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Dec 18, 2020

Scaling ops at TrialSpark and Oscar Health

Bobby Guelich
Former Head of Operations at TrialSpark

Bobby is the former Head of Operations at TrialSpark, a healthcare startup focused on bringing new treatments to patients faster and more efficiently by reimagining the clinical trial. Prior to TrialSpark, Bobby held a number of leadership positions at Oscar Health, including Vice President of Customer Care Strategy and Head of Sales. Bobby began his career at Bridgewater Associates.

You can follow him on Twitter and LinkedIn.

1:01   Who is Bobby?

4:03   Life lessons Bobby learned from Bridgewater

5:21   How Bobby joined Oscar Health

7:38   How Bobby joined TrialSpark and what is TrialSpark?

10:26   Expectations when Bobby first joined TrialSpark

11:00   Bobby's day to day

12:55   Bobby's definition of ops

14:05   Ops at TrialSpark

16:43   Common pitfalls of companies with un-unified experiences

17:55   How has ops changed at TrialSpark

26:24   Hiring for ops

28:54   Internal tools at TrialSpark

31:23   How to keep team informed when processes change

33:39   Ops in a heavily regulated domain (FDA regulations)

36:53   Advice for folks considering a career in ops

38:10   What excites Bobby a this moment

39:23   How to reach Bobby on Twitter (@BobbyGuelich)

[Apologies for spelling mistakes as the transcript is machine generated]

Bobby: [00:00:29] Hey Derrick. How's it going?

Derrick: [00:00:31] Great. How are you?

Bobby: [00:00:31] Not too bad.  we have a tropical storm going on, but other than that, I’m well.

Derrick: [00:00:40] Well, thanks for joining us during a tropical storm. I hear this is like the second coming of the same tropical storm.

Bobby: [00:00:45] Yeah, we,  we got lucky with this one, so decided to double back and hit us again.

But could be worse, thankfully, not a hurricane, so still good. All right.

Derrick: [00:00:54] You know, in California when you somewhere rings, so you can always send them.

Bobby: [00:00:59] I'll do what I can.

Derrick: [00:01:01] Well, thanks again for joining us to kick things off. Maybe there's a really simple question that we can start with, which is who is Bobby?

What is your story?

Bobby: [00:01:11] Yeah, sure. Happy to.  so I'm originally from Minnesota, grew up in a suburb just outside of Minneapolis and for collegeI've started companies,  where I majored in economics and finance. And,  I thinkI, a lot of folks coming out of school, didn't really know what I wanted to do.

and at the time most people, in this situation were applying to finance and consulting jobs and I've known it like economics a bunch. So this seemed like,  something that made sense for me as well and wound up,  joining the hedge fund Bridgewater associates,  which I think is pretty well known now.

But at the time,  it was a relatively unknown firm out in the middle of Connecticut. And I wound up having a really great five and a half years there.  the work was really interesting and the people were great.  but ultimately got to the point,  I realized it just, wasn't passionate about the impact of what we were doing.

as fascinating to try and understand how the global economy worked, but frankly just couldn't get excited about making money for other people. so decided to make a change at that point and,  have a lot of folks who.  no, they want to make a change, but aren't sure what they want to do.

decided to go back to business school and known, coming out of Bridgewater that I wanted to work fora company, that had a clear social mission. so I spent a bunch of my first year at business school exploring, industries and companies that fit that description. And through this, Matt did an internship, at Oscar health between my first and second year there.

And this really wound up being a pretty transformational experience for me. You had actually originally joined the help, work on the products, side of things there, but pretty quickly realized that,  I was more interested in operational problems and gravitating that way. And it was the really early days there, there, you know, less than 15 people or so there at the time.

there's no shortage of things to tackle. And so,  at the end of the summer, I wound up getting a good opportunity to stay on full-time, and realized, this is exactly the type of opportunity that I'd hoped for coming out of business school. so made the decision at that point to drop out, and stay on and help build Oscar.

And so then the next four years were pretty much a whirlwind. over those four years, held four different operational leadership roles, including building out the inside sales team, leading the full sales organization, and leading the build out of an operation center in Arizona that now houses, much, the company's operational teams.

And, after four years Lasker, came to the point again whereI was ready for a change. And so that point wound up joining trails work, which is a healthcare startup in the biopharma space, focused on running clinical trials faster and more efficiently than the traditional model. And so there for the last three years or so, I've got operations, for actually just leaving a couple of months ago to take some time off.

long story short, you can basically solve my last seven years experiences building a scaling operations at early stage healthcare companies.

