An Interview With Jerome Knyszewsk
Ninety percent of a leader’s role is freeing up your staff to think and perform. Like many companies, we’ve reminded ourselves over and over that we should hire staff who are better than we are, that we should hire A players, and I think we do a good job of identifying and hiring strong talent. But then what? What do you do with a company full of A players? Hopefully, your answer is to get out of their way. That’s a good answer, but it’s only half the right answer. The right answer is to get out of their way and remove any obstacles in their path. Why hire great people but trim their wings? As a leader, your most important role is making your staff successful.
As part of our series called “5 Things I Wish Someone Told Me Before I Began Leading My Company”, we had the pleasure of interviewing G. Cameron Deemer. He serves as DrFirst’s president and brings more than 20 years of healthcare industry experience to this position. He joined DrFirst in 2004 as the Director of Product Management and was appointed general manager in 2005. Since joining DrFirst, Mr. Deemer has played an instrumental role in formalizing and driving improved business processes, while developing new technology strategies to leverage the benefits of e-prescribing and other DrFirst platform services for providers, hospitals, payers, and other healthcare stakeholders. He has also been a strong proponent of promoting interoperability in the healthcare industry by sharing clinical data between systems. Before joining DrFirst, Mr. Deemer was Assistant Vice President of Product Management for PCS Health Systems/AdvancePCS and also led the e-prescribing and practice management product strategy for NDCHealth.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I started my career in the ministry, first as a youth minister, then as a senior pastor for a church in Tempe, AZ. This was around the time when the IBM personal computer was first introduced, and I got interested in programming and the application of technology to linguistic problems. I lived for a number of years in Papua New Guinea, working on reducing spoken languages to written languages in order to translate the Bible into those local tongues. I got into healthcare IT quite accidentally. I returned to the States in the middle of the recession in the early nineties, and after an extensive search, found work with a prescription benefit management company in Scottsdale. A decade in the PBM industry led me to work more specifically on electronic prescribing for a large company that was developing the network to carry prescriptions, then later to DrFirst, where we’ve been working on innovations around medication management for over 20 years.
What was the “Aha Moment” that led to the idea for your current company? Can you share that story with us?
Jim Chen founded DrFirst when he realized that the VPN technology he’d developed at his first startup could be applied to the problem doctors were facing in the late nineties: a demand that they adopt expensive electronic medical records and claims systems at the same time that they were facing major reductions in reimbursement for their work. It soon became clear that the internet in 2000, the year DrFirst was founded, didn’t yet have sufficient bandwidth to support remote access to physician systems, and DrFirst pivoted to electronic prescribing.
I joined the company in 2004, at a time when it was struggling to survive. I was drawn to the company by two things, really. One was that medication management was a sweet spot for me; the other was the character of the founder. After experiencing the culture of a couple of very large HIT companies, I was searching for a CEO who viewed people as people, not resources, and I found that at DrFirst.
Can you tell us a story about the hard times that you faced when you first started your journey? Did you ever consider giving up? Where did you get the drive to continue even though things were so hard?
In 2004, DrFirst was out of cash and struggling to meet payroll every two weeks. Physicians weren’t buying electronic prescribing, well-funded competitors were popping up, and our then-president left the company to join one of them. The staff was devastated. On the positive side, our company had the best e-prescribing technology in the industry and the awards to prove it. Too bad no one wanted it.
What motivated me to keep going was the challenge of solving the puzzle, how to get this great tech into doctors’ hands and how to get them to use it. By the end of 2004, we figured it out. Sell it to someone who did care and who wanted change: major health plans. We shifted our focus to payers. They were willing to buy thousands of licenses, which we would then give away to physicians. It still wasn’t easy, but it became the start of a much safer, more informed way of managing medications that today is largely taken for granted.
So, how are things going today? How did your grit and resilience lead to your eventual success?
Like many companies, we didn’t go through just one hard time, or even two. The healthcare IT industry has changed dramatically over the last 20 years, particularly as the federal and state governments stepped in with extensive regulations. To stay relevant and continue to grow, we had to be willing not just to pivot but to commit completely to those pivots. One of the things we’ve talked a lot about over the years was the “flywheel” concept that Jim Collins discussed in his book, “Good to Great.” It’s the idea that it’s very difficult at the beginning to launch a business or product, and you’ll initially do a lot of work for little payoff, but if you stick with it and put energy into the initiative day after day, that flywheel will begin to move and will gain speed over time until it’s very hard to stop. We clung to that concept as we launched innovations, then drove those new technologies until they succeeded. Today DrFirst has a thriving business providing a number of medication management and secure collaboration services to hundreds of medical record system vendors, thousands of hospitals and post-acute care facilities, and a growing number of pharmacies. Our newest business reaches over a million patients a week, helping make sure they are able to get started on therapy.
