This Culture Deck Powers the World’s Toughest Work
People & Culture

This Culture Deck Powers the World’s Toughest Work

Possible Health endeavors to bring high-quality health care to the world's harshest environments. It's powered by incredible culture.

Possible is a nonprofit that operates in one of the most challenging environments on the planet. In rural Nepal, it is a health care provider for a community of over 260,000 people who live largely without access to electricity, clean water, and basic infrastructure — including roads. The population is still recovering from a civil war that ended almost 10 years ago, the average income is US$150, and the average patient walks 2.5 hours one way to receive care. With all these odds stacked against them, the Possible team has been told their work isimpossiblehundreds of times, but they’ve still managed to succeed where others haven’t.

What does this have to do with technology startups? A lot, according to Possible CEO Mark Arnoldy. Starting a company requires the ability to break down barriers, push immovable boundaries, attract the right people to your cause, and remain undeterred in the face of failure, bad news, and heartbreak. All of this, he says, is about culture: How you implement it and how you communicate it.

Earlier this year, Possible created what it calls its “For-Impact Culture Code,” a list of 10 principles that shape the organization’s approach to its work. Since then, the deck has attracted a lot of attention from donors, NGOs and corporate partners. It also serves as an example for any organization striving to create a culture that drives action and alignment.

What a Good Culture Deck Accomplishes

“Whether you’re nonprofit or for-profit, every organization should seek to optimize three things: speed, transparency, and accountability,” says Arnoldy. “A document that not only codifies how you operate but why should demand all three.”

Defined culture often sounds like a “nice to have” for startups that are moving at a breakneck pace just to ship their product, but when you get down to it, “Culture is a set of routines and daily commitments that not only accelerate your work, but make sure it reflects your values,” Arnoldy says. (Netflix is famous for emphasizing its culture deck too.)

For example, he calls Possible’s standing morning meeting “culture in progress.” It’s a 10 to 15 minute call connecting even its most remote team members, where everyone shares something they will get done that day that is “big enough to matter and small enough to ship.” In this small amount of time, Arnoldy is able to reinforce speed, make sure everyone knows what everyone else is working on, and make the entire team accountable for optimizing their day to accomplish a set goal.

“Culture should give you structure to scale fast and extreme clarity around what makes your approach unique.”

“We’re driven by the unrelenting pursuit of remarkable results for our patients where most people think it can’t be done; and we have ample opportunity to give up, fail, and surrender,” Arnoldy says. “Startups face the same reality: Easy defeat unless you have a set of principles that people actually want to come back to because they feel accurately described and empowered by them day in and day out.”

In addition to motivating employees, Possible’s Culture Code has helped it crush some of its biggest roadblocks by projecting a formidable identity to the outside world, and forging its most productive partnerships.

“Where we work, there appeared to be no solution to referral care. There was no way for someone to go to a local facility with a complex heart problem or a lung problem and have access to a specialist who could help them,” he says. “By partnering with seven national referral hospitals, and health crowd-funding organizationWatsi, we’re now able to not just get patients to the right doctors, but actually have someone accompany them to be their advocate.”

When Arnoldy and his team set out to create their culture deck, they invested significant time and energy in its clarity and presentation for exactly this reason. “We could have just sent around a Word Doc, but we wanted to be able to hand this out to people and say, this is the kind of team you want to be working with.”

At the same time, a strong culture deck gives you the opportunity to say what you aren’t. “It’s critical that you draw a line in the sand and express who you are and who you aren’t with complete transparency. Otherwise, you’re going to end up with a deluded set of partners or employees who waste your time, not the ones who will help you build.”

Possible’s entire Culture Code, listing all ten of its guiding principles, can be found here:

The Golden Circle Exercise

So, when it comes to building a deck that encapsulates your company’s culture, where do you start?

To answer this question, Arnoldy references a TED talk by Simon Sinek (TED’s third most popular talk of all time), who drew parallels between great leaders throughout history and surfaced one common differentiator: They all started with ‘why’ they were doing what they were doing. Sounds simple enough, but in a world where people are engineering incremental features or simply looking to land a well-respected job, it’s a tenet that’s easily forgotten.

