This is the latest in a series of stories about startup culture. This week, our reporter checked out Practice Fusion in San Francisco, a stark contrast to Twilio’s fast-paced work ethic, and Couchsurfing’s laid-back hippie culture.

If CEO Ryan Howard hadn’t been involved a serious motorcycle accident, Practice Fusion would have crashed and burned years ago.

Howard was knocking on investors’ doors to fund his free electronic health record (EHR) with little success. Doctors were reluctant to ditch paper-based systems, so it seemed to the VC crowd like the right idea at the wrong time.

But unwilling to admit defeat, he used cash from the settlement from his motorcycle accident to pay the salaries of three employees.

“We were going out of business, I needed two root canals, and I was in massive debt,” said Howard in an interview at the company’s sprawling San Francisco office. “I would define the period of 2005 to 2007 as me, in my pajamas, furiously working in my house.”

In 2009, Congress passed the Health Information Technology for Economic and Clinical Health Act. With the Obama administration committed to the proliferation of EHR’s, Practice Fusion caught the attention of a band of angels, including investor Peter Thiel, the managing partner of Founders Fund. Thiel recently declared: “Practice Fusion revolutionizes our interactions with the medical community, just as Facebook did for social networking.”

Thiel saw an opportunity to take advantage of a government mandate that push doctors to adopt an EHR. The fixed deadline is 2015 — after that, eligible health care providers who don’t comply will be penalized by CMS, the federal agency that administers Medicare and Medicaid.

With eligible doctors and hospitals receiving “meaningful use” checks for switching over to Practice Fusion’s free EMR,  it’s not a tough sell. Albert Santalo, the CEO of cloud-based EHR provider CareCloud, is a competitor but credited Practice Fusion for its “evangelist efforts” and creating ”greater awareness of EHR technology by doctors in general.”

With new investment, Practice Fusion stacked up its sales team, and grew 500 percent for two years in a row. Last year, according to Howard, it turned over “serious solid revenue,” primarily through advertising. It recently had to revise its expectations for 2013, as a few weeks into the new year, the sales team secured its first million dollar advertising deal with a major pharmaceutical company.

Practice Fusion has about 150,000 users, including doctors, nurses and hospital admin, which is about six percent of the addressable market. Howard sees an opportunity to make money through the fast-growing store of data. Stripped of any personally identifiable markers, patient information can be sold to pharmaceutical companies.

He responds to a question about potential privacy concerns by listing the positive outcomes from mining data about doctors and patients. “We can recommend drug therapies based on their popularity [with previous patients],” he said, and claims there are 200,000 avoidable deaths a year because “data is simply not shared.”

This is in sharp contrast to online health portal WebMD, which is struggling to conserve its relationships with big pharma and recently laid off 14 percent of its staff. In its seven years, Practice Fusion has grown to over 250 employees, and has about 20 job openings.

What’s the culture like?

Employees at Practice Fusion’s office in downtown San Francisco are reminded every day about the sheer fluke that led to the startup’s existence.

“A great leader has to be vulnerable,” Howard explained. Photographs and news clippings from Practice Fusion’s past adorn the walls. I even saw a fading Starbucks napkin, a souvenir from the founding team’s first “office.”

The well-funded startup is in full hiring mode, but it’s looking for a specific type of employee to add to its team.

It may seem counter-intuitive, but the ideal job candidate, according to Howard, has little or no health care experience. In his view, employees that have worked in the industry for too long as less inclined to dream up big ideas, and the “unlearning” process takes too long.

Practice Fusion is looking for high-achievers, but it’s important to Howard that employees are “happy and healthy,” and fit in with the culture. During a walk through the company’s offices (his dog trailing behind), he told me about a seriously talented engineer who was recently asked to leave as he didn’t get on with the team.

New employees undergo an extensive training process, which involves several weeks of education on a range of relevant health care topics, such as meaningful use, billing, and the regulatory issues facing big pharma. Similar to larger companies like Google, Practice Fusion emphasizes professional development, and mentors assigned to junior-level employees ensure that they meet goals.

High-performing employees have the freedom to try their hand at roles in different departments — one staff member I met started out in the call center (this team cold-calls doctors to inform them about the free EMR) and later shifted into product.

Word of warning: If you love to pig out on cookies and soda, Practice Fusion is probably not for you. The kitchen is fully stocked with healthy and organic food, and it has no carbonated drinks.

“I believe you should be emotionally and physically at your best,” explained Howard, who also insisted on offering free weekly yoga and soccer classes for the staff. This focus on balance means the startup has been able to retain talent through its ups and downs.

In a recent end-of-year report from RockHealth and Interwest Partners, survey respondents predicted that Practice Fusion would be the most likely digital health company to IPO in 2013. The company raised a massive $34 million in venture funding in June.

For those that stayed loyal to the company from its early days, the bet is about to pay off.

What are the best perks?

