One of the reasons why I first started researching early-stage entrepreneurs was because I relished the chance of seeing the future being made. Sometimes these changes come rapidly, with startups chasing competitors, and others, they're the product of careful germination and patient product research. A perfect example of this is doctorly, a yet-to-launch health tech company from Berlin aiming to revolutionize the doctor-patient relationship through a lean and intuitive SaaS solution. Even before it's official release, doctorly has already been the product of hundreds of hours of customer research, interviews, and one-on-one sessions with both doctors and patients across Germany, one of Europe's most difficult to tackle consumer health markets. The company's six co-founders have a vision of building a fully integrated solution that helps doctors spend less time on paperwork, and lets people take better control of their health. I sat down with Samir El-Alami, doctorly's CEO and one of it's co-founders to learn the full story about how they're working to usher in a new future for patients and practitioners.
Hi Samir, thank you for taking part in this interview on tech.eu. Can you tell us a little bit about doctorly?
Samir: My name is Samir El-Alami, and I'm the CEO and co-founder of doctorly, a Berlin-based health-tech startup. We kicked things off and raised our first money in January 2018. We are six co-founders (yup, six!), so it's a large and multi-talented founding team. When we first got together, we sat down and we wrote on a whiteboard, ‘enable people to live healthier lives’. This became, and will always be, the ‘why’ we, as a business, exist. Prior to officially kicking off the business and fundraising, we actually spent six solid months, full time, trying to work out how we could best achieve that vision. Our research revealed that there are a lot of modular health-tech companies out there, with very disparate visions and technological approaches to health related problems. We were seeing a lot of wearable devices, chatbots, home testing kits, telemedicine and digital booking startups, and while some of them are excellent at what they do, they all seem to be treating the ‘symptoms’ of what we see as systemic issues within the health industry. We are all patients and can empathise with the common pain points within the health industry (long waiting times, little access to data, etc), but when we looked closely across the industry we saw that all roads lead (eventually) back to the relationship between the patient and the practice doctors (e.g. GPs).
We actually went and visited 100s of medical practices and found that the doctors and medical staff were actually very pro-innovation and digitisation. They were very open to new ideas and adopting new technologies, but they were suffering.
Ultimately, much of the suffering was due to the software they were using to manage their practice. This software is where they do 70-80% of their work, (prescriptions, health records, diagnosis, billing, etc). It genuinely shook us to the core to discover how doctors and medical staff were being forced to work in this day and age. This software was launched in the mid-80s-early 90s, mostly DOS based, no UX, no UI... well barely any UI!. There’s no proper utilisation of cloud technology, no automation. It’s just OLD. So we thought, ‘Oh, that's, that's terrible’. We asked doctors why they are using these old softwares and the responses were always, ‘Well, there's nothing else available’. We asked, What the worst thing about being a doctor is, and they all said, ‘Well, we spend around 60-70% of our working time on admin’. We also asked why they aren’t using these newer digital tools and services, and the responses, ‘Well, they don't integrate with our current software (how could they)? So we have to use them all separately, which actually creates more work for the . So I won't do it. I don't need to, my patients can just deal with my fax machine, my landline telephone and my paper documentation’. So it became clear! ‘How’ are we going to enable people to live healthier lives? By simplifying and improving the interactions between doctors, patients and the wider healthcare industry.
Our first product is a brand new, cloud powered, fully digital, centralised practice management system. It's a big, regulated piece of software that we've been developing for the past 18 months, and we plan to launch in Q2 2020. We are building it in cooperation with a large number of doctors and medical staff. We deeply analysed their processes and their workflows, and what we found was that (Using our modern technology and UX principles) we could cut the time spent on admin within the practice by 50%!! This is like music to medical professionals ears. The doctors fully embrace a modern SaaS business model, they love our non-modular approach (i.e. a single price, all of the features included), and that they can easily replace what they currently use via our efficient migration and onboarding process.
Our second product is a patient facing health app. By modernising the medical practice with our practice management software, we are able to ensure that the integration level between patient and doctor can reach standards never seen before. If your doctor uses our software, you as a patient get our free app (via the doctor), where you can manage your health in a genuinely connected way. You will be able to digitally book your appointments, you can access your health records, you can enrich your health records, you can conduct telemedicine consultations, with the ultimate goal of centralising your healthcare data and management within a single account.
Via the doctorly practice management system and the doctorly health app, we are able to build tools and services to help doctors, medical staff and patients work together in a mutually beneficial way. This relationship is the foundation of the health industry and where meaningful (bottom-up) disruption has to start.
