Wednesday, January 02, 2013

Building the Worlds Most Desirable Company in 2013 : By The Book

At a recent annual Venture Capital 2012 round-up meeting, I had a different agenda. Instead of trying to see what we did wrong and who made a gazzilion dollars, I wanted to find out, what would make the worlds most desirable companies to work for? Even if it has just one employee.

For me, the word was 'desire' - often used in a sensuous context. The market today wants that, they want to be seduced and have that exclusive role play when they engage with you. They want to feel wanted and treated with experiences like their have never had. 

Build a service that people think they absolutely need even if they don't. Build a product that anyone can use out of the box without any instruction manual. Build an experience that seduces every user by making them fall helplessly in love with your product. Kind of like when the iPad first came out.

de·sir·a·ble  
/dəˈzī(ə)rəbəl/
Adjective
Wanted or wished for as being an attractive, useful, or necessary course of action.

The Boston pundits and area ivy leagers had big words to share with me, most of them lexicons rather than something I could put in practice the next morning. I was taking notes and 3 words stuck out: wow, amazing, seduce.

Ok, that was a start!


se·duce  
/siˈd(y)o͞os/
Verb
  1. Attract (someone) to a belief or into a course of action that is inadvisable or foolhardy

So let's talk about the word wow  (sorry to disappoint all World of Warcraft fans)
Exclamation:
Expressing astonishment or admiration.
  1. A sensational success.
  2. Slow pitch fluctuation in sound reproduction, perceptible in long notes.
Verb
Impress and excite (someone) greatly

When I first saw NEST I was jaw dropped. Not because of the core function of what the device did, but because of the "how" it performed that core function. I wanted to buy it even when I did not need it and even when it did absolutely nothing that drastically different for me. It's a thermostat for heavens sake! But it appealed to all my senses: design, creativity, convinience, appeal of something no one yet has, brag factor and being able to do something unnaturally (controlling you home heating via your iPhone from 4,000 mi away). Within a minute of reading about it, I started searching for that button on the site.

Does your idea makes your customers go "Holly mother of God . . . that is amazing!" or "How in the world did you do that" or "I am going to spend my entire pay check on it"? No . . . then rethink your development approach and launch strategy. Kind of like when Zero-G was first launched in the market. All I can still say is "wow"!!!!

a·maz·ing  
/əˈmāziNG/
Adjective
  1. Causing great surprise or wonder; astonishing.
  2. Startlingly impressive
Remember when IRC Chat first came out in the 90's. I felt like Captain Spock talking to my counsin half a world and 9 time zones away in real time. Then remember when Digital Cameras came out, when your first email went out, your first wireless internet experience in-flight, your first skydiving experience . . . . . even if you are developing a serious architecture diagram for medical software, make it do something that has never been done before (Imagine if EMR's could connect with consumer health devices and provide real time intelligence to care coordinators on adverse events).

Does your product wake your customers up from sleep and make them remember you a life time? Does it provide that 'almost magical' experience that makes even the most depressed individuals fall in love with you? Does it bring a smile to your face everytime you use it? Can your products think for your customers? Does it become default nature for your customers to use your products as 'verbs'? Google it!

Your ability to keep your customers guessing in wonder and surprise and bring them to what you deliver again and again are key ingredients for anyone to admire you. The retail consumer today uses the iPad or a 16GB RAM on a Quad Core laptop. They have little to no patience about slow download speeds, non-intuitive functions and ugly products. They can multi-task and want to be constantly amazed. Mediocracy will instantly kill you (well, unless you are in the enterprise software market of course).

Be amazing, seduce your customers and wow in every experience you give them. Kind of like movies stars.


Read more!

Sunday, January 08, 2012

2012 Outlook

The pace of my blogging has surely slowed down since I left Generation Health. Many have asked if I can increase the pace with all the new things I encounter on the "other side" of healthcare - research. I plan to talk about in next month. 


Before I get into 2012, let me look back at my 2011 predictions and see where I missed the mark and where I did not.


I said SEARCH will be hot and it sure was. Google's refocus on search as its core revenue generating technology, the sale of Endeca to IBM and, SAP's acquisitions and finally GoogleVentures' increasing portfolio of early stage investments in analytics based companies across both B2C and B2B space.


I said VISUAL DISPLAYS will be king in the B2C space - well I see more 3D gaming, more off the shelf technology for displaying metrics and I just saw a view from Microsoft labs demonstrating transparent cell phones in development. I was very close on this one.


CONTENT MANAGEMENT @ HOME was a downer. We did not see as many innovations in 2011 as I had expected. Neither did see services based approach, expect a cloud offering from Apple and Google - which was one small piece of the pie. Motorola had a half baked idea at CES 2012 recently but nothing too useful.


CONTENT CREATION was huge. Especially consumer content. As global markets boast denser internet penetration and as mobile access to content creation tools gain momentum, 2011 saw bigger boost in multimedia content. This has its good and bad sides. If everyone sounds like an expert then no one is an expert. Consumer generated content, especially for commerce, has somewhat diluted my ability to think objectively.


I said POWER would be big. 2011 saw more dollars put in alternative fuels, energy and battrey technologies than the past 5 years. But no innovations yet. 2011 was the year of realizing this gap and funding ideas. 


I said HEALTHCARE IT would be big. It indeed was . . . 2011 was implementation mode in the hospital and research world. Consumer healthcare start-ups are through the roof - almost a gold rush kind of a scenario. 


