Learning to Walk — A Startup’s perspective.

Ravi Kamalendiran
Dec 5, 2019 · 8 min read

In the mid part of 2016, a class mate who I hadn’t seen for over fifteen years sent a message to our otherwise colorful school WhatsApp group, asking about how to set up a company and that he too was about to move back to Sri Lanka after an extensive stint in the middle east. As I had done the same only a couple of years back, I replied with some of the information needed. The following blog is an attempt to capture how we started, the driving forces behind our growth, the pitfalls we faced and where we are now.

Every animal that’s born takes a certain amount of time before it can walk, for some animals that time might be quite small as fifteen to thirty minutes, like in the case of herbivores on the plains of Africa. But for some animals that period can be relatively long like for us humans where we start to walk almost after a year since birth. Organizations behave quite similarly where some find their feet relatively sooner whilst others take more time and the ones that don’t or forget how to walk go out of existence. This blog tries to explain how Cloud Solutions International (CSI), a two-year-old organization is trying to walk.

CSI is the only off shore IT company of the Dr. Sulaiman Al-Habib medical group, a group that owns multiple hospitals in three different countries as well as an IT company in its home country, the Kingdom of Saudi Arabia. It should be noted that all the other sibling companies are profit centers whilst CSI is the only cost center — which means we are like the flat footed little sibling born in to a family where all the other members of the family are Olympic Champions. So pressure was something we were accustomed to from day one.

Birth to the Six Month Period

Creating and driving an organization is an uphill task, which is made easier or more difficult based on the employees you hire. It was no exception for us as well, but fortunately for us we hired right and we had people who knew what type of people were needed. After clearing the initial hurdle of getting approval by the relevant authorities, we got down to the business of clearing the next hurdle, which was location. Location is the pull factor for potential employees, other than the marketing done by the interviewer. The initial approval was for eighty staff members so we needed an office space that was accessible, was in a decent location and cost effective. We started off by renting a room with four desks at the Bernard’s office space location as the current office at St Anthony’s Mawatha had to be refurbished. Soon as the cafeteria was renovated at the current office, we shifted with interviews being held both at the café, as well as White and Co. We wanted an open culture where everyone had access to and could communicate with everyone, also we wanted a flat structure. We also ensured that the entire office was open without individual work spaces where each desk was a hot desk and the senior staff was encouraged to move desks every now and then.

We had quite a few informal gatherings whilst trying to establish processes and standards. We celebrated everything from festivals to birthdays coming together as a company. The advantages of this approach was that people started to come out of their shells, contributing and wanting to contribute towards the growth and success of the organization. There were many late nights but there were relatively no complains. The disadvantage of our approach was two-fold, the first one is that, we failed to understand the importance of support staff such as Project Managers, Business Analysts, Human Resources. Because of our employee strength some neglecting support staff didn’t impact us too much, although having them from the start would definitely have changed where we are now. The second disadvantage was our office approach. Agile teams should be collocated with the scrum master being the gate keeper to the team. Open office meant that we didn’t have shut off spaces where one team can occupy and work together.

Impact of the disadvantages were negated by our employees and their “never give up” attitude. Talented employees who loved our technology stack along with the “never say die” attitude meant that we were able to work through our issues by coming together, ensuring that senior staff and the junior staff shared the long work hours.

Cloud Solutions International had started to roll over in its proverbial cot.

Six Months to the one-year period

Excitement and eagerness to learn a relatively unknown domain was the overall theme within the organization during this period. The domain knowledge was given by experts who flew down to Sri Lanka and spent their time with us in Colombo. On our part we ensured that every subject matter expert who touched our shores fell in love with our country. Each subject matter expert or SME held knowledge pertaining to their respective areas. We had a Lab Manager from the Dubai hospital to teach us how a medical laboratory works. For our clinical modules we had a neonatal pediatric consultant bringing us up to speed on the doctor’s view of an outpatient, inpatient, labour and delivery room as well as Neonatal Intensive Care Units. We also had nurses, intensive care unit staff and financial experts from our parent group visit us in order to update our knowledge.

Daily knowledge transfer sessions were the norm where during the day we would listen to how the system should work and in the evening would put them in to documentation with possible diagrams. The documents were then sent to the expert to review and either change or accept. In parallel our user interface and user experience were busy building prototypes which were also demonstrated and improved. We had three teams in the beginning working on one finance module, Revenue Cycle Management, a clinical module aimed at the outpatient department and the Laboratory Module which was an ancillary requirement.

