Not Being Organized Around Customer Solutions: Cliff Bleustein, MD, MBA

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My guest for Episode #86 of the My Favorite Mistake podcast is Cliff Bleustein, MD, MBA, the Global President and CEO at AposHealth. Read his full corporate bio here.

Dr.Bleustein graduated from the Medical College of Wisconsin and completed his internship at the New York Hospital Medical Center of Queens. He later completed his residency in urology at Montefiore Medical Center. He went on to private practice Urology and became a board-certified Urologist. Dr. Bleustein earned a bachelor’s degree in science from the University of Wisconsin, Madison. He also received an executive master’s degree in business administration from NYU Stern School of Business where he now teaches Healthcare Economics as an Adjunct Professor.

In today's episode, Cliff tells a “favorite mistake” story about his time at a previous company. What happened when they realized that they were organized around technologies, but the customers wanted solutions. How did the company get to be that way and why did nothing change?

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Automated Transcript (Likely Contains Mistakes)

Mark Graban (0s):

Episode 86, Dr. Cliff Bleustein, CEO of AposHealth

Dr. Cliff Bleustein (6s):

What they really wanted from us was to bring to them solutions. The current structure of our organization was around technology.

Mark Graban (21s):

I'm Mark Graban. This is My Favorite Mistake. In this podcast, you'll hear business leaders and other really interesting people talking about their favorite mistakes because we all make mistakes, but what matters is learning from our mistakes instead of repeating them over and over again. So this is the place for honest reflection and conversation, personal growth and professional success. Visit our website at myfavoritemistake,podcast.com. For show notes, links, and more, go to…. Take two, for show notes, links, and more, go to markgraban.com/mistake86.

Mark Graban (1m 6s):

Please follow rate and review. If you like the episode, please share it on social media. As always, thanks for listening. And we're joined today by Cliff Bleustein. He is the president and CEO of AposHealth. They're a medical device company. He is an adjunct professor at the NYU Stern School of Business, and he is also a urologist. So it's quite an interesting background and Cliff, thank you so much for being here today. How are you?

Dr. Cliff Bleustein (1m 32s):

Great. Thanks for having me here, Mark.

Mark Graban (1m 34s):

Yeah, well, it's, it's, it's my pleasure. And you know, we'll dive right in. I think this will trigger a lot of good conversation. Cliff, what would you say is your favorite mistake?

Dr. Cliff Bleustein (1m 45s):

My favorite mistake was really at a prior company where I was charged at leading a large consultancy practice. And when I came into the practice from the outside, you know, ultimately you want to evaluate your teams and see what you're doing. And you often look in multiple areas to see that the strategy structure, people process technology are, are all aligned and it became very clear having gone out on a road show to speak with our customers, that what they really wanted from us as a company was to bring to them solutions and that the current structure of our organization was around technologies.

Dr. Cliff Bleustein (2m 30s):

You know, in particular, you know, specific types of electronic health record, you know, like an EPIC program or Cerner program. And we really spent, you know, ultimately the next, you know, three to six months thinking through what are solutions, how can we deliver them? What does that look like in the marketplace? What kind of things where our customers really value and, and what are the people that we have in order to deliver and execute on that? We spent a lot of time actually looking at every individual within the organization, which was no small feat because we're talking about hundreds of people and we ultimately decided and figured out what we thought would be a really good composition of teams to deliver solutions.

Dr. Cliff Bleustein (3m 13s):

And really over a period of several months, we figured out the new organizational structure, the new solution stacks, we then got engagement, or we thought we had engagement of all of the leaders to really drive this. And, and we thought through what the sales pitches were going to be and, and what was the information they needed, how would we message this to our teams and our people? And then really over the course of a weekend, we ultimately then switched about half of the team's managers to, to, to new teams and, and had our all new solutions to go to the market. And, you know, we immediately expected that the teams would get together and start working on figuring out how they're going to deliver solutions.

Dr. Cliff Bleustein (3m 56s):

What are the capabilities and what that would look like. And what we found was business as usual, really nothing changed. And within the first couple of weeks, only some of the groups really started to come back with really interesting solutions to the problems that we are trying to solve. And what was more interesting was we started to get feedback from a lot of our top performers and a lot of our top performers actually came back and were not happy with their new managers. So it was kind of an interesting problem where all of a sudden, we thought we were going to go around and build some great solutions, and we're going to have great teams that are really engaged.