• Healthy meals: Food is catered every day, and Practice Fusion has a fully stocked kitchen with delicious treats. From time to time, the company will invite nutritionists to meet the staff and discuss healthy eating plans. 
• Fitness opportunities: New employees receive a FitBit to help them track activity levels throughout the day. In addition, a weekly yoga class takes place in the office, and everyone may have a discounted gym membership.
• Computer science classes: Employees that want to bolster their mobile development or Excel skills can enroll for free in any of Academy X’s classes.
• Dog-friendly office: Howard is rarely seen without his trusty sidekick.
• Work/life balance: Employees receive four weeks of PTO per year, in addition to the standard vacation time.

Hiring?

• You betcha. Practice Fusion has openings in almost all its departments at a variety of levels. The fast-growing startup is currently hiring in legal, finance, operations, product design, engineering and more. 

“Startup culture” is a new series that highlights what it’s really like to work at a Bay Area startup. Please send your suggestions for the most rockin’ office spaces, startup happy hours, or company perks via email (christina@venturebeat.com) or Twitter (@chrissyfarr). 

This is the latest in a series of stories about startup culture. This week, our reporter popped into Twilio’s fast-paced offices, a stark contrast to Couchsurfing’s laid-back hippie culture.

Few other companies have internalized the “Lean Startup” movement — the rapid product cycles, culture of experimentation, and emphasis on customer feedback — more so than Twilio.

The San Francisco-based cloud communications provider is the quintessential “lean startup,” a term coined by serial entrepreneur Eric Ries. Spend a few hours at the downtown offices and you’ll step into a culture that is the polar opposite of Microsoft’s slow-moving, bureaucracy-laden culture that strangled innovation in that company’s heyday.

Twilio has stepped (or more accurately, sped) into its own renaissance. As Sandy O’Gormon, the vice president of talent, puts it: “Our philosophy is to ship, ship, ship, and stay ahead.” O’Gorman leads the team that can make or break the company’s sustained growth: recruiting and HR. “We hire, hire, hire. It’s a fast-paced learning environment.”

For Twilio, a startup that helps developers put phone communication features into their applications, the challenge has been to meet the internal demand for engineers. ”We are small and new and finding our way in the world,” admits Lia Coniglio, Twilio’s human resources manager.

Shortly after I arrived at Twilio’s offices, Coniglio and her colleague in the marketing department, Michael Selvidge, gave me a tour. I had to ask Selvidge about Danielle Morrill, his former boss, who recently left to launch her own startup, Referly. Morrill was the company’s first non-technical hire, and had a major part to play in turning a nerdy tech startup into a recognized brand in Silicon Valley. According to Selvidge, her “be everywhere, be awesome” ethic is in DNA of the marketing team.

Twilio’s CEO, the high-energy, perpetually smiling Jeff Lawson dipped in and out of the offices, occasionally peering through the glass into a jam-packed conference room. At the end of the week, the product and engineering teams gather for “standups,” where every employee gets a few minutes to present their recent accomplishments, and brainstorm ideas.

To maintain its pace of innovation, the San Francisco-based startup is hiring engineers at an intractable rate of 20 per quarter. To meet this goal, they have 10 developer evangelists scattered across the country and a strong recruiting team. Given the technical talent shortage in the Bay Area, here’s how the company has won over engineers in record numbers:

Best perks?

• Unlimited personal time off: Working at a startup can be exhausting; people often complain about the unhealthy work/life balance. At Twilio, if an employee is feeling burnt out, they can ask for a few days to rest and recuperate. According to the recruiting team, those who would take undue advantage of this flexibility are probably not Twilio material. “We are more worried about making sure people actually take enough time off,” said O’Gormon.
• Learning opportunities: Every new hire at Twilio has to build an app. Got no skills? The first several weeks involve intensive training, so you’ll learn on the job. Read more about how Twilio teaches its employees to code here.
• Free Kindles: Every employee receives a Kindle and reimbursement for a book.
• Work from home: Employees can take meetings from home, which is a benefit for those who are commuting into San Francisco. It’s not a strict 9 to 5 — as long as they get their work done, employees have flexible working hours.
• Engineers can spent time on innovative projects: Similarly to Google’s policy in its early days, Twilio allots time for the engineering and design teams to work on their own projects. Essentially, it’s a week-long hackfest, where they have the creative freedom to build cool stuff with the API. From the most recent Tweakweek, the top three projects are already being put into construction.

What’s the culture like?

