The Messy Middle of Medical Innovation: 5 Japanese Principles That Saved My Sanity (And My Startups)

Levi Cheptora

Thu, 20 Nov 2025

INTRODUCTION: The Messy Middle, Theatre of Madness

Let me tell you something I wish someone had whispered into my ears when I built my first healthcare venture:

“In business, especially medical entrepreneurship, the beginning is sweet tea, the middle is hot pepper, and the ending is either honey or hospital admission.”
— Modernized African Proverb (with clinical relevance)

If you’ve ever built a hospital system, launched a medical device, trained clinicians, deployed a digital health platform, or even just tried to convince a health regulator that your software is not a weapon, you know exactly what I mean.

I’ve built five ventures now — from digital health to clinical education, from tech-enabled primary care systems to AI diagnostic tools — and what I’ve learned is this:

There is nothing more character-building than building in healthcare.

Forget entrepreneurship being “hard.”
Healthcare entrepreneurship is hard + regulated + mission-critical + underfunded + over-scrutinized + humanity-dependent + politically entangled + scientifically intensive.

And still, we push.

Because at the core, those of us who innovate in medicine are wired differently. We don’t just want to make money — we want to fix the things everyone else complains about but never acts on.

But the messy middle — that long, painful, chaotic stretch between idea and impact — can feel like trying to herd goats during a rainstorm. You think they are going left; suddenly they are on the neighbor’s roof. Same with product development.

Over the years, 5 principles kept me grounded. They’re Japanese, but they align uncannily with African entrepreneurial survival instincts.

I’ve tailored them specifically for medical innovators, creative entrepreneurs, clinicians, researchers, and healthcare leaders.

Let’s dive in.

1. KAIZEN — Continuous Improvement, One Microscopic Step at a Time

Kaizen is the art of constant improvement, and if you’re in healthcare innovation, you already practice this without knowing. Because nothing in health works perfectly the first time — not the prototype, not the regulatory submission, not the clinical workflow, not even your explanation to investors.

WHAT KAIZEN MEANS FOR HEALTHCARE ENTREPRENEURS

It means:

• Build the imperfect version first.
• Test it ruthlessly.
• Rebuild it quietly.
• Pretend you knew what you were doing all along.

THE AFRICAN TRUTH ABOUT KAIZEN

My grandmother used to tell me,

“Even the ugliest chicken can learn to fly when the fox arrives.”

That is Kaizen.

You don’t improve because you’re comfortable — you improve because the system will eat you alive if you don’t adapt.

CASE STUDY: The EMR That Refused to Behave

In my second startup, we were designing an EMR for rural clinics. The first version was so bad that even I didn’t want to use it. A nurse looked at me and said,

“Daktari, this thing needs prayer.”

Not feedback — prayer.

But we applied Kaizen:

• We watched clinicians for days.
• We redesigned workflows.
• We did shadowing, user interviews, and burned through versions like a bakery burns through charcoal.
• Improvement upon improvement until the system stopped fighting us.

That’s Kaizen.

KAIZEN IN ACTION: The Healthcare Version

→ Come up with messy ideas — no shame.
→ Test them in the wild (clinics, wards, communities).
→ Collect brutal feedback (health workers don’t sugarcoat).
→ Compare what works vs what fails tragically.
→ Refine prototypes, workflows, SOPs.
→ Standardize successful systems.
→ Then do it again.

THE RIBCRACKING ANECDOTE

One time we piloted a triage AI system at a clinic. It had a bug where everyone with a headache was classified as “Possible Pregnancy.”

Imagine a 70-year-old man being told:
“Congratulations, you may be expecting.”

The clinic nearly chased us out with stethoscopes.

But Kaizen saved us:

• Fix
• Test
• Improve
• Repeat

You survive by iteration.

2. SHOSHIN — The Beginner’s Mind

Shoshin teaches us to stay curious and humble, even when we are the subject-matter experts.

In healthcare innovation, this is golden because:

• Clinicians think they know everything.
• Engineers think clinicians know nothing.
• Patients think everyone is confused.
• Regulators think all of you are dangerous.

Shoshin restores balance.

WHY SHOSHIN MATTERS IN MEDICAL INNOVATION

Because even after years of training, research, product testing, and certifications, you will still be wrong about something.

A beginner’s mind leaves room for:

• Feedback
• Adjustments
• Listening
• Curiosity
• Relearning

CASE STUDY: The Misleading Assumption

We once assumed that digitizing patient records would automatically make clinicians happy.

Ha!
Ha!
Ha! Clinical laughter intensifies

A nurse told us:

“Digital is good, but if power goes off again, please don’t look at me.”

