Learning from the Signs

As a product manager for a suite of clinical applications, I get to play translator / arbiter among clinicians, programmers, IT, QA, and trainers. I get to see things from both sides of the table: the hospital’s side and the vendor’s side.

At a hospital site last week, I noticed something for the first time. Signs. Lots of them. Everywhere. And by chance, Paul Levy of Not Running a Hospital just wrote about signs, too.

CAUTION. AUTHORIZED PERSONNEL ONLY

NOTICE: RING BELL BEFORE ENTERING.

RESTRICTED AREA. GET PERMISSION BEFORE ENTERING.

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Literally everywhere you look in hospitals, there are signs telling you what to do and not to do. Big brother is constantly watching and guiding you, making sure you do exactly as he wants. You don’t dare step out of line, and if you do, the proof that you should have known better is on the video cameras and walls. Ignorance is bliss, and you can’t claim ignorance.

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Then I thought about my white collar office job, where we have about 100 employees. The only instructive sign (that isn’t inappropriate or an inspirational poster) that comes to mind is one above the sink that reminds people to refill coffee when it runs out, wash it down the sink, clean their own dishes, etc. The sign is hysterical. Check it out.

It’s interesting to compare and contrast these two vastly different organizational cultures. The practice of medicine is paternalistic, not only within hospital hierarchy’s organizational structure, but even in the doctor-patient relationship itself. "Do what the doctor tells you because he’s the doctor." The connotation around ORDERS is very top-down. It’s a direct order. You must do it.

Of course you must lock your computer when you leave, enter pass codes to go through doors and log in to IT systems, bar code scan everything that you do, and look only at the charts you’re supposed to, all while being monitored by security cameras at every corner. You do your job per protocol, always. There are no exceptions, no oopsies. If there are, big brother knows and there are sure to be forms filed and licenses revoked if you step too far out of line.

Startups are radically different. Anything goes. Sexual analogies and innuendo are woven through most conversations, cursing is rampant and often encouraged, and everyone is trying to make as much noise as possible. You have to be loud to be heard among the other 390,820,324 startups that are just as trivial as yours. There are standouts, but the startup community is just anarchy that pretends not be. The only thing maintaining a semblance of order is a shared dream: build awesome stuff that makes lots of money.

For health startups, this presents a fun challenge. Be crazy, be wild, make noise, and be just little bit obnoxious. But be professional, be sterile, be formal, and always maintain an image that your mother would approve of.

Health IT startups walk on cultural balance beams. It’s a blast.

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Kyle Samani is a technology enthusiast who is passionate about healthcare and technology startups.

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