“Focus on What Customers Actually Want, Not What We Think They Want”

Show Notes

Few professionals need to be perfect at their job as much as a surgeon. The trick for surgeons is trying to become skilled and experienced at performing surgery without being able to practice on real patients. Fortunately, Precision OS is helping to solve the problem of surgeons lacking hands-on experience by using VR to simulate real-life conditions of a surgery that can help surgeons gain experience and assess their performance. The Vancouver-based startup is creating technology that could change the medical field for the better.

Precision OS co-founder and CEO Danny Goel visited with startup coach Roland Siebelink on this week’s episode of the Midstage Startup Momentum Podcast. Danny talked about there is a need for this kind of technology and how Precision OS can make a positive change for both doctors and patients. They also discussed Danny’s unique journey from the medical field to the startup world:

• How Danny has his co-founders built their team based on the company’s three pillars.
• The reason Precision OS took an indirect go-to-market approach.
• The key to getting large MedTech companies to meet with a small startup.
• How partnerships with professional associations have driven the company’s marketing.
• The three metrics Precision OS uses to measure success.
• How Danny receives the advice and recommendations he receives from mentors and advisors.

Transcript

Roland Siebelink: Hello and welcome to the Midstage Startup Momentum Podcast. My name is Roland Siebelink and I am a coach and ally to many of the fastest growing startups around the world, one of which is in our studio today. It’s Danny Goel, the CEO and founder of Precision OS. Hello, Danny. What an honor.

Danny Goel: Hi, Roland. Thanks for having me here. It’s a pleasure.

Roland Siebelink: Oh, absolutely. We’ve been scheduling and rescheduling to find a spot in your busy schedule, so I’m so glad that it finally made it happen. Let’s get started. The first question, as always, is, Danny, what does Precision OS do? Who do you target? And what difference do you make in the world?

Danny Goel: Thanks for your question, Roland. We solve a problem around the globe, which is focused on the lack of hands-on training that we get as surgical trainees - early career surgeons, and even later career surgeons, who want to learn a new procedure or technique. And what we do at Precision OS is we provide an experiential simulation that allows you to behave in a lifelike and authentic environment that provides metrics and assessment of your performance in that ecosystem.

Roland Siebelink: Like a flight simulator for aspiring surgeons?

Danny Goel: That’s a very, very good analogy.

Roland Siebelink: Tell me how you got to that idea, Danny.

Danny Goel: Personally, I always wanted to be as skilled as I possibly could. And I found that when I started my training - importantly, when I started my practice - that my hands-on experience was limited to one environment, and that was only the operating room. And by virtue of that, I traveled quite a bit to learn from my mentors and experts, both in fellowship and then beyond. But it doesn’t really work for most people to do that because it’s highly expensive. It’s not accessible. And there’s a logistical challenge that we have to address when we go to the operating room of another surgeon or expert.

When I met my two co-founders, Rob and Colin, and the first time I put on a VR headset and realized how experiential and immersive it was, I was very, very impressed by the technology at the time. And that’s what led to where we are today, which is creating our software that allows you to behave in that really authentic manner in this high-fidelity environment.

Roland Siebelink: Wow. That’s amazing. For those of us who have now done medical training or haven’t been anywhere near an operating room - at least not in a professional capacity - what was it like? How did surgeons train their new brothers and sisters in the art of surgery and where did they get the practice materials from?

Danny Goel: A lot of it’s based on theoretical knowledge, which we get examined on during training. We also use a lot of video content to watch how others train. Of course, we undertake the apprenticeship model in the operating room, which is we’re taught and we get to experience what it’s like to actually operate in the OR on actual patients.

Part of that model is you end up performing some aspects of the case that are critical, depending on your level of training. And then some aspects are the non-critical - or what we call basic skills. It’s a combination of both those as you progress through your residency and your fellowship training where you get to do less of the automated things because you’re good at those. The goal is to flex you into more of the critical steps that actually have a direct impact on the patient outcome. And that’s how the model has been for decades, if not longer. And it’s based on the initial philosophy of, if I see it, then I should be able to do it, and then eventually I should be able to teach another person.

Roland Siebelink: What’s wrong with that approach?

Danny Goel: It’s actually a very good approach. The problem is the exposure is limited. There’s several problems with it. One is that it’s a limited approach access, meaning that you don’t get to operate every day. And when we calculated the number of minutes that a trainee gets to practice in the operating room, it averages about 15 minutes per day on average over the course of five years.

Roland Siebelink: It’s very, very low. I had no idea.

