Startup Pitches (Beanstalks)

MINOLTA DIGITAL CAMERA

These are some of the new startups disrupting the health industry – possibly the largest industry on the planet.

The products I saw pitched were point of care cortisol testing and a novel method for delivering vaccines and preventing spoil. This is a fantastic initiative for new healthcare startups

Normal Flora. Artwork by Anna Dumitriu

Art meets the microbiome Fantastic art/science fusion blog by this Brighton based artist. We need more of this in medicine and as scientists it helps to keep us grounded in reality.

She has also done a lot of work on microbiological resistance and seeks to raise awareness of this through art. Fantastic!

Anna 063

NHS Hacks

What happens when clinicians working in the NHS collide with coders and software developers?  Awesome stuff is what! That’s the whole point of NHS Hacks – different fields working …

Source: NHS Hacks

Notes on Lean Startup methodology with a veteran John Spindler aka Capital Enterprise

I learned so much from this guy I had to share it with others…

Now is the Time

Why bother starting a lifestyle business. You are sitting on so much value and you want to share that with the world not just make your life easier. you don’t want a checklist business!

‘Big will not beat small anymore. The fast will beat the slow’ — Rupert Murdoch. Even he is aware of it.

Ask yourself: Where can your business be in 12 weeks?

Incumbents should note that there are hidden ‘gun’s’ (startups) in peoples garages which contain bullets with other companies names on them.

‘Think big, act small, fail fast, learn rapidly’ — Eric Ries

Lean Startup: Eric Ries

As an investor, John Spindler finds the lack of background research by entrepreneurs to be one of the most commonly encountered frustrating problems. To solve this he suggested:

Make 2 columns:

  1. Fact column- 2–3 facts you KNOW about this business plan.

2. Second column- Hypotheses. What things do I need to find out to build this thing?

Work out what is your OPPORTUNITY HYPOTHESIS. Build, Measure, Learn. Call it a project rather than a business because it is easier to fail fast. (I like the psychology of this idea and have already found it helpful).

In the experimental stage check your are measuring the right metrics, evaluation of them will lead to excellent execution.

Startup Owners Manual: Steve Blank and Bob Dorf

Don’t build something nobody wants

3 types of advice: validated, negative and useless. (Validated/Negative advice in 8 weeks can be tested to see if it works. Good or bad it will help you. )

However, 95% of advice is useless in the next 8 weeks. Therefore, shelve it because it’s useless to you now.

Lean is just about organising the chaos, reducing waste and risk, providing more learning and a common language. IF your core assumption is wrong you need to test that FIRST. Then you will save yourself a lot of time.

It’s a common language. There is jargon and as soon as you learn it you can communicate with others — be ‘in the club’ as it were.

If you are going to build, do a lot of thinking. Then build the thing that teaches you what you need to learn.

The number one thing an investor will look at is the team. If you can convince a quality person to join you that is a sign of success. If you can recruit a quality army this is your number 1 asset! What quality of ARMY can you recruit? Investors will care about this more than anything else as it is the biggest single determinant of success.

Get OTHERS to validate your product. Your own validation is not that valuable but multiple external validations are.

Testing Hypotheses

A good hypothesis is simple & clear, written as a statement, establishes participants (who), variables (what’s involved) and prediction of an outcome (evidence).

The Pepsi Challenge type scenario is NOT the right first validation exercise. You have to assume that the first answer is wrong. Ask 5 why’s & eventually you might get to the nub of it. AVOID CONFIRMATION BIAS like the plague.

Most people are NOT early adopters in ANYTHING. Most people have habits that are very hard to break.

MVP is not a crappy version of the product. It is a prototype. Consierge MVP is legitimate. It can be a simple landing page, it can be a proof of concept, it can be something for people to engage with, it can be a paper prototype, a pitch, fake demo video, or something to help a developer to understand. It is just a way to answer the questions you need to answer.

