
Ask HN: How to think about retention when the goal is churn? - flowns
I&#x27;m running a medical device startup. We make a treatment for depression. A discussion that often comes up is how we should think about and present our retention numbers. Since, ultimately our goal is to make our users recover from depression, and churn. Im looking for articles or other resources discussing growth and retention for these types of businesses. Or does anyone have any thoughts on this?<p>Dating apps have the same problem to some extent I guess.<p>This is a great article about growth, but I feel it doesn&#x27;t really apply to our case: https:&#x2F;&#x2F;www.ycombinator.com&#x2F;library&#x2F;59-how-to-set-up-hire-and-scale-a-growth-strategy-and-team
======
troydavis
I haven’t seen articles about this, but it comes down to this: your app needs
a way to differentiate good churn (solved the problem) from bad churn (merely
stopped using the app). An exit poll would be unlikely to get used by those
whose problems weren’t solved, so you’d have to get more creative than that.

That said, in your case, I’m skeptical that you’ll have much hidden good churn
in the early days. Depression seems like a long-lasting enough problem - and
one that requires ongoing maintenance - that I’d defer this question until
you’re receiving anecdotes like “3 months using your app has changed my life!
Thank you!” every week (like dating sites do from people in new
relationships). Make sure users know you value those stories. When emails like
that start showing up regularly, like weekly, then maybe good churn is big
enough to be worth trying to calculate. Also, you’ll have some actual examples
that show how success manifests in app usage.)

(Obvious exception if your app is totally transactional, like a directory of
therapists and all you do is connect the patient. If you’re providing help
over time, some users will thank you if it works.)

~~~
flowns
Thanks for your great thoughts. I agree and this is what we are trying to do.
We collect a lot of great testimonials/reviews and have an exit poll to try to
understand why ppl leave. Our main objective is ofc treatment success,
something we can track well.

But in these times when many VCs are looking for SaaS models this issue is a
bit tricky.

------
muzani
One of my startup friends brought up that there's a billion dollar company
whose work is funerals. I joked that they're doing pretty well for a company
with 0% retention rate.

But how does such a company do well? Their focus is customer acquisition and
referrals. It's perfect for something like curing depression too.

One of my clients is a mental health app. What we do is track their feedback
on discomfort levels (physical, mental, emotional, visual) and how it
increases or decreases as the treatment progresses. The payment system has
been either pay one shot the first time or via donation. I'm wary of anything
that charges for a subscription.

------
Jugurtha
> _Dating apps have the same problem to some extent I guess._

No. I think Kent Beck tweeted something along those lines, that the mere fact
one was still using the app meant the app failed to do the "job to be done"
and my reply was that the tweet assumed that search would stop once a match
was found, when clearly it wasn't necessarily the case. Many users do
concurrent processing of matches, with some being better than others as their
processing algorithm is more efficient, and they can handle more IO and
compute workloads. Some do round-robin. Though others pin one thread for
processing matches sequentially.

I think this is different. This is similar to hospitals optimizing for
patients not coming back after coming in (mitigation), and systems being
improved to _prevent_ "failure demand".

What you can draw inspiration from is "remote patient monitoring". I think you
have to find differences in _behavior_ from metrics and dimensions. There's
that scene from the "Apollo 13" movie where the characters rip off vitals
monitoring electrodes and the ground person freaks out looking at the
telemetry data thinking they had lost the crew.

I also think the hypothesis that the goal is "churn" is to be revisited. Can
we view your device as something that accompanies someone suffering from
depression until they recover, and then _preventing_ them from relapse and
regression. Your device helps get _better_ , and it is a spectrum, not a
binary "depressed"/"not depressed". Similar to physical fitness, you don't
stop once you're _there_ , because _there_ is dynamic. So your product adapts
and can provide value throughout the journey, as opposed to punctual.

It's not a wedding planner one needs punctually, it's more like a buddy who
will be there at the wedding, during the divorce, after a hangover, at the
gym, and much more. Support.

So, what are the behaviors exhibited by people who are depressed, by people
who are recovering, by people who're giving up (maybe throwing the device).
Can you detect those?

You may have started in a niche thing with depression, but could eventually
later expand to wellness.

------
codegeek
Don't call it churn. Call it "cured". In fact, your success metrics should
depend on how many clients you acquired and how many you cured. Imagine
saying:

"Over the years, we have helped 1000+ clients get better/cured".

