Signature Series: What Does It Take To Scale and Innovate Globally | LSI Europe '25

Nadine Hachach-Haram  0:07  
Well, hello, hello, Joe. Good to see you again, always.

Joe Mullings  0:10  
So you know, this is, this is the signature series, and we can take this so many places, and that's one of the things that I like about this conversation. Most of the people in the audience will know proximity, but I think what we should do is is cover the proximity story in the early part, and then your motivation for going here, but then I really want to talk about what it is to be a CEO, a founder, and the and the struggles that you've had along the way. Many times people don't like to talk about struggles, but that's where the lessons are learned. And I think I'd like to share those lessons with people here,

Nadine Hachach-Haram  0:47  
for sure. I mean, again, some people will know the story. I am a practicing surgeon, and I had spent about 10 years working in global surgery and working with medical device companies, helping them train on new products, on new devices, and it was becoming increasingly clear to me as a surgeon, that we were, we were seeing a lot of variability and care, variability and outcomes, but also everything was quite limited by CO presence, like you had to be in the room at the same time to actually deploy any knowledge or skill. And you know, obviously, I'm very passionate about the operating room. It's such an incredibly rich environment. When you think about the people, the care they're delivering, the knowledge you know it takes years to train those doctors, those nurses, but also the intricacy of like that, the device interaction, whether using a robot, a stand, an imaging system, all of this richness is not really captured in any shape or form. And so really, all you're left with is something on a medical record that says I did this operation at 955 and that's it. And as I start to think about, you know, the supply demand gap, the 5 billion people lack access to safe surgery, compounded by the huge acceleration of new devices coming to market. I mean, look just outside, how many companies there are with new kit, new equipment, new devices, new imaging systems. How are we going to sort of connect all of those dots? How are we going to create that ecosystem that enables you to connect expertise, collect all this various data and activate insights? And it's interesting. I was having dinner with someone quite high up in the tech world yesterday, and she was saying, the problem we have as GPU manufacturers and looking at compute and power and knowledge is it's really about the data economy. But how do you leverage that data economy and ecosystems where they're in this the information data still very siloed, and so we're we've done an okay job at that in pharma and genomics, because you're sort of aggregating like the bio bank and you're looking at these data sets. But in surgery, we don't have that. And so if you create an operating system that comes into any environment and does become that aggregator that is connecting all those data sets, connecting experts to work together, capturing those knowledge and insights in real time, and unlocking real time insights, real time knowledge that either helps you deliver a case better or bring gives you an advice during a case that you didn't think you could have, or helps, frankly, drive workflow in a room. Because we're really under utilizing these assets that we invest in that could be a real game changer and how we deliver and scale surgical care. And I use the word surgery to really mean anything procedural. It could be calf labs, endoscopy suites, minor ops rooms. It's really anything where you're interacting with patients and delivering care on that process. And so that was really the ambition for me. And I think, you know, growing up not, you know, not always in England. I grew up in Lebanon for a period of time. You see kind of discrepancy, and you see lack of access, and it wanes on you. And so I thought, if we could build this operating system that can turn every operating room into a smart, connected, data driven environment that can make an impact in the world, it's going to be hugely powerful and and that's really the mission we went on. But as with all things, you know, these big, bold ideas, like, are really hard. And like, you know, I remember walking into ors in 2013 and saying, Well, what if we could? And, you know, every surgeon said, like, What the hell are you talking about? Like, get out of here. You know, this is nonsense. And so I needed to sort of break down this like big concept into, like, bite sized chunks. And I still remember my pitch deck from like, 2016 or 2017 I had, it's like, four bite sized chunks. It's like, okay, we're going to start with telepresence. Like, that's really about education. No one's really going to fault you. Like, that's all really about, how do you connect doctors and we have an I'm a surge. Like, we have egos. We love, we love an audience. You know, that's why we're not smart clinicians and outpatient clinic rooms talking to be like we're, you know, we want the audience in the or it's, it's why they call it a theater here in England, it's an operating theater. And so I'm like, All right, if we just convince doctors in the or that telepresence is a really great way for you. To connect with your colleagues, your old fellows, that's going to be a way to get them interested. And so we started with that and and that was kind of an easy direct to surge and sort of sell you like, you know, wouldn't you like to have your connectivity? But that was really our back door. And to get these or connected, because we had to get ba to get that done. We had to put cameras in the room to get that done, we have to create data sensors to get that done. And so that was it. So remember, the first bucket was telepresence. The second bucket was, how do we create content and media management around it so people can start to record their cases again? It's on the path to data. We then said, Well, how do we create a community of users and sort of experts around that? And then we said, how do we build the data economy? And we've, we've stayed true to all of those journeys, but it's taken us 10 years. Like it's not something that happens overnight.