Dr. Cliff Bleustein (4m 40s):

And we started to find some really, really unhappy people. What we learned from this was that a lot of the managers that we thought were going to be able to be agile and change actually really didn't have any intention of changing at all. And many of the people that were our top performers actually got frustrated when they were put with new managers who weren't really trying to drive, drive the change. It's kind of a, an interesting problem for, for an organization that you're trying to turn around and make sure from a strategic perspective that, that we're going to be aligned with what the markets want. So there was a clear change in the marketplace.

Dr. Cliff Bleustein (5m 20s):

We had to address it, then either we changed or, or the business probably would not thrive in into the future.

Mark Graban (5m 28s):

So it seems like there's, there's maybe two different levels of what was going on there related to organizational structure. Some of this might have been before your time coming in, but you know, why did things get to a point where there was that misalignment? Was it because of evolution in the marketplace and there was need to adapt or was there a kind of a deeper misunderstanding of we have technologies versus customers want solutions? That's a, that's kind of a common challenge.

Dr. Cliff Bleustein (5m 57s):

Yeah, it's a great question. I think that the structure of the organization was consistent with how the work is delivered. So normally when you're delivering your solutions or delivering individual technologies or the skill sets that you need come from certain technology groups or families, and it made sense to organize from a delivery perspective into those solution stacks. I think the, the market very clearly changed. And you know, what we heard from our customers for example, was if you look at electronic health records, you know, there are many platforms out there that hospital systems use epic, Cerner express scripts and so on.

Dr. Cliff Bleustein (6m 41s):

And when we went to our customers, many of them said, listen, cliff, we use more than one platform. We're not only using one solution. So if you're going to come to help us, you need to be able to deliver solutions that understand the complexity of our organizations and the fact that we have multiple different EMR platforms running across our organization. And how do we manage that? And that partly is a market Forrest that drove us to, to really try and think differently. So I think it was just a natural evolution of where it was going. I also think it's a contrast between how you sell and how you deliver.

Dr. Cliff Bleustein (7m 24s):

And I think that there's often a contrast in many organizations between really the sales arm and the delivery arm and in consultancy, usually the sales arm and the delivery arm are one in the same.

Mark Graban (7m 39s):

And was there an issue, is it a matter of, you know, the customer was wanting a single point of contact and they were having to interact with different sales or support contacts for those different technologies, as opposed to having something that seemed more integrated from there?

Dr. Cliff Bleustein (7m 57s):

Yeah. I think that's certainly one part of it. I think, you know, many organizations find it very hard to deal with larger complex organizations because they don't know who to call to get, to get a solution. I think many companies like, like my prior one actually had really good account management. So you had an account manager that was supposed to be the point person, but they're usually still bringing in other teams that are bringing the products to the market to solve whatever problems they happen to have. So I do think that part of it is it has to do with how do you interact with, with a single point of contact? It's just easy.

Mark Graban (8m 38s):

So then I think the second part, it seems of the scenario, the first part was, okay, well, how did he get to be that way? And then there was recognition that it has to change when I heard you say, you know, nothing changed and people were unhappy. Is this something that could be framed as some people might call a change management issue? Like, was it the wrong solution or was, was there something about the approach that didn't get people on board, whether that was the managers or those top performers,

Dr. Cliff Bleustein (9m 10s):

He, you know, many times, many times people talk about culture, you know, eating strategy for lunch. I actually think that that's kind of a misnomer and my experience has been, and, and this was a perfect learning example of it. It's all about the people. And I think ultimately there are many individuals out there that are very comfortable with change and that are able to manage through in a very agile way, all of the different factors that are coming into play. And I think frankly, there are other individuals that really just are not comfortable with that. I think that what we learned very quickly, fortunately, was to be able to identify those individuals that would be able to change.

Dr. Cliff Bleustein (9m 59s):

And we very quickly promoted up or enhanced the responsibilities for those individuals that were very comfortable with changed. And we really either demoted or change the role for those individuals that didn't want to change. And it's not that they're not good people. It's just, everyone has a different skillset and a different capabilities. So we needed to change. We know that we needed to change. We found the people that could help us execute on that and then promoted them up. And I think that was able to fix a lot of the challenges that, that you brought up.

