Guest Bio:
Dr. Deborah Wake – (CEO/clinical lead for MyWay Digital Health (MyDiabetesMyWay), and Reader/ Consultant Physician at University of Edinburgh/ NHS Lothian)
List of question themes and full question:
- How to recognise trends early – Before you went into business-related projects, I understand you started off ahead of the curve with podcasts and online courses when they were still pretty new. What influenced you to start things early?
- Scaling impact – So, you mentioned you were frustrated with clinics and how the changes you were making weren’t scalable to the wider population. Could you tell me a little more about that?
- Idea generation – I’d like to deconstruct the process of how this all started. With all these new start-ups, it’s easy to look back at them retrospectively and think ‘that was obvious’. I’m sure there are many people who have thought of the same ideas but haven’t gone the extra mile to make it into reality. How was it for you with your business? Did you sit with the idea for a long time, meditate upon it, plan it out, or was it more like one day you had the spark?
- User adoption – You mentioned there’s 50,000 patients out there who are using your technology. Usually it’s very hard to get new technology adopted, how did you get your app adopted?
- Important qualities for entrepreneurs – If you guys had stopped the first time you had gotten rejected, this all wouldn’t have come out. What things have you found are important in entrepreneurship?
- Working with NHS – I understand the way the business sustains itself is through contracts with the NHS. I’m sure they must be quite rigorous to see if it is cost effective. Tell us about the how that process works.
- Demonstrating value – If you could get support from all these other regions, you wouldn’t have to get funding from the NHS immediately. I imagine it must be a challenge as well because the results from your program e.g. improvements in outcomes from diabetes, would take a while to be seen. How do you prove your results?
- Hiring – You talked about hiring staff. Were you involved in the hiring process and if you were, what kind of qualities were you looking for?
- Remote work – Do you have remote workers?
- Management – How do you manage your people? Once you’ve got so many employees hired in the company, how do you know what everyone’s doing? Is there a way you know how much work’s being done, what kind of work’s being done?
- Balancing clinical work – How much of your time do you spend clinically?
- Overseas connections – You mentioned you’re working with overseas countries like Kuwait, China, India etc. How did you get connected to these countries? What tips do you have for others who are wishing to establish these international relations?
- Other interesting problems in medicine – A bit of a hypothetical question, if you hadn’t started this business, would there be any other area of medicine which you would envision yourself working on?
- Books – Are you a reader? Do you have any books you could recommend?
- Favourite entrepreneurs – Do you have any favourite entrepreneurs?
- Advice – Lastly, do you have any advice to medical students and young doctors out there who are thinking of jumping into business or innovation?
Podcast Transcript
How to recognise trends early
Q1: Before you went into business-related projects, I understand you started off ahead of the curve with podcasts and online courses when they were still pretty new. What influenced you to start things early?
A1: I’ve always been interested in technology, and even part of the reason I chose diabetes (as a specialist area) is because I thought that that’s an area where technology can influence things dramatically both in terms of how we deliver care and also how we influence the public through education, support and lifestyle change. And it’s kind of thinking ‘how do you scale that?’, ‘how do you use other vehicles to get that impact?’. I’ve also always been interested in teaching and education so there was a natural draw to that.
In terms of the use of technology, a lot of my influence came from my husband actually – he’s non-medical, he’s now a film director – but he’s always been somebody who’s a first adopter of anything that’s come out; I remember when the first computers came out, there’s a picture of him where his mum bought him his first computer! So I’ve always had a vision to make a difference and to make a difference in scale. I’ve been slightly frustrated in clinics where you can spend a lot of time seeing one person and you might make a lot of difference to their lives, but with the rise of diabetes, chronic diseases and global epidemics of non-communicable diseases, we need to change the way we’re doing this because we don’t have the resources, time and capacity to keep doing this and there’s very little evidence that the current model of care really works. So, I think it was a hybrid of my desire to change things and impact at scale and him (my husband) being ahead of the curve with technology.