Now onto 2012 and where I see the big opportunities:

  • Analytic Convergence: How do I connect the dots between social media channels, transaction channels for my products - both on and off line and print media. There are companies addressing this we are still in kindergarden as far as true meaningful insights go.
  • Consumer Health: related apps, companies and services are popping up everywhere. The good news is that everyone realizes that this is an issue and innovation will not come from the big boys. The bad news is that ultimately in order for these companies to function as designed, reach the masses and allow them to collaborate - you will have to engage the big boys - which means the most innovative or compelling idea may not win. E.g. GoogleHealth. The companies that really matter in my opinion are CVS/Medco (powered by Surescripts), UnitedHealth, Wellpoint, Cigna and the Blues. Bet's are these folks address ~70% of the covered population in the United States. That's ~100 million people and their money flow. Pharma, device and bio-tech companies all need distribution, coverage and management so ultimately - these companies above dominate no matter what the circumstance. And he who controls the distribution and money to the masses control innovation.
  • Gaming: Face it - we like to be entertained but now we like feedback and sometimes even helped while being entertained. No matter what the situation or the context. Eating, playing, travelling, watching ads, buying stuff, teaching, learning, receiving healthcare - even sleeping and exercising. And there are game based apps for every need now - most of them absolutely useless but that's R&D dollars to where the market is going. Whether you like to play alone or collaborate - the opportunity is to 'entertain your way through commerce, healthcare and going about your daily life'. Figure a way out to build a game that allows you to obtain points based on how much you walk and redeem those points at Amazon or iApps and you are a winner.
  • Mobility: There is no more "web vs. mobile". No matter what the device, we're all connected to the internet all the time. I now have 14 devices in my household alone that connect to the internet, 5 of them 24x7. With mobility comes expectations - I was really annoyed recently to learn that I have to "plug" in my point and shoot camera to download pictures so I am thinking about buying an wireless SD card. I want to share, communicate, see and do things like commerce instantly. Anything that forces me to wait or extra effort will not cut it. I want my car electronics to remind me on my phone that I need to fill in a gas and tell me where I can get the cheapest one (Yelp+BMW=Awsomeness). I want hands free concierge (Reverse Siri) to schedule my appointment for my next haircut based on a reminder, I want my phone to tell me if I need to schedule an appointment with my doctor as I am not feeling well and I want my cell phone to provide immediate medical grade diagnostics.

There are more, more specifically in Clean Tech and transport space where opportunities in developing countries are massive. But these are more infrastructure projects where government involvement is critical and thus are not ideal for small, nimble venture funded start-ups. These are just my top investment opportunities, not necessarily investment strategies. That's a different topic for a different day. 


Read more!

Monday, October 03, 2011

Health 2.0 San Francisco: Musings

The Good (1.2) - Momentum, enthusiasm, ideas, capital commitments, execution, analytics, pharmacogenomics and steps in the right direction. Many companies, many voices, many singing the same tune.


The Bad (1) - Cereal aisle effect - clarity or confusion? I almost needed an "organic aisle" of companies focused on patients. As a patient, am I now expected to log into 14 different "portals" to pick up my medication used in my self injectable? But that's what the vendors will tell you. I see, I see . . . I see a bubble. M&A artists rejoice! Need a "Sustainability Prize" next year.


The Ugly (0.0) - Standards (lack of), interoperability, FDA pipeline, massive fragmentation, naivety of some tech entrepreneurs new to healthcare and design centric patient engagement models. Why is the physician seen as a non-entity - he is the primary influencer in most healthcare related decisions - chronic or acute. And why isn't anyone following the money - its a capital economy - insurance companies, PBM's and adjudication companies need to be involved - as much as they are seen as our red haired brother.


Notice I am not on Health 2.0 yet. We think we are - but we are not. We will be when 1 hospital can share the information with another and keep you in the loop - electronically by sending you an email (just like when you transfer money from one account to the other). We will be when you can share your medical device information on the go easily with your physicians and derive actionable adjustments to your regimen from a live person. We will be 2.0 when you are able to influence the market and change how research is conducted.We will be when your social interactions become as important as your clinic interactions.  We will be when you are in the drivers seat making a true difference in creating best practices. 


But today - you are merely chasing several chickens who fell out of a truck - some with their heads cut off. 


Read more!

Sunday, May 22, 2011

Can an economist be replaced?

Today is a strange day. It is strange because I realized no matter how hard anyone works – in the end – if we’re lucky and smarter than the guy sitting next to us – we’ll get it right. If not – we will continue with the hope to get it right somehow. There is really nothing you or I can do anything about how things are going to go. It’s all about how you can influence others to listen to your rants.

I started attending board meetings and investor presentations at the age of 10. Often, my father used to pick me up from school and have me do my homework at his office. This was the early 80’s. In the beginning, I was confused as to what people were really trying to say during these meetings. Answers to questions were meant to confuse rather than clarify. My questions to these gentlemen were generally ignored under “you’re too young to understand” but I continued my quest to try and decipher the conversations that occurred on a daily basis.

I soon found out that communication clarity had a decreasing return - higher the position lower the quality of communication. The engineers were at the top of my list – even at Grade 6, I knew what they were saying and understood why they were saying it. But I had no idea what the VP’s and C-Level were talking about. They used a lot of big words to say the same thing a hundred different ways. They sounded really important and intellectual and had several degrees after their names. My ‘ah-ha’ moment finally came to fruition after I was laid off the first time from CMGI back in the hay-days of the internet boom. It took me a solid decade and a half to understand what the board in those meetings really meant.

What he meant (as I understood 15 years later): I have no idea about our market size or our existing production capacity or how many people actually want what we make. In fact I don’t even know what we make anymore and who we compete with. But I’d like to go ahead and invest all our reserves in this deal anyways.

Dilbert was right after all!

This example clarifies why we screwed up in 2000, 2008 and about to do it again in a few years. In fact, economic cycles used have longer bell curves and it seems they’re getting shorter and shorter. With increasing and over-communicated media frenzied self-reporting news junkies that we are, our responses to everything is faster. John Chambers’ email to his employees about the confusion that reigns supreme at Cisco was in the hands of googlers within 20 minutes after he pushed the “send” button. How do you think we reacted at this and how do you think Wall St. interpreted this email? Now imagine you are in 1997 and it took you 2 weeks to get to this story and by the way – only in the hands of a small elite internet minority. Do you think we would have reacted the same way? It just means our idiocy is brought to light much faster than it used to. Before we did not have a voice – now – we blog. Capital market decisions are based more on speculation than facts. Speculation is just a fancy word for “I don’t have a clue so let’s bet”.