Joe Mullings  5:48  
One of the things and you and I have been very close almost now for about seven, eight years, and it seems like the market got stuck on telepresence. Yes, right? And I don't think they so you are undertaking something pretty substantial. Historically, med tech has been an episodic moment in time of care. You sold the catheter, you did a diagnostic, you did a procedure and then one and done, correct. But what you're proposing with proximity was enveloping, surveilling, and I use that in a positive sense, not knowing how to get paid for that, right? The health care system is not rewarding people yet on how to be paid for that. What were you thinking?

Nadine Hachach-Haram  6:33  
I mean, for us, we were thinking like, what are going to be the business models that are going to on? Because it's, I'll take a step back, I think you're absolutely right on telepresence. Like, everyone went for telepresence. Like, that's what it is. It's going to be rep replacement. Oh, my God, this is like my investors, Aven LED systems, craft and burn, because there's loads of companies that are doing just the rep replacement piece. That market is too small. Number one, two, it'll get commoditized pretty quickly. That's not really where the sort of the juice is. It's an important part of it, but it's not enough. Three is, like, I keep telling you, I was like, Do you really think our investors would have given us a, you know, 100 $20 million if we were just going to build a telepresence solution? Like, you don't need that much money for a lot. A lot of the companies who were trying to focus on just telepresence were rolling up third party software, like, I'm just going to deploy something really quickly. We were building a stack. We were building a vendor neutral stack that can sit across any procedure that works towards

Joe Mullings  7:29  
that data. Sort of unpack that for me, though, before we go further, because when you say we're building a stack, an open API, I'm a customer and I'm a soft tissue robot, or I'm a structural heart company. How do I fit into that proximity platform

Nadine Hachach-Haram  7:45  
that way? So what you want is you, it's almost like, if you think about, go back to Salesforce, right? So they had the underlying sort of functionality. Then you had the sales force application itself, and then you had the community of other applications that feed within it. For us, that's exactly we're building. We're building the data aggregation layer. We're then building our own applications, so telepresence, media management, etc. So and we'll talk about the use cases, but also we can integrate and deploy other applications on our system as well. So if you're a robotics company and you're like, right, I need to move my robot to become an edge and cloud connected device where data integration is possible. Connectivity is key. Real time insights are there. They were trying to build all this stuff alongside their robot. Today, we're seeing a lot of Barton me saying, I don't really need to build this proxy. Done a great job. I'll just take their SDK white labeled, and we'll put it on my robot. And you saw a few press releases in the summer. We've got, we're working with loads of companies, some public, some less public, but if you're a catheter company, and you're thinking, how am I going to scale and deploy my catheter to, you know, hundreds and hundreds of doctors around the world, you could do this virtually. And so we put proximity in those rooms. Again, a good friend of ours, Amr, is using proximity for deploying his new catheters every room that he's trying to go and train doctors in proximity is in there. And so now he can train 10 times more doctors and nurses using our technology. So the use cases may be different, but the platform is the same, and so you can unlock the different applications, frankly, quite similar to your iPhone. You might want the Air BnB app. I might want something else, but the phone is the operating system. I want one system, and I want to layer all my applications within that system as well, and that feeds into what hospitals want. They don't want to work with 10 different applications. They don't want to use one software for the robot x and another software for video tower y. They're like, we just, you know, our IT. Systems are stretch. We're going to work with one system along the way. And so we look at the intelli presence was just our wedge into the market. It was never going to be the only thing we were going to do. It was always going to be just our journey to get the behavioral change that was needed to get doctors comfortable with video and sensors and audio and mod AI models in the operating room. And now we've moved very far away. I mean, we have that as an. Application, but now we're looking at workflow. We have sensors looking at the turnover time in the room. When did the case start? When did the case finish? And so going back to your original question is we had to be very clever at building multiple business models to almost bridge us to a point where the market was really ready for data economy of the or if we were just building towards a hope and a prayer that one day the hospitals will get there, we'd have, like no revenue for quite a long time, and we had to commercialize the product. We had to get it out at scale. And so we started with telepresence and education. The first bit, we then added the media and data aggregation layer. The second bit, we then monetize the SDK with strategics and device companies, and now we're monetizing our intelligence suite where we go directly to hospitals and say, We can turn your operating rooms into intelligent rooms. We can tell you the utilization of your room, we can tell you what equipment is being used in your room. We can tell you how to drive more efficiency in your room and add more cases in your room. And that business model lands very well with hospitals, because they need to drive revenue for our audience. SDK, just so like a

