Monthly Archives: May 2005

I had a dream.

I had a dream. In this dream, it is time for me to have my annual physical. I log in to my physician’s web site and schedule myself for an appointment. I look at my records to see what screenings I’m due for. He has sent me a reminder already telling me I need to have my cholesterol checked, but I want to be sure he hasn’t missed anything. The screen reminds me that I must fast for twelve hours before my appointment, and that I must wear loose clothing so I can have my treadmill test.

On the day of the physical, I log in to a kiosk in his office, swipe my insurance card, swipe my credit card for the co-pay, and sit down. There’s one woman at the front desk, but she is handling phone requests. No one needs to check me in.

Minutes later, I’m called in to the examining room, where the nurse hooks me up to the digital devices that record my vital signs. The table I’m sitting on weighs me automatically and enters my weight in my electronic health record, flagging the record with the fact that I’ve gained weight since last year.

When my blood pressure, pulse and temperature are taken, I say good bye to the nurse and wait for the doctor to come in. He arrives, having already read my chart in the hall on his tablet PC. He has seen the updates, and greets me with “so, you’ve gained four pounds. What’s up with that? Your BMI is now 26.”

I’m shamed. We look at my numbers on the screen. Now he says to me, “you know, you have normal blood pressure by the old rules, but by the new rules we’d like to get it lower.” I say I don’t care. He says,”look at this. You have a 15% of stroking out next year with this blood pressure. If you lower it ten points and lose ten pounds, see how it changes your risk.” A new scenario is on the screen, telling me it lowers my risk of dying to 2%. I decide to lose the weight and quit eating salt.

The doctor looks at all my numbers on all his screens, and compares my old tests to my new ones. Then he compares me to all his other patients, and to all the other women my age in his practice. Then he compares me to all the other women my age in Maricopa County. By comparison, I’m in pretty good shape. I want to stay there. We discuss how to make that happen. More exercise, less food.

An alert comes up on the screen. I’m due for a mammogram. He clicks on the computer and ends up on the Mayo Clinic web site, — where I have my mammograms. He presses a button, asks me when I want to go, populates some fields with the push of another key, and suddenly I’m getting an email alert on my Blackberry that I’ve been scheduled by Mayo for a mammogram.

We talk about my mental health, my back, my hip, and all the other minor stuff I have. He’s not rushed, and I feel like he’s really listening, not running off to the next room. He writes what I say on the tablet, and it comes out on the chart typed.

I get dressed and walk out of the office. On the way, I swipe my card again to pay for things that won’t be covered by my insurance. I also pick up a written copy of my prescriptions, which have already been emailed to my pharmacy. The written copy is just in case I go out of the country and need something.

It has taken me an hour less than usual to have this physical, because my doctor has gone to EHR (electronic health records) and has automated his office. I haven’t had to wait while they pull my chart, and wait again while he shuffles through it to find the last visit.

In the meantime, the doctor has cut his overhead by two people: the one who checks people in at the front desk, and the one who pulls and delivers the charts. He has accelerated his receivables by allowing online bill presentment and payment, and by putting the kiosk in his waiting room. For the first time in his practice, he’s actually MAKING money, instead of just shuffling it in and out of accounts. And he doesn’t have to dictate or write to the chart at the end of the day.

I told you it was a dream. But it doesn’t have to be. Last Saturday I went to a presentation given by some physicians who actually use all this technology, which actually exists. Why don’t they all? Cost, fear of change…whatever. But one of the presenting docs pointed out that in this day and age, he who has the data has the power, and there’s no reason why that shouldn’t be the doctor. All he has to do is be willing to collect it and look at it.

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Is my city an incubator?

Is my city an incubator? Thank God it is. We in Phoenix can bitch, but we shouldn�t. I�m sitting in a panel discussion at the National Business Incubator Association in which a speaker is comparing Phoenix to Philadelphia. His perception (he�s from Philly) is that in Phoenix, there�s a belief that the pie is growing, and that thus there�s a willingness to collaborate. He spoke sadly of the fiefdoms in Philly, and about the reverse pyramid model of government in Phoenix with the customer at the top. In Philly the residents are not seen as customers of the government, and it�s a zero sum game, in which if the suburbs grow, the city loses.

But a recent National League of Cities survey says that most municipalities will be less able to meet their financial obligations in 2005 than in 2004, and many of them are thinking of budget cuts and increased taxes. Even Phoenix. (Some communities in the west and Midwest are even worse off than the northeast, despite continued growth.) 75% of CFOS in western cities reported deteriorating conditions, declining fiscal fortunes. If it were not for the housing market, they�d be in even worse shape. They all seem to expect a pretty hard landing.

The fiscal problems of cities come from a convergence of factors. Some are internal, such as flawed financial planning and overgenerous pensions. But many are external: post 911 security issues, unfunded federal mandates, job losses, online sales that decrease city sales revenues, and the flight of people who work in the city to suburbs.

