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You know, I've read through a handful of "health" startup companies on GlassDoor, especially those that had posted on HN, and I would say more than half have si

You know, I've read through a handful of "health" startup companies on GlassDoor, especially those that had posted on HN, and I would say more than half have similar issues as Babylon. Sentiment such as "a great cause" but "horrible management", and "tons of smart people" but "bad leadership". I wonder why it's so common at healthcare startups.

g_p 6y ago
I wonder if there's a factor in the make-up of the founding team needed to raise money and gain traction through credibility, that leads to this? The leadership and management issues being so common makes me wonder if the resulting founding teams lack the experience of running technical teams and cultivating a good environment and morale. I suspect it's inherently NP-hard to manage a tech team whose work you can't yourself do. I imagine little of the founding C-suite of "health' startups has experienced the "length of a piece of string" engineering deadline when trying to solve complex issues etc, and perhaps that feeds into culture?
- rubatuga 6y ago
  I highly doubt it’s NP hard, given that humans have a hierarchical structure. Even if you assume a fully connected graph, you still only have n^2 connections. Nonetheless, I believe that it is mainly the fact that health itself is hard to iterate on, and requires knowledge from so many domains. It’s possible that the employees who were frustrated in the companies were expecting quicker iterations.
- LyndsySimon 6y ago
  I admit I hadn’t read your comment when I posted a sibling to it. I agree with you. I think successful healthcare tech companies go through a growth stage first where the key is a solid basis in the healthcare field. Engineering experience isn’t as important in the beginning... right up to the point where everything comes to a screeching halt as tech debt reaches the point where it rapidly expands to consume pretty much all of the engineering team’s time.
LyndsySimon 6y ago
I’ve worked at three healthcare startups so far, and have researched dozens to decide if they were somewhere I wanted to work. My intuition is that healthcare is a field that is fundamentally at odds with the tech community mantra of “move fast and break things”. Rapid iteration is absolutely necessary to get a company off the ground, and that is not _incompatible_ with healthcare. I’ve found that there is an inflection point in the growth of healthcare companies where they have to rapidly change from “startup” to “mature business” and that seems to be very difficult to manage from a business standpoint. Very broadly speaking - if a company is founded by “tech people”, this point is when their product reaches product/market fit and begins to gain users exponentially. The tech stack is typically pretty solid at this point (common and expected issues with tech debt, etc., excluded), but there often seems to have been insufficient attention paid to the regulatory issues surrounding PHI/PII. This can lead to data breaches like in the OP, but more often I think it leads to a period of slower iteration while engineering retools the product to properly deal with the regulatory concerns. If a company is founded by “healthcare people”, security is _usually_ handled appropriately almost from the very beginning, but this point is reached when the feature set of the product gets too big for the developers to keep stable while implementing new features. This seems to lead to instability and a slow death march for the development team as the performance issues start to pop up more and more often, and new features take longer and longer to implement. Successfully navigating this means bringing on more experienced developers/engineers and a focus on “best practices” - automated testing, a proper CI/CD pipeline, etc.

g_p 6y ago

I wonder if there's a factor in the make-up of the founding team needed to raise money and gain traction through credibility, that leads to this? The leadership and management issues being so common makes me wonder if the resulting founding teams lack the experience of running technical teams and cultivating a good environment and morale. I suspect it's inherently NP-hard to manage a tech team whose work you can't yourself do. I imagine little of the founding C-suite of "health' startups has experienced the "length of a piece of string" engineering deadline when trying to solve complex issues etc, and perhaps that feeds into culture?

rubatuga 6y ago
I highly doubt it’s NP hard, given that humans have a hierarchical structure. Even if you assume a fully connected graph, you still only have n^2 connections. Nonetheless, I believe that it is mainly the fact that health itself is hard to iterate on, and requires knowledge from so many domains. It’s possible that the employees who were frustrated in the companies were expecting quicker iterations.
LyndsySimon 6y ago
I admit I hadn’t read your comment when I posted a sibling to it. I agree with you. I think successful healthcare tech companies go through a growth stage first where the key is a solid basis in the healthcare field. Engineering experience isn’t as important in the beginning... right up to the point where everything comes to a screeching halt as tech debt reaches the point where it rapidly expands to consume pretty much all of the engineering team’s time.

LyndsySimon 6y ago

I’ve worked at three healthcare startups so far, and have researched dozens to decide if they were somewhere I wanted to work. My intuition is that healthcare is a field that is fundamentally at odds with the tech community mantra of “move fast and break things”. Rapid iteration is absolutely necessary to get a company off the ground, and that is not _incompatible_ with healthcare. I’ve found that there is an inflection point in the growth of healthcare companies where they have to rapidly change from “startup” to “mature business” and that seems to be very difficult to manage from a business standpoint. Very broadly speaking - if a company is founded by “tech people”, this point is when their product reaches product/market fit and begins to gain users exponentially. The tech stack is typically pretty solid at this point (common and expected issues with tech debt, etc., excluded), but there often seems to have been insufficient attention paid to the regulatory issues surrounding PHI/PII. This can lead to data breaches like in the OP, but more often I think it leads to a period of slower iteration while engineering retools the product to properly deal with the regulatory concerns. If a company is founded by “healthcare people”, security is _usually_ handled appropriately almost from the very beginning, but this point is reached when the feature set of the product gets too big for the developers to keep stable while implementing new features. This seems to lead to instability and a slow death march for the development team as the performance issues start to pop up more and more often, and new features take longer and longer to implement. Successfully navigating this means bringing on more experienced developers/engineers and a focus on “best practices” - automated testing, a proper CI/CD pipeline, etc.