Latest / Clinician to CEO : Export Your Medical Device With Confidence By Overcoming Go To Market Roadblocks For Medtech Growth / #215 | How Clinicians Really Decide Whether to Adopt Your MedTech Product

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#215 | How Clinicians Really Decide Whether to Adopt Your MedTech Product · Clinician to CEO : Export Your Medical Device With Confidence By Overcoming Go To Market Roadblocks For Medtech Growth

• 0:00
  The one thing that you're gonna learn on today's episode is what actually influences clinicians' decisions to adopt new products, and spoiler alert, it's not just because they may be a better product.
• 0:11
  Welcome to Clinician to CEO, the podcast helping clinicians simplify your go-to-market strategy so that you can stop guessing and turn your working prototypes into international MedTech businesses.
• 0:23
  I'm your host, Hakeem Aade.
• 0:25
  Let's get started.
• 0:27
  The three things that you'll discover today are, number one, how clinicians really evaluate new medical technologies beyond the clinical evidence.
• 0:34
  Number two, the hidden factors that influence adoption, including workflow, trust, and team dynamics.
• 0:39
  And number three, practical ways to make your products easier for clinicians to adopt and champion.
• 0:45
  So today's guest is Dr.
• 0:46
  Tangwan Asafo, Assistant Professor and Division Chief of Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine.
• 0:55
  And throughout her career, Tangwan has been responsible for evaluating, implementing, and working with new technologies in one of the world's leading healthcare organizations.
• 1:04
  Now, obviously, that gives her a unique perspective on how clinicians really decide whether a new product deserves a place in everyday clinical practice.
• 1:12
  And in today's episode, Tangwan is going to help me step inside the mind of a clinician to understand how healthcare professionals really make decisions about adopting innovation and therefore, what med tech founders often misunderstand when bringing new products
• 1:26
  to market.
• 1:27
  Thank you for joining me today, Dr.
• 1:29
  Asafo.
• 1:30
  Delighted you could come on and join us.
• 1:31
  Thank you for this opportunity.
• 1:33
  Lovely.
• 1:33
  So we'll get straight into it.
• 1:34
  Throughout your career, as I mentioned in the intro, you've evaluated and implemented lots of new technologies.
• 1:38
  So when you're assessing something new, what's generally going through your mind?
• 1:43
  Is there anything specific that you're looking for?
• 1:45
  As a, as an anesthesiologist, I obviously am thinking about my patient first.
• 1:49
  So how is this going to help me look after my patient?
• 1:53
  I think for most of us, that is a, a question that lives in our subconscious all the time, and that is definitely, the first thing that goes through our minds when we're presented with something new.
• 2:04
  Okay.
• 2:04
  And then the next thing to go through?
• 2:06
  The next thing, I think a lot of this depends on where you are, and certainly depends on what your role is within your department.
• 2:14
  As you mentioned, I've been in leadership for quite some time, so automatically I think about, how easy is this going to be to use for my staff.
• 2:24
  I also think about whether we're going to be able to afford it, right?
• 2:27
  Whether we're going to be able to bring it on.
• 2:28
  I also think about other competing, requests that, that land at the same time we're presented to, a new technology.
• 2:35
  In, in any leadership role, you have to be responsible for meeting regulatory requirements.
• 2:40
  That is very important.
• 2:41
  And for us in anesthesia, as in many other procedural and surgical spaces, the, the, the ease of, cleaning and disinfecting are also very, important considerations.
• 2:53
  Okay, so I'm just gonna go through those again.
• 2:55
  'Cause you said patient first, ease of use effectively, affordability, competing requests that might be coming in at the same time, and then regulatory compliance.
• 3:02
  Is that kind of the order of operations, or would that be if you were to look at those five, yeah, it's five, would you rearrange those into different priorities, or would that be how you'd think about it?
• 3:12
  That's how I would think about it.
• 3:13
  I think that as a clinician, I'm going to look for a product that helps me look after my patients, and I'm going to look at the affordability, not because it may be prohibitive, but, I have to think about
• 3:25
  a way to bring it into our operating rooms even if it is, expensive, right?
• 3:30
  So then I would have to, sort out a way to make the case that, the outcomes of the patients far outweighs what looks like an initially high cost, right?
• 3:39
  And I think that's for many, for many bits of equipment that are, on the outset look like they're very expensive, there are many ways we can, show our hospital leadership that in the end there are cost savings down
• 3:51
  the line.
• 3:52
  And that might not be very obvious, when the product is initially presented to you.
• 3:55
  I'll give you an example.