Mark Graban (10m 33s):

Yeah. I mean, I agree with your assessment, you know, somebody is seeming resistance to change. It doesn't mean they're a bad person. It's people are complicated. Change is a process as, as some would say, I'm, I'm, I'm curious, you know, I want to ask a few questions about, you know, being a physician, being a urologist. And, you know, I'm just kind of thinking of in my work in healthcare, I've been exposed to people who are trying to folk on folks, they're trying to help patients change behaviors for different reasons. And that's easier for some people to change behaviors from, you know, things related to things that affect their health or their medical condition.

Mark Graban (11m 15s):

Were there any lessons learned or things that you can think of more broadly in medicine and treating patients when it comes to helping patients accept and embrace change?

Dr. Cliff Bleustein (11m 26s):

The answer is patient engagement is one of the most difficult challenges in all of healthcare. I think this is a problem that a lot of people have been trying to solve for. I think at my current company, Apple's health, our approach to patient engagement is that we believe we need to meet patients wherever they want to meet with us. And the answer to that is to try and think through a truly customer centric view. I think much of healthcare was structured, frankly, from a physician perspective. So how do we deliver healthcare from either the hospitals efficiency or the physicians physician see, or the care providers efficiency, as opposed to truly thinking about how does the patient want to interact with us?

Dr. Cliff Bleustein (12m 12s):

And, and so we do, what's called omni-channel marketing. We send text messages to patients. We create chatbots, we send them emails, we do a video conferencing, we do in-person visits and we try and meet them wherever. And however they want to meet with us. And we believe that, you know, you may get 5% of the people through text messaging. You may get another five to 10 from an app. There are some others that frankly just want to see you in person. They don't want to talk to a machine. They don't want a chat bot. They don't want to go online and get answers. There, there are others that are happy to speak with an AI driven chat bot.

Dr. Cliff Bleustein (12m 52s):

And so I think healthcare really needs to change. And, and until we change and become more customer centric, we will not get the engagement that, you know, companies like Facebook, like most of the banks do today and, and, and many other companies.

Mark Graban (13m 10s):

So it might help, you know, if you can provide a little bit of context about AposHealth and what are the products, or maybe we can frame it in terms of solutions. Could you talk about that difference? Like, you know, who is the customer? Is it who, you know, who's purchasing this? Is it the physicians, the patients it's probably complicated.

Dr. Cliff Bleustein (13m 32s):

Yeah. You know, unfortunately nothing in healthcare is, is easy. Everything is complex, but we are an FDA cleared medical device for the treatment of knee osteoarthritis with temporary improvement in pain and function. So we, our, our, our strategy to the market was to get payer coverage. Once we had payer coverage, we then went out to create what I would say as our distribution network or those healthcare providers, traditionally physical therapists, orthopedic surgeons, pain doctors that administer the therapy. And really our therapy is a shoe like device that gets 'em these pods underneath it that get based upon gait parameters, customized to an individual patient.

Dr. Cliff Bleustein (14m 20s):

And then our real consumer is, is the patient who has knee osteoarthritis. If you look at that demographic or that market, you know, attracts very similar with knee osteoarthritis. So roughly 60% women, 40% men, the target age is roughly, you know, 59 to 60 years of age since that's when the, the incidents of neon osteoarthritis is really.

Mark Graban (14m 48s):

Yeah. And so is how do you frame, or what were the lessons learned from the previous company about framing all of this as clearly there is technology, but then it seems like from a solution standpoint, the thing in terms of a patient benefit, what were some of the lessons learned in terms of kind of communicating and getting acceptance of something new on the market?

Dr. Cliff Bleustein (15m 12s):

Yeah, it's all about what's in it for me, I think at the end of the day, people want to know that whatever it is you're doing is going to be a value to them, our product, they really find valuable because it helps to alleviate their pain and improve their function. And, and many of our patients have suffered from an average for six to eight years with knee pain. They've often tried and failed other treatment modalities like injections and physical therapy and pain medication. So when they have something new that they can try, that's nonsurgical, they liked that as a solution. And if it, if it works, which it does, then, then they get real benefit out of that.