Joe Mullings  11:09  
kids right to development kit that works on their system through FDA, already, right?

Nadine Hachach-Haram  11:15  
Exactly.

Joe Mullings  11:15  
Okay. So as a hello. So as a as a founder and a visionary in that area, you and I had conversations about the market. Kind of got stuck on a telepresence tool. And to others out here, there have found that a company, there's always stepping stone one, stepping stone two, stepping stone three. When you come to the market, you have this narrative in order to get into the market. Oftentimes it becomes the anchor as you move to step two. Chat about that,

Nadine Hachach-Haram  11:47  
look, I think that was as much an opportunity as it was a problem for us. Like just talking about challenges is we kind of got pigeonholed into telepresence, and that was, like, really hard to break through. I probably argue we still get pigeonholed in telepresence, and people, probably competitors, also want to pitch and Hol us in telepresence. And we see that, like, I see pitch decks, that they're sort of presenting the customers. And like, oh, proximity, telepres. Like, no, we do a lot more than that, because that's that's an easy place to sort of position us. And so we, because we felt, for all the obvious reasons we've talked about, like, going straight from nothing to we are the all whole end to end operating system was just too much of a conceptual leap for customers. We were trying to sort of break it down into bite size, so we went telepresence first, and then mid and so we're having to a lot of comms and marketing now to sort of reposition us as a company, like for people to see us as the operating system. And again, what then people tend says, well, you're pivoting. It's like, No, I promise you, we're not. Like, if you look at our original decks, it's always been this vision, and there's no way investors would have given us that much money if it was just this. And so we still have to do work on that. But I think, again, I'm out there talking to partners and customers all the time. I think ultimately the proof will be in the pudding. As they say here, it's going to be in those deals that we get. So, for example, the three or four announcements that came in the summer around robotic companies like his tosonics and imperative using proximities platform is a testament to we are much more that. And I have to say, on the back of those announcements, we have like seven other deals now happening because of that, and so we just have to work really hard on kind of refining the messaging. I think that's something that is hard to do in a market where the people are still trying to kind of box you in, because it's easier to conceptualize you as a as a like a point solution versus a platform. And those are cliches, because everyone says the word platform, and everyone wants to be a platform, but, but I think, and again, speaking to this tech person last night, there, there are very few. There are very few, if any, and she couldn't name a single company other than us that really has done the end to end platform for operating rooms,

Joe Mullings  13:56  
and she's got inside baseball, and again, for the founders out here. Like I just I was late getting to this session today because we're chatting through an organization that is entering the market needs to have a narrative to get into the market, a familiar narrative in the market, acceptable to the investment community, but when you longitudinally, take it, you know, down to the fiscal end of what they want to do, they're on their way to being a much bigger product. What's your message to those out here right now that have to get that first step in, but you know, it's going to get them caught when they get the step two, because they aren't in the room every day.

