About
The through-line is not industry expertise. It is enterprise value creation.
Most companies do not stall because they lack technology, talent, or attractive markets. They stall because the organization never evolves as quickly as its opportunity. I have spent decades leading companies through precisely those moments.
1985, before any of it
Where it started, and where it went back to
My professional life began in January 1985, inside the George Washington University Medical School. A research team there was building what became the APACHE Score, the system doctors still use to predict whether a patient will survive the ICU. I was not one of the scientists. I was the software developer in the room. The system lived on paper forms, and my job was to automate all of it for the PC: collect the data from ICU devices, put it into a database, and run regression analysis against a known dataset. Data in, model applied, prediction out.
Four decades later, the industry calls that architecture AI. I call it the first time I watched medical data change a clinical decision. In 1987 I left for the US House of Representatives IT group, building the national LAN infrastructure, and in 1990 for Microsoft, and it took me four decades to get back to where I started. When people ask why a generalist ended up in MedTech, the honest answer is that MedTech is where I began.
The arc
Four rules I have paid for
Sell outcomes, never features
Read →Capital is a craft
Read →A different organization first
Read →Lima to Bellevue
Born in Lima. In the United States since 1980, when I came for school and stayed to build. Married to Sarah, the best decision I ever made, and bonus dad to her twins. Four children, two sons-in-law, one granddaughter, and a standing tennis game. For the past three years I have mentored CEOs of minority owned businesses through Ascend, sponsored by JPMorgan Chase and anchored at my alma mater, the UW Foster School of Business. Good scaling advice should not require a seven-figure consulting engagement. After decades of learning, this is how I give back.
Field notes
The industries changed.
The questions never did.
If something here lines up with a problem you are sitting with, write to me. I read what comes in and I answer what I can. English or Spanish, whichever is easier for you.
There is no form and nobody in the way. One email is usually enough to work out whether there is anything here worth your time.
juan@juanvegarra.com · +1.425.246.8496 · Bellevue, Washington
What I actually recommend
Books, frameworks, and sources that survived the operating years.