Whether you like it or not – the state of the economy is in a constant flux because there is so much information out there, most of it absolutely useless and out of context, that it is impossible for an average person to make sense of what’s really going on. Add the complexity of cross-border trade dependencies of goods and services and you’ve got yourself a big mess. And it’s this average person that is running the economy. Decisions in households and companies are more reactionary than factual consensus based. This results in nonsensical decisions and skewed economic outcomes.

Think about it – with all the combined knowledge of financial super-houses and the Fortune 500’s and with all their IT prowess – we still screwed up and no one had a clue what hit them. We let our lack of common sense run so supreme and deep that we defied all economic theories. And then we played the blame game. This is similar to 3 - 5 year olds eating sugared candies running around amok and banging their heads on the dining table and blaming the table for hurting them.

Our Government operates in an even greater conundrum and it would be waste of everyones time and effort to get into those details. Long story short – the Government is even more clueless than the private sector – the only difference is they have access to nukes, tanks can blow up countries and print cash.

And the other side of the grass is not green either. The EU is in deeper doodoo than we are given they operate as a union of countries – most of their monetary parameters completely out of sync with each other. So comparatively, we seem less stupid and other countries were copying us to put our “policies” in place.

Economists are a shrinking minority in my opinion. Before, theories worked because the level of market influence was controlled and fairly sustained with most information never communicated. Today, it’s the complete opposite both at the micro as well as macro level so there isn’t really a point to any of these economic text book theories. This is a bold statement to make but I stick to it. The past 3 cycles have baffled even the most renowned economists. I think we are over analyzing and making things more complicated than they need to be. I really believe common sense goes a long way and if people really wanted to hedge bets, they should put information in perspective.

But that’s wishful thinking. The real economic dependancies are not supply and demand factors – its information. The speed, the medium and the rate with which information is communicated. Look at how google rates its news stories – based on how many times it has been read. Whether or not there is any relevance to capital markets or not – most predictive modeling algorithms at hedge funds and private equity market leans towards frequency of information – not depth of information. There is no contextual approach in today’s world.

For a lot of young entrepreneurs entering the capital markets – remember – it’s not really about facts or how smart you are. People have already made up their minds and who you know. It’s about how you can navigate through all the idiocy floating around and finally bet on something or someone that you hope won’t screw-up.

After all – that’s the basis of venture capital, isn’t it? Try it a hundred times – maybe we’re right once. J

Create something that can filter through the information overload, put things in perspective and logically explain if the news should have any bearing on capital markets. Essentially – write a code to replace the economists’ job function. Now that’s a killer app!


Read more! Link

Tuesday, December 28, 2010

2011 Outlook

If 2009 was the year of hope, bail outs, 'fixing' our economy, saving your dollar, tax rebates, shrinking private equity market and being politically correct, 2010 brought us the grim realization that US is no longer a super-power, political shakeout between the republican and democratic primaries, lame duck congress sessions, the healthcare debate, the iPad, Chevy Volt, 1 in 7 Americans living in poverty, our burgeoning debt with China, increasing corruption scandals, over 10% unemployment - and angry birds!

My intention is to be a realist. Most start-ups I have seen fail over the past decade was because of 'experienced' staff running a new venture like the big blue and trying to do what they have always done without paying heed to new and emerging ideas. This philosophy has almost never worked in any sector. Now imagine running a country like a failed start-up. What would you do differently if you could not jump ship? (or will you?). Today - China and India produce more PhD engineers, scientists and inventors than US and increasingly revolutionary tech and medical devices come from R&D in these 2 countries.

Pick 10 successful ventures who exited over the past decade in any sector in the valley or in Boston. The ones who typically succeeded were the ones with the least experienced founders who completely rethought traditional boundaries and concepts of doing business and who focused on the small picture. They all seemed to have a product that people wanted or created markets by creating a gap that did not exist before. This includes the healthcare space - which many argue does not fall into a traditional venture category due to serious adoption issues, convoluted regulatory landscape and a severely fragmented revenue structure.

I believe 2011 will be a strange year for many reasons. I am no statesman but it seems like we're constantly debating a pseudo-socialist model in most our public interest sectors of healthcare, social security, taxation, banking and manufacturing. Think how many large private companies are now government controlled compared to 2008. The issues that faced us in Bush era are the same today and in some cases, 10x bigger and devastating to you and me. I also think our political correctness compared to any other country in the world has gone completely amok prompting strange behaviour across the country (how come I can't say Merry Christmas anymore, why do I need permission to hang the American Flag, why do we give kids in school the option to "opt-in" to sing the pledge of the legion - why can't I call a spade a spade?). These have become more than annoyances and thus groups like the tea party.

All of the above factors (and a lot more) make US seem like a poor region to start any business or attract foreign capital in 2011. But the picture is not that grim. I think US is at a critical juncture where it can take the high road and continue to flaunt its artificial influence over the world economy or we can get down to the basics and make sure we roll-up our sleeves and build stuff the rest of the world wants and get out of debt - period! Just like we used to back in the day.

The following is my A-list of where and what I think will be some of the most attractive markets/products for the next 12-18 months both from job creation as well as new ventures perspective:

  1. Search <> Text: Yes, this space is still hot. We're always asking questions, hopefully more intelligent ones. We're constantly seeking things, looking to compare, find, track, manage and connect with others trying to do the same. Search feeds our ego - it gives us a greater sense of control and power over things. And search is no longer restricted to text. :)

  2. Visual Displays = New Applications: I am already seeing big dollars put into display technologies like 3D-Televisions, transparent LCD screens and super hi-resolution medical displays. This will bring a plethora of new applications across industries as a technology as a platform is now an enabler of interactive content.

  3. Content Management @ Home: Media creation is cheap, storage is cheap, collaboration is cheap - managing content is neither cheap nor do today's technology solutions do it as well as they should. I want to wirelessly share my pictures from my computer to my TV without spending hundreds of dollars and hours trying to make yet another console work. Don't have that option today.

