Health Innovators
Health Innovators

Episode · 2 years ago

Why Waterfall Doesn't Work & How to Manage Strategy


Healthcare innovators are usually in such a rush to get to market that they don’t take the time to create the correct framework for decision making and develop the right strategies. Usually, they employ a waterfall strategy, which makes them susceptible to failure.

How can we implement incrementally, instead of taking a static approach? Why is it a huge mistake to lock down our strategy without making it flexible, iterative, and data-centric? How do we connect the insights between the disparate parts of the commercialization process?

On this episode, we talk about why the waterfall strategy doesn’t suit the healthcare commercialization process, and why a “set-and-forget” approach is a costly mistake.


Success in healthcare commercialization starts with slowing down to wrestle with our assumptions. -Dr. Roxie Mooney


3 Takeaways

  • The strategy for successful innovation is not meant to be static. We need an agile, iterative methodology that keeps up with the dynamic nature of healthcare. 


  • The waterfall method is not flexible enough. Consumer needs, market trends, and competitors aren’t fixed. Our strategies have to account for that level of constant change. 


  • Set a strategy that leaves options open. Just like Napoleon, one of the greatest strategists in history, we should be setting strategies that give us options and maneuverability. There’s no sense in sticking with a strategy even in the face of conflicting data.

The decisions we make in healthcare don’t function in a vacuum. Because of this, healthcare innovators are up against a lot of challenges that can affect the commercialization process. The first step healthcare innovators can take to beat the odds is to have a framework for those commercialization decisions, from concept to launch and beyond. 


Our strategy needs to reflect the dynamic and complex nature of the healthcare industry; and if we make decisions in the right sequence, we will avoid market failure, use our organizational resources well, and increase the profits of our innovations.

Welcome to Coiq and first of its kindvideo program about health, innovators earlier doctors and influencers, andthey are stories about writing the roller coaster of health care andovation. I'm your host doctor, Roxy Founder of Legacy, DNA marketing groupand it's time to raise our COIQ welcome back to Youyq listeners ontoday show we're cutting another solo episode with Matt Johnson. Ourexecutive producer for the video and podcast show. Thank you so much forjoining us. Roxy plusrose always awesome, and you have your own podcast,shall I do I do and and enjoy, enjoy, having kinds of deep conversation so oon my own podcast. We talk a lot about strategy in the area that I operate in.So when I show up to these I know I'm going to have a really INDEPP, reallygood conversation, and I al end up pulling things out of this- that I cango applying to my own business, which is a blast for me, but we're going totalk about strategy on the fly. You...

...know strategy being kind of static andthere's this this idea and I think a lot of people have it doesn't matterwhat fields you're in, but especially, it seems like in healthcare, the H Y.You just just get the strategy right once and then just let's hit the groundrunning, let's get to market. Let's get out, let you know get it in front ofsystem get in front of users like let's just get out there and do it right andthen that that will that will take care of itself and it kind of goes back tothe thing we've talked about before, which is that hey? As long as you havethe best solution, it's going to win out which we dealt with before we knowthat that's not true. So let's talk about strategy a little bit. What'swhat's your feeling well, and I think that it's you know all entrepreneurs.I've never met an entrepreneur that didn't really operate fast and furiousright, and so the idea of leap, frogging over strategy and gettingthemto the tactics just makes you know, entreprepreneurs feel good they're,making progress and they're that much closer to success. You know so, butthat can be a losing strategy without even realizing it per son. Well Yeah,because there's other people involved.

We've talked about this on on previousepisodes that it's not up to us. We can think we have the most awesome thing:Buth ther's, especially in healthcare, with it being multisided, there's somany things to consider. Even just one element which you mentioned on aprevious episode, the fact that sometimes the people who use a productor an innovation are not the people who pay for it. That alone introduces somuch complexity in the decision of who are you selling to and who is buying itand who are you marketing it to that's just one element of a strategy that canhave all sorts of implications up and down our our entire business. So anyway,let's jump into like, if you had kind of- I guess the when you look around atthe market and you see what people are doing, both the innovators themselves,who are leading the companies and developing new solutions and the peoplethat they pay to help them with their strategy, essentially you're, seeingkind of the same problem. What is that problem so, most of the time there isn't aframework for that decision, making a take place. So it's a little bit moreWilly Nilly kind of add, Hawk and- and... you know, there's all sorts ofinherent challenges to that. I may be leaving some strategic decisions on thetable that I'm not even aware that I need to make- or I may be overlooking some of the connectionsbetween those strategic decisions, and so you know none of these decisions,kind of function in Asilo or kind of independent they're, all in ar related,and so, if I don't have a framework that mind, Yeu is based upon some typeof theoretical principle right, so it has to have some type of backbone,incredibility to it that I'm I'm going to be more susceptible to failure and,like we've talked about on some other episodes that you know, the failurerate is really high. Ninety five percent of innovations that are broughtto market fail. So what is one of the first steps that health innovators cando to kind of beat? Those odds is to have a framework for thosecommercialization decisions, all the way from concept to launch and beyondyeah yeah agreed, and it's it. You...

