Growth is NOT just about Cash Flow and Capital

There is an inherent conflict that emerges with growth! The stress on cash flow is only the first symptoms of what is to come.

First, few people really understand what it takes to grow. When a company is growing, everyday is a new day, with a new set of challenges. Relationships get tested and become strained.

A chorus begins, “If we only had more money…we need more resources…we need more time…they want what?”

Absolutely!  Resources and expectations must be managed. And, it’s important to have a cash, capital or lines of credit that will allow for a few expensive mistakes. But, possibly more concerning is the confusion that occurs with growth.

It is confusion that is dangerous to a business!

Growth will pressure all the current norms of the business. Test your people and readiness, before the market does.

A few simple questions will give you clues:   “If you are given $x,xxx,xxx, how will you put the money to work? What will you be doing differently tomorrow, one month from now, three months from now? How will we define success with the money?

It’s not enough to WANT growth or develop a business plan.

New customers will be different from old ones…

Customer demands will increase…

Product requirements will shift…

Skill gaps will emerge…

Systems will no longer function as they once did…

Everything will take longer than expected…

It will always be more expensive than expected…

Profits will erode…

Payables will rise…

The Payroll clock will never quit ticking…

People will feel the stress…and, some won’t make it through it. Replacing a dead soldier with a new one will be expensive, in time and money!

Why? That’s not important. Growth just does…

What is important? Begin preparing for it…

Life Choices

As I visited a recent entrepreneur’s event, the topic of Life Choices emerged. One presenter noted a simple fact: there are countries around the world where most important decisions in a person’s life are made by others.

Wow! That’s a bit sobering. It got me to thinking… considering the choices that I have made in my life. Those moments where I stood at crossroads, and the path chosen would be an incredibly different path from the other. The list is a long at this point. There are those choices that have worked out really well, and there are those that have required me to accept that no choice is without its risk. I’ve taken my lumps and moved on.

Yet, how really and truly blessed we are in this country…the fact that we get to choose!

We hold an incredible core belief in our right to destiny. We get to manage our own Life Choices, in the pursuit of happiness.

But, how many of us really do that?  How many of us really make active Life Choices, or do we allow life circumstances to force us into actions that may or may not be of our choice?

Life Choices are, at times, largely a leap of faith…actions taken on feelings, hunches or intuition. It’s a given we will make mistakes when we are young…for all kinds of reasons. But, with age, we should have a better sense of ourselves. We should be able to define more clearly what makes us happy…what fulfills us.  Hopefully, we can say we’ve learned to evaluate advantages and consequences of our choices and begin employing a certain wisdom in Life Choices.

Again, how many of us really do that?  And, if not, why?

Life is short!  Having command over our Life Choices carries a deep responsibility to find happiness.  And, maybe more importantly, prepare our children for honoring the right to define our Life Choices!

We can all find a crutch, an excuse or even someone to blame for poor life choices. And, all of us, at some point in our life, have done just that. Yet, what could we achieve, if we’d fully accept the blessing and the responsibility of our Life Choices?  How far could each of us go?

The Answer:  It’s impossible to know until you try!

Alchemy of Successful Business

From basic matter to gold! A successful venture is like alchemy, and the entrepreneur is the alchemist.

Success = Markets + Ideas + Talent + Resources + Timing

As if it were a science equation, a successful venture requires the right people, coming together at the right time, in the right market, with the right ideas, employing the right resources.

That’s a lot of right things that have to come together!

Is achieving a successful venture a science or something other?

The current business environment would suggest it’s science. A lot of money is flowing into young companies.

Certain elements of a venture come down to practical and fundamental decisions:

  • The market needs to be big enough to support the intended growth.
  • Members of the team need to have experience in the market.
  • The product or services must meet a significant want or need in the market.
  • Competitors must be identified and mapped for strengths, weaknesses and market share.
  • Capital must be available to fund growth.
  • There must be a plan and a budget.

But, if it were a science, then success rates in early stage ventures would explode. It’s not quite that easy.

