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Hi there everyone. Um Great to see you back for our next session on Innovation Skills. Um And we've got some fantastic speakers to kind of uh again talk about how you can, you know, upskill yourself in innovation and develop as a trainee. Um So our first speaker is um Mr Ryan Kirstein, who is a consultant plastic surgeon and the lead for the Royal Colon Surgeons England, uh future surgery innovation hub. Um And he's gonna be sharing opportunities to develop as a trainee. Hi, good morning. Firstly, thank you ever so much to Matt and the entire Atet team for the invitation to the Atet Innovation Summit and congratulations on putting together and a fantastic program. So my name is Ryan Kerstein. I am a consultant, plastic surgeon working in Bucks and for the Trust. I'm also the associate medical director for research and Innovation uh for the Royal College of Surgeons. I'm the editor for bulletin and also the lead for the eye hub, the surgeons innovation hub. I have a number of academic roles for clinical innovation, my own startup. Uh and I do some consulting for a number of med tech companies. I hope that this presentation, I can bring all this experience together to show the importance of clinical innovation. But Michael, importantly that career path of being a clinical innovator. So the aim of today's session is to follow up. So 13th to talk about a definite gym for a healthcare, even I know that you would have heard a number of talks already as part of the summit that have discussed innovation. And I'm pretty sure that the number of them will be looking at innovation slightly differently. So I'm gonna put my spin on how I see health innovation and how I frame it. And later on that then move on to the second part, which is how do you upskill in innovation in order to, to take on those future clinical innovation worlds to it? I think medicine is entering a really exciting period. I think it's entering into healthcare 3.0 now for the more astute in the audience, if I'm calling it healthcare 3.0 I don't see there's any but that means there must be a 0.1 or 1.0 and a 2.0. So what, what is it, where, where have we come from and where we live? So healthcare 1.0 I would argue is that empirical medicine period, that trial and error. So from ancient times to probably in the late 19th century, mainly based on tradition, but with a very limited understanding of why things worked if they did work, uh, treatments largely rudimentary. Er, and towards the end of that period is when we started to understand a bit more about basic hygiene, er, a bit more about what herbal remedies worked and didn't and some very, very, very rudimentary surgical, then we left healthcare 1.8 and so 2.8 which I'd argue was the kind of period of the rise of science and evidence based practice. And that went from that late 19th century period up to yesterday. Um And in that time, we'd start to understand the germ theory, anesthesia and antibiotics and those two things combined allowed surgery to really flourish. It was a period that we started to establish hospitals and medical schools and then specialization uh as opposed to being able to do whatever and wherever. Um and it was a really exciting and really pushed medicine forward. But I think out of 3.0 we're gonna go even further. And the thing with 2.0 is that actually our surgical heroes of yesteryear were to come into a theater today. The reality is that uh we're pretty unchanged, that model of uh treating 1 to 1, the one doctor and one patient who exist. And actually the the fundamentals of how we deliver surgery with uh uh a scalpel and some forceps is unchanged. So wh they may be a bit surprised by the computer sitting in the corner of the operating room. Actually, not much has really so healthcare 3.0 And I'm gonna preface this by saying that I think it's the most exciting period of health care. And that is partly out of necessity in that we can't keep doing what we're doing because m medicine is becoming more expensive. Um Expectations are higher and so on. And that Einstein adage of it's insane to think they do the same thing over and over again and expect a different result is where we are and why we have to change it, why we have to move away from health and it's being empowered by the fact that we are breaking silence, the ability as healthcare professionals to interact and collaborate with engineers and academics and data scientists who really change how we deliver care is changing. But not only that technology is being democratized and in many ways, I do hate that term, but it does fit that ability that any of us to reach to our phone, go to check DPD or whatever flavor of gene A I that, that you like and we can code almost anything instantaneously without the need of AAA computer degree. Um or we can start to prototype things using 3D printers has just hugely changed the um the the landscape and what's know that there is uh a drive from above in order to change and adopt innovations. So we look at the wh o that they state that health innovation er will improve efficiency and effectiveness. Even NHS England, if you go on to their website, they talk about innovation being critical to enabling NHS England to achieve its ambitions. Um And they also talk about um kind of UK PLC and the fact that we have the world's largest unified healthcare system. So if we can innovate and answer problems and drive change, not only will that benefit the healthcare of the UK, but potentially the healthcare internationally would be benefits coming back into the UK. There's two really great documents that I think underline this, the topple report and the future of Surgery report. Both are kind of 4 to 5 years old now. But they really set the team for what innovation is and how we're gonna change how we deliver in the future surgery report. They talked about bringing uh innovative technologies, enhancing our understanding disease and wider collaboration to improve patient care. But really the crux of those two documents said that all this exciting technology is coming and it's gonna change how we deliver care, but to really deliver it and really to reap the benefits of it, we need to upscale our workforce, we need to have surgical innovators that understand the technology can appraise it and can be at the forefront of a do it. So I've already used the term innovation a lot. What is it? What, what is innovation there for me? There are three parts to it and the first part is the most and that is what is the need, what is the problem that needs to be solved? So, in this, by the problem to be told, these are the things that if you could change, if you think about your day to day job, if there's one thing you could think about it, what would it be? What's that thing that you spend more time doing than any other thing? Even