The questions you need to ask when starting a new business

Question mark

Are you thinking of a career change? Perhaps you like the idea of starting your own business, or even developing something new by setting up a start-up? In that case, read on, and I’ll share with you a few things that we’ve learned on the way.

The first thing to say, and a big mistake that we’ve made, is that your idea is almost the least important part. We spent years at itamus developing a wonderful solution, without checking whether anyone wanted it. We now call it “the Behemoth”. Because it’s a massive and (mostly) unwanted monster… Continue reading “The questions you need to ask when starting a new business”

What’s the big idea?


Do you ever dream of being your own boss? Does the idea of creating something new appeal to you? Do you want to work at something that’s truly yours?

Many people do. And I’m sure, like many people, you’re just waiting for the right idea. I mean, after all, if only we’d thought of Facebook, then we’d all be billionaires, right?

Or perhaps you’ve already done it. You’ve quit work and are working on your plan to market purple marmalade (It looks like jam, but tastes of orange!™) and are pouring everything that you own into the idea to make it work…

Here’s the thing. In both cases you’d be making an error, because your idea isn’t that important. I hope this blog can convince you why.

Continue reading “What’s the big idea?”

A tale of two meetings


Ok, confession time. For someone who spends an awful lot of time proselytising that other people should get out and get talking to potential customers as much as possible, we’ve not always walked the walk ourselves. So please view this as a sort of morality tale, and learn from our mistakes, so that you don’t have to repeat them.

About 18 months ago, we’d been working on our blood pressure management system for about 3 years. In that time, we’d not spoken to a single customer and barely mentioned it to a few of our work colleagues. We had bought some traffic through AdWords, and poured over data that was too small to show any useful information. It didn’t matter because we were building our masterpiece, and when we unleashed it on the world, people would come flocking. Because it did everything that anyone could possibly want it to do.

Somehow, word got out about what we were working on, and we were invited to meet with a potential customer to show them what we were working on.

Continue reading “A tale of two meetings”

The advantage of being a medical founder


We’re currently doing customer development. One of our strategies has been to set up a Facebook group where patients can ask us questions. Our value proposition for the group is quite simple. “We are two UK-trained GPs. Please ask us your questions about high blood pressure and we will attempt to answer them as best we can. We regret that we cannot give specific medical advice. We want to know what it is that you want to know.”

And it works. We’ve got a group of people who ask us their questions about blood pressure, and we try our best to help them by giving them the best answers that we can. They’re under no obligation to us, but occasionally we’ll ask the group a question, and we’ve asked for UK based volunteers to talk to.
Continue reading “The advantage of being a medical founder”

Screening vs testing – are you making the same mistake?


In old London town, Inspector Closet has been called to solve a murder. Lady Lotta Ouaste the third has been found murdered at Ouaste Mansions.

The only clue, a tin of moustache wax dropped at the scene of the crime…

Fortunately Closet is on the case. The roads are closed and the area is sealed. Closet quickly deduces that the murderer has a moustache. He asks the local constabulary to round up everyone with a moustache in the area.

Unfortunately, Ouaste Mansions is in Shoreditch. There are a lot of moustachioed citizens to round up.

Crowds soon start to gather and demand the release of their baristas, web-designers and food bloggers. “Productive” work has ground to a halt. Chaos ensues. The moustached many have to be released.

Later that day Closet receives information from Lady Ouaste’s lawyer. She changed her will only the day before, bequeathing everything to her young lover, a conceptual artist and erstwhile entrepreneur Holden Roman. A man with previous convictions for violence and a significant craft beer habit. A man who was being chased by some pretty serious VCs for the money he owed them.

Outside of the front door to Roman’s work/live space, Closet hears a suspicious buzzing sound. He kicks down the door and breaks in. He’s just in the nick of time as he catches the guilty man in the act of shaving off his moustache…

Another case solved by the great detective. Closet can go back to his Sudoku.

The moral of the story?

Too many health tech companies are building better moustache detectors and then wondering why they can’t sell them to famous detectives…

Do you understand the difference between screening and testing, and why it is vital to your value proposition? Let us know in the comments below.