  4. Content Creation: Rich content + traffic is what people still pay for just like 1999. If you can produce unique content that draws a large number of repetitive traffic to your app/site - you're in business. There are many market segments that are still off-line or if on-line, do not have the necessary tools to expand their business in line with today's communication modalities. It does not need to make sense you know - Angry Birds did not make sense - until they became a phenom! (I hear they even have a movie coming out).

  5. Power: All these gadgets, electric cars and not enough power. Power requirements have been very slow to keep up with improvements in interactive heavy media content and will be the #1 issue with any retail products. Especially when oil prices are going up as is your electric bill.

  6. Healthcare: This is a big one! And I am not talking about enabling our physicians with EMR's. There needs to be services that generate greater patient ownership of their health, provide incentives to lead a healthier lifestyle (as strange as this sounds - 70% of us are considered obese) and enable the physicians with alternative revenue channels (capitated model for primary care kicking in 2011 thus producing widgets no longer makes money). However, I think the clinical content will still be controlled by the hospital systems (a.k.a. physicians) and overall HIT adoption will still lag behind claims. The US private medical insurance billing and charge capture is one of the most unnecessarily complicated and medically irrelevant needs that physicians have to comply with. And unfortunately, this market is controlled via the large EMR / Billing system vendors.
And here's my list of industry trends:

  1. 300 medical record companies in US alone . . . come on! This is an M&A gold mine waiting to happen.
  2. Traditional concierge care (or flavours of it) as a product line offering in large medical centers. The baby boomer generation is unhealthy, needy, rich and getting old fast and most importantly - are willing to spend.
  3. Enterprise IT Security: Still tops #1 IT capital spend (and has shown-up in operating budgets by virtue of cloud services and virtualized storage). Increasing federal and regulatory mandates will require brute force efforts for crowd control and audit. Can't live with it - can't live without it. This is going to get worse!
  4. Retail Micro-Finance: Worsening economy, longer job-loss-to-job-find cycles and life-style support needs will prompt ideas that will give people the opportunity to finance anywhere from a few hundred dollars to a few thousand.
  5. Telecommuting: is any IT managers nightmare. But this is unavoidable given companies are now giving options to their staff to work-from-home as a benefit to save expensive real-estate space. That means remote device management, connectivity, remote activity audit and control will become a part of any IT security budget and an important one.
  6. Apple's inroad into enterprise computing: has always been debated. However, Mr. Jobs has a long way before Apple can claim its spot in the server rooms, especially with connectivity, security and cross-compatibility with microsoft applications. Apple is not "already there" in my opinion and poses gapping holes in network device manageability.
  7. Venture Capital: is always be around but I still see more and more funds out of comission and teams shrinking in size and scope. This just means the larger corporate venture funds will hopefully gain momentum.
  8. Mobile Application Convergence: In today's telecom world, he who controls content controls the network. The CLEC's like the old Bell South and AT&T have increasing revenue dependance on content acrather than connectivity. Android's open-source rize claims to canibalize Apple's walled-garden market share in many ways. But one cannot expect to choose a side at all times. This is a great opportunity for application developers to make enable content that is able to reside on multiple device platforms as well be cross compatible. My applications should be device agnostic - not device dependant. This is a bold statement and I beliebe late 2011 will be the early signs of developers realizing this.

These are what I consider market needs. I am sure there are folks thinking about some of these ideas already. I encourage you to think outside the box, knock down the barriers of titles and see what you can do to put America back in the game.


Read more! Link

Friday, July 30, 2010

Chief Everything Officer

I was recently talking to a friend who served with the 101st Airborne near Camp Ranh Bay in Vietnam. He was barely 16 years old during his first tour of duty in ’65 with the 327th Infantry but was soon promoted to a Lieutenant in 2 years. I was surprised he even lasted that long given the average life span for anyone on ground operations in Vietnam was less than a month. He had been shot twice, lost his entire company in an ambush, had no more than 10 rounds of ammo on his .45 Colt and was without food or water with no radio to basecamp. Air support was impossible because of close combat nature of the mission. Think Tom Beranger (“Sergeant Barnes”) from the movie Platoon.

And the above played out during his second mission within two weeks of deployment. Talk about being thrown in the fire!

Execution = You: Start-ups truly test people for survival, patience, decision making and creative problem solving. For few, these traits come naturally but for most others, it’s a challenge. Your experience counts but experience alone does not define an entrepreneur, your philosophy and your culture does. Now these are not tactical traits but become more important than domain skills. This is especially true when companies go through rapid progression in growth and activity in a short period of time. If the average culture adoption per event for an employee is 6 months, think 5 events per month or 2.5 years per employee per month to adjust to fundamental changes in the company structure and business model. Now if I had 20 employees, each with their own culture adoption curve, I’d never get anything done in time to stay in business.

You <> Barriers: Think about school. Wasn’t it intimidating going to kindergarten, first grade … you don’t know many people, you’re not quite sure where to sit, you don’t know who the class bully is, you don’t know what to wear, you’re not sure what the teacher is going to say, what the homework is going to look like, etc. But you still made it and you made friends and you learnt a lot and many still cherish those memories. The same way, when I think back to my first start-up, we really did not know what we were doing until the first order came in, we were never quite sure what we were selling until we made our first sale and we were never sure how we would work together and in what teams until we somehow figured a way to play well in the sandbox. In the end, we built a team and the team made things happen, not me alone. We went from a collection of people to a team because each one of us played all the roles, some tactically, some strategically some philosophically. If we failed, it was because each one of us filed to play all the roles collectively. With a hand-full of people, the company is YOU. The barriers are you! So change it and stop complaining.