though it's not actually that important, but it's just the process of getting it done. Maybe it's requesting scans or booking patients for the theater or reviewing histology. It seems to be, take up more time than anything else, but isn't necessarily clinically more important than anything else? Is there a better process for doing your job? Is there that thing that you go? Well, actually, why don't we go this way because at the same time or I can do more than one at the same time. What's the thing that you get recurrent complaints or problems? Obviously, none of us get recurrent complaints if we did. What are the complaints that we, that we get? What are they if we were to kind of feed them? Is there a particular area that seems to attract more uh iron than anywhere else? What's the task that frustrates you? What do you go home at night and kind of put e and you're on the half or your pet or your plant or whatever it is that um that you, you kind of moan to, what's that thing that gets you, er, irritated finally, is there something that can be done quicker or better? So, in principle, those are the, the areas, but how do we take that from just being a nag to actually a problem worth solving? And II would argue this, that this is the first of a number of books I would recommend uh it's Arnold Schwarzenegger's most recent book, um Seven Tools For Life. And in it, he says a problem can't be that bad if it hasn't motivated you to do something about it, but also don't complain about a situation unless you're prepared to do something about it. So thinking back of all those kind of buckets of problems, what are the problems you go? Right. That's the one I I'm fed up of doing that and that's what I'm gonna change. And that's the starting point for innovation in and what are the problems with? Two point? Oh, so we're really gonna make 3.0 to tax. What are the areas of concern? What's these, it's these kind of four buckets, efficiency and costs that healthcare costs are rising. We have increasing wait times and we have inefficient protesters. We know this work for shortages, the issues around attracting the, the best and brightest, but then keeping them in healthcare access and equity. And especially if we move the land from a national NHS picture to global healthcare actually, how do we address the huge disparities in in healthcare delivery and patient experience? How many people can really hand on heart? Say that every patient I interacted today. I gave them an experience that was not that I would want my own friends and family to. Ok. One. What's need? Number two, what's the value that addressing that need? Now, what does addressing the value mean? I know it could be that addressing the value is this that you're about to create the latest healthcare unicorn, you're fine. And if you do, congratulations, uh remember this talk and um uh hopefully this is what triggered you, but the reality is for most of innovations and certainly in healthcare, you're unlikely to be uh about to create the next year. But what is value when it comes to healthcare? One of two things, it's either addressing outcome or cost. Unsurprisingly, you either improve outcomes or reduce costs. Now it's really hard to genuinely, genuinely, genuinely improve health outcomes. There, there will be things to do but um i it due to wall changes and actually it's not the kind of, it's not the easy thing to do. The lower hanging fruit is how do we address healthcare costs? Now, it could be that you can create something that is cheaper than the incumbent. Fine. Congratulations. But actually you don't necessarily need to think about it that way. It could be that you do something. For example, you reduce the admin burden and in doing so, improve morale and in doing so er increase retention and thus reduce the need for recruitment, which is incredibly expensive. And so in doing so, you have reduced the costs even though um the upfront, it may be more expensive than the whatever you do have to do one of these two things in order to do that. So once you have your need and you know the value that addressing that need would be then and only then do you then start saying? OK, well, what's the tool that I need in order to address it? This is what makes it really exciting at the moment in that there are all these tools that are suddenly coming into healthcare that we have access to it, 3D, printing, robotic A I extended realities or apps. And the key is that you take your problem and you find the most appropriate solution for that problem as opposed to going, I really want to use extended reality. Where can I crowbar that into? It's saying, well, actually I have a problem with staff training because very few people are seeing major burns in the UK, but they're a huge problem. So therefore, is there an extended reality er solution that I can do to address this? And it's always important when thinking about technology to keep this in mind that bad technology can make the situation worse in the US. 44% of physicians. Um complain of or, or, or experience burnout in a third of nurses when uh further interviewed about this, 50% it is due to their electronic health record. It's a tool that was introduced to solve a problem that's actually made the situation worse. You need to make sure that you are doing the right tool for the right problem again. So how can we train for health care innovation? The first thing is mindset, everything else. Uh And there are five things we're gonna discuss, but mindset is absolutely gay. That you what I would, what would be a disaster is if everyone thought, oh, I need to innovate just to tick the box in my CV. In the same way that kind of research and teaching has become the thing that everyone has to do that they innovate your mindset to be something that you want to do, something that you're driven to do something about because it's not easy. Um And you want to be felt passionately about the problems you're solving in order to um then once you've kind of grounded the you innovation, then the, the next step is knowledge to how do you build up your innovation? Knowledge, what to those training? Uh And we'll, we'll discuss some of this in more detail and your network are probably the two areas and then finally your experience. So you have you, your knowledge and your experience and your experience will come from either internal NHS opportunities or external industry opportunities. So that's all about innovation mindset. The first thing uh is to not accept poor protest to challenge the status quo when you feel that uh a service has fallen to advocate for continuous improvement. Um And, and that includes when you come up against well established uh processes that people just do. If you think that actually that can be improved, challenge it and encourage a culture where feedback is actively taught and address