Danny Goel: Yeah. When you compare it to how athletes train, it’s a fraction of the time when you actually focus on the technical aspect of what you’re supposed to be really, really good at when you graduate. The biggest risk with that model is that it’s high risk for the patient. You’re lower on the proficiency side of the axis. And we know from literature that the lower volume or the lower number of procedures you do for a particular procedure, the higher chances of not doing it well and then end up leading to a bad outcome.

Roland Siebelink: Yeah, in my head, I’m comparing this to Malcolm Gladwell that the true practice requires 10,000 hours of practice to be totally fluent at something. It sounds like your 15 minutes a day don’t get anywhere close to that.

Danny Goel: In addition to that, I think the important part of Malcolm Gladwell’s book is the concept of deliberate practice. You’re not just repeating mindlessly the same exercise over and over again. I really like to use the analogy of golf is when you go to the driving range and you hit a bucket of balls, you’re not usually getting better on the actual golf course. Deliberate practice theory would suggest that if I practice hitting a nine iron 130 yards straight and slightly to the right and to the left, that’s a little bit more systematic approach to getting better. And we know that can actually improve your result on the golf course when it’s much more deliberate.

We lack that currently in healthcare. This focus on just knowing what to do, the steps of the procedure, is foundational and it’s important. But when you think of a layer above that, to try to get better at those key steps and when to make those micro decisions, that’s the part that we’re really focused on.

Roland Siebelink: Of course, I think many people can see the potential of this technology. But a lot of the risk must also be in can you actually realize this technology. Can you talk a little bit about your co-founders and how you set up the business and try to reach maximum success?

Danny Goel: I’ve been very fortunate to meet Rob and Colin. Both of them come from the video game industry. They’ve spent 20-plus years in the industry each. And I’ll talk about Rob for starters. He’s our creative director or chief creative director. How he thinks of things from a fidelity perspective has really allowed us to have that high-fidelity appearance in the virtual environment, which when we’re teaching something as significant as surgery, I think accuracy and fidelity from that perspective is extremely important. He’s built a team around that knowledge base and that experience that he’s had to help drive the visual appearance of our environment.

Colin, who’s our chief technical officer, is a brilliant engineer who actually - he allows what Rob and I combined from the education perspective, from the visual perspective, to actually make it behave authentically. Meaning that when you are going to ream the bone - that’s a term we use when you’re shaving bone down -or when you’re gonna drill the bone, that he’s enabled the environment to allow you to move very freely in that environment, which then captures a much more deeper aspect of your behavior - your decision making.

The combination of medical education as a surgeon, bringing that to life from a fidelity perspective - and fidelity is used in two words, one how it looks and number two is how it feels - I’ve been fortunate to have my two co-founders who bring that body of knowledge and then we’ve built a team under those three pillars to help support that.

Roland Siebelink: Okay. Excellent. How big is the team now and how have you divided it up in different roles?

Danny Goel: We have our leadership team. We have over 60 people now. Again, we’ve built it under those three pillars. On the medical education simulation side, we have industry-leading advisors. On the clinical side, which helps support the need and the relevance of what we’re building. On the fidelity side, Rob has built a team under him to help drive that ongoing visual fidelity. And then Colin has built a very, very solid engineering team under him to help support that. Of course, we have layers around that include the product, which helps support the voice of the customer within our product. And then we have our sales and marketing team. Those are the big pillars that we have within the company. We’ve started from a foundational reason as to why the problem exists or that there is a problem. And then how best to attack that problem with our solution.

Roland Siebelink: Okay. One question I would have around the strategy. The vision’s pretty clear. But I can imagine that it can feel at times like boiling the ocean to be able to support all kinds of different procedures - and maybe that betrays my lack of medical knowledge. But did you have to focus on a certain area to build first or to go to market with first? What did you guys think about that?

Danny Goel: As an orthopedic surgeon, the natural first choice would be to focus on orthopedics. We’ve built the spectrum of procedures and orthopedics from shoulder all the way to the lower extremity. In addition to that, we’ve focused on arthroscopy, which is putting a camera into a joint.

And we’ve expanded even beyond that now into soft tissue surgery, which in itself is a very big challenge, which our team has been able to solve.

Roland Siebelink: Okay. Yes. I’m sure that the fidelity side has had their headaches around that. Can you talk a little bit about the go-to market? Picking an area of surgery implies a certain go-to market. How did you build up the team? How did you get initial traction?

