A Marathon of Sprints: Techstars Healthcare, in partnership with Cedars-Sinai

Before we started Techstars, I made a promise to myself and a friend that I’d write a weekly blog about what happened and what I learned. Well I skipped week 4, so this is a combo post. Fair warning, it’s a bit long.

A lot of people like to refer to entrepreneurism as a marathon, rather than a sprint. Frankly, I think that’s wrong. My (somewhat limited) experience so far has shown me that starting a company is more like a series of sprints, connected only by the occasional break to re-orient yourself as a founder.

While I’ve never run a marathon, I think I understand the general concept. Running a marathon requires a deliberate focus to keep your pace consistent over a great distance, right? That’s not startup life. At least not in my experience.

In my experience, startup life is about all out speed, and somewhat deliberate chaos. Needed to make a major decision yesterday? Manageable. Just found out about a grant opportunity? Bring it. Major product revisions before the rollout this Friday? Assemble the devs!

It may get crazy on a fairly regular basis, but the sprints of startup life are pretty normal and they’re generally pretty distinct. You run a 100m dash, collect yourself, power through the 200m race, take another breather to make sure you’re on the right track, and knock out a 400m sprint. Easy? No. Impossible? Also no.

Sometimes its ugly. 

So if starting a company is a marathon of sprints, what is an accelerator? Again, recognize that I’m coming at this analogy from a point of inexperience, but Techstars feels like a marathon of those Spartan/Tough Mudder/etc. races.

Here’s the big difference vs normal startup life: in an accelerator, you set a big weekly goal for yourself that requires several components to come together. That may be normal for some companies, but it doesn’t fit medical devices well. To achieve those goals, you’re sprinting (finding experts/stakeholders to talk with), leaping over hurdles (setting up meetings), slogging through mud (product development), making semi-blind leaps (also product development. Or business strategy. Both), crawling under razor wire (definitely anything to do with regulatory compliance), and trying to avoid the jerk with the fire hose (customers and/or investors giving feedback). And that’s all just Tuesday. Oh and don’t forget that you set yourself two big goals this week, because you’re a masochistic jerk.

Turns out Soylent isn’t people. It’s astronauts. Tasty tasty astronauts.

Perhaps this process is slightly better for the companies with larger teams, but word around the Soylent fridge is that the variety of the work may be reduced on an individual basis, but there’s an corresponding increase in the magnitude of work. Racing around to put out small fires becomes flying cross-country to fight blazes.

Sorry, my analogy got away from me there… We were talking about running weren’t we? And who would put fires on a track where people are racing? Probably a competitor.

If it sounds like we’re a bit crazy to deal with all this, allow me to confirm your suspicions. We’re not just dealing with our crazy world, we’re probably loving it. Well most days. Generally not Tuesdays though. Tuesdays are the worst.

                                                                           . . .

So what did we learn the past two weeks? A lot:

Perception of our prototype performance vs current laryngoscopes, where 3 is equal performance.

Weekly key performance indicators (KPIs) and hardware companies don’t quite fit with each other. It has taken us about four weeks to get there, but we finally have a KPI graph to show — potential users of our scope like the design changes we’ve made! Once we’re outside of the accelerator environment where weekly gains are necessary, our KPIs will make much more sense on a monthly cadence.

See that patent print? It’s from 1937 and the most common laryngoscope design has changed very little since then. Replacing it is my motivation.

However, our Kanban is kind of sad. Look at that backlog! Gross. The huge backlog stems from struggling to prioritize work when it all seems important.So we had to create a “reconsider” category to allow ourselves a way out of dealing with things that still feel important, but we know aren’t going to happen this week. I’ll let you know when it really starts helping.

When really uncommon or interesting feedback comes your way, it is important to fully consider the source and the implications of following the feedback. We received some feedback about our business strategy that we hadn’t heard before during mentor madness and got similarly challenging feedback in week 5. The questions that were posed to us forced us to revisit not just our targets for first sales, but also our timeline to corporate and distribution partnerships. You know, just a few minor details.