elaborate, you cannot do all this on your own. We have a set of skills with clinicians, but that does not mean we have the full answer. So look to other teams, actually, maybe that other teams have already come up with a solution to the problem you've had. Um but go and seek out those other teams, be it other um clinical teams or other uh areas of industry in order to expand what it is that you can bring, encourage pilot projects and iterate those improvements over and over again. Er and view those team project failures cos there will be some as opportunities to learn, work out what went wrong. And so when you go again, you have better experience and this is the key, this one more than anything else um is ABCD. So not airway breathing circulation that goes out the window when it comes to it, it's always the connecting dots. Look at where actually I'd probably be best. So by this piece of technology as opposed to that or bringing in this team or this person, uh instead of this group, um you want to be able to look outside of healthcare actually, how are similar problems dealt with in industry elsewhere? What can we learn from the world outside? Talk about training. Well, there are kind of two bits of the training, they're kind of formal educated and self directed. So from a formal point of view, come along to the the I hub events that we run and I'll, I'll show you our, our QR code that you can take a photo of shortly that we do a number of different work jobs and uh and different areas across the innovation journey, join healthcare hackathons or innovation competitions to get experience of the innovation projects and innovation thinking and also build up that network and we'll come onto it again shortly. And obviously, I know that we are a group of surgeons. We tend to be quite uh type a personality and, and, and we're kind of trainer in order to really change and do something you need a degree. If you're that way inclined, there are a number of NS ES uh in health innovation or digital health that can provide you with that, but you don't need to do that. And actually, I haven't done that and I've done OK. Um There's a number of um platforms, you can pick up free courses in Edex or even Google offer courses on data science or machine learning. Er and then there's courses that are free on digital health. Also, books definitely read things like the lean start up or the innovators dilemma. And it just gets you to kind of starting to think in a, in an innovation mindset network, network, network network is so key. It's so important to build a really strong network, participate, come to events like the IH another shameless plugged for the Ih Akon to Innovation Forums, you free resources, so linkedin or co-founder or meet up. So they're either digital or in person events to connect with board leaders, connect with allies that will help you build your um your, your ideas up um And join those groups, go and collaborate. And if you do start building up that network, kind of both seek mentors but seek your tribe members, seek the people that maybe you will collaborate and do something together with or will champion the things you're doing or be able to connect with other people. But also see the people that are further along that journey and get advice from them. I've very rarely had anyone say no. When I've tried to connect with them on, on linkedin or whatever it would be, they, I've got this idea. Could you help? Um But when you do reach out to people offer some value back in the other way, kind of introduce yourself, show why you think this is important. Um And follow up, keep connections live, er, because it's really easy to connect with people and then do nothing with it. So, leave messages every now and again to see how they're doing, keep those things live. And then, um, I've touched on, I have quite a lot in these last couple of slides, but this is exactly what we're trying to do. We're trying to bring together the ability to get educated, to have events and to connect both industry and clinicians. So that way we can start to um things. Here's a QR code, uh wait 10 seconds, take a photo of it. It comes up at the end as well. So don't worry, I'm just conscious of time. Come and join the IH and um come and join our events, right? What else can you do? So internal opportunities you don't need to overcomplicate this. We'll do audits and quips. Well, that is a great way to start you identifying a problem and coming up with solutions. Now, coming up with a potent to deal with something is unlikely to be the next unicorn, but actually it gets you into that process and there will be things that are translatable because on the whole healthcare problems are similar everywhere. So if you identify a problem in your trust, the the reality is that the departments nearby or the trusts nearby or the trusts nationally have the same problem. We ran an ihab event this year which was looking at Q I to start up to this thing. Also look at institutional roles. There are a number of Clinical Innovation Fellowships. We have one in buck to we set up um Chelsea, we has one guys and ST Thomas. All there's a number of these around. I allow you to stay in clinical and build up an innovation experience. Once you have an idea um that you wanna take forward, there's things like the Clinical Entrepreneur Program or the Natural Innovation Accelerator that are there to help you take the to while keeping you in health. Also there's external opportunities. So looking at taking ups or oop ci took an OP C er and went to work at the Boston consulting group, a big management consulting firm to look at how they do project management and change management and, and healthcare and technology. Um A number of technologies themselves. Uh Sorry, companies themselves will allow you to go and spend some time uh with them or go and join a start up. I know companies like in have a program that allows you to uh spend some time within the product team to understand the challenges, unintended decision making processes that go on in healthcare. Um I can't threaten up the elevated mindset and that desire to want to change how we deliver healthcare is is the a start and almost bang on time. Uh the that's the end. So thank you ever so much. Please do keep in contact my details of the QR code on the left and the QR code on the right is the IH um sign up. She please do sign up, come and join our event and I look forward to meeting you online or enjoy the rest of the. Thank you so much to er Ryan for being here and providing that talk. Unfortunately, you can't be here, live with us, but we do have er Miss Nhar Yasin, a colorectal robotic surgeon and chair of the Future of Surgery for the Royal College of Surgeons of England, who will be doing a whole talk later on to look forward to that. But um thought it would be good to be able to be here just