One of my friends used to say about his entrepreneurial experience, “It was an overnight success that took 17 years to achieve!” He was also a Vince Lombardi fan. For him, it was all about Lombardi’s “planning the work and working the plan”.

But, even though hard work is an incredibly important part of success, hard work alone will not make a venture successful.

Why does success become elusive in growth ventures?

Just as the word alchemy suggests, there is a magical quality about it!

Change—we know that’s the one constant in life. So, even with careful analysis and planning, the environment will require a venture to pivot from the initial plan. In my opinion, success is then about the alchemist: the entrepreneur becoming a Leader.

When the plan must be modified, it is Leadership that brings a company out of chaos with renewed focus and direction. Leaders must judge the situation, determine the best course of action and convince others the new course, is indeed, the best course.

Leaders must get buy-in from those above him/her (boards and investors), peers (customers and suppliers) and those that report to her/him (employees). However, many entrepreneurs see leadership as a solely positional power, and it becomes their Achilles’ heel in the success of the venture.

Entrepreneurs have very special and unique gifts:


Work Ethic




But, the entrepreneur must recognize the difference between natural talents and leadership skills. The entrepreneur’s strengths become the greatest challenges in growing into a leader.

Yet, for growth of the business to occur, leadership must develop. The alchemist must quickly gain new skills—or hire them into the venture.

Both are hard work!


Great links and resources:

LeappAhead, by Jim McGraw

Kauffman Entrepreneurship


KC Source Link

Springboard Enterprises

Act Like the Customer

“Never doubt that a small group of thoughtful, committed people can change the world: indeed, it’s all that ever has…” Margaret Meade

I whole-heartedly believe this statement is true!

Having spent the majority of my career in high growth, technology companies, the quote seems to offer me the necessary inspiration to tackle enormous problems with very few resources. Although I’d like to say that competitive pressures or market forces are the primary challenges for growth businesses, what I have learned is quite the opposite. My consulting years have taught me that far more business problems are associated with factors within the control of the business.

Of those controllable factors, there is one common mistake. This error is controllable, and it is a lapse that could have been easily prevented, but the same error appears over and over, regardless of the number of resources, the size of team or the maturity of products:

Failing to close the loop by acting like a customer.

Despite the fact that all of us are customers of some businesses, we often make the mistake of undervaluing the “customer experience” our own customers have. This can arise from a number of reasons: over-confidence in execution of a task, under-appreciation of quality control, or a lack of appreciation for the value of customer experience in the basic decision to “do” business, now and in the future.

Time after time, management tells me they are convinced external forces are holding back their company’s success. Financial pressures have made “a problem” evident, but they have not been able to determine “the problem”. My initial training in computers dictates that I begin my assessment with a fundamental approach to troubleshooting. I engage with the company’s customers, often with push back from management.

This fundamental troubleshooting approach requires me to start by acting like the customer. I attempt to experience what a customer experiences, but with fresh eyes and open ears, and without any preset expectations for the experience. I always approach the “customer experience” anticipating delight, and, in a few instances, I have experienced incredible delight. For those businesses, a market analysis and competitive review is warranted; however, for the majority of business, I learn that improving their customer experience will bring immediate wins by correcting a number of basic block and tackle problems.

Interestingly, almost every organization has had at least one internal person trying to tell others that the customer experience is the root of the company’s problems, but, almost always, the organization diminished that person’s voice.

For me success in business is about making quality as important in the execution of technology projects as the other elements in the timeline. Success begins with budget, making a team responsible for quality review, but success significantly increases with senior support. That senior support can’t be a thinly initiated lip service for the customer experience, but rather a cultural impact. As quality checks continue, the quality folks must be able to stop a project if the issues are significant enough. And, of course, it is all validated when someone within says, “Wait, what about the customer?”, and is actually valued at the table.

One of Jeff Bezos’ most famous acts in the early days of forming Amazon was called “the empty chair”. If you haven’t heard of it, it is worth a Google search.