Thanks to JP at www.transformcustomers.com for this great cartoon

Consierge means it is not scalable. It’s just there to allow you to learn. Beware, If your hypothesis is circular then its not a hypothesis and you need to think again.

Key assumptions you need to make

At least several other people are working on the same thing right now. How you think this your business idea will work is probably wrong. Your main job is to learn faster than the competitors. That is why the team is the key. It is the process and the people that win NOT the product itself.

The market is not stable and anyone who doesn’t keep moving forward will fall behind.

Call it a project, give it a name, sell something, convince someone else to join, set a goal that will inspire you, live 6 months in the future, fall in love with the problem and not your solution. Follow Peter Thiel’s philosophy as per ‘Zero to One’ (find it on Amazon its a good book.)

Teams

There are two types of teams. Napoleon team — they will follow your every command. The best teams however are people who are smarter than you and can do things you can’t and you bring them on the journey with you. They don’t want to just be footsoldiers for your army.

Bare minimum you need a hipster (domain insight), hacker (builder) and hustler (seller) to succeed.

Paul Graham- You need three things to be a successful entrepreneur — a great team, proof that customers want it and a willingness to do it with minimal money!

Regarding Customers

‘Make something people want’ — Paul Graham, Y Combinator

Avoid wasting too much time trying to change the ‘stuck’ middle who don’t want to innovate because they are very good at using the current system. Are your people your assets or your problem?

Before building your business ask: What problem would someone else solve for me?

Another thought: The number of secrets in the world is roughly equivalent to the number of startups we need.

How did the companies that are currently successful scale. When you scale big you win even if your product is inferior. Unless you can bring 10* value you are unlikely to be able to displace an incumbent. (As per Peter Thiel).

Design Thinking

He would thoroughly recommend doing Stanford’s online course on design thinking (8–10 hours). Emphasise, define, ideate, prototype, test. Do it in groups if you can, it will radically transform your thinking.

‘Kick Ass’ products have evidence that they solve a customers problem in a big market. Focus on the early adopters. People you can beta test with. Commit 5 people. They need to know they are aren’t buying a perfect solution.

They are trying to find a home made solution. They want you to succeed, they will give you their time and honest feedback and you have a relationship of trust. Your mum is not one of these first customers!

Do you know the demographic? Needs and goals? Problems that need solving, Present behaviours? How do they go about solving those problems? Reference group? The behaviours and the psychology are key.

Behaviour Change

BJ Fogg. Head of behavioural theory at Stanford. B=mat. B=behaviours, m=motivation, a=pre-acquired ability, t=triggers (we are all contextual. We need external triggers to get us to change our behaviour. Every product is a behaviour change. Activation threshold affected by these three things, the triggers have to be enough to get them over the threshold.

Source: B.Fogg (Stanford) Site as per diagram.

Can you make something better than it already is? make something simpler? In an ideal world how would this problem be solved? Better, Simpler or emerging methods?

He suggests we build 5 actual profiles of 5 potential customers (actual people) . The more specific the better: Motivation, Habit , Income, Age, Location, Status, Backstory. Become intimately acquainted with there problems.

Then understand the full use-case lifecycle.

Source: @capenterprise — John Spindler

What do these personas do when ‘triggered?’

Entrepreneurship is a career. Startups are risky experiments. You don’t have to experiment full time. Start today with what you have.

Do you invest in startups who don’t use lean methodology? Yes but its rarer. Sometimes people just get damn lucky and hit a home run of first base but its the exception rather than the rule and it might not be repeatable.

Then he talked about financing and how ‘founders fit’ and how investors look at these things. Do you have someone resourceful, someone who can do x and y. The team you build now might well not be the team that takes it to the next level. Identify the task in hand and see if the team members can get you there.

Funders and investors must fit. An investor should never distort the function of the startup because this is your task. You have the hands on the controls. They are investing in you!

Suggested reading: Moms test by Rob Fitzpatrick, Running Lean by Ash Maurya and Lean Startup by Eric Ries.