But what about the hospitals? What about the governmental healthcare bodies? What about pharmacies, health insurances and other health-tech companies that are building really cool stuff, basically, the wider health care industry!? We decided, we want to be able to integrate those organisations directly into our software. We want to work with the wider healthcare industry to align goals and make processes more standardised, optimised and innovative, always with the ultimate goal of enabling people to live healthier lives.
With this is mind, we are building a third product, the doctorly integration ecosystem/platform. Through it, doctors and their medical staff are able to access, not only the doctorly tools and services, but also the best products from the wider market to further optimise the working of their practice.
Our Health app users will also be able to access the best tools and services via one account. Nobody wants 50 apps on their phone to measure and manage their health, and no doctor wants to use 50 different software solutions with different logins and no integrations. Ultimately, we're a modern technology platform with an ecosystem enabling the wider health industry the opportunity to work with our doctors and patients in a way that adds value!
Let's face it, there are companies who have spent the past six years building a chatbot or eight years building a booking tool, or seven years building a gynecological cervical cancer examination tool, we're not going to be able to compete with that, the smart play is to aim for synergy, to bring them all together.
- Practice software = helping the doctors and medical staff.
- Health app = helping the patients.
- Ecosystem/Platform = helping the wider health industry.
We were backed very early on by a group of (some of the best) EU investors; Target Global, Seedcamp, Speedinvest, UNIQA ventures and a host of value adding Angels.
tech.eu: It’s clear what you are building with doctorly, is definitely not a small task at work there. What is also interesting, you're working in Germany, which has an incredibly high threshold for privacy, and also, working in the health sector when you're dealing with bureaucracy, it is very difficult to get these innovations on board. So how have you been able to first of all work with the doctors in an effective way and also with convincing government and local authorities that this is something that it's okay to innovate on?
Samir: Really, really good questions. Many of the answers, I can now provide, were surprising to me, so maybe it surprises you too. Yes, Germany has a high level (compared to other countries) of “don't spy on me” paranoia, something that can be understood when you analyse the relatively recent history of the country. It’s a key reason why, thus far, the cloud has not been embraced within the health industry, doctors literally keep your health data on paper, DVDs or old private servers in their house for safekeeping. It's almost useless as far as big data or preventative medicine opportunities are concerned.
We believe that health data is incredibly important and sensitive, thus it needs to be protected and secured. However it is also a key tool within healthcare, without data doctors can not do their job. If we restrict the quality, quantity and access of data from doctors, then the healthcare you will receive is always sub-optimum. So we have to find a way to embrace modern technologies, while keeping data privacy and security at the forefront of our agenda, in order to take healthcare to new levels fit for the 21st century.
In Germany, practices tend to be owned by the doctors themselves, so every practice, to one extent or another, can feel quite different from another with respect to service level and modernisation. Practices that look after state insured patients (nearly all of them) do have to abide by the rules and structures set in place by multiple regulatory bodies (e.g. the KBV), but there is a lot of leeway, and a lack of support (in my opinion), on how the ‘business’ should actually be run.
Things that we are lucky enough to focus on everyday within a startup environment, e.g. productivity tools, better working processes, user experience, scalability factors… these are not trained into a doctor prior to running their own practice.
We have met with over 1,500 practices so far and the feedback has been great! Finally, someone is going to provide doctors with modern software that enables them to spend time on what really matters, i.e. the patients. We really haven’t felt any resistance from the medical community with respect to embracing the need for better software. I think they really appreciate our consultative approach, i.e. taking the time to really understand their needs and goals, and then building a software… as opposed to shoving a bunch of ‘efficient’ modular digital tools in their face, something they complain happens a lot from within the health-tech industry.
Getting practices to partner up with us, test features, give feedback on designs, sign letters of intent etc, ahead of launch, this has all been a very smooth process so far. During my, three-plus years in Germany, I’ve learned that the quality of doctors and medical staff here is very high indeed! Comparatively speaking (compared to the UK for instance) well funded, and the patient to doctor ratio is very good (so waiting times for most medical appointments are not too bad).
However, the technical infrastructure is one of the worst I have come across in Western Europe. The good thing is that the regulatory and professional bodies are fully aware of the problems and seem to be genuinely taking steps to help address the multiple deficiencies throughout the industry.
