2023 Was Hard, So Here's To Hitting 2024 Harder

I heard someone say the other day, we founders say every year that this was the hardest year ever, and what that basically tells us is we are more capable and resourceful than we think.

For 2023, we operated by one word: Survive. Although it was a battle in the trenches, looking back it was actually one of the most transformative years for us as well. Thank you to everyone for supporting us as we managed to solidify our permanence.?

First some quick-hitting milestones:

Fewer + Larger. Our client count was reduced to 20, but our average client value exploded, from $100k to $300k ACV and from average length of 1.2 to 2 years.????

Controlling Our Fate. We had our first down year ever, a 15% drop in annual revenue, but with a pivot to fat-cutting, we managed to match last year’s profits, which gave us an unexpected cushion to still invest into 4 R&D projects.?

EHR Muscle. We brought in an industry titan Scott Rossignol (Epic, Nordic integrations lead) as our Head of Integrations, bringing strategic & engineering leadership that was felt right away. We’ve integrated with 3 major medical centers this year, and expect this to grow in 2024.

Chemistry Up. Our average staff tenure is now 3 years, up from the industry average of 2 that we were stuck at forever.????

Little Flights. Few things have been more amazing to witness than so many team members essentially growing up together and building families of their own. I became the latest in a string of employees to have a post-covid baby.?

But founder to founder, the biggest milestone is always the lessons learned. So here are my 12 days of belated Christmas lessons, which I’m hoping will carry into 2024 even as market conditions turn around.

Re-Build the Right Way. We operated in a scale-focused mode when we were flying (2x-ing annually). We had to get back to the basics, figuring out product market fit in a different macro environment by experimenting with pricing, leaning into healthcare, offering more solutions, and doing things that don’t scale. We paused our account management team entirely, with C-levels now taking revolving monthly meetings with all accounts to get constant feedback on how to add value.

Free Workshops Help Everyone. We operated for years only doing paid workshops to prevent giving out free work.? In this market we took a different approach, to sell solutions rather than?process.? It gave our prospects a peek into why we’re far more than software developers so that closing deals became more of a formality, and it also showed us whom we’re likely to work well together with.? Getting our top product minds into these workshops was BY FAR our highest-ROI move of 2023.? ?????

Vision Isn’t Everything, but Without It You’re Random. We learned that doing R&D projects the right way is extremely hard as a services company. The risk of “building roadmaps into oblivion before selling” and context switching from services to saas are both extremely high. The most important guardrail was to install a trusted visionary to each project to find the right balance of spending / targeting / building / sales readiness.??

As an Engineering Team, Engineer Discomfort. Engineering oftentimes succumbs to creature comforts. The hardest thing to do was push for engineering changes as a CEO, but turned out it’s worth falling on that sword. Our best engineers ended up appreciating where we landed once we removed a ton of DevOps using Render and Supabase, and added automation with the likes of Sonarcloud and Copilot. It meant more time creating, less time in debugging and sysadmin.??

Automate Everything, then Expect Hard Conversations. Even when your whole team loves automation academically, when it impacts their jobs…..We had hard conversations across sales & marketing to engineering & product. Technical Copywriting became 2x as fast with GPT, and the no code game changed forever with some platforms exporting code. We spent much of the year assuring that hardcore adoption meant an opportunity to do more of what we love, not job loss, and we backed this up.

Solve Real Problems, and You’ll Be Alright. The AI hype will die down, not in the sense of AI going away but consensus on what generative AI can do. Companies that continue to solve real problems like pose detection for MSK and healthcare staffing will continue to thrive, with LLMs being a mere part of the solution stack. Stay in your lane.??

HIPAA is no longer a moat. No healthcare buzzwords are moats anymore. Signed BAAs are now being offered at far cheaper costs than ever with even cloud hosting wrappers like Render. Instead, the moat for us becomes a deeper understanding of healthcare UX, systems integrations, regulation, and architecting software and integrations with privacy in mind.? Customers want solutions now over technical expertise or process.??

Winner Takes All. 4 R&D projects: 2 post-revenue and 2 pre-revenue, but my plan is still to cut out everything besides one when one separates from the pack. Each still has promise, but we all know that it takes more than promise & a working product. It takes a laser pointer of funds, effort, creativity, marketing & sales, and focus. We can’t afford any ounce of distraction once we find traction, so I’m expecting a sad See Ya Later to multiple exciting projects.??

AI Means Lean is In. With AI, we will stay closer to our current headcount than what we were at back in 2021 even as the market improves. I no longer believe having a huge company is a positive metric. Expect the rise of far more highly profitable, lean companies to compete with.??

Invest into Enterprise, and Wait. Not just via outbound campaigns with that becoming more saturated than ever. We’re bringing in enterprise sales to attend healthcare and medtech conferences to meet with decision-makers. There’s no rocket science here, just a long game our better competitors have played to win.??

In Healthcare, Even Shortcuts Take 3-6 Months.? It generally takes longer to sell to a system now than to build an EHR-integrated healthcare app.? Healthcare clinicians founders who think they have an easy route to their healthcare system are advised to knock on IT”s door once dev starts, because it will probably take 3-6 months before we get the greenlight to integrate.?????

There are A Players, and then there are high-agency A Players . I’ll admit the latter get more attention and rewards from us. Recognizing and giving autonomy, skin in game, and fate-defining challenges to those players is critical for the whole team to constantly avoid the status quo with escape velocity.??

Most Importantly, Invest Into 1-1’s.? Don’t wait until it’s too late to have conversations with your people, or you’ll never know what they’re dealing with until it’s too late.? This is preventative medicine to avoid becoming a revolving door.??

Happy new year everyone and let’s kick some ass in 2024.??

Joe??