

Resilience captures the cognitive tendency of an individual to cope with stressful, adverse, and devastating situations, to be able to recover from failures, and to constructively sustain his or her efforts to pursue goals. In reality, successful entrepreneurs are not easily beaten by distress or rejections. Instead, they are able to remain or resume a calm state of mind, to tactically frame and analyze problems, dig into the root cause of failures, and to search for ways to get back on track again (Sinclair & Wallston, 2004).

Interdisciplinary teamwork and collaboration refers to the ability of individuals to form partnerships with a team of professionally diverse individuals in a participatory, collaborative, and coordinated approach to share decisionmaking around issues as the means to achieving improved health outcomes (Orchard & Curran, 2003).

Assessing the feasibility of an opportunity emphasizes the need for innovators to make evaluations or judgments on whether emerging information or changes would lead to viable opportunities with profit potential (McMullen & Shepherd, 2006).

Self-Efficacy/Confidence relates to an entrepreneur’s self-confidence and selfassurance about his or her ability to take on challenges, to perform certain set of tasks as needed or expected, and to control processes, contingencies, or consequences in the entrepreneurial pursuit (Bandura, 1997; Baron & Markman, 2005; Tierney & Farmer, 2002).

Building and using networks concerns one’s ability to establish, maintain, and structure his or her contact network(s) in ways that foster relationships, enhance access to opportunities and/or resources, and potentially lead to realization of his or her objectives (Aldrich, 1999).

Tenacity/Perseverance refers to the extent to which entrepreneurs are committed to seeing their vision through, to endure the long journey to carry out venture creation, to work fervently despite challenges or adversity, to maintain interests, and persist with efforts in achieving goals (Duckworth & Quinn 2009; Hmieleski & Corbett, 2006).

Understanding of healthcare systems entails having a firm grasp of the various components of the health system and an understanding of the major issues faced by the stakeholders.

Resource leveraging/Bootstrapping describes the need to overcome resource constraints by leveraging resources from others. It also reflects a tendency for innovators to demonstrate an inclination towards effectual rather than causal reasoning in bringing together unique resource combinations (Greene &Brown, 1997; Honig, 2001; Politis, Winborg, & Dahlstrand, 2011).

Creative problem solving/Imaginativeness is characterized by Schumpeter (1942), who posited that creative destruction plays a key role in the innovation process. Innovators who start something are engaged in a process of creative imagination in which opportunities are exploited by continuously combining resources in new ways (Kirzner, 1973; Chiles, Bluedorn, & Gupta, 2007).

Design thinking is a human-centered, prototype-driven process for innovation that can be applied to product, service, and business design. It is the process of questioning, observing, and experimenting, so that you can become better equipped to capture valuable information and develop new business ideas. It requires experimentation in order to understand how things work, to test new business ideas or different approaches, and to look for valuable insights that may emerge in the process (Brown, 2008).

Guerrilla skills is a label adapted from a warfare context, describing approaches that center on clever ways to take advantage of one’s surroundings, do more with less, to rely upon unconventional tactics, and to utilize resources not recognized by others in accomplishing tasks within entrepreneurial firms (Schindehutte, Morris & Pitt, 2008).

Risk management/mitigation involves the systematic monitoring, assessing, hedging, transferring, and/or exploiting multifaceted risks encountered as an innovation initiative unfolds. Risk-aversive attitudes discourage individuals from innovative activities (Cramera et al., 2002), while successful entrepreneurs are willing to first recognize and bear the uncertainty or risk needed to take entrepreneurial actions, and are able to manage risk rather than simply trying to avoid risk (McMullen & Shepherd, 2006).

Cross disciplinary knowledge refers to an understanding of the connections, interrelations, and interactions between different fields of knowledge (Mosseri, 2006).

Change management is the ability to understand and manage driving forces, visions, and processes that fuel large-scale transformation (Kottler, 2011).

Information management is the collection and management of information from one or more sources and the distribution of that information to one or more audiences.

Behavioral economics refers to an understanding of psychological, social, cognitive, and emotional factors on the economic decisions of individuals and institutions, and the consequences for market prices, returns, and resource allocation (Lin, 2012). It is the understanding that drives decision making.

Whether you get an MD/MBA/MHA/JD/MPH or some other concoction of credentials, it is likely that you will have blind spots and that they won’t be filled in your formal training. Try not to let school get in the way of your education.

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GUEST POST from Arlen Meyers

A bubble is an economic cycle characterized by the rapid escalation of asset prices followed by a contraction. It is created by a surge in asset prices unwarranted by the fundamentals of the asset and driven by exuberant market behavior. When no more investors are willing to buy at the elevated price, a massive sell-off occurs, causing the bubble to deflate.

The pattern of a bubble is pretty consistent, despite variations in how the cycle is interpreted.