This article came out of notes I took on a talk by @capenterprise at the first NHS clinical entrepreneurs pit stop – The beginning of a new journey. Or see my medium blog

John Spindler @capenterprise on the Lean Startup Method: Part 2 – The Customer. @ #NHSClinEnt

‘Make something people want’ – Paul Graham, Y Combinator

Avoid wasting too much time trying to change the ‘stuck’ middle who don’t want to innovate because they are very good at using the current system. Are your people your assets or your problem?

Before building your business ask: What problem would someone else solve for me?

Another thought: The number of secrets in the world is roughly equivalent to the number of startups we need.

How did the companies that are currently successful scale. When you scale big you win even if your product is inferior. Unless you can bring 10* value you are unlikely to be able to displace an incumbent. (As per Peter Thiel).

Design Thinking: He would thoroughly recommend we all do Stanford’s online course on design thinking (8-10 hours). Emphasise, define, ideate, prototype, test. Do it in groups if you can. Great course

‘Kick Ass’ products have evidence that they solve a customers problem in a big market. Focus on the early adopters. People you can beta test with. Commit 5 people. They need to know they are aren’t buying a perfect solution.

They are trying to find a home made solution. They want you to succeed, they will give you their time and honest feedback and you have a relationship of trust. Your mum is not one of these first customers!

Do you know the demographic? Needs and goals? Problems that need solving, Present behaviours? How do they go about solving those problems? Reference group? The behaviours and the psychology are key.

BJ Fogg. Head of behavioural theory at Stanford. B=mat. B=behaviours, m=motivation, a=pre-acquired ability, t=triggers (we are all contextual. We need external triggers to get us to change our behaviour. Every product is a behaviour change. Activation threshold affected by these three things, the triggers have to be enough to get them over the threshold.

fogg-behavior-model

Source: B.Fogg (Stanford) Site as per diagram.

Can you make something better than it already is, make something simpler. In an ideal world how would this problem be solved. Better, Simpler or emerging.

John suggests we build 5 actual profiles of people. The more specific the better. Motivation, Habit , Income, Age, Location, Status, Backstory.

Understand the full use-case lifecycle.

You need a hipster (domain insight), hacker (builder) and hustler (the first two work for him for free!).

Source: Capital Enterprise – John Spindlercap-enterprise-full-case-use-scenario

What do these personas do when ‘triggered?’

Entrepreneurship is a career. Startups are risky experiments. You don’t have to experiment full time. Start today with what you have.

Suggested reading: Moms test by Rob Fitzpatrick, Running Lean by Ash Maurya and Lean Startup by Eric Ries.

#NHSclinent. John Spindler @capenterprise talks about lean startup methodology – Part 1

Brilliant start to the clinical entrepreneur programme. @Tonyyoung and @theonlytoby introduce the programme (below)

img_20160924_094759

Building a culture of entrepreneurial strength should be at the heart of what we are doing.

John Spindler @capenterprise – Lean Startup

Why bother starting a lifestyle business if you are a doctor. You have so much value and you want to share that with the world not just make your life easier. you don’t want a checklist business!

‘Big will not beat small anymore. The fast will beat the slow’ – Rupert Murdoch. Even he is aware of it.

Where can your business be in 12 weeks?

‘There are hidden gun’s in peoples garages which contain bullets with other companies names on them.’

‘Think big, act small, fail fast, learn rapidly’ – Eric Ries

methodology_innovation

As an investor, John Spindler finds the lack of background research by entrepreneurs to be one of the most commonly encountered frustrating problems.

2 columns:

Fact column- 2-3 facts you KNOW about what you about about do with this business.

Second column- Hypothesis. What things do I need to know to build this thing?

What is your OPPORTUNITY HYPOTHESIS. Build, Measure, Learn. Call it a project rather than a business because it is easier to fail fast. Like the psychology of this.

Experimental stage, metrics, evaluation leads to excellent execution.

startup

Don’t build something nobody wants!