You = Culture: 99% of the working people have never worked in a start-up before. All these 99% of the folks were taught to think silo’d, structured and be in their own world. You may disagree, but under the hood, it is true J These same people come to a completely new environment without any barriers, culture, structure, processes, tools, etc. And each one of these folks apply context to build what they think has worked for them in the past. That’s the good news but that’s also the bad news. The good news is that is has worked for you in the past, the bad news is that is has only worked for you in the past. Now imagine all 10 people thinking this way. Again – nothing would ever get done. Unless – you stop being who you are, break all the rules and unscrew that door on your office and throw it away. I would almost say – don’t be in an office. Work in a large open environment. Think and talk about everything as a group – the good, the bad and the ugly. There is no room and time for being territorial and private about anything. If you the few of you can’t work together, how can ou build a 100 people team?

Culture <> You: You really don’t want this. The culture defined by a few can easily overtake the majority. Most facts in life are merely someone repeating the same issue a gazillion times for a long time before it is considered the truth. The next time someone tells you a fact – dig a little deeper and if it is anything beyond blatantly apparent – try and kill it by execution context. Most often it will have a positive effect. And those that repeatedly communicate the same issue, I think it’s time to have a chat with them. It’s business – nothing personal!

You <> Complaints: You joined a start-up to innovate and build new things and fix what’s broken today. Like your mother said when you had trouble playing with your toys or you found your homework too hard or you did not like your greens – suck it up, try again and work on it till you get to a point where you like what you do. There are after all, only a few of you so why can’t you make it work. There is really no time for “he said – she said” in a start-up. Just execute aggressively and you will see your rewards! Complaints are a negative culture, negativity creates animosity, animosity leads to fault lines for teams and fault lines ultimately leads to fractures. Fractures lead to “Going Out of Business” because we were too busy complaining.

You = CxO: If you were the CEO, CFO, COO, CIO, CMO, etc etc all in one . . . what would you do? How would you sell, market, build a product, build the technology, negotiate, manage your money, people, etc. Unless you role-play, you will never understand the challenges. I think all start-up employees should at least spend 1 day a month in a different role than they are.

You = Change: The reason start-ups survive and are successful is because they change and adapt well to that change. The art is in identifying the need for change. Changes is always needed but you are the one who executes on changes. If you sit around like a loaf of bread, you will eventually die out.

You = Creativity: Most people come to entrepreneurs with problems. Few come with solutions. But everyone is opinionated. It’s a classic tug-of-war between who is more valuable and productive – the person responsible for coming up with issues or the person who thinks knows it all. The answer lies in the approach and the situation in which things are presented. You can turn any negative experience into positive if you just change your lens and look at the “problem” as a “work-flow re-org”. If the person coming to you with issues everyday only hears the positive, there will be a day when he/she will realize that and be positive themselves. Not always true but true in most cases. Its even more fun when you successfully do something which was told could not be done. I have never found a traditional proven route to get there. It’s has always been via the road less travelled.

I am sure there are others that I haven’t captured here. Break down the titles, break down the barriers and break down the walls. See if you can all live together, communicate and facilitate an environment where things get done and fast. And for that, you have to be a chief at everything – or at least the key people need to be chiefs at everything.

By the way, the friend I was talking about earlier in this blog – he has successfully founded 3 companies, run 2 venture funds and is now retired and is an active philanthropist. He always told me “Janak, if I did not do what I had to do – I’d be dead”. Maybe it’s that sense of moral, ethical and execution criticality that made him what he is today.


Read more! Link

Monday, April 26, 2010

The Art Is In The Execution : Execution Is In The Cloud

Starting a business in 2010 is very different than 1998. Everything from hiring logistics, financials, telecom, space acquisition to managing my IT infrastructure can be achieved in a matter of hours if not minutes. I am a true believer that your competitiveness lies in how fast, how decisively and how accurately you align execution to tools that allow you to execute effectively. The cloud space is gaining more attention, because the economics of this model are unarguably most appealing to small and mid-sized businesses. Not only that, but even achieving regulatory compliance that meet stringent of guidelines can be done very quickly. Companies like Rackspace are SAS 70 II & ISO 27001 compliant with a fully operational HIPAA / HITECH control procedures in place. Others like Navisite can get your entire development platform up and running within a day with full access to dedicated hardware. And folks like Box.net, HyperOffice and SharePoint 2010 achieve far better scale and real-time colloboration and document management compared to something you will build inhouse.

A lot of skiptisism for hosted models come from old school thinking about managed service providers where audit, security and access were big concerns. That is no longer the case given the banking and life sciences industry slowly leaning towards managing sensitive data in the cloud environment. We now have tools (hardware, software) and standardized processes in the areas like server virtualization, encryption and remote device management that will allow you to be very creative and in complete control over who can and cannot get to the information you own even to folks who host your data. These companies are also willing to sign NDA's and provide necessary compliance documentation to meet even the strictest of state privacy guidelines (E.g. MA CR 17).

As the need for data and regulatory controls increase, need for speed, availability and audit increases and from what I can see, having an inhouse IT platform that does all will become the thing of the past. Putting highly depreciable metal in your server room will gain little support 5 years from now and you better have a darn good financial arguement to do that. With small to mid-sized organizations, the trust model seems to be slowly shifting gears from that of an in-house IT department to that of managed service organizations because you are comparing justifying labor + equipment + licenses + space + management + compliance certifications to an hourly labor cost or a per byte cost that does all.

If I do want to hire and build IT, I will do that only if it there is an arguement for building a strong IP portfolio and a disruptive product that truely adds value to bottom line operations. Think about what increases market cap, valuation, M&A attractiveness and your brand and what tools affect these areas directly? Then think about your transactional risk appetitite and operational overhead to own some of these tools. If you think you absolutely cannot operate in the cloud with whats out there, then so be it. The reasons for bring IT inhouse go beyond technical reasons. You are doing it in 2010 because of non-IT related agenda or you know that your operations will not scale as fast as you want by being in the cloud.
Back-office IT as a commodity is already here. Question is - are you using it as well as you should?


