Written by

Michael Berger

Michael Berger
Supported & proofread by: Freya HallSarah Lechner

Part 1 – The art of scaling as an AI MedTech startup

For those who didn’t read my previous article, the following intro is for you. Last time, I told the story from the very beginning, I spoke about the team and how the company I had been working with had grown from 2 founders to almost 15 people. When it was written, the company had been around for about two years but a lot happened in that time, so in my article I endeavoured to merely provide an overview. I wrote a lot about the pros and cons of implementing a quality management system (aka: QMS), why you should celebrate doing it, what the challenges are for a startup and how we iterated ours.

This time, I’m going to dig deeper into four topics, spanning over 3 articles. The story will still be told from my perspective (a regulatory and quality management point of view), although not as explicitly. This series will provide you with insights and first-hand examples that highlight how working culture influences performance, what strategy has to do with it and the role communication has to play.

Preface – Scaling from 10 to 30 people

Scaling your startup will affect many areas of your organisation,including processes, products, structure, communication, culture and location. If you’re scaling for the first time, the nature and extent of the impact can be difficult to foresee.

In those articles I will share the experience we gathered from scaling our team to three times the original size. In particular:

  1. how to ensure you have the right strategy to scale your organisation,
  2. the importance of updating and implementing new processes and tools, and
  3. how to define and maintain culture and communication practices.

Ensure you have the right strategy to scale the organisation

At the beginning of a journey, the group of people joining forces often have similar ideas in mind. Starting with two to three people on the team, it feels easy to maintain clarity of what you are doing and why you are doing it. Even if you grow to ten or more people, you can usually recognise easily if the team is not sailing in a similar direction and correct it informally.

For us, communicating important information within the team came naturally at this stage. Not only did our management system tell us when it was the right time to update our vision-mission-strategy (V-M-S) statements, but we were also able to identify misalignment between individuals through weekly 1on1s. However, after a certain point, which for us was when we grew beyond the size of 15, such misalignments became harder to detect. Especially when receiving additional funding and aiming for faster growth, we had to draw up a plan in order to avoid getting lost.

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Overview of the activities undergone while executing our project

Disjointment in the team can occur when the organisation is not putting enough effort into defining and communicating the overall goal, or when external factors are changing drastically fast. Such external influences include but are not limited to economic developments, changing market trends, changing stakeholders and growing or shrinking of the business size. In our case, the size of the team grew substantially, and therewith, conditions changed internally very fast too. So the management team asked ourselves how much we saw the company reflected in our mission, and then started asking the rest of the team whether they would be interested in updating it.

Up to the point of having 15 people on the team, we had never learned what it took to maintain the quality of information atscale. We realised that we needed more sophisticated, proactive approaches to maintain our culture.

After receiving affirmative feedback from the team, we began to update the company’s V-M-S, in accordance with the concept of strategic planning(1). The V-M-S were formulated into easily understandable phrases, which reflected how we saw the future of the company and the industry, and then were translated into workable and achievable objectives. Before describing how we did this, and what we learned from it, I would like to tell you why we decided to do it.

Why is it important to have a strategy that is aligned throughout the organisation?

People tend to move and develop in different directions, although this is normal it can have particularly prevalent implications when it comes to your culture and strategy. Taking the salt shaker theory

We differentiate between eight levels of participation which reflects the degree of team member inclusion in the decision making process, based on the idea of ladder of citizen participation by Sherry Arnstein(2). Proceeding with Arnstein’s approach, we began consulting the team. We gathered their opinions, comments, views and feed-back on the V-M-S statements and the corresponding objectives defined for the following quarter.

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We chose the the 4th step on the ladder of participation to involve the team

Based on this consultation, we came up with a three step plan for how to update our V-M-S and objectives, which would include the whole team. Shortly after merging our companies, almost one year prior, we went through a similar process, but on a smaller scale. That time, the purpose was to find a common direction that the newly formed TM could agree upon. Given it was technically our second attempt at this, you would think we would be confident in the process, , but this time was different. Based on our findings while talking to the team, we addressed that issue within the TM, during one of our extended MMCs(3). As we reached the end of the previous period of our short term goals (defined for one year), the timing was almost perfect. All together, it took us a bit less than 5 weeks, to have everything in place. The work needed added up to roughly 115 working hours and we involved more than 20 people in the process.

Hot tip: Provide a detailed explanation of why you are starting this process, how it will work, what results to expect, who is involved and how each phase will be communicated. This will help you to minimise the energy spent (aka: talking and repeating yourself over and over) while going through the process. In addition, it makes it easier to remember what you have planned in the first place.

