Don't sell burnt (product) sandwiches
Making a product in healthcare is a venerable duty. Take it seriously.
I’m writing up a long series of posts on evaluating Managed Integration/Healthcare API providers that I plan on releasing over three weeks starting next week. In the meantime, enjoy this brief musing on healthcare product.
Like many of you, I have been trapped in the house in a cold winter as we wait for our lives to get back to normal from the pandemic. One of the movies I’ve watched a few times has been Jon Favreau’s 2014 Chef. Produced, written by and also starring Favreau, Chef tells the story of Chef Carl Casper. Casper is down on their luck and has lost his creative mojo. Stuck in a rut and prevented from taking creative risks by owner of their restaurant, Carl eventually snaps after a bad review hoisted upon a menu he is effectively forced to cook by the restaurant owner. After losing his job and being publicly humiliated on the internet, Chef Casper rejuvenates his career by starting a food truck and embarking on a cross-country journey with his son and best friend. It’s a heart-warming story full of great cinematography of mouth-watering meals, strong acting performances and bright locales. The movie also operates on many levels as allegory of the tensions of being a creative within the film industry: where the chef is the Film Director, the restaurant owner the Studio Head and the critic is still the critic.
One of the more poignant moments in the movie is when they are making Cubano sandwiches for some workers in thanks for their help setting up their truck. Carl’s son burns a cubano on the griddle. When Carl tells him to throw it out, his son pushes back “So? They’re not paying for it.” Carl stops the line, pulls his son aside and provides this speech about his own passion for excellence in cooking (and, by proxy filmmaking) and the joy the commitment to his craft has provided:
I might not do everything great in my life. I'm not perfect. I'm not the best husband and I'm sorry if I wasn't the best father. But I'm good at this. And I want to share this with you. And I want to teach you what I learned. I get to touch people's lives with what I do, it keeps me going and I love it. And I think if you give it a shot you might love it too. Now, should we have served that sandwich?
In my journeys, I get to interact with a wide variety of people. Some folks have been working in healthcare much longer than I have. Some folks are brand new. One of the things that provides me with energy are folks who have passion for improving healthcare. With folks who have been working at improving healthcare for 40+ years still treating every day like it was their first and smart people who are entering healthcare after seeing the inequality and friction they have experienced themselves. For as frustrating as operating within the confines as healthcare can be, it’s more rewarding than not.
As such, it always dismays me to see people selling the burnt sandwich equivalent of a product. I am not naive to the power dynamics and economics of healthcare itself and this assertion in and of itself is somewhat “Michael Scott-esque” in nature. But I believe that the need to make and support good products is not only important but ethically essential. Working in healthcare technology, many of us are insulated from the true tribulations of healthcare itself. We are spared the death, the tragedy, the second guessing, the financial impact on patients and more. We mostly just need to make good software that doesn’t let down clinicians and patients that delivers a greater ROI than just putting that money into the pockets of the clinicians and patients themselves. That task itself is easier said that done, but the pursuit of those endeavors are mostly non-risky.
While there are many good intentioned failures to serve a good product, deliberately known poor products should be as reviled as the burnt sandwich. There are many varieties of these “burnt product” sandwiches, but I think these are most common:
The-fake-it-until-you-make-it-and-then-keep-faking-it
I have nothing against the Lean Startup methodology. You should test hypotheses as inexpensively as possible and as rapidly as possible. That may be wireframes. That may be just bootstrapping a new workflow in Office/GSuite. There are plenty of simple businesses in healthcare that do not require much by way of technical sophistication and instead rely mostly on better distribution of personnel. Sending a doctor to provide a checkup of a Medicare Advantage patient post-discharge or solidifying the chain of care by consolidating acute care with SNF/LTCs is not inherently a technical problem.
But if you do plan on selling software, you eventually have to have a plan to make it. And then you have to make it. There are so many companies who believed that they could sell ahead of their product so much and then collect services or other revenue while they could never deliver on the product. It’s entirely free to say things like “we’ll use ML to better target patients” or “we can change physician and patient behavior” or “this product drives outcomes and efficiencies”. No one’s life has ever been improved by a really nice looking figma prototype. Well, perhaps the UX/PM team so they have something to show for their efforts. But it doesn’t drive clinical improvement. Again, if the prototype is just the first phase in making the product, that’s great and good product lifecycle work. But if the plan is to sell-sell-sell the half baked prototype into perpetuity, just don’t.
I care (but only during business hours in my time zone)
You should get paid for your work and you shouldn’t work overtime for free. Your product pricing should ensure that if you have to burn the midnight oil due to “user error” that you can pay people well to support those products and efforts.
That being said, I’m always shocked when healthcare technology companies do not want to support their products for the 24/7/365 needs that clinicians and patients have. First, mostly because this doesn’t take a lot of work unless you have a crappy, unreliable product. Second, because it implies that you are not in the same boat as the clinicians and patients who need help and WTF. When you make a product that interjects itself into the provider-patient relationship, you are effectively inserting yourself into the patient’s Care Team. It’s your responsibility that you are there when you are needed, not when you want to.
There are lifestyle products and businesses within healthcare (try consulting!) and there are good products and businesses outside of it. If you want to toss a product over the fence and hope it works 9-5 PT, you had better make a perfect product.
When all you have is a limited-use hammer, everything looks like a nail
It’s not bad for something to have limited scope. Your app may only help patients with one condition, your device only interpret one signal. Even more broad categories of efforts like “interoperability” are limited in their use cases.
It’s easier to make software now than ever before and verticals do not always inherently need to be winner take all. Some determination on whether or not your product can meet $need with $existingFunctionality is good product discovery. Over utilization or unchecked sales teams, however, is the equivalent unapproved off-label medication use that is just as dangerous as letting patients pick their own drugs.
As product people, we always need to be in search of a larger TAM/SAM/SOM. But in healthcare there are major ethical concerns to doing so carelessly. It’s tempting to do this, especially when you think that you can control what happens after the sale or after the pitch. It’s easy to trick yourself into thinking you can figure out how to solve the problem later. But sometimes you can’t. The unsolved challenges of healthcare are endeavors worth trying and failing at, but the difficulty in solving their problems should be treated with the gravity they deserve.
In closing
When you’re working on a healthcare product, use the golden rule. Think if it’s something that you would want to use or if an action you would take would be how you would want to be treated as a patient or as a customer. Imagine your products being used by people in a tough situation and apply empathy to how you work with healthcare workers and patients. Don’t serve burnt sandwiches, chef.
Thanks again for reading! Stay tuned for my write up on evaluating managed integration providers next week.