When I wanted to dismiss the feedback or revert back to old decisions (out of laziness/frustration/decision exhaustion), Maggie really dug in to make sure we got the most out of the feedback that we could. The result was a lot of additional effort to make sure we found the right experts that could give us specific feedback about our niche, but we have much more clarity now. So not only did I get a lesson in the value of digging into feedback, I got a reminder that your startup co-founder is critically important during tough times.

So what did we learn from all the feedback? The business development strategy possibilities for a medical device company are very, very diverse. Maybe that is a really predictable answer, but I could easily write a post on just medical device business strategy and not cover it all. Maybe I will, later.

The inter-program bond continues to grow, at speeds and strengths I have not witnessed before. Each time one of the companies has experienced a major challenge, the rest of the cohort has been incredibly supportive.Sometimes it’s simply encouragement, sometimes that support is connections to experts, and others it’s actively helping solve a problem. We experienced all of this in the past two weeks, and I’m really grateful for the opportunity to work in such an uncommonly supportive environment.

This is going to sound dumb, but I had a revelation the other day, based on my experience intubating a simulator in the Cedars-Sinai patient simulator lab… our laryngoscope is going to have a potentially massive impact on the lives of the patients it touches. Only through a fervent focus on perfecting the device can we ensure that our device will only improve patient outcomes. This unfortunately means that product design setbacks, while not inherently positive, are important because they refocus us on getting the design right. Not until we get our fully functional prototypes into the lab again in two weeks will be be able to prove the efficacy of our recent design changes.

Other random thoughts:

• Patience may be a virtue, but it’s a pain in the ass. Unfortunately everything seems to ask me to be patient lately.
• Louisville, we talked about having an open relationship, right? LA has been flirting really hard with me, and I’m finding it hard to resist…

If you enjoyed this, follow me here (and on Twitter) for more. Also, please share with anyone you know in entrepreneurship; disseminating my knowledge gained from this experience is a big goal for me. I’ll be writing a weekly recap of lessons learned during Techstars, along with some occasional posts about medical devices, startups, healthcare, etc.

Techstars: A Journey into Healthcare

We had a dream — a big dream — to make the world better with Virtual Reality. Working with the best academics in the world, we learned how VR could help people tackle big human problems. Academic research has proven time and time again, VR can make us more empathetic, reduce anxiety, and even help decrease severe acute pain.

We talked to a lot of people, at big companies, and big organizations (even the White House) about this big idea. Some smiled. Many nodded. Cedars Sinai and a few other innovators took action! A few months later, we find ourselves involved as part of the first Techstars Healthcare Accelerator, in partnership with Cedars-Sinai.

After an NBC News segment aired about our pilot with Cedars, a number of people in the investment and tech community recommended that we take a look at the accelerator. We realized we were onto something HUGE. We already had our plan, and this would change it. We asked advice from many business leaders and met with the Techstars and Cedars-Sinai Managing Director. We felt the influence of the Techstars community. It became clear that when enough smart people tell you to do something, you better do it.

Techstars Healthcare Accelerator

The Techstars Healthcare Accelerator Program, in partnership with Cedars-Sinai, is a 3-month intensive program that provides access to capital, mentorship, business development and more, to illuminate the entrepreneurial journey. It’s basically a crash course in the healthcare landscape to help drive innovation. As part of Techstars, we moved our office and came together with a great number of healthcare tech innovators. We immediately felt the value out of being part of the community. The accelerator environment is collaborative and challenging, and we needed to bring our “game faces” as innovative, smart-as-hell entrepreneurs enveloped us, united behind a common purpose. With access to some of the top healthcare professionals and business people in the country, who all want to see us succeed, and with Cedars fully engaged from the C-suite down, the support has been overwhelmingly positive.