perhaps to ask a few questions on the back of what Ryan's been talking about. Um So we definitely have a couple of questions and if any of the audience has uh a question, type it in the chat. Um But I'm gonna kick off with. Um, so Ryan has mentioned about some of the problems about healthcare 2.0 how do you envisage some of the issues as we go into this kind of digital surgery age? Thanks very much and congratulations to you all. Uh Matt Kenny and the whole team for a fantastic innovation summit. Um Ryan's talk was, was absolutely energetic. I think I'd quite like to join the I HUB myself. Um But the, the, the real question is uh one of the points that Ryan mentioned is that we need to be thinking about what are the solutions to the problems and how can we bring in the digital era that we're in and in a to try and sort out these problems? And there are several in health care, but I'm amongst the brightest and the most energetic. So the most important thing is to see. Well, if there is a digital solution, how can we bring that in to a healthcare problem? Something as simple as currently using electronic patient pathways and thinking of the patient journey, keeping the patient in the focus of all that we do. And if we do that, we won't go wrong whether it's training, whether it's innovation or anything related to patient care. So think of the patient and their digital journey and seeing how we can extract uh one element of that and using technology to improve that, whether it's um uh monitoring that's remote or trying to make sure that everything is on our online system that will improve the trainees experience of doing audits, research, et cetera. So there are there are lots of things that we do. We just need to have an open mind and see where that technologies can help us. So um he we also mentioned about box ticking. So I think something that we're really passionate about acid and rad is trying to get out of um I guess forcing people to do box ticking and, and having the innovation kind of centered mindset. So how do you think we can kind of support that and foster that in, in UK and global medical education? I think we're veering away from that. And if you look at deaneries and what your requirements are for CCT, they have changed over the years remarkably. So at the moment, you're not required to have three first or publications in order to proceed to CCT understanding GCP principles and being involved in research in general. The associate pi pathway is one way of being involved. So we are evolving and the traditional way of training perhaps on how I was trained is very different to how you guys are being trained at the moment. So it's important not to just tick boxes for the sake of ticking the boxes, find that passion. Look at your USP, look at where you want to be in the future and then work backwards on how to take the steps to move forward to, to be the person that you want to be, whether you're an educator, researcher innovator or a combination of these um uh elements and look at portfolio careers. People these days are not just one thing or the other. So it's not one box that fits all. So it's about that passion and also because it's not easy, you know, to try and take up all the things that are available out there. It involves time and it involves investment into oneself, including us being here on a Saturday, for example. But if you don't, if you're not passionate about something, you're not going to invest that time. So I would really, I don't think we should collect badges or tick boxes. I think we should follow our passions. Sounds great. Unfortunately, that's all we have time for, for questions, but uh I particularly look forward to hearing uh your talk and some time for questions later this afternoon. So thank you so much for being here, new her. Um So we can now introduce our second speaker of this innovation centered. Er we have Doctor Shannon Germanos who is a brilliant speaker and I've actually already had the pleasure of listening to this video. So it's a real treat. Um She is a uh a venture capitalist investor in biotechnology and health tech. Um and is the head of Global Affairs for proxy and has a whole host of experience that I'm sure you're gonna learn about. Um And she's gonna basically tell us how to make a start up. Um So we look forward to, to hearing this. Hi, everybody. My name is Shannon Shabaa Germanos and I'm the founder and CEO of lacuna Advisors based out of Geneva Switzerland. So that's where I'm uh talking to you from today. This is a prerecorded message, of course, for the asset team and for your conference that's happening right now. It's very exciting to hear that there are seed stage entrepreneurs that are sitting in the audience today trying to figure out your way forward in your journey and your story towards creation and getting a company and an idea out to the market. So I wanted to share just very, very briefly, just simple stuff that many of you already probably know majority of. But I just wanna make sure that you have some of the basics under your belt when considering building your company and that journey to exit or acquisition. So I'm going to share my screen really quickly and get this up here. Great. I hope everybody can see that. So essentially, this is entitled Insights for seed level founders, considerations for long term success in the current startup landscape. So a little bit about me. Um I am in midlife right now and I had a very, very strange career that went from political negotiation in the Middle East for 13 years, all the way through to working in Sub Saharan Africa on building large scale private public partnerships. Um having to do with agriculture and sustainable agriculture. After having done this entire career, I met my husband who came from the private equity and hedge fund universe and when we met, he said to me, you know, I've really done great in my career, but I feel very disconnected from what I love most, which is working with early stage entrepreneurs and having hands on in private equity and in hedge funds, you're very removed from that. So he wanted to get back to the business of company building and helping entrepreneurs to do that. So we decided that together the most important area for the future was health care. It's a defensive area, but it's also one in which there's intrinsic impact built into it. So this is where we decided to set up our own private family office, a single family office based between Geneva and uh London. And to focus on healthcare companies that can change the way equitable access to health care is delivered with a global footprint. That's something that's very, very important for us. And as I started to recognize that health care was a deep, deep importance and that, that was something that was emerging um significantly, I decided to go back and do a master's and a phd