Unlocking Startups Using These 3 Rules With Sal Braico
By: Skot Waldron
Tags: Company Culture

Skot Waldron:

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So I just met a guy named Sal, and yes, he’s from New Jersey. Now he lives in Madison, Wisconsin. Take that for what it’s worth. Sal is an entrepreneur at heart. This dude has started four/five companies, depending on who you ask. And it’s all in the healthcare space. Healthcare is hard and Sal knows that, but he takes on the challenge and he has a few rules for how to make your startup more successful.

He lists three of those rules and number one is awesome. And I’m going to just tell you that it is, nevermind. I’m not going to tell you. I’m going to let Sal tell you what his three rules are. And number one has a lot to do with what we talk about on this show. So I want you to listen up. Sal brings a lot to the table. Number one, he’s going to talk about his new healthcare company that he is starting called Pivotal Health, and he is going to enlighten you about what that takes to start up a company. It’s on the pains, the frustrations, and also the rewards that go along with that. Stay tuned. It’s going to be awesome. Let’s do this thing.

Tell us a little bit about what you’re doing now and where you come from.

Sal Braico:

Yeah. I am not new to the entrepreneurial world. This is my, I guess third startup, I guess maybe fourth startup. So for the last, close to 20 years, I’ve been starting and/or running startup companies. Everything in the last 18 to 20 years has all been in healthcare. I was the first employee of a biotech company back in 2002. And I ran that for about four or five years. And then I started a medical device company, ran that for another four years or so. And then I went to a more established business. It was a pharmacy company, but it was really like about to grow really fast. So I got there to kind of help grow that. And then I went to run a healthcare IT company, and I’m just leaving that. And now I’m in the process of starting up Pivotal Health.

So what pivotal is really doing is trying to bring consumer friendly healthcare. The health systems of today are filled with fantastic people, really passionate, smart people who want to help people, but they’re not great for those everyday problems that you have. For the sore throats, for the ear infections, for those kinds of things. The big health systems are really not good for that. They’re fantastic if you have cancer, if you need a heart surgery, if you have something big. Then there are fantastic health systems across this country.

But for those everyday things, healthcare is not easy. Who do you call? When do you call? Is this covered? Is this not covered? Do you go to the ER? Do you go to the urgent care? All of these things, people face these issues every day. And if you have kids, then you’re dealing with those issues with your kids. Is this an ear infection? Oh my God, do I have to pack up all the kids and bring them to the ER? What do you do?

And so some business partners and I have decided to kind of create this platform where we can deliver high quality, convenient healthcare, and we’re going to combine house calls and telehealth. So if we need to send a clinician to your home, then we will do that. If it can be solved with a telehealth call, then we could do that as well. But it’d all be done at a time that works for you.

SKOT WALDRON:

Okay. So there’s a lot of questions with that, right?

SAL BRAICO:

Yeah.

SKOT WALDRON:

First of all, we’re just going to start on, ask the question. So why have you been in healthcare for so long? I mean like two decades of healthcare. Healthcare is hard. You just like to take on hard things? What’s the whole thing there?

SAL BRAICO:

It kind of started by accident. Actually, I went to business school at the University of Wisconsin and I went into business school with the intention of probably starting an IT company or something. I had an engineering background and I had worked in IT. And so that was my plan. But during the second year of business school, I actually got connected with two University of Wisconsin professors who had an idea for a biotech company.

And so I worked with them to create the first business plan. I convinced them to bring me on as employee number one. And I just I’ve been in healthcare ever since. It’s a very specific industry. It’s very different than the financial industry. It’s very different from like tech companies. It’s got its own specific things for better or for worse.

So I’ve just been kind of doing it. I did the biotech and then I did the medical device and then I did the pharmacy home healthcare business, and then the healthcare IT company, and then now this. So all of those things have kind of led. I’m like taking things that I’ve learned from each of those and using that knowledge, using all of the pain that I felt going through all those things, all of the really hard things that you learn and taking all those to work on this thing.