Nadine Hachach-Haram  14:31  
Yeah, look, it's a tough one, and it's a catch 22 but I think at the end of the day, like when you're starting out, it's like the blue sky vision stuff is great, but like, at the end of the day, it's like, what are you delivering now? And that's what you're going to be measuring. Because what I've seen the flip side, I've seen companies that have come out and tried to do the, oh, we do everything for everyone, and then have never been able to deliver on one thing. And that is reputationally very damaging. And so if I had to choose one of those two. To, you know, evils. If I can say that I'd rather do the I'm going to break it into bite sized chunks. I'm going to I'm going to message what I have now, what I have today. I can sign post to a vision and an ambition I would like to have, but you really have to be true to what you can actually deliver today. And we know companies that have sold the ocean, sold the world and actually then deliver it on nothing. And those can't come back because the credibility in the market, the market's not tolerant. I mean, if you come and say that you're going to deliver AI solutions, and you don't have that yet today, that's it. You're done. And so I'm still proud. I still would do it again the same way I might have just maybe refine and maybe given more of a hint of where we're going, but I would still break it down and try and do it in bite size, and deliver on everything you say you're going to deliver, and then go to the next thing and go to the next thing, because that's where you build credibility. And knock on wood. You know, for us, we have credibility in the market. People trust our brand. They know that when we say we're going to deliver something, we do deliver it and we stick to it.

Joe Mullings  16:02  
How do you wrestle with the health care system has misaligned interests in it, the hospital, for the most part, if you take away the top 1% of the elite hospitals, is still static in regards to its digital solutions of the future. But that's where it's going. How do you move this advanced product like proximity or this environment into those settings, through administrators, through finance, through it, and there are some out here who have digital solutions in the healthcare setting, in the clinical setting.

Nadine Hachach-Haram  16:36  
No, it's a great question, and I would sort of look at it in two ways. I think one is, like, really understanding, let's take the operating room. I mean, obviously the, you know, the beauty, the person who loves the kind of the importance of the or wants to really just believe that it's about the patient, the surgeon, like, that's really all it's about, you know, surgeon and team giving great care to patients. But, like, the reality is that's not the case like the or is really about a trifecta of like, stakeholders, right? It's your hospital administrators, and what they care about is really driving throughput and revenue and efficiency and quality care to a system. And they're running a business. You have the clinical teams that are just passionate about delivering care for the patient, and they're doing the right thing every single day in that room. And then you have the strategic med device companies that you know are big part of that equation, because ultimately we're using their devices to deliver that care. They also have, I mean, they want to do the right thing. Of course, they want to build great products, but they also have to run a business. And so their interests may not be aligned with the surgeons interest, which may not be aligned with it, with the administrators sort of purpose, and you're sitting there thinking, well, how can I align everyone's interests? And so when we had to think about our product, we had to think about because I don't want to build three different products with your different customer bases. I want one product that unlocks value for each of those. And so that's something you really should be thinking about. We don't need to talk about how we did it. But as you think about your products, is really understanding who are the stakeholders in the room, and how do you try to build something that unlocks value for each of them without having to build three different products or four different products, depending on your stakeholders. So that's one. Two is with the administrators. We in the early days, we're like, right? If, if this is quite a leap for them, we're going to have to find those early health systems that want skin in the game and being disruptive, want the brand of being a disruptive partner, and how do you create a structure with them and a deal that they can be part of the CO development with you, because you're still learning as you're going along. So it's going to be a bit of a clunky product, but you can align it to them financially or through ownership in the business. I mean, I've seen companies do warrants or sort of warrant structures with them, but ensure that they have a front, like, literally a seat at the table, involved in, like, the product roadmap, involved in how you're developing this. They're the ones on stage talking about this, and they can take the credit for, like, being innovators and innovative in that, and that really works well. And it's just about finding the right systems. And when I say finding the right system is two things. One is, somehow systems talk a great game about being innovative, but they're just so mired, you know, against their their best intention with bureaucracy, they're just too big, and that's really difficult, because you have to go through a lot of committees and red tape to actually get anything going. Then there are these health systems that may not have the biggest brand, but like they really are great systems to work with. They're scrappier. They're slightly the underdog. You know, they want to move quick. They can move quick, and they want some brand recognition. I would pick those any day and every day over the big brand names that have a lot of bureaucracy, because trying to get through those systems could take you 1824, months. Those scrap your systems can make decisions pretty quickly. You've got a quick route to the CEO, and you could start to show ROI quickly. You don't have time. You don't you know you're burning cap. Hospital, you don't have 18 or 24 months to prove something with a big bureaucratic system, and at this stage, almost the brand of the hospital matters to some extent, but really the results of what you deliver is what really matters. Can you prove an ROI? Does your technology either prove a financial gain, a new, you know, opportunity for the hospital, a new revenue drive, or something that you can now pick up as a playbook and go sell to the next 10 hospitals. And that's really what matters.