The Digital Challenge: The Impact of Wearables on Providers

The tech gifts available during this year’s Holiday Season, like the Amazon Echo, Fitbit, Apple Watch and Playstation VR, provide a mixture of artificial intelligence, augmented reality, natural language processing, biometrics and more. Not to be outdone, the makers of refrigerators, laundry appliances, doorbells, security systems and other consumer electronics are also manufacturing devices that fill the home with an impressive array of technology.

Consumers are being surrounded at home with products that provide rich experiences in voice-activated, sensor-automated, and algorithm-driven technology, so where does that leave us in healthcare? As individuals include wearable technology in their homes, shouldn’t we be including similar technology as part of care models? Reasons for not moving forward with technology in healthcare ring ever more hollow as the technologies are adopted in other parts of our lives.

Digital approaches to healthcare hold promise for quickly advancing our ability to serve patients. From Primary Care to Specialties and Ambulatory to Acute, the opportunities to advance treatment modalities, care programs and service models seem boundless. And, just in time, when we are in such need of advancements!

It is easy to imagine some objections that might be raised to using these technologies, so let’s consider them one by one.

#1 – HIPAA won’t allow us to…
In the past, we have modified the contractual agreement with the patient for other purposes, such as research data, regulatory compliance, payer submissions, etc. If we decide the benefits would be great enough, the consumer would receive a new HIPAA Release covering new use and exchange of data terms.

#2 – We can’t rely on the data…
Every day, we encounter data that may or may not be entirely correct. Data is gathered from all kinds of devices in the healthcare setting, and the precision of each device is often unknown. For example, weight scales must be continually calibrated to assure their accuracy, but do we know when the scale used in your Primary Care Physician’s office was last calibrated by a licensed weights and measures professional?

#3 – New devices require FDA approval…
For some devices, yes, FDA approval may be required before they could be incorporated. However, there are a myriad of processes that do not require approval to be used.

#4 – We can’t integrate the data….
While this may have been true in the past, the world has moved forward in standardizing data, allowing for easier integration. The old barriers of competitive differentiation through proprietary data are being quickly erased in favor of competing on the breadth of integration that can be achieved easily, seamlessly, without the interaction of a human.

#5 – We can’t really know that the data is from this person….
While this is likely the most legitimate concern of all expressed, there is a certain amount of personal responsibility that must be included with the adoption of any system. For example, when a medication is prescribed, we never really know that a patient took it as instructed, yet a new lab is taken and renewals are prescribed.

#6 – Payers won’t pay for it…
Does the payer pay for the EHR? Do payers pay for the billing system? Do payers pay for the scheduling system? What about stethoscopes, scales and blood pressure cuffs? Payers cannot pay for each business practice—there are other ways to calculate ROIs for deployment of technology.

Pressures on the healthcare system require that we thoughtfully consider ways to move forward. For the CIO in healthcare, the changing landscape requires new strategies. Consider a few critical shifts in thinking in order to prepare your organization:

  • Define an agile health technology platform for your organization, including data exchange strategies related to commercially available devices.
  • Take a hard look at the contemporary methods for confirming identity used by other highly regulated industries (banking, insurance, etc.) and develop a fully electronic method to establish data exchange.
  • Stop valuing DATA and begin valuing methods of USING DATA. As you consider engaging with wearable data, don’t value the detailed, discrete stream, rather value the reporting, similar to a lab report to a Physician.
  • Redefine the core value of your technology teams.
  • Begin investing your time in Medical Review Committees and Clinical Operations Committees, not in an effort to create controls around the flow of data, but in an effort to understand the needs, perspectives and emerging trends coming from the patient care arena.

With the new and powerful computing methods targeting individualized consumer needs, new advancements are in reach to serve chronic and acute populations in new ways. The emerging number of health and fitness devices on the wrists of patients entering the Primary Care Practice offers an opportunity to examine their current state in a low risk manner and begin mapping alternative methods of serving these patients.

Leadership Matters – Understanding the American Dream

I have come to the realization that it is no small wonder that companies entering the US market from elsewhere don’t “get America” or Americans while those of us who grew up and have stayed within the confines of American markets cannot possibly understand how truly unique, or maybe more poignantly, “crazy” we seem to others. Americans are often referred to as “cowboys”, “from the wild west”, “rednecks”, “entrepreneurs” and more.