So the National League of Cities has said that cities must strengthen and promote themselves as centers of opportunity. Actually, that how they started; in the Middle Ages and again in the Industrial Revolution, cities were the places with the jobs, the places with the educational institutions, the places with the services. Now what can they be?

Cities must develop additional sources of revenue. Which means they must be redesigned to be effected incubators of new businesses, products, and services. More new businesses can generate more sales, payroll and property revenues to replace the declining influence of old line corporate headquarters.

So from that vantage point, what makes a city an incubator? �an environment designed to stimulate the birth, growth and development of new enterprises by improving their opportunities for the acquisition and exploitation of resources with the objective of facilitating and accelerating the development and commercialization of products and services.�

The prerequisites of business incubation are physical, human, social, organizational, and economic. The physical factors include real estate, facilities and equipment. Human capital is obvious � it�s engineers and scientists, but also managers, lawyers, and accountants. We could go on, but the important point is that the resources entrepreneurs need are embedded in diverse and multiple institutions: governments, academic and research institutions, professional and industry associations, financial institutions, foundations and philanthropists, and even religious institutions and ethnic collectives.

A good incubator manager brokers all these resources. So does a city.

If your city is to be a good business incubator, it must incorporate a business incubation policy and agenda in its economic development plan that is articulated to all citizens in the city. All the institutions in the city must communicate, cooperate, collaborate, capitalize and coordinate the incubation of new businesses.

The existence of an incubator in a community tells the world that entrepreneurship exists in the community and is valued. Interaction facilitates activity, but it is the critical exchanges and transactions among institutional stakeholders and entrepreneurs that build the market. Entrepreneurs don�t come to communities that don�t seem to want them.

But the next generations of entrepreneurs will come from different venues and institutions than the last. They may not even come from the United States. In many older cities, entrepreneurs have to be encouraged. Having worked for large corporations, they�re not willing to take the leap to self-employment. Phoenix is fortunate; we never have had a culture of economic dependence, and we will not require the huge culture shift that many cities who used to have corporate headquarters have developed.

This perspective is MORE than just making lemons out of the local lemonade; it is understanding the uniqueness of Phoenix to be a leadership city in the next century. There�s an index here at this conference called Business Incubation Competency. It�s indicative of the degree or extent to which multiple and diverse institutions work together to cooperate and catalyze new companies.

According to these measures, Phoenix is a city with a high Business Incubation Competency. Although our entrepreneurs complain, perhaps they should not. They come from a culture of entrepreneurship in a city of entrepreneurship, and one that is not suffering quite the diminution of resources characteristic of other cities.

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I just saw N. again

I just saw N. for the first time in almost five years. She’s a former business acquaintance of mine, now a friend, an Egyptian female serial entrepreneur and venture capitalist. (There aren’t that many of those :-)) She is also a Thunderbird grad and a veteran of the New York financing trenches. She recently raised $16 million for six different companies and then decided to start another one of her own. Could she be any more competent to do a startup? It’s hard to imagine so.

So now she is the proud owner of Ink and Toner Depot (www.inkandtonerdepot.net), a flourishing little business that sells remanufactured printer cartridges either online or through associations as a member benefit. It�s aimed at the SOHO market, and it seems N. has more business than she knows what to do with, because she is doing it all on her own.

N.is more fortunate than the average entrepreneur. First of all, having analyzed business plans for the past ten or so years, she knows what she’s doing. She has a business plan. She has a product for which she knows the market. She has some good corporate contracts with companies that employ independent contractors (insurance salesmen, etc) who print a lot, and who like to save money.

So of the three things a funding source looks at when evaluating a business, N. has two — the technology and the traction. She has cash flow (although it’s small). She has a sound value proposition (30-80% off retail prices), a collaborative sales model (revenue-sharing with associations), and a product that is a razor blade. HP sells more than a million printers a week, and most of those can use a re-manufactured consumable.

However, she can grow because she doesn’t have the team.

It�s rare when I meet with an entrepreneur who doesn�t ask me to find money. But this woman can find her own money. What she isn�t easily able to find is someone to share the burdens, the joys, and the roller coaster ride of the business. Like everyone else, she�s exhausted and needs a fresh pair of eyes to look at all her decisions.

And, like everyone else, she can�t get money without a team because she doesn�t pass the �bus test:� if she got hit by a bus, her business could not go on.

Why am I telling you this? Well, three reasons. First of all, it�s instructive. Too many entrepreneurs try to do everything themselves, either because they feel they can�t afford to pay anyone else or because they are afraid to lose any of their previous �equity.�

Second, because I believe in the power of the written word. I think if I put it out there, someone will manifest and be the right person to join N.

And third, because I think there�s a business opportunity in matching partners with opportunities and automating that process.

Now why doesn�t social software already do this?

I think because the value proposition of social software is to make contacts, but not necessarily to find the �right� contacts. If you already know that you want to sell your software tool to Microsoft, social networking software can probably help you search for a given job title or person within Microsoft who might be your buyer.