With podcasts for example, it was really him saying “well I’ve heard of this thing called podcasting coming out, and I’d quite like to do some, what could we do?” and he said “well you’ve got all this specialist knowledge around diabetes and health, why don’t we try that”. It was a double act with us talking to each other: him being the lay-guy who knew nothing, and me trying to interpret this Lancet journal to him in the hopes that it’d have some public impact. I don’t think the podcast was brilliant in terms of quality of production but it was just an experiment using technology to get something out to a much bigger audience in a quick way whilst still remaining at a level where people can understand it and it can have an impact. It was a bit of experimentation on both our parts but it led to various newspapers picking up on it because it was the first medical podcast in the UK at the time so it was fairly ground-breaking.
Then the Scotsman approached me to write a column for them, so for 3 years I was a columnist on the Scotsman, on the back of having done the podcast, and it was another way of getting the message out to a big audience. They pretty much let me write whatever what I wanted to as long as I was basing it on scientific evidence and knowledge but distilling it down to whatever was topical at the time to talk about. That eventually led me to working as a TV doctor for 3 years. So these kinds of things springboard and the thing with television and media, again part of that was thanks to my husband’s help as a film producer (in our family you can’t go anywhere without getting a camera in your face!). He’s always kept my awareness up of the potential value of film, television and media where you can really transmit stories and communicate so much better than you often can through written word, so his influence has come through a lot of that. The TV work led on to other stuff and just general engagement with technology has led to the scale we’ve done with the MyDiabetes MyWay app.
Scaling impact
Q2: So, you mentioned you were frustrated with clinics and how the changes you were making weren’t scalable to the wider population. Could you tell me a little more about that?
A2: The frustrating thing is that for a lot of our patients, you might see them every 6 months at a clinic, but that’s not necessarily going to lead to care when they need help and they run into difficulties and you’ve got this rigid schedule of when you’re going to see them – even when you do see them probably not much changes. What we need is a much more flexible way of communicating with patients at a time when they need it and also intervening early rather than the current ‘reactive model of care’. Things like diabetes and heart disease, most of it actually starts 10 years before these events where people are admitted to hospital due to heart attacks and strokes, things that are a huge burden to the system. With technology we can actually pick these things up early and start to predict ahead of time.
It’s the frustration as well, being on call in the middle of the night seeing people turn up with heart attacks, strokes, and you just think all this stuff could have been prevented 5 years ago if we had intervened in a different way, maybe supported this person through a different medium, got them on the right medications. We wouldn’t have to be here at midnight seeing someone with a septic foot that they have to amputate. I think it was a build-up of frustration with the different bits of the system, thinking “how have we gotten to this point?” and actually thinking “we can do this a lot better with technology that can support and pick things up early”. The evidence guidelines tell us exactly what we should be doing to reduce the risk of these diseases, so how do you operationalise that at a big scalable level. You’ll still need humans, you’ll still need medical staff, but actually with technology to help us, it allows us to focus on the areas that really need help, not just seeing the worried well every 6 months.
Idea generation
Q3: I’d like to deconstruct the process of how this all started. With all these new start-ups, it’s easy to look back at them retrospectively and think ‘that was obvious’. I’m sure there are many people who have thought of the same ideas but haven’t gone the extra mile to make it into reality. How was it for you with your business? Did you sit with the idea for a long time, meditate upon it, plan it out, or was it more like one day you had the spark?
A3: I’ll take you through the journey of where we went with MyDigital Health which is the company we spun out of the university 2-3 years ago now. It was a very iterative process at that point but quite early on I could see the vision of where this could get to and it took a long time to get there and I think you’re right, in terms of Uber, sometimes it’s not the idea but it’s about how you make the idea happen. A lot of people wonder why some things scale and other ideas never get off the ground and I think there are so many factors that influence that around the leadership, the people who are driving it, the opportunity, the finance, the environment. It’s multiple things that come together to make that happen and we were lucky to some extent.
