Operating Principles, Culture, and the Nexer Experience

Our mission at NexHealth is to accelerate innovation in healthcare. We do this by connecting patients, doctors, and developers.

In the long run, the way to look at our product is that we’re a protocol moving data from point A to point B. Today, we help The Smilist, a dental service organization, send data from their servers to TrueLark’s servers (a software company). In the future, we want to be able to send data from a Roche lab in Germany to a hospital in the US. We simplify the movement of data from point A to point B.

However, we know the entities that hold the data, EHR vendors, insurance carriers, pharmacy chains etc. do not want this data to be so easily interoperable. On the other hand, people that actually need to use the data for treatment or other operations, like doctors and patients, want to use our technology to move their data from point A to B.

This, by default, means we’re taking on the whole “system” at a global scale. Sometimes it will be adversarial, but our hope is that most of the time it will be friendly through established and formal partnerships. Executing on this roadmap means lots of high quality decisions will need to be made, challenges overcome, all while growing revenue and the customer base.

Making the right decisions, solving challenges, and growth are only possible through the right culture. A culture that’s built specifically for NexHealth, our market, and context. Everything defined in this document is designed to help us build that specific culture for NexHealth.

Starting with our Operating Principles. Our Principles are designed to help us make decisions that solve both our long term and short term challenges.
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Our long term challenges are: 

• Doctors are focused on providing care, and are less tech savvy as a result.
• Historically, healthtech has not been an attractive place to work for ambitious talent. 
• “The system,” - Nearly all EHR vendors, insurance carriers, pharmacy chains, and any entity that holds consumer data - is resistant to change.

Our short term challenges:

• Keeping customers insanely happy.
• Growing our customer and revenue base quickly, month by month.
• Expanding our TAM.
• Building and developing a great team.

Executing with urgency is how we are going to accelerate innovation in healthcare. From 2020 to the end of 2022, we went from 5 people to nearly 300 people, $4M in funding to $176M in funding, and $18M valuation to $1B valuation. We are keeping a similar pace of doubling year over year and are delivering value to customers across the healthcare ecosystem. 

Read about the key milestones, including product launches and fundraising, that have shaped NexHealth into the thriving organization that it is today.

To achieve our lofty goals and propel our growth forward, each of our actions and decisions stem from seven core operating principles:

• Solve the customer’s problems, not yours
  When making decisions, think from the perspective of the customer. It’s easy to make decisions that make our lives simpler, but not the customer's.
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• Do the things others are not willing to do for our customers
  As a Nexer, always go after the hardest problems for our customers. Pursue things at the highest quality. Move at the fastest pace.
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• Take ownership
  Act like a founder. Own your roles, destinies, mistakes, behavior, and our mission. The buck stops with each of us - no blaming or excuses.
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• Say what’s on your mind, with positive intent
  Be direct, proactive, transparent, and frequent in your communication. 
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• Default trust
  As a Nexer, you do not have to earn trust, trust is given to you by default. If we by default trust each other, our speed of communication, feedback, information sharing, and overall improvements will be a lot faster.
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• Think in first principles
  We first identify the problem and then break it down to its fundamentals before diving into solutions. We constantly ask “why” to validate our assumptions. 
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• Live in the details
  As a Nexer, you should know all the details about all the things you do. If you’re in the details, you will make high quality decisions.

Why do some cultures last thousands of years? Why do some die off while others persist generations after generations?

It’s because of the daily rituals, beliefs, and lore that the culture lives and passes on from one person to another. For example, meditate every single day, attend church every Sun, wear your team’s sports jersey on game day, believe in a specific creation process, respect cultural artifacts, etc. 

A group of people sharing common daily rituals, beliefs, and lore means those groups of people feel strong kinship, trust, and passion. And they enthusiastically pass it on to the next group of people. Similarly, in order for NexHealth to build a lasting culture, we need to have our own set of common rituals, beliefs, and lore: our own way of operating.

In addition to our operating principles , here’s our way of working:

• Non-hierarchical
  We’re not a traditional hierarchical company with titles and all the politics that come with it. We’re a culture where people’s impacts are measured in scope and outcomes, not their titles. As a result, we’ve replaced titles with job scopes, and have internal levels and ladders so we can properly reward Nexers as they progress in their careers.
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• Talking to customers
  Every Nexer uses our product and visits a real customer in their first 90 days. 
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• Metrics visibility
  Every Nexer, regardless of their role, has visibility into all of our core metrics in real time. You can’t take ownership if you don’t have the right information.

• Supporting Nexers through their career
  As we continue to grow the company, we want to ensure employees have a long career at NexHealth. We will continue to evolve our employee offerings and support system to stay current with the needs of the team.

• Celebrations
  We recognize value in company-wide celebrations but each team should have its own culture and celebrations to recognize the impact of the team’s performance (like rewarding new shoes to top performers).
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• Rituals
  It’s important for Nexers to participate in all of our company-wide rituals like the monthly all-hands, visiting customers, offsites, planning sessions, shoe awards, etc.