in Neuroscience at UCL in London. Everybody thought I was crazy. I was too old. I had done something completely different in, in my career. But I really felt that if I was going to invest our assets into startups within health care, I needed to really understand how things were done at the bench and really understand how science is done and analysis is done statistically. So I went back, I got that done. It was very, very tough and challenging, but I did graduate with a phd in Neuroscience. And so I could really understand how bench science is carried forward and that has served me very well. Moving forward. Since that point, I was able to establish Lacuna advisors, which is my company based here in Switzerland. And this is a sample portfolio of some of the companies that we currently have today making deep impact globally. From proximity, which is a digital surgical collaboration platform to Elara Health, which is bringing um very accessible healthcare solutions to rural Africa all the way through to Cron, which is working on A I assisted um X rays and scans for breast cancer. So we have currently 16 total companies in our portfolio. We're not a big VC, but it is still a really nice portfolio that we are very, very proud of. And that my husband and I go through the due diligence with our team, we analyze ourselves and that we decide how to involve ourselves in these companies as they grow. Um We like to be very, very hands on with our founders. So that's a little bit about us and what we've been doing to date, I sit on different investment committees from the NHS all the way through to other investment firms, VC firms that focus on women's health and women L companies. Um I also have sat on global health agencies based out of Geneva of course, and I also s uh serve as a head of global health at proximity, which is one of our portfolio companies helping them to think through their impact strategy. For their tool in emerging and frontier markets. So startups, well, it really is about solving your own problem. The path to su a successful startup really is about observation in your own environment. And many of you will have seen that whether it's a need that you have, your family has your community has. That's what gives you the idea for what it is that you want to build for and the best start up, as they say, it generally comes from somebody needing to scratch an itch. And that's how Warren Buffett, for example, invests himself. He loved Coca Cola, he drank it every day. And so he decided it was best to invest in Coca Cola because it was going to do well. If he loved it, so many other people must also love it too. So it's not just about coming up with the smartest idea in the world that is novel, it's about solving a problem that exists that you've observed for others and matching that together key considerations for founders. Wow, this is really important. I put it into a pyramid like Maslow's hierarchy of need. The very bottom. The most important foundation of anything that you do is to be self-aware and humble and hire a strong and complementary team. Why is that so many times? I see that there can be a great scientist who has an amazing idea on technology and that's what they're good at, but they're not necessarily a CEO, they don't know how to run a business. We can't be all things all the time everywhere. We need to be aware of where comparative advantages sit. What am I good at? What am I bad at? And to be OK to let the ego go and to build a deep bench of expertise around you, to be able to make it all the way through a very long, very arduous journey to acquisition or exit. You're gonna need skill sets like a CFO Chief financial Officer, a chief operating officer, CEO chief operating officer CFO and then the founder who has the technology, who understands the idea and concept and makes sure that that vision and mission is consistently being driven forward. So to be able to be humble and self aware, which is hard for all of us to do is the first thing to challenge yourself with, validate the product market fit with data. That is so important. Just because you think you've got a great idea. You've got to make sure to do some pilots, get out there and see, put it into the hands of people, your end user and make sure that there is in fact a product market fit. And one of the interesting things I realized is that as investors come to your data room, if you don't know what a data room is, it's where all of your main important documents sit from articles in corporation to your budget and run rate to um any IP documents that you might have a lot of early funders or founders will utilize Google Drive, for example, to hold all of key documents in a password protected manner. There's some interesting uh tools available out there as well that let you do that in a more secure way. And so when a uh investor comes and says, I'd like to see your data room, you're able to then give them the password access once they sign an N DA to be able to see all that information and make sure all of your documents and registrations are in order one of the things that investors like myself like to see in those data rooms are letters of intent in a seed stage. It's really back of the napkin, right? You're writing a bunch of things on the back of a napkin. It's an idea. You really don't have revenue yet if you do. That's great. But what you want to be able to show is go to your main end user institutions and say, if I were to build this, if this were to come to market, would you be a buyer? They don't have to commit to anything except for, to write that letter and say yes. As a matter of fact, this would be something that I would be interested in procuring or purchasing those letters of validation, drive your evaluation up your value up just by those letters. So these little tips and tricks are things that are really important to demonstrate that product market fit, prioritize the customer feedback and adapt quickly. You really have to shed ego. Once again, very, very fast, you need to be able to pivot quickly get stuff out into the market. Run pilots, see what's going on, get that customer feedback and listen and observe. Where are the kinks? Where are the issues? How can you start to then make that experience that much better so that your customers having a flawless experience, end to end and then finally define a clear revenue path. I think a lot of times I see founders, especially if they're in A I or in data or these sorts of things that they, they will have the greatest presentation in terms of their technology, but they are not focused on giving me what is your revenue path? Not today, maybe a year from now, maybe two years from now. What does that look like? And it has to be anchored in something real Americans tend to go really far off their just planet and saying we're gonna be able to make $6 