But social software doesn�t really tell you if someone could be your ideal business partner.( I don�t think you can search for a CEO or a CFO on LinkedIn.) And neither does EHarmony or Match.com. That�s especially true if you want someone to join as a partner rather than as a hired gun.

One of the most recurrent problems I see in startups (or, more accurately, in attempted startups that never really get started) is the failure to begin with a good, competent group of people whether virtual or real. Somehow, most entrepreneurs think if they can�t pay someone, they can�t have them on the team.

Myself, I don�t believe that, because I have more than once �paid to play� on the team of a startup. One time I�m fond of talking about occurred when a serial entrepreneur friend of mine wanted to seed his second company. He gathered a group of six of us together, each with different talents. He collected $5000 from each of us in cash, and then made us promise the equivalent in sweat equity over the next six months. There was a doctor in the group who had no applicable talent, and if I remember correctly, he paid double the cash to be part of the team.

The cash was used to do things like start the patent filings and put the corporation together correctly. The sweat equity was used to handle all the chores involved with starting up and driving our little stake in the ground. (This, by the way, was almost fifteen years ago, so the ante might be a little higher by now).

The fun part of this was when the first round of funding came in, and we all had the opportunity to cash out or stay in. And guess who the angel was who took out the friends, family and fools? (us) It was the rock group U-2! How could any of us have missed that experience?

So who is going to help N.? By the way, if all you want is printer cartridges and you go to http://www.inkandtonerdepot.net and type in Francine when you order, you will get a 10% discount. Such a deal ?

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Most people would rather consign

Most people would rather consign themselves to lives of quiet desperation in Dilbert-like cubicles than start businesses of their own, a fact that I find alternately amusing and worthy of disdain, especially in a global universe.

Surely by now you have heard Lou Dobbs rail about the outsourcing of America, a theme that makes me want to throw a shoe at the TV screen. And yet, the American worker seems to have the same sense of entitlement to a job that the crack-addicted welfare mother has to her Aid to Families with Dependent Children.

Not only are most jobs deadening; they are not even secure. Today, even the Dilbert jobs often go to the country in which they can be done either most cost effectively or most expeditiously during a 24-hour work day. There’s no longer any reason to trade off your freedom, creativity, and control– there’s no 21st century Organization Man, no corporate ladder to climb in an increasingly flat organization. The two leading American car manufacturers just had their bonds rated “junk.”

Even the government lays off, downsizes, and freezes hiring, as legislatures force tax cuts. In some school districts, teachers (once known as the safest jobs of all) are regularly RIF’d (subjected to Reduction in Force layoffs) at the end of the year until the budgets and enrollments are figured out.

So why don’t more people become entrepreneurs? It’s gotta be pure fear. A new study by the outplacement firm Right Management says that when employees are laid off, more than 4 out of 10 (44%) consider self-employment � a percentage almost four times higher than the number of people who are actually self-employed in the U.S. (12%).

Although 56% of respondents said they are thinking of changing careers, approximately 40% actually go through with this � including about one-third who switch industries for their next jobs (perform the same job function, but in a different industry), and less than 10% who start their own businesses.

�There is a trend toward more displaced employees switching industries for their next jobs, but fewer going into business for themselves,” says the Right Management study.

We’ll do anything rather than take the responsibility for their own economic lives. Guaranteed paychecks are just another form of welfare.

But I don’t believe we are going to have any choice in the next century.

The era in which someone could expect to work for a single company for an entire career was a brief blip on the screen of human history, a by product of the Industrial Revolution. During the Industrial Age, workers were brought together in “companies” because the tools to manufacture were centrally located at the factory. We had assembly lines and expensive equipment at central locations.

But that era is over — at least in the developed world. So now what do we do? No one needs us to swell the ranks of an assembly line or even stand in front of a classroom. Government workers are replaced by online portals that process vehicle licenses, business information, and social services. So we are thrown back on our own ingenuity.

Well, throughout most of mankind’s evolution, almost everyone worked for himself, flowing with the market and reinventing themselves when necessary for survival. How can we recapture that hunger, that enthusiasm for our own survival, that competitiveness in the face of the larger animal (which is probably China)?

My sense is that in the next century, we are going to have to be hungry again, and we are going to have to work for ourselves. But ours won’t be the same kind of entrepreneurship as I have seen in my travels: the woman in Africa raising chickens to sell eggs; or the man on the streets of India hawking pashminas; or the children in the streets Mexico peddling chewing gum or cleaning windows. (As recently as fifty years ago, children in New York ran up to your car windows and tried to clean them for pocket change while you were waiting at a traffic light.

Ours will be an entrepreneurship of ideas, not of products. It may be an entrepreneurship of services, such as genetically engineered individualized therapies for cancer, or dog walking. But at some point in your career, you will undoubtedly find yourself working for “the brand called you.”

Yes, you may hire some people to help you. A lone person can’t bring a new drug to market. But those people will be short term hires, ad hoc teams, independent contractors — not lifelong company men.

It’s changing, folks. Hop on for the ride.

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