On Founder wellness

This article is the twentieth in the Startup Series on FirstPost’s Tech2 section and first appeared on August the 6th, 2017.

In the very first column in this series, I wrote about the loneliness of entrepreneurship. Add to that the stresses of building and running a fledgling business, with the worries of making cash last, making sales, making payroll, and just making it to the end of the month sometimes, and we have the makings of a psychological nightmare for founders. In the recent years, there has been more than one founder suicide, a sad outcome which is often preventable.

Nobody, no failed or successful founder, can tell you how it is supposed to be. A venture isn’t about rational factors alone. As founders we give so much to it that we can lose the plot. If however getting out of bed gets harder, it is time for a rethink. Here are some pointers.

Recognise the signs.

There are signs when we aren’t coping. Others can sometimes see them before we acknowledge them. These signs include (but are not limited to): poor sleep patterns; inability to concentrate or get anything done; messed-up appetite or eating patterns; loss of energy and focus; creeping substance abuse in the form of increasing use of caffeine, alcohol, cigarettes, pot etc. in the name of needing a kick, relaxation, help to fall asleep, stress relief.

Ignoring these is not wise. Inadequate or poor sleep affects our judgment including moral judgment. Poor nutrition affects energy levels but can also contribute to stress. The impact of substance abuse on judgment, motor skills and on general wellbeing is widely known too.

Ignoring any of these is unhelpful to your ability to be a good founder.

Take stock and distinguish busyness from strategic progress.

When I see stressed founders — and I include my former self in those — I ask if they stop and take stock. It is a simple step but powerful in its impact on focusing one’s efforts.

Do you feel purposeful in your pursuit, or are you just cranking the handle? Can you distinguish busyness from strategic progress?

Being permanently busy hampers our ability to engage in deep and creative thinking.

Schedule leisure.

“What is this life if, full of care,
We have no time to stand and stare.”

Welsh poet William Henry Davies’s ode to Leisure might be anathema to most founders, as they flinch when I ask what they do in their free time. “I have no free time.” “But you have the same 24 hours as everyone else.” “Um…”.

Every once in a while, the question gets heard. And then they stop.

You schedule meetings, don’t you? How about scheduling a form of downtime as you would an important meeting? This is after all just an appointment, one you keep with yourself.

What should your leisure look like? Anything you want it to look like, as long as it utterly distracts you from work, recharges you and energises you. Some find solace in nature walks and hikes, others in books. Yet others cook or find time to help social and charitable causes. A few engage in extreme sports. Find what works for you and commit time to it, weekly if not daily.

Talk to people not related to your work or Startuplandia.

And do that regularly. One of the key essentials as a founder, focused on one’s narrow goals, is to keep perspective. That requires looking above the parapet and being open to being challenged.

The story of the well-known “innovator” Square comes to mind. The idea was to let small merchants accept cards using a square dongle. It worked well in the USA. But Europe and the UK were far more advanced in their card security features. The dongle had no capability to accept chip-and-pin enabled cards. The famous founder did not dig in his heels, but worked to understand the limitations of their offering and explored other avenues.

People not invested in your space may detract but many a time, they also have views which may make you think.

Build a wellness and self care routine.

It wont be much fun, would it, if your company is celebrating milestones and you are sitting under your desk rendered immobile by your anxiety, or worse, in hospital with stress related illness.

Wellness is not a hipster idea. Wellness – physical, mental, psychological, spiritual – enables us to follow our dreams, giving our best to all we do.

And if we don’t give the best to our startups, really, why are we bothering?

Work and isolation

On the same day that I saw a journalist in London seeking to speak with people about workplace isolation, a friend in California noted that she wanted to have a little social but found that her real world community was either virtual or non-existent.

My friend in California chalked her lack of community down to her being an entrepreneur, where long hours of work mean one’s options to socialise are mainly people who are employees or customers, both of which can be awkward.

When I mentioned workplace isolation to friends in senior corporate jobs, one quipped that this isolation malarkey was all down to people opting to work in the gig economy. Another noted, with a sigh, that the more senior one became in a large corporation, the more isolated one became, with fewer and fewer people seeing one as human, and fewer still willing to speak truths to power, so to speak. Indeed the story of António Horta Osório, the CEO of Lloyds Bank in the UK, and his spiralling into depression that led to a breakdown is well-known and one of the few honest stories of the impact of isolation to come out in public.