SKOT WALDRON:

On your journey, you’ve encountered a lot of things, things that didn’t go so well, things that went awesome. And like you said, you’ve learned your lessons throughout all these different ventures to launch now this. I’m assuming this is not going to be your last, right? Seeing the trend of what’s happened over the past 20 years that this is something … What does it take to build this? So this is, you say your fourth or your fifth?

SAL BRAICO:

Fourth or fifth, depending on how you count them. Yeah.

SKOT WALDRON:

Okay. Fourth or fifth depending on how you count. What’s one of the secrets? Like inform us, what does it take to launch a startup, because there’s a lot of people that want to launch startups in this country and a lot of them fail and you’ve had successes. You probably had failures in the past as well. Or we won’t call them failures. Let’s call them learning experiences, in the past. What’s the secret? What do you use as a backbone to help keep you moving?

SAL BRAICO:

So I think number one, tenacity, it takes a lot of tenacity. You have to talk to a lot of people. You have to get told no many, many times, and you just have to keep on doing it. You’ve got to keep on knocking on the doors. You’ve got to keep on making those phone calls. You’ve got to keep on recruiting people. You just need to keep on doing it. And that’s tough. It’s not easy to be told no over and over again, or to have people say, why you can’t do this. Oh no, that’s too hard. There’s too many hospitals and people are going to their primary care physician.

No, no, I look at what does it take to make this thing work? Let’s really focus on that. Let’s focus on what does it take to make a project work. Now there’s always risk. Always. Are those risks, things that I can work on, mitigate? So for example, with the biotech company, one of the major risks that was out there was the FDA. We were working on a very novel product. And the FDA at that time did not have a lot of experience looking at products like that. So that’s a tremendous risk, regulatory risk. Looking back on it, I would probably not do that company again because that’s a risk that’s out of my control.

With the medical device company, there was a risk of if this product would actually work. Again, that was out of my control. I could raise all the money in the world. I could have a great team of people, but if the product doesn’t actually work, if it doesn’t help the animals that it was being tested in, or if you don’t get those results, there’s really not much that you can do.

In a company like this, there’s no technical risk. There’s no intellectual property risk. There’s no any other kinds of like technical science risk. This is all operations. Can you raise the capital that you need? That’s going to be a sales process. I need to convince people to invest in this. Can we create a scalable platform? We’re not going to really build anything new technically. It’s going to be all off the shelf software. Can we hire the right people? I’ve hired and fired many, many people before. Can we create the scalable platform?

So this is all like human operational risk and having done and seen all the things that I’ve done so far, I’m very comfortable with that. I believe that I can figure this out. I believe I can hire the right people to help me figure this out. That’s also something that I’ve learned too, is really focused on hiring people that have done this before.

For example, one of the key things about what we’re going to be doing is billing. We need to process claims and send claims into insurance companies. I know from the past, if I have a billing person who has never done that before, that is going to create problems. So this time I’m going to focus on finding people that have done this before. People that have done this type of billing before. I may have to pay a little bit more for that, but that’s okay. I don’t have a problem with that because I know the problems that can happen if you don’t have that right person. Can people learn? Of course they can, but they can only learn if they’re learning from someone that has done it before.

SKOT WALDRON:

So hard skills. What about the soft skills? So you’ve got hard skills, the things that you want to hire for. You know you need somebody in this role to fulfill this position and this job to get this thing done. And yes, we want competent people that have experience, and we’re even willing to pay more for them. What about the type of people that you want working for you?

SAL BRAICO:

So I have a couple of rules. Number one, no jerks. None.

SKOT WALDRON:

No jerks. Oh man. But what if they’re good at their job? No?

SAL BRAICO:

Nope.

SKOT WALDRON:

Okay. No jerks

SAL BRAICO:

Life is too short. I’ve worked with many jerks before and it just drains you. It makes you feel sick at the end of the day that you have to deal with this person. You’re like, well, why can’t they just understand? Absolutely no jerks. So the person has to be someone that … You don’t have to be best friends with them, but they have to get along with everybody. Okay, number one.

Number two. Are they smart? Do they have horsepower? If you don’t have the horsepower, then you’re not going to be able to figure things out. And then number three, have they done it before? Those are the three things that I always look for. Is it a nice person? Is it someone that I want to spend time with? Do I want to figure out problems with this person?

