Creating Synergy between Roles and Goals

Explore how aligning OKRs with TODs drives innovation and flexibility in clinical trials, with insights from the success story of a pioneering SaaS healthcare startup.


How HumanFirst, a pioneering SaaS healthcare startup, leverages OKRs (Objectives and Key Results) and keeps employees aligned as the team grows and its goals evolve.

Clinical trials establish trust in the safety and efficacy of pharmaceuticals, but pivots and restarts often plague trial design–posing a hardship for firms and for patients waiting on a lifesaving treatment.

There are thousands of tools available for collecting data and measuring patient outcomes, making it a challenge to zero in on the right one for a particular trial. HumanFirst, founded in 2017 by Andy Coravos, makes it easier to select the right tools for data collection, such as wearable devices (also known as Digital Health Technologies, or DHTs) and for patient outcome assessment, including imaging, lab tests, and electronic patient questionnaires.

The vetted data HumanFirst provides has already helped 24 of the nation’s top 25 pharmaceutical companies build more efficient and effective clinical trials. It plans to continue aiding in the acceleration of drug development with its dynamic catalog of 3,000 DHTs and outcome assessments that can gather more than 15,000 measures to address 1,000+ medical conditions.

When employees wear multiple hats

Just as speed matters in vetting medications that save lives and reduce suffering, time is of the essence for a startup like HumanFirst. “The more trials we support, the better patient care gets,” says Chloe Yoo, Chloe Yoo, Head of Operations and Finance.

Improving patient care and patient lives is the reason Yoo joined HumanFirst, while the organization’s flatness, flexibility, and opportunities have given her compelling reasons to stay. In this small startup, things move fast and change constantly. Every role is mission critical, and, as Yoo says, “Every single person wears a lot of hats.” To serve emerging priorities and opportunities, the team must allocate resources rapidly and fluidly.

“People have moved from engineering to product and from marketing to product ops,” says Coravos. She realized a traditional job description wasn’t flexible enough for a startup. So she replaced them with“Tours of Duty,” an approach borrowed from her time as entrepreneur-in-residence with the Food & Drug Administration. Tours of Duty (TODs) are short-term assignments of 6-18 months, creating flexibility for employees around roles at HumanFirst. “It’s a marriage between what the company needs and where people bring strength and a desire to stretch and grow,” Coravos says.

TODs describe roles in three parts: a mission, a set of responsibilities, and outcomes. Some roles, such as those that are purely operational, may have a long list of responsibilities, while others, in product and engineering are more outcome driven. Term length can vary too. But every TOD describes overarching outcomes that are expected by the end of the term.

TODs not only allocate resources to the most critical areas, they keep people engaged. “The culture and morale here is better than anywhere I’ve seen, and I think it’s because changing roles is celebrated,” says Chloe Yoo. “You don’t expect people to stay at a startup forever, and while they are here, you want them to be constantly changing and growing.”

Yoo, for example, initially joined HumanFirst in an operational role focused on internal business processes. “Now, I barely touch that.” she says. “Those responsibilities are now managed by a handful of people, and I spend 90% of my time on finance and on driving sales partnerships.” As for the speed and intensity of the startup environment, Yoo says, “Twelve months here is like three years somewhere else. The number of things you touch in one year is wild. The number of things you touch in one day is wild!”

Aligning roles with goals

If TODs help HumanFirst get things done, OKRs help the team get the right things done. Coravos has made them part of her strategy since the beginning, but the process has evolved.

She initially created top-down OKRs cascading from the CEO. Later she then tried bottom-up, but found that neither approach fully promoted ownership, engagement, or alignment. Now, the whole leadership team collaborates on top-line OKRs. “We focus on our highest order outcome,” says Yoo, “which is to increase the number of clinical trials we support.” Once leadership unveils the top-line OKRs, the rest of the organization ladders back up to them through the lens of individual TODs. Managers vet alignment between the OKRs and the outcomes expected of the TODs. And if an OKR doesn’t align with an existing TOD, they create a new one.

For example, in one quarter when pipeline development became a top priority, the operations associate shifted to a TOD focused on sales and marketing, driving and monitoring both inbound and outbound efforts.

Most new OKRs line up with an existing TOD. Christine Campbell, HumanFirst’s chief of staff, is an example. “As we start executing on what we have planned for the quarter, we see where the team needs more support to get something over the line,” she says. “In a generalist Tour of Duty like chief of staff, I can flex and do whatever our existing team doesn’t have the bandwidth to do.”

Sometimes a TOD is completed, and employees can propose new ones or apply for any open TOD. Someone might take on a TOD to develop a playbook for sales processes, then move on to something new, while another team member gains skills in a TOD that executes against and improves upon that playbook.

“I started off as a research analyst,” says Campbell. “Very quickly I was thinking about how data entered into the back end was being presented on the front end for our customers. This lent itself to thinking about being a product owner or manager.” She had never worked with engineers before, but with their help, “it was really fun to learn the technical side.” After working as a product manager, then leading product, Campbell realized she could bring good insights to a TOD in relationship management. “Because I was so deep on the product side, knowing how we built what we did and seeking feedback, I was then able to set up our customer experience team. I was just so excited to learn and do all the things!”

For HumanFirst, TODs and OKRs are just better together. “Every teammate has a job description and a Tour of Duty,” says Coravos. And every Tour of Duty is linked to OKRs. While they are related, Coravos bases compensation on how individuals fulfill overall roles and responsibilities. OKRs reflect an individual’s alignment with team outcomes. But it’s the combination of OKRs and Tours of Duty that allows employees to grow and change while remaining focused on the organization’s priorities as they fluctuate.

“In a startup, nobody will have the same role a year from now,” says Coravos, “but people deserve to know what they are doing (and why) and have a voice in pursuing a role that works for them.”

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