• Document culture
  Most decisions are made over written, narrative documents, and not meetings. All relevant documents, recordings, meeting notes, emails, Slack messages etc., should be easily searchable by everyone across the company.
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• Communication etiquette
  
  Email
  Email should be used for most communication, especially when the recipient needs to either take an action or give a thoughtful response. Each team has an email distribution group where all emails get CC’d to. For example, if a marketing team member is sending an email to the head of marketing with information relevant to the entire team, marketing_private@nexhealth.com should get cc’d. This way the whole team has access to all emails that they can search for and read on their own time.
  
  Slack
  Slack should only be used for quick, urgent, and non-thoughtful communication.
  
  Meetings
  Outside of effective team operating mechanisms (e.g. weekly team meeting), having a meeting should be the exception, not the default. We try to avoid holding meetings. Instead, we write documents and circulate to as many people as possible for alignment, comments, and visibility. Only hold meetings if there is no alignment after circulating your written document. If we do need to hold a meeting, ensure that each meeting calendar invite is populated with a well written document articulating your thoughts, questions, and action items in advance of sending to your peers. Include as few people as possible in meeting invites.

Our company was built upon certain beliefs about the market, the world, and how we want to shape it. These are a few important ones we share:

1. Incumbents are entrenched in a business model that does not want data interoperability, but healthcare data should be freely interoperable.
2. Free exchange of data will enable more innovation. Through faster innovation, most problems in healthcare can be solved.
3. The government can’t build the solution.
4. We are a tech company and not a healthcare company.
5. In the next decade, there will be an Amazon or Microsoft of healthcare. NexHealth will be it.
6. NexHealth is supposed to be hard. We’re not riding a market trend to success, we’re creating our own success by manually rewiring healthcare data flow. Similar to Amazon rewiring the physical world with warehouses and shipping logistics to succeed vs Google riding the internet wave.
7. Our timeline is in decades, but our customers decide whether or not to stay with us monthly. As a result, we need to have short term operational excellence while maintaining long term vision.
8. We believe that most of the talent that will change healthcare will come from outside the industry.
9. The greatest good we can be doing for society is to succeed in our mission. This means we will dedicate 100% of our resources to our mission.
10. We recognize having different communities within NexHealth makes the company stronger and gives us the best chance at fulfilling our mission.   
11. We’re short term pessimistic, but long term optimistic. 

In order for us to succeed in our mission, we need to become a go-to destination for smart and ambitious people. We want and expect that Nexers are proud of the work they are doing along with the culture that exists within the company. However, not everyone will be a fit for our space, product, and culture. So we need to cultivate an experience that seeks out those who are motivated by our culture and high expectations for success, and ensure we are supporting and retaining those that choose to join.‍‍

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Who is a Nexer?

A Nexer is mission driven and intelligent with a growth mindset. They build for the long-term, desire greatness, can problem solve and learn quickly, and are not so arrogant that they are not willing to change.

They are happy when they get to work on challenging problems, build lasting things, learn a ton, and grow as individuals. They’re not entitled. They care about quality of performance and maintaining high performance amongst Nexers from individual contributors to leadership.

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Defining high performance 

High performance is made up of 3 things: speed, quality, and quantity. In other words, your ability to get a lot done in a very short period of time in high quality is the definition of high performance. At NexHealth, you should be able to get things done 2-3X faster and 2-3X higher quality than what you’d consider normal for yourself.
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Tenure
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Our goal for tenure at NexHealth are high performers stay >6 years, and low performers stay <6 months. Whenever a Nexer does resign, we want them to be a champion for our brand. We want to give them the best experience possible on the way out.

Nexers can be found in San Francisco, Draper, and remotely across the country.

Where do Nexers Work?

The NexHealth team can be found at either of our locations, 12936 Frontrunner Blvd Suite 525, Draper, UT 84020, Bay Area headquarters, 445 Bush St San Francisco, CA 94108 and remotely across the United States in cities like, New York, Los AngelesChicago, and Seattle.

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Amazon has “your margin is my opportunity.” At NexHealth, we have “your talent is my opportunity.” 

Most of our competitors in the space suffer because their teams do not maintain high quality or hold a high bar for performance. They have good products with clear market needs, but an inability to execute and scale into leading market share because they don’t retain high performers or maintain a compelling culture. 

We have a great vision, differentiated product, we’re well capitalized, and have high growth. However, all of this is eventually copy-able by competitors. The only way we achieve our mission is through our talent and culture. And when we do achieve our mission of accelerating innovation in healthcare, the world will be a far better place than it is today.

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Recruiting: how does a Nexer hear about us?

We need to build our employer brand so that ideally a future Nexer hears about us from another Nexer. The secondary way a potential Nexer should hear about us is internal recruiters or social media channels like, Instagram, Facebook, Linkedin, X, TikTok and Youtube. Once a potential Nexer does hear about us, they should have ample public content and information available to learn what it’s like to work at NexHealth.

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