Medical Leadership: You Can't Win the Iditarod With A Team Of Pit Bulls

Medicine is no longer a single doc in a silo.

I, as well as most of my colleagues in medical leadership, trained in the era of the medical pit bull. The most desirable medical schools and training programs were the ones where only the strongest were admitted and the toughest survived (and we're not talking just about the patients!).

We loved the Professor and Attendings who put the most unrealistic demands on us. We mocked colleagues who complained. Being on call every other night meant missing half the patients. Leaving the hospital before 9 PM on your "night off" showed a lack of commitment. Asking for help showed weakness and incompetence. Sensitivity was seen as a barrier to optimal performance.

We pit bulls did well in an era when medical practice and care delivery were performed in silos. Trained for autonomy, we ruled in an environment that encouraged and rewarded such. You can't beat a pit bull one on one.

Imagine now a "team" of pit bulls. Imagine them harnessed together and expected to pull a sled laden with enormous weight over the most difficult of terrrain with minimal resources. Not a pretty piucture. Maybe we need to train more huskies and less pit bulls.

But wait, you say, medical schools have changed since the days of purges and leaches. They are investing in diversity, sensitivity training, and communication. Perhaps, but there are still a lot of us pit bulls on the faculties and, more importantly, in positions of leadership and authority in healthcare delivery systems.

While we're training future sled dogs, we need physician leaders today who can get the pit bulls to pull the sled together. this is our challenge now and for the foreseeable future.

Effective physician leadership requires a combination of traits and skills. Fortunately many physicians already possess leadership traits: passion, self-confidence, and knowledge. Unfortunately, however, most need to learn leadership skills: mastery of emotional intelligence and crucial conversations, relationship management, and team building. With proper training, motivation and commitment, these skills can be acquired.

The era of medical autonomy, silos and fragmentation is over. The fantasy of the pit bull cannot be sustained by our financial and demographic reality. The only way to maintain healthcare quality, reduce its cost and increase its distribution is to integrate its delivery along the broadest of continuums. Unexplained variance must be eliminated, outcomes must be tracked and performance metrics must be measured. All of these challenges will require cooperative rather than autonomous behavior. This is our Iditarod sled. We need trained physician leaders who can help us drag this sled together to the finish line.

Interview With The Entrepreneurial MD

Dr. Philippa Kennealy interviewed me not long ago for her Conversations with Trailblazers podcast on The Entrepreneurial MD blog.  

You can read her blog post here or skip directly to the podcast by clicking here .  

In the podcast entitled Bitten by the travel bug, this MD wants to get you going places, we discuss the transition to being an entrepreneur, taking measured risk, the beginnings of ExpedMed and the Medical Fusion Conference, and our vision for physician career change.

Physician Outsourcing: Technology Will Flatten The Medical World?

Medical outsourcing is going to become standard practice for specialties that don't require high-touch patient interaction; Radiology is one such example.

Here's a story from Canada that shows how this will start, but it will become much more prevalant as 'local' or 'regional' outsourcing.

When an Ontario man fell off a ladder and struck his head recently, the life-saving medical treatment he received included a surprising assist from halfway around the world.

The radiologist who read his brain scan, diagnosing a potentially lethal blood clot, was based in India, part of an unusual new twist on the overseas outsourcing trend.

A six-month-old arrangement between the Indian "teleradiology" company and an unnamed Canadian imaging centre is one of the first examples in this country of foreign medical outsourcing, a development that has professional groups and medical regulators here worried.

MRI, CT scan and X-ray images taken in Ontario and converted to digital format are zapped to the subcontinent over the Internet and interpreted by Canadian-trained Indian radiologists, who then report back on their findings.

A spokesman for Telediagnosys, based in the Western Indian city of Pune, said the service his firm offers is cheaper and faster than what is provided by overworked local specialists.

"Their earlier radiologist used to take at least 48 hours to give the reports and charged more than us," Dr. Ashish Dhawad, chief operating officer of Telediagnosys, said in an e-mail interview. His company turns around non-emergency work for the Ontario imaging centre within 12 hours.

Professional associations and regulators, however, question whether the quality of work would match that of a radiologist closer to hand, and ask whether disciplinary action would be possible against the offshore doctors if something went wrong.