Sinek describes what he calls the Golden Circle, with ‘Why?’ at the center, encircled by ‘How?’ encircled by ‘What.’ Arnoldy used this framework when he started to build Possible’s culture, and recommends it to other founders building cultural documentation from scratch. To illustrate its value, he recites Sinek’s relatable example: Apple.

“You look at Apple, and you see a company that inspires the passion of its employees and millions of people around the world,” he says. “But they don’t do this by saying, ‘We make great computers, buy them.’ They say, ‘In everything we do, we believe in challenging the status quo. We believe in thinking differently.’ That’s their ‘why’ and they are very consistent in their communication.’”

As Sinek puts it:

“People don't buy what you do, they buy why you do it.”

For nonprofits, having a clear sense of purpose draws in donors and helps them expand their footprint. For companies, it can help cut through the noise and send a clear signal that earns you customersandbrand ambassadors who will share your value with others.

Once you have your ‘why’ at the core of your golden circle, you can think about how you plan to deliver on that purpose, and the ‘what’ — the actual actions and programs that you’ll put out there into the world. For Apple, it builds computers that allow the people who buy them to think, work and interact with the world differently. For Possible, these circles flesh out the rest of its culture deck:

  • How: The qualities that will help it deliver on its promise to provide quality health care.
  • What: How products and programs should look and be structured to meet this standard.

“One of the best qualities of the Golden Circle exercise is that it’s inherently aspirational,” Arnoldy says. “We’re constantly trying to learn what works, how we want to act, how we can reach more people with the best care. The ‘how’ and ‘what’ may change as long as the ‘why’ remains the same. This is how a working culture stays flexible.”

There are several attributes in particular that Arnoldy highlights as being relevant to any organization that doesn’t just want to succeed, but make real change for its customers, in its industry, and for its employees.


“Grit is maybe the most important quality your organization can have,” says Arnoldy. “Failure comes often and it hits you hard. At the end of the day, your team, and especially your leaders need to remind themselves that the work their doing isn’t about ego or self-gratification or recognition.”

“Gritty people don't care what's in their bio if they're not actually getting the job done.”

“You want people to be dedicated to the battle irrespective of outcome. We always share a quote from the Gita that says, 'You’re obligated to the battle, but not entitled to its fruits,'" he says. “No matter what gets in their way, they will continue to execute. That, more than anything, is the best secret sauce I’ve seen for any organization.”

When it comes to hiring for grit, Arnoldy admits that it’s an inexact science. In most cases, you need to do your best to suss out these qualities during the interview process and then take a leap of faith. “We try to get people out there doing the work as soon as possible — and that’s the real moment of truth.”

When interviewing, he recommends two key questions. First, ask candidates if they feel lucky to be where they are in their career. A positive answer points to optimism and gratitude. Then ask candidates to tell you about a time when they took a risk and failed, and a time when they took a risk and succeeded. Ask them what the difference was in their approach, how they felt, what they did afterward. “This really shows you how willing someone is to be bold, to fail, how resilient they are when they do, how humble and execution-focused they remain even when they succeed. Grit is very closely tied to humility.”

Surfacing whether or not a candidate has grit is Possible’s number one objective in any interview process. “The rest of the interview is really defined by how they respond to these questions,” Arnoldy says. “And if we’re satisfied with their abilities in this area, we try to get them into the work as soon as possible to see if this carries over into real world situations.”

Most startup employees are not operating in harsh environments or lacking basic necessities, but grit is still vital to their companies’ success. Founding a company is incredibly difficult, and failure is always a palpable reality. Making grit a pillar of culture, and a determining factor in the hiring process, can ensure that you build a team that gets things done no matter what.

Efficiency as a Moral Must

“One of the great challenges of our generation is to prove that purpose can triumph over profit.”

Every startup is built to serve customers, whether they are consumers or enterprises. And the only way to win is to serve this group very well — better than your competitors. When you make this concept core to your day-to-day operations, you start to treat efficiency as an imperative, Arnoldy says.If you can instill your employees with a sense of moral obligation to your stakeholders, they will motivate themselves to do their best work.