When you look at the key industry stakeholders, (Government, Doctors, Patients, Health Insurance, Pharmaceuticals, Research Institutes, Health/Med-Tech, etc), you have to ask yourself ‘are they all aligned on the same goals and strategies to achieve them’? You could argue that they all want us to live a longer and healthier life, but for VERY different reasons. These different reasons and diverging interests mean that there is a serious lack of alignment on how to build an integrated holistic healthcare system, focused on the wellbeing of the patient. This is, ultimately, a disintegrated healthcare industry!
When we said we were going to do this , the regulatory body, KBV, have been incredibly supportive. We've actually already won two awards from within the regulatory landscape. A pitching competition, in 2018, held by the KV-Telematik and the most recent one was being included in a list of 10 of the most innovative products in Germany for doctors, the KBV future practice program, in 2019.
Whatever your role in this industry, everyone recognises the need for technological disruption to ease the pressure on medical professionals, while increasing the quality and efficiency of the care given throughout the wide-ranging value chain. While we haven't launched yet, the KBV (and doctors, medical staff, health insurance, etc) are excited to see some new innovations!
Ultimately, you can build all of the coolest stuff in the world right now, but if it doesn't work with how the doctor works, they'll reject it. If the doctors reject it, even if we go direct to consumer/patient, the ultimate effect of our products will be diminished.
As far as the regulations are concerned, yes, Germany, is probably the hardest and biggest in Europe. They have high standards, a very complex state insurance remuneration system, and while the regulatory bodies have been really great with us, they don’t have the best technical documentation to work with in order to build the product. We actually see the complexity and high standards within Germany as a BIG positive. From a business defensibility perspective; the higher the barrier for entry, the less likely we will encounter a lot of competition (probably why there has been so little innovation in this space since the 80s/90s). The high standards and meticulous regulatory approval process only serves to ensure a better quality we're forced to achieve, and when you are building such important software, you shouldn’t be allowed to cut corners.
Eventually, we will internationalise outside of Germany, into other EU countries. ‘Made in Germany’! It's a standard, isn't it? It's like, look what we did in Germany. Now we come to the UK, Italy, France, Spain, etc... they see that as a positive indicator! We chose Germany as our launch market because we wanted to build a high quality product, the need here is great, and it’s the biggest market in Europe (go big or go home). The highest standards of data security and regulatory processes ensure our product is going to be excellent, and not just cutting edge from a technological perspective, but compliant, safe and secure.
tech.eu: Previously, when you were at Health Pioneers, and you mentioned how you've been working with the governmental regulatory bodies, that's something that really stood out to me about about your solution. But can you tell me a little bit about how you got into this health space initially, like, what started this journey for you?
Samir: My personal story, very shortly, is; I always did very well in school, but didn’t have a particular career aspiration. I studied archaeology at University because I find it a fascinating subject, maybe some aspirations of being an Indiana Jones type. But, it wasn't for me. After a little traveling and briefly trying out a few different jobs I took a role in a startup doing marketing, and I fell in love. I’ve been blessed with some amazing mentors along the way! Ultimately, why I love startups is because my personal growth is not dictated, nor restricted, by a corporate structure. It's by what I can handle. There's always too much work and never enough people to do it, so I could always develop at a pace which I was capable of.
I have always had an affinity for people, needs, communication and had creative streak which lent itself well to marketing activities. I quickly became a head of performance marketing, I became a chief marketing officer, I had more product focused responsibilities, I became a cofounder (enabling someone else's vision), then a founder (bringing my own vision to life). Along the way, I was young, and I did lots of cool and innovative stuff, e.g. a couple of dating products and as I got a little bit more mature, I thought ‘banking the underbanked, that's a problem worth solving’. I got to live and work in multiple countries, solving new and diverse problems. My last business was an insurance carrier, fully regulated and live now in Germany (ONE insurance, part of the wefox group).
After that, I said to myself, Okay, the next business I want to build needs to be culture first, because I think that's the most important thing about building a business, hiring people and developing them, creating an ecosystem where people can develop and will, ultimately, pay it forward when they leave. The second thing I wanted to do was something big and meaningful, so I needed to choose an industry that needed serious disruption. The two I personally looked at, were education and health, both massively important industries and both haven’t really felt that ‘internet/smart-phone service level jump’ we have seen in almost every other industry.
I actually think, though I personally enjoyed my time in the education system, school sucks for many people. But, ultimately, I don't feel qualified to create the change that is needed in the mainstream education system. It's so entrenched in the political system within each country and isn’t, at its heart, disruptable in a purely tech-way. I then looked at health, and I though, technology could actually make a big fundamental difference, and after meetings with my soon to be cofounders, we agreed health was the way to go.