Without even reflecting over my own career of over 20 years, I know instinctively that the gig economy did not create workplace isolation. It is an existential condition of human beings to seek both camaraderie and company, and solitude: the former perhaps to generate ideas and to rejuvenate the self, the latter to reflect, create, and indeed, rejuvenate.

My experience of isolation in corporate life came from many sources. One  of them was being a gender minority. I even wrote a piece about my experience in Cosmopolitan magazine’s India edition around 1996-97. While my male colleagues were good people, it was tricky to socialise with them weekend after weekend. The city I lived in, Delhi, did not then have public transport so it was expensive, unreliable, unsafe, or all of the above to go across town to attend book readings or see films etc.  My solution was to start learning German on the weekends, which earned me much mockery but also a career break into Europe to open a new country office.

That unfortunately brought its own flavour of isolation. This time I was in Switzerland’s German speaking region, as a gender, ethnicity, and apparently age minority in the IT industry. My coping was hugely eased by my friendship with two others in a similar boat, both foreign to the German speaking regions in their own ways.

I then transitioned to a role in the UK where my team was spread across time zones. That was splendid isolation indeed as I began work at home at about 4.30am to catch my Asia-based team members as they began the day and the work day rolled on all the way to California. Going into the office was an option but I needed a few hours in the day unplugged. This is the bit of my experience now cited in this FT article the journalist mentioned earlier was writing.

You see, there are many ways the structure of corporate work and workplaces can be isolating.

My life as an independent consultant and advisor, an entrepreneur if you will, after the corporate stint, has been a solitary experience, save for meeting clients at lunch and sometimes friends for coffee. This fits the cliched image of the gig economy that I mentioned earlier.

Yet somehow we cope. And many of us continue to thrive.

My sense is that women cope better. Most women are socialised to seek and build communities, “to tend and befriend” not just in times of great stress. The web is helping break geographical barriers and enhance some sense of community. MumsNet is a well-known example of such a community. Several closed and secret groups of women founders and leaders thrive on Facebook. Some such as Blooming Founders and NOI Club have physical world components too. With the burdensome expectations of performance of masculine behaviour, men suffer silently — and alone — in their loneliness. This does not help workplaces or society.

Institutionalised solutions are emerging too. The gig economy worker, the entrepreneur and the small-corporate worker alike now have options. WeWork provides co-working spaces, designed to foster serendipitous and organic networking. The company has diversified into providing co-living in a few cities around the world too and it is branded WeLive.

Some criticise WeLive as an extension of dormitory or student halls living but really now! In the face of all this evidence of loneliness and isolation, that is the best criticism you can come up with?

As I said to Emma in that FT article, loneliness can have an existential quality. It forces us to examine the meaning of life in ways being surrounded by people all the time does not make feasible. From that isolation emerge creativity and ingenuity. But it can also foster mental health and addiction problems for many.

The real solution for us all lies perhaps in Goldilocks’s perfect porridge — not too much isolation, not too much cacophony of human company. Each person’s “perfect” however will differ.

What does all this mean for the design of work and workplaces? And indeed for our lives and societies?

As I see it, we may need a complete rethink of our shared and personal spaces. For workplaces, it could mean the provisioning of both open spaces to socialise and banter, and closed, quieter spaces to think and do actual work, sometimes energised by that interaction. Our living spaces need similar possibilities, if not within our own homes, then within the larger context of our neighbourhoods and cities we live in.

Politically and socially, we seem to be in an upheaval worldwide. Many are selling us the nostalgia of a glorious past, which, some argue, keep us from imagining better futures.

In this churn, could we hope to create a new order of things that are actually designed to serve the humans that use or inhabit them? Much like the Arts & Crafts movement’s thinking on spaces, a hundred years on?

I need to reflect on this. Alone. Perhaps you do too. Let’s convene later!

Four for Friday (15)

This week’s eclectic, interesting reads:

The hall of shame? A list of VCs with no female investing partners.