"Imaging studies are not to be downplayed and treated as a commodity like a pound of butter or sack of wheat," said Dr. David Vickar, an Edmonton radiologist. "This is a consultation we are doing; it is not a laboratory test."

Meanwhile, as Canada continues to grapple with a severe physician shortage, observers speculate that foreign medical outsourcing could eventually expand to include other services, including pathology -- analysis of human tissue -- and even remote-control surgery.

In a paper just published in the journal Healthcare Quarterly, Sally Bean, a bio-ethicist at the University of Toronto, predicts that a lack of doctors and new technology will lead to a bigger role for health care outsourcing.

She suggests, though, that standards be developed to ensure privacy and quality are safeguarded and legal liability issues are addressed.

"It's a matter of how well it's done," Ms. Bean said. "If it's regulated and we're taking quality and safety and liability concerns seriously, then it could be a good thing."

Dr. Dhawad said his company has two radiologists who were trained in Canada and are certified in the specialty by the Royal College of Physicians and Surgeons. The firm has done mostly non-emergency work for a diagnostic-imaging centre in Ontario for the past six months.

All commercial markets, and medicine is a commercial marketplace, push for maximum efficiency. The fact that physicians will be impacted by this won't prevent it from happening and tired arguments that it's not in the best interest of patients are false on their face. While there will be much hand-wringing, gnashing of teeth, lawsuits and stories in the press of outsourcing gone wrong, it is in the best interest of the marketplace AND the patient population at large.

The fact that technology solutions are more efficient, more reliable, and scalable mean that this is an inevitability. It also means that it's an opportunity for physicians who embrace it.

The Pickup Line

A clearly articulated value proposition is something your grandmother could understand.

The story goes an eager entrepreneur walks into the office of a potential investor. Eager to present his pitch, the inventor sits in front of the investor’s desk and gets ready to start his well -rehearsed pitch. Before he could get out the first word, however, the investor throws a match book across his desk and quietly says, “On the back of that, describe your idea”.

While there are unique challenges and characteristics of new bioenterprises, fundamentally the elements of success are the same as any other business.

The first task is to define your position based on the target segment you intend to dominate. Too often, particularly with technologically based companies, the inventor or scientist discovers  or invents something .  They then start the process of a solution looking for a problem. Instead of being problem solvers, a more successful strategy is to be a problem seeker, design a solution that is better than what is presently offered and execute a plan to commercialize it.

Once you identify a large, growing, important, potentially profitable unmet need, the next step is to define a value proposition that describes how you intend to dominate the market  you’ve identified.  Value is the difference between the tangible and intangible benefits of buying a product or service minus (or divided by) the tangible or intangible costs.  Your value proposition is the promise you make to your customers to provide them value if they buy or use  your product.

The third element of success is to construct a business model, i.e.  provide your product or service in such a way that it costs less to make it and sell it than what people are willing to pay for it thus generating a profit and sustaining the business.

Finally, your value proposition and business model will need to be better than the competition. Otherwise, there is no reason for customers to switch or consider your product.

There are several models for articulating your value proposition and they are typically used to create an elevator pitch.

One model , described by Geoffrey Moore in his book “Crossing the Chasm”,  is to use the following template and just fill in the blanks:

• For (describe the target customers-beachhead segment only)
• Who are dissatisfied with (describe the current market alternative)
• Our product is a (new product category)
• That provides (key problem solving capability)
• Unlike (the product alternative or competition)
• We have assembled (key whole product features and benefits )

Another similar model is the NABC model:

• Define the NEEDS of the target segment
• Say what APPROACH you are taking to eliminate the market pain
• State clearly the BENEFITS /Cost of using your product
• Differentiate your product from the COMPETITION

The development of your feasibility, commercialization or business plan should result in a clearer and more precise , compelling value proposition as you go through several iterations of analysis. You’ll know you are getting close when you can tell someone your value proposition in the brief time it takes to go up a few floors in an elevator or on the back of a matchbook.

Being A Medical Entrepreneur Is Risky Business: Spotting The Landmines

Your job as an medical entrepreneur is to kill your idea early and often.

The innovation landscape is littered with buzzwords describing the impact of new ideas: earth-shattering, killer-app, disruptive, blockbuster, game-changer. Your idea, invention or discovery might be one of them. However, before you get ahead of yourself, or full of yourself, take time to do a high-level risk assessment. In this exercise, your goal is to kill your idea early and often and continually ask "Why shouldn't I kill this idea now?"

