Company

Our Culture

The Anterior we're building

The best companies in the world take a long time to pen their culture and values. This is partly because it's so hard to do (what even is culture?), but also because culture isn't something you prescribe and dictate more than it is something you describe and celebrate, and to do so takes time, attention, and nurture.

The same is true at Anterior. It's probably too early to declare what our culture is; we've only just started to build it. But it's still worth taking a shot at, even if just to state that culture is important to us now and that it deserves deliberate attention today. It's also to recognize what we think are the seedlings of an enviable culture that is already taking root here at Anterior, and to celebrate the incredible people we already get to work alongside every day.

“I love working at Anterior. It's the most productive and valued that I 've ever felt as an employee and I'd like to very candidly say that leadership have the culture nailed. This isn't an easy thing to do, but you 're doing it. I suspect that for any future Anterior alumni, this company will forever be the bar.”Anterior Employee Self-Reflection Memo

There are lots of ways to talk about culture and values, and we've taken inspiration from some of our favorites. The Browser Company beautifully outline their Notes on “Values” Roadtrips in prose, whilst Stripe has their more succinct Operating Principles. Rob Strasser (or was it Phil Knight?) wrote the famous 10 Principles at Nike, and the original “culture deck” at Netflix continues to influence today. These are all worth reading and aspiring towards, and each has its own perspective on the kind of culture it takes to build the best perspective on the kind of culture it takes to build the best company in the world for its own time, place, and mission.

Here are some ideas that we think, in aggregate, capture what we mean when we say “culture”:

  • What happens when no one else is watching?
  • What one can assume about someone at Anterior having never met them
  • Our immune system (which should be alienating to those who don't fit)
  • The way we talk about the past
  • Culture = People
  • “Prevents the process creep that typically happens when companies grow and try to dummy-proof their organizations”

Finally, and most importantly, great culture shows up as great results, not just neatly-crafted manifestos.

With all that said, here's what we think we know about Anterior's culture so far.

Who we are

Delightfully intense,

People at Anterior are the rare combination of the nicest yet most intense people you'll ever meet. They're delightful in that they hold a sincere regard for everyone around them and are weird around the edges in a way that attracts and always leaves an impression. And they're intense in that they're extremely dissatisfied (perhaps unforgiving) with mediocrity, be it from themselves or others, always raising everyone around them to the high standards to which they hold themselves. They're serious about what really matters and light-hearted about everything else.

and uncomfortably candid.

Feedback is the breakfast of champions.Ken Blanchard

Feedback is like strength training: it's best done purposefully with growth in mind and produces a healthy discomfort that results in hypertrophy and self-healing — and an organization's ability to self-heal is strongly correlated with its win rate.

At Anterior, we embrace feedback, and the bar is set such that if feedback is not offered directly and doesn't feel at least slightly uncomfortable to give or receive, it's not useful. Direct feedback also averts a culture of gossip. Gossip is feedback that got lost along the way, passed on to everyone except the appropriate recipient, and gossip correlates inversely with the strength of a company's feedback culture.

Open imposters,

It's an unwritten rule that we won't hire someone at Anterior if they don't make us feel like imposters. We must feel that we have more to lose than them if they don't join us, and that we have more to learn from them than they do from us. At Anterior, we each embrace our imposter syndrome; for us it's the strongest signal that we are in the right rooms (if you're otherwise the smartest person in the room, you're in the wrong one!).

who learn loudly,

Everyone at Anterior has an insatiable thirst to learn, even (or especially) in areas outside their domain. We believe stupid questions exist, but we don't entertain egos and are happy to ask such questions out loud on the path to learning.

Engineering pester GTM for lessons learned from the last customer negotiation, and Clinical Operations are often the most eager audience at Engineering stand-ups. Most of our team are clinicians, academics, or they otherwise self-identify as students before anything else. We like to say that we're all really here to learn and grow and, in doing so, we'll build a generational company along the way — rather than the other way round.

and are happily wrong.

