Welcome To Entrepreneurship

Everyone is one Google search away from getting the information that they need, to start doing work that matters.

What is unfortunate though, is that lot of information isn’t a Google search away.  There’s a lot of stuff in business that people don’t write or talk about.

When I meet other entrepreneurs, we talk about things between ourselves that we wouldn’t ever dare utter in public, or write about in a public space.

I suppose the reason we don’t speak about certain things in public is simply because it would be too controversial and no one can be bothered to deal with the consequences.  I imagine this is the same reason why parents lie to their children when they start asking those difficult questions.  It’s just easier not to tell the truth.

This really sucks for anyone who wants to read about or learn about entrepreneurship passively from the back seat.

The unfortunate reality is that you can only really learn about entrepreneurship by sitting at the front, behind the steering wheel.  Don’t know how to drive?  Don’t know where you’re going?  That means you’re doing it right.  Welcome to entrepreneurship.


Ignorance Is Strength

I was reading some George Orwell and I came across this quote:

“In our society, those who have the best knowledge of what is happening are also those who are furthest from seeing the world as it is. In general, the greater the understanding, the greater the delusion; the more intelligent, the less sane.” 

These two sentences in effect perfectly sum up what is wrong with not only society, but also with large organisations.

My own experience in the world of medicine echoes this sentiment.  I am always struck by how front line staff are all able to perfectly describe what is wrong with the NHS and can offer dozens and dozens of solutions to improve things, to make things more efficient and to make things better for patients.

However there are certain people (the “Inner Circle” as George Orwell calls them), who move away from actually seeing patients, see the healthcare system as a whole, see the challenges that we face socioeconomically, see the future (or think they can see the future) problems and so on.  As a result, these people end up knowing nothing about what actually needs to be done.

What does this mean for people on the front line?

Well, for the first time ever, thanks to the decreasing costs of technology, it means you can choose to pick yourself and create work that actually matters.  Work which is informed by actual reality.

Is it any wonder that incumbents get disrupted?  They are blinded by their own size and informed ignorance.

Which Bit Matters?

I just left the Clinical Entrepreneur Pit Stop Event, ran by NHS Innovation (I’ll do a full write up soon!), but it was incredibly useful getting feedback from seasoned entrepreneurs and pioneers as usual.

This pit stop talked a lot about how to fund raise from VCs, Angels as well as creating partnerships with different organisations.

I think entrepreneurship is all about walking a path that hasn’t been walked before.  Walking an un-walked path unlocks value that hasn’t been released before.  It was interesting to hear how fundraising is one of those things that you just can’t innovate on though!  You just have to play things by the book and put in a lot of due diligence.

I think that examining things and questioning things is important.

Often people will perceive that running a successful company means getting Angel investing, followed by VC funding.  Often people feel that to be successful you have to fund-raise.

But what actually makes an entrepreneur successful?  Can we dissect the actions of really successful entrepreneurs and figure out what they were trying to say with their advice around fundraising.

When looking at the successful entrepreneurs, they all had something in common: they made something that the market really wanted!

The fundraising came as a result of having created something that was needed!

When getting ready for bed, people brush their teeth, get into their pyjamas, turn the light off, lie on a soft surface of some kind, turn the lights off and then shut their eyes.  Actually the only two things you need to do to get to sleep is lie down (or sit) and shut your eyes.  Everything else is superfluous to what you need to do.

I think startups and businesses are the same.  Fundraising isn’t a must, creating something the market wants is.  The rest of the actions are just following the motions.

Creating Tension

Michael Schrage has written about what great organisations do.

And his term for it is:

“Who do you want your customers to become?”

I think this is similar to asking “what change do you want to make?”.

Harley Davidson is an amazing brand, worth billions of dollars.  Not because they make the best bikes in the world, but because they’ve turned a group of “outsiders” into “insiders”.  These outsiders used to be disrespected and frowned upon.  But when these people come together they feel something.  Harley Davidson made change happen.

Why is it that so many people line up outside the Apple Store for the newest phone?  It’s because Apple has made us into consumers that now have good taste in digital goods.

If we are going to make change.  You and I – what change are we going to make with our work?

I think doing important work means you have to be the one “in the spot”.  To do important work means you have to choose to be the one in the spot.

Being in the spot doesn’t mean it’s your “job” to do the work, or that the “dummies guide” told you to do the work.  It doesn’t mean you’re doing it because “everyone else is doing it”.

The work that matters, the work that we have the chance to create in our lives, is never work that other people could do.  It’s never the work being done by lots and lots of people.

The work that matters is the type of work where people would miss you if you were gone.  The work that matters is the type of work where people would be sad if you stopped.

Most of use work in organisations.  And most organisations are obsessed with authority.  “Can he do that?” “How come he didn’t ask me if he could do that?”  “Can I do that?”  “Who has the authority?”  “Who has the authority to spend for this?”  “Give me a raise so I can tell other people what to do.”

And this search for authority informs most of the bureaucracies in our life.  If you only had more authority, the thinking goes, then you could get “on the spot” and do the work that matters.

Well, no one’s giving you authority any time soon.  But there is something else you can take any time you want; responsibility.

People who take responsibility get responsibility.  No one gives it to you, you take it.  And what comes with it is the willingness to give away credit.  If you are giving away credit and taking responsibility when things go wrong, there is a looooong line of people out the door who want to work with you.

And this is super hard.  Because not only do you have to go “on the spot” and say; “I am going to do this”, but then you have to be responsible for what happens next.

Which leads to this huge idea about change.  Because when we do work that matters, we are changing other people.

There are two problems when creating change in other people: other people don’t want to change and we (ourselves) don’t want to be responsible for creating change.  Tension in us, tension in them.