Derrick: [00:03:54] Congrats on the last seven years. And,  that's awesome that you're taking a break and just take a pause to think.

Bobby: [00:03:59] Thanks. Glad to be doing it.

Derrick: [00:04:03] Are there any, since that you still use in your daily life from Bridgewater?

Bobby: [00:04:08] It's a good question.  I think one of the, I don't know if you have read the principles and also re  for those listeners who haven't heard of this, Ray wrote a book called principles a couple of years ago,  based on his life philosophy and what he thought made him at Bridgewater successful.

and has actually really interesting because I joined Bridgewater back in 2006. And so at the time, none of that was written, he was basically going through the process of documenting all those principles.And  it was really interesting to see that in action. And I think there's a few things from that it really stuck with me.

one thing I'd say is, he has this thing called the five step process for, basically addressing any problems.  essentially what's the goal you're trying to solve. What's the problem. that's getting in the way of that goal. How do you diagnose that problem?What's the best design and then how do you go about executing that design?

And it's a pretty simple, straightforward five steps, but, I think when you're in the heat of things, it can often be easy to miss one of those steps. And that basic framework is something that I still apply a lot, in my day-to-day. And then, I think the other thing is frankly, Bridgewater is a very transparent and direct place.

And I think, spending my first five and a half years of my career there, that's really rubbed off on me a lot. And I think,  shapes a lot of how I approach things.  my current jobs as well.

Derrick: [00:05:21] And then after Bridgewater, as you mentioned, you went to Stanford for business school and the summer between your first and second year you were in New York City at Oscar health.

How did you find out about Oscar health? And the second is what made you stay at Oscar given?  for one,  the weather in California is beautiful or any New York is snowing, half a year,

Bobby: [00:05:43] Yeah.  I was fortunate. I got connected to Oscar because,  some of the earliest employees there and one of the founders and currency also,  his next Bridgewater person.

and here's some of the early folks there.  and like I said,I had been looking for something that I thought had a bigger social impact and one of the trout to start up. And  it seemed like something that'd be a really good thing to try out for a summer. And,  yeah, I wound up, I really ended up loving it.

 that's, what made it hard to leave?  California,  the weather in Palo Alto is hard to beat for sure. But,  this is exactly the type of opportunity I realized,  I was looking for a big mission, which was to reinvent health insurance with the patient at the center.

it was building a lot of,  really interesting technology to support that.  and it was just a really great,  initial team.  so made that call. And I think,  my parents thought I was a little bit nuts at first to be dropping out, but, um, you know being a great experience,  I'll say the funny thing that I wasn't expecting,  is that in some ways dropping out of business school has given me more credibility in the startup world.

People tend to look favorably on dropouts in this space.  it's turned out all right.

Derrick: [00:06:51] And then, so you said you joined when it had around 15 employees. What was the makeup of the first 15 employees?

Bobby: [00:07:00] So it was actually, it was pretty interesting. It was a few different segments of folks. So there's the co-founders and then there was about five or so,  industry veterans.

So people who had worked in health insurance, all their boats,  in different aspects of it.  they, frankly brought a lot of the know-how and credibility around building a health insurance company.  and then the rest of the team,  which wasn't that many folks,  five to 10 people.

It was mostly more startup folks.  small product and engineering, a few folks in those roles.  and then just frankly, a few generalists,  kind of folks who could do a little bit of everything as the company was just getting off the ground.

Derrick: [00:07:38] And so after four years or so, you joined trial spark maybe to talk a little bit more about trial spark.

How did you find about trial spark and why did you join? And maybe before we dive into those two questions, what is trial spark?

Bobby: [00:07:52] Yeah, sure. Happy to. So I'm explaining trials for, it can be a little bit tricky if you don't know anything about, clinical trials. So I'll try and keep this relatively high level and digestible, but,  it's a big picture trial Spark's mission,  is to bring treatments to patients faster and more efficiently,  by re-imagining the clinical trial.

And so it does this in a few different ways.  so first, transport can start to expand the pool of clinical trials.  as there's just generally a shortage of clinical trial sites out there,  by helping regular clinical practices. So thank you know, your primary care doc or a specialist,  helping them participate in a clinical trial.

