As companies grow from scrappy startups to scale-ups, they face a critical challenge: how to maintain a deep understanding of customer needs while dealing with rapidly increasing complexity. I recently had the pleasure of chatting with Nick Altebrando, an experienced product leader and the current Chief Product Officer at Ada, who has a ton of experience taking companies through the “Scale Up” Phase. Nick shared valuable insights on prioritizing customer needs, leveraging data effectively, and balancing stakeholder interests in fast-growing companies.
Q: Nick, you've led product teams at several scale-up companies in the healthcare space. What draws you to this particular stage of company growth?
Nick: The scale-up phase is really the sweet spot for my personality and skills. I'm more structured than what a super early-stage startup would benefit from, but I'm a bit too anti-structure for a large corporation. I also like being able to move quickly between granular details and high-level strategic thinking. In a scale-up, you're constantly wrestling with how to execute on your vision, and that "how" becomes a strategic consideration in itself.
Q: Can you elaborate on what you mean by focusing on the "how"?
Nick: Absolutely. Let's take an example from my time at AbleTo, which offered online behavioural health services. We knew we wanted to treat more people with the same limited staff, which meant we needed to do more things digitally. But figuring out exactly how to do that involved a lot of strategic decisions.
What specific value could we offer through digital channels versus human interaction? How could we keep users engaged in their care? Should we focus on communication tools, goal-tracking features, or something else entirely? We ended up programmatizing evidence-based cognitive behavioural therapy into an app, but that wasn't obvious from the start. There were a lot of competing ideas, and we had to figure out which ones to target and how to execute them effectively.
Q: How do you approach prioritizing these competing ideas and customer needs?
Nick: I use two main exercises that I overlay. First, I firmly believe that to be successful, whatever you do has to solve the needs of all relevant constituents. In a B2B2C model, for instance, you need to consider the needs of the end user, the business customer, and your own company. If you're not addressing all three simultaneously, someone's left out and it's likely to fail.
The second approach involves using a variety of data collection methods. I'm probably a bit more rigid about this than some people, but I find that many research techniques, while valuable, are poor at predicting what will actually work. The exception is when you can get prototypes or real products into users' hands.
Q: So you're saying that what customers say they want isn't always what they'll actually use?
Nick: Exactly. There's a famous Steve Jobs quote about this – people don't always know what they want until you show it to them. Even when people think they want something practical, it doesn't mean they'll actually find the time to use it.
. If you look at personal health metric tracking for example, 40-60% of people have been saying they'd find it really useful to track their personal health data going back 10 years. But in practice, most people don't make time for it. The products that have stuck around in this space are the ones that passively collect data, like activity bands. There’s a subset of people with really serious health concerns that are highly motivated to track various things and if you just talk to them you might think “I’ve found it! Something to engage the masses!” But it doesn’t. It engages a niche.
Q: How do you balance all these inputs – customer feedback, usage data, business needs – when making product decisions?
Nick: It's crucial to start by shipping something and then looking at how customers are actually using it. Are they using it as you expected? What pain points are they trying to address? Then you can go back to the usage data and form hypotheses about whether the product is actually supporting what customers say they're trying to do.
This creates a feedback cycle that informs what you ship next. Sometimes you'll find that a feature you thought was great isn't being used at all. That's when you can go talk to people and ask why. Maybe it sounded useful, but they don't have time for it. That insight is actionable – you can then look at ways to make it less time-consuming or more passive.
Q: With limited resources, how do you decide what to prioritize and what to say no to?
Nick: There are a few key considerations. First, I believe that any changes or improvements should be adjacent to what you're already doing. If you're building something that doesn't connect directly to your current offering, you're essentially creating a new product, even if it's in the same app or website. Some people think of this as a pivot. It’s not - it’s a new startup.
Beyond that, I look at statistical impact. If a change will only affect 5% of users versus one that impacts 60-70%, that gives you a pretty good idea of which will be more impactful. You'd be surprised how much time companies sometimes spend on features that only a tiny fraction of users engage with.
Of course, you also have to consider the revenue impact. At the scale-up stage, driving revenue is typically the most important factor for the business. But it's not just about your company's revenue – you need to prioritize things that will deliver more value for your customers too, often by helping them make or save money.
Q: Any final thoughts for product leaders navigating the scale-up phase?
Nick: Remember that you can't solve everything, and sometimes the solution isn't a product change at all. It might be improving onboarding, training, or access to existing features. Always be looking for that balance between what users say they want, what the data shows they actually do, and what drives value for all stakeholders in the ecosystem.
Conclusion
Nick's insights highlight several key principles for product leaders in fast-growing companies:
- Focus on solving problems for all stakeholders simultaneously 🎯
- Use a mix of quantitative and qualitative data, but prioritize actual usage over stated preferences 📊
- Look for adjacent improvements rather than entirely new products 🧩
- Always tie decisions back to value creation - for users and the business 💰
By following these guidelines, product teams can navigate the transition from startup to scale-up more effectively, maintaining customer-centricity while driving sustainable growth.
