Tiger Buford, an orthopedic recruiter, argues that innovation comes from iterating fast, not from one perfect idea. At Ellipse Technologies, weekly redesigns and rapid experiments let a startup outpace established competitors. The formula: build, measure, learn, repeat.
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Brought to you by Tiger Buford. Hello, orthopedic friends. Welcome to Inside Orthopedics. My name is Tiger. I'm an orthopedic industry insider and retained recruiter for early-stage orthopedic companies. Thank you for listening. This is episode number 21. Titled How to Create Innovation in Orthopedics. This one is for those who are creating new products or leading the new product development process or leading the entire company in orthopedics. I spent 30 years in R&D and saw, saw a lot of things that worked and a lot of things that didn't work, and I'd like to share a killer app for innovation that I discovered. Enjoy. Don't forget to subscribe. Thank Tiger Buford for your next hire. Keep iterating, my friends. Okay, let's jump in. We all know the successful innovation stories in orthopedics. Stories like Danek, SpineTech, Kyphon, Arthrex, Mako, hand innovations, Mazor Robotics, And they all started from zero and rocketed to success through innovation. The common belief is that the founders of these companies had a brilliant innovation idea and they just executed it perfectly. This is far from the truth. All of these companies actually iterated their way to success. No company inside or outside of orthopedics ever gets it right the first time. Even the giant companies of today— Amazon, Google, Facebook— all iterated their way into success. Contrary to popular belief, Silicon Valley isn't innovative at all. It's actually iterative. Even looking at art, if you look below the surface of the Mona Lisa, you'll find layers of draft sketches, false starts, major alterations. So, the iterative process could be the most overlooked tool in orthopedics for innovation. As we enter the next decade, this will become a killer app for innovative orthopedic startups. Companies that can create an iterative culture will win. Quick look at the definition of what is an iterative process. It's a process for arriving at a decision or desired result by repeating rounds of analysis or a cycle of operations. The objective is to bring the desired decision or result closer to discovery with each repetition or iteration. That's a mouthful. Think of the iterative process as trial and error company culture. This is really a way of thinking, a culture, not really a tool. For instance, the big orthopedic companies cannot iterate. They're lost causes. Management is too afraid to make mistakes. This is why they overpay for startups that have made mistakes for them. When I worked inside the big orthopedic companies, the focus was design perfection. The project goal statement spelled out the perfect total knee or perfect pedicle screw system or perfect extremities system. Engineers would grind for years and then announce that the final design was ready for testing. There are obvious reasons why the perfection approach doesn't work: slow, costly, lack of new products in the pipeline, not enough customer feedback. and groupthink. Every year, however, there are a select few orthopedic companies who have learned to iterate for innovation. This is where the magic usually happens. Let me share a personal experience. From 2012 to 2016 at Ellipse Technologies, we iterated our way to success. We out-innovated the competition, which at that time was Smith Nephew, Synthes, Medtronic Spine, with a culture of iteration. Back in 2008, Ellipse was a little-known VC-backed startup focused on bariatric control. We knew nothing about orthopedics. The culture and mindset was smartly built on the iterative process. New ideas were built, tested, and evaluated at an alarming pace. If you missed a week, You would be amazed at all the changes. All products and processes were fair game to iterate. Here's a few examples from Ellipse. We redesigned our implant systems weekly. We asked ourselves, can we make it better for our customers? We experimented with creative regulatory strategies. We asked, how do we find a way to receive 510 clearance for remote control implants and kits? A lofty goal. We redesigned the implant assembly and testing processes weekly. We asked, can we build the product faster and with less waste? We experimented with borderless sales strategies that quickly put us into 20 countries. We asked, where are our evangelist customers and how do we best serve them? We even reorganized the company every few months for speed. We asked, what is the best organizational structure and physical layout to go faster in the next few months? So that was just a personal example. Let's look at the process or the mechanics of iteration. The mechanics are really simple. There are 3 simple steps: build, measure, learn. Then implement the good stuff. First, build. Brainstorm and redesign the product or process or service and do it fast. Second, measure. Put the new product in the field and measure it, test it, get the feedback fast. Thirdly, learn. Review the data, evaluate what happened, what were the bad pieces, what were the good pieces that can be implemented now. So this is the 3-step cycle that you do over and over again. Let's talk about how to start an iteration in your company. Any company can take advantage of iteration to out-innovate your competition. Try things in small doses first. Instill an iterative process in all areas— product design, Marketing, surgeon training, regulatory approaches, distribution models. Here are a few actionable ideas. In R&D, in product design, anoint a product improvement engineer. This is a dedicated engineer who is in tune with surgeons and sales force. He or she should attend surgical cases at least twice a month. And particularly those with unhappy surgeon customers. You don't really learn anything from happy customers. Then come back and quickly redesign, prototype, and reevaluate. Let's look at marketing. This is an easy one. Today, iteration is really the only way to market. In the 2020s, companies will be marketing directly to surgeons and patients through social media channels. Read my article called Fire Your Marketing Head if he or she is not changing ads and content regularly. Now let's look at sales and distribution. Sales is a local phenomenon. Every city, every hospital, every surgeon is a different sell. Experiment with different selling techniques, different incentives, different training programs. Different contracts and prices. Incentivize the sales force to cross-pollinate their winning techniques with other salespeople. When it works with one customer, try it with another one across the country. And let's talk about funding. Try different pitches with different investors and just keep the good stuff. Discard the ineffective stuff. One size never fits all when you are out raising money. Most companies use the same slide deck the entire time. So you get the theme here. So in closing, here's a final word. Your company should reward employees who embrace the iterative process. Catch them in the act and make sure that you publicly applaud their behavior. You are giving permission to the entire company to try new approaches when you do this. Over time, the culture will start to change to a culture of experimentation, and innovation will happen. Iteration plus iteration plus iteration with speed will lead you to innovation. That's it. Talk to you next time.