The way that MyDiabetes MyWay started was probably about 15 years ago now: I was on maternity leave with my first son at the time and one of the consultants was talking about this project where they wanted to make an educational website about diabetes. This had been partly driven by the Scottish government because diabetes numbers were rising and they needed to do something at a larger scale, so they went around all the trusts in NHS Scotland, gathered sets of information, videos, whatever was new at the time and put it in one place and made it available for all people in Scotland. One of the consultants who had been asked to look at that knew that I had an interest in technology and figured “she’s off on maternity leave, she has nothing to do, let’s get her involved with it”.
It was through that process which made me realise that we’ve got this amazing system in Scotland where we’ve joined up all the data for people with diabetes, all the clinicians use a single electronic health record (EHR) for diabetes and its one of the only countries in the world where we have a complete diabetes registry across the whole country. This had been going on for about 20 years and Scott has been involved with joining that up and supporting that clinically as well. So that was a lightbulb moment because, it’s all very good from an educational resources point of view, but actually where we’re gonna get the real value is if we start to personalise the care. There’s no point in just delivering knowledge, we know that knowledge doesn’t change things; you can give patients stuff to read but all the data suggests it’s about the personalisation. People are interested in their own stuff – you get a blood test done you want to know what the results are – so it’s having that ability to personalise the response back to that person so that the information they are getting is absolutely specific for them, they’re getting educational material that is right for them in their diabetes journey.
The first thing we needed to do was to make the EHR personal for the patients so that they could see that and feel empowered. We’re very paternalistic with medicine traditionally; we know the results and we’ll say “oh, you’re doing very well that’s fine”, but actually we should be saying “your HBA1c is 9%, it should be 7.5% this is what you need to do to get it down, these are the drugs you’re on, these are the risks of the disease etc.”. I think there’s a general feeling that patients can’t cope with that sort of information but actually the majority can if you really simplify it down, use visual ways of representing risk in different ways, try and put this back into the patient’s hands to empower them and use the data to drive the personal approach – over the last 12 years in Scotland, that’s what’s been happening.
Over these past 8 or 9 years, we’ve managed to decentralise the system so every person with diabetes can access the EHR online and again that’s pretty unique in the world and now we’ve started linking the data with their home blood sugar recordings and anything else they’re collecting at home. We’re entering this world of the internet of things (IoT) where everything you touch is going to be connected and has a potential for collecting data and for us that means using that info with machine learning to start thinking about giving personalised responses. Some of the recent projects we’ve been working on which we were awarded the innovate UK grant (a 1,000,000£ grant) has been looking at how do we take these data streams and give a tailored response back to the patients which could be down to the level of: “you need to take 2 more units of insulin at the moment”, or you can inform clinicians “of the 5 drugs used for type 2 diabetes, patient X is going to respond better to these 2”. In some cases, patients might think they have T2DM but actually our system thinks they have a more unusual form of DM. So it’s about starting to use that data mining through AI to help clinicians and patients directly in terms of getting the right care.
Over time, we’ve done more with data integration, and what we did with Scotland we is we scaled this up so every person in Scotland can access it. 50,000 people are registered to use this data driven system – its pretty unique in the world to have a platform that’s scaled across the whole country with that volume of users. We’ve started to win international awards as a result of that, and about 5-6 years ago we started to think about how we could scale this outside Scotland. The more we went to conferences, people would come to us and say “that’s amazing, can we have it in England? Wales? Australia” and we were getting international requests to use the technology. At that point we could only say “well, we’d love to help you but actually we’re just the university of Dundee, we’re doing this with the Scottish government and that’s as far as it goes” and we tried running a business plan but there wasn’t really anyone that could help us – we were put in touch with somebody who looked at what we had written and kind of threw it back at us and didn’t really tell us about how we could turn that into something.
