Building a Culture of Honesty, Trust, and Accountability at Remedy

It’s been nearly four months since two of my best friends and I left MIT to work on something together. After a significant amount of exploration and iteration, we finally discovered a thesis and vision that we wanted to dedicate the next ten years of our life to — fundamentally redesigning our country’s broken healthcare system, starting with primary care. While I could spend days upon days talking about the state of U.S. healthcare, its individual components, misaligned incentive structures, and failure points, I want to touch on a much more universal concern for startup founders in this reflection.

As we make progress on our product, we've been thinking seriously about the implications of bringing fresh minds onto the team. If we find the right people, the first several teammates will help us iterate much more quickly towards product market fit and accelerate the growth of our platform. It’s important to keep in mind, however, that first hires have a dramatic impact on our team's culture, and a toxic culture is one of the most significant threats to the success of an early stage startup. Consequently, our early team must embody the culture we want to foster as an organization. This, to me, is more important than any skill set or prior experience.

So the question becomes what kind of culture are we striving for? While most companies look for people with intellectual curiosity and unrelenting resourcefulness, I think one aspect of company culture that is often overlooked is courage. Specifically, I think there are some subtle aspects of courage that are often overlooked. Yes, an early startup hire must be brave enough to forgo the comforts of a stable job, predictable work hours, and well-defined responsibilites, but that's only half of the story.

We're looking for people who are honest about their mistakes and intentions. The best leaders are transparent about why and how things went wrong, and they always hold themselves accountable for their shortcomings. They hold themselves and the people around them to an incredibly high moral standard. In the heat of the moment, when everything seems to be going wrong, this takes a whole lot of courage.

My cofounders will be the first to tell you that this form of courage is one of the most important aspects I look for in the people I consider working with. During my second year at MIT, I participated in a 24 hour competition with teammates that misrepresented their contribution to a project. They wanted to reimplement a Microsoft Research paper that could make seamlessly looping GIFs from short video segments. The project involved some research in computer vision that they had been studying for over a week, but given that I only learned about the concept the morning of the competition, I quickly found that I didn't know the details algorithm well enough to reimplement it within the span of 24 hours. As a result, I ended up working on the user interface, and did not invest the time required to understand what my teammates were building and whether their code accomplished what they claimed it did. It wasn't until well after the competition, when a more detailed investigation was launched, that I realized that the results my teammates were feeding to the user interface were plagiarized.

The incident sparked a headline article in the school paper and took an excruciating toll on my personal health. The shock of the realization triggered a temporary cardiac arrhythmia that landed me in the hospital. And for long time, I suffered from crippling social anxiety. Trusting others was difficult, and it took time for me to heal. During this time I had several conversations with close friends and mentors to help me grow, but probably the most comforting realization was that I was not alone. In fact, in a talk that he gave at Stanford, former Google CEO Eric Schmidt described a similar experience he had at hardware manufacturer Novell:

I went to Novell under the mistaken idea that I wanted to be a CEO and failed to do any due diligence. Had I done the due diligence I wouldn't have taken the job, and therefore I would not have gone to Google, so it's probably good I didn't do the due diligence. But at Novell, there was a week which we remember, my colleague and I who had joined with me, was the worst week ever. Our basic goal was to get out of this with our professional reputations intact and not in jail. And that's after you join a company you discover the books are cooked, the people are frauds, and the customers aren't paying, and so forth and so on.¹

I learned a valuable lesson from the aftermath of that competition. And in retrospect, I'm glad I learned this lesson early on in my career instead of when I was knee deep in the startup that I deeply cared about. Although many of my friends have made excuses on my behalf — that it wasn't something that I could have seen coming or that I wouldn't have had the time to thoroughly check their work in a 24 hour competition — I consider this experience a moment of personal failure. I failed to understand how important culture is to the success of a team, whether it's a 24 hour competition or a potentially lifelong relationship. When transparency and honest communication break down, that spells disaster for a startup. At the end of the day, it isn't enough for a single person to hold themselves to a high moral standard. This courage must be part of the team's DNA.

In healthcare, honesty, trust, and accountability are especially critical. The healthcare system is where it is today because of people who sought to reap profits at the expense of people in desperate need. The result is that affordability and access are at all time lows and doctors "feel like a pawn in a moneymaking game for hospital administrators."² If we're to build a system that puts the patient first and allows doctors to practice without having to play corporate politics, we must be brutally honest about our design and intentions, and hold ourselves accountable for when things don't go as we expect. It's a tall order, but it's worth the effort to make the world a better place.

¹https://www.youtube.com/watch?v=hcRxFRgNpns
²https://www.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361