We had a secret weapon at our startup.
Ellipse was a VC-funded startup with zero bench strength in orthopedics. I joined in 2012 as the VP R&D. On paper, we had nothing. We had meager sales, finite funding, very few employees, few products, few customers and few regulatory clearances. However, we had a secret weapon. Our CEO coached us regularly that we had a weapon that we could leverage against the competition every day – a high tolerance for risk.
We had the ability to take on extreme RISK…  and we knew our competitors did not. We could try anything to see if it worked.  We embraced a high-risk culture to blow past the competition.

How did Ellipse use risk?
A few real examples.

We redesigned our implant systems weekly. Can we make it better for our customers?

We experimented with creative regulatory strategies. How do we find a way to receive 510(k) clearances for remote control implants in kids?

We redesigned the product assembly and testing processes weekly. Can we build the products faster and with less waste?

We experimented with borderless sales strategies that quickly put us into 20 countries. Where are our evangelist customers and how do we best serve them?

We reorganized the company every few months for speed. What is the best organizational structure and physical layout to go faster in the next six months?

The result was that we outran the big Orthos with the rapid development of new technologies that solved unique clinical problems. After a couple of years, we literally had zero competition in our two market niches – remote control spinal growing rods and remote control limb lengthening.  In a span of 6 months, we had accomplished what Smith and Nephew had struggled to do in 6 years and counting with limb lengthening.  The competition was in the rearview mirror and we never looked back. We booked annual sales of $1M, 6M, 12M, 24M, and 42M before being acquired by NUVA for $410M. During this exponential doubling of sales, the employee count grew from 12 to 120.
 
 

The Big Ortho Mindset
The Big Orthos avoids risk at all costs. They play “not to lose”.  As a recruiter, I talk to good people stuck in these Big Ortho companies each week. Even though they have massive resources to work with, they spend their time doing group think exercises in endless meetings. Nobody can make a decision. Nobody is willing to stand up and take a chance because:

management has to protect earnings and the shareholders first,

management has to protect the zillions of dollars of legacy products out in the field,

management has to protect their jobs by not taking chances and screwing up.

The big Orthos have completely forgotten how to innovate.  All new products are slow incremental improvements.  It is no longer in their DNA to innovate. Their innovation strategy has defaulted down to a single tactic – acquiring innovative Orthos.
 
 

The Startup Mindset
Today, the big and small Orthos have inverted cultures.

In a small Ortho, you are applauded for promoting creative ideas that challenge the way things are done. The result is that you will be given the latitude to test your crazy idea out. You may go down a rat hole and learn something for the company, or you may be a hero.
In the big Ortho, you are slowly pushed out (or fired) for promoting creative ideas that challenge the way things are done. The result is that you will undermine your career there.

In small Ortho, plans are fluid. What can we do this week to create value?
In big Ortho, you develop annual plans and five-year plans.

In small Ortho, success comes from identifying a worthy risk and having the courage to embrace it.
In big Ortho, success comes from growing the top line with existed products.
In small Ortho, employees are evaluated based on what they are going to do for the company today, tomorrow, and this week. This is forward-looking. In big Ortho, employees are evaluated based on what they did do for the company last year. This is backward looking.
I could go on and on here, but you can feel the cultural differences.

The Takehome Message for Small Orthopedic Companies
If you are leading a small orthopedic company, you must NEVER FORGET the unique leverage that you have over the competition is the ability to take on RISK.

Win by embracing a culture of risk taking!

1. Your Time
Your time is valuable. By engaging Tiger, you are free to focus on your business, not self-recruiting. Working with Tiger is like having your own in-house recruiting firm and advisor.
 
2. Pure Orthopedics
You know Tiger. He has his finger on the pulse of Orthopedics and he shares honest thoughts with you. You get access to his his advice, industry insights and Podcasts.
 
3. Best
Tiger has built great teams in Orthopedic companies over decades. He knows what separates a high-impact player from just filling a chair. He draws from his extensive network to find you the right “A Player.”
 
4. Fit
After leading orthopedic startups, Tiger knows the right mindset that performs well in the smaller cultures. Some people have the “right stuff” for the small dynamic cultures, others do not.
 
5. All In 
You get Tiger 100%.  He personally works on your search. He does not hand your search to inexperienced subordinates who click around on the internet. Let your competitors use those other recruiters who delegate their searches.
 

 
You deserve more.  Talk with Tiger.

Orthopedic leaders call me to complain about the lack of innovation coming out of R&D.  My advice is for them to get out of their lane and jump into the next lane. Explore technologies that are not inside your building.  The answer to their innovation problem can be found in new technology fields, not in their current domain.
Orthopedic companies are lopsided in mechanical engineering and design; therefore, they naturally try to solve clinical problems with mechanical and design tools.

If you really want an innovation breakthrough…  you must trespass across well-established disciplinary boundaries to combine different technologies that don’t belong together.

Historical
Let’s look back at Orthopedic history. The really big jumps in innovation occur when two or more technologies merge.  Combining these two technologies seemed crazy when it happened. They didn’t seem to belong together, but they created some real game-changers.
You will be familiar with these examples, but you may not realize that the innovation emerged because of the amalgamation of the two unlikely technologies.

Small video camera + small shaver instrument = Arthroscopy
Bone cement + balloon angioplasty = Kyphoplasty
Ex-fix + algorithm = Taylor Spatial Frame 
Imaging + 3D-printing of implant materials = Personalized Implants

Today
Orthopedic innovation is accelerating faster than ever and the driver is these technology combinations. Companies that mingle different technologies will win, companies that stay in their box will lose.
I experienced this first-hand at Ellipse Technologies.  The engineer founders at Ellipse merged two technologies that did not belong together:   telescopic implants + magnetic driven motors. The resulting innovation in spine (named MAGEC) was growing rods for EOS patients who avoided 10 surgeries in their lifetime. The resulting innovation in limb lengthening (named PRECICE) was an Ilizarov-like system that was entirely intramedullary.
Ellipse’s unlikely technology combination could be described as:
telescopic implants + magnetic motors = Remote Control Therapy

Future
Now let’s look towards the future. There are more technologies to choose from than at any time in orthopedics history.
Which ones would you combine to solve a big clinical problem?

New biomaterials

3D -printing

Robotics

VR / AR

Haptic technologies

Nanotechnology

Wearable sensors

Synthetic biology

Real-time imaging

Mobile health apps

5G, connectivity, and IOT

Implantable sensors

Gamification

Telemedicine treatment

Tiny micro-motors

Genome editing

Blockchain

AI

Let me suggest a few combinations to warm you up.

Wearable sensors + implants = Better Clinical Outcomes 
Robotics + AI = Surgery without Surgeons (faster/cheaper/better 24 hrs per day)
Synthetic biology + 3D-printing = Patient-specific Soft Tissue Repair
Real-time imaging + AI = Better Diagnostics without Physicians

Take-home Message
If you want BIG leaps in innovation, your company should start thinking about combining disparate technologies. Today, your company does not have expertise in many of these areas, but the good news is that it is easy to find. In the golden age of the internet and connectivity, you have access to multi-discipline engineers and technology domain experts worldwide who can help you. Invest in multi-disciplined engineers who can navigate and lead diverse technologies – electrical engineering, mechatronics, machine learning, optics, software engineering, and connectivity. See in the figure below all of the disciplines that come together in medical devices today.

Experiment. Brainstorm. Shake the box.

How is your company combining technologies for BIG breakthroughs in innovation?