...mentioned the typical entrepreneurbeing kind of the fast and the furious. We all have that idea that well, ifninety five percent of businesses fail, those are the dumb ones, I'm in thefive percent- that's not Gona. I and the five perehappening to me, come on now one hundred percent. We all think welland that's you know, that's there's a lot of beauty in that,because that's why we are that's. Why we're entrepreneurs? That's, why we'recreating things that don't exist, and it's that kind of optimism that really fuels us and helpsus overcome all those hurdles that we face in this journey. That is a hundredpercent. True, everything is everything. Is a trade off an a balance? It's yeingyeah, all right, so so, when we look at having a framework, so we talked alittle bit about you know like doing strategy on the fly which most of us doobviously having having a framework basically lets. You know exactly whatall the factors are that you should be taking into account before you even sitdown to make the decision. So when I...

...think about that to me that meanshaving better a better idea like a Romat, better vision almost like takingthe blinders off, but it also means you kind of know if you know all thefactors that go into it, you probably know. Okay, here are the five things Idon't really know, and I've never really taken the time to even ask themarket- and I know that's part of your strategic framework- is knowing who andwhen to go, ask to get the data that you need right, yeah, yeah, absolutelyso it's it's really! It's all of those decisions that collectively you know define that commercializationprocess and every decision that's being made you're building confidence becauseyou're taking the time to kind of wrestle with the research wrestle withthe data kind of double check or play devil's advocate with some of yourassumptions, there's so much biased, that's just kind of inherent to thiswhole process. So a lot of times you know health innovators want to movefast and furious and get to market,...

...because we're all you know trying towin and be first to market, but the reality is. Is Success is slowing downjust a little bit to wrestle with those assumptions kind of think a little bitdifferently think a little bit deeper about these decisions, because Iguarantee you that when you have this, you know proven framework that thisstrategy that you have as an output is going to be very different. Then if youdidn't take the time to wrestle with some of those ideas, I've seen ithappen time and time again yeah. I read something really interesting. I thinkit was actually just yesterday stumbled across this little piece of information.I was working on some content for my own book, which I know you're workingon yours as well. I think ours are actually going to come out around thesame time. September October is whic, is awesome yeah, I know so we're both in the kindof the strategy n, the deep thinking, good decision making business. So Istumbled across a piece of information which was about Napoleon, which is youknow widely considered like the...

...greatest military thinker andstrategist of all time. One of the things that he was famous for was thethe preceeding always proceeding with two options and other words. He neverconsidered strategy to be something that he did back at the palace. Andthen you just kind of carry out on the ground strategy was just it wasbasically just like is hey. This is how we make decisions, and it's always thiskind of iterative process. So he learned how to set strategy in such away that it gave him options and maneuverability later on, and that'sone of the key things that, if you're working with a good thinker, someonelike you, if you're a health, innovator and they're working with you, I thinkyou have the ability to kind of lead them through a process, ofsettingstrategy and making good decisions. It's not about cutting yourself offfrom decisions. It's about creating options, so you can move with whateverthe market wants, because that's always changing and being flexible, becauseconsumer needs aren't fixed market trends. Aren't fixd competitors aren'tfixed, so those things are continuously...

...evolving and changing, and so you knowyou know the work that I do with folks. Is that we're developing that emergentstrategy that we're going to go to the market and test even the work that wedo together over this twelve week period? Is We're not saying that at the end ofthose twelve weeks that all those decisions are fixed and we're confidentthat this is the exact strategy for going to market? We're? Just sayingthat we believe that this is our most profitable strategy, based upon thedata in the research in the framework that we've used and then we go into themarket and it's still irritive in an irrative, inflexible process,because we're continuously infusing new learnings throughout that yeah, whichis we alluded to before we hit record, but I wanted to bring it into thisconversation. You mentioned something that basically, the waterfall doesn'twork right. That kind of project management decision style explain alittle bit about what you mean by that,...