Number two, are they smart? Can they bring some creativity to the position? Can they figure out problems? There’s always problems. Nothing ever goes right. There’s always something that breaks. Always. Almost every day something doesn’t go according to plan. So you need to have people on your team that can figure those problems out. Because if everything has to go up to the CEO or to the COO, it’s just not going to work.

I like to give people freedom to figure out things and then to please come to me if they need help. But my first question when people who work for me when they bring me problems, my first question is, what would you do? What do you think? Because they probably know a lot more about that specific area than me.

SKOT WALDRON:

So hire people smarter than you in that thing?

SAL BRAICO:

Yep.

SKOT WALDRON:

So, no jerks, make sure they can think and figure things out and do they have the experience. Solid three rules. Love it. I love that your first one is no jerks. Like really good. Let’s revisit that for a second. What does the jerk do? What does the jerk encapsulate? And what’s the result of that on the culture?

SAL BRAICO:

So a jerk may dismiss the ideas of their teammates without really listening to them. A jerk may just be rude with kind of how they talk to people, how they treat people. A jerk would be arrogant to the point. And you know, confidence is not arrogance. There’s a difference there, but who may be arrogant and think that they know better and that they don’t want to learn.

I think everyone needs to always be learning. If you think that you don’t have to learn, if you think like, well, I’ve done this before. If you have that attitude, then you’re a jerk. You need to be open. You need to be willing to listen. And then also you need to be friendly. Just the everyday kind of conversational skills of asking people, hey, how was your day? What did you do this weekend and things like that. I mean, that’s important. You may not really care what the person did over the weekend, but it makes them feel good if you at least ask them. And so if you can’t at least fake it, then there’s a problem there.

SKOT WALDRON:

Really good. The results of that type of individual, we treat it like a greenhouse. Our businesses are greenhouses and we’re trying to grow plants. And everybody in there represents a plant, everybody in our business and we have these plants and we’re nurturing them and we’re growing them. Some of them need different things to grow. And then we bring toxicity into that greenhouse and it just starts killing the life in everything. And it just spreads and it’s done. And then people can’t be productive. Have you seen that happen?

SAL BRAICO:

Yeah, I’ve seen it multiple times. I saw it even back before when I was working in IT. There was a guy that was on our team. We were working on this project. I mean, he was a total jerk and you couldn’t approach him. All of the younger guys, and I was one of the younger guys at that time, you were afraid to ask him anything, because he just didn’t want to be bothered.

And so that caused problems. That caused technical problems and things, things that he could have easily solved. But we were so afraid of talking to him because he was such a jerk. Things ended up not working the way that they should. And so I saw it there and I’ve just seen it afterwards. People that they don’t care about anybody else. They only care about themselves. People feel that. Most people feel that pretty quickly. You can tell within a day if someone’s a jerk or not. Like during the interview process, people try to put up that good face and all that kind of stuff. But soon after that, you can see very, very quickly if they’re a jerk or not.

SKOT WALDRON:

It kills collaboration, is what I just heard you say, right? There’s this, when there’s a problem, there’s a culture of fear and domination where I’m tiptoeing. I don’t want to speak up because I know I’m just going to get bulldozed and crushed and I don’t want to do that. Self-preservation kicks in. It’s like, nope, life’s too short for that. It’s like that dude’s going to crash and burn. He’ll crash and burn a little bit. And that hurts productivity overall. Nobody wants to operate that way.

So now you, launching a new company, have a very defined number one rule of no jerks because of the understanding and the experience of what that does to cultures and how that impacts things. You have an interesting thought about how you want to invest in people and create engagement within your new company. Explain that a little bit.

SAL BRAICO:

Yeah. I strongly believe that all employees should have some piece of the equity. They should get some stock options. They should get that in the company, because there, they will be taking a chance. So it’s important that as the company’s value goes up, that they also are able to participate in that. So one day if the company goes public, or if it gets sold or something. Maybe someone walks away with $50,000 or they walk away with like $100,000 or $200,000, or maybe even more. That’s awesome.