Joe Mullings  20:26  
And what's interesting is I've that's the third time in two days I've heard that narrative twice before in private meetings with startups I'm working with, and they were doing exactly that. They're initiating with smaller healthcare systems coming in and saying, We will pay for our product in these current procedures to show you we can increase efficiency, drop cost. And then if after that, we can show you an economic model, will you start buying our product Exactly? And so that's very similar to what you just shared, but you can do that and prove out an economic model very, very adeptly, with that small environment, correct?

Nadine Hachach-Haram  21:05  
It's going to either be that or it's going to be a system that has a very strong like venture innovation, sort of fly wheel, of which there are only really a handful, like, you've got mayo, you've got cedars, you've got a few that have that connection. You know, let's take an example, the the cedars, the the venture, and that whole business reports into the CFO of the hospital, who's working close to the CEO. So it's not like, Oh, it's a nice venture thing on the side, it reports straight to the CFO of the hospital. So you get that access to the system quite directly. You know, in Mayo. It's a big strategic arm of the system, and some other systems, the corporate develop arms are quite disconnected from, you know, they're almost having to do the sell themselves into the system. I think with those, it's going to be really hard. And so you really kind of, you need access to the health system. You need access to the front line. Just going to the venture arm that might be able to do a bit of business development for you. It's really hard.

Joe Mullings  22:04  
Well, let's, let's give a little, a little gift to of your insight to the founders who are sitting out here right now and again. One of the beautiful things about you is your transparency in our conversations we always have. And I had that one as many times over the last couple of years as we navigated these tough markets, but in your darkest moments as a CEO, which is very lonely place to be, those out here, right? Yeah, you know that. I know that it's to the outside world romantic, but it's oftentimes very, very lonely, darkest. Moments. What guidance do you give to the CEOs who are either going through that out here right now or going to go through it ultimately?

Nadine Hachach-Haram  22:53  
I think you know, again, I would say it's an incredibly lonely place, and I think even on the highs and lows, and I was chatting to someone yesterday. It's the it's the responsibility you have, of like all the people that have left their big, you know, their jobs or other opportunities to like, to back you, to be with you on this journey, which you know, and they know is going to be a really bumpy journey. So you already have that added pressure above and beyond. You know the struggle with failure. You know wanting to see your vision through, but also all the people that are you know that following you on that you know, how do you maintain that leadership and save face as you're going through that, and in those tough times, you're trying to rally the troops to keep going, but in your in your mind, you're panicking. You're like, Oh my God. Like, you know, how am I going to get through this? And it's such a difficult balance to, you know, you want to be open and transparent with your leadership team, but you also want to spook the team as you're sort of working through that. And I think in those deep, dark moments, you're going to have to be, you know, there's a there's a humility, and there's, like, this really honest discussion you're going to have to have with yourself, because often you're having it with yourself, because it's, it's a very, very difficult discussion to have with people around you. Luckily, you and I, like, we've got, again, great family and support structures around this so we can have those discussions. But you're sort of sitting there trying to make a couple of decisions, like one, do I keep going? Like, is this worth keeping on? Like, is the, you know, is this really a product? Like, am I really solving a problem? Does this really need to exist, or is it more my ego? Like, do we really need to keep going? Or do we kill this quickly and move to the next thing? So, you know, those, those are one of the things you're having in your head. And, look, I've had to have some pretty tough discussions, even with, you know, either founders within our portfolio or companies that I'm I've just been helping say, like, you know, probably time to call it a day, like, so that's one thing you're going through in your mind. Like, am I calling it a day, or are we going to keep going? For me, it was definitely we have to keep going. That there's, there's so much more to be done here. So then you're strain to figure out, well, how do I keep going? Like, you know, do I need to bootstrap some more? Do I go raise money? Do I need to think about a different and direct route? Do I need to go through partnerships? Like, how do we how am I going to make this win? And, you know, as someone who, you know is quite competitive and loves to win, you know, it's, it's those moments, and it's usually like on a weekend, when you're having those sort of thoughts. Those sort of thoughts, like, we think, you know what, I'm going to reach out to a competitor, I'm going to reach out to so and I'll have those discussions. And it's, it's those tight moments that force you to really think out of the box. And so I think So my message to everyone is, you know, you need to be reg I mean, whether you're winning or not, you have to constantly have have those discussions with yourself, those honest, reflective moments. For me, often it's on a 14 hour flight to somewhere, because we're always on a plane. But, you know, ask yourself those questions, am I still doing the right thing for the right reasons? Is this a company that still needs to exist? If yes, do I have the right team and people around me to do it? And it's tough sometimes, like moving on teams and sort of, you know, do I have the right investors or investor group? Am I partnering with the right people to get there? And is it time to reach out to companies that we should probably look at joining forces or and and people know me in the market? I mean, I I reach out to all my competitors anytime, because I just think you just have to have a relationship with all of them, because you never know what's going to happen in the market downstream. You never know if a consolidation needs to happen. You never know if you need them in a tight spot. And I think you have to have that kind of relationship. So I reach out all the time. I talk to all of them, and I would advise people to do that as well. So I know if I've answered your question, but it is tough, and you just have to be really honest with yourself and recheck yourself all the time. Because, look, you can get a bit of the whole, I'm a CEO and the ego, but you have to keep yourself in check and recheck yourself time and time again. I'm going