...because that is we think of it in termsof, if you were to kind of lay out this,this process of setting your tratety, that's probably what most people woulddo. Okay, I'm going to make this set of decisions and then lock those down andthen wont to make the Nexto Decisions and te lock those down and show themthe closet, because they're made right, yeah. Aha, we by the water, foll, otheyeah- and you know an to your point about you- know Napoleon. You know whenhe's out on the FEL, the battlefield he's not like. Oh well, you know whatthe the opposing team you know did something differently, and now ourstrategieis not effective, but we made that decision so we're going forwardwith it anyway right, you're, adopting and changing a, and so you know thewaterfall method can be successful in a lot of applications. But I think whenit comes to developing your commercialization strategy, that it'sjust really not flexible enough, we need more of an agile methodology thatwe're using to build that commercialization strategy because,like you said it's not fixed where you're making decisions and it's inthis IC static sequence of events. It's...

...not like one thing happens and then itends and then another decision make is made, and then that ends and so forth.It's irritive it just continues of you know: Bill Test, ITERAT, build test,iterate and really that's. I sometimes it's hard for health innovators to kindof swallow, because we want to check it off the list. We want to market as done,but this is really a process that happens throughout the entire life ofthe company, because it's always changing, and so we never we. You knowwe will get to a point where we believe that we've got the a deliberatestrategy that we say: okay, we've identified product market fit and webelieve that this is going to be our scalable strategy for scaling thebusiness and really growing, but even at that point, you're still analyzing.The even if it's just insurance, you know again like evaluating newcompetitors, evaluating the trend and your overall market niche. You know,like you always need to be. You Know...

Eyes Open. That said Yeah. I think oneof the one of the things thet entrepreneurs would love to be true,but it's not true. Theres Tha success comes from putting the blinders on andjust working your tail off, and then everything will be fine. I wish thatwas the case, because, if every, if the only thing that separated us fromsuccesss hard work well, then you know there'l be a lot more successful people.Sadly, that's not the case yeah, so I don't think we can reallyever take the blinders and keep them on. We need to kind of always have theblinders off there's. You know we need to focus on what we're doing executethe strategy we've set, but still be consistently keeping our eyes open andknowing what to look for, and that's where that strategy framework kind ofhelps, even once we know what we're doing for the next ninety days,understanding and having that framework in place gives you a way to consistently reevaluate wour strategywithout starting from scratch every time you're. Just looking for thespecific factors that are important, yeah absolutely, and I think focus iskey right. So if you are a startup or an emergent company, I mean there's,you know you're, usually short on cash,...'re, usually short on people andwhat you've got the most obvious things to do, and so how do you I you know, sothis kind of gives you a framework of what decisions do you need to make nowthat are going to have the most impact to your success, and so it kind ofgives you this sequencein of decisionmaking and then helping youkind of connect, the dots between that decision making. So that way, you aremaximizing the use of your resources, both time and money, and really knowingwhere to focus, because it's it's really. I mean, I think that that's abig pitfall is that as an entrepreneur that I have so many things to do that,I don't know what to do when and and so I'm spread too thin and and I'm justdistracted and and I'm not getting the results I'm looking for. So you knowhaving that framework really kind of gives us guard rails in that decision,making process yeah it's a good way to put it almost like a bowling withbumper rails, makes it a lot easier,...'s. The only way bolt three hundredto only way we don't end up in the gutter, all right, so you're doing a wholespeaking of like the strategic process and getting the right input and Feedbakso you're doing this. This workshop you've got coming up and at a bighealthcare event, so tell people just a little bit of briefly about theworkshop and where they can learn more and connected yeah. Absolutely so we'regoing to be doing a workshop on patient Cocret, patient product co creation atthe Connected Health Conference in Boston in October, love to see youthere and you can get more information about it than the connected healthwebsite awesome and then, besides, you know kind of listening to the podcaston Apple podcasts and spotify and Stitcher, and all the usual places andleaving your lovely five star review for all your glorious content and goodguess. The besides that fun stuff which people should do wr. Where else canthey go to kind of dive deeper into the framework and learn more about thestrategic work that you do yeah absolutely they can visit our websitelegacy. Hyphen, dnacom, very cool...'ve got all kinds of fun resources.There Awesome rockhe's a pleasure. I love talking about this stuff. It'salways bloss. Thanks, Mat appreciate it bye, bye. What's the difference between waunchingand commercializing, a health care Novation, many people will watch a newproduct. Few will commercialize it to learn the difference between watchand commercialization and to watch past episodes of the show head to our videoshow page at Dr Roxycom. Thank so much for watching and listening to the showyou can subscribe to the latest episodes on your favorite podcast, APPlike apple podcasts and spotify, or subscribe to the video episodes on ourYoutube Channel, no matter the platform just search Coyq with Dr Roxey untilnext time. LET'S RAISE OUR COIQ.

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