We realized:

• The problem wasn’t the software.
• The problem was the infrastructure.

Shoshin helped us ask:

• “What would make this easier for you?”
• “What would make this safer for patients?”
• “How do you want to record information?”
• “What frustrates you the most?”

Those questions led to solar solutions, offline backup syncs, and workflow redesigns.

AFRICAN WISDOM MEETS SHOSHIN

“When you think you’ve seen all the snakes, a new one grows legs.”

Meaning:
The moment you assume you know everything, healthcare will humble you.

SHOSHIN IN PRACTICE FOR HEALTH INNOVATORS

→ Ask your team questions before offering solutions.
→ Watch users interact with your product in silence.
→ Listen with full attention, not with your rebuttal loading.
→ Be willing to unlearn what you thought was obvious.
→ Accept that sometimes, a janitor will understand your workflow better than you.

3. KINTSUGI — Turning Failures into Golden Lessons

Kintsugi teaches that broken things can become more beautiful after repair.
In healthcare innovation, failure is not just common — it is mandatory.

You will:

• Fail prototypes.
• Fail pitches.
• Fail funding rounds.
• Fail regulatory submissions.
• Fail launches.
• Fail assumptions.

But each failure strengthens the journey.

REAL-WORLD MEDICAL FAILURE STORY (THAT HURT, BUT WE LEARNED)

We once deployed a maternal health tool we were extremely proud of. Beautiful interface. Solid AI backend. Smooth UX.

The problem?

Mothers couldn’t use it.

Not because they were uneducated — they were extremely smart.
They simply didn’t have:

• Smartphones
• Data
• Wi-Fi
• Power

We built a solution for a context that didn’t exist.

But instead of giving up, we rethought everything:

• USSD-based tools
• SMS education
• Community midwife versions
• Offline features
• Voice-based systems in local languages

We turned a failure into a case study of contextual innovation.

That’s Kintsugi.

AFRICAN PROVERB FOR KINTSUGI

“The child who falls in the river is the one who learns how to swim fastest.”

Meaning:
The pain is part of the transformation.

HEALTHCARE EXAMPLE: When The Product Breaks

If your AI misdiagnoses, or your app crashes, or your wearable overheats like a Nokia torch in 2004, or your hospital software freezes during a ward round — you learn. You rebuild.

Healthcare innovation is not for the emotionally fragile.
It is for those with enough resilience to stand back up after medicine itself punches them in the liver.

4. IKIGAI — Finding Your Reason for Innovating in Healthcare

Ikigai is a compass — the intersection of:

• What you love
• What you’re good at
• What the world needs
• What you can be paid for

When you find that sweet intersection, your work stops feeling like work and becomes mission.

IKIGAI FOR MEDICAL INNOVATORS

We don’t build in healthcare because it’s glamorous.
There is nothing glamorous about:

• Endless paperwork
• Swallowing regulatory bureaucracy
• Begging auditors for mercy
• Arguing with procurement
• Convincing investors that “market size” is not just a guess

We build because we are called.

CASE STUDY: The Moment My Ikigai Became Clear

I once met a woman in a rural clinic who had traveled 27 km on foot to get her child examined.
The child had severe pneumonia.
She said, “If we had information or tools near us, maybe I wouldn’t have walked this far.”

That day, my Ikigai crystallized:

My work is to bring healthcare closer to people — through innovation, technology, and systems.

Not for acclaim.
Not for titles.
But because the world needs it.

IKIGAI AND AFRICAN WISDOM

“A river that forgets its source will dry.”

You must remember why you started.

IKIGAI QUESTIONS FOR MEDICAL ENTREPRENEURS

1. What part of healthcare makes your heart beat faster?
2. What skills do you have that others struggle with?
3. What health challenge keeps you awake at night?
4. Who is willing to pay for the problem you solve?
5. What would you still be doing at 2 a.m. even if no one clapped for you?

Your answers shape your legacy.

5. WABI-SABI — Beauty in Imperfection and Change

Healthcare innovation is one giant mess.
Systems break.
Patients change.
Policies shift.
Technology evolves.
Funding disappears mysteriously.
Clinics burn down your user guide because “it is too long.”

Wabi-Sabi teaches us to appreciate the imperfection instead of fighting it.

WHAT WABI-SABI TEACHES HEALTH ENTREPRENEURS

→ Accept situations as they are.
→ Focus on simplicity, not complexity.
→ Create products that adapt, not dominate.
→ Build for real environments, not ideal ones.
→ Find peace in uncertainty.