Joe Mullings  26:59  
to push you out in some thin ice here, boards generally bring money, and only the fortunate founders have boards with real operating experience. I missed the old days of the 90s, when I started in this business, when VCs were true operators, and now they tend to be a lot more, less operation, more spreadsheet. Do you look what do you tell about CEOs who are looking over their shoulder, because next week, they may not even be in this role? How do you think about that? I didn't prep your perspective or from from Nadine perspective, right? We've got all this tied up. We've got 100 lives that work with us. They've each got four family members, so in aggregate, I've got 500 lives that are depending on me. I've got a board that's got my back, but at the end of the day, they have fiduciary responsibility to the LPS. There's all kind of dynamics there, and then there's this survival bias and our egos and the car payment. Yeah, right. So how does the CEO manage that? The Psychology of that?

Nadine Hachach-Haram  28:09  
I mean, it's interesting, especially for the founder CEO, yeah, because, in a way, the CEO that's been hired into a company, it's a slightly easier, it's just a gig like, you know, obviously they're going to drive that, but, you know, they may not be as emotionally attached to it's a job, and you know, they'll probably have 10 other offers the next day if they're doing a decent job or they have a good track record. But the founder CEO, the first time, Founder CEO, doesn't have that track record. This is it like they've put everything into this. This is their reputation. This is their credibility. This is their path. They might have left a career to do this. That's a harder nuance. And that's harder because you also know that at the end of the you don't have any guarantee, like, I mean, my board could fire me at any time. Even though it's my company. I built it, it's my idea. They could fire me at any time. And so that becomes a really interesting nuance as well, because there is that sort of extra level of survival bias. It's like, I need the board to continue to back me. I'm trying to drive the category. This is my first Founder CEO gig, so I want to also drive my profile. So it's also you're driving your personal profile and the company profile, so that I think it's a much harder nuance when you're a founder CEO than being just the CEO. And I think at that point, look, you can try to overthink all of those scenarios all the time and constantly looking over your shoulder, which I've seen friends who are founder CEOs do all the time, that you're trying to game the system, like I'm going to sort of pitch one thing to the board. And I just think you can't operate that way, like I think you're here to do a job. You got to put your, you know, throw your everything at it, do your best. That integrity and that reputation will carry you through. And, you know, even in my perspective, if, if I don't know, a year from now, the board think it's time for a new chief exec, that's fine, and then that will be like, what role do I play in the industry? I. Yeah, and I would hope that over the years of having built a business, build the credibility, but that you have some track record then that enables you to do that. And personally, for me, you know, I'm committed to proximate and growing it. But again, you don't have that luxury of knowing that you're going to always be there. And so you have to work every day like you know, you have to deliver. You have to deliver. You have deliver for your team. You have to deliver for the 500 people. You have to deliver for your board. You have to live for your customers and try and just do the right thing. It's a tough one, but it's definitely more emotional when you're the founder.

