The Paradoxical Need For Ecosystems Despite Potentially Destructive Problems With Them

Sherri Douville
6 min readAug 22, 2022

Navigating the Untrustworthy (In Startup High Tech Context): The Dishonest, Thieves, With Bad/No Values/Character, and Even the Naïve & Idealistic

The paradox of ecosystems is that you need them, especially in the case of software for medical technology. Though there is a trust vacuum due to widespread lack of trustworthy players. The reasons are many including lack of values, poor ethics, and even naïveté. That’s why there are a ton of problems with them and lots of dangers in ecosystems. This post doesn’t cover a myriad of alliances between financial beneficiaries of or board relationships of dishonest players, and needing to be aware of those landmines in the ecosystem. Think of it like only having access to shark infested water instead of fresh water. You like and want to be in the water, though you have to be smart in the water and see sharks for what they are.

1) The best book for encountering egos “Unmasking Narcissism” 2) Finding NEMO

Sing along “Who let the sharks out” with “who let the dogs out”

The right ecosystem for an innovator is not what most people think it is. It’s not “open” and not “free” to all. On the contrary, it should be highly selective and super exclusive. This has nothing to do with the value of inclusion or diversity that can and should be operationalized in ways that don’t put your career or organization in jeopardy or cost more time than the benefits.

Before anything, first filter everything through the lens of the fact that most organizations and people, despite what they say; they in reality despise innovation. Innovators experience this in many different ways, mostly manifesting as undesirable behaviors by those lacking self awareness.

“Research has found that we actually harbor an aversion to creators and creativity; subconsciously, we see creativity as noxious and disruptive, and as a recent study demonstrated, this bias can potentially discourage us from undertaking an innovative project.”

Then there are the morally bankrupt extreme elements of any sector such as “longtermism.” Where the rules of decency don’t apply, players would be tempted to make things up and lie about anything, even multi-billion dollar transactions, public scale works; all only for hidden personal gains.

Once you accept and process these two above hurdles, learn further why the innovator’s ecosystem has to be super exclusive and almost stealth.

Companies and individuals without good values and character ruin it for everyone else because there’s no trust. The biggest examples for how this plays out are:

1) Fishing expeditions which are extremely time wasteful. I overheard a CEO at a party brag about putting a smaller company out of business by wasting their time. Most of us know about these scenarios and have heard about them many times from valley insiders.

2) IP theft; short of outright theft, there are also scenarios where an investor has competed with their own investment

3) The secondary pain in the rear is not just the perpetrator themselves; but the naïve and idealistic stakeholder that accidentally overexposes you to a perpetrator.

Naïve stakeholders can put you in great danger, for example see: fishing expeditions here:

A good summary of the issue of stolen IP which can happen from various scenarios and players: hostile foreign actors, former employees, competitors etc. Many large companies focus more on deploying lawyers to block innovation than on creating real innovation:

It’s Time To Play Fair on IP:

“U.S. Lawmakers have recently been calling out players for unfair, uncompetitive, and outright harmful actions recently.” They are responding to what this article calls ”clear evidence that their approach to other company’s patents is to steal first, fight it out in court later.” (Note that Fortune is widely known as pro-business and rated center-right on

Misaligned goals between ecosystem sectors (building a business vs the public sector/not to be confused with “publicly traded”). Notice the misaligned priorities between ecosystem player types pictured here.

Sherri Douville, “Multidisciplinary Approach to Healthcare IT” Presented to Stanford Medicine Care Scholars Innovation Series

Six scenarios where there can be no real ecosystem or partnership:

1) When there is no trust (fishing for information, wasting time whether intentional or accidental due to steep learning curves mismatched with aptitude)

2) When there are no common values: the workforce doesn’t know the difference between “first do no harm” required in medicine and “who cares who gets harmed” and acts from the latter.

3) When there is no ethics or character (gain international reputation for stealing IP); everyone in Silicon Valley knows who these companies and players are.

4) When there is no honor; the behavior will be more about squashing and stealing from innovators than actually competently executing on their own innovation work. Again, everyone knows who they are and it’s sad that instead of innovating, they waste everyone’s time stealing IP despite enormous resources at disposal.

5) When there are weak or no management or leadership competencies across strategic, project, operational, and domain, in our case, clinical elements; that leaves a bulk of the workload to operationalize any ecosystem activity to the most skilled entity. Every organizational affiliation or collaboration has to be managed, coordinated, and led. Therefore, the overhead and benefits tradeoffs for the management, coordination, and leadership workload need to be evaluated very carefully.

6) Various stakeholders’ knowledge gaps can also be enormous and scary to align around. This is not the same thing as; though it’s related to incompetence. It is difficult to discern evil from incompetence many times if the results are similarly undesirable.

From Business Insider Video on Incompetence of Criminal Gangs Resulting in Harms, Not Just Intent to Harm

Despite all of these very real difficult ecosystem problems, we still at Medigram seek to and actively work to build a leading, best in class ecosystem. Our simple rule: Recognize and double down on those real and rare potential partners.

Here is a map pictured below of what’s needed for long term success.

Build out the connections and competencies to orchestrate this map for yourself and for your exclusive (invite-in) highly vetted and trusted partners, individuals (not necessarily entire organizations) of high quality, high integrity, great reputation, wise players. Vett them very carefully.

Figure 1. Isenberg’s model of an entrepreneurship ecosystem [2]

Rare real partner opportunities: Target highly competent, high self esteem, with great reputations, high integrity partners with high EQ. That allows for them to work through knowledge gaps and learning curves (enterprise software, startup, medicine) in a way that’s productive as opposed to what’s destructive. There are always stunning knowledge gaps in medical technology, even for recognized experts in it. There are additional knowledge gaps that are domain specific and separately specific to enterprise software startups. In software for medical technology; you’ve never seen so many knowledge gaps. The ideal partner profile is a person who is extremely secure; they aren’t in their profession for social popularity. They play a long game, not a short ego trip, and have almost like a greater calling to make a real impact with their lives and work.

By Sherri Douville, CEO at Medigram, the Mobile Medicine company. Recognized in 8 categories of top CEOs by Boardroom Media (Across SMS, mHealth, iOS, IT, Database, Big Data, Android, Healthcare). Top ranked medical market executive worldwideand #1 ranked in mobile technology categories (mhealth, iOS, Android), #1–2 (on any given day) for the cybersecurity market in the U.S. on Crunchbase. Best selling editor/author, Mobile Medicine: Overcoming People, Culture, and Governance


[2] ENTREPRENEURIAL ECOSYSTEMS AND GROWTH ORIENTED ENTREPRENEURSHIP Background paper prepared for the workshop organised by the OECD LEED Programme and the Dutch Ministry of Economic Affairs on — Scientific Figure on ResearchGate. Available from: [accessed 21 Aug, 2022]

Sherri Douville