As a trial site. And so that practically speaking means that we give these practices, the training and the staffing and the equipment to run clinical trials.  the second piece is that we build technology to facilitate the conduct of these trials,  which we can get into a little bit later.  third, we also help trial States recruit patients primarily through kind of digital marketing means and forth.

we run end to end clinical trials. Is what's known in the industry as a contract research organization,  which you can essentially think of as like the project management and oversight layer,  that coordinates the end to end,  clinical trial. So I'll pause there  is that makes sense?

Derrick: [00:09:09] Yeah. That makes a lot of sense.  and how did you find out about TrialSpark?

Bobby: [00:09:12] That's a trial spark,  shares an investor,  with Oscar. And so when I made the decision to leave Oscar,  I was fortunate that they connected me to a few different,  healthcare startups. So I knew I wanted to stay in the industry and,  as I got to those trial spark,  there was a few things that frankly just got me really excited about the company.

so one was just,  the. Huge mission,  in general. So again, just as some context,  the primary bottleneck to getting more treatments to market,  is actually the clinical trial. So drug discovery is getting easier and less expensive with a lot of the technology that's been built recently.

But the clinical trial looks more or less the same as it has for the last 20 to 30 years. So if you could actually make a meaningful Delta in the cost and time that it takes to run a clinical trial,  you can actually increase the number of medicines  that make it to patients.And  just thought this was a really impactful and interesting mission.

and then the other piece was,  one was really impressed by the leadership of the company. I just really connected  with the co-founders, and was impressed by,  their talent, their vision, their values. And then the role is an exciting one. I'd led departments at Oscar,  but this was an opportunity to lead it at different scales,  roughly half or so, the company rolled up tome.

so it was excited about the growth opportunity as well.

Derrick: [00:10:26] So how big was trial spark  when you first joined and what were your expectations going into trial spark?

Bobby: [00:10:32] Yeah. So trust work was a little under 20 people want to join. So roughly similar size to Oscar, as well as had a pretty good sense.

I'll say at least what  that scale of company felt like. And,  frankly just expect it to be pretty crazy.  It was the early days. And we had a lot to figure out still about what work was needed to get done and then had to build the teams and prostitutes to support it. So I thought it was going to be pretty crazy and bother putting up some expectations.

Derrick: [00:11:00] What would you say  your day-to-day like,  obviously I'm assuming it's changed from the first year or the first day to the third year, but what was the average day in the life of Bobby while you were at trial spark?

Bobby: [00:11:12] It's always.  so it was hard to talk about an average day, but a startup, I do have to say.

maybe just, again, a little bit of context about my role. I was leading operations, which,  for most of my time there met that I over saw a few different departments.  one focused on building out our network of clinical trial sites.  one focused on recruiting patients for the trials that we were conducting.

and then our core clinical department, which was responsible for executing those studies.  and then I also let the build out of  our contract research organization business line, and it was a member of the executive leadership team. And  no day looks the same. I'll say there's like a few broad categories that my work fell into.

so one people was a huge one and that was probably the biggest one. So that was,  hiring coaching and performance management, things of that nature.  strategy work was another big one.  supporting company strategy efforts to finding team priorities, ensuring our organizational structure made sense,  process development and execution was another big one.

just supporting my teams as they design processes.  and we're executing that. And then communication, was a huge part of my role. So just making sure that there was good alignment within my teams,  and across the company. In terms of priority isn't and what was going on. And then I think probably one of the biggest things, honestly, day-to-day was just firefighting.

the reality of any startup is that there is always fires going on. And the question is usually what's the biggest fire at any given time. And frankly, day-to-day a lot of it was trying to figure out what was the biggest fire that needed to be fought that day and making sure it was getting taken care of.

Derrick: [00:12:39] I think that's a great point. I remember this quote from Brian Chesky. And the early days of Airbnb and how off send some emails being like, Oh, there's this fire then that this is other fire. And Brian Chesky, his response was just let it burn because you have to focus.

Bobby: [00:12:54] Yeah.

Derrick: [00:12:55] And so what does operations mean to you? Because I'm assuming that operations at trial sparks slash Oscar slash Bridgewater, is very different from companies like ups or,

Bobby: [00:13:08] Yeah, I think it's a really good question. And, I think operations can look very different depending on the context, but I think for me at the conceptual level, I think of operations as really designing, building and running a machine.