• Just in it for the cash? You’re probably not a fit: “We see compensation and equity packages as table stakes,” said Coniglio. Like any other well-funded startup, Twilio offers a competitive salary, but if you’re just earn a fast buck, other companies pay significantly higher salaries. Twilio’s recruiting team sells the culture and product to potential recruits.
• Everybody has a voice: Whether it’s a company outing or a minor change to the lunch menu, at all ranks of the company, employees are encouraged to speak up.
• A maker culture: Everyone has to code: At a startup, how often do you see an engineer setting aside an afternoon to teach a recently hired marketing analyst to build a mobile app? I was surprised to see it, too — but this kind of collaboration is a stroke of genius! It’s useful for anyone to develop technical ability, especially for marketers who will need to grapple with software and communicate with customers. But it’s a two-way street: marketing and sales professionals also have experience to bring to the table. I noticed that one developer received an impromptu Twitter tutorial from his colleague in the marketing team.
• We communicate in the language of apps: To stand out, Bessemer Venture Partners developed a Twilio app to present the term sheet for the startup’s recent funding round. The founders dialed into a Twilio-connected number to hear an automated voice message: “Press one for $5 million, press two for $10 million, press three for $15 million. …” Check out the full story here. Likewise, anyone smart enough to develops a Twilio app to apply for a job, would definitely be a stand-out candidate!
• Customers are king: The company is reliant on these third-party developers and the applications they create with Twilio’s open API. “The focus is on empowering and enabling our customers. It’s not on us; it’s what people do with our technology,” said O’Gorman. “On our platform, apps are being built that help people find sex offenders and veterans find jobs.”

Hiring?

You betcha! Twilio has openings in marketing and sales, customer support, and, of course, engineering. If you’re into Macbooks, automated testing and distributed architecture, you’ll fit right in!

“Startup culture” is a new series that highlights what it’s really like to work at a Bay Area startup. We’ll be profiling a startup every two weeks. Please send your suggestions for the most rockin’ office spaces, startup happy hours, or company perks via email (christina@venturebeat.com) or Twitter (@chrissyfarr). 

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In some ways, the CouchSurfing headquarters in San Francisco is exactly what you’d expect. It’s got an engineer rocking a “don’t shave” T-shirt, a twentysomething community manager who likes to put his feet up, and a CEO who plays a round of table tennis to take the edge off a Friday afternoon.

You’ll also find the signs of a cash-flush startup: the in-house chef, the fully stocked fridge, and the enviable perks. Since the traveler network and website transitioned into a B Corp., it has attracted some heavy-duty interest from investors. As we reported last month, the company that connects travelers with strangers willing to spare their couch pulled in $15 million in a General Catalyst-led funding round.

To compete with tech companies like Google and Facebook, CouchSurfing is one of many that offers great benefits and perks to attract talent and ensure its employees stick around. During a visit to CouchSurfing’s office in San Francisco’s Design District (just west of the Mission Bay neighborhood), I got a feel for the vibe, and new chief executive Tony Espinoza gave me a sense for what it’s really like to work at his company.

Best perks?

• Travel: Employees can take off two weeks per year (expenses paid) to stay on a stranger’s couch anywhere in the world. According to CouchSurfing, how else could you learn about the company’s value if you haven’t experienced it yourself?
• Snacks: CouchSurfing stocks the fridge with soda and coffee, and a personal chef rings the gong whenever a healthy snack is ready. CouchSurfing has plenty of vegan and gluten-free employees, so these folk always have plenty of options. During my visit, I enjoyed mouthwatering figs wrapped in goat cheese.
• Benefits: Employees can expect the usual benefits package, with health, vision, and dental coverage with support for spouses and dependents.
• The “work from the couch” mentality: More often than not, staff meetings take place on one of the half-dozen comfy couches.

What’s the culture like?

• Decor: Everywhere you look, you see postcards and pictures of CouchSurfers traveling the globe. It gives the office an exotic vibe, and you genuinely feel like you could hop a jet to Paris at a moment’s notice.
• Comfy: A swing is in the middle of the office, as is a Ping-Pong table that isn’t gathering dust in the corner somewhere. Many of the employees walk into the office, take off their shoes, and settle in for a day of customer support, programming, or designing. And no, it doesn’t reek of smelly feet!
• Quiet with natural light: The office is full of sunlight, and it’s large and spread over multiple floors. Employees can take frequent “work from home” days and travel during the summer, so it was less bustling than I expected for a Friday afternoon. You’ll hear talking and laughing from the couches where employees gather for impromptu meetings. But in the engineering corner, you’ll only hear tap-tap of keyboards. Esponiza told me that the offices can get much busier, but it depends on the season and time of day.
• A light corporate touch: While CouchSurfing has conference rooms, it’s hard to imagine them being used much with the exception of the monthly board meeting. Employees are often working from home, and they have a great deal of flexibility as long as they get their work done.

Hiring?

• You betcha! CouchSurfing has openings for engineers at a variety of levels, trust and safety officers (CouchSurfing has a full team dedicated to ensuring that you won’t be sleeping on the couch of an axe murderer), product managers, and more. Check out the full list of openings here.

UPDATE 10/5/2012: We have revised this article to more accurately define the company’s vacation policies.

“Startup culture” is a new series that highlights what it’s really like to work at a Bay Area startup. We’ll be profiling a startup every two weeks. Please send your suggestions for the most rockin’ office spaces, startup happy hours, or company perks via email (christina@venturebeat.com) or Twitter (@chrissyfarr).