No Operating Manual
A podcast about building healthcare companies when there’s no clear path and no one tells you what comes next.
Each episode features candid conversations with founders and operators working at the earliest stages, where decisions are made with incomplete information and roles are undefined. The focus is on the real work: what you learn, what you have to unlearn, and what it actually takes to make healthcare companies function in the real world.
No Operating Manual is a podcast about building healthcare companies when there’s no clear path and no one tells you what comes next. Each episode features candid conversations with founders and operators working at the earliest stages, where decisions are made with incomplete information and roles are undefined. The focus is on the real work: what you learn, what you have to unlearn, and what it actually takes to make healthcare companies function in the real world. Derek Barrett has been watching the specialty care referral system fail patients for over two decades. As an EMR product manager at 23, he first learned how referrals actually worked. Not much has changed since. Today, as co-founder and CEO of Switchboard Health, he’s doing something about it. In this episode, Derek walks Erin through the real cost of a broken referral process. It’s not just the frustration of patients who can’t find an in-network specialist or wait months for an appointment, but the downstream clinical and financial consequences when people give up entirely. We’re talking tens of thousands of dollars in avoidable costs, and health trajectories that get knocked permanently off course. Switchboard’s approach works directly inside the EMR, identifying the right specialist at the right moment — factoring in location, insurance, wait times, and clinical fit — so that patients leave the exam room with a plan. Derek also reflects on what’s changed in healthcare technology since Switchboard launched in 2022, why the pace of change is forcing even young companies to rebuild from scratch, and what he’s learned transitioning from advisor and investor to first-time founder. Including what that actually looks like on a Tuesday night in a Starbucks parking lot.
