The startup success grid

I have been watching ortho startups for 30 years. This simple grid is surprisingly predictive of outcomes.

In the grid, I am putting aside all the usual success factors – funding, technology, regulatory pathway, reimbursement, patents, strategic partners, board, leadership experience, product-market-fit – and pitting Leadership aggressiveness against Market tailwinds.

I believe that ALL orthopedic startups fall into one of these success quadrants.

The Y-axis

In a Pull Market tailwinds are created when there is a product with a unique clinical solution and with zero competition. I experienced Pull first hand at Ellipse with MAGEC. Hospitals, surgeons and patient families requested MAGEC worldwide before we had regulatory clearances or sales support. Various MAGEC blogs were started by families of EOS children when we had no marketing.

In a Push Market headwinds are created when there is a product with too many competitive choices and too little differentiation. Push is all about pricing, contracts, relationships, service level, and the product doesn’t really matter. This is the bulk of startups unfortunately.

The X-Axis

No explanation needed, as we have all worked for both Timid and Ferocious Leadership at one time or another.

Ferocious + Push

The bottom right quadrant is brutal. If you find yourself there, get out, switch ideas, do something different.

Ferocious + Pull

The big winners are in the upper right quadrant… but they are very rare. A few examples.

Danek – Ronnie Pickard. Ferocious leadership and unprecedented Pull because of surgeon loyalty after the pedicle screw lawsuit.

Kyphon – Dr. Mark Reiley, Arie Scholten, and Karen Talmadge. Ferocious focus and leadership and a new MIS product category with zero competition.

Mako Surgical – Rony Abovitz and Maurice Ferre. Ferocious execution with the first haptic robotic system in joints.

Ellipse Technologies – Ed Roschak. Ferocious focus and leadership and big market Pull.

Timid + Pull

I don’t want to dunk on any timid leadership startups, so send me your suggestion for a startup example for this quadrant.

Timid + Push

Again, send me your suggestion for a startup example for this quadrant.