billion because of nothing Europeans tend to be a lot more austere and a lot more. Um they hold back and they don't give all the details because they're afraid of over promising. You've gotta find a middle ground there, you need to sell and you need to be exciting in your pitch. But at the same time, the revenue path has to be anchored in some reality. So the next thing I would say, ensure your company holds IP rights, especially because a lot of you are gonna be in med device or implants and these sorts of things. First thing that investors are going to look at is whether or not your data room has IP documentation if you don't being in process is very important, but you will then knock off a huge amount of investors if you haven't even started the process of IP. So I would say friends and family are the ones that you bring around you to invest, to believe in your concept until you can get that IP filing and then go to external investors. That's the point of hesitation and risk for a lot of people that they don't wanna take two choose investors that offer more than capital. This is so important guys cause oh I gotta tell you investors always promise the world and then they don't do anything. Let me tell you from experience whether it's venture capital firms or it's angel investors, they tend to disappear after the check is cut and you think money is the most important thing. It's not during the seed stage, their networks, their connections, their ability to act as a pair of hands for you. Because you at that point may not have enough money to hire full time people. You might all be working on a fractional basis. So you need to have all hands on deck people who believe very much in what it is that your company is doing and are willing to get stuck in open doors, make sure that you're able to raise at the next round that you are then opening up. And one of the things I'll tell you is that venture capital firms, for example, they do a spray and pray approach this early. Those are just to get their foot in the door, they will not be doing anything. They won't lift a finger until around series B when they start to see traction and that this is going to start to perform in their portfolio. Well, that is when those, you'll start to see them coming in, having meetings doing things before that don't expect anything from these big firms. They might have a lot of money and a lot of name and a lot of all of those things, but you won't really be able to leverage it well for yourself. So it's usually those angel investors who are very well aligned that have very specific things that they can bring to the table that they can articulate to you. And you can look at things like their track record, what have they done before? So you can talk to companies that they've invested in before and see. How do they show up for these companies and then select the right people for that So preserving ownership early this, I can't emphasize this any more than possible. I it's really, really, really tough in this sort of macro environment where everything is up and down in the financial markets. People are nervous, things are going on. War is happening. Elections are happening. Well, people start to get very, very conservative in terms of where they invest. So it's not always, everybody says there's money everywhere, there's liquidity everywhere. It's not necessarily true. Depends on the sector and depends on your access points. So be strategic with your equity distribution, you have to see everything as a pie. You've got a finite pie available that you can cut up into pieces and make available throughout the course of your entire company's growth until exit. Imagine everybody keeps saying seven years, seven years, seven years, that's what it takes to exit. I think everybody knows now, that's absolutely untrue. It takes at least 10 years. Most companies within healthcare will be 10 to 15 years. That's how long it takes. You can, you can get lucky. You might be at a different point in your growth, but give yourself the time to know that you can't control macro market forces that can cause you to derail at some point or have to pause or not hit your targets on time. So given that you might have to keep raising money and giving away more pieces of the pie. So don't give away more than 20% at the seed stage of your company to maintain your leverage. This is critical. We've seen so many companies who thought that 500 K or 250 K was a big amount of money and they were desperate and they really needed it. And so they gave away 25 to 30% of their company under pressure. And that was a disaster that made it so they don't have enough pie to give away later on and made it very risky. They lost control of a lot of their company and not only that, that handcuffs other investors coming in later because if I'm an investor coming in and you've given away early on 25 to 30% of your company, I'm gonna think they don't have a clear head on their shoulders. They were panicked. That makes me nervous about their company and I'm not sure if we're gonna be able to make it all the way through with what we need. So, a good investor isn't going to also put you into that kind of situation because they know that that's going to also weaken the company significantly as well. So I know how hard it can be. I know it can be really, really tough and that 500 K or that 250 K is gonna look really good, maintain your position. Hold it is everything for the success of your company understanding term sheets. So it's very, very, there's a lot of jargon out there, there's a lot of stuff, but the key things is no liquidation preferences, right? The standard is a one time nonparticipating preference. And that means that in a liquidation event, you know, the people who invested that are able to get at least the amount of their investment back before it trickles down to the rest of the individuals in the cascade, including the founder and other investors and um and other team members. So it, it prohibits them from double dipping. They at least first get back the amount of what their investment was and then you start to calculate what everybody gets. So that's a basic. People will try to negotiate things uh with preference, other preferences and other rights, but that's a standard control provisions. So for your leadership in your company, it is so important to not give away everything to the V CS and to the board as well. You need to make sure as a founder, you maintain decision making rights that you have veto rights that you advocate for and fight for because you've got attention there. Investors are gonna want you to do certain things, but you as a founder know what you have to do in order to be successful in this company. So you need to be able to have balanced rights where not everybody needs to necessarily have a voting board seat. They could have