Designed to produce a certain outcome,  with high quality, consistency and efficiency. And so this machine could be super different depending on what the businesses and what the industry is.  it could be manufacturing cars, it could be delivering a great doctor's visit.  it can be producing an amazing TV show.

and the machine can also even be just processes that are within departments that are not typically considered, quote-unquote operations.So, hiring processes or processes for managing engineering projects. And  obviously it's a ton of differences across what these machines can look like depending on, the business and the industry and the team, but at the end of the day, they're all, I think it helps to see them all as machines that are just designed to deliver a great outcome in a repeatable and scalable way.

Derrick: [00:14:05] And can we talk specifically about certain types of operations, uh, trialspark, what types of unique problems were present our trial spark and how did operations help. Deal with these problems.

Bobby: [00:14:18] Sure. Yeah. So I think the way that I've always categorized, trial spark, and I think you can bucket a lot of other healthcare startups in this way, as well asa tech enabled services business.

for us, we were delivering a healthcare service, which in our case was a clinical trial, and really seeking to make it more efficient and higher quality through the use of technology. And  I think there's a few, there's many challenges that are common to these types of businesses, but just to highlight a few, like one of the biggest ones is they're very people driven businesses.

you know what I mean by that is in health care, you're usually delivering really complex and sensitive service. it can have a huge impact on someone's health, obviously.and then as well as their financial health. And so I'll, technology can play a huge role in enabling these services.

For the most part, there's still person to person interactions. patients, a doctor, a patient, a nurse,  patient to customer service representative.And  what this means is that having really some people, operations is critical. So, you're hiring, you're onboarding and you're training your performance management, knowledge management, your change management of your company culture.

there's a ton that goes into to, make it, you've got a really strong people team, delivering those services and then. That's a second challenge that, I don't know how universal it is, but we experienced it at both, Oscar and trial spark, which is that actually ensuring a really thoughtful when unified patient experience can be quite challenging.

so often you'll find that a patient will touch different teams within the business. your sales team, your marketing team, your product team, and then a variety of different operational teams. And so it's really critical to set up your organization in the early days, in a way that facilitates a coherent well-designed patient experience.

and this can sound relatively easy and straightforward, but in practice can be quite difficult as it requires a lot of coordination,  across the company in the various teams. I'd say the third thing is true of healthcare. And I think in a number of other industries as well, it's just operating in a heavily regulated environment is hard to invest the time to learn you need the times industry expertise, whether it's consultants or full-time hires.

who can help you navigate the regs as well? you need to be prepared to go slower than you other otherwise might want to, since the cost of mistakes can be so much higher. and then if you're in your business, if you're in a business whose operations can be audited, which is true of both Austria and Charles Park, you need to make sure that you're building in a way from day one that pair you, to manage these audits.

Derrick: [00:16:43] And to double click into point number two that you made in terms of this unified experience. When you look at a company that might not be the best in terms of having a unified experience, what do you think they do wrong? Is it internally they haven't designed, the processes where the different departments have good handoffs or is it something else?

Bobby: [00:17:03] Yeah, it can just be really hard to see what the patient experiences when you're sitting inside, because what you can often see happen is that each, each different team will optimize around what their engagement with the consumer is.Right. And so that can mean there's, disjointed handoffs between different stages or it can mean that you just don't even realize what one.

One different team is doing, relative to what you're doing.  your marketing team might be sending something out,  about an upcoming opportunity or whatever. And then, your customer service team might be sending a different message out at the same time. And , unless you're really organized around what those engagements with the, consumer look like, it can be disjointed.

It could not make sense. It can be confusing.  and it winds up just defeating the purpose of what you're really trying to produce, which is, a really great coherence,  experience for your customer.

Derrick: [00:17:57] How has ops at trial spark changed from the first day when you joined to, I guess three years later.

Bobby: [00:18:04] Yeah.  it's a good question. So I've actually now had the opportunity to experience, the early days through rapid scale at two healthcare startups and. No broadly speaking, I've found that you can categorize the evolution of operations. At least at companies like this, into three different stages.

It's the first thing I'd call just what is the work?and  in the early days, you're often just figuring out what the actual work that you need to get done is the product and the services are changing quickly.  as you're learning about what customers want. and so as this is changing, so who are the processes that are needed to support it?