3 types of advice: validated and negative (in 8 weeks you can test it and see if it works. Good or bad it will help)

95% of advice is useless in the next 8 weeks. Shelve it because it’s useless.

Lean is just about organising the chaos, reducing waste and risk, providing more learning and a common language. IF your core assumption is wrong you need to test that FIRST. Then you will save yourself a lot of time.

It’s a common language. There is jargon and as soon as you learn it you can communicate with others – be ‘in the club’ as it were.

If you are going to build do a lot of thinking. Then build the thing that teaches you what you need to learn.

The number one thing an investor will look at is the team. If you can convince a quality person to join you that is a sign of successfulness. If you can recruit a quality army this is your number 1 asset!  What quality of ARMY can you recruit? Investors will care about this more than anything else as it is the biggest determinant of success.

Get OTHERS to validate your product. Your own validation is not that valuable but multiple external validations are.

A good hypothesis is simple & clear, written as a statement, establishes participants (who), variables (what’s involved) and prediction of an outcome (evidence).

The Pepsi Challenge type scenario is NOT the right first validation exercise. You have to assume that the first answer is wrong. Ask 5 why’s eventually & you might get to the nub of it. AVOID CONFIRMATION BIAS like the plague.

Most people are NOT early adopters in ANYTHING. Most people have habits that are very hard to break.

MVP is not a crappy version of the product. It is a prototype. Consierge MVP is legitimate. It can be a simple landing page, it can be a proof of concept, it can be something for people to engage with, it can be a paper prototype, a pitch, fake demo video, or something to help a developer to understand. It is just a way to answer the questions you need to answer.

minimum-viable-product-2-848x458

Consierge means it is not scalable. It’s just there to allow you to learn. If your hypothesis is circular then its not a hypothesis.

Key assumptions: At least several other people are working on the same thing right now. How you think this your business idea will work is probably wrong. Your main job is to learn faster than the competitors. That is why the team is the key. It is the process and the people that win NOT the product itself.

The market is not stable and anyone who doesn’t keep moving forward will fall behind.

Call it a project, give it a name, sell something, convince someone else to join, set a goal that will inspire you, live 6 months in the future, fall in love with the problem and not your solution. Follow Peter Thiel’s philosophy as per ‘Zero to One’ (find it on Amazon its a good book.)

Don’t call it a business because you will overprotect it. Call it a ‘project’. Get people to devote time to your thing.

There are two types of teams. Napoleon team – they will follow your every command. The best teams however are people who are smarter than you and can do things you can’t and you bring them on the journey with you. They don’t want to just be footsoldiers for your army.

Paul Graham- You need three things to be a successful entrepreneur – a great team, proof that customers want it and a willingness to do it with minimal money!

Then questions:

Do you invest in startups who don’t use lean methodology? Yes but its rarer. Sometimes people just get damn lucky and hit a home run of first base but its the exception rather than the rule and it might not be repeatable.

Then he talked about financing and how ‘founders fit’ and how investors look at these things. Do you have someone resourceful, someone who can do x and y. The team you build now might well not be the team that takes it to the next level. Identify the task in hand and see if the team members can get you there.

Funders and investors must fit. An investor should never distort the function of the startup because this is your task. You have the hands on the controls. They are investing in you!

Thanks John.

More interesting tech at NHS Expo 2016

Lifelight

This is a really cool sensor system that is brilliant ad it is so simple yet massively effective. The founder Lawrence, is a legend and is doing great things via Southamptons catalyst programme. Watch this space! If I had money to invest I would invested in this.

XPERYE

Used by Shafi Ahmed in London this is a neat peice of kit using Google glass to transmit the wearers vision to a computer. The images can then be annotated or altered to be used in teaching etc. With the Google glass version 1 no longer available and a time lag for its successor and at £300/month this is potentially a very nice little training tool in the right context at the moment. It is certainly fun to play with.

PA consulting’s offerings 

PA consulting have introduced these products at the expo. This is a new probe for measuring Barretts oesophagus through the scope. It was next to the cytosponge but for some reason that had disappeared today. Both very promising innovations in my specialty (gastro) for Barrett’s surveillance.