observer rights. For example, there's transparency, they can be present, they can see what's going on without being able to vote or you may wanna bring in an external member who is not a part of the VC landscape or the company, but an expert perhaps that knows the market well, that can help to then explain to the investors on your behalf, what needs to be done and that can balance things too. So control provisions is really important to negotiate balance rights. Um Example of that as well, we can, I'm not gonna linger on this, but conversion to common stock can align interest post liquidation, but that's very, very, very far down the road. But just take a note of that, take a look at it later. That's for when you exit, but make sure that you're looking at everything from the beginning, how you want to build this strategically through the years all the way through to either acquisition or exit. So what are the types of uh term sheets that are commonly used within seed stage? And I would say that those are either safes or convertible notes. There are other things like warrants that are a lot more complicated, but let's just stick with these two to begin with. The safe is the simplest fastest to draft. It's no interest accrual, it's not debt, essentially, it's very founder friendly and it lets you kick the whole kind of leadership board evaluation of your company down the road because in your state now as a company, it's very hard, you cannot put a dollar value to it. You're not making any revenue. It might be a brand new technology that there's really no benchmark in the market for. So this gives you time to be able to start getting that traction and to be able to really value it at a series a point and then convert to equity. It's less protection for the investor because it's less predictable for the conversion timing. So sometimes investors won't necessarily want a safe, they'll want a convertible note. We'll talk about that in a second. But, but the safe came out of Y Combinator originally and Y Combinator said we need something that's quick and fast and really just gets um capital moving into these companies without having heavy legalese and which holds everything up and, and makes too many decisions and putting the cart before the horse. So that's where the safe concept came from. And it's very well known and, and pe most people are aware of that if they're investing the convertible note is debt because interest can accrue and often that includes a maturity date for when that then converts, which gives it added security for the investor. So it's slightly more complex and you might have a 4 to 7% interest that is negotiated. It really depends on what you're able to negotiate with your investors for this. And that's basically saying because I'm taking this risk, I get some interest um on that as well. And there will be different kinds of um terms thrown around in terms of getting a discount. So when it converts to equity, they get a 20% discount. So these are all the type of things that people will negotiate saying I'm coming in early with you. I'm taking a heck of a lot more risk than other people later on are taking. So I want stuff. So you're gonna have to negotiate that with your investors and be realistic. There are what are considered norms. Everybody will try to be cheeky. Of course, it really depends on the market conditions. How many people are around you in your circle that you think you can raise money from and how desperate the company is. So as soon as an investor starts to smell that desperation, you're gonna start to see harder terms coming down, hold your ground. So ownership guidelines, seed round elution aim to keep below 20%. That's a good standard, use safe or convertible motive as we talked about with valuation caps, make sure you have valuation caps to protect the equity. Don't just blow out maintain an option pool of at least 10 to 15%. This is super important. People don't always think about this, ensure that enough equity in that ply we talked about is reserved for future key hires and ad advisers. Everybody will expect that if you are a good company that has a lot of promise. They're gonna want a piece of that pie from the option pool and you're gonna need to look at potentially vesting that over four years. So that aligns things right. If you work, I'll give you this much from the option pool and you have to work for four years to be able to vest all of that so that they can't just get everything and then walk away six months later, it's very, very important to stack it that way. It's common. But you need to have an option pool to be able to incentivize your team as well. Really good hires to be able to pull them in great advisors, et cetera. They need to get some upside as well. Founder friendly terms as we talked about one times nonparticipating liquidation, preference, majority consent versus unanimous investor approval. This is really, really important, make sure to have majority consent for your board decisions because if you look for unanimous investor approval, it's gonna be impossible to get everybody to agree to something you just need a majority to push it over. So make sure that you don't become hijacked by one single person that can be difficult board observer rights instead of full voting rights for investors. We talked about that before. There's different combinations that you can put together board observer rights, as I said, transparent and yet doesn't necessarily have a voting capacity. That's one way to go to avoid common traps don't rush fundraising folks raise with strategic invent uh intent to avoid down rounds. This is something that, oh, it's such a tricky balance. Um You need to raise enough to get you to the next inflection point. That's for sure. Don't scrimp raise what you need to raise, especially in environments like this where it's so up and down, you don't know where things are gonna be. But at the same time, I've seen so many talented founders raise a huge valuation and they've got to hit milestones within a certain amount of time when they're gonna run out of money. And that means that if they don't hit those milestones, they're gonna have to go down in their evaluation and they have a down round, they go backwards. Investors don't like that. It shows that your company is not doing something right in this week and you need to be super clear about the milestones that you need to achieve to hit the valuation that you raised for. Ok. At the beginning when you're super excited, you're talking about 80 million or 50 million or 20 million. You get all excited. Yes, I could hit that. Yes, I could do that. Yes. Yes. Yes. Everything under the sun, believe me is going to go pear shaped during that period, you're gonna get hit from every side. Your main guy is gonna leave the market's gonna tank. You're gonna have, I mean, look