If you can help pay for their kid’s college, if you can help them buy a car, if you can help them pay off student loans or a house. That’s all incredible things. And by giving them that ownership, I want them to feel like this is their company. It’s not just mine. I can’t do this. Me and my business partners, we can’t make this work without everybody. We’re going to be out taking care of people. So every time one of our clinicians goes out to someone’s house, they are representing Pivotal Health. And so they need to bring that attitude of, yeah, I want to help you, let’s solve this problem. And so I want them to feel like that, hey, this is important. Not just for the company, it’s important for me as well. I feel strongly that companies like this, all employees should definitely participate in that equity.

SKOT WALDRON:

I get so frustrated when I see companies not investing in their people and not helping them feel part of the growth and the opportunities there, because what happens is that the excitement may fizzle from that first initial, I’m getting hired at this new company and I have a job, but what happens when they have a bad day or a bad week or a bad month, or there is a little bit of bad harmony inside the office, or maybe some hard conversation happens. They have no skin in the game. There’ll be just like, I’m out. Peace.

Or it’s, I still need a paycheck, but I’m not giving you anymore. They go out as your brand representatives, they represent your brand, who you are as a company, and they’re visiting those patients. And that reputation is going to spread and it’s going to help, or it’s going to hurt your business. Investing in them, helps them invest in the patient, which in turn comes right back around to you.

SAL BRAICO:

Exactly. Right. We don’t want to just take care of people once. I want them to come back to us over and over again. I mean you don’t just have one medical problem a year. Most people have two or three, especially when you have kids and things like that. People get sick.

I’m going to stress to everybody, always do what is best for the patient. It may mean that we lose money on this one interaction. So what? Who cares? If they know that we took care of them, if they know that we help them out, they’re going to keep on coming back to us. And when their friend calls them and says, hey, my son has this, or, hey, my husband’s not feeling well. They’re going to be like, hey, call up these guys. Call up Pivotal. They will help you out.

SKOT WALDRON:

Love it. Invest in your people, they’ll invest in the patient. That patient feels loved, taken care of, feels like you’re serving them, turn right back around and serve you. So many ways.

SAL BRAICO:

Exactly.

SKOT WALDRON:

How can people get in touch with you? When is this launching? Tell us about Pivotal and the future and how do we engage with you? What’s the thing you’re doing right now and what do you need help with?

SAL BRAICO:

So we’re in the process of raising capital. So we’re out talking to potential investors now. We only want to talk to people that have the means to invest. This is an early stage company. People that are angels, maybe some venture capital firms. So we’re out talking to those people. The best way people to reach me is probably email. It’s sal.braico@pivotalhealth.care. And we would be glad to go through the business plan with them and walk them through it. But that’s what we’re in the process of doing right now. We’ve been kind of refining the business plan, kind of getting all of the pieces together so that we can get this money in the door and just kind of get the operation going.

SKOT WALDRON:

Sounds awesome. Sounds exciting. You’ve been down this road before. You look cool, calm, collected. I don’t know if you’re just faking it, but you know, good job at doing whatever you’re doing. Awesome conversation. Thanks. I really appreciate you being on, Sal, and sharing some insights with us about building companies from the ground up and what that takes and just really appreciate the value you brought.

SAL BRAICO:

Great. Skot, thank you very much.

SKOT WALDRON:

Rule number one, no jerks. I love it. Jerks destroy companies because they destroy culture, which destroys people, which means collaboration is dead, which means the company, the atmosphere, the productivity, nobody wants to belong to a culture that grows jerks. We all want to belong to something that we feel invested in and that we feel part of and that we can grow with. And that is what’s important when starting your company. That was his rule number one.

And then finally, also we need to find people that can think. Use your brains. Yes, there’s processes and systems. Use your brains. You need to be able to think. And then the experience, the hard skills, make sure you’re developing yourself in a way that makes you valuable to other people around you. Thank you, Sal. Good information and good luck with the startup.

You can find all of my interviews at skotwaldron.com. On my blog, you can find a lot of free resources there for building teams, helping unlock the potential of people and your teams and your organizations. There’s a bunch of free resources there. You can also find these interviews on my YouTube channel. Again, it’s been fun being with you. See you.

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