Dr. Cliff Bleustein (15m 58s):

So unless you can figure out a way to, to drive value to the end user, they're, they're not going to want to use it.

Mark Graban (16m 6s):

Yeah. And as you framed it, you know, the, the what's in it, for me, that that clear benefit seems important, whether it's maybe something medical or even back to the story that you were telling the, what the what's in it for me, if we were to say, Hey, do you want this new technology on your foot? People might say, well, no, I don't want that. What they want is less pain. And the other benefits that come with it, that seems clear organizational issues like you were describing. I wonder, was there a clear what's in it for me, for those managers or for those performers in terms of, you know, embracing that change that they were, that they were thrown into?

Dr. Cliff Bleustein (16m 48s):

Yeah. It's a great question that we didn't probably contemplate at the time. I think at the time, honestly, we were really more focused on what our consumer wants. And I think one of the mistakes we made in, in implementing this was probably not really addressing that issue as well as we should have and making sure that they understood what the value to them was. And I don't think we clearly articulated that either. I think from our perspective, we were looking at it as business unit leaders, as we need to improve sales, we need to improve utilization of our consultancy. We need to get the solutions out to the marketplace and that you should want to do this because if you don't do this, you're not going to have a job.

Dr. Cliff Bleustein (17m 33s):

And while that is a what's in it, for me, it really is not ultimately the kind of driver that's going to be effective and, and influencing others and, and winning hearts and minds. So I think that that probably was a, an additional mistake that we did the time in terms of not clearly articulating the what's in it for them as well as we should have, and probably could have,

Mark Graban (17m 60s):

Well know, thank you for sharing that, you know, that, that reflection on that, you know, I think of, yeah, it's great to be customer focused, but you know, part of what I hear you saying is that there are other stakeholders and people we need to have accepting if not enthusiastic of that change so it can benefit the customers and therefore the organization.

Dr. Cliff Bleustein (18m 20s):

Yeah. I think every, you know, one of the biggest challenges is focus. You know, when you're an organization and you're trying to make change, you can really only focus on so many things. And one of the challenges is how do you find the right balance between all of the different stakeholders? Because no matter what initiative you're trying to do, you're always touching multiple stakeholders and it's hard to focus on all of them all of the time. It doesn't mean you don't try and plan for it, but, but in the, in the midst of, of the day-to-day activities, you know, it's hard to focus on more than, you know, two to three things and do it really well.

Dr. Cliff Bleustein (19m 0s):

So I, I think, you know, while, while we could have done that better, you know, it's about balance, right? You can only spend so much time and, and moving an organization and people can really only focus on so many things. So I think stakeholder managements are a really important concept. I think not everyone does it well. And, and I think part of the hardest part is to really focus in on who's your most important stakeholder, and then what are the next round of them and what can you do to touch as many as you possibly can, or, or at least manage it.

Mark Graban (19m 35s):

Yeah. So I also want to ask him, I want to ask basically the same question I'm asking you to kind of think of a, you know, two different proverbial hats first off as a clinician, and then secondly, as CEO of AposHealth. So, you know, with your urologist hat on thinking as a physician, what are some of your thoughts or reflections, you know, here on the podcast, we talked so much about learning from mistakes, which means, you know, an openness about mistakes. What, what are your thoughts about, you know, that, that culture in your experience in medicine,

Dr. Cliff Bleustein (20m 12s):

You know, medicine has a history of being extraordinarily conservative and some would say conservative to the point where they struggle to adopt new innovations and technologies. And, and while the number often changes, they often say the time between when a new technology is, is, you know, started and actually implemented as at least 17 years. And some people go up or down on that number, but 17 years is a really long time for adoption of anything. I'm a firm that if you're not making mistakes, you're probably not moving aggressively enough.

Dr. Cliff Bleustein (20m 53s):

You're probably not taking enough risks. And, and ultimately you're really hurting yourself in terms of, of innovation, you know, choosing to do nothing is or nothing. New is a strategy and it's rarely a good one. So I, I'm a firm believer in making mistakes. I tell my team all the time, you know, that, that it's okay to make mistakes. You know, let's identify the mistakes. Let's not lay blame. Let's just figure out why that happened. What happened? How do we fix it going forward? And what do we have to learn from it? Because if people are afraid to make mistakes, then they're also afraid to make decisions.