Joe Mullings  30:31  
You also lead organizations here in the UK that provide funding to startups. How do you view? Tell us a little bit about that. And then how do you view the CEOs when you meet them and you're determining whether or not they get the funding? And that might be some insight for some people

Nadine Hachach-Haram  30:54  
out here. Yeah, so I've had the luxury, and I think it's just my passion about the whole category is, you know, the NHS doesn't really have a corporate venture arm. It's never had one, but there is a need to sort of create that intersection and that alignment of incentives around financial, workforce, the health system, and so a few colleagues and I actually set up the and the first NHS backed venture fund called Meridian health ventures. But it was key for us that it wasn't going to be just NHS money. That was going to be other investors as well. So we have people like cedar, Sinai, Hartford health systems here, foundations here. So it's about a 50 million fund, and we invest in early stage, pre seed, seed and early a and going back to your point on being operators. All of the GPS of this funder have been operators, or are still operators. And I think that's really important, because we you basically couldn't see like we've seen it all between the three of us. We have seen it all difficult boards, difficult teams, how you hire, how you deploy capital, how you build product, the MVP, like literally any scenario we have seen it good or bad, and I think that gives us a real edge. Two, we have the relationships to the health system, so we can quite quickly translate these technologies into the system. And at that early stage, I mean, you're really backing the founder it is a little bit about the technology, of course, but you're backing the founding team. And like, do they have the grit? Do they have the resilience? Do they understand that? Are they obsessed about their customer? How are you testing that? How are you vetting that? Well, part, it's a combination of one is we, we actually put them in because we have access to the health systems. We actually get them to audition with the health systems quite a few times. So we won't invest in a company if we haven't seen health systems saying, Yeah, I want to work with them, and I'm ready to take this on. Yes, this is absolutely a problem that we have. If this works, I'll buy this tomorrow, because we have that access, we can do that. And so we do that, and then partly it's between us. I mean myself, kind of having seen it, sitting with the founders and really understanding their motivation. And we've got a few of them in the audience today. We've got Michael, we've got aim, we've got a few who, you know, it's that undeniable sort of passion and grit to sort of drive this through. And seeing them going through those bumpy journeys of trying to build this product and supporting them through that has been really inspiring. So I think the ones that turn me off, that I'm like, Absolutely not, are the ones that don't listen because, you know, they'll do a pitch, you'll be like, but have you thought about, you know, maybe this business model? Have you thought about this? No, no, no, this is the way we're going to do this, how it's going to work. It's like, all right, it's okay. I might not be right, but if you're not even willing to listen to people who are operating, then how are you going to listen to your customers that are telling you what you're doing is not really solving that problem. And so I think that humility is like such an humility in EQ is a big, big thing we look for.

Joe Mullings  33:50  
So that was good to know the successful CEO. What's the list of three things you tell them stop doing that?

Nadine Hachach-Haram  34:00  
Yeah, it's funny. It's like, stop telling the doctors what they need, or just the customer. Let's say it could be an it could be the porter in the in the house. It could be any customer. And, like, stop telling them you know what their problem is and how you're going to solve it. Like, listen to that. Listen like, kha gave us two ears. Like, use them. And I've seen people like, go in and they're just like, on pitch mode immediately, talking at the customer. And what you just want to do when you start is like, just step back and listen until this day when I and our products pretty, like, valid in the market every time and every time I get on a call the customer, my first was like, tell me about your problem. Like, talk to me about what your main challenges are. What is, what is keeping up at night, what is the main thing? And so they'll say, oh, it's the or and workflow. Okay, tell me. What is it in the workflow? Don't assume anything. And so the ones that go in all straight into their pitch without listening or engaging or understanding are going to fail. Deserve a number. Too well, I think it's sort of like, be willing to iterate. Be willing to sort of work through the feedback. And I, you know, you said it yesterday, about, like, the ugly baby, people are going to tell your baby's ugly and just be willing to say, okay, like, how do I make it prettier? Like, help me. Can Can you help me? Like, let's work together to make it happen. I think those two things are really, really important.

