“Focus on What Customers Actually Want, Not What We Think They Want”
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
- 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
- The three metrics Precision OS uses to measure success.
- How Danny receives the advice and recommendations he receives from mentors and
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
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
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
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
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
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
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
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
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
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
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
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.