How Trump did it – strategies from the tech industry


Donald Trump. Love him or hate him, and there are plenty on both sides, he’s pulled off an historic electoral upset.

What’s interesting to me, is how he’s used cutting edge business strategy taken from the tech industry to do it.

Hillary raised more money than him. Hillary was more qualified than him. Hillary will likely end up with more of the popular vote than him. By all of the accepted metrics of modern political campaigns he shouldn’t have won. And yet he did. The big question now, is how?

As someone in the start-up world, I think there are interesting parallels between the lean start-up movement and his campaign. In fact it would seem to be a classic disruptive strategy.

Continue reading “How Trump did it – strategies from the tech industry”

How not to fall down a lift-shaft…


Have you ever wondered what would happen if you were in a lift and the cable were to snap?

Perhaps you imagine a brief moment of terror before you free fall to your doom?

Well, fortunately, no such thing would happen. This is because of the “Otis safety brake”. The safety brake is an excellent example of a failsafe system. Indeed before the invention of the Otis brake, buildings were limited to a maximum of 7 stories in height as lifts were considered too dangerous.

The safety brake is an ingenious design. As long as the lift cable is pulling against the weight of the lift, it lets the lift move up and down the shaft. If the cable breaks, there is no longer tension, and brakes spring closed and stop the lift from moving .

In this way, it is a “fail safe” device. Failure of the cable causes the device to default to its “safe mode”.


Fail-safe systems

Systems too can be designed to be fail-safe. fail-safe system is one in which that when an anticipated failure happens, the system defaults to a safe course of action. In lifts, sooner or later the cable will wear out. When it does, it is designed so that the brakes will be applied safely. In systems, this means that when we design a workflow, if something doesn’t happen, then everything should stop.

The WHO theatre checklist is an excellent example of a failsafe human system. If an item on the checklist is not completed, then the procedure should not go ahead. These checklists have been shown to have significantly reduced complications from operations.

So it may surprise you to realise that in the UK, when it comes to gun licensing, we do not have a failsafe system…

In fact, we have a fail-dangerous system. Which is ironic, as these changes were supposedly introduced to improve gun safety.


Dangerous system design

Currently, when someone applies for a gun licence, the police write to their GP. In their letter, the police request that the GP search the patient’s records to see if there are any previous issues that may mean that the applicant isn’t suitable to own a gun. So far so good…

However, the next step in the process is where things start to go wrong. If the police don’t get a reply from the GP, they assume that everything is ok and issue the licence.

I think you may be able to see the problem here. If the police don’t receive a reply then they assume that everything is ok. This means that if the GP doesn’t receive the request for some reason then the licence goes ahead anyway. If the GP objects, and for some reason the reply gets lost, the licence goes ahead anyway. If the GP forgets to look, then the licence goes ahead anyway…

The letter also states that if the GP doesn’t object to the licence, then they also need to record that the patient has one. This puts the onus on GPs to report to the police if they then develop concerns about the patient.


Designing around “human factors”

In this scenario, we are relying on a GP surgery to act perfectly. We’re relying on the GP to never get distracted. We’re relying on the mail never to lose a letter. We’re relying on the GP never to overlook something.

You may well be thinking that this is a really important issue so the GP should just pull their socks up. This is an important issue, but so are many other things that a GP has to deal with every day.

GPs are human. Humans are frail. We all make mistakes. And just as we have designed our lifts to take account of the cable snapping, isn’t it about time that we designed our safety systems to take account of GPs making mistakes?

We’d love to hear your thoughts on this. Let us know in the comments.

Make it easy


Have you ever had one of those moments when you’re trying to get to sleep and you suddenly realise that you’ve forgotten to do something really important?

For me, it’s usually paying an important bill, or returning a telephone call.

The thing is, I mean to do it, I really do. And then I get distracted, and it doesn’t get done. And then three weeks later, I suddenly remember whilst I’m lying in bed trying to go to sleep.
In this blog post, I’m going to explain how understanding why this happens could help us in healthcare. I’m also going to give a concrete example of how working smarter could have made a recent announcement have a far greater impact… Continue reading “Make it easy”