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Fertilize Your Hidden Rage

by Jonathan Bush, President & CEO

Disruptive leadership. That’s a thing now? I’m told that this is a kind of leadership—I thought it was a market dynamic.


What does it take to be a "disruptive" leader?

Does it mean talk like a pirate when explaining how the company will be cutting benefits?

Does it mean dress like Ali G and try to imitate him but only muster a WASP accent?

I suppose it does…but that’s the easy part.

Job #1 in leading a true market disruptive: FIND AND FERTILIZE THE HIDDEN RAGE AT THE STATUS QUO THAT LIES WITHIN ALL OF US. Find it in yourself and feed it and then find it in others and attract them to work with you.

I’m constantly looking for change in my personal life. For example, I just bought a Tesla. My other car is a 1983 Land Rover. Why? Because in 1983 you didn’t need to sell cars with a seatbelt dinger and airbags in the front seat and because Tesla is the first ATTACKER disruptive car maker to make it past the fetal stage in my entire life. I must feed them. I HATE the established car industry! I have been trapped inside a small number of culturally (and occasionally financially) bankrupt brands that have lost any interest in fighting the over-regulated morass that constrains.

In recruitment for athenahealth, we are looking for people with the same desire to change things for the better. Ever see this ad?

In retention, we blow up 30% of the jobs in the company every year and recycle the people into new roles. This way, if we accidentally hire a stability addict, we get rid of them within three years on average.

All of this is going well.

I think the biggest challenge I face as a disruptive leader is finding a way of leading this way without making my clients nervous.

Some 30% of our revenue comes from non-profit hospitals and 30% comes from traditional medical practices and clinics. These are some of the most conservatively run institutions in our society…and many of us like it that way. They are, after all, operating under the Hippocratic oath (“First, do no harm”). While they like that we know how to use the Internet, they DO NOT want to see anything fast and loose with who sees what, and I get it! They are also afraid of losing market share and deathly afraid of losing pricing power as society starts to come down on the cost of health care. My job is to serve these people and not scare or “disruptive” them.

Luckily, 40% of my revenues come from disrupters. These are venture-backed, for-profit businesses that have come to health care with disruptive business models. They include for-profit hospital chains like Vanguard, which has an expressly stated goal to REDUCE the hospitalization that it provides per capita by 25% and replace it with new market share and new approaches to care. They include an ambulance chain that is looking at providing emergency room care RIGHT THERE IN THE AMBULANCE, generating MASSIVE savings and improvements in quality of life for many chronically ill patients. They include MedExpress and other urgent care chains that set up shop outside overly busy ERs and treat the 80% of patients that don’t truly need a full hospital but do need treatment urgently in minutes! These guys are all growing like mad, which I love, but more importantly they are providing a model of DISRUPTION as a GOOD THING that the other 60% of my clients MUST learn from…or perish.

My goal is to keep my freak flag flying…but learn how to put it in my pocket and have a mature conversation with my established clients about why they want to become disrupters themselves. If I get them there, we are all good. If I don’t, I run the risk of being a risk or a disappointment to the majority of my revenue.

As athenahealth grows and the revenues from established, change-cautious players grows with it, the pressure to ease off will rise.

I must mature in my ability to keep doing it…but I must keep doing it…or I am afraid my clients will slip from part of the solution to part of the problem.

Jonathan Bush is the President and CEO of athenahealth.

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