We need to be right more often than wrong (at least on the big bets). But two wrongs do sometimes make a right: we embrace the role that wrong answers play in clearing the path to the right ones, and everyone at Anterior is happy to be proven wrong if it means Anterior gets to be proven right.

This manifests as “strong opinions, weakly held,” fostering that intense yet collaborative culture we enjoy. This dynamic allows us to reach high conviction quickly on good decisions, which, under the surface, were only achieved because we were happy to be wrong along the way.

How we work

Move fast and fix things

Similar to Facebook's “Move Fast and Break Things”, except we prefer to place our focus on the other side of the coin. At Anterior we expect quality be shipped at pace, and refuse to suffer excuses for mediocrity (which is anything else).

Multiple times a week I'll get the question/challenge: “if we are in healthcare, how can our value be speed?”. Or “you can either have it good, or you can have it fast.” Or some other ridiculous “either-or”-type posit. This is a false dichotomy meant to pigeon-hole you into mediocrity. Speed does not come at the cost of rigor. Almost all real work is done in intense, focused, deep sprints. No distractions, limited meetings, and just real heads down pushing.Tanay Tandon

There are several examples that demonstrate speed not only does not have to be at the expense of quality, but may be the surest path to it:

  1. Google Maps was slow, clunky, and an XML-driven monstrosity. Brett Taylor (early engineer) was frustrated, and re-built it from scratch in a 48 hour coding binge over the weekend. It became the infrastructure that still runs today, 1/3rd of the original size, with literally 10x faster load times.
  2. The initial iPod was conceived, designed, and shipped to customers within 7 months of starting by Tony Fadell and Apple. This is a complex hardware device with little to no initial supply chain. It became the basis of a 10-year transformation of Apple into a trillion dollar empire. That 7-month sprint was somewhat unprecedented in consumer hardware, but it built that foundation.
  3. The Empire State Building was entirely built in just 410 days in 1930. It has lasted a century, is structurally sound, safe, a beacon of America, and continues to function. Compare this to the Millenium Tower built in San Francisco in 2005. It took 5 years, with multiple "committees", "planning sessions", "community guided safety". It is now leaning/tilting, deemed unsafe, and cannot fully be used. Competence matters.

More examples here: Fast by Patrick Collison

Play the long game in short sprints

To borrow language from Stripe: we're macro-optimists and micro-pessimists. We're optimistically committed to tomorrow's big picture whilst critically obsessed over the milestones that get us there. No problem is too big or nebulous if it's in the way of our vision, but we don't underestimate the potential for failure and or the size of the challenges that lie in getting things right today. We believe winners win by consistently maintaining a strong bias to action over the long-term, building everything with tomorrow in mind.

Details create the big picture.Sanford I. Weill

Grow roses through the concrete

Software in healthcare is like concrete: plain and ugly. The default is to become another slab. Or, instead, we could be the rose that grew through the concrete.

Long live the rose that grew from the concrete when no one else ever cared.Tupac Shakur

We are led by design in everything we do, from our user interfaces to our invoice letters. We index highly on the importance of beauty and aesthetics to Anterior's success.

A lot of the most successful companies are those that are distinguished by the extent to which they exhibit appreciation for and skill in realizing craft and beauty…it might be the case that craft and the pursuit of it is as important as it's ever been…part of what's interesting about these aesthetic qualities is they're generally speaking unquantifiable…and yet they influence people in significant ways. People very demonstrably care about aesthetics. And if they're a company, they care about the aesthetic characteristics of the products that they produce. On an intuitive level, people know that that's true.Patrick Collison

Democracy is overrated

We don't make decisions through consensus or committee. Every decision has a DRI (directly responsible individual) whose job is to collect inputs (weighing them appropriately; not every opinion is created equal) and then make an informed decision. But, ultimately, they are held accountable for the outcomes of that decision.

Everyone else's job is to communicate their view strongly with evidence, then be happy to disagree and commit.