And so this has a  few different implications.  one is that from a higher perspective, it's helpful to hire generalists,  who are smart, independent, and willing to do whatever's needed to get the job done. nothing's below them.  from an org structure perspective, you really don't want to cement any organizational structures at this stage.

it's obviously important to clarify responsibilities. but you want to set expectations with your team that things can and will change as the business evolves. And finally, from a technology perspective, you typically don't want to invest heavily in technology is the internal tool technology at this point,  and waterline off the shelf products as much as possible, Google sheets and forms, air table and things like that.

it's almost never the right allocation of scarce product and engineering resources to build internal tools at this stage, unless it's something that's absolutely core to your product. And  so that's basically the first stage, the second stage I'd call, establishing the initial foundation. And at this age, you typically have a pretty clear definition of what your product or service is and are working to build out the well-defined processes,  to support it.

And if you're lucky and things are going well, actually the stage can be pretty stressful because you're usually. Racing to put basic processes in place while the business is growing quickly. And  you're simultaneously fighting fires due to your lack of processes.  being able to prioritize, building the processes while also taking care of those hottest buyers is a really hard balancing act.

And, particularly  as your attention is often drawn to the fire side of things, rather than the infrastructure side of things. And so at this stage, I think a few applications as well,  from an org structure perspective, you're starting to put in,  a clearer and more defined or a structure based on the work that needs to get done.

I will say though, it's important to recognize that your org structure is going to change regularly. So continuing to set expectations, with the team about this is really important,  Okay, on average, in my experience, the word change, the org is changing,  every six months or so,  at this stage of the company.

no setting these expectations is really important,  from a hiring perspective,  since you're now starting to define teams and roles more clearly,  you typically have target profiles that you're looking to fill. And so your focus is less on generalist at this point and more on how do you start building a scalable talent pipeline, including where you source talent and  what your interview process looks like.

and then at the SIDS, you're also really starting to,  Invest in other people processes as well. So that's solid onboarding training, the knowledge management systems in particular. because this is a service largely delivered at people. It's really important to establish consistency now put on your team.

And  this depends on how well your team's brought up to speed and how you keep them current  as processes change. And then one of the things I really want to highlight at the stages is you might start thinking about whether or not to dedicate, specific operational excellence resources.

if you don't.Inevitably,  execution as a metric before tends to take priority. And so it can be really hard to dig yourself out of a hole. If you don't have dedicated resources that are thinking about the processes and systems to enable these teams. And then from a technology perspective, it often makes sense to start investing a little heavier in technology at this point.

So this can either be building internally your, or,  starting to configure more. So if you're off the shelves,  products and ideally the stage, you also a product manager who you can partner with to make these decisions.  particularly one who has experience building internal tools.

And then the third stage, like it  broadly speaking, not classified as solidifying and scaling. And so the exact shape that things take at this stage can vary quite a lot.  it could be hundred madness if the business is taking off and you may be rushing to upgrade your internal team and systems to meet the demands,  or it could be a slower and more measured growth, which is typically easier to manage.

but may not allow you to make improvements as quickly as you like, because you're not able to invest in the same way. And  maybe again, just to highlight a few applications,  at this stage, your hiring onboarding training and knowledge management systems should be getting much better and it's acknowledged management communication in particular becomes increasingly important here.

usually the team's too big for information to be disseminated informally. So you need to have away of ensuring that info gets out in a timely manner in a way that can be internalized by the team. And likewise your knowledge management systems need to be organized well and kept up to date. So it's easy for the team to find the information I need when they need it.

another thing I'd also really be thinking about, you want to be thinking about obviously the whole way along,  but you really need to start investing in is,  culture and performance management. So just as an example, you might have some early team members who are starting to get frustrated as the role is narrowed in scope and become a little bit more rope over time.

If this happens, it can negatively impact the broader team.And also, your overall talent level may have decreased a little bit as well, particularly if you had to scale quickly. So managing performance becomes increasingly important,  at this stage as well.  ensuring that your team's both motivated and high-performing takes a lot of investment,  at this stage, And then finally on the technology side,  the path you're taking here largely depends on how well the solutions you've implemented in stage two are working.

they might be starting to break is as  the scale increases.  so you might start building more internal tools or for the customized in your, off the shelf products.  and if you're using an off the shelf product,  cost might start becoming more of a factor as well.  particularly  if your team has grown quite a bit.

So again, it's really helpful to have. I'm a product manager here to help with  these decisions.