Dr. Cliff Bleustein (21m 36s):

And what you really don't want is, is to make people afraid to make decisions. So, and any organization, what I would say is if you're not making mistakes, that probably means you're not giving the people on the ground enough ability to make choices and, and make decisions on their own and, and empowering them. And I think it's really important to empower your teams. I think it's important to identify mistakes you asked, you know, where does that come from? You know, as a physician, as a surgeon, we used to have something called morbidity and mortality conferences or the morbidity and mortality conferences is actually a protective environment.

Dr. Cliff Bleustein (22m 15s):

So anything that is disclosed in a morbidity and mortality conference, can't be disclosed in a court of law. What that actually does is that allows you to look at something that may not have happened the way you would've liked it to, in terms of a surgical outcome, or in other words, a complication. And then in an open forum, have a conversation with other doctors who are in your field and sometimes outside of your field about, you know, did you make a mistake? What could you have done differently? Did you miss something she'd do out of something differently? You know, okay. When it happened, how did you manage it? And did you manage it appropriately? And what would you have done differently after the fact? And I think that that's a wonderful forum to really learn and grow from.

Dr. Cliff Bleustein (22m 59s):

And I think, you know, because I had that experience as a surgical resident, I think I try and emulate that in, in the business world as well. You know, Hey, what happened this week? What went wrong? What could we affect? You know, how do we move ahead and not lay blame? And I think because of that, you can innovate and move quickly.

Mark Graban (23m 19s):

Well, I think that's a really important and transferable cultural traits. You talk about, you know, the, the M&M conferences and, and that open forum in the agile software space. People talk about doing retrospectives, which I think is intended to have a similar, you know, sort of in the military. I think people use phrases like after action review, you know, this, this, the similar idea. And, you know, it's just got me thinking of like people who are, let's say in a sales environment, software sales, consulting, sales, let's say, you thought you had some big deal and he ended up losing it because they went to a competitor or they decided not to move forward at all.

Mark Graban (24m 1s):

It would be interesting to do that same sort of M&M review of, you know, kind of a, blame-free not, not who blew the deal kind of discussion, but what ha what do we think happened? What do we know? What are we learning from that? What are we doing moving forward? That, that seems like an interesting thing that other types of businesses could embrace.

Dr. Cliff Bleustein (24m 22s):

You know, we used to actually do that in our consultancy. We actually, when we lost, we've got the client and we'd asked if we could do a debrief with them and say, listen, we know we lost that's okay. You know, can we actually have an open and honest conversation about what did we do? Well, what could we have done better? And why did we lose? And, and, you know, what's important about that is to make sure that you're getting the real answer, you know, many times, you know, because it's easy, they'll just say, well, you cost too much. Or the other people had a better pitch or a better skill set. I think it's often important to make sure you're asking, you know, the second, the third, the fourth questions to make sure you're really getting to what the problem is, because I think many times when you do these debriefs, everybody wants to take the easy, superficial reason as to why you lost.

Dr. Cliff Bleustein (25m 15s):

And, and it's very rarely because your pricing was too much or, you know, so it's important to really delve into that because my experience was, we never lost because of pricing. If somebody really liked us and they thought we cost too much, they call you up and say, you guys cost too much. Can you come down? And if you come down on your price and you still scope it out, you know, we'll give you this engagement, but, you know, you're way too expensive. And that was always a solution. So I always made sure to ask 2, 3, 4 clarifying questions to make sure that we got to the real meat of the matter.

Mark Graban (25m 52s):

Yeah. And in my professional space, we talked about getting to the root cause or at least digging beneath the surface. And that's why I distinguished, what do we think happened? And what do we know happened? Like, you know, coaches, you know, people who have coached me and problem solving anything, losing a deal is a problem to kick in the problem, solving mode. You know, what, what do we know and how do we know it? Are we making assumptions versus having real fact? And I like what you said about asking those follow-up questions where let's say, somebody might say like, well, we thought you weren't a good fit. I don't know what that means. Right. Well, you have to ask follow ups and try to get more specific at Sam's.