Read more! Link

Tuesday, December 29, 2009

Phone Etiquette: The One's I haven't Come Across

Not a day goes by when I receive calls and emails from people introducing themselves or calling me back regarding work. One would think that in 2010, we pretty much nailed down art of leaving voice mails or greeting someone on the phone or replying to a voice mail. But I guess, for the majority, it is still a learning experience. A lot has been written over the years about phone etiquettes but here are some that I have not come across and ones that drive me crazy and I wish people would be a little more diligent about how they communicate in general:

When leaving voice mails:

  1. Context: PLEASE PLEASE tell me why you're calling me. Don't give me your name and # and expect me to remember why you called. If you are Mike, I know 8 Mike's so tell me your last name and the company you're calling me from and regarding what.
  2. Clarity for Return Communication: When you leave me your call back number, do not so fast as I have to replay your message 10 times to get each 10 digit. Slow down a bit and think if you could remember a 10 digit # yourself if you spoke that fast. Talk fast until you reach a communication point where you need me to take down your tel #, email or an address. Second, do not assume I have your cell phone # on my phone because my phone could have been switched off, out of network or you may be calling from a private line.
  3. Black-Out Awareness: Most calls I receive are from people on cell phones. Cell phone technology in the US is ~12 years behind (I am being generous here) the rest of the developed world. So things like 'dead spots', going in and out of network, latency, etc is very common even on our so-called 3G networks. Be aware of this fact and don't expect that I got every word of what you said. I know - this is not your fault but as far as possible, make sure you have network on your cell phone before you touch that dial-pad.
  4. Story Telling Habits: If it takes you >1 min to convey something in a voice mail, wait to talk to me or email me. Either clarify your thoughts before you call and if the topic is indeed big, just wait till you get me on the phone. A voice mail is meant to convey a quick message for a follow-up, not an engaging but 1 way conversation.
  5. Device Awareness: I avoid talking to certain people when they call me from their cell phone when they sound like they have a wet towel around their mouth. Then there are phones which do not have any concept of back-ground noise cancellation and pick up every little sound forcing me to hear everything else other than the message in the voice mail. This is true for both land-line as well as cell phones. Be aware of how you sound to the other person. There are folks out there with devices that are 10 or more years old so honestly - get a new device. They're not that expensive you know!
  6. Call back Protocol: Almost everyone that leaves a voice mail expect me to return their calls. But the question is, I don't know when to call you because I don't know your time zone neither do I know when you are free. Tell me the time and date you left me the message because carrier voice mails are not reliable and are sometimes not instant. I could be in the airplane and switched off my cell phone or my battery could have died. Then tell me a few times i can call you at and on which time zone. I have landed up returning someones call at 5 AM California time and that is embarrassing for me as much it is for you.
  7. Location Awareness: So you have great network availability, a high-end smart phone and you are a pro at leaving voice mails. But you call me from the airport or you are in a food court of a mall or you are walking the streets of New York. That means I can't hear a word of what you just said in the voice mail. It is difficult for me to decipher your message from the gate attendant or that crying child at the mall. Especially when you have a Bluetooth ear-piece around you.


When you talk to someone over the phone, in addition to above, here are a few more:

  1. Context: I love it when people call me and say "Hi, this is Ben". My instant reply to something like that is "Hello, and I am Harry Potter". Because I have no idea who Ben is - unless I work with a Ben or have a friend/family who is called Ben and I have talked to you a hundred times before. Refer to the context piece above for voice mails because the conversation only gets interesting after the Harry Potter retort! :)
  2. Time Sensitivity: Most people just start talking to me once they make an introduction. It reminds me of call center sales calls from people reading scripts as soon as I pick up the phone, unaware of whether I have the time or the appropriate frame of mind or the opportunity to have whatever conversation you seek to engage me in. Unless we have scheduled a call, be courteous enough to ask if this is an appropriate time and that how long I can talk for. Do not assume that I will listen to you as soon as you open your mouth. And be respectful of people's times for work calls. I have received calls at 9 PM on a Friday and 2 PM on a Saturday. Unless we mutually decide on a time like this, I am not sure I would want to give you a call back if I hear from you at ungodly hours.
  3. Topic Sensitivity: This may sound like common sense but I have had folks call me regarding confidential and very private topics in a public place. Just wait till we meet or till both of us are in a place where we can talk freely. Maybe you don't want to talk about certain topics over the phone at all.
  4. Stop Multi Tasking: Stop typing, chewing, eating, drinking, taking a dump, constantly cough while in a conversation. I really don't need to hear you when you poop!
  5. Group Conversations: Conference calls are interesting, especially when a group of you are on a speaker phone. Most corporate conference devices are downright bad and sound like a Jedi's hologram relayed from a distant galaxy. Get closer to the device if you have one of those star-fishes in your conference room or any device owned by companies like Nortel, Cisco or Avaya! :)


