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From startup to scaleup: how to build and retain your company culture

20 April 2021   |  
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In the latest blog, Charlotte Chorley, Director of Strategic Alignment and Communications, explores why company culture is so important and what start-ups can do to keep their culture as they grow. 

With 90% of startups failing, a company’s first few years are critical. During this time, founders are often laser-focused on building their products and services, as well as remaining on an upwards growth trajectory. But one important element that is often overlooked during this period of growth is building the right company culture. 

Culture has been a workplace buzzword for years, but the last twelve months has put it at the top of the agenda for many organisations as they have transitioned to decentralised and distributed working models. Best defined as the way in which a company interacts with its employees (and vice versa), culture plays a huge role in a company’s success and should be right next to strategy when it comes to a CEO’s or leadership team’s priorities. In a 2015 study, more than 90% of CEOs said that company culture was important in their organisation, and over 50% said that culture played an influential role in productivity, creativity, and profitability. Culture covers everything from values and mission, to leadership style and working environments, and is the second most important factor employees consider when it comes to where they want to work. 

As Healx has grown over the last seven years, its culture has needed to be both resilient and flexible in response to shifting needs. By going through the scaling process ourselves, we’ve picked up a few lessons on how to future-proof our culture, and we’ve also taken inspiration from other organisations and experts who have gone through the transformation from start-up to scale-up. Here’s what we have learnt:

Align on a common mission 

At the core of every successful company is its mission. Having and communicating a mission attracts, unites, and motivates employees by giving them a purpose. This purpose helps employees shape the values, norms, and beliefs of an organisation. Indeed, adapting Frances Frei and Anne Morriss’ comment in the Harvard Business Review, the company mission should be the blueprint to tell employees what to do when the CEO isn’t in the room. 

I, like many of the Healx team, am motivated by mission-driven organisations and I was drawn to how Healx wanted to make a positive impact on the lives of those suffering with rare conditions by identifying and progressing novel treatments at scale. I was also inspired by the founders’ (Dr Tim Guilliams and Dr David Brown) commitment to putting their mission at the forefront of everything they do. 

Patient impact is our number one value, and we encourage everyone to question the work they’re doing to make sure it is going to have a positive impact on a patient somewhere down the line. We also regularly invite rare disease patients to our ‘All Hands’ meetings, to share their experiences and perspectives on their illness and access to treatments. Hearing directly from them reminds us all of why we turn up to work each day, and keeps us aligned on our North Star. This year, we are also trialling ‘Community Days’. Every employee will get one day to spend out of the office doing something with the rare disease community, whether that’s volunteering, raising money, lending their skills in-house or something else. As we have continued on our growth journey, keeping patients at the heart of everything we do has allowed us to retain our strong culture and ensure everyone embodies our values. 

This experience has shown us that defining the company mission is only the first step—the greater challenge is often finding ways to implement it. Company mission, values, and culture all depend on the workforce continually remaining aligned. We’ve explained how we try to do that above, but there are certainly other ways to do it. For example, organisational experts NOBL advocate for a culture contract. Teams can use this to agree on boundaries and set a standard for behaviour that will permeate through operations. Importantly, drafting an agreement which takes all opinions into account means that employees will be more motivated to succeed since they have had a part to play in its creation. Reviewing the contract as the company moves through growth phases is also crucial, so that processes can develop to align with new goals. This gives the entire workforce the power to shape their own culture, and voice how the business can continue to scale with its mission in mind.

Open up the decision-making process

One of the many appeals of a startup’s culture is its autonomous work ethic. In the early days, everyone is involved in the decision making process and company structure is less apparent. This instills a bond between employees, making them feel united in their mission and responsible for the direction the company is going. It’s also an important marker of the company’s culture. However, as a company grows, hierarchies emerge and decisions are often siloed upwards to senior management. This can lead to employees feeling unseen and unmotivated, which in turn can have a detrimental effect on company culture. 

We haven’t always got the balance right at Healx, but one thing we’re trying to do is to open up the decision-making process through cross-functional teams and team-based Objectives and Key Results (OKRs). OKRs have long been championed by the likes of Google and LinkedIn as a way of establishing ambitious goals and tracking progress. They create alignment around a mission (since all OKRs should work towards a common goal) and they provide focus by creating commitment and accountability. Critically, they promote buy-in as they have to be developed by the people who are actually doing the work. Every year, Healx’s senior team set out the Strategic Priorities for the next twelve months and the top priorities for the coming quarter. From this, cross-functional teams come together to identify where they can move the needle and develop their plans. This process gives autonomy back to the team to shape and direct their own work, whilst also ensuring everyone is striving towards the same mission. 

Netflix has another model for decision making at scale, made famous by their ‘no rules’ culture. At Netflix, leaders ‘lead with context’, giving their teams all of the relevant information needed to make a decision. They then trust their team members to make decisions that are in the best interest of the company, without approval or oversight from higher management. When something goes right, the team can celebrate—and when it goes wrong, the team is encouraged to share the learning with the rest of the company so they can keep growing. Although Netflix’s decentralised approach is seen by some as extreme, it shows how decision-making frameworks are a central part of a company culture and something every leader should consider adapting as they scale. 

Communication leads to connection   

The points above have highlighted the need for mission and direction, but what underpins both of these is communication. Having leaders who are visible and regularly reinforce the culture and vision of the company is critical, alongside providing the right tools and spaces for teams to connect with one another and share information. 

The shift to remote working has highlighted this importance, as many businesses have had to quickly implement new technologies and practices to keep communication alive. Alongside our weekly All Hands meetings, which focus on celebrating wins and keeping people updated on progress, our teams have also been using a variety of tools to coordinate their work. Platforms like Monday.com, Miro, and Slack have allowed operations to keep moving forward at pace, meaning we can continue to deliver patient impact. We have also created best practice documents on how to optimally use Slack and Confluence. As a business which has remained focused on scaling during a time of crisis, we have hired and onboarded over 30 new joiners since March 2020. These new technologies and processes have kept all employees, old and new, aligned and in touch regardless of where they are based.

But this past year hasn’t been all work and no play. We have also kept our culture alive by hosting a variety of virtual activities such as company-wide Team Weeks and regular coffee breaks where our employees can continue to nurture relationships outside of work. We have also set up ‘Special Interest Groups’ on a number of topics, such as D&I or coding, where those interested in attending can discuss the specified subject in-depth during dedicated sessions. Communication, both on work-based matters and broader subjects, is a critical pillar to many company cultures – and mastering it now by using the right tools and processes will be key for companies looking to scale. 


Building a successful culture is difficult, regardless of the size of the company or the stage of growth it is in. But for startups looking to become scaleups, creating a resilient and mission-driven culture that is curated by all employees is fundamental to attracting the best talent and bolstering business success. Despite the obstacles companies will face on their growth journey, investing time and resources into carving out a unifying and impactful culture will allow them to reap the benefits of an empowered workforce for years to come.

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