I have five co-founders, a neurosurgeon, an operations expert, a technology expert, a product specialist and a sales/business development specialist. We all got together and we came to the conclusion that we want to enable people to healthier lives. That's a worthy mission. That's a worthy use of our time and talent. We accepted that this is a ‘regulate before innovate’ industry and it may take many years to get anywhere near our vision, but agreed that sometimes the right thing to do is the hard thing.
Regarding out practice management software, there's an excellent and long-term SaaS model there. Yes, investors like that. But ultimately, it also gets us closer to the patient via our health app and into the realm of enabling preventive medicine and digital personalised services via our platform/ecosystem. So yeah, if I'm going to spend the next 10 years of my life doing something, I think disrupting the health industry, even if we improve it by 3,4,5 percent, it will make a massive difference.
tech.eu: How did you connect with your five co founders, there are six of you on the founding team? How did you all connect and kind of come to this point, you know, this is where we want to go?
Samir: It was a relatively short process. A few years back, after my time as the CMO of Kreditech, I met Julian Teicke, the founder of wefox (an excellent insurtech startup based in Berlin). We were wanting to work together, but it just didn't work out (that's a whole different story).
Eventually I had the privilege to co-found the insurtech startup (ONE), which is now part of the wefox group, we really liked working together, and he introduced me to his brother, Nicklas Teicke, who was working in Berlin managing his own startup (Empaua, an excellent salesforce consultancy), which was doing really, really well. But he was ready for a change.
- Julian also introduced me to Dr Archil Eristavi, an experienced neurosurgeon who was super passionate about building something to improve his industry. It was a big leap for him, ‘Ok I'm going to quit my job in London as a neurosurgeon, come to Berlin and help to build the change I want to see’.
- Our CTO, Sebastian Lau, is a long-term friend of mine who is just one of the best developers I have had the chance to meet over the years, I think he was living in Croatia at the time, ready for his next big adventure, he hopped onto a plane to Berlin.
- Alex Boghean, a Developer/Product Specialist, was the second employee at Nick’s last startup Empaua, and was also ready to build something BIG. So he flew in from Romania.
- Anna Von Stackelberg, our CBDO, was SO passionate about being able to manage her family's health and making our vision a reality!
- Then there was Six! Six passionate, complementary, diverse, international founders with a shared product vision and desire to build a great culture.
The balance is great; 1 growth/strategy, 1 operations, 1 tech, 1 tech/product, 1 medical, 1 sales/BD, a really solid base of experience and talent to build a successful tech company. I feel sorry for some of my friends who are first-time entrepreneurs, because I know what it’s like, (in many respects) they really have no idea what they're doing. They have no contacts, and they just go out there with a vision. I'm lucky in so much as I've worked at different startups over the past decade, I've built contacts, I knew investors and successful entrepreneurs, so when I decided to do this, and the great team was coming together, it had its own kind of natural momentum.
But the company, from my perspective, has been 11 years in the making. All of my experience, trials, tribulations and victories brought me here and now with a purpose to build doctorly. My co founders had their own compelling journeys too and it’s just a beautiful thing that we can do this together.
tech.eu: You’re from London, but doctorly is firmly based in Berlin. Can you talk a little bit about what brought you to Berlin in the first place?
Samir: Work, ultimately. I really liked living in different countries and different cities over the years, it enables you to keep learning and growing. The first time I came to Germany, I was the Chief Marketing Officer of Kreditech, a FinTech startup based in Hamburg, which was great. After, I did some startup consulting (Growth, Marketing, Product) in Berlin, between more involved longer term roles.
Once you visit a few startups in Berlin, you're like, okay, this city's interesting. I'm a bit too old (33) for the city, to love it as much as the younger (techno/party) crowd, I think. But it's a pretty cool place. Then I was in the Philippines (Manila) for a while working with a great founding team on an interesting fintech startup focused on S.E Asia, after this I came back to Europe and met up with Julian, and was just super impressed with what he was doing with Finance Fox (which then became wefox).
Then ONE was created in Berlin/Zurich mostly. After the decision to move on was made, Julian was really supportive of what I wanted to do next. he was actually our first angel investor (prior to a fully fleshed out vision, he just loved the team, vision & energy).
