Creating a Starfish: lessons learned from starting an organization with 4 co-founders

Noora Health co-founders Shahed Alam, Katy Ashe, Jessie Liu and Edith Elliott — with Anubhav Arora (first hire) floating. [photo by Rachel Hamburg, comically horrible photoshopping by Katy]

Four co-founders. We’ve gotten plenty of weird looks when we introduce ourselves as such. It’s double, if not quadruple, the industry standard, and co-founding a company isn’t seen as a “more-the merrier” use case. How we did it still baffles us, but four years after we first met, we’ve gained some shrapnel of insight.

I’m going to borrow a Hindi quote used recently by a close friend and our first hire, Anubhav Arora, as a — perhaps slightly overdramatic — disclaimer, “Jo bhi main kehna chahun barbaad kare alphas mere” or, “Words will destroy whatever I mean to say.” That said, here’s my attempt to put some learnings from our wild and beautiful journey into words.


Huge strokes of luck and a lot of intention. We were semi-randomly brought together as self-selecting graduate students who took an intense, idealistic class called Design for Extreme Affordability. Each of us came in with a growth mindset, but “Extreme” served as an incubator that was a positive feedback spiral to think in terms of radical possibilities. Our early experimental days removed the veneer of socially-acceptable norms that ideas are required to be realistic. The Extreme community normalized failure as necessary. It set a high bar for the amount of perseverance a team should reasonably have to implement and iterate on an idea.


Love and fundamental respect always win. The decision for each of us to drop what we were doing and go “all-in” with Noora was personal & asynchronous, but we all did it because of the people first. Given that each of us was already highly invested in the idea, this was particularly telling. We believe good people are more important to success than a monumental cause. A good team can mean a lot of things — compatible personalities, shared values, aligned motivations, humor. Practically, that meant that we all enjoyed having annual retreats in treehouses where we made art to describe our best future selves, and resorted to playing “what is your nightmare” to genuinely air our fears that tail-spun into hilarity. At the core, we knew that we could share our best selves, our worst selves, but always our true selves with each other.


Leaning in to personality tendencies. We’re an unintentionally well-balanced team (half extrovert vs. introvert, half more internal product vs. external partnerships, half medical vs. non-medical). Even so, each of us started off pluripotent and leaned more into certain personality traits to meet the team’s needs. Edith, who’s great at telling our story, took on the majority of development and marketing needs; Shahed, who’s great at making everyone want to be his friend, became our natural partnerships lead; Katy, who’s got a sixth sense for being attuned to other people’s wants and needs, leads empathy work and design; and I, who love ground-truthing, talent-hunting and process management, took on impact evaluation and human resources.

What was tough in our early start-up soup days was that this was nebulous, and it took some sieving and shaking for us to fall into “neat” categories. After several external meetings where all four of us attended, but one-to-two people would pitch and answer questions, we quickly realized the organization couldn’t work with do-it-all and ride-along-for-everything mentalities. We were still in student-class-project mode and needed to adapt fast.

We’ve gone through fairly organic sanding to be very honest about our natural tendencies and have learned to address them head-on to fix or work through them. Disputes are unavoidable ebbs in the flow of any relationship that carves out so much time and space together, and we chose to use them as opportunities to learn about another facet of each other. Tough conversations about work styles, missed communication opportunities, or product direction have been goldmines for unveiling personality quirks. Since we know deep down, there’s that bedrock of love and respect, we’re not afraid to have those real talks.


Building cofounder intuition. From the get-go, we made decisions by consensus. This took considerably more time, but it was an organic way for us to learn patterns of how each of us think and approach problems. There were frequently misalignments or wiggle room of desired processes, but to-date, not of desired outcomes. By massaging out solutions based on each of our perspectives, we developed a good intuition for how each of us would react in any given circumstance. Each misreading has been fodder for honing future predictions. As a result, we have incredible trust in each other’s values, decisions, and actions to represent the whole. Now, we really only need to get consensus on big organizational direction decisions.

In parallel with talking out our reasoning for a certain decision, we also frequently talked about our individual fears and “existential crises” for the organization and plans for attack. The lines blurred often when we were talking about work or personal life, since individual values would inevitably come up. Those values were guiding pillars in strategy that were unintentionally woven into the culture of Noora.


Letting go of ego. We started off as a bunch of twenty-something-year-olds who decided to become a four-parent communal family in raising this organization. We’ve each sacrificed for infant, then toddler, and now teenage Noora’s needs and best interest, while attempting to stay true to self. Luckily, there are four of us to split responsibilities , but it has taken immense amounts of honest communication and trial and error to balance on this dynamic equilibrium.


Emphasis on the individual. We built Noora as an organization that keeps people first, which for us, means respecting people’s agency, treating everyone with dignity, and recognizing the shared humanity in us all. This principle applies to patient families we work for, our employees and fellows, and ourselves. With regard to this last point, drawing personal boundaries to ensure wellness was the first ground rule we set as a team in Extreme, when we knew that this intense class tended to consume. We’ve managed to mostly hold ourselves accountable, despite the endless needs of breathing life into Noora. The lapses when we’ve noticed one person sacrificing too much has put stress on our entire ecosystem, so it’s in Noora’s best interest when one of us advocates for another cofounder’s wellbeing — whether it be Shahed going running, Edith chasing a sunset with her husband, Katy hosting a party, or me, mad-dashing to the ocean. We can’t be good friends, family members, members of our respective communities, or cofounders as overly-extended people.

Noora Team on our annual strategy retreat in September 2016. This year we spent a few days hiking and hatching plans for our next couple years with the full team in tree houses on an elephant reserve in Kerala, India.

Future. The Noora universe is unique because it was built upon the sum of our individual cofounder values and personalities, but in order to hit lightspeed, we need to be able to communicate and externalize why Noora exists. In the past couple of years, we’ve expanded beyond just our first couple of hires to build a team of talented, driven individuals. In order for newcomers to invest in us, we need to make it easy for them to swim in sync with our work and cultural rhythm. This opportunity is presenting itself currently with my departure from Noora to finish medical school. While I’m sad to be sidelined, replacing my piece of the puzzle will give room for others to step in, and like a starfish, sprout another leg.