A SCENARIO FROM THE FIELD

We once trained a clinic on a digital triage system. Everything was perfect until the power went out and a baby goat entered the ward.

The clinician calmly said,
“This is why your system must work offline.”

Sometimes change comes wrapped in fur.

AFRICAN PROVERB MEETS WABI-SABI

“No matter how neat the village looks in the morning, goats will rearrange it in the afternoon.”

Meaning:
Chaos is natural.
Your work is to remain at peace.

WABI-SABI FOR MEDICAL ENTREPRENEURS

→ Your prototype will be imperfect.
→ Your team will have bad days.
→ Your system will crash.
→ Your pitch may flop.
→ Your path will be messy.

Peace comes when you stop resisting the reality of the journey.

THE BEAUTY OF THESE FIVE PRINCIPLES TOGETHER

The magic of Kaizen, Shoshin, Kintsugi, Ikigai, and Wabi-Sabi is that none of them ask you to be perfect.
They ask you to be:

• Humble
• Curious
• Persistent
• Purposeful
• Peaceful

They ask you to embrace your humanity — and your limitations.

They ask you to keep walking even when the path is broken.

They ask you to find strength in the messy middle.

REAL-WORLD MEDICAL ENTREPRENEURSHIP SCENARIOS USING THESE PRINCIPLES

Scenario 1: Your digital health app crashes on launch day

→ KAIZEN: Fix, iterate, patch.
→ KINTSUGI: Document what went wrong and build a better version.
→ SHOSHIN: Ask users what frustrated them most.
→ WABI-SABI: Accept that launch chaos is normal.
→ IKIGAI: Remember why you built the tool in the first place.

Scenario 2: Investors reject your pitch

→ KINTSUGI: Strengthen the broken parts.
→ KAIZEN: Improve your model, clarify your value.
→ SHOSHIN: Listen to feedback without ego.
→ IKIGAI: Remind yourself that funding is not validation.
→ WABI-SABI: Not every investor is meant for your journey.

Scenario 3: The Ministry of Health delays your approval for 8 months

→ WABI-SABI: Regulations are slow everywhere.
→ KAIZEN: Refine documentation.
→ SHOSHIN: Ask what you misunderstood about the process.
→ IKIGAI: Remember the public health impact.
→ KINTSUGI: Use the waiting period to build something stronger.

Scenario 4: Your team is burning out

→ SHOSHIN: Ask what they need.
→ WABI-SABI: Accept that humans aren’t robots.
→ KAIZEN: Improve workflows to reduce stress.
→ KINTSUGI: Share stories of failures to normalize struggle.
→ IKIGAI: Realign everyone with the mission.

Scenario 5: You feel overwhelmed, tired, and ready to quit

→ WABI-SABI: Accept the imperfection of your journey.
→ IKIGAI: Reconnect with your “why.”
→ KINTSUGI: Look at your failures as experience, not defeat.
→ SHOSHIN: Approach challenges with fresh curiosity.
→ KAIZEN: Take one small step today — even a tiny one.

AFRICAN ANECDOTES & HUMOR TO KEEP YOU SANE

Let me leave you with these rib-cracking but true insights:

1. “If you want to go fast, go alone. If you want to innovate in healthcare, cancel your weekend plans.”

2. “A startup founder without stress is either lying or has not launched yet.”

3. “When the app works in the office but fails in the village, remember: even a rooster crows differently away from home.”

4. “Investors will tell you to come back when you have traction; patients will tell you to come back when the medicine works.”

5. “Hospitals will tell you your system is good — then continue using pen and paper until Jesus returns.”

Laughter is medicine.
Use it generously.

CONCLUSION: IF EVERYTHING FEELS MESSY RIGHT NOW, YOU’RE ON THE RIGHT PATH

You are building in one of the hardest industries on Earth.
You are navigating:

• Human lives
• Science
• Regulations
• Technology
• Politics
• Limited funding
• Broken systems
• Cultural barriers
• Infrastructure gaps

Yet you continue.

That alone is heroic.

So if you are in the messy middle right now — overwhelmed, questioning yourself, tired of bugs, demotivated by rejections, frustrated by bureaucracy, struggling with burnout, doubting your vision —

You are not failing.
You are transforming.

Healthcare innovation is not a straight path — it is a winding African village road:
scenic, bumpy, unpredictable, and full of goats.

Keep going.

Because the world needs what you’re building.
Patients are waiting.
Communities are counting on you.
Clinicians need support.
Systems need change.

And you — yes, you — are uniquely positioned to deliver it.

Courage, founder.
The messy middle is where legends are made.