In bioinnovation, the risk categories generally include:

1. TECHNICAL RISK: Will my invention or discovery do what I claim it will do?

2. FUNDING RISK: Will I be able to get the money to do what I want to do when I want to do it?

3. INTELLECTUAL PROPERTY RISK: Will I be able to protect the intellectual property I create, control it,  and defend it?

4. EXECUTION/TEAM RISK: Will I be able to surround myself with experienced exectives who wil be able to execute our business plan?

5. MARKET RISK: Is their a large enough unmet need that will continue to grow and be profitable?

6. INDUSTRY RISK: Will the industry continue to grow and be immune from threat of substitutes, competitors, shifting supplier and buyer power?

7. BUSINESS MODEL RISK: Will your proposed business model, i.e., how you will make money, work?

8. REVENUE MODEL RISK: Are your assumptions about number of leads, conversion ratios, units sold, revenue/unit and repeat business valid, or are you betting on "only" .1% of the China market?

9. COST RISK: Are your fixed and variable cost projections reasonable?

10. REGULATORY AND REIMBURSEMENT RISK: Will you be able to get FDA approval and get someone to pay for your drug , device or diagnostic before the money runs out?

Give yourself 1-10 points for each category.

70-100: You've got a shot

50-70: Sounds like you have more work to do

<50: Don't give up your day job.

Performing this risk analysis before moving ahead with a formal feasibility plan (forget the business plan, dude, you are SO not there yet) will help you avoid spending time, effort and lots of money on an idea that was DOA from the beginning. The last thing you want to hear is your spouse telling you "I told you so".

An iPad Anyone?

So I finally broke down and purchased an iPad.  

For about a year I've been wondering if I should get an ebook reader like the Kindle or the Nook. When Apple came out with the iPad my curiosity heightened, but after a cursory review, I wondered what I would do with such a gadget. I mean, I already had an iPhone — wasn't an iPad simply a glorified iPhone without the ability to make phone calls?

Click to read more ...

Dancing For Dollars: Raising Seed Stage Capital

Finding the right investor is about much more than finding someone to write you a check.

Dancing with the Stars continues to get good ratings, maybe because of the the Palin factor, maybe because of the ornate, skimpy outfits or bare –chested celebrities strutting their stuff in front of millions. I don’t watch the show very often, but I’m a big fan of another extravaganza of choreography, the early stage company money dance, the money minuet, the cha-cha for cash. In this intricately interwoven , highly developed two-step , inventors and investors feel each other out, try to find the right fit and come to terms in a process that easily trumps the best fox trot, flamenco or fandango.

One takes the lead, the other follows. Eye ball to eye ball, with dramatic flair, there are moments of action, suspense, intrigue, passion , deception, and dazzling technique, all summed up with an exciting lift or a death defying twirl before the big ending. What’s more, I work on both sides of the aisle as an advisor to an investment bank, HeadwatersMB and to early stage companies looking for money, so I get a front row seat to the finals.

There are several articles and tips on what investors look for. The titles of the articles typically start with “5 Things" or “What investors look for". Like a ballroom dancer, though, let’s talk about what inventors should look for in a good investment partner.

Firstly, can they execute? Does the investment banker , private equity or money manager have a track record, connections, a client list, business process and skill sets to find the money and get the deal done within your time frame and budget. With the IPO market deader than a duet without music, target investors will come from family offices, endowments, private money and strategic partners. BioAngels, are hard to find outside of most major bioclusters. For that reason, the geographic coverage of your investment partner should be broad.

Secondly, is there a fit? Like a well matched couple performing the paso doble, you should find a partner with the same risk temperament, personality, and business savvy as you. They should have a technical background and a client list in industries similar to yours, with a thorough understanding of the investment landscape in your industry or specialty.

Finally, there are the intangibles. That certain “je n’ais sais quois” -the drama of their pitch, the energy to do the job, compatibility or having a feel for what you are trying to achieve. They just get it.

Finding the right investor is about much more than finding someone to write you a check. Anybody can move their feet when the music starts. Your job is to find a partner with whom you are in synch and who will work with you over the long term even after the music stops.

Ok. One, two, three...