What do you think makes your company stand out? Can you share a story?
We definitely stand out because of our dedication to innovation. We know it’s not always lucrative to be the first at new technologies, but we love bringing solutions to med management problems. A good example of this is our development of the technology for electronic prescribing of controlled substances. The idea actually came during a breakfast meeting at which we were asked to participate in an initiative to completely secure the drug supply chain end to end. Knowing the proposed public/private key infrastructure sounded good on paper but wasn’t practical for roll out to a million prescribers, our founder collaborated with others in the company to develop an alternative concept based around the “trusted network” used to transmit electronic prescriptions. With an idea in hand, we pitched it first to the Drug Enforcement Administration, then piloted the technology in western Massachusetts under a special waiver. After a couple of years, the DEA proposed rules based on the pilot, and we became the first company certified under the new rules. Then we started the hard process of selling and implementing the tech. Today the technology is well known and increasingly common, but it took about eight years of hard work to make it possible.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lessons or ‘takeaways’ you learned from that?
I would love to share a funny story, but every mistake I remember seems more horrifying than funny. The cost of a mistake when you’re dealing with healthcare tech can be very high in terms of regulatory compliance or human suffering. One of the earliest mistakes I remember was doing some fax marketing before we fully understood regulations governing the use of fax machines. We had intended to send a special offer to our existing customers, but we inadvertently included some chiropractors on the fax list with whom we did not have a pre-existing relationship. About a month before the statute of limitations ran out, we began to hear from a handful of those fax recipients that we were going to face a class-action lawsuit. We were, fortunately, able to resolve the situation, and we could laugh about our near-miss later, but it made us very careful to be sure we thoroughly understood the regulations governing our marketing activities from then on!
Often leaders are asked to share the best advice they received. But let’s reverse the question. Can you share a story about advice you’ve received that you now wish you never followed?
I’ve been very fortunate to have received good advice, a lot of good advice, over the course of my career. It’s difficult to even think of any bad advice, except maybe one thing. I remember vividly the day our little tech company was visited by a major private equity firm. I was looking across the table at one of the principals, a mover and shaker in the industry who handled billion-dollar deals. He was wearing a ratty old sweater and jeans. Yet, he still had the command of the room. I looked down at my suit and tie and decided right then that was the last time I would ever wear a tie for a client meeting. The old adage that you should dress up as a sign of respect had become badly outdated, and I was late to the party. It turns out that what matters is the quality of your message, not the quality of your suit.
You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
I think this question could have a lot of different answers, depending on the person. For me, it was being naturally dissatisfied when things weren’t “right,” being good at synthesizing information, and being comfortable with the success of others.
Since I came to business late, I really had no idea whether I would perform well and actually didn’t even know what good performance looked like, yet somehow, I was regularly advanced, moving up every 6–9 months. I realized later that what I was being singled out for was fixing “problems.” For example, in one role. I was working with system vendors to certify that their applications could send transactions to a mainframe with all the data in the proper fields and formats. This involved literally counting characters on a printout. I found that inefficient and dull. So I created a set of templates by cutting windows in heavy paper and labeling the openings so I could lay them over printouts and quickly see if everything was correct. But this still required a manual process. So then I borrowed a PC that wasn’t being used, found a developer who was willing to show me how to write a small program to emulate the mainframe’s handshake protocol, and I added functions to accept, interpret, and reply to test transmissions. With that old box running under my desk, I no longer needed to check results while vendors were in the process of development; I could wait until their final test and then just check my program to see whether they passed. With my job automated, I could volunteer to work on other projects and soon found that I had been promoted to manager.
The ability to take in a broad array of information and synthesize it into new ideas is critical for success in business. One of our newest and most successful products was the result of first identifying what we wanted to do, then what the blockers were, then asking, “What if those were not blockers but, instead, were enablers?” That process of tricking your mind into looking at a problem from the opposite end is fairly well known, but to execute it well requires a broad array of knowledge and the ability to tie it together in new and unexpected ways. In “The Effective Executive,” Peter Drucker calls this looking up and out. In my experience, it’s good to indulge your natural curiosity quite broadly. You never know how something you learn in one discipline will apply to a problem in another.
