Below are some excerpts from our conversation with Owen McCarthy, Co-founder and President of MedRhythms, a Maine-based digital therapeutics company that uses music to help drive clinical outcomes for people following neuro injury or disease.  The idea for the company was born when Owen’s co-founder Brian utilized auditory techniques as a clinician at Spaulding Rehab to help people recover from walking deficits twice as fast as traditional physical therapy.  Now, MedRhythms is working towards FDA approval so they can reach patients across the globe.  Owen talks about what its like to lead a start-up where failing fast and failing cheap is not an option when it comes to patient health, but staying nimble and moving fast is still crucial to success.

You can listen to the full episode by clicking the audio image below, on our website, or on iTunes (more podcast players coming soon!).  Know someone who would be great on the Big Time Small Business podcast?  E-mail in at podcast@chenmarkcapital.com.

Focus is your friend

In startup land, in general–and this is a hypothesis I have–there are two trains of thought.  One is you get $800 million from SoftBank and you can do lots of things [at once], and that only happens to a few companies.

The other way is dream big, set your sights big, but focus on something really well, and do it really well.  Get your first 10 customers, 100 customers, 1000 customers, and then expand.  Because that’s your advantage as a startup, it’s the hyper focus.  Do that really well and be nimble around what you learned from there.

People over ideas

It was a scenario where I knew the co-founder, who was a clinician getting great results, and I trusted him.  I think that’s really important because it’s people that actually get things done.  It’s not the idea. Those are a dime a dozen.  It’s really the people that you work with, that you push through with in the trenches, that are really important.

On priorities, time management, and making decisions

I always ask myself, on Sunday night, “If I did one thing this week, what would make the most difference?” And if I can get that one thing accomplished, that one thing decided on, that one thing done, usually, that one thing drives 80% of the week.  [Usually,] it’s fairly big.  This week it might have been to decide on our comparison group for our clinical trial, which then would get submitted next week.  That’s a big deal.  A lot of money, time, and risk go into that.

On the time management side, I always block, at least, three or four hours every week to not have meetings or calls, or anything to work on whatever those big things are.  It’s sacred in my mind.  I need to do this because I need time to think and to strategize.

How do I think about making high-risk decisions with incomplete information?  That’s a really tough one.  That doesn’t work [well] for the team.  Often times, the team needs a hill to take, and making no decision, or waffling on the decision so you might make a better decision in two weeks, sets the team back two weeks.

Therefore, it’s, “What’s the risk of two weeks of missed time of the rest of the team versus getting it slightly wrong?”  It’s a judgment call to say, “We’re going to take this hill, let’s go.” And once you get to that hill, it sometimes is easier to say, “Actually, let’s go over to that hill. We’re almost there.”

Wall Sit Wednesdays

We have stand-ups with the team daily.  Everyone reports on what that they’re doing.  I try to use the opportunity to describe why I’m working on what I’m working on and how it connects to what everyone else is working on.  That’s tactical.  It’s every single day, 7-10 minutes long.  Wednesdays are less because it’s wall-sit Wednesday, so everyone has to do a wall-sit.  That meeting is over quickly.  It flies.

The stand-up is meant to just catch people up, quickly.  If anyone has a question about anything, they have an opportunity to talk about it.  So at 9:30 every single day, the train leaves the station, no matter if I’m there or Brian’s there.  We’re all accountable to 9:30.  We don’t want to waste anyone’s time. That regular communication helps.  Also, for things that are really important, you have to say them many times, so we consistently, intentionally, bring that [stuff] up, because it’s really important to us.

Owen’s three steps to culture

It’s interesting that you mentioned the wall-sit Wednesday, because, while that’s important, one of the things that we’ve tried to nail into the culture is [that] no one’s more important than anyone else.  And how that was signaled is that the stand-up, every day, starts at 9:30.  They don’t have to wait for executives to be there.  If we’re late, we’re late, and the rest of the team doesn’t need to wait for someone to bang the gavel and start the meeting.  It goes no matter what.  That’s one thing–we’re all on the same team.  We’re not more important than the rest of the team.

Brian and I are also a model-the-way-type of leader.  If there’s a meeting about a topic, and the agenda is sent in advance, I come with pre-prepared notes.  If there are items that are assigned to me by someone else, I will stay up all night to make sure they get done.  Because the worst thing is to waste anyone’s time, and not to be excellent at what you do, or thoughtful at what you do.  That’s number two.

Number three is [being] timely in responding to things.  Get back to emails, give them back the message, get back to things fast.  You never want to be the bottleneck, and we don’t want bottlenecks.  If there’s a bottleneck, let’s triangulate it immediately, and remove it.  I don’t want anyone, at 3 o’clock saying, “This is in my way. I’m just going to hang around for the next few hours and go home, and I’ll deal with it tomorrow.”  We just wasted a full day of work.  Address those things immediately, if they come up, and get them out of the way.  Then there should be no excuses about why things get done.