Read more! Link

Tuesday, December 01, 2009

Doing Business in India - 10 Commandments

The below are general observations of doing business in India. With every generic rule, there is always an exception but being an Indian born and raised in India, I concur to these observations yet once again many years after I left the country.
  1. 1 Timing: People are late (always) to show up for meetings by at last 20 mins, personal or not. If someone tells you they will be at a certain location for diner at 8 PM, they will most likely show up late. Getting things done on time is rare and thus missed deadlines are common. Work typically starts around 10 AM, 2 hours later than western counter-parts. Allot 25-40% additional time to anything anyone tells you. That's just how the culture works.
  2. Interaction: Just because you sent an email does not mean you will get a reply. It depends on who you send the email to and at what hour. You're better off getting an answer by walking over to whoever it is you need to talk to. The hierarchy system is rampant contrary to western style of work-environment. Your superior is a "sir" and the big cheese is typically addressed as "boss". You need to take permission before you speak to your superiors in many cases. In most cases, you cannot leave your desk until your supervisor has left the office. You could be swatting flies but you have to stick around. Oddly enough, is cases I noticed, people stick around as late as possible as a show of dedication to the company - even when they don't actually do real work. The supervisors expect that. Coming home at 9 / 10 PM is common.
  3. Ethics: Like the Japanese, most businesses still expect their employees to stick around till they retire. I know this trend is changing slowly. You are expected to work long hours when you 1st join the company and are given the grunt work. Family is second work is first (again - very similar to the Japanese). Almost everyone I know from school and college is in this situation. Compared to US and European standards, there is zero work-life balance and overall quality of life is poor in the corporate world. This includes working for multi-national US based firms too.
  4. Personality: Indians are happy people. They really don't have any issues in life. They like to please. Sometimes this becomes a problem when they agree with everything you say and say yes to everything you need - whether or not they understand underlying risks and dependencies or whether or not they even have the capabilities you seek. One needs to diligently make sure clarity of communication and expectations are maintained at all times. Like Italians and Spaniards, Indians are loud animated people. If you have never left Maine, you will be in a culture shock.
  5. Regulatory & Business Environment: Getting site licenses for construction, incorporating companies, labor contracts, obtaining permits (there's a permit for everything), etc involves state regulators. Red tape, bureaucracy, convoluted laws and political interference is rampant. As much as people like to say its getting better, I would say its just getting more polished and at different levels. You pretty much need to bribe everyone from the "watchman" who guards your premises to your mail delivery guy to your support staff to the banker who will finance your expansion strategy. The word bribe is a grey area as sometimes you are blatantly asked to be put cash on the table before your work gets done and sometimes its a part of some religious matter. The latter is tricky because you need to decide how much and when to give out cash in order to continue business as usual. There are also random unscheduled Government declared "bandhs" (or closures/curfews) - defying which can be dangerous at times depending on the situation. If you have been to Mexico or Nigeria, you will know exactly what I am talking about.
  6. Religious Etiquette: India is a land of culture and over 100 of them. All unique in history and rich in their teachings. Thus, there are a lot of holidays and many reasons why someone would take time off. I have seen everything from people showing up one day with a shaved head for a sales meeting to folks with various marks and piercings on their body to folks wearing traditional clothes for a closing. Fyi . . . these guys I am referencing are Tier 1 M&A professionals from big ibanking houses to top CIO's of major corporations. This is something one needs to respect and understand.
  7. Logistics: India severely lacks basic infrastructure that we in the developed world take for granted. Roads, electricity, connectivity (Internet, telecom, wireless, etc) can depend from place to place even in major cities like Bombay. This will (and is already) change overtime but in a place as small as India with 1+ billion people, there are bound to be challenges related to commuting and communication support. But it will be a while before we can expect highways and traffic congestion to ease. Commuting in cities like Bombay and Bangalore is similar to Hong Kong, London, New York or Penang. A distance of 5 miles could easily take an hour. Basic internet connectivity is still a pipe dream for many and costs 3 to 4 times as much as what developed countries might typically pay (will change in the next decade with massive investments in WiFi and Wireless Broadband). Driving in India is challenging because basic civic sense, discipline and respect/consideration for others is a foreign concept. It is partially due to the infrastructure and partially due to lack of education and driving standards for giving out licences. If you thought the St Mary's round-about in Milan was a death sentence, try the Haji Ali circle in Bombay. Small traffic infractions are gotten away with by bribing the cop right on the street so its the price most people expect to pay to drive how they do in India.
  8. Communication: Most people I know do not have a voice mail or a call waiting service on their cell phones (because it costs more). So you can reach someone only if they want to be reached. If someone needs to reach you, they will call you and hang-up - its called "missed call back". Which means if I see I have a missed called from you, I will call you back. Inbound calls are free but outbound calls are charged (by virtue of airtime + $ or both). While on the phone, people can suddenly start talking to others without notifying you otherwise (not as common but enough for me to notice). It is common for people to have second names and call you by that name. It is also common for people to whistle, shout or clap their hands in order to address someone - even if I am literally right across the room. This is a cultural and a socio-economic thing - do not take offense.
  9. Food: Like the Japanese, most business conversations happen over food. Food is at the epicenter for everything. It is common for subordinates to invite their boss(s) over for lunch/diner at their house. Indians are some of the best cooks in the world (no exceptions - everyone of them including the maid next door) and they are proud to show it. 1 office of 50 employees can represent 50 different cuisines. Experience and explore that and don't find it strange that someone spent 6 hours cooking for you for 1 meal. Respect that - because food is a bonding thing. Did I say it is also one of the spiciest cuisines in the world.
  10. Class System: In the US, my friends are those I cherish and spend time with for who they are not what they are. In India, its the opposite. The rich mingle only with the rich and so on. The age old class system still exists and my guess is that it will continue to for a long time. You will never see a partner at a law firm hang out with the peons - even over cricket. Your social standing is defined based on who you interact with and who your friends are and where your kids go to school. Think Hollywood/LA meets Upper East Side here.
Like every country, in order to be successful, one needs to play the game of the locals. You can't expect to be a Bostonian in Bombay or a Texan in Bangalore. Will not work. You are in India for business because you want their business. If you want their business, be one with the culture. You might also learn some new tricks and cuisines in bargain! :)


Read more! Link

Friday, November 20, 2009

Personalized Medicine Conference: Learnings & Interpretations

I attended the Personalized Medicine conference in Boston recently. The overall theme centered around clinical effectiveness of genetic tests, the economics, the logistics of interpreting these tests and innovation in this space.


Talks began by discussing issues facing healthcare in the US today and what measures, federal and private, were being put in place to mitigate some of them. There is no right or wrong on any of these arguments being made because the truth is – no one has a darn clue about what the right path is to ‘fix’ the system. One could assert from logical conclusions that the top 2 issues of increasing costs and decreasing access to care providers is not sustainable – even in the short term. Here is my view on this issue.


A capitalistic economy has way too many inter-dependant relationships influencing each other at different intervals. By that I mean one cannot expect to have 100% success by introducing a pseudo-socialist healthcare model in a capitalistic economy. And a capitalistic economy is far from perfect, rather thrives on hype cycles and steep economic curves. But somehow, our economy has managed to correct itself over the decades, by way of intervention from the market itself or by way of the feds helping us out or some combination of both. This is the price we pay for innovation.