Our journey is dynamic and exciting, and we’ve learned a lot. Here are a few of our key takeaways from this experience thus far:

The Value of VR in Healthcare

VR can help patients in a variety of departments from Emergency and Surgery, to OBGYN and Pediatrics. From reducing anxiety before an operation to distracting a patient from pain after surgery, the therapeutic benefits for a patient using VR have proven beneficial in improving the healthcare experience.

One of the most important metrics is patient satisfaction. Under the Affordable Care Act, there’s an increasing importance of patient satisfaction scores for hospitals. In fact, quality is now being tied to reimbursement, with a percentage of Medicare reimbursements tied to quality measures. Thus far, our VR technology has been really helpful to patients in managing their anxiety and pain and we’re excited to see how this affects patient satisfaction long term.

Redefining “Better Design”

Even with the best content in the world, VR wouldn’t be integrated into healthcare if it isn’t easy to use, embraced by the healthcare professionals and is non-disruptive to a very complex work flow. We’ve redefined our “better design” mantra to include not just the patient experience, but also workflow design and staff experience. Our applications can be experienced from the confines of a hospital bed, from different positions (seated, supine, etc.) and by people of all ages and backgrounds, all easily managed by the nursing staff.

Plus, there are a lot of small, but important things to figure out, such as sanitation. If you’ve ever tried VR at a conference or public display, you know it’s not the most sanitary experience. Your face touches the same part of the headset as hundreds of others. We have had to innovate on how to take a consumer technology and make it useful in healthcare.

Demonstrating ROI

Ultimately, there needs to be a clear value proposition for the patient, the staff, and the healthcare provider. There is a lot of really engaging, entertaining VR content out there. But, there are very few content developers who are performing clinical validation and extensive user research to understand the effectiveness and usability of their content. For VR to be embraced in healthcare, there needs to be clear value demonstrated for helping the patient improve their experience in healthcare, helping the staff engage their patients in an innovative yet practical way, and for the healthcare provider to see benefits in their P&L.

In the coming weeks, STAY TUNED for updates on our journey to Demo Day. If you enjoyed this post, please share it to help spread our message. You can also find us here: Twitter, Facebook & LinkedIn.

Week Three Recap: Techstars Healthcare, in partnership with Cedars-Sinai

The third week of the Techstars/Cedars-Sinai accelerator was really pretty crazy. Between our official, round-robin style meetings with mentors (back-to-back, 25 min each), feedback sessions with physicians, and other appointments we crammed onto the calendar, Maggie and I met with about 45 different stakeholders last week.

Just like week two, we heard lots of varied opinions. And, just like week two, we saw a lot of this kind of expression around the CS Spaceship. Do we regret it? No. Are we somewhat confused? Yup.

Aside from meetings from dawn to dusk, week three was also a big week for Inscope Medical because we had a new prototype to test with physicians. I even got to take our prototype into the amazing patient simulator lab that C-S uses for training and intubate a dummy with the newest Inscope Direct Laryngoscope.

Unfortunately, during all this testing, we found a few more design details that need to be fixed. And that brings me to what I learned (or re-learned) last week. Fair warning, it was a densely-packed week.

We tend to value losses more than we value gains. While I’ve read about loss aversion before, I had a very personal experience with it this week and it was fascinating to step back and analyze my reaction. I made a mistake with a design decision a few weeks ago that was realized this week. That mistake will cost us about $5–10k to fix and 2–4 weeks of development time. In the grand scheme of things, it’s a minor loss that won’t kill us.

However, finding that mistake hurt. It hurt really bad. For about a day, I was an angry mess. I couldn’t forgive myself. What struck me later though, is my negative reaction to this setback was significantly stronger than my positive reaction to the budget/timeline savings we managed to find in week two, despite those savings being greater in magnitude than the losses. Adding the week two gains and week three losses, we’re still looking at a net positive. Yet, I spent a day angry at myself for a mistake. Guess I’m still human.

