When Malcolm Gladwell released David and Goliath: Underdogs, Misfits, and the Art of Battling Giants, he turned the spotlight on a topic that is at the core of entrepreneurship. New companies are almost always fighting larger players--Goliaths--with established products and customers, money, and name recognition. And yet the growth of our economy is dependent on the Davids winning.

Put another way by Mahatma Gandhi, someone who was certainly David to an almost insurmountable Goliath, "First they ignore you, then they laugh at you, then they fight you, then you win." It's a good mantra for all startups to keep in mind and one that defines an entrepreneur's stages of development far better than "seed round," "A round," and "B round."

Here's what is important to know about each of these stages:

1. They Ignore You.

One of my least-favorite types of startups are those that claim to be in "stealth mode." That's its own kind of hubris. When you start a company, the world doesn't care what you're doing, but this can be powerful in its own way. This is when you and your company should define why you exist, what you seek to change, and then build a solution that makes that change a reality. That doesn't mean your product or service won't change during this phase; it will. But if you stick to that purity of thought, you will advance.

At Axial Exchange, we believe that patients actively engaging with their own care helps improve outcomes and lower costs--and we speak and write about this all the time. Though I'm sure large companies aren't losing sleep over us, it hasn't stopped 90 percent of all large hospitals from visiting our site and reading our white papers. We are establishing ourselves in the marketplace as experts in the growing trend toward patient engagement, even though we are not yet a commercial threat.

2. They Laugh at You.

This is sometimes referred to as the fly-swatting stage. Here, either Goliaths, or perhaps laggard customer segments, discount what you're saying because you threaten their worldview. They don't take you seriously, but you're beginning to irritate them. During this stage, you must speak your truth, and deliver value that proves that truth.

In our marketplace, Epic Systems is the 10,000-pound Goliath that continues to build systems centered on hospitals. Axial, on the other hand, builds systems that are centered on patients and connect to the hospitals. Silly? We'll see.

3. They Fight You.

Here, you are seriously beginning to bug Goliath. At my former company, Red Hat, no one will forget when Larry Ellison, at Oracle World 2008, used his 30-minute keynote to talk about what was wrong with Red Hat and open source, giving up valuable customer time to address his new enemy. At first, we were scared. But it turned out to be one of the pivotal moments in Red Hat's growth. You need to know who your Goliaths are.

Axial is not yet at this stage, but I look forward to the time we get there.

4. You Win.

Very few companies get here, and really, it's a mixed blessing. It is then that you're Goliath, and others are now David, and they will be relentless.


Joanne Rohde, named one of the Top 50 in Digital Health by Goldman Sachs and Rock Health, is on a mission to change health care by engaging patients and their families on the path to health, and by helping hospitals offer better care and outcomes by applying modern business principles to health care. She has led Axial Exchange to national recognition, placing first in the HHS Transition of Care Contest, and attracting top-tier investors, including Mayo Clinic. No stranger to driving change, as former COO and director of  health IT Strategy at Red Hat, Rohde and her team created a customer-first service model that propelled Red Hat from $100 million to $500 million in revenue. As CIO of UBS Investment Banking IT, she oversaw a $1 billion-plus annual budget and 1,500 mission-critical systems.

Axial Exchange is revolutionizing the way that patients manage their health. With Axial, hospitals are able to keep their patients continuously engaged, resulting in dramatically improved health outcomes and much more satisfied patients. Axial drives engagement by giving patients the information and interactive tools needed in order to get well--all delivered securely to the device of the patient's choice. Patients can share their health information with providers and caregivers. Health systems benefit via lower readmissions and improved patient-satisfaction scores.

Published on: Nov 6, 2014
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