From there, Berlin just kept making sense. I have a great support network (Empaua, wefox, ONE, Org.os, Taiwa, Global Citizen Foundation, HeartSpace) all working in a single location, Excellent access to people/talent, there are strong investors in Germany, E.g. Target Global (one of our early backers).
Germany is Europe's biggest market, and then there is Brexit. I don't really want to get into that, but, we just don't know how that will turn out. I was born and raised in London and love that city to death, it’s so multicultural and vibrant.. but the talent pool in Berlin is growing and growing so I don’t think we are missing out in that respect. Also, this is sad, but you know, typical Britishness, you don't need to speak German in Berlin. So it's a really comfortable initial transition from a lifestyle perspective.
tech.eu: Can you talk a little bit about the kind of health or med-tech scene in Berlin? There are a couple of interesting players there. Why is Berlin a great place to have a med tech startup right now?
Samir: I think Berlin is just a great place, in general, to have a startup right now. It's a maturing ecosystem, and every city kind of goes for its own thing. Berlin, it reminds me a bit of London. London’s specialty is predominantly FinTech and it's quite famous for that. But there's lots of other things happening there too, this is reflected in Berlin.
There's a lot more money in Berlin (and the market in general) now, which can be used to take risks on more interesting startups. If I were a VC, I would look at that and say, “Where are the health-tech unicorns”? Because we all know that they're there to be had, but there aren't that many examples of them out there in recent years (compared to other industries). You have Doctolib recently, achieving a unicorn status with a booking platform, mostly due to their accomplishments in France. That's a really good example of where there's so much open road in front of us for disruption/innovation and value add, that a relatively small disruption like that (digital booking for medical appointments) can be so valuable in one country.
As far as investors are concerned, they all know it's there (the big opportunities across health/med-tech). They just don't seem sure about ‘when’, because we had that eCommerce boom, marketplaces, a big FinTech period, we're having an insuretech one at the moment, and the healthtech one is just... I think they recognise how highly regulated the space is and I think that's actually a little off putting (to entrepreneurs and investors alike).
Every time I have pitched this (doctorly) to investors, they always ask who our competition is in Germany, and we respond, with all due respect, there isn’t any. There are big ‘incumbents’ of course, but looking at the software doctors are using, I am not concerned that we won’t be able to convince doctors to switch (in fact doctors are contacting us every day asking when we will be ready for them to switch). Investors then ask, what about across Europe, there must be other startups doing this, because it's such an obvious a space to disrupt? Of course there are, but mostly in non-regulated spaces, i.e. software for doctors to add value in specific/modular ways… but working ‘around’ the current archaic software used for the core workflows within the practice.
When I talk to startup people, they always tell me “Yeah, like, I would never do that. First, it's a massive piece of software. Secondly, it's highly regulated. So you can almost double or triple the development time. And thirdly, you're selling to doctors, which is not easy”.
Why would they (the entrepreneurs) build a startup like doctorly when they can go build a (more immediately) sexy chatbot, which is not regulated, or they could go and do a booking tool, which is not regulated, and so on. So, it's just one of those things where I think investors & entrepreneurs alike, who want to truly disrupt the health industry at scale, have to be prepared for the longer game. This means larger rounds of investment and longer-term visions for growth.
It’s not like deep-tech, where you have to invest a hell of a lot of money on cutting edge technologies, then wait for 10 years, and hope for something good in the end. But something like what we are doing, I would describe as ‘Wide-Tech’, it’s just a whole lot of (regulated) software & very high standards to reach (due to the importance of the software) before launching!
If you're aiming to make a significant change in this industry, you need to invest money, and you need very strong teams that can execute. And I think that's it, when you look at insurance, at the beginning, everyone was doing comparison and digital brokerages. Now, there's actually fully licensed, fully regulated startup insurance carriers built from scratch (e.g. with ONE). That's how you enact real change. So I think investors are seeing that now and we just need a few of the brave ones to back the big health-tech visions in Berlin. It's such an interesting space right now, because of the regulatory situation it makes for really creative solutions.
To be honest, every time I pitch this to an investor, I get some of the similar questions. Are you using the blockchain? Do you use AI? And I always just say, No, while I know these are sexy technologies, there just wasn't any need (maybe in the future). If you go into a practice, all you see are BASIC inefficiencies, and I have one of these characters, where I just can't see it. I just, I can't watch people do the same task four times, which could have been done once. And that is actually, simply put, what we did at the beginning.