So that leads me to my next point, and one that I don’t quite do a good job of recognizing for myself yet. Most people do a poor job of consistently understanding individual responsibility in a team effort.The mistake I mentioned above? It wasn’t completely my fault. Neither were the gains we found in week two. But it’s still easier for me to assign blame to myself during bad times and distribute praise during the good times.

You have to find an anchor to keep you sane during really intense stretches. Last week felt really off-balance at almost all times to me. My sense of time was (is) completely lost because the density of activity and information is pretty staggering. My sense of clarity about our company and product has been challenged in several different ways. My normal stress-relieving outlets are a couple hundred miles away because we moved out to LA for the program. In short, last week was a breeding ground for sudden failure.

About mid-week I realized that I was really in need of some stability to help weather the storm. So what was my anchor? Simply walking, actually. The 25 minute (or much longer sometimes) walk back to my apartment at the end of each day has turned out to be a great time to reflect on the day and absorb feedback from mentors.

Also, Audi won the first FIA WEC race of the season at Silverstone over the weekend! :D

When reflecting and discussing your progress with mentors, try to end on a good note or an actionable item. If you don’t follow this, you’ll end up like me at our weekly program recap meeting; you’ll cause a super awkward silence after you announce your struggles. We’re not talking about awkward chuckles, but full-blown crickets. Yup, I sure can liven up a party.

Going back to my previous comments about the design mistakes I made, last week was a great reminder that you should steal as much as you (legally) can from existing products in your industry. “But Adam, stealing is wrong.” You can’t see it, but I’m glaring at you as you think this.

You know what’s more wrong? Dumping a bunch of your startup’s money into designing a product when there is a proven design in the public domain that you can modify. Also, this helps reduce the potential negative impact of your other innovative features on the customer. Remember, humans, like sleep aids, are habit-forming. Try to avoid breaking too many habits at once.

Have I gotten this feedback before? Yes, of course.

Did I ignore it? Yes, of course. Well, not entirely, but I did ignore just enough for the resulting mistake to sear the lesson into my brain.

Will you regret it if you (completely) ignore the collective wisdom of established products/competitors in your market? Yes, of course.

It’s all about team, team, team. It seems like I keep mentioning something about team value. However after a few weeks in program, this takes on a bit of a different meaning. Quite suddenly, the value of other co-founders in the cohort, partners, your contractors, etc. skyrocketed for us, because the weight of all the decisions and meetings of the week became difficult to bear alone. Without an incredible contractor partnership, a strong and supportive cohort, and great partners, week three would have been much worse.

That brings me to my last cliche of this blog post; there’s a lot of beauty in the struggle. The really lazy, but really common reaction to the challenges of each new day (or each new feedback data point of Mentor Madness) is to complain or allow the stressors to win.

It takes real courage and uncommon stamina to take on each new challenge with a smile and positive attitude. I certainly am not a shining example of staying positive in the face of adversity; there are several co-founders in our cohort who could serve as the example.

However, two in particular have spread positivity, built up other cohort members, and thoroughly improved the program experience around them, all while enduring a situation that would cause most founders to quit. It’s amazing to see that two people can put in the effort necessary to continue to give the best of themselves when their own struggle is so great. To be in their presence is both humbling and uplifting.

Other random thoughts:

Cultivating your network via LinkedIn is super powerful. Ask John Hill.

I’ll defer to Mark Suster’s wisdom about navigating confusing feedback, and just note that it takes diligence to put this advice into effect.

UberEats is really easy to get addicted to when your day is super packed. Travis Kalanick do I get free UberEats now?

Soylent isn’t as viable a meal substitute as I hoped it would be. Bummer.

If you enjoyed this, follow me here (and on Twitter) for more. Also, please share with anyone you know in entrepreneurship; disseminating my knowledge gained from this experience is a big goal for me. I’ll be writing a weekly recap of lessons learned during Techstars, along with some occasional posts about medical devices, startups, healthcare, etc.