The Case For Private Businesses In The NHS

As a GP and entrepreneur, with my own software being used in the NHS, I have found that my opinion has continually changed with regards to businesses in the NHS.

I used to think as a junior doctor that a lot of the private companies dealing with the NHS were evil for two main reasons: overcharging the NHS for their services and the unethical use of patient data.

I think these two points are still valid for certain companies.  If you read some of the reviews of some of the NHS software suppliers then it’s patently obvious that certain organisations like TPP who provide the electronic health records for around 30% of NHS GP practices have stonewalled themselves from criticism.  Their software is also very dated and horrible to use as a result.

But, there are some great things about private enterprise.  One of the greatest differences between government ran organisations and private enterprises is accountability.

We live in an age where when there is outrage at a private company, real change can happen.  Just look at how the CEO of a multibillion dollar company was recently ousted for unethical behaviour.

I think that the world is changing.  People and consumers have a voice now, because of the Internet and how connected we are.  We can raise our concerns when we’re not happy and take our business elsewhere, or in my case start a business which is more ethically sound (I hope! :p ).

I feel that this is quite different from government organisations.  As private businesses become more transparent and ethical due to consumer pressures, large government organisations are appearing more and more opaque as time passes by.  Due to the lack of market place pressures they are also very inefficient and lack the focus that private enterprises need just to survive – but this is the subject of another blog post! 🙂

Selling “Time”

I really think that this blog post is a must read for any business owner out there.  I was introduced to this concept a while back and it has been continually brewing in my mind.  It’s totally changed my outlook on my own businesses and how other businesses operate.

The big idea:  It seems that businesses nowadays are selling “time” rather than anything else.  No matter what industry, it seems that what companies are actually doing is selling “time”. 

This sounded really weird to me at first, but now it’s actually painfully obvious.

We may think that Uber sells taxi rides.  But what it really sells is time.  Before I’ve gotten off of a train ride, I’ve already called an Uber.  It’s selling me time.  Time that I would have wasted waiting around for a taxi if it wasn’t for Uber.

What does Amazon sell?  Retail goods?  Actually it sells time. It takes me a second to order a product and get it delivered the next day.

Does JustEat or GrubHub sell food?  Or does it sell time and convenience.

What about Instacart?

It’s a really interesting way of looking at things and has implications for my own health tech startup.  Yes, I am automating a load of medical work, but actually when I think about it, I’m selling doctors and patients their time back to them.

One of the things that I’ve been thinking about recently is why this is such a big deal.

I think it’s a big deal because technology has allowed us to tap into a whole market place that didn’t even exist just a decade ago: the market place of time.  And back of the envelope maths says that this new market place is worth trillions of pounds.

Middle C

I have always thought of the guitar as one of the most emotive instruments.  I suppose that’s why I gravitated to it at such a young age.

What really stuck me the other day was how many ways there are to play a single note.  A pianist would kill to have so many options and ways of hitting a single note.

It’s so strange that when we play this instrument we leave our DNA in each note.  My family and others who listen to my music would immediately be able to tell that it was my music they were listening to after just a couple of notes.

Yngwie, Guthrie, Tosin – I can tell I’m listening to them after just a few notes.

I have a theory:  The better the guitarist, the less notes they have to play before you know whose playing.

Defining Cleverness

I was trying to figure out how to define cleverness the other day.  I was coming up with all sorts of ideas and thoughts.

But, it was too difficult for me to define it in a succinct way so I asked my girlfriend how she would define cleverness.  She immediately said:

“It’s having knowledge and putting it to good use!”

I think she’s pretty clever….

How To Tell When You’re Speaking To A Manager

“I’ll Try”

“I can’t promise”

“I’m not sure what my boss will say about that”

“That’s not possible”

“We can’t do that”

“It’s against policy”

“I can’t make someone else do their job”

Managers avoid accountability and often believe they are powerless to make an impact in the world.

Leaders however, seek out to be made accountable as they realise they can have a large impact in the world by working with those around them.