Those who do not understand us, also do not understand our “American Dream”. Americans are truly individuals, and we live a fantastic “American Dream”. The majority of Americans today have parents who realized the American Dream–the idea of which, alone, makes us unique. Any company entering America’s economy must understand the Dream in order to “get Americans” and find success in our culture. One of the pieces of the dream is that we tend to manage monopolies out of our economy and favor the underdog.

Often, not understanding the Dream allows management to believe the “toolbox” they have used to manage employees and serve customers in their own country is the same “toolbox” to use here. In the best cases, this legacy “toolbox” is a folly and management finds itself extremely limited in its ability to create sustainable results. In the worst case, the hubris of applying an unchanged “toolbox” creates an over exposure and vulnerability that is not detected until far too late.

Using the right “toolbox” is extremely important to succeed in America! The right “toolbox” motivates, the wrong “toolbox” means spending money without achieving results.

Companies coming to America too often underestimate the power of the “toolbox”. Their management methods lack the nuance needed to engage in American culture. And, although recent examples of “muscling” our political process may have had a short term impact on our culture, one needs to ask the cost of achieving that success and sustaining it.

There are many more effective tools–which may be uncomfortable to outsiders–that can be used and that are much more cost effective and successful. Basically, regardless of what others believe about us around the world, we ultimately know, deep down inside in America, that this crazy Dream is still alive and engrained in our culture. And, so far, it has worked for us!

Leadership Matters – Principles and Behavior

Leadership Principles are curious.  One might say it is an oxymoron, as the recent behavior of some of our most prominent Leaders seems to strongly suggest there are no principles.

One only has to turn on the news for an example.  The information that rolls out about what has been happening within our government, and then the insistence that because “it has been happening for a number of years” equates to public knowledge, much less acceptance, is fundamentally dishonest.  The Foundation of our Nation is our Constitution, and in order to have trust, our Leaders must recognize the importance of adhering to certain principles.

Leaders are only leaders when there are followers.  If one thinks about it much, the sources of power for Leaders are limited—positional, political and popular support.  Each of these forms of power largely relies on principles and behavior.

Principles form the basis for which others can trust and believe—and it is through trust and belief that followers offer support and take action.  Leaders are often able to avoid scrutiny over principles through rhetoric and platitudes—but only in the short run.  Over time, Leaders are not able to escape the way in which behavior reveals true principles.  For we all know deep down in some recess of our conscience, true Principles form a system of trust and confidence which each of us need to thrive and succeed.

Principles are an internal set of guidelines for decision making.  We look to Leaders to give us a foundation of trust in the basic manner of thinking and behavior forming his/her decisions.  Honesty is an example of a principle that is core to developing trust, and it is trust for which each of us moves and makes decisions in our daily lives.

Pure logic would say trust is essential to forming the overall system for which people are able to be successful, and honesty, as a Principle, is essential in forming trust.  Over time, behaviors will reveal whether or not we are able to trust in the honesty of our Leaders.
Why, then, do Leaders struggle so much with Principles?

There are likely various reasons, but the most immediate is personal gain. Personal gain can be in the form of money, power, notoriety or acceptance.  Too often, Leaders fall into the trap of telling us what we want to hear, not what we need to hear.   In the effort of achieving personal gain, Leaders seem to believe that straying from their Principles is acceptable if it is only temporary. Unfortunately, it is not.  Principles must be firmly set in the minds of Leaders—and personal gain must be placed as secondary to Principles.

One might say, the true test of Leadership is when personal gain is abandoned for the sake of Principles.   Wouldn’t that be refreshing to see? And something to truly believe in and follow.

Leadership Matters

All too often, the value of leadership is overlooked.   It doesn’t matter if it is within a community organization, a for-profit company or a country.    The demographics of the constituency do not seem to matter either.  Regardless of race, gender, educational level or vocation, more times than not the value of good leadership is overlooked until a bout of really bad leadership awakens people.

