We are working with a new client who are building a healthcare startup. I was talking to him about Lean Startups, and he sent me a long email with some great tips about what Lean is and how to build a Lean Startup. This is the best resource I have found with links to more great stuff, and I have blogged it here with his permission. Thanks to Subbu Arumugam from Sufo.org and SugarSnap. Mail follow. (Very slightly redacted.)

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Super happy you’re reading about lean startup philosophies and methodologies. I attend most of the chicago lean startup circle meetups. The last one was great because they discuss how to properly conduct “problem” interviews and “solution” interviews – which is very unnatural for first timers – and it’s the most important step. They filmed it, but the video isn’t up yet. I’ll send you a link when it goes up.

We got started in this “cult” about 3 years ago when marc andreessen mentioned steve blank’s book in his blog - the post was actually deleted by him accidentally, but someone saved all of the old content here . If you’re interested in his old stuff, definitely great reading, nothing/ little to do with lean.

Others started getting in on the party. brad cooper and patrick vlaskovits created a “cheat sheet” book based on the first two steps of steve’s very difficult-to-read book. It’s a practical “how to” do customer development which is the central theme, and most important first step.

Steve Blank defines a startup as an organization formed to search for a repeatable and scalable business model. Most of the folks above, including Steve believe that you’ve figured it out when you’ve reached product-market fit. so while all of the above was happening, there was a startup marketer – Sean Ellis – who was doing his own thing consulting for scores of startups, completely oblivious to the lean movement, and he noticed that product-market fit was achieved when 40% of your early customers say they’re “very disappointed” if you take away your product . He then started realizing that his philosophies were very similar to the lean movement. Sean blogs very infrequently now since he is involved in his own startup.

We found ourselves following more and more of the practical lean philosophies as earlier iterations of Sufo didn’t work.

The core philosophies are:

Finding a top three problem, not a four through ten problem – and maybe even working on three “top three” problems concurrently – via customer interviews (people want their top problems solved, and will pay for them to be solved, they will continue to use their own work-arounds for their lower priority problems) (see slide ten in this deck - the deck itself is awesome.) Create a solution via wireframe or paper drawings – and ask customers if they would (a) use the solution and (b) would they pay for it – via solution interviews Some of this can be tested without interviews – a “minimum viable product” can be a sign up form (like the wufoo form that we have on the current live version of sufo) – or even an adwords campaign (“buy a hover car”) and see if people click through before building the product Make sure your cost to acquire customers, and operations of your business, can be subsidized by the price you’re charging for your solution Keep iterating til you get product-market fit

Our first version of sufo didn’t solve an existing problem (“linkedin for doctors”), the second one did (filming conferences and charging doctors $ to access the video content), but not enough doctors would pay for it, and when asked why, they wanted (1) CME credit, and (2) said our content wasn’t refreshed frequently enough (which is the nature of filming conferences) – so this version of Sufo addresses both of those concerns.

Not all lean philosophies work well when applied to health tech startups – it seems to be better applied for consumer apps. We’re documenting what we’re finding, along with a friend who has his own health tech startup. We plan to present on this in april. I help co-organize the chicago health 2.0/ tech meetup group , and we ran a pitch contest this past june – we pushed for entrepreneurs to use lean principles. One of the toughest things the applicants had was playing in the “two sided market” area… where value isn’t created for your users until you already have another group of users on board using your product – think ebay and other marketplaces.

Many health tech startups are two sided markets. In fact, our version of Sufo is the first step to creating one side of a marketplace, where the other side is interested in information from doctors. We have to get doctors using Sufo first at scale before we can bring on analysts interested in what doctors do/say.

With very little to do with lean, here’s some great reading on two sided markets:

But back to where the lean movement is now