Step #1: Get the TM on board, first review with the provided tools, get your teams opinion

Based on the information gathered from the team, we decided together with the TM, to invest time and resources updating our V-M-S and defining new goals. Our first step was to review the current state of the V-M-S and its corresponding objectives. The review happened together with the TM but included input from our side, namely: we gave a presentation which outlined the purpose of the V-M-S, how to build a better vision statement(4) and some examples we considered as well formulated statements. This first review session resulted in feedback from the TM on the wording of our current V-M-S statements and their intended messages. This wasn’t a quick win, but an achievement which paid off throughout the process. Members of the TM team had slightly different opinions about where this ship should sail and how to articulate it. To successfully guide the team through it, thorough preparation was needed. Following this, a strong mentoring during the meeting got us faster and closer to an agreeable goal.

Following this sess

Step #2: Get individual feedback from the team, aggregate it, get your TM opinion

We started by talking to all team members individually, informing them that we had prepared the tools for gathering their feedback and explaining to them how we expected the process to proceed. Those tools included a Google slide deck giving background information on how we ses V-M-S and how those statements should be defined. Additionally it presented the current statement version and already suggested changes. For the feedback collection, we used a standardized Google form with different questions regarding the statements itself. As most of the team were familiar with the current version of the V-M-S statements already, we sent them the same content we presented to the TM and asked for their opinions, comments and alternative versions of it.

As a result, we received tons of feedback, comments and alternative phrasings. We then summarised their submissions to get a feeling for the common message. Following this, we thanked the team and got back to the TM with the results, presenting them both their suggestions and the ones made by the team. We wanted the TM to get a feeling and understanding of their team members’ perspectives and to see if both statements could be combined or revised to find a version which satisfies everybody.

As the result seemed to be promising, we decided not to do another round of back and forth and proceeded with the final step.

Step #3 : Provide a final draft, revise it with the TM, present it to the team

At this point, we summarised everything learned so far into one document which listed three statements and their derived objectives. This document included an alternative version for each of the V-M-S statements, based on the learnings so far. This highlighted the differences between the current statements and the new proposals. In addition, we provided a list of goals verified to follow SMART criteria(5).

We, the top management and myself, worked in this document on the wording for another hour or so before agreeing upon our final version.. The TM then formally agreed on the newly revised statements, by literally – but digitally – signing them off.

Once signed off, we could begin integrating them into our IMS. This began by updating the V-M-S statements and objectives in the initial presentation, our IMS Manual, the brand manual, related documents and everything else we could think of. Then, in order to formally complete the process in accordance with our change management process, we updated and closed the related JIRA ticket. Lastly and most importantly, we then communicated the results of this whole process on all channels available: slack, email, in chats by the coffee machine, and during a half an hour presentation at our team retreat. We were thankful for the efforts, meaning the time and energy spent by every team member involved, and we wanted to ensure we communicated this appreciation to everybody.

Hot tip: If you have a web page, or other mediums showing messages related to the V-M-S statements, such as social media, please do not forget to update those too! The V-M-S has signalling power internally but also externally so don’t be sloppy. Update it all, do it right, keep it tight.

Hot tip: I know I already said it, but really, show appreciation for the time and energy invested by the people. Do it honestly, sincerely and mean it. Do it in person and do it in front of others so that everybody can see you are doing it.

Step #4: Follow the PDCA cycle and check your results

Now, it may feel like you’re done at this point but you are not done. The IMS requires constant and incremental improvement and feedback, this process especially. We did not want to just talk about the usefulness of the Deming cycle but to actually practice it.

It was serendipitous that we intended to perform our management feedback loop(6) later that year( not to be confused with the management review required by ISO 13485) The loop was the perfect opportunity to check and verify the effectiveness of our efforts. Therefore, we included a couple of questions regarding our V-M-S and objectives into the anonymous questionnaire that was distributed to the team (excluding management). The result was overwhelmingly positive: the team felt aligned with the process and the result of our most recent iteration. Due to the fact that we agreed on celebrating small wins, this felt like the right time to pop a bottle.

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Footnotes & references:

(1) Mintzberg, Henry; Quinn, James B. (1996). The Strategy Process: Concepts, Contexts, Cases. Prentice Hall

(2) Arnstein, Sherry R.(1969) ‘A Ladder Of Citizen Participation’, Journal of the American Planning, Association, 35: 4, 216 — 224

(3) The monday morning ceremony (MMC) took place every week and lasted for 20 minutes. It’s a check in for the whole team and was done in a similar manner as daily stand ups. Once a month we did an extension of  that, including the top management and team leads to synchronize the leadership team in certain areas in a more extensive way. It lasted for about 2 hours, with proper protocols taken, different to the MMC, where one slide on a slide deck for the whole organisation was enough.

(4) Kirkpatrick, Shelley (2008) “How to Build a Better Vision Statement,” Academic Leadership: The Online Journal: Vol. 6 : Iss. 4 , Article 5

(5) Yemm, Graham (2013). Essential Guide to Leading Your Team : How to Set Goals, Measure Performance and Reward Talent. Pearson Education.

(6) The management feedback loop was a standardised tool we used two times a year to get individual and anonymised feedback from the team, proactively. Another ceremony we practiced to keep communication working.