Why?   My belief is that we are fundamentally selfish as humans.  We have difficulty accepting a basic premise of good leadership:  the path of least resistance is almost always the wrong path.  Our basic selfish nature makes us want to ignore or avoid difficult situations, and we are happy to listen to leaders who tell followers there are no consequences for selfish behaviors, but these bad habits will only produce failure.

I find this period in our country, along with the world, to be particularly instructive.  It is clear to see that years of bad leadership decisions worldwide, not just now–but for decades, have brought us to a distinctly difficult period in history.   Good leadership within organizations is never fully credited for successes, but bad leadership is palpable as one walks through the door.   Our worst examples of leadership result in an active blame game that allows leaders to escape through the back door, precisely because the broad constituency has been an accomplice to the situation.  When leadership is done with mediocrity, general frustration and confusion rule the day.

Every morning, I get up and check in with the world.  I make it a point to attempt to find out what has happened throughout the rest of the world.  (Notice I use the word “attempt”.)  I then spend a little time trying to understanding what others believe our issues are closer at home.   I continue on with my workday and attempt to address issues that challenge a number of small businesses (again, the word “attempt”).   Often in the evenings, I am involved in a community group for which voluntary input is essential to the ongoing activities, and here is the thought that I go to bed with each night these days:  Leadership Matters.

What keeps me awake for far too long at night is not the idea that leadership matters, but rather: “If leadership matters, why do we continue to repeat the mistakes, generation after generation, of supporting bad leaders?   If leadership matters, why is so little time invested in bringing along other really good leaders at all levels of the organization, a failure demonstrated by even good leaders?  If leadership matters, why do all problems get blamed on the lack of money and resources?

Regardless of the answers to these questions, leadership is the difference between success and failure.   Throwing more money at organizations will do nothing to improve the problems related to bad leadership.  Instead, we must find ways to develop good leadership in the future and to encourage good leadership practices in our current situations.

Think Core Values

Recently, I was asked to help find a speaker for a gathering of Healthcare IT innovators and professionals in the Kansas City area.   The group was put together in collaboration with the economic development efforts in the community.  As I reviewed the people that had been instrumental to my thinking, a select few names came to the top of the list, and we chose Dr. David Voran, M.D., Family Practitioner and Medical Director of Clinical Quality Improvement at Heartland Health System.  Dr. Voran is one of the most innovative thinkers in healthcare today.   Each time I hear him speak, I think and I learn.  This time was no different.

Dr. Voran spoke on a broad range of topics related to the future of healthcare and the role innovations in technology will play for patients and providers.  He spoke of embracing a patient’s ability to explore and self-direct care—recognizing personal responsibility plays a big role in the future of healthcare.   He spoke of technology targeting individuals, not big institutions, and innovators thinking small to do big things.  He recognized doctors, insurers and governments can’t change lifestyle disease cycles—only the individual, with the help of feedback loops, can change personal behavior—but the system must deliver when individuals do their part.  He referenced the need to disrupt the rigid barriers in care created by professional boundaries—it drives up costs and limits access to care.  Finally, he stated that incentives for care must be reviewed—are we paying health professionals to do what we want them to do?

While all of these points were interesting, what was more intriguing to me is the consistency of Dr. Voran’s core values, as I’ve experienced him over the last fifteen years. He has been remarkably consistent in both explaining his beliefs and holding true to them over the years.  In doing so, he has demonstrated a degree of professionalism and commitment that is admirable.

I started thinking about a few philosophical questions.  How long do you have to know a person before you recognize their personal core values?  What behaviors and actions demonstrate their personal commitment to those core values?  What happens when the collective profession or leadership of an organization move adversely as compared to an individual’s core values?   How do ethical and principled people act when that occurs?