“I think there’s something to making an impact that is more motivational than money,” he says. “Creating a business that affects people’s lives, even in small ways, is extremely powerful. You can make this point part of your management model. For us, we tell our employees to imagine that a patient is sitting right beside them. For other companies, imagine a customer in need, who doesn’t have the solution you’re capable of delivering to them. When you do this, you create a company that will constantly push itself toward self-improvement.”

Foster Greatness

“To run a truly great organization, your leadership needs to know that everything they produce, every piece of work that leaves their hands, is about building trust,” says Arnoldy. “When you view things through this lens, even small things like typos matter. Suddenly never sending a document with typos becomes very important.”

Increasingly, people have shorter and shorter attention spans for new companies. They interact with them briefly over the web or on their phones, and in that tiny window of time, a product either earns their trust or is likely never used again. Given this reality, you have to constantly strive to be the best at what you do — and you won’t get there by keeping your eyes fixed on quotas or competitors.

“We don’t spend all this time and attention on good design and delivery just to raise more money from our funders — that’s not why we do it,” Arnoldy says. “I think if that was the case we’d constantly be making compromises, saying things like, ‘Well this is better than what 80% of NGOs do, so it’s good enough.’ We have to keep pushing harder than that.”

“You can either be JV or varsity. It's drive and the constant push to be better that makes the difference.”

The team at Possible constantly evaluates its work before it goes out, and uses the categories junior varsity (JV) and varsity to determine what needs more work and what’s ready for prime time. “We see so many companies and organizations shipping JV quality products. Our goal is to only ship varsity.”

Be An Informed Contrarian

It’s noble to make a run at the impossible. It’s the only way humanity makes progress. Whether you’re redefining an industry or pitching a counterintuitive solution to a common problem, you have the chance to make great change — but only if you’ve done your homework.

At Possible, Arnoldy and his team are constantly defying naysayers and trying new things. But they aren’t strategizing in a vacuum. “We dove into Nepal’s national health care budget, where we looked at what’s called the ‘absorptive capacity’ of the government — basically, what the government is able to spend in the health care sector,” Arnoldy says. “It turned out that in any given year, they were only spending 70% of their allocated budget, so we promoted this idea that they could invest a lot more.”

Unsurprisingly, he was met with a lot of skepticism. People told him repeatedly that the government was too poor, too corrupt, and too bureaucratic to change its ways. He responded by showing them that Possible’s solutions only cost US$3.48 per capita and that the government was actively willing to spend US$6 to $7 to do the same thing. “We were able to literally show them the room for growth in this area.”

When you’re challenging the status quo, you need to keep asking ‘why’ things are the way they are until you get a satisfying answer, and “we don’t have enough data” doesn’t count, Arnoldy says. “Good entrepreneurs find a way to create data sets — even if you have to dig deep into tangentially related data, or speak to enough people to make anecdotal evidence significant.” You want a culture that emphasizes educated disruption.

“Sometimes you have to do things that don't scale to make your point.”

This is especially true when you don’t have a large pool of users, customers or patients to draw from. When this is the case, the best thing you can do is spend more time with the ones you do have. Figure out what makes them tick, how your product or service could better meet their needs, how you can invest your resources in solving their problems. In the process, you create your data set, you learn about how you might reach more people, and you create brand advocates who feel like they have a stake in your long-term success.

“The patients we’ve spent this time with go back to their home villages and tell everyone about their experience with our system — word of mouth has grown dramatically,” Arnoldy says. “I think this is very telling for the technology sector too, in the sense that when you invest the time and energy in understanding the needs of one or a few users, they can help you create a lot more demand.

Design for Dignity

“In both the technology and nonprofit sectors, there are these massive power and knowledge imbalances where we tend to underestimate users’ appreciation for great design — whether it’s visual, product or interaction design,” Arnoldy says. “What we’ve seen consistently, whether people are rich or poor, no matter where they are from, they have an ingrained sense of what makes a good product.”