1. Displacement: This stage takes place when investors start to notice a new paradigm, like a new product or technology, or historically low interest rates — basically anything that gets their attention.
2. Boom: Prices start to rise at first, then get momentum as more investors enter the market. This sets up the stage for the boom. There is an overall sense of failing to jump in, causing even more people to start buying assets.
3. Euphoria: When euphoria hits and asset prices skyrocket, caution is thrown out the window.
4. Profit taking: Figuring out when the bubble will burst isn’t easy; once a bubble has burst, it will not inflate again. But anyone who looks at the warning signs will make money by selling off positions.
5. Panic: Asset prices change course and drop as quickly as they rose. Investors and others want to liquidate them at any price. Asset prices decline as supply outshines demand.

A somewhat similar model is the Gartner Hype Cycle.

Some think that there is a digital health bubble, an innovation bubble, a higher ed bubble , a graduate school bubble, a law school bubble and maybe even a medical school bubble.

One report suggests that leading digital health companies have not yet demonstrated substantial impact on disease burden or cost in the US health care system. The findings indicate the importance of fostering an environment, with regard to policy and the consumer market, that encourages the development of evidence-based, high-impact products.

Sick care innovation centers aren’t much better.

I believe whether you believe there is a bubble or not depends on the lens you use to see progress and how you define  and measure the outcome and impact of new things or old things done in a new way:

1. There might be technology bubbles, but technologies are not necessarily innovations i.e new things or old things done in a new way that create significant multiples of user defined value i.e quality/cost. Here is what you should know about innovation and how to measure it.
2. Sick care innovation takes a long time and constantly evolves, building on scientific and technological inventions and discoveries requiring a supportive culture, leaderpreneurs and ecosystems.
3. There are significant barriers to sick care innovation dissemination and implementation, so you need to take the long view
4. Occaisionally, significant innovations, like anesthesia, antibiotics or clean water, significantly shifts the curve with a rare demonstration of a paroxysm of progress
5. There are many stakeholders in sick care and each one values a product or service differently and asks for a different value proposition. For example, doctors value quality, patients value experience and convenience. What is a bubble to one is a boon to another
6. Sick care is a highly regulated industry so the path of progress depends as much on socioeconomic and political winds as it does discovery or inventions
7. Translating inventions to innovations is the work of entrepreneurs. The sick care entrepreneurial workforce and entrepreneurial cultures are in their infancy. The entrepreneurial mindset is foreign to most sick care professionals.
8. The educational and workforce models and the resulting talent pipelines producing knowledge technicians are archaic and outdated
9. The business model of Sickcare USA is not designed to create or value innovation or teach participants how to create it
10. There is no Moore’s Law in sick care so innovations many times translate into increased costs, not lower ones

There might be technological bubbles, like the dot come bust or digital health froth, but I don’t think there are sick care innovation bubbles. If anything, we are just beginning to learn how to translate inventions to innovations and data to value. Given the pace of progress, many of us won’t be around to see the results, let alone hear the pop.

Like the old Chinese proverb goes, “If you want to know what water is, don’t ask the fish”

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GUEST POST from Arlen Meyers

Sickcare professional entrepreneurs come in several flavors: private practitioners, technopreneurs, social entrepreneurs, edupreneurs, academic entrepreneurs, service providers and physician investors.

Some are intrapreneurs i.e. employed physicians trying or expected to add value to their employers by acting like entrepreneurs. In other words, they are trying to create employer defined value through the deployment of innovation by deploying a product, service or model that is designed to improve quality, access and the doctor and patient experience while decreasing costs.

What’s more, there are some basic biomedical and clinical innovation roadmaps- drugs, devices, digital health and care delivery, be it internal or something others can use outside of your organization. Each requires different knowledge, skills, abilities and competencies.

A lot has been written about how to innovate in your organization and overcome the barriers. The stops along the intrapreneur innovation roadmap typically involve:

1. Picking the right problem to solve
2. Creating the right product that solves the problem
3. Finding the right champion with the passion, perseverance and political savvy to execute
4. Helping the champion build a team that includes the right partners and sponsors
5. Overcoming the processes within the organzation that are barriers or working around them
6. Making sure that everyone is focused on the same purpose or desired results that are aligned with organizational priorities
7. Not punishing failure
8. Enabling pilots to demonstrate proof of concept that do not leave innovators in pilot purgatory
9. Pricing the solution appropriately and using the right revenue model
10. Punting on the idea when the evidence indicates the dog won’t eat the food

Here’s why you should hire physician intrapreneurs and what to do with them once you have. It doesn’t always go by the book,

Getting your intrapreneurial idea over the goal line is hard. Be sure mind your P’s (and Q’s) when you try.

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GUEST POST from Arlen Meyers

Every entrepreneur who has succeeded or failed (is there a difference?) has advice about how to get the right people on the bus. What questions should you ask at the interview? What character traits should you seek and how do you do that? How much is science and how much is just going with your gut and whether you click?

What Google found was that interview scores had no correlation with performance, of those who got hired.

Likewise, advisors or potential employees want to find the right fit as well. The rules are somewhat different when it comes to the board of directors, the management team, employees, consultants and advisors.

Maybe flipping a coin or a job lottery would save a bunch of time and money and get the same results.

I’ve been on both sides of the table so allow me share my two cents on how to staff your startup:

1. Hope for the best and expect to fire fast. Give yourself lots of wiggle room.

2. Don’t hire hood ornaments (doctors with fancy credentials that you parade on your website and pitch deck) unless you simply need one for credibility and really don’t expect them to do much more.