Nobody really got it, they didn’t get the concept, the scalability of it and we could’ve just walked away at that point but a year later we had another go and we got some funding from the local DHI (Digital Health Institute) to start a some work into commercialisation, which led into a program called the ‘Convert’s Challenge’ which is for university spinouts. There we met Brian McNicoll, the entrepreneurship lead of the university and he got interested in what we were doing and supported us in building our business plan. We went to this challenge, from several hundred entries, got down to the final 6 to present our ideas. That gave us a year’s worth of business mentoring and support to spin the company out, which led to other things: we got funding to this competition called Scottish edge, we won multiple Innovate UK grants which allowed us to support and build a business and we’ve now grown.
Currently, we’ve got 20 people working for the company and several sub-contractors. We’ve deployed in ¼ of NHS England and we’re starting to look at international markets such as the US, Middle East and India working with people who are wanting to take our project forward in those areas. For us and for those who join our company, it’s about making that impact and we’ve got evidence now in Scotland that it’s significantly improved outcomes for patients with Diabetes and it’s saved a lot of money. Every 1 pound you spend in our system, which we can rule out at a cost of 1 pound per patient per year, you save about 5 pounds in healthcare costs. So that’s people not turning up with amputations, heart attacks and things. That 5:1 return in investment is fairly unparalleled in other systems and that’s a big part of the value proposition of this model going forwards and getting us adopted. We’ve been supported by a lot of schemes in NHS England who’ve looked at our evidence and are trying to get us supported to scale up to that system. We know there’s an impact and potential for good outcomes so the goal now is to try and scale that as much as we can to get the benefit. With international markets, the challenge is how to adapt it to different countries and cultural adaptation of the products.
User adoption
Q4: You mentioned there’s 50,000 patients out there who are using your technology. Usually it’s very hard to get new technology adopted, how did you get your app adopted?
A4: We see ourselves as part of the healthcare system. There’s lots of people who make apps and put them on the app store – maybe some of them get widely adopted, some do not. Ours was built on top of the healthcare system, looking into the data and how you could communicate with the healthcare team, so it became an integral part of their care which created value for patients and made them reliant on it. It’s important to think about what problem you’re solving, what is the clinical need, and then building something up from there. If you’ve got something that really addresses that need then it’ll probably work. If you’re producing something different that people can’t create themselves and you’re using that to give a personalised response, that’s important too. There’s a few key things that an app intervention needs to really work: (1) it’s accessible, so it works on a phone, (2) it’s personalised, so it gives patients personalised feedback and is based on a data-driven functionality and (3) it communicates back with the healthcare team and patients, giving them support. There’s still a lot of emerging research on it but these are the things that will drive success and we stick to these principles, tweaking our model along the way. Technology changes all the time so we just have to keep evolving.
Important qualities for entrepreneurs
Q5: If you guys had stopped the first time you had gotten rejected, this all wouldn’t have come out. What things have you found are important in entrepreneurship?
A5: I’ve done a few talks on the entrepreneur journey so I’ve looked at the characteristics that are common to all entrepreneurs who break through the process and succeed. I’ve found that tenacity is one of those things that comes out more than anything else. It’s being able to believe in yourself. It’s really important to listen to feedback and adapt your idea but once you know what you’re doing has value, tenacity is key. You have to keep trying again and again, problem-solving and that’s something I’ve always been good at. I don’t like saying no, I don’t like walking away from things. I’m one of these people where if I’m in a traffic jam I’ll find all the backroads to get to my destination instead of sitting in the queue! So, an important characteristic is having the tenacity to keep at it.
