Grand Rounds Blog

Each week, our CEO writes or video records a Sunday Night Note to the entire company. Sometimes, he chooses someone else to author the note. The writer is encouraged to share whatever ideas are on her or his mind. Our tradition of the Sunday Night Note serves to educate and inspire our team with commentary relevant to our shared goals and it allows us to learn from diverse perspectives company-wide. 

Below is my Sunday Night Note written just before the coronavirus pandemic hit the US. Given the current context, I believe these practices that help us maximize our impact and value are even more important today. I hope this post inspires you to take action towards achieving your goals in the most meaningful ways possible.


As we refine our 2020 plan and priorities, I’ve been thinking about the role our Engineering, Product & Design teams (commonly referred to as EPD) play and how we enable Grand Rounds to achieve our mission. I believe our impact relies upon our ability to maximize the value we can create, at scale and with speed.

Let me share how I am thinking about this…

Maximizing ROI of your R&D Investments

My third week at a past employer, one of my teams was celebrating the launch of a new feature. I was excited for the launch, but as I asked questions, “What was the impact?” and “What was the improvement?”, people cited the perceived improvements from the prior flow, but the metrics were lacking or unchanged. We had built a solution to a problem that we roughly but not deeply understood, and therefore, we did not have the means to understand if the solution was indeed the right solution or actually solved the problem.

We had spent several weeks building a “nice-to-have” feature and not a critical new enhancement, and that isn’t how you build a multibillion dollar company. Over time we became better, with metrics, monitoring, and focused prioritization, so that we could define the ROI and justify the levels of investment in a particular area.

It is important to define how I think of ROI, as often, it invokes a financial perspective and concepts such as costs, margin, rate of return, etc. Those are all valid, but an equally important part is the value. As builders, we also consider the value we create with the investment and how we maximize that value. For the purpose of this discussion, delivering a positive ROI is the process of creating positive impact to the user (and therefore, our business) that is valued more than the cost of creation. 

When you get really good at delivering outsized value as a result of your invested time and resources, you can build a company that truly scales. Then, you’re only bound by the size of the problem space (or market) and your speed to execute against it. At Grand Rounds, our problem space is huge: healthcare in the US alone is a 4 trillion dollar space! And unlike many other companies, there is a deep and universal human need and impact involved in healthcare. To deliver value at scale in this space, technology has to play a critical role in unlocking and enabling our care and clinical team to reach a larger member population in significant, high-value ways.

Maximizing ROI with Speed and at Scale

This is the problem that I, and my peers in EPD, think about: How do we increase our ROI (business impact > cost), at speed and scale. For me, this relies on three components: 1) ability to measure, 2) highest expected value and 3) speed of execution.

1) Measurement: First and foremost is the ability to measure (“You can’t improve what you don’t measure”). We’re investing in our data infrastructure and specifically building data aggregation and monitoring tools which bring all of the data to one place.  Our ability to leverage data will enable us to understand our members, their journey through the entire product and non-product ecosystem, and measure the impact of everything we do. This, combined with user research and our teams’ overall efforts, helps us to more fully understand our users and deliver on what they value.

2) Highest expected value: In its simplest form, we have three ways to create value: we can increase a) a product’s usefulness, b) the efficiency of the product (both in creation or consumption) and/or c) the frequency that it’s used. This requires a deep understanding of the problem space (not just the solution space), as it allows us to identify the most appropriate and differentiated value we can create for our users.

The concept of expected value takes value creation a step further by requiring that we take into consideration the probability that we are successful, the potential downside if we are not, along with the absolute value we believe we will create. Assessment of expected value helps you determine which investments to pursue to maximize your impact given potential risks and rewards. The solution that has the highest expected value is the one that takes intelligent bets across a set of desired outcomes to maximize impact. This requires taking on smart risks and making big, bold bets.

Our current investments in our mobile app, data factory and infrastructure, and the core member experience, are creating a strong foundation upon which we can experiment and execute against these bets. Our recent additions of our healthy living checklist and care plans were much easier to execute because we had invested in building out the technology that allows our care and clinical team members to take action on our data insights. Continuing to build out our technical foundations and measurement capabilities will enable us to take more bets with a lower upfront cost to test them.

3) Speed: We can debate, design, hypothesize and strategize for months, but there is only one path to see results: execute and launch. This doesn’t mean we ship the first idea that comes to mind, but rather, the opposite. We invest deliberately in understanding the problem, identifying both what we know in addition to the unknowns. This enables us to define key milestones where we can test and measure, learn and iterate, and ultimately adapt quickly to build a successful product. Building and scaling a product is an iterative process. Each day without real user-feedback and hence, increasingly sharper direction, is a tangible cost to the company.

As an example, we shipped a new product feature a little over a week ago. Through initial user feedback, we’ve come to realize that it is missing some desired functionality, and I am thankful for all of our team members who are working to improve this. However, because we shipped early, we learned that some aspects of the new feature that we originally thought would be important are not actually as critical as we anticipated and therefore not a high priority to deliver. By shipping faster, we are able to more rapidly learn, assess value and make informed improvements, which I believe is one of the most important factors in a team’s success.

Our Learning Journey

We are learning as a team and getting better everyday — positively impacting the value we are delivering to our members and the ROI we are delivering to our company as a result. As I look at our team’s roadmap and where we’re headed as a company, I’m excited and optimistic about the ways we will maximize our impact as a result of our intentional efforts.

We have a team that embodies the humble/hungry/smart attributes with grit and passion necessary to raise the standard of healthcare for everyone, everywhere, and I’m grateful to be working with this team towards our bold mission. If this sounds interesting to you, check us out! We’re hiring.

Man in front of whiteboard in group meeting


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