Accordingly, Possible has built a culture that keeps design top of mind in everything it does. “One thing that is often overlooked for the sake of cutting costs is that beautiful, well-designed hospitals are much more likely to make an impact. It might sound superficial, but there’s proof that people have better experiences. Clinical staff members conduct themselves more professionally. From the infrastructure all the way down to physicians' business cards, a dignified facility is going to attract more people and do a better job.”

Similarly for technology startups, design can influence how seriously people take their work, how much users are willing to engage, how much personal data they feel comfortable volunteering. Companies like Mint, for example, need people to give them access to their finances — and the best way to encourage this is through solid, trustworthy design.

“The best design bridges gaps, creates similarities, generates empathy.”

While tech entrepreneurs may not think about creating dignity for their users in the way Arnoldy does, they probably should. “You want to create a culture where everyone understands that users deserve beautiful, intuitive design — where it becomes a sign of respect — and just because you know more about the technology than them doesn’t mean you can skimp on the presentation.”

Sports Team vs. Family

It’s not rare to hear startups describe themselves as “one big family.” Many others subscribe to the idea that they should leave their personal lives out of it and behave more like winning sports teams. Arnoldy argues that you need a blend of both to optimize performance, secure high morale, and keep things running smoothly.

“We want our team members to feel like they’re working for the best company in the field, and the only way that’s going to be true is if they feel cared about holistically as human beings,” he says. “You can’t have a tradeoff between professional intensity and personal support — that’s a lesson I wish I would have learned a lot earlier. I used to believe they were on opposite sides of the same spectrum, but now I see that they are on different spectrums altogether.”

“You're only able to be professionally intense if your employees want to do their best work for you.”

This doesn’t necessarily mean delving into employees’ personal problems, forgiving huge errors, or allowing them to slack off. You still want to field an all-star team. Instead, you should strive to create a leadership culture based on personal growth, structure that encourages employees’ wellbeing, and the humility to admit that no one is perfect, and that that’s okay as long as everyone truly is trying their best.”

Striking the right balance is also a matter of hiring the right people in the first place. That’s another reason Arnoldy likes to get new hires into the work as fast as possible — if they don’t like it or can’t make it work, it’s better for them to part ways sooner than later.

“Fundamentally, you want to hire people with growth mindsets,” he says. “Research shows that most people either have a fixed mindset or a growth mindset — the only way they’re going to survive and flourish in a challenging, uncertain environment is if they have the latter.”

Part of creating a culture of growth is pairing promising hires with the right mentors to help them discover and exercise their talents. “We want to give people all the tools and opportunities we can to direct their own growth. That’s how we’ll end up with people who can lead whole areas of the business. On their first day of onboarding, we ask specifically, 'Who do you want to connect with as a potential mentor?' Then we'll do everything we can to make it happen.”


Once you’ve documented your culture, you need to deploy it in a way that will matter. “When we created our Culture Code, we made it clear that it had the same magnitude as the rebranding of the whole organization, the re-launch of the website, everything,” Arnoldy says.

“We sat down with both leadership teams in the U.S. and Nepal to present the final list of cultural values, but the purpose of these meetings was to discuss in detail what would be different going forward,” he says. “When we phrased it that way, the deck suddenly became a catalyst for changes that people really wanted to make. We talked about the implications it had for increasing speed, transparency and accountability, and we got so much feedback about the tools we were using for patient monitoring and performance evaluations, management structure, how work was really getting done. It got everyone aligned.”

These discussions prompted Arnoldy and his team to share the deck with the partners that touched these parts of the organization. They sent it to Asana, BambooHR, and Small Improvements — companies they were already working with to track their work, candidates and employee performance. All three came back inspired, with fresh ideas for how they could work with Possible to improve existing systems.

“Your culture isn’t just about how your company or organization operates on the inside, it also defines all of your interactions,” says Arnoldy. “Put it in words. Make it something you’re proud to share. Make it your calling card for all the great work you can and will do.”

For the holiday season, check out Possible's campaign and learn how you can build Nepal's first rural teaching hospital.