We consulted hundreds of medical practices and we simply asked questions, e.g. how do you do your bookings? How do you do your diagnosis? How long do you spend on notes for each patient? How do you do your quarterly state billing? How do you communicate with your state patients and your private patients? How do you handle your internal HR? How do you handle your business finances, and (with all due respect to how hard these medical professionals work) everything was terrible (from a process/technology perspective).
Doctors, typically, are not trying to be great business people, they are trying to be great doctors. So we said, let's just build something that addresses their needs and sorts all of this out. Something that then sets practices up to embrace a new age of digitisation, which has a great knock-on effect for patients and the wider industry (who are also hungry for modernisation). Yes, we had a challenge ahead of us with respect to regulatory requirements, but while these do take time, there are rules and structures in place for a reason and it’s just a matter of integrating that into our software.
In general, I think Germany is in desperate need of a med/health-tech revolution, and this is not lost on anyone (from government to founders). This is reflected by a definite increase in the number of health/med-tech startups in the last year, more conferences and health-specific digital schemes and we have some great successes within the Berlin Health-tech scene already (here’s hoping for many more)!
tech.eu: What do you think has been one of the most surprising things you've learned since coming into this field?
Samir: How innovative doctors are! People often have the preconception that doctors are old, conservative people and that they don’t want to change and liked to keep things super old school, doing everything on paper etc. In Germany, doctors typically keep practicing until they retire, and the next doctors who actually get to own the practice, usually already 40 years old, 45 years old. We have visited (demoed) close to 2,000 practices since mid 2017 until now, and they were predominantly ‘very cool’. We had one doctor, he was 65-67, and he saw the demo and simply said, “I love this”. He has no business reason to get behind our movement right now, he has a very successful practice and plans to retire before we launch, but he really loved it. And that was it. That was the change that occurred in my mind. It wasn't that doctors were against change, It was that people (tech businesses) didn't understand them, and didn't understand the needs and pain points. Doctors are reasonably wealthy, they have Mac computers at home, iPhones in their pockets, Sonos speakers on their walls, they use Uber… But when they come to work, they use this goddamned ‘typewriter with a screen’! They absolutely know it’s terrible and hate it with a passion, but they don’t feel they have a better option currently.
When people come and just try and sell them some random modular digital tool, telling doctors why they should use this and that, be more digital… We learned early on, in order to help the doctors, in order to make the sale, in order to enable the transition, we have to understand and take over the pain of the doctors & medical staff. This is a super connected industry, many doctors study together, go to trainings together, conferences together, are in unions together. So for us, being the friend of the doctors, understanding their needs, helping them to reach their goals and solve their pain points, this relationship is our focus and will pay dividends in the future as we look to scale our reach and expand our product offerings (nationally and internationally) in a big way!
tech.eu: You've been involved in startups for a really long time now. What’s one lesson, or one takeaway for future founders or prospective founders? What would it be?
Samir: That’s tough. First, fundraising and Angels. A lot of people seem to try to go to VCs super early (I have an idea, can I have a million euros… a quick route to a no and an ‘almost’ closed door). I believe, initially, getting backing from experienced individuals (Angels) who believe in you and your team and have value to add early on, makes a big difference in the fundraising process. Good quality Angels get you to where you need to go before you go to a VC team, they ask some of the hard questions, they make intros to other Angels (VCs too) and get that momentum going VCs like to see, i.e. these good Angels see something here worth investing in.
Secondly, as for the team, and I've made this mistake in the past, founding a business with somebody who's an excellent match, as far as skills are concerned, but culturally not, is not sustainable. So if you're going to found a business, make sure that you and your co founders are culturally and vision aligned.
Third, don't forget the importance of culture. Most early-stage startups don't focus on culture at all, and then try and fix (it always needs fixing) it after they raise their series A. In my opinion and experience you need to consciously focus on this from day one! You need to establish and live the company values, hire for them, promote people who live them, make sure all company decisions are measured against them. Culture is everything for a company.
Fourth, the personal growth vision of the individual is just as important as the vision and development of the company. Keeping hold of talent is imperative to the long term success of your business and in this day and age, people are motivated by compelling vision and purpose, the ability to develop and grow and to be part of something special. Don’t forget to value your people as individuals.
And yeah, that's really it! The startup will likely dominate your life, so you need to accept that to an extent, but don’t let it become a ‘negative’. It shouldn't be ‘your life’ in a bad way, but it should be a large aspect in your life, at least during the beginning phases of the company, which is a one to three year period. It’s a lifestyle, not a job.