• 3:57
  We used a different sort of oxygen mask for, obese patients in our procedural areas many years ago, and what this meant was that, the colonoscopy, endoscopy echo could proceed at a faster rate because you had a superior oxygen
• 4:13
  mask.
• 4:14
  That means you can get through more cases.
• 4:16
  You're not interrupted, you're not stopping the case in the middle to, improve the patient's oxygenation.
• 4:21
  So what looked like a much more expensive mask at the outset has actually allowed us to deliver far more cases uninterrupted.
• 4:29
  So you have a, improvement in patient safety as well as a cost saving that it's easily demonstrable to the hospital leadership.
• 4:36
  Yeah.
• 4:36
  So effect to what you're saying there, you're looking at the cost in use over time rather than just the acquisition cost Unit...
• 4:42
  Exactly.
• 4:43
  Yeah.
• 4:43
  The unit cost of the, of the item.
• 4:45
  That's a very simple, explanation, but, a, and a very simple example, but we still have that mask, today.
• 4:51
  That we decided to share the cost with the gastroenterology department initially, and eventually, they wanted to transfer the cost back to our department, and there's no, there's really no problem, for us now because the hospital has seen that,
• 5:05
  the, the patients benefit and the caseload, shows that we are able to push more cases through the system, as a result of using that.
• 5:12
  No, thank you very much.
• 5:13
  So in terms of med tech founders that are listening to this or watching this, w- and the people that you've seen come in to present new products to you, what would you say that they don't understand at the
• 5:24
  moment, or they don't give an impression that they understand when they speak to you about that decision-making process?
• 5:29
  I think of in many instances, there has been an attempt to explain the clinical utility And at a very simple level, many of us understand the clinical utility, unless it's something brand new, there, isn't a brand new vital
• 5:46
  sign that we- we're not currently measuring.
• 5:48
  Yeah.
• 5:48
  And I'll give you an example.
• 5:49
  Probably about a year, two years ago, a new, machine for monitoring depth of muscle relaxation was presented to me, and the individual bringing this product was trying to explain to me the importance of, neuromuscular monitoring.
• 6:04
  This is nothing new.
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  This is something you, you learn in medical school.
• 6:07
  So if you want to introduce something like that, you need a, a product that doesn't interrupt my workflow, that isn't hindered by a bulky operating room, that has an easy place to fit amongst our anesthesia workstation, right?
• 6:24
  And then that's not gonna be limited depending on how the patient is positioned and moved.
• 6:28
  So if you're not able to, show me a product that I can actually use, then I don't really need a lecture on how to monitor, depth of muscle relaxation.
• 6:37
  And, is that something that you see, 10% of the time, 50% of the time, 99% of the time?
• 6:42
  I would say between, 50 and 80%, right?
• 6:45
  Okay.
• 6:46
  We're not asking for, lessons in physiology or pharmacology.
• 6:50
  But we don't want to add things to the patient care that don't really have real benefits, right?
• 6:56
  And so sometimes if used as they, as intended and if they work the way the company hopes, then they would.
• 7:03
  But if they are introduced and start interfering with, the IV tubing, are only applicable with certain operations because of the way the patient's positioned, then it just, going to be abandoned, and we've seen this happen with, other, many
• 7:18
  bits of equipments over the years.
• 7:19
  As I said, there, are not really that many new, parameters for physiological monitoring, so we don't really need a lesson in physiology, and I think often people lead with that in the hope that we're going to overlook some
• 7:31
  of the other challenges associated with introducing the product.
• 7:34
  Understandable.
• 7:35
  You mentioned the workflow there, and this is one of the bugbears of mine when I'm speaking to founders actually, 'cause the, I find that they often don't think about the workflow and how it's gonna impact, not just the
• 7:46
  patient, 'cause the patient's ob- obviously critical as you've put there, but also how's the clinician gonna use it?
• 7:50
  How's it gonna work, in theater, et cetera.
• 7:52
  So can you think, and I don't, I genuinely don't know what the answer is Can you think of any products that you've brought in that actually make the workflow more difficult, but have got an outcome that is you're
• 8:02
  thinking, "Oh, this is the panacea"?
• 8:03
  Or is the workflow always a, a critical, point in terms of whether or not you're gonna use that product?
• 8:08
  Something that's made the workflow much more difficult.
• 8:12
  There is something that we have, introduced that, we, because of an end of life of a previous product.
• 8:19
  Okay.
• 8:19
  And this is a, a rapid infuser for, major surgeries where there's a lot of blood loss and you need to administer fluid, rapidly.
• 8:26
  And we have always used, more than one, one, one manufacturer for this particular device.
• 8:31
  And, we had to move to a separate, a new product a couple of years ago.