Joe Mullings  35:20  
And so you created a category, proximity, created a category, that category didn't exist. And so actually, more more difficult than that, it couldn't figure out how to get paid yet based on classic health care rewards. How are you navigating that? And you and I have had this discussion, just be the last person standing, because that system will get there.

Nadine Hachach-Haram  35:42  
Yeah, a couple things. One is we needed to vary from day one, diversify our revenue stream. Because, you know, we all know how system revenue cycles are long, and it takes a while, and then you have to prove the ROI, and you get that going. I mean, when it goes, it goes well. I mean, we're now doubling and doubling and doubling. I mean, it's going really well, but we needed time to we needed time for the market to get there. And so we were able to identify other more acute revenue streams that we could tap into that would buy us that time to prove the longer ROI that was needed the system. So early on, we went straight to med device company said, look, I can help you tomorrow train twice as many doctors in half the time. I can prove this to you really quickly. You can prove this out in an eight week period. I'm going to help you reduce your OpEx. This is the, this is like we model their financial Excel sheet. I said, this is I'm going to reduce your OPEX, and how you're going to do this. Great, you know? I said, just try us. Try us out. And very quickly, we were showing ROI to them, and so we were getting them buying our product quickly. And so because we were able to get them to subsidize our journey, and we were giving good value to them, that enabled us to then invest and spend time on the longer ROI, which was on things like aI models around workflow, AI models for case segmentation intelligence and the or that takes longer now we and so that bought us a few years. Remember, we started in 2018, 2019, doing this. And now we're at a point where I would say 50% of our revenues, health system. 50% is meant device. And so what's beautiful is that by giving ourselves that time and space, we were able to go deeper with our strategics and build out more in the stack for them. So it wasn't just transactions, like, right? How do we continue to unlock value for you, whilst at the same time creating a new revenue stream within health systems? And the best part of that is it wouldn't have to build different products for that was just deploying the product with the right ROI and business case. And so today, I'd say 60, 70% of our revenue stateside, of our total revenue, 50% is strategic. 50% is health system. And we're able to double and double and double. And so there's a bit of that, like survival time and understanding ways to drive revenue to do that, but recognizing is, once you're commercial, you're going to be measured on commercial metrics. So you can't half ass commercial. You can't say, well, kind of want to be commercial? Maybe not. Once you're commercial, you're commercial, and so your valuation, how you raise money, you offend, your due diligence, is going to be on your revenue, your margins, etc. So make sure you're ready to make that commercial jump to do it.

Joe Mullings  38:14  
So in our last minute here at your hometown, it's an industry that you love dearly. You have clearly been an ambassador for the entire med tech industry. I think nobody carries the message better than you. What would you share to the CEOs, the founders, the investors, the strategics out here,

Nadine Hachach-Haram  38:33  
to the investors and the strategics? I would say absolutely there are unbelievable gems in this market that have been able to build incredible businesses at a fraction of the cost with great IP, great tech. They're just more humble. I've not just had that sort of access, that sort of a lot of US companies have, so I would absolutely back companies here. They are great. They're frugal, but they're very ambitious. They're sort of small and mighty, is what I would say, from a kind from the software sort of SME perspective. And then, of course, we've got great stories like organoxe and CMR and others. So, you know, we have a track record of being able to build great businesses here. So from investors and the strategics back them, look at them, support them. They, I promise you, will deliver 10 times, 10 times over, because they have that sort of desire to prove themselves and as the underdog. And I think for the startups you know, start to really think about markets outside of the UK, because the UK market is not big enough. Prove yourself here. Build a create a great, repeatable playbook and business, but very quickly, think about, how do I go? How do I build a bigger How do I work into a bigger Tam? Because even as a fund, when we look about if we're looking at companies that are just selling to the UK, it's not big enough, and so we sort of shy away from them. We need companies that have ambitions to grow into other markets. 

Joe Mullings  39:51  
Beautiful. Well, thank you, Nadine, as always, thank you, and please share your appreciation with Nadine, thanks very much.