TEDx NHS

TED has finally landed in the NHS. This proves people are gradually catching the vision. Bring it on…!

New tools to market at Expo 2016

Creavo
This beauty could revolutionise the admission of chest pain. It can more accurately diagnose ACS AND unstable angina in just 3 minutes in the ED. It’s currently going through studies to validate it but I can see it being very successful as it’s price point is only around £100k and it could save NHS trusts millions.

Creavomedtech only just formed. Based in Leeds with a strong support structure, good corporate backing and strong technical expertise linked to the university I think this is one to watch!

Early Sense

This platform by early sense could be useful for patients with dementia as a way to monitor them remotely. However, there are lots of cheaper bed alarms. At £3500 a bed I think this products USP is the monitoring rather than anything else.

Vanguard

This is not a new technology but it’s beginning to scale. Portable theatres and endoscopy units could help some hospitals who have capacity issues. This polentally also has a role in major incident management.

Centrihealth

This is a context based health platform. More advanced than a normal EPR (electronic patient record) system. This uses AI to filter the data and produce a useful record. This tool is FANTASTIC, but they have not yet broken into the NHS because their marketing strategy is wrong. It took me ages to get what they are actually doing and I think thats why they are struggling here. THIS IS A PATIENT SAFETY TOOL NOT A ‘CONTEXTUALISATION’ ONE. If you read this then get in contact because I think I can help you.

There are many more innovative solutions here but these ones caught my eye. To see more visit the EXPO website.

Novel Imagers / VR kit

In the last couple of weeks I have been contacted by several people who have designed various gadgets for Medical VR/interaction. They are iridescent imaging, VIZR, D-EYE and Gesturetek. 

First up Iridescent Imaging 

Mitch Downey founded this company to create fantastic small and life-size VR projections.m  see more images here: http://iridescentimaging.com  The technology looks fantastic but as you might expect it isn’t cheap. I can really see how these might be useful for virtual clinics, particularly in specialties where walking in front of the doctor is a key part of the exam: ie. Rheumatology / Neurology. However, a remarkable product needs a great website and this is something that needs a bit of work. 

Then there is D-EYE

This thing looks excellent. It can effectively enable an ophthalmologist to diagnose a child remotely in another country using just their smartphone but more likely it will be a great clinic application. To be honest I want one on my emergency unit as it looks so easy to use but again these things are new and therefore costly. https://www.d-eyecare.com

Next up VIZR

This is more like a clinician assistant (like Google glass) they feel their user interface and information is more up to date. It looks like a smart gadget but as the video on the site demonstrates it is not entirely unobtrusive to the patient looking at the doctor http://www.vizrtech.com

Time will tell whether there will be enough uptake. My feeling is that unfortunately for this device we are still several years away from IoT and the effects of Big Data having their full impact to help this device work. 

Finally we have http://www.gesturetekhealth.com

These guys are doing something a bit different. Trying to get physical controls to work for rehab /those with disabilities. Unfortunately the website is dire which is a shame as they have some really cool products like Irex-an upper and lower extremity training system. 

It looks like they are doing a great work in their niche. 

Note I have just started a medium blog as well and plan to integrate them later so watch this space. 

Some new wearables / healthtech

Firstly there is Ozmo https://www.ozmo.io a drink bottle that measures your fluid intake. Seems like a good idea as it can connect to a variety of different other wearables but weighing in at $70 it’s not cheap (especially as I have a habit of leaving these things behind). 

Next there is Heart-In http://heartin.net/heartin.html

Not a great website but looks interesting. Unfortunately, the product is not that different from lots of others and I can’t work out how it is differentiated. 

Finally there is pulmaware by strados Labs. http://www.stradoslabsllc.com. 

This one looks the most interesting and unique of the lot. The website is clear and the product something that most asthma patients will understand.

 This one definitely gets my pick if the week and if I had lung disease I would strongly consider getting it.