Dr. Cliff Bleustein (26m 33s):

Yeah. And, and honestly, many times I found our debriefs to complete completely meaningless after a pitch. You know, there are some pitches we said, oh, we nailed it. Then we weren't even to the next and other ones, we thought we did a horrible job. And somehow we won the deal. So I think it's, I think your own impressions of yourselves often, isn't the best reflection. That's why I always like to get external people. Even when we practice, we used to practice with other, other groups that had nothing to do with us to see how we came across.

Mark Graban (27m 7s):

Interesting. There's really a good, a good lesson there. And before we wrap up, I was gonna ask one other follow up question. You talk about sort of that conservative approach or being slow. I've heard, you know, ballpark 20 years, like you said, so order of magnitude that same scale, and there are many, many historical examples going back more than a hundred years of, of, you know, changes that were slow to be embraced. And, you know, I think of the one expression that you hear attributed to medicine first do no harm. And it seems like that might lead certainly like as a patient, I want my medical team to be careful.

Mark Graban (27m 47s):

So rushing into some new technology could cause harm, but it seems like there are certain situations where being too slow to embrace or adopt or approve new medications or new technologies could cause harm in a different way. How, what are your thoughts? As I realized you probably a difficult question, how do you strike that balance? Not going too quickly, not going too slow.

Dr. Cliff Bleustein (28m 10s):

So again, as a physician, we all take the Hippocratic oath and we all believe, you know, primum non nocere , you know, at first do no harm. So I, I understand that. I think, you know, if you look at an example in the drug world, there there's two approaches. One where you will not approve a drug until you've pretty much tested on animals, tested on smaller humans, done dosing trials then, and done it on larger groups. And then you show them that there are no side effects and everything else. And it's a very long and expensive process that often costs billions of dollars to bring it to market. There's another philosophy that says, listen, let's bring it to market faster.

Dr. Cliff Bleustein (28m 52s):

Let's do a little bit less testing. Let's do it on humans. Let's make sure that it, you know, at first blush seems to be safe and the fact of, and really do a tremendous amount of post-marketing surveillance. And they're just dying metrically opposed points of view, you know, one you're trying to prevent any harm from happening before you ever bring it to market, which has some advantages and disadvantages versus the other end of the spectrum, which is bringing to market very quickly. And then after you bring it to market, you make sure that it's still safe, you know, and, and there is no right, and there is no wrong answer. I personally have a bias more towards the, the latter, which is bringing to market faster and test it very, very closely for any form of postmarketing problems that arise out of it.

Dr. Cliff Bleustein (29m 39s):

Because ultimately you never know in either method, if there are going to be challenges afterwards, and I'd rather make sure that regardless of the path that's taken, that you you're continuing to monitor it very tightly for, for bad outcomes. And I think you also risk adjusted. You know, there are some things that are extraordinarily low risk, so why wouldn't you want to bring it to market very quickly versus some other things like some drugs and gene therapy and other things that may be a little bit higher risk of having an untoward effect.

Mark Graban (30m 13s):

Yeah. All right. Well, very interesting. So our guest today has been Dr. Cliff Bleustein. He is the president and CEO at AposHealth and, and Cliff. I want to thank you. I think there's interesting opportunities to kind of think through and connect the dots, your story from sort of enterprise technology, sales and solutions, medicine lessons from surgery, and, you know, leading a company like you do today. So thank you very much for sharing all of that and for being

Dr. Cliff Bleustein (30m 39s):

A guest, mark, thank you very much for having me. I appreciate the opportunity.

Mark Graban (30m 43s):

Thanks again to Dr. Cliff Bleustein for being our guest today. For show notes, links, and more go to markgraban.com/mistake86. And I hope this podcast inspires you to reflect on your own mistakes, how you can learn from them or turn them into a positive I've had listeners tell me they've started being more open and honest about mistakes and their work. And they're trying to create a workplace culture where it's safe to speak up about problems, cause that leads to more improvement and better business results. If you have feedback or a story to share, you can email me myfavoritemistakepodcast@gmail.com. And again, our website is myfavoritemistakepodcast.com.

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Automated Transcript (Likely Contains Mistakes)