Listening to Dr. Voran, it seems to me that healthcare providers, patients and policymakers are on a collision course related to core values—technology will be the highway and innovators the pace car. The years ahead will reveal the core values held by individuals, professionals, organizations and government—and I suspect a stark contrast will be on display from one group to the next.  I believe, as consumers of healthcare, we will see the greatest examples of personal character along with the most disappointing of character flaws.  At the core of our nation’s challenges is the fact that healthcare and the supporting businesses around healthcare delivery have become big money.   At the same time, individuals may desire freedom of choice, but with that comes responsibility and a willingness to accept the outcome of decisions.   In between all of that is a government that wants to hide from the financial realities of an aging population and policies which have ultimately slowed the growth of our economy.

Questions for America:  Will we become creative and innovate or will we wallow in the current circumstances?  Where will we stand when core values are challenged by the defensive nature of our current system?  Will we hide behind rules and policy in order to not have to make hard choices?

Although each of us will have different ideas for what will fix America’s healthcare dilemma, the key aspect will be our personal commitment to our core values.

The Spirit of Business: Do It Anyway

Over the past few years, there have been a number of hard struggles within my personal life with extended family.  As I have participated in the aging of my parents, my siblings and I have been entwined in the challenges of maintaining a long-held, family-operated business.   On many occasions, I have found myself having a conversation between my head and my heart, and it always goes like this…

I say to myself, “I am not sure this is the best move for me…”

Self says back, “Do it anyway…”

I say to myself, “I may even have others mad at me for doing it…”

Self says back, “Do it anyway… they will see the right-ness in the action…”

I say to myself, “What about those who will laugh and make fun of me…”

Self says back, “Do it anyway…do you really care what others think?”

I say to myself, “My kids are already upset with how much time I devote to work and extended family…”

Self says back, “Do it anyway…it will model commitment and perseverance.”

I say to myself, “I may lose all that I’ve invested in it if it doesn’t work out…”

Self says back, “Do it anyway….risk is a part of life and reward only comes with risk…”

I say to myself, “I’m not sure that I’m smart enough…”

Self says back, “Do it anyway….you didn’t know how to walk before you took your first step…”

There are so many reasons to not take risks in life and business.  Even when you know, in your heart, taking certain actions are the “right thing to do” or the “smart thing to do” or even the “most financially prudent thing to do”, still, taking risks seems to be the “hardest thing to do” right now. Freedom to independently think and act is under attack.

I have personally found that there are far more people willing to tell us why we shouldn’t proceed, even at the slightest hint of risk involved above the norms of the day.  Of course, the “norms of the day” are a key element of how others see risk.   What does that mean?   Risk today, with 9% unemployment, is very different than risk in 2005.

I am convinced that when you start having inner conversations with yourself, like the one above, it is your intuition speaking to you. There may be several reasons your inner self is speaking to you, such as the protective “fight or flight” response that is so deeply genetically encoded in our being.   Equally, it might be the opportunistic “hunt or starve” response in the “survival of the fittest” environment.   Or, it just might be our unconscious acknowledgement of “right and wrong” playing upon our psyche.  But, it knows you must act!

My mother used to say, “your inner voice exists to keep you alive!”.   However, I’ve learned to distinguish between the inner voice and the selfish self.   Answer a few “rational” questions in testing your motivations.   Are you considering this risky move because of selfish desires or in order to protect, feed and clothe your family?   Are you considering this risky move because of ego or an unwillingness to act in reasonable ways based on today’s economy?   Are you just angry someone told you “no”?
It should be obvious which reasons belong to the selfish self.

There are risks taken to protect and advance, and there are risks taken as purely a reaction to selfish self-interests. We are in the middle of dramatic social and economic change.  For the first time in my working career, hard choices and careful introspection is required IN ALL BUSINESS AND PERSONAL ACTIVITIES.

We must recapture our soul and spirit!   The real beauty of America is in its ability to adapt and change.  As a society, we have been willing to do what was necessary to survive and then place great bets to thrive and grow.   Within each of our families, the American spirit has brought us through recessions, depressions, war and great prosperity.  In our businesses, it has been the willingness to “tighten the belt” when necessary, but still find ways to be creative and innovative.   It is in our free elections, that we choose our destiny! 

It is now the time for yet another generation of Americans to rekindle our inner spirit.  The inner self is speaking…and I believe it is speaking to more than just a few.