5 years ago, we didn’t know anything in business. We had clinician academics, a tech savvy guy but we didn’t know anything else so we thought maybe this isn’t a good business idea, I mean what did we know? In those times, actually getting up and finding people to support you is important. Anywhere you go you’ll get critics who will tell you that your idea won’t work. You’ve got to lose those people and find those who will give you positive support and help you push at it. Those are the characteristics you look for when you’re recruiting as well. You will live or die with your team and the people around you. We had some really hard decisions to make in the beginning of the company about team members who had worked with us for years, but where we are now we’re in a fantastic place and I think we’re really lucky that because of what we’re doing, generally you get people coming to you because they like the value of what you’re doing. A lot of them would have been working in corporate environments for 5 years or whatever job it was that wasn’t really fulfilling. So we’ve got people coming to us – they might even be taking a cut in salary – and we’ve got people who’ve been working in high-profile jobs who want to work with us because often they’ve got a link to Diabetes or they see the value in what we’re doing. So, it’s finding this set of people, who have a ‘can-do’ attitude and find a purpose in the things you’re doing. Because they’ll carry the vision and work twice as hard because they’ll believe in it. And we’ve done other things about incentivising employees as well. We’ve got a share option scheme where a new member of the company has the option to get shares of the company. It’s things like that, increasing ownership of the idea and trying to let everybody contribute to that vision and develop it.
Working with NHS
Q6: I understand the way the business sustains itself is through contracts with the NHS. I’m sure they must be quite rigorous to see if it is cost effective. Tell us about the how that process works.
A6: We built it up gradually in Scotland with the help of the Scottish government, and they saw that we were doing a good job and had made some sales, so they gave us a bit of money to get growing in that way. It was nothing commercial, it was all just to pay the salaries of the people who were doing this project. What we’re doing commercially in England, what they’re looking for, is you’ll go through certain regions: England has clinical commissioning groups which will commission services for that region, and they will buy it. Sometimes they group together, in groups of 3 or 4, and they go under a region and that region would search for services. So we got in touch with them to say “we’ve got this Scottish program running with a certain budget and we’re expecting, say, 5% return next year”. In some sense, it’s ridiculously hard because there’s no spare money in the system. One of the paradoxes about the NHS is that it has to innovate to become more cost-effective but it’s always running on a tight budget and at a loss, so there’s not enough spare cash in the system for others to take that money and do something different. If you could bring an idea to the table and say “right, it’s going to cost you this much”, the NHS has to say “right, what am I going to have to stop doing in order to pay for that”.
It’s changing, though, in England especially there’s innovation strategies, there’s clinical transformation funding which determines what level of budget can be used for these types of projects although you still have to find the funding to sustain your project. So there’s no easy answer to getting a commission from the NHS other than you develop your product as best you can, do your clinical trials, gather the evidence – we’ve already published a lot to show that our project works, saves money and improves health – and usually they’ll fight for some transformation funding to get implemented in the area. Once it’s implemented, you often want to track the outcomes so, for example, monitor it for a year and see how it goes. At the end of that process if you can see that it’s working and adding value, they’ll try to find some money to keep it going. Once you get into a budget – we’ve become part of the diabetes budget for some areas for example – it’s usually easy to continue, but it’s still a fight with the NHS. The NHS is great at many things but it’s not great at adopting innovation and it doesn’t have a good mechanism to do that and it recognises that.
Part of the reason why we’re looking at international markets is because you go to places like America where there’s a big private healthcare service, you can get private healthcare suppliers. In the Middle East, the way the administration makes decision about things is somewhat less bureaucratic than the NHS. It’s different for different places and we’re finding that out as we explore overseas. Wherever we go we have to think about “who’s paying for it here” and “what are they looking for” to try and adapt to new places.
Demonstrating value
Q7: If you could get support from all these other regions, you wouldn’t have to get funding from the NHS immediately. I imagine it must be a challenge as well because the results from your program e.g. improvements in outcomes from diabetes, would take a while to be seen. How do you prove your results?