Derrick: [00:24:20] Wow.  that's a lot to unpack there. I appreciate that. In terms of,  click into a few things, the first one would be in terms of people management, what is the best practice there?

Let's say for stage two and three. Is it having a semi-annual or annual. Performance review, is it,  you talk a lot about transparency. Is it being transparent about them and say, Hey, here's where you're going to end up next year on this current path. What do you think of that role?  what's the best practice?

Bobby: [00:24:47] Yeah. So this is a really big topic. So maybe you mentioned a few different things. I'm happy to go deeper on any of them. so  I think first, obviously it starts with having a really great hiring process. So knowing.  what's exactly the profile you're looking for or  what's the talent pool to go after and then a good,  evaluation process for that.

assuming you've got that in place, it really then starts with what are the expectations that you're setting for the team as they're joining the company. So  it really clear for them. What's expected of them in the role, what good looks  how their performance will be evaluated.

And then if they do well, what does that look like?  so actually it takes quite a bit of thought to think, okay, I actually lay out what are these responsibilities and really clear way. How do you measure those? And what can even,  career progression in particular, in a startup is always a hard topic because things are changing so quickly and you don't,  you don't have level one, two and three from day one in the same way.

You might as a really big established company. And  Trying to create those levels where they make sense is a good thing, but also just setting expectations that,  your path, the startup might be a little bit more fluid depending on how the company evolves.  and so I think this is something that,  I might touch on later, but,  I think one of the things  that people who join startups can really do is take a hand in what their own development and growth path looks like.

So  if they're doing well,  they should be having conversations with their manager and other folks in the company to hope fully identify areas where as they grow, it might be a good fit for them,  improve and increase their career.

Derrick: [00:26:24] And double clicking into hiring and the processes around hiring.

I think there's been a lot that's written and talked about in terms of,  how do you hire engineers and what the process is there, but there really hasn't been a lot written about how do you hire quote unquote offs. Right so what is the exact process? How many interviews do you do? What do you look for?

Who's evolved. I think just shutting light in, into that would be cool.

Bobby: [00:26:49] Yeah. Again, it's going to, not to Dutch question anyway. Good depend a lot on, but what's the team that you're building. and what's the,  how difficult, and what's the nature of the work that they're doing.

So maybe you can give an example and make it a little bit more real.  so at Oscar,  one of the jobs held there,  was, leading our inside sales team and. Ask her to pretty interesting in inside sales challenge,  we were selling direct insurance directly to consumers and our sales season was essentially three months long each year.

There was an open enrollment period,  from roughly. Late October through December,January,  where we do,  80 plus percent of the sales for the  entire year. And so what that meant for us is we, that dramatically scale up our team or sales team for that period, and then scale it back down.

and  because we just couldn't carry  that size of a team the entire year. It just didn't make sense given the business. And so for us, that meant essentially developing what,  Especially we described as a sales training program because it can be difficult to find,  a team that's going to be willing to sign on for three, four or five  month job.

And so we,  we pitched the role that way and then had a really high stakes throughput,  training process or sorry, interview process,  because we knew we wouldn't be able to find folks with a lot of experience. And so it really came down to. No, how can we quickly evaluate a lot of folks, who we think meet a few different criteria or,  we'll give our customers really great experience and are really fast learners and just generally have a really great attitude.

And so we would run big interview blitz days,  so evaluate people along  those dimensions. And so that's just one, like pretty unique example  of a high throughput hiring process.  I've hired clinical teams as well, nurses,  clinical coordinators, things like that. And that tends to  look different as well.

So it really,  again, a long-winded way of saying, I think it really depends on what's the team and the characteristics that you're looking for and being really prescriptive about that. And then how you evaluate that through your interview process.

Derrick: [00:28:54] Interesting and talking slightly more about internal tools.

Do you mind just sharing with the audience, some specific examples of internal tools that were built at Oscar as well as trial spark?

Bobby: [00:29:06] Yeah. Sure.  I think  maybe for just giving us a few examples, I think a highlight, just a few principles that we thought about when. Deciding whether or not to build something internally or to go,  use something more off the shelf.

If none of this isI'd say pretty groundbreaking, but I think one is how well defined is the process. So if it's something that's really evolving quickly,  or might not have a lot of longevity, but someone in the company is,  you're much more inclined to use off the shelf versus building yourself.

what's the complexity of the process. So if it's really complex, it can be hard to configure  off the shelf tools.  A big one is how much of a, whether it contributes to a key differentiator for the business. And so if it does, it can be really worth it to invest in something custom and building a house.