Nothing is what happens when everyone has to agreeSeth Godin

Build a car, not a faster horse

If I had asked my customers what they wanted they would have said a faster horse.Henry Ford

We're user-obsessed and always build what our users want. But what our users want isn't always exactly what they say.

Everyone at Anterior is empowered to think outside (no box needed). We aren't afraid to have opinions on what we think our users actually want. This allows us to truly take the side of the user, to make their interests our own, and to creatively problem-solve alongside them rather than for them.

After the speech came the hard work of defining the product. The product plan was weighed down with hundreds of requirements from our existing customers. The product management team had an allergic reaction to prioritizing potentially good features above features that might hypothetically beat BladeLogic. They would say, “How can we walk away from requirements that we know to be true to pursue something that we think will help?”

It turns out that is exactly what product strategy is all about—figuring out the right product is the innovator's job, not the customer's job. The customer only knows what she thinks she wants based on her experience with the current product. The innovator can take into account everything that it's possible, but often must go against what she knows to be true. As a result, innovation requires a combination of knowledge, skill, and courage.Ben Horowitz

How we lead

Lever, not leader

Leaders at Anterior are Levers: our job is to make teams greater than the sum of their individuals. We do this by being servants first, always asking questions like “what can I do for my team?”, “where can I unlock things?”, and “where can I get out of the way?”.

Leaders at Anterior are expected to be in the trenches with their team, and no task should be beneath us: we do whatever it takes to make our teams, and Anterior, win.

Servant leadership is all about making the goals clear and then rolling your sleeves up and doing whatever it takes to help people win. In that situation, they don't work for you; you work for them.Ken Blanchard

People first, second, and third

People are everything at Anterior and we believe that if leaders look after their people, they look after Anterior's success.

The team you build is the company you build, not the plan you make.Vinod Khosla

The best way to build a world-class company is to attract, nurture, and retain world-class people. And the best way to do so is to do it resolvedly from day one; world-class people attract, nurture, and retain world-class people. Everything else (all the buzzwords: culture, values, performance) are second-order consequences that fall neatly out of this condition.

Your company is only as extraordinary as your peopleEkaterina Walter

Condor moments

Good leaders should be “right, a lot.” But, equally, a poor decision can quickly be fatal. Whilst leaders must be decisive and trust their gut, we also need to know when to pause and take a “condor moment”, sometimes especially in high-stakes and decisive moments. This allows Anterior to operate with the long-term view and lets us endure where those around us may otherwise falter.

One of most valuable lessons I carry with me from Sandhurst military training is the notion of the ‘Condor Moment.’

All you need to take a Condor Moment is your own presence of mind and an appropriate length of time – it can be hours or perhaps days for longer-term planning tasks. If you are fire-fighting in a contingency situation, you may only be able to take a few seconds or minutes. The time is worth it, though (despite your initial feelings about urgency or what others around you may say). It improves your chances of getting things right (or as right as they can be) as you go forward. Treat it as an investment to improve the chance of success.

Context, not control

“Full-company ownership” is something we expect from everyone at Anterior. We won’t hire someone unless we think we can give them 100% trust from Day 1 to make important decisions on behalf of the company. But to truly enable ownership within teams, leaders must allow for full context. This means full transparency, zero gatekeeping, and the freedom to work on what you think will make Anterior successful. The most important context is the company’s mission, and people at Anterior are empowered to do whatever it takes to achieve it.

The greatest people are self-managing. They don’t need to be managed. Once they know what to do, they’ll go figure out how to do it…what they need is a common vision, and that’s what leadership is.Steve Jobs

Merit over masks

When you join Anterior, you leave brands, titles, and other such masks at the door. What matters now is the value you bring to Anterior and its people, and how eager you are to contribute and learn. When our leaders focus on merit alone, all the masks drop and focus turns away from the people and towards substance, resulting in an extraordinary pace of learning for the entire company and its people.

The only way to win is to learn faster than anyone else.Eric Ries