A7: Well there’s things you can monitor, like HbA1c, blood sugar, blood pressure, cholesterol and they’ll change within 6 months to a year so you can show that they’ve improved. What we do then is model that – a lot of famous diabetes studies have tracked how improvements in blood sugar control within big cohorts correspond to other outcome measures over time. We’re able to do use that process as a way of modelling health economic benefits so we can look at changes in blood sugar and blood pressure etc. for 6 months, and then use that to model how many A&E admissions you’ll reduce in a year’s time, and how much cost you will save in 10 years’ time. What we are able to do with health economic modelling is generate an actual number and then follow that up with observations. Looking at patients 5 years down the line for example, the best evidence is actually counting the real numbers. So that’s the usefulness of health economic modelling, using short term numbers to project future costs.
Hiring
Q8: You talked about hiring staff. Were you involved in the hiring process and if you were, what kind of qualities were you looking for?
A8: I’ve been lucky, particularly in Scotland which has an amazing community with programs that have really supported us in terms of our skills at the entrepreneurship side of things. But there’s a lot in this field that takes you out of your comfort zone, like hiring decisions for example. We were quite grateful of the support we received from someone at the entrepreneurship unit of the University of Dundee, and he’s been great because he knows what needs to be done in the first 2 or 3 years of a company’s life and he can sit in with us when we’re looking at hiring applicants and say “these are the skills you need”. We’ve had to recruit a lot of software developers which is really hard because we’re competing against big companies. There’s not enough developers and they’re really hard to find, so for those cases we’ve had to rely on recruiting agents who go out and find the right people for us. For other people like operations, language and so on, we find them ourselves.
I think it’s more important to recruit people who have the right fundamental personality characteristics versus someone who has the right experience and skillset. It’s much more important to recruit people who are self-learners, who have a positive can-do attitude, who can approach things differently. Once you find them you can then go through things like personal experience, skills etc. but that’s something you can tick off quite easily. Sometimes we’ll give them a challenge and come back a while later to see how they perform, and that kind of thing’s quite important in this field. The other thing that we have is we’ll put new hires on probation for a few months which gives them a chance to see how they get on with the company and it also gives us the chance to see if we’ve got the right person for the job.
I think the challenge now is in the next stage. The chances are we’re going to double our numbers (staff) over the next 6 months and that’s what we’ve really struggled with. You start to lose track of things, so when you scale that up quickly you have to make sure that your company’s values and vision are really consistent each time you hire. We’ll see how it goes.
Remote work
Q9: Do you have remote workers?
A9: Well most of our staff are based around the central Dundee area but we’ve got an Edinburgh office and a lot of time we’re spending it down south in London, Manchester etc. so there’s a lot of travelling. We’ve got some staff who are based outside of Glasgow and it takes them an hour and a half to get here every day, so they have flexible working times e.g. working here 3 days a week, working there 2 days a week. We’ve got some staff who hold other responsibilities, so they don’t have to be in the whole week. And I think that model works fine as long as you’ve got people who you can trust in. The other thing about that is people value these kinds of flexible working initiatives, which might actually help them choose your job over another company’s job.
Management
Q10: How do you manage your people? Once you’ve got so many employees hired in the company, how do you know what everyone’s doing? Is there a way you know how much work’s being done, what kind of work’s being done?
A10: Since we also have employees who work remotely, we have team huddles and talk to each other every day virtually so wherever they are they can take part. Once a week we have a full team catchup on Skype, and we’ve got operations meetings during the week as well. A lot of it is around establishing proper communication and having structure within your team. We use Trello chat and all sorts of mapping work so everybody knows what they should be working on for the next few months. If you’ve got a small team the communication’s really good, but again the challenge is in scaling that up to bigger teams. How you maintain that network and tracking is where it becomes harder. It’s one of those things where we try and have clear management and ensure that there’s clear feedback from people as well. So it’s embedding these strategies into our daily work and inspiring the values of our company so that we all work as one. A lot of it comes down to these sorts of things, and so much of it comes down to people. It’s the people that make your team and actually getting there and doing stuff really depends on what sorts of people you know.