What You’re Not Told

Businesses that were created five years ago faced a different set of challenges than the challenges they would have faced today.  They also would have dealt with a market place which looks very different than today.

That’s not to say it’s easier or harder today.  It’s just different.

I think most people would be surprised by how level the playing field is for everyone.  Entrepreneurs who have been successful in the past will face the same challenges in the market place as first time entrepreneurs.  Sure, they may be better financed and have better connections.  But connections can be made and finance won’t save you when you don’t have something that the market actually wants.

What does this mean?  This means that there is only one “now” in business.  And as a result most books on business are irrelevant as they’re not talking about what the world looks like today, but what the world looked like when (or before!) the book was written.

As a result, realise that there is no guide to executing your idea and business plan.  There is no book that will tell you what to do next, there is no list of ingredients telling you the recipe for a successful startup, there isn’t a video that will tell you who to call next.

There is only “now”, you, your idea and your strategy.

And that’s all you need.

“Hey….What Languages Is Your App Written In?! What Should My App Use???” Here’s The Definitive Answer!

Entrepreneurs often discuss this topic ad nauseam.  It’s often a tell that the entrepreneur in question has no idea about tech and is just trying to sound well-informed.

My advice is this: If you are not technical then don’t waste more than thirty minutes of your time worrying about what language your app should be written in.

Here’s the lowdown on what non technical people need to know.

The most common server-side languages are PHP, followed by Ruby and Python.  If you’re making an app for an Apple device then you’ll be using Objective-C.  Android uses mostly Java.

Your data gets stored on a database (this is the reason why when you refresh your page your Amazon account doesn’t disappear, as your data isn’t stored by the browser, but on a database somewhere).  The most common databases are MySQL and NoSQL.

Some people like to argue saying that one language is better, faster, easier to code than the other.  Some people say that Ruby is the quickest and therefore you should be using this for your app.

So what should you use to make your app?  Well I would say to decide, you first need to become aware of what you are actually trying to achieve.

As an entrepreneur all you should be worried about is getting your product out, scaling and then being in a position to hire more people.

Basically if you are making an app, every order of magnitude you hit will require a huge build to cope with demand.  The code used in your MVP won’t be able to keep up with 10,000 active users at the same time.  It will require another large build.  When you reach 100,000 people you’ll need another big build.  In essence, if you are aiming to go big, then you’ll need to hire people to scale (this is also one of the reasons why if you’re not a coding ninja already,  you shouldn’t learn how to code to build a business, as it’ll take you 10 years to gain mastery in this domain).

And this is the reason why you shouldn’t really care about what the actual languages being used in your app are, but how easy it is to hire people who can code in those languages/technologies.  

PHP is by far and away the most popular server-side language on the web.  As of today >82% of the web uses this technology.  Compare this with 0.5% using Ruby and 0.2% using Python.  (You can see the stats on this web page: Click me!)

In terms of databases MySQL is the most popular.  (Click here for a breakdown of database use: Click me!)

So this is my point.  If your app uses the most popular languages then you will be able hire anyone from anywhere in the world to build and iterate for you.  It also drives costs down.  If you choose much less popular languages such as Python and Ruby then you won’t be able to scale, you’ll have a much harder time to find someone to hire and it will cost you more.

Try to avoid fads.  A lot of startups are using things like MongoDB, for their databases, but there really is no point.  MySQL does everything you need.

And what about people who say that it’s much quicker to build in Ruby / Python?  Well if you’re making a MVP, the difference in time is minimal.  The outcome and what your app will be able to do will also be minimal.  So basically, it’s a non issue.  What will be an issue is that if you use languages which are much less popular, you will have a much more difficult time scaling and hiring.

I also believe that this reasoning should also guide you with regards to what languages you should pick if you want to learn to code.  I can’t believe the number of people who don’t know Javascript, PHP and MySQL.  They’re shooting themselves in the foot as they will inevitably have to return to these at some point if they’re serious about code.