But if not,  you might be willing to go with an off the shelf product, even if it's ultimately a little bit suboptimal. And then frankly, what, how good are the off the shelf solutions,  and what are their costs and how easy is it to customize them. And  maybe don't apply some of this to Austrian trial spark.

Areas where we builtin house.  and Oscar, we build, we built our own customer service,  CRM in house,  which was a big decision for us.There's a lot of CRMs out there in the market. but the service that we were providing to our members was such a big differentiator for the company that we thought it made sense to invest in building that technology ourselves, to make sure  that process was as efficient and high clause as it could be.

And similarly at trial spark,  we built the software in house to manage all of our clinical child visits and capture, the clinical trial data that was being generated through those business businesses. Again, something that we thought was a huge differentiator for the company in terms of efficiency and quality, on the flip side, in terms of where do we go with off the shelf things,  Charles Park, an example would be,  how we onboarded clinical trial sites.

It was a relatively simple checklist based process. So I think the early days we use air table to manage that,  but really, any checklist type product would have been fine for that.  and then we also use,  an off the shelf project management tool to manage our end to end clinical trials,  which we want to customize in a fair amount, but that was much easier than trying to build, A new project management tool, because there's  a lot of good tools out there in the market.

Derrick: [00:31:20] Going back to talking about these processes and internal tools, how often do processes change at trial spark as well as Oscar, and how did you make sure that the team knew that these change happened right earlier, you talked about communications being critical to scaling the team and the organization.

Was it just, paying the team on Slack and being like, Hey, step four for a particular process changed, or how do you quote unquote updates the humans involved in these processes?

Bobby: [00:31:44] Yeah. So your first question, how often would they change all the time?  processes change pretty much nonstop.

And even if the process isn't necessarily changing pieces of information that people need to know about them, we're changing constantly.  for example, policies that our customer service team needed to implement and follow it at Oscar we're changing all the time. And  in the early days when the team's small,  it's easier to be a little bit more informal, but, especially as you start to grow and the throughput increases, like you need to be much more organized and disciplined about.

What this looks like. And this really actually for me, gets back to the topic of operational excellence or operations support.  in the early days it's usually the people who are, building the processes are also the ones executing now.  but this doesn't scale.  as you grow and if you're doing increases, it eventually makes sense to establish a team that's purely focused on enabling the frontline team,  to be more efficient.

And so this is the team that's in charge of things like onboarding and training and knowledge management communications.  they'll all be the partner,  as it relates to building internal tools.  to your specific question, this is the team that really,  takes charge of making sure everyone's up to date on the process, changes and policy changes that are happening.

And you know, this, I don't think there's a silver bullet with this.  we. I'd say we  took, an approach of also surrounding the team with these changes. So there was email updates, we'd reinforce them in team meetings.  we had wikis that included all of this information.

We sent out quizzes to make sure that the team internalized these things. So it's, it's hard right there. They're in the thick of things every day, dealing with what's coming at them. It can be really hard for them to stay on top of things. And so we  took a multi-pronged approach.  To make sure we were doing everything we cut to central.

They stayed up to date.

Derrick: [00:33:39] And then can we also touch a little bit on the unique challenges around healthcare tech ops? I think you touched on this slightly earlier, but there are certain,  FDA regulations that as a healthcare company, one has to follow. And I believe there are also rules around validations as well.

Bobby: [00:33:55] Can you just touch on that? Yeah, sure. okay. Healthcare operations  is not for the faint of heart.  there's a few things on that. So one is just the overall complexity of the healthcare system makes it hard.  specifically, just to give an example of this,  and Oscar,  we didn't control the healthcare system.

We were just the insurer. and  our members would call us with problems that they were running into. And so that in a lot of ways meant that we were the customer service for the entire healthcare system,  which meant that people could go down all sorts of crazy different paths and find themselves in all sorts of difficult situations.

and so our team needed to be equipped to handle that. So just complexity in terms of what can happen in healthcare. It makes it really challenging.  the regulatory,  side of things is,  Also a really big one. You need to make sure,  the regulations inside and out and that you're building the processes and systems to be compliant,  as well as auditable.