The notion that ‘one-size-fits-all’ will act as a pixie-dust solution to mend our broken ways is ludicrous. We need data exchange standards by way of a federal mandate (kudos to the CMS/HHS office who is already doing this piece), we need to re-align the payment system to where its needed the most (i.e. Primary Care) and provide incentives to enter medical school and lastly, pay for outcomes and not for producing widgets (the most difficult of metrics). Science is and will always be there to compliment medicine – but science is not the answer to fix medicine.


o v e r h e a r d “Less than 1% of total payments in healthcare actually go to the primary care doc”.


Then there was the grim news of some retail genetics companies like Decode Diagnostics declaring bankruptcy – which was typically expected for any hype-cycle. DNA Direct saved itself by realigning its strategy to work directly with labs and care providers than relying entirely on retail. Besides, retail genetics is more of a fad than a real science that is clinically actionable at this point. Sorry 23ANDME, no one really cares about you at this point. Maybe in 5 years I will throw a glance at you. We really don’t have time for what’s cool right now. My advice to you – stop ‘selling risk’ and scaring people, educate the medical community (your biggest allies are primary care docs) and stop making claims that instigate litigations behavior by the patient.


The figure-heads in healthcare IT presented the usual challenges of IT and operational infrastructure to support genetic tests. And the potentially shifting lab test market from the ‘lab’ to the physician office ultimately to the patient’s house and into the patients hands in real-time. The expected time-line for these events to be a reality was 2020.


o v e r h e a r d “It won’t be long before users will be able to whip out their Blackberry’s and swipe their finger across the screen for a real-time genetic test that will tell them exactly what they need to be doing to maintain their health”.


We heard from several venture capitalists on panels with CEO’s from big name firms like McKesson, Labcore, Elli Lily, United Health and Blue Cross Blue Shield. VC’s, known for their brutal honesty, were . . . . well . . brutally honest. Accusing VC’s of ‘funding crap and creating market turmoil’ is meaningless because VC’s create markets for which people pay. And sometimes people pay for crap. In this case, the ‘value’ equation is $’s. If you don’t agree with me, help me understand what real social interaction value does a company like Facebook provide?


There are exceptions of course – but I am trying to defend against general notions here. VC’s go where there’s money and they do create sustainable value. If BCBS or United Health or J&J pay for solutions from companies funded by VC’s, then that’s an innovation factor that should be addressed at United Health – not the start-up. The start-up exists because United Health fails to innovate. VC’s fuel innovation gaps. And entrepreneurs are the ones who mitigate these gaps. They are my true hero's.


o v e r h e a r d VC’s should make decisions that help sustain tangible value, not just focus on investor $ ”.


There was a ton of discussion around clinical efficacy from genetic tests compared to current guidelines and standard treatment protocols. The room was basically divided 50-50. The scientific community urged the medical community to lean towards genetic tests as the gold standard for the future but reality is very different and there is no established clinical value in deferring screening or diagnostic decisions to genetic tests. Family or social history is good enough without any significantly better outcomes. This might change 10 years from now, but not in the foreseeable future – thus putting primary care out of the equation (again). The business community felt that payments and reimbursements should be addressed before anything else. Physicians like to see administrative efficiencies and clinical effectiveness – but more importantly – there needs to be a financial argument for a switch.


o v e r h e a r d when all else fails, examine patient”.


There were many start-up companies touting their solution as the nest best thing. In today’s economy and from what I have seen in the past, I am not easily impressed by such claims – no matter who you are or what you do. This is healthcare, not eCommerce. There were a few that seemed to be adding tremendous value to existing infrastructure – whether its making benefits management decisions on behalf of the employee / insurance company or helping pharmacies get better at medication error / interaction management at the point of dispensing.


There was no mention of GoogleHealth or MS Health Vault or any other PHR’s. I was expecting to at least see them because the distribution and interpretation mechanism behind the education piece for patients seemed synonymous with PHR’s. One would think that Navigenics or Genetech may want to partner with the likes of Dossia but I guess that remains to be seen.


There was also very little discussion about privacy and the odd-ball state vs. federal law issues facing compliance officers and regulators alike.


o v e r h e a r d GINA is just HIPAA in disguise – a law without teeth”.


Lastly, the opportunity for biggest impact still remains in the asymptomatic domains of oncology and cardiology (highest mortality biggest procedure costs). Yes, there are R&D dollars in infectious disease, chronic disease conditions like diabetes, asthma and certain degenerative states like Alzheimer’s – but they pale in comparison with the former two I mentioned above. It also seemed that there were more resources being put in areas of diagnostic testing compared to procedural or pharmacogenomics.


Some of the pharma folks with the old school block-buster drug mentality are clearly showing signs of nervousness and they should. The philosophy of long drawn out clinical trials for large baseline population based on homogenous stratification will not work. There are ~a dozen or so drugs which currently require (by the FDA) to have a genetic test done before they can be administered. And there are several dozen in the FDA pipeline slated to hit the market that will absolutely require very specific genetic tests to be qualify as administrable. Medications are no longer considered patient agnostic, rather patient dependant.


o v e r h e a r d over 80% of women diagnosed with breast cancer undergo chemo, however it is shown only around 5% or so actually benefit from this therapy and an even smaller percentage of this 5% are 100% successful in the long term”.


This country faces big challenges. Basic care delivery and access issues still persist and ~80% of the physicians across the US have no computers or any way to share any information outside their office. Physicians today struggle with payments from insurance companies, catering to the free care and under-insured pool and have very little human contact time to make good of what the patient really cares for.


Our ability to make sense of care delivery before delivering science is critical. As long as we put science before how humans behave and what they expect, we will still be struggling with the same questions 10 years from now.


o v e r h e a r d Healthcare is the last cottage industry in America other than dry-cleaners. And even they use computers”.


Read more! Link
Get Free Shots from Snap.com