3. Clarify expectations, timelines and benchmarks

4. Rent advisors, don’t buy them

5. Barter, don’t rent, if possible

6. Expect most people to put a hand up, not show up

7. Define your next critical success factor (like raising 2M dollars in seed money) and find people who can help get it done. Once it’s done, stop and empty the bus, and reload. For example, suppose your company has achievements to date that include FDA 510(k) submission, provisional and non-provisional patent filing (there is no such thing as a non-provisional patent granted by the USPTO), and patent attorney freedom-to-operate letter (here’s what that is). You have raised $200,000 from angel investors and are currently raising $1.5M in the current seed round with a valuation of $10M. Who do you want to help, how and how much will you compensate them and for how long?

8. Don’t give away the store early in the game. If you are successful, you’ll have to give it away to get the money anyway so keep your powder dry

9. Hire people who are card carrying members of the Get Shit Done Club  

10. Evolve as fast as you can from a knowledge technician to manager, to leader, to entrepreneur to leaderpreneur i.e. work on the company, not in it.

11. Be careful about hiring interns since there are practical and labor law issues that can make your life more complicated than it already is or is going to be. Internships are supposed to be about helping the intern. You want people who primary purpose is to help your company as much and as soon as possible

12. Don’t overhire for quality or quantity. Do you really need to hire that expensive CFO when what you really need is someone to keep the books and do payroll at this stage of the game? What about business development, sales and marketing?

13. Figure out whether you are hiring someone, or joining someone, to help with strategy or tactics. At the beginning, it is usually a cacophany of both. As the company validates its model, though, there is the risk of the distraction of traction. For a surgical benefits management company, for example, you need to focus and define your SCOPE.

14. The single most important question you can ask yourself is, “Do I like and trust these people?” The second is, “Can I deliver what they want, or am I just doing this to stroke my ego and make some bucks?”

15. If you had one more day to live, would you spend it in a co-working space wearing a hoodie? How about training and hiring felons?

16. Promote intergenerational collaboration

Here are some tips on hiring sales people and avoiding the mistakes.

This on-demand talent model, dubbed SPEED by the author (Success, Plan, Execute, Evaluate, Decide), is good for the company, and good for all specialized, dedicated, and high performing people in the workforce today. Your company gets the flexibility to adapt quickly to the needs of a rapidly changing marketplace, and workers get to broaden their experience in the work they love.

One empirical analysis shows that companies that are equipped with both business and technical skills are disproportionately more likely to introduce new-to-the market innovations than firms that have only one of these skills. However, not all firms that are equipped with both types of skills are able to profit from them. Firms profit disproportionately from a mix of business and technical skills when the founder has technical knowledge and employs additional business experts. By contrast, we find no evidence of complimentary either when business and technical skills are balanced within a founding team, or when a founder with business skills hires employees with technical skills.

Entrepreneurial startup success is about entrepreneurial startup TEAMwork i.e.finding the people:

1. Who have Talent
2. Who can Execute
3. Who can Articulate a vision, mission, values and strategy
4. Who know how to raise, manage, protect and make large sums of Money

That means you will have to find people who play some skill positions like problem seeker, problem solver, money finder, score keeper, product developer, business builder, dot connector, risk manager and story teller.

The startup lineup should also have people in it with these skills and abilities.

How do you compensate these people without breaking the startup bank? Here are some ideas.

Hiring the right people makes the difference between fun and misery. Plan to make lots of mistakes and fire fast. Pivoting often means taking casualties.

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GUEST POST from Arlen Meyers

Doctors and their patients are joining forces in a pitched battle. There are six technologies that are colliding in sick care. They represent the front lines of the 4th Industrial Revolution. Which side wins will have significant impact on the future of medicine and society.

The 4th Industrial Revolution is a mental model created by the leaders of the Joint Economic Forum and describes how physical, digital and biologic technologies have collided and the resulting challenges and opportunities that presents. Strategies to win the revolution are designed to create guardrails around the potential collateral damage. But minimizing that damage will take state of the art weapons:

1. Rules and regulations for 4th industrial revolution technologies that balance the public health with innovation
2. Educational systems that create a diverse talent pipeline with the knowledge, skills and abilities to win the war
3. Rethinking STEM education
4. Stress the arts and soft skills education as part of public education with the necessary funding to support it
5. Create cost effectiveness screens for digital health products and services
6. Enforce tougher cybersecurity protections
7. Reform digital health reimbursement and payment rules
8.  Turn sick care into health care by paying for health
9.  Lead the revolution innovators, don’t manage innovation
10.  Rethink federally funding university and federal research lab technology transfer

We will need a new operating system for the 4th industrial revolution.

The American Medical Informatics Association is urging the Trump administration to leverage an existing industry strategy on artificial intelligence research and development, rather than beginning from scratch.

DARPA is a government agency responsible for developing and deploying weapons for warfighters of the future. We need CARPA- The Cyberhealth Advanced Research Projects Agency- to man the war room and do the same for doctors and their patients and an “czar” to run it.

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