And I'll touch on this in a second. And then data privacy is obviously a huge thing in healthcare. making sure that the TAC team plays a huge role in terms of HIPAA. And you need to make sure  your team is really trained on HIPAA, as well as data privacy, making sure that,  you're protecting people's health information.

So all of these things just create a lot of. Overhead for building operations,  in healthcare. And so maybe just to give an example of this, with respect to trial sparks, Just some background in the pharma industry, trial sites can be audited at any time by you to the pharma company or the FDA.

And when they audit you need to be able to prove that you followed every step of the clinical trial correctly, which means a couple of things. First, you need to make sure that all of your processes are well-documented.  which you can imagine a harvest isn't a startup that's. Changing basically non-stop to make sure you have a fully document.

You're not just building the process, but you're documenting exactly what it looks like. So this just creates a huge amount of overhead for all the processes that we were building. And then second, you need to be able to prove that you followed each step of the process correctly. So you need some sort of paper trail,  whether it's actual  paper, or an electronic log that demonstrates that the process was, was actually followed.

In the industry, they say a lot,  if it wasn't documented, it didn't happen.And so again, it's just created a huge amount of overhead,  for everything where we were building. And then you mentioned validation. This was this fact that our tech team more  than the operations side, but essentially what that means is that every single piece of technology that we built in house, you needed to prove you needed to document that it did exactly what you said it was going to do.

And so this. Yeah, it makes sense why this regulation existed.  the clinical trial data that we're generating  is the most important aspect. If you want to make sure that's generated in a really accurate way, but it created a huge amount of overhead for our product engineering teams and slowed down the development cycles.

So,  big picture, it's just a lot of overhead in healthcare, which exists for a lot of really great and important reasons,  but it,  can slow you down and it definitely makes things harder.

Derrick: [00:36:53] In terms of some closing questions, what advice would you have for folks who are earlier in their careers who are considering a career in ops?

Bobby: [00:37:02] Yeah, I'd say. A couple things. So I think one is, don't actually worry too much about what your first role is. instead I'd say look for a couple of things. First is look for companies that are growing quickly.  if the company is doing well and you're doing a good job, Great opportunities are almost certainly going to open up and,  my own experience has been this somewhat, andI've seen it with a lot of other people too, is that it allows you to take on responsibility and a lot of responsibility much earlier in your career.

worry more about finding the company that you're excited about and you think is growing quickly, then exactly where you slot in.  and then just do a really great job and you're more than likely going to have good opportunities emerge. And the other thing I'd say, and this can be harder to assess, but try and get a sense of it through the interview processes.

see if there's someone there, hopefully your manager, Who's someone you can really learn from, cause it can be a huge accelerator to have a great mentor.  looking for a job that has that opportunity and if you're lucky enough to find it, do everything you can to make that person as successful as possible because that's going to make them want to invest,  invest in you.

Derrick: [00:38:08] That's amazing advice.  and then the second question is  what are you most excited about in the world of this moment?

Bobby: [00:38:16] Sure. That's a big question.  a little bit, probably a little bit off the topic for this, but now I think for me,  the thing at the moment I'm most excited about,  is probably categorize as meditation and other forms of mental training.

it's almost a truism that the quality of our mind is what determines the quality  of our lives. And so no. I think the thing that a lot of people don't realize and I'll say I didn't,  is that it's really possible to improve your mind through training,  much the same way you'd improve your body through physical training.

And I think there's actually a really critical insight that,  we can materially improve the quality of our lives if we know how to train our minds and,  take the time to do  so this is something I have to spend a lot of time with right now, both in terms of reading and practicing meditation.

Derrick: [00:39:01] That's amazing. I remember in  early2019, I was doing yoga twice a day. And. My quality of life was amazing. I told myself that going forward, I always do yoga twice a day for the rest of my life. And so far this year I've done yoga like twice startup.

Bobby: [00:39:20] I'm not surprised about that.

Derrick: [00:39:23] So I need to get back  into meditation and yoga.  And the last question is how can folks reach you on the internet?

Bobby: [00:39:30] Yeah,  probably easiest as Twitter.  just ask Bobby, you look,  and you can also reach out to me throughLinkedIn. I'm usually pretty good at responding on that.

Derrick: [00:39:38] Awesome. We'll have those links in the show notes as well, so people can find the exact URL. Well, Bobby, thank you so much for sharing your insights and stories. This has been awesome.

Bobby: [00:39:48] Thanks so much for having me. It was a pleasure.