One step closer to Eternal Sunshine Of The Spotless Mind? The forgetting pill.

The case for the e-book as a more intimate literary experience.

Mark Zuckerberg as an autocratic dictator? You don’t say.

Whose data are they anyway?

What a difference two days make!

First, T-Mobile in the UK informed the Information Commissioner’s Office that some of its own rogue employees had sold on the firm’s contract customer data to third parties. These third parties then ring the contract customers just before their contract expiry to offer deals that may or may not be kosher, or the best deals on the market.

So exactly what data might a mobile network operator hold on a contract customer? These data include the customer’s name, address, date of birth, and bank account details or credit card details for collecting bills. A credit check is also run before contracts can be agreed. While the identity of the said “third party” is unclear, there is of course no compensation for any mishaps. So much for our famed data protection code that prevents more things from happening than it enables!

A day later, Iceland’s deCODE Genetics filed for asset protection under Chapter 11. The firm’s customer testimonials include one from Dorrit Mousaieff, Iceland’s first lady. The firm offered personalized DNA testing through its deCODEme website too.

Under Chapter 11, deCODE is now looking to sell its assets. These “assets” include the genetic data of 140,000 Icelanders. And DNA samples of an undisclosed number of customers, their identification details, possibly the reports of the analyses conducted on the DNA samples. All held under contracts which prevent the sharing of the data or the information with third parties such as insurers etc. But will that hold when one contracting party goes bust? Who is the custodian of that contract? Who will uphold it and what recourse exists for customers whose DNA and data are hanging in the balance?

Meanwhile, it was reported that a credit card processor in Spain was being investigated for enabling a major credit card scam. The scam has affected over 100,000 cards in Germany. While their credit card contracts protect them against fraud, someone will end up paying for it. Depending on where the PCI-DSS compromise is found and how the liability is established, any or more of the players in the payment value chain – the issuer, the acquirer, the processor, the retailer or the customer – may end up suffering the real monetary loss.

Note the commonalities? All three industries are highly regulated but so different from one another that one may be tempted to ignore any possibilities of transposed learnings. Two major themes emerge:

  • These incidents point to some of the many complex challenges that unite otherwise disparate, highly regulated businesses: customer data ownership, data security, privacy breaches, liability, recourse and compensation.
  • They also illustrate while human beings – employees, third parties, contractors, service providers – remain the weakest link in data protection, the more fundamental questions are often missed. These could be related to the business’s survival and how regulatory complexity may mean that resolving data breaches is not really straightforward.

As a large number of consumers sit in limbo in fear of their data falling into the wrong hands, it has to be asked: When the custodians fail, who protects the consumer?

These test cases will all provide fascinating insight and may well set the precedent. Not least set the stage for the essential reform to remove all the unnecessary information that businesses insist on collecting from customers, when they have no way to guarantee the security of the data.

Healthcare Services Outsourcing to India?

This post emerged from a question asked by a friend on LinkedIn. The question was:

Are (sic) Healthcare services outsourcing from India the next big opportunity? Health-insurance companies based out of the US are giving the option to customers, to get their surgeries / medical procedures done from Indian hospitals. Is it now time to give healthcare outsourcing its due?

The question fascinates me on several fronts. I work with India investors interested in several sectors, including Outsourcing. I also work with investors keen on biotechnology and pharmaceutical sectors. In addition, I work in comparative health policy which, with my strategy hat on, I cannot help but frame in the context of the comparative advantage of nations.

As an investment opportunity, Healthcare Services Outsourcing (HSO), which also goes by the names ‘medical tourism‘, ‘health tourism’, ‘medical travel’ etc, is a no-brainer. If an investor from Britain or America wishes to invest in facilities in India that cater exclusively to economically well-heeled but health-wise, down-at-heel patients from developed countries, the returns are easy to make. The case is not hard to make from the perspective of the 3Ps of healthcare – payer, provider and patient.

The economics stack up pretty easily from the payer’s perspective although I think there is a divide between private sector payers, such as insurance companies and public sector payers such as the UK’s National Health Service (NHS). Take it with a pinch of salt, if you will, but here is an interesting ‘ready reckoner‘ of relative costs and waiting times in the NHS with those in India. The comparison does not include the cost of poorly understood risks, of corrective action when things go wrong and the cost of any adverse impact on future healthcare premia.