at the world we're living in right now, statistically, it's impossible for things to just be smooth and let you hit every target perfectly. May you be so lucky but be realistic about that and build in the contingency so that you understand I'm raising with intent for what I need to give myself enough room to hit the inflection point so I can hit the next evaluation and I'm not running short. That's the hardest part. Right. When you come to a point where you need to raise money, I've got oh a couple more weeks. Oh no, I've got to hit, I've got to close my round, but I'm about to close a huge contract which would then bump my evaluation. You don't wanna be held over a barrel. So that's why it's a nice little dance. It's a tango, make sure that you raise with intent and don't be greedy, reward your high performers and appreciate those who bring you to those milestones. So many founders, I see. And this is ubiquitously across the board. They start off, very humble, very appreciative of everyone, including their early small investors, very appreciative and as they get more under their belt and they become more famous and they reach series B and C and D. You start to see that they start to talk more in eye. I did this, I was able to bring it here. It's my company. And the thing is is that we never do anything as an island. We don't do things alone. It is not our own genius that carries us anywhere in this world. It is always a team and you have to reward your high performers. So you don't hemorrhage talent and you don't have internal dissatisfaction. You want to have innovation, you wanna have push, you wanna have incentivization to be able to cross the finish line together with strength. Don't be greedy reward. Finally think global designed for the world because business is evolving and investors as well as teams want to demonstrate impact folks. So you've got this thing where I think founders, especially with medical devices and things like that will develop for just America, North America and Europe. That's where you know, the highest total adjustable market sits, highest margins sit. So they might just build a huge piece of kit that needs a lot of energy or is very fancy. But if you can think from the beginning and rethink your strategy and ask yourself the question, is there a different way I can design my product to be able to be used anywhere? What ends up happening is your total adjustable market opens up quite significantly and where you might not get margin as much margin, you might get volume. So it may be that your technology is only to serve certain markets and that's fine. But ask yourself the question. Design from the outset is important. Will my technology be useful in low middle income countries? For example, what are their environments like what are some of their main uh issues that they might face in terms of electricity or space or whatever? And how do we make this accessible? Otherwise we are contributing to the disparity between the global North and the global South in terms of technological equity. What people have access to? Number one, number two, we've seen all the statistics that gen Z and all those that are coming onto the market. They want meaning and purpose in what they do in their companies. That's no small thing. They're willing to take less pay for a company that has solid vision, solid impact, they want something to be proud of. So this is a way that you can retain great staff, great teams create impact hit ESG targets and strategies and also see if you can have a greater t total adjustable market. If it's not again margin, it's volume. So do consider that and I'll give you a sense of a company that was able to do that. Butterfly ultrasound. Many of you have probably heard of butterfly, I'm sure you have but ultrasound can be quite large. But when you shrink it down into the palm of your hand and you utilize your iphone to be able to demonstrate and show the image, you can bring that into the most austere of circumstances in any market and it becomes infinitely usable. So butterfly has had enormous success in places like Middle America. This is not just in places like Africa or India or Southeast Asia, our backyards in Europe or in the US have the same issues. It's about access and making sure that those in more rural circumstances or who don't have access can be able to get a hold of these sorts of technologies and change the way healthcare is delivered. So I love this example because it's so clever, it's designed so, so cleverly, it has so much more use potential. That's something to really think about and to um I think if you can build it into the beginning of your strategy, looking forward to how you can serve the global public. Fantastic. So that's pretty much it. But I can say no fear, fear defeats more people than any other thing in the world. Ralph Waldo Emerson, isn't that true? We all live with this inherent fear of what if I can't, what if I fail? What if I don't know anything else other than being a scientist or a doctor or whatever it is? And I'm not an entrepreneur and I'm not that jump off the cliff, you've got one life one chance. So if you have a great idea, you don't have to solve world cancer or world peace. But great ideas need to be brought into the world. This is how we grow and we stretch. And I can tell you for myself, I've had so many iterations in my career. Failure is a part of venture capital failure is a part of innovation. There's nothing to um be ashamed of. So let go and make sure that you realize it's not all about you. That's why you build a team around you that's successful, that's strong, that is able to cover your flank and that you're able to through your journey continue to be self reflective so you can grow and you don't get stuck and you don't become the monster, but you become the great. So, looking forward to hearing from all of you. Thank you. Thanks for this opportunity. I hope it was helpful. It's just a little tiny snapshot into this process. And if you'd like to reach out, feel free to email info at lacuna advisors.com, talk to you soon. Buh-bye, right? What a pretty incredible masterclass, er, that was er, phenomenal just to, I guess, see that perspective and, and how you build a company and how you sort of um take things forward and particularly, you know, the, the um consideration around funding I think is something that a lot of medics don't really have an appreciation of. So that's brilliant. Um We are going to move on to our abstract sessions now. Um So particularly a friend who's still here who is presenting an abstractly to move on over. We've got four sessions running simultaneously as well. Um So anyone else in the audience wants to join, er, please do so I'll be running for an hour and then we'll go into lunch, uh, before the start of the afternoon session. So, uh, we'll see you all there.