If you can move the earth …

I recently realized something about working in product companies that sell to healthcare providers. I am writing this in the hope that at least a few engineers contemplating working in Healthcare IT read this post and come out with a better perspective about one aspect of working in the Healthcare IT sector.

Give me a place to stand on, and I will move the Earth
— Archimedes of Syracuse

Tl;dr: If you can move the earth, may be it is time to build yourself a place to stand.


Background

Until recently, I worked with a wonderful Healthcare IT company that improves patient safety and helps reduce clinical harm. Engineering was cranking out a very high quality product and deploying it bi-weekly to our users. For the size and scope of the product, the number of customer reported issues was extremely low. And yet, I noticed that a lot of the client facing folk were unusually uneasy about the software. Initially, I put it down to previous bad experiences that could have occurred before engineering had the luxury of full time QA. But over the years their uneasiness with software persisted. I did my best to empathize with them. But for the life of me, I could not understand why these super-smart people had not re-calibrated their comfort levels. When my read on a situation differs from how a bunch of smart people feel, I pretend that they are right and try to refute my own theory. I do not try to change them – especially if it seems like they have more experience or better background information. I usually try and think through the situation on long walks. If, after hours of concentrated thinking, I am unable to crack the puzzle, I simply file it away in my memory (actually in Evernote) as a problem that I need to revisit. Well, this was one such unsolved problem for a long time!


The slow and rather late realization

I run a company that provides outsourced testing services to startups. I recently became completely steeped in sales. Our clients have had a very positive experience with Qxf2 so far. They recommend us and go out of their way to ensure our collaboration works effectively. The tutorials we post on this blog help a number of companies solve problems that their testers are having trouble with – and we receive comments and emails thanking us. So I’d like to think Qxf2 Services is, at the very least, competent at what we do. And that I have something solid to sell.

My initial sales calls hit an invisible wall that took me some time to spot. I could not even reach prospects that had previously had bad experiences with outsourcing. Even when I had been referred to by trusted, high ranking folks, companies would avoid me. How good our product or service was did not matter to these prospects. It just mattered that we existed in a sector that had repeatedly over-promised and then failed to deliver. I joked about this invisible hurdle with one friend. It was like I knew how to move the earth but had no place to stand.

Our client base grew. My management habits seemed to change. I started to fret about how our work could be perceived by our clients. I became paranoid about communication patterns and quality of code and how employees framed their work. I refused to place technically competent employees with poor communication habits on to client engagements – a financially stupid thing for me to do. As part of new hire orientation, I started requiring new employees to read about horror stories about outsourcing gone bad. I blindly justified all this in the name of providing outstanding service and how we were different and how we had higher standards than others. You know, the same thing that every other outsourcing company says!

And then one day the realization dawned. Here was a fantastic service/product that was doing great but I was feeling uneasy. Voila! I could now solve a problem that had troubled me before.


The invisible hurdle

Upon introspection, I realized that my sales calls had two hurdles. The first and invisible hurdle was convincing someone to listen to an outsourcing provider. The second and very visible hurdle was to convince them that Qxf2 had the skills for the job. To get past the the first and invisible hurdle, I have to convince my prospects that we will avoid the mistakes of other outsourcing providers. Most of my employees are not going to be even aware of the invisible hurdle. They have not tripped over it dozens of times. And learning experiences like that are hard to identify and translate into writing. Now if any of my employees end up making mistakes that were discussed on the sales call, then I feel like I proactively lied on the sales call. I do not want to be a liar. So I guess the shift in my management habits, that happened after my client base grew, centered around addressing the invisible hurdle.


All ok Freud, but where is Healthcare IT in all this?

Healthcare IT has built itself an invisible hurdle too. For more than 25 years, IT has made lofty claims of revolutionizing healthcare. While it has delivered substantial improvements, the advancements pale in comparison to the promises made. So if you are an engineer planning to join a software startup in the healthcare space, I have some unsolicited advice to give. Obviously your situation is going to be unique. So do not treat this as sage advice but instead mull over the points I make. It may leave you with one more angle to view your situation.

1. How clients are likely to perceive your company depends on their history with IT
It took me a long time to accept this – the history that your client has with your industry is a major component in the way your product is going to be perceived. As techies, we tend to forget that our clients see us less as “This Awesome Company with excellent engineering practices and high recruitment standards” but more as “Yet another software company promising us something”. Obviously you cannot drive all your engineering decisions based on this – but add it as a factor in your thinking.

2. Business folk are likely to be uneasy about software
You are likely going to be hired because of your technical background. So if you are coming from a different industry, it is important to be intellectually aware of this point. Your business folk are going to be uneasy about software, uneasy at a level that is not present in say, the tech geeks selling to tech geeks market. This does not mean they are evil or ignorant or want to get you. As a highly analytical and rational engineer, I had unknowingly stumbled into a similar behavior pattern. They are probably protecting a business interest or a sales promise that is not obvious. I do not how to make it better – but being intellectually aware of this point is a start.

3. Emphasize resilience and responsibility over speed and accuracy
When dealing with your non-engineering colleagues, emphasize resilience and responsibility. Imagine you are selling a car to an industry. To most industries, you would emphasize the speed, the look and the horsepower. But if you are selling a car to the healthcare industry, it is worth pointing out the air bags and the automatic braking system and the different check lights you have to spot trouble. When you demo your work to your non-engineering colleagues, take time to point out the air bags you have designed into the system. Also as techies, we tend to do a lot of things responsibly and then forget to mention it because it hardly took us any time. You back up your data? Great! Take the time tell your business folk that you are resilient to hard disk crashes and machine failure. I am pretty sure these points will end up being mentioned in client meetings.


Why bother join such an industry?

I wrote this section in case you feel like all this is too much drama to tolerate just to have the opportunity to work in Healthcare IT.

1. Being in a healthcare company gets you access to data
Open data in the healthcare space is hard to come by. So the difference between being in a healthcare company and working outside it is enormous. Don’t believe me? Just attend a Health 2.0 conference in your city. I will bet you a game of chess that you will notice dozens of folk who have abstract ideas and but no access to data.

2. Technology matters
There are two hurdles not just one. Clearing just the invisible hurdle is not enough. And there are interesting technical problems that you can chip away at and solve over time.


Hopefully this post helps you prepare for your journey into healthcare IT. Drop me a note below if you want to discuss any of the points made.


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