Think of a great artist from centuries ago.  Got someone?  They created art that was universally hated by everyone!  Whether it’s Jackson Pollock or Elvis.  That person is hated.  But that person says “No!” and says “I’m making it anyway!”.

But it’s ok, because it was their responsibility and they wanted to create a change.

Are you willing to create this tension?

NHS Startup Part XVI – Thoughts On Integration

As integration with some of the large NHS IT suppliers comes closer and closer I am thinking more and more in-depth about what is the best way forward.

Integration when I first started my business seemed to be the holy grail!  It seemed to be the panacea to all of my problems.  However, as it was not feasible to integrate initially (most of the large IT suppliers don’t want to integrate as they want to own a monopoly, I didn’t have the contacts at that point to even begin discussions with the large suppliers to integrate and we still hadn’t tested out our assumptions / if our product would even work) I decided to take a massive leap of faith and build a stand alone system.

Being a stand alone system has loads of advantages.  The APIs for most of the legacy software in the NHS are hard to use, have poor functionality and limits what you can do.  It also locks you into a system which is inherently broken and can’t keep up with the demands of modern medicine – If the existing systems were so good, then my company wouldn’t exist!  It also prohibits you from using third-party apps which you want to incorporate into your service as they are not approved by the NHS.

Not being integrated allows you to be super lean, iterate, build new phases, do A/B testing and so on.  The flexibility and the speed simply wouldn’t be possible with integration.

This is the dilemma in my mind: We’ve managed to launch our product in several surgeries now and next month we’ll be launching our service to a massive 70,000 patient company.  This all occurred within a six month time period (our product first launched at the end of Dec 16/beginning of Jan 17).  This leads me to believe that it is possible to grow the business without integration.

So why integrate?  It will open up a massive distribution channel.  EMIS who are very keen to get integration going, own >50% of the primary care EPR market.  TPP who I should be able to integrate with as well own about 30% of the market.  This would mean that integration would allow us to scale enormously.  Integration also means that we wouldn’t need to worry about a lot of scaling issues which may arise otherwise.

Well this sounds amazing!  But what are the down sides?  The down sides is that you’ve essentially given over control of your whole company!!!!  Is that really the best way forward?


A graph showing what happened to many websites after Google’s search engine update (Panda Update)

Giving over control of distribution is a big risk.  It’s like relying on google to provide all your web traffic or depending on amazon to sell your products.  One rule break, one update of an algorithm and you’re dead!

In effect, one of these big IT companies may just decide to kill my company for the hell of it.

I don’t think a strong foundation of a company can be built on someone else selling for you.  Entrepreneurs take responsibility for their own success, I am not prepared to give that over.

The other thing I’ve realised is that being an integrated app in someone elses system will really reduce the amount of money we may possibly be able to make in the long run.  In the short run it will provide a big boost in revenue, but not so much in the long run.

“Back of the envelope” maths is important.  If I solely rely on integration for distribution, I realised that hypothetically we would be making in the tens of thousands of pounds a month.  However, without integration and with control of our own distribution, we could be making in the hundreds of thousands of pounds a month.  Theoretically an order of magnitude difference!  Too hard to ignore.

So, here is the new strategy for my startup!

We integrate.  But, we provide very limited functionality with the integrated version so that people can get a taste of what we can do.  Want the full version?  Then you’ll need to dump your existing system which is garbage anyway and switch over to ours instead if you want to really increase your revenue and improve inefficiencies!

This seems like the wise move for the time being and the definite way forward in my particular case.

Integration no longer seems like the panacea I once thought.

NHS Startup Part XV – “It’s Up To Us Now.”

We launched a new phase of our app for our patients and Primary Care services this week.  The build for this phase was huge and we have been steadily working on it for the previous four months (designing, building, testing, messing up ad nauseum).

I think we’ve really nailed what we intended to do.  As we collect more data, it should show that we’ve increased how efficient things are running at the practice, that more revenue is being made and that patients also prefer our new app to the existing means.

My main fear for this launch was actually the practice and the number of staff that work there.

As our app continues to expand and increase in its abilities it requires a concerted effort by everyone at the surgery for it to really work to its full potential.

I was initially worried about this.  Up to now, a small number of staff at the practice have been doing everything and they didn’t even need to do much to make the app as successful as it has been.  Now everyone in the practice has a small part to play to make it really grow and have a bigger impact.

Could they do it?  Would they do anything wrong?  What happens if they simply don’t want to?

These were the questions running through my head.  Although the launch itself went without a hitch, I was leaving the surgery still thinking that someone may mess something up.  That’s when someone from the team said:

“It’s up to us now”

At that point I just felt a massive sense of relief.  I truly do believe that the team are all bought in now.  I realised that giving people something to do with regards to my app isn’t bad.  It’s actually good, because now everyone is bought in and involved in the mission.

I guess being a leader is about leading from the front, aligning people and then creating change.  Maybe I was trying to create change from the back and by not leading all this time.

One thing’s for sure though – if someone does mess up.  I won’t be upset or angry.  I’ll be grateful they tried.

The Brick Walls Are There For A Reason

I recently came across a lecture by Randy Pausch, who was a Professor at Carnegie Mellon University.  At the age of 46 he was diagnosed with terminal pancreatic cancer when he gave his last lecture.   

There is a quote from the lecture that I just absolutely love:

“The brick walls are there for a reason.  The brick walls are not there to keep us out; the brick walls are there to give us a chance to show how badly we want something.  The brick walls are there to stop the people who don’t want it badly enough.  They are there to stop the other people.”

“Other people” are most people.  You better be damn sure you’re not the “other people”, because they’re the ones that just complain, play the victim and then give up!