Highlight has to be how we celebrated our one-year anniversary at Cinnamon Grand along with our Group CEO and our Sister Company CEO. The exact details of the celebrations are a bit hazy to me as it was that good a party. The baby had started to crawl and was not confined to the cot.

First to the Second Year

Sometime during the first year, we got news that the Ministry of Health for the Kingdom of Saudi Arabia was looking for a vendor to implement an HIS system in line with their vision to become paperless. Our sister company was also in the running to be one of the chosen vendors. But as the Ministry of Health or MOH wanted a cloud application, we were asked to ramp up. In response to the demands, our company begun growing almost doubling in head count. We also started to circumvent process, where from Scrum we switched to Kanban without keeping the work in progress to a minimum and integration between modules were not considered. I akin these decisions to the process of learning to walk, where the first few steps aren’t sure footed and more often than not involves the act of falling.

But with the act of falling also comes the knowledge of how to break fall and also how to rise back up after the pitfalls. Cloud Solutions International kept at trying to create a system that was worthy of a nation. We started more modules like the Specialized Clinics, Operation Room and towards the end of the second year, the Emergency Room which were all clinical modules. We also started the Pharmacy, and Blood Bank module which were ancillary requirements. And we also started the administration modules of which would take care of where the patient gets admitted to. It has to be stated that we bit off a bit more than what we could chew. But the workforce didn’t lose faith, as they persevered through days and nights ensuring that the VIDA Health Information System took shape.

And as the system started to take shape, we could say that we had start to wobble, not entirely confident, but not giving up on walking either.

Second Year to Present

The second year involved course correction, and for starters we got a Human Resources Manager, and the Human Resources Function was established. We also got a Business Analyst Lead to compliment the UI/UX Lead and along with Social Media Management established the Product Management function. The Project Management, Data Analysis and Data Migration functions was given priority with the objective of going in to production. The Dev-Ops team was created with a mixture of both internal resources as well as external recruitment. With the establishment of these functions we started to see benefits. The Human Resources function was tasked with allowing an open culture as well as looking after employees bring about a work-life balance. With the product management function came ownership for the requirements where the Business Analysts were empowered to act as proxy product owners. With project managers becoming more statistical came the maintenance and tracking internal data tracking which would lead to governance.

From a product perspective, we involved our sister company, Cloud Solutions (CS) in the Kingdom Of Saudi Arabia, with the objective of having an independent test team verify the functionality, stability and certify that the product was indeed up to standard fit for a hospital. We also had an independent security audit done on the application as well and we consulted a US based company on Usability. The analysis of the above mentioned external parties meant that we had a pretty accurate idea of where our product is and what we needed to do, in order to get it where want it to be. It was another hurdle, but one which our teams knew how to clear. We started with amalgamating services and databases to a manageable size, moving on to implementing the security considerations mentioned, whilst in parallel we also started fixing issues that were raised by the CS test team. And when it came to change in functionality, we started to prioritize and analyze both the impact of doing the change vs risk of not going ahead with the change, so that only absolutely necessary changes made it the developer whilst the rest were captured in the backlog.

As the iterations went by, we started to see that our product became more stable, it became more manageable to build and deploy. Errors were becoming easier to debug and the gremlins stayed away. The wobble had gone and in its place was a confident stride. In my opinion it is the pace of the stride and maintaining the pace was what was left for us to work on.

Conclusion

At present we are in the process of going live for the Ministry of Interior (Kingdom of Saudi Arabia). We are also doing demonstrations to prospective clients and where the clients themselves are in the process of doing proof of concepts with our system. Conquering the Saudi Arabian Health market certainly was not an easy task, and in that task we have just started to scratch the surface. We won a couple of local awards and were also recognized by Oracle (KSA) along the way. We have been honored to have our products also listed alongside Healthcare giants such as Epic and Cerner.

Cloud Solutions International Drives Healthcare Innovations and the innovations we did allow us to seamlessly switch between one cloud provider to another, switch between one database to another, run on a managed Kubernetes Environment or on a platform built from bare metal.

The organization that was conceptualized in 2016 is now definitely walking, a confident walk. But we will stay humble and ensure that we change with technology as if we do not, how can our clients stay ahead of disruptive technology.

Cloud Solutions International

Cloud Solutions International is a software product development company specialized in health care domain.

Ravi Kamalendiran

Written by

Cloud Solutions International

Cloud Solutions International is a software product development company specialized in health care domain.

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