I wasn’t always good at making the most of others’ ability to contribute. There was a time when I felt I needed to be the best contributor in order to earn my keep. Today, instead of focusing on what I bring to the table, I try to focus on hiring people who are truly the best we can find at what they do. My role has become more about how to free them up and align their efforts, not how to be better than them at what they do. I found that the more comfortable I became with not being the expert, the more productive everyone else could be. We have fantastically talented people at DrFirst; why wouldn’t I get out of their way and give them a leg up? A lot of brilliant thought and competent action goes to waste if we don’t learn to help others excel.
Which tips would you recommend to your colleagues in your industry to help them to thrive and not “burn out”?
- Sleep at night. It truly is lonely at the top, and there are infinite things to worry about. Unfortunately, worry doesn’t solve problems, but sleep might. You need energy and creativity to find solutions, so learn to let go at night and start again in the morning.
- Bring yourself to your role. It took me a while, but I eventually realized that effective leaders come in all shapes and sizes. Being authentic counts for a lot. Trying to be someone you aren’t is a stressful way to live, and it’s easily spotted by the people who work for you. Being comfortable with yourself builds trust with employees who want to know the real you if they’re going to trust you with years of their careers.
What are the most common mistakes you have seen CEOs & founders make when they start a business? What can be done to avoid those errors?
- Leaders are particularly prone to expecting rapid success. An interesting thing about business mistakes is that businesses of all sizes seem to be equally susceptible to them. The evidence is clear in the extensive boneyard of startups that ran out of money long before they were able to turn the corner and scale into profitability. But large, mature companies are equally prone to this error. Running a company of thousands can provide enough separation from reality to make anything seem possible if you just want it to be. To avoid falling prey to unrealistic expectations involves actually believing that the worst-case scenario is possible. You COULD run out of money; you COULD have trouble selling your new product into the mass of current clients who, for whatever reason, don’t love it as much as you want them to. Being honest with ourselves is one of the toughest things we can ever learn to do, but until we can believe in the bad as firmly as we believe in the good, we won’t prepare properly for waiting out the gap between idea and mass adoption.
- Sticking too long with a bad strategy. In 2004, our company was nearly dead. Our only product, electronic prescribing, was inexplicably not in demand; doctors seemed fine with writing prescriptions on paper, and we were struggling to make payroll every two weeks. In desperation, we finally hit on a solution. Sell it to someone who DID care about the adoption of e-prescribing: health plans. We threw our efforts into making a case to the payer community, and it worked! They bought licenses by the hundreds, by the thousands, and gave them away to providers. Our success was noted and quickly followed by our key competitors, and soon we were all selling to health plans. Four years later, it was all over. The federal government announced a series of incentives and penalties designed to ensure physician adoption of the technology. Although we had deals in progress, we realized that no health plan would pay another cent toward e-prescribing if the US taxpayer was going to fund it. So we quit the market. Immediately. We stopped selling to payers and hired a new sales team to target physicians. It took a while to gain traction with physician sales, but we had done the right thing. Our major competitors continued to try to sell into the health plan market, but not a single deal was completed in the years following the announcement of federal incentives. Sticking too long with a bad strategy may not be a fatal error, but it certainly is a common mistake. To avoid getting caught flat-footed when it’s time to pivot really comes down to three things: 1) spending time with your customers in the field so that you aren’t getting secondhand information about what is and isn’t working; 2) taking time to not only notice events which might impact your strategy but actually think hard about the implications; 3) finding the courage to make the decision to pivot because if you don’t take the risk, there’s really no mechanism by which your team can get it done. You get the glory if you’re right; you live with the repercussions if you’re wrong. But positive action is generally your best chance for a breakthrough, whether you got it exactly right or not.
- Relying on consultants to create innovation. I was taught very early in my career that the most common use of consultants is to provide political cover for CEOs who want to drive change without accepting full responsibility for the decision. That’s probably not completely true, although it’s sometimes true. I’ve seen consultants engaged for many purposes, but one of the worst uses of consultants I’ve seen is to create or drive innovation. The problem is very simple and is common to experts who make their living as individual contributors in any market. Consultants talk to consultants; they speak the same language; they repeat common wisdom; they are acceptable to their peers through a shared set of attitudes and thoughts; they live in an echo chamber. There are also human factors, like the pride of invention and ownership of IP, which are not usually available to consultants. The right way to use consultants is for education where your team is weak, for introductions where your team is blocked, and for manpower when you are shorthanded need special skills. Instead of counting on consultants for innovation, teach your team to think, to collaborate, to experiment, and to fail in a productive way. Real innovation comes from escaping the echo chamber, not living in it.
In your experience, which aspect of running a company tends to be most underestimated? Can you explain or give an example?