Danny Goel: Given that we focused on orthopedics, our initial target was the medical device companies because they are really intimately appropriately aligned with our agenda of teaching people how to do surgeries safely. For example, if I’m doing a shoulder replacement, I need to know exactly where to put that implant to get the best result. Of course, surgical decision-making and patient outcomes are really important - there’s multiple buckets that lead to a good outcome.

We’re focused in the operating room so that a medical device product can be used appropriately, safely for the pathology they’re about to treat - or the abnormality. That was our initial start and go-to market was to focus on the medical device companies and create value for them because they want to ensure that their products are used safely. At the same time provide value for the end user, which is to make sure that they’re actually understanding the problem and how to apply that medical device to that particular scenario.

Roland Siebelink: Okay. That’s very clearly an indirect go-to-market strategy at first, working through partners that already have a vested interest in that medical education side and making sure that their products are used correctly and safely. Really love that.

How do you even start persuading, as a small startup, big medical device companies to even consider having a meeting with you?

Danny Goel: That’s a very good question. I would say that it’s all about value. What is the value to them and to their end user when you present a new product? If you go back, they’ve been using an effective model for training for a long time. And that includes having people go to a cadaver lab, bringing their implants in, having experts as part of that model, and training the next generation or the existing generation of surgeons. Now we’re trying to change that, or at least augment that, with a new product - VR is new; it’s foreign to most people. It’s becoming more mainstream now. It hasn’t reached that tipping point yet. I’d be the first to say that it is still very early in the virtual reality environment for people to actually know what it is and actually conceptualize the power of what it can do.

I think demonstrating how it can be effective was done in a number of ways. And I think talking about it is one thing. But proving that it actually works is a second thing and perhaps more important. The shoulder and elbow society in Canada, as well as the Canada Orthopedic Association funded a study where we randomized senior residents to try VR or reading a document, specifically a paper written by a surgeon, and then examining them on a cadaver lab to see how effective they were.

We repeated that study - or the society repeated that study - comparing VR to video. And we’ve shown in both those randomized trials, which have been published, that it significantly augments or enhances the experience when they do have cadavers. That in itself is if you’re gonna spend the money to have a cadaver experience, wouldn’t it be great to ensure that your attendees got the most of that experience using something like VR?

Roland Siebelink: Exactly. In a way, you’re competing with cadavers.

Danny Goel: Yeah. We’re competing with them and we don’t wanna discount them because they’re a very effective model of learning. But what we’ve shown is that it can augment that experience dramatically at a fraction of the price.

Roland Siebelink: What can you share, Danny, in terms of the traction? You already mentioned you have over 60 people now in the team. But what does this mean in terms of how many sites do you have it operational? How many doctors are using it? How many students are being trained on it? Whatever you can share and you’re comfortable with.

Danny Goel: Our traction includes the fact that we’re working with several leading medical device companies in the world right now. We have 50 medical schools or residency programs that are actively engaged with our software. In addition to that, which I think is also part of the ecosystem, we have multiple society partnerships. And the professional societies - their members consist of, in this case, orthopedic surgeons. And their goal is to train other surgeons on techniques and products, and to ensure that safe surgery is also carried out by a broader audience. We’ve partnered with the American Shoulder Elbow Society, the International Society for Hip Arthroscopy, the Foundation of Advancing Pediatrics, as well as a nonprofit SIGN Fracture Care.

That part of the ecosystem is an important part of how we establish our brand, not only with our product but the research that we’ve done that shows our product actually works.

Roland Siebelink: Okay. Very good. Danny, I think MedTech, and especially anything in MedTech hardware, has a notorious reputation of having to fight with extremely conservative buyers who don’t wanna try new stuff or who feel it’s too risky. How do you think about that? And what did you do to break through that conservatism, that wait-and-see mindset that I sometimes hear from other MedTech companies?

Danny Goel: Specifically I think their core focus as well is on education. Every medical device company we work with, that is a top priority for them - to ensure that their products are used safely. Everybody’s at risk when a patient has a bad outcome. Most importantly, the patient. The agendas are aligned from our core focus, their core focus, societies, and the medical schools.

I think proving that - again, I go back to the validation with the research is really, really important because if you can prove that it works and medical device and just MedTech in general, historically the trend has been, we introduce a device and then we research it after. And we’ve taken a little bit of a different approach here to say: “Here’s a powerful technology. Let’s prove that it works because that’s an important piece. And then let’s showcase that that research actually demonstrates what we actually are claiming that it does.”

Medical devices don’t necessarily have to do that out of the gates because they’re making changes to an existing product that’s already been in place for some time. But now we’re completely changing and introducing a completely new technology with a new piece of hardware. And I think that that’s an important pathway to take, to receive that acceptance and relevance and validation from those audiences.