Balancing clinical work
Q11: How much of your time do you spend clinically?
A11: I do a couple of clinics a week, and the focus is purely on Diabetes. I think it’s important to keep that going because it keeps me grounded on the work that we do. I’m clinical lead of the university as well and I have arrangements that mean I spend a couple of hours a week doing work there. The company stuff is definitely all consuming – what that means is that I literally have to work my weekends and nights to keep the company going, because it’s growing at such a rate. On top of that I have to find time to do my university work and clinical lead work. So the business stuff is more than a full time job, but I think anyone who goes into start-up and wants to be successful needs to be able to commit to these hours. I don’t know anyone who’s worked 9 to 5, 5 days a week to scale a business, it just doesn’t happen like that. Unless you know somebody, who has very deep pockets and can throw money at it! But if you’re trying to fight for contracts and funding from the government, these things take time to plan applications, so you need to dedicate the hours.
Overseas connections
Q12: You mentioned you’re working with overseas countries like Kuwait, China, India etc. How did you get connected to these countries? What tips do you have for others who are wishing to establish these international relations?
A12: With Kuwait, it was thanks to a University academic program that was running in partnership with Kuwait and so we got introduced to some people who were working in the Middle East looking at diabetes. More recently, some tips I would suggest are looking into the Scottish Enterprise and Scottish Development International, which are government bodies that support businesses overseas. If you link up with them, they’ll fund trade missions and that’s a really good way of integrating into that environment. They also have people in posts over there who will help you. The department of international trade also supports businesses who are trying to deploy overseas so they have funding and access to experts who can get you in touch with the right people. There’s also all the usual stuff, so for example for India we had connections with other people who had been doing research there in these centres as well as some personal connections. I knew some doctors from India, and they’d say “oh yeah my brother in law is running this big clinic over there” or “I’ve got a friend who works in the ministry”. It was pretty much the same with Saudi Arabia. When you start running a business you start talking to a lot of other businesses, some of which are already in these overseas markets. As long as they’re not in direct competition with you, they’ll often share knowledge and contacts with you. It comes back down to networking.
Other interesting problems in medicine
Q13: A bit of a hypothetical question, if you hadn’t started this business, would there be any other area of medicine which you would envision yourself working on?
A13: That’s an interesting personal point: despite the fact that I’m working ridiculous hours, I now feel like I’ve found my place if that makes sense. Previously, I was a doctor and I was doing academic work, but the lifestyle never quite fit for me. Working in a big bureaucratic organisation, you can’t get stuff done quickly and that was frustrating. The great thing about your own business is you can work flexibly, move fast, hire people and connect to places – that really fit with me. So yeah, if I hadn’t started this I’d probably be carrying along as an NHS doctor, doing academic work and a bit of teaching since I’ve enjoyed that as well. Perhaps public health might’ve been something I should’ve gone into because it fits with what I’m doing.
If I hadn’t been doing this, would I have been doing something different? I don’t know, depends on how much the frustrations would have gotten the best out of me! I might have gone off and done something completely different, but the honest answer is I don’t know. The great thing about medicine is that the working conditions are very different depending on the specialty you choose. Nowadays there’s lots of programs and opportunities for doctors to branch out, such as clinical fellowship training programs that encourage people with medical backgrounds to explore other fields. You can do that with a university to a certain point as well, even with things that are non-academic: there’s all sorts of support groups, online groups and the faculty of clinical informatics (here in Dundee). The field is evolving; when I trained, it was a very traditional career path and I had to do this (business) stuff on the side to keep myself interested. What I’d say to people who are interested in this is that there’s all sorts of opportunities out there, especially with the internet and social media, so don’t be constrained by the barriers and think that you’re meant to fit within a certain box.