At least to some providers, the risks are manifestly clear. In the recent days, the UK’s NHS, which is also a payer, is asking patients to pay for corrective surgery after elective surgeries abroad go awry. For an opposite perspective – how costs to NHS add up when un-entitled foreigners abuse its free-at-the-point-of-delivery health service – see this short video from Sky News.

From the patient’s perspective, the prospect of reduced waiting times is enhanced often by the possibility of an exotic holiday in a two-fer. Not just that, patients can often get treatments which are rationed or otherwise unavailable from their provider such as obesity operations not easily available on the NHS.

The business model “HSO as medical tourism” is therefore easily fundable. The question is – in Guy Kawasaki’s succinct words – here: it is fundable, but is it viable? From the perspective of comparative advantage of India as a nation, one needs to ask: is it sustainable? Let’s examine this a bit.

India has a sufficiency of factor conditions such as good, English speaking doctors and now good infrastructure to deliver advanced surgeries and treatments. That is an attractive proposition on its own for HSO providers and seekers. But as far as domestic demand conditions are concerned, Indians carry a disproportionate burden of diseases such as malaria on the one hand, and diabetes and heart disease on the other. So there is a need. But a considerable number, estimated between 15% and 25%, remain in extreme poverty, so the purchasing power is curtailed. “HSO as business model” focuses on the factor conditions but sustainable comparative advantage for India will arise from not its relatively smaller magnitude factor conditions but also its considerable demand conditions.

The experiences of doctors in India, working on the coalface are instructive – on the one hand, about the larger failures of public health policy and practice in India, and on the other, about their value as intensive learning or potential for ‘knowledge transfer’, if you will.

Much discussion was generated by a BMJ editorial, titled Poor Countries Make The Best Teachers. My response was:

“… a doctor in the United States, who had trained in India, told me an anecdote that shows the flipside of Byrne’s experience on elective as a medical student in India, a learning experience she described as second to none. In a lecture during my acquaintance’s residency, she noticed that her professor and other residents were puzzled by the x-ray film of a boy’s limbs. They could not identify what could possibly have been wrong with him. The doctor, who had seen much rickets in India, identified it correctly and to the amazement of her colleagues. Poor countries, sadly, still provide reasons to train Western doctors in diseases that may not afflict the West right now but, with mass scale migrations, could easily become a problem in the future.”

What does this mean for investment opportunities? Well, a lot, if we think differently about HSO.

* A better, scalable and sustainable investment would lie in raising the profile of the usefulness of training doctors from developed countries in India. This will enable doctors from developed countries to understand, diagnose and treat better those diseases, which were hitherto geographically confined or eliminated, but are now resurgent and truly ‘globalised’, thanks to travel and mass migration.

* In return, the doctors from developed countries could teach the Indian doctors about innovative methods such as advanced surgical techniques, give equipment and test kits, as well as help with public health programmes particularly expanding capacity and service delivery.

* Indian healthcare system, in turn, could invest some of the profits to provide essential preventative services and public health programmes to its poor populace. India’s main factor conditions, the doctors, could therefore become not just financially better off but also more influential stakeholders in this healthier future for all.

How is that for a model for healthcare services outsourcing?

Yes, I know this is not a fashionable view. But it certainly is the most sustainable way to go forward where good health and access to good healthcare is not the privilege of the few ‘haves’ but the fundamental right of the many ‘have nots’.

As for why I am arguing a case to reduce the primacy of the potential of “HSO as medical tourism” model, I prefer to let Cicero explain that.

“The man who can hold forth on every matter under debate in two contradictory ways of pleading, or can argue for and against every proposition that can be laid down – such a man is the true, the complete, and the only orator.”

Over to you, and Santé!

Related reading:

Credit crunch and public health

Health and the Indian Economy – one of my guest posts on the Indian Economy blog

The world’s front-office? – an old post examining India’s outsourcing industry

New York Times says Uninsured Put a Strain on Hospitals. How about ‘Poverty and inadequate access to healthcare puts a strain on human beings’ for a title?