Roland Siebelink: This is a podcast and we wanna talk about all the good stuff about you, Danny, and about Precision OS. But a lot of the founders listening to this podcast are also interested in what was hard, what didn’t go so well, what have been some key learnings or things in which you’d have to reinvent yourself a little bit as a startup and where did you get better for dealing with those problems?

Danny Goel: That’s a very good question. And if I was to look back five years ago, being a surgeon, I think the trend for surgeons is to stay in clinical practice, and you find other opportunities that enhance and add richness to your practice. Some people educate. Some people do research. And when I went into this business pathway, it was somewhat new to me because we traditionally don’t get a lot of business education. The exciting part about this was not only the technology and the passion behind what we were doing, but also moving into a completely different area of understanding what does a marketing function do? What’s the relevance of it? How to read financial statements. What is a go to market strategy? How to think about software because we’re in the widget world, which is hip and knee replacements or shoulder replacements and anchors. But now we’re talking about something in a digital format, so understanding software, software development.

Part of that education was self induced, driven by myself, so learning about it. But I ask my co-founders a lot of questions. And it’s to educate myself about this space. But then having mentors and advisors that have lived and breathed this environment most of their lives was a key part of that. And I think that it’s achievable. But you have to be willing to ask a lot of questions. And you have to be open to test your assumptions on many areas.

Roland Siebelink: Talk a little bit more about those mentors and advisors. Some people would add investors to that as well. How do you deal with one mentor who tells you A and the other tells you B and you just figure it out?

Danny Goel: That’s a common thing. And I read an interesting article about receiving recommendations. But at the end of the day, it’s up to me and the team to decide which of those recommendations make the most sense for our people and for our business. But it’s very important to hear all the recommendations because then you can distill all the different thoughts and theories that have been brought to you and make much more informed decisions based on those recommendations.

Roland Siebelink: Absolutely. Very good. I personally also found that sometimes the best mentors and advisors are those who don’t necessarily give you recommendations but ask you the right questions. That’s been a personal learning for me at least. Anyway, Danny, how big do you see Precision OS become over the years?

Danny Goel: If I was to reframe your question, what does success look like? Success has many forms. I would say the first metric for me and our founders is to have the best people. And keeping or maintaining that culture of having the best people is perhaps the most important thing for us. Number aside, I’m less focused on the number but more focused on the quality. And we strive to have the best people in the company in all regards. They say when you hire A people, they will additionally hire A people. That’s a primary focus for us.

The second part of it is on the product side, to deliver on the mission through our product. We’re a product-led company. And that means focusing on what our customers actually want, as opposed to what we think they want.

I think the third thing is we’re a business, so we have to focus on the revenue piece as well. That is a third part of our metric. I would put them in sequence to say these are the top three priorities of our company.

Roland Siebelink: Okay. That makes total sense. Danny, those people who’ve been following all this to the end, how can they figure out more about Precision OS? Where should they go? What should they download? And also, how could they help you and Precision OS do better?

Danny Goel: If anybody ever wants to contact me, they should be prepared for me to ask them questions as well. I always find that everybody I speak with, I’m always open to learn from their experience. I’ll certainly do a lot of listening, and then provide whatever inputs I have to that. And they can contact me through email or through LinkedIn. I think that’s the best source.

Driving awareness of the ecosystem in general is probably an ask that I would have. If you think about VR, if you’re thinking about VR, assess the landscape, do the research, and ask yourself what part of this technology is important to you. But if you take a step back and say, what problem do I really have that I’m trying to solve?” And see if it fits because I don’t think VR is the answer for everything. I think it does solve a problem that we’re addressing and focusing on. But it’s not for everything, so it doesn’t apply to every single part of it. It’s not a panacea.

Roland Siebelink: Absolutely. Even if the technology is so exciting, make sure that you actually solve a real use case and that the technology is the best fit for that.

Okay. Very good. Anyone who wants to be in touch with any Danny Goel, you can also drop me a line and I’ll provide an introduction. Danny, this has been an absolute pleasure. Thank you so much for spending time on our podcast today.

Danny Goel: I wanna thank you, Roland, for your time. Really appreciate it.

Roland Siebelink: Absolutely. And, listeners, we will have on our episode for you next week one of the founders of the most exciting, fast-growing startup companies all around the world, just like Danny. Thank you everyone.

Roland Siebelink talks all things tech startup and bring you interviews with tech cofounders across the world.