I feel the aloneness of the CEO role is widely underestimated, except perhaps by CEOs. It’s an immense responsibility to hold the livelihoods of tens, hundreds, or thousands of people in your hand and to navigate the minefield of decisions, any one of which might be a life-or-death call for the company. Add to this the fact that you’ll never please everyone, so you live under a constant cloud of disapproval.
Ok super. Here is the main question of our interview. What are your “5 Things I Wish Someone Told Me Before I Began Leading My Company”? Please share a story or an example for each.
Things I wish I had known:
#1: Success is usually a marathon, not a sprint. When I joined DrFirst, the founder sat me down and said, “Cam, I want to be number three. Help me keep us alive long enough to finish third!” His theory was that in tech industries, there are always three companies standing at the end of the day, and he wanted to be one of them. For me, this was a wake-up call that building our business would be a war of attrition, a struggle to survive long enough to thrive. And it was an acknowledgment that our job wasn’t to hit a home run the first time we stepped to the plate. Our role was to load up the bases. Eventually, success caught up with us.
#2: The talking heads aren’t always right. I’d love to say they’re never right, but it would be more accurate to say they are seldom helpful in creating true innovation. In the late 2000s, I had breakfast in Washington with our founder and two executives representing one of the largest pharmaceutical manufacturers. They wanted to elicit our participation in an industry-wide initiative to secure the drug supply chain, from the factory to the final dispensing event. The security framework they had developed was based on a “public key/private key” framework. It was a very standard approach, and “everyone” knew it was the right way to move forward. Our founder disagreed; he said it was too heavy, too expensive, that it could never be implemented successfully across the number of providers who practiced in the US. Over the next few months, we developed an alternative approach based on the common “trusted network” that existed in our market, and today the entire system for EPCS (electronic prescribing of controlled substances) is based on our work. This type of story is very common. “Experts” in industry and government are often behind the curve and actually slow innovation, but they get a lot of press.
#3: Leaders don’t fit a single mold. I don’t believe that I’m an outlier when I say I’ve spent most of my career feeling inadequate to my role. I’m an introvert. I’m more comfortable alone than surrounded by people. I like to think and not talk. And in my eyes, I never fit the mold of the bold, confident leader. It took many, many years to realize that leadership isn’t a matter of show; it’s a matter of effectiveness. And there are many paths to effectiveness. I benefited a great deal from Jim Collin’s description of leadership in his book Good to Great. For me, it pointed to defining effectiveness as my ability to enable others rather than to be a certain type of personality.
#4: Caring is different when you’re in charge. During my early years at DrFirst, I remember looking for our founder and being told that he had flown to visit a group of our family and friend investors; we were not going to be able to pay staff unless he came back with enough cash to fund payroll. When you are the last resort, the final decider, all the problems roll toward you. If you have a good team, they’ll intercept many of these, but the worst ones will end up at your feet with no one but you to make the decision or perform the action. And that’s rough when you think about not only your shareholders but also your staff and their families, whose welfare depends on your wisdom and ability and willingness to see and do the right thing.
#5: Ninety percent of a leader’s role is freeing up your staff to think and perform. Like many companies, we’ve reminded ourselves over and over that we should hire staff who are better than we are, that we should hire A players, and I think we do a good job of identifying and hiring strong talent. But then what? What do you do with a company full of A players? Hopefully, your answer is to get out of their way. That’s a good answer, but it’s only half the right answer. The right answer is to get out of their way and remove any obstacles in their path. Why hire great people but trim their wings? As a leader, your most important role is making your staff successful.
Bonus #6: Time management is not about getting everything scheduled. I can’t tell you how many times I’ve tried to implement time management techniques. It wasn’t until I read and reread the chapter on time management in Peter Drucker’s little book, The Effective Executive, that I finally understood what was wrong with the conventional wisdom about organizing yourself. Drucker very pragmatically noted that you will never have enough time for everything your organization wants from you, so there’s no point stressing too hard about your calendar; just accept that it will fill up. Instead, focus on setting aside large enough chunks of time to do the things that only you can do. If you don’t, those things just won’t get done. Make sure to schedule that small number of vital tasks and just lightly manage everything else. My personal secret is that most of what I don’t do resolves itself anyway.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
I am very frustrated that we have not managed, as a country, to have a useful discussion on the future of healthcare. Although I’m very conservative by nature, I can see the human suffering inherent in being uninsured or underinsured that results from our insistence on applying amoral business principles to a problem measured in human tears. Compassion will be as important as capitalism in solving America’s health crisis. I would very much like to be part of an attempt to think pragmatically about the real problem of ensuring equitable and universal access to healthcare.
How can our readers further follow you online?
This was very inspiring. Thank you so much for joining us!
Read the article from Authority Magazine on Medium.