I think people who have skillsets across all sorts of different areas are becoming incredibly valuable people, and we’ve undervalued them in the past. One of the reasons I think we’re doing quite well in our current model is that we’ve got people like myself and others in the company who have come from academic NHS backgrounds who now have business experience. There are so many tech companies which are built from people with no clinical experience whatsoever. The more you can build skillsets across different traditional disciplines, the better. That’s when the magic happens, that’s when you can bridge gaps and work with people or learn skills yourself from other industries. There are all sorts of specialists within business and those are critical roles, but they’re probably not going to be leaders of the business, because you need someone who has a bigger picture and is not going to get too bogged down by the details.
Books
Q14: Are you a reader? Do you have any books you could recommend?
A14: I’m not a great reader; it’s funny, when you look at my learning style, I’m not someone who learns by reading, I’m someone who learns by doing. I’ve got a lot of books on entrepreneurship which I’ve started reading but haven’t quite gotten to finishing. I think books on entrepreneurship methodology are quite interesting. There’s a science behind entrepreneurship, and the case is becoming stronger – look at these guys in the US. They’re making building blocks that you can work to, like in the ‘12 steps to entrepreneurship’ for example, that’s one of the books I’m reading. There’re strategies, models you can use to achieve that and I think this rings true not only in entrepreneurship but also any other skills you’re trying to build in your daily life. There’re all sorts of books, like ‘Startup Blind?’ and there’s another one on ‘Building startups??’, I’ve read most of that but I haven’t gotten all the way to the end of it yet! Some of that stuff is on rapid learning as well which is really important in tech businesses: to learn fast, build stuff, if it doesn’t work rebuild it, keep testing it.
Favourite entrepreneurs
Q15: Do you have any favourite entrepreneurs?
A15: We were very lucky in that when we went to the US we got the chance to look at Silicon Valley and see how companies like Google, Apple etc. scaled up. That really helped me realise that for the stuff we do in Scotland, we were thinking of scaling up say in England, when actually we could have been looking at the bigger picture and thinking about scaling up across the world. These Silicon Valley companies are all built to interact with companies across the other side of the world! It was quite interesting for us as well we got invited to a spaceship company in the Mojave Desert that was building spaceships for space tourism and seeing how they implemented infrastructure across the world to get this done. Jeb Bush? I hear is quite a good example of an entrepreneur, he’s got a really good work ethic part of which is about trying to get more women into technology. I remember they also had a really good idea of having name badges with interesting company ethics phrases printed on the other side like ‘Hard grind’?. Of course, you can’t forget Steve Jobs, who isn’t maybe a person who was liked for his personality type but is definitely remembered for his mentality and philosophy in terms of what he did to build the company. He brought in a history professor into his company and people were wondering what use he would have for that in a tech company, but it was all about diversifying the skillset. Steve was a ‘social academic’ who really understood how people work; he knew how to bring people in, which is a completely different skillset. I met that history professor when we went to Silicon Valley and we sat down for a chat where he told us all sorts of stories about his time in Apple.
Advice
Q16: Lastly, do you have any advice to medical students and young doctors out there who are thinking of jumping into business or innovation?
A16: Don’t feel constrained by boundaries. If you’ve got an idea, go and do it and look for opportunities, there’s all sorts of people out there who can help you: if you’re a medical student, go and speak to your school of entrepreneurship. Don’t be scared to find people who are doing work similar to what you’re interested in and speak to them. Speak to other like-minded people, whether it be via online communities or in person. I think it’s easy to get despondent about an idea if you’re the only person thinking about it every day, but if you can attach yourself to a network and share that idea with other people around you, that will keep things going. There’s lots of people out there who are a step ahead of you in the journey and although you might need a bit of tenacity to get a date in their diary, you’d be surprised how many would be happy to share their stories with you and mentor you. Think about where you want to be in 5 years’ time and start thinking about what contacts and mechanisms you could put in place to get there. There’s also lots of local funding that you can use to get your idea off the ground so research that and apply for it.