• 8:35
  And I think the, the challenge there is that the setup is very complex.
• 8:41
  Okay?
• 8:42
  And, they...
• 8:42
  The company did come and give several training sessions, and they have trained our support staff, our anesthesia techs who use it also.
• 8:50
  But because it's something that is not used every day, then it's very difficult to keep people's competencies up in that.
• 8:58
  So it has m- for those cases, the workflow is difficult, but it really is a piece equipment that we have to have for those very, critical cases, whose frequency is very unpredictable, right?
• 9:09
  'Cause you're talking about a, a catastrophe, a gunshot wound, a bad, a rupture of an aneurysm, that sort of thing.
• 9:15
  So would I be right in saying that in reality, if it makes your workflow more complex, unless, as the example you've just given, it's like lifesaving, you're not even gonna think about it?
• 9:27
  No.
• 9:27
  No.
• 9:27
  Yeah.
• 9:27
  We're just not.
• 9:27
  I think there are a couple of, the, the other example is a, a machine for what we call jet ventilation.
• 9:33
  We had used a very outdated product for a while, and, another one was proposed that had a bit more, precision in, in, in measuring the values of the flows and pressures, et cetera.
• 9:44
  And, that had the same, that had the same problem in that the, the, the cases weren't very frequent, so every time you needed to use it, some sort of in- in-service r- was required.
• 9:54
  It's not really the sort of, piece of equipment where the rep would show up at the hospital every time.
• 9:58
  And certainly, I think in anesthesia, that happens less so than in surgery where the orthopedic surgeon will have the rep in the room, going over implants, et cetera.
• 10:07
  In this case, because, and this is exactly a perfect example because that's not a, of necessarily something that is, we have the alternative that works We, we still ha-have the old of, the older machine and we have, almost
• 10:21
  discontinued use of the, the newer and fancier, machine for that purpose.
• 10:26
  Okay.
• 10:26
  And I suppose leading on from that, and it's in the same vein, when a new product has come, have you ever, you, have you ever seen...
• 10:32
  Let's say, for example, you've got two products and someone's talking to you about them.
• 10:34
  Have you ever seen a technically better product lose to what people would, and the manufacturer would assume is an inferior one?
• 10:41
  I think, maybe not technically better, but they're newer and, more, I guess easier to use on s- on the surface.
• 10:50
  And this happened to us, probably about 10 years ago.
• 10:53
  And in that case, the product was, there was some service recovery and we now are using it.
• 10:59
  And I'll tell you what happened there.
• 11:00
  This was a type of video laryng- laryngoscope, and when we first, when it was first introduced, I think there was just a lack of, understanding about the feedback the clinicians were giving about this particular product.
• 11:12
  We had a few people who'd used it at their previous, jobs who thought it was great, and it was dead in the water when it got to us.
• 11:19
  A couple of people tried to use it, the screen was cracked, there were complaints, and we kept being told, "No, no, no, it's fine."
• 11:25
  The view wasn't great, and this was not the experience that others who'd used it at other institutions had.
• 11:31
  So in our department we had a sole champion who said, "It's great, I've used it before."
• 11:36
  And all it took were a couple of...
• 11:38
  And, and this is a piece of equipment you need for, an airway emergency.
• 11:42
  So you'll imagine that our threshold for, putting up with it is very low, right?
• 11:46
  We're not gonna, we're not gonna, give it many chances, and that's exactly what happened.
• 11:50
  So rather than, come and explore with us and find out why all of a sudden it wasn't working, there was just silence from the company rep.
• 11:57
  Fast-forward the pandemic, maybe a couple of year- years before the pandemic, we got newer ones.
• 12:03
  We had, again, because we had two other products that were similar from different companies, there wasn't a huge appetite to buy many of these, these previously failed, video laryngoscopes.
• 12:15
  They had one advantage however.
• 12:17
  They were easier to clean, they were smaller.
• 12:19
  And now when we went into COVID, we needed something that was more portable.
• 12:24
  Yeah.
• 12:24
  And also for, from a, from a sort of, cost point of view, we now did not really have to make a big case as to why we need to buy a third thing when we had two other, brands
• 12:34
  of the same, and what we were able to rapidly expand our fleet.
• 12:38
  And to today, that still remains the most commonly used video laryngoscope Yeah.
• 12:43
  So that picks up what you said e-earlier in terms of how easy it is to use, isn't it?
• 12:46
  'Cause effectively you moved to something, that you just said was easy to clean.
• 12:49
  that, that jumped into that bucket of easier to use 'cause it's the, the whole process.
• 12:54
  And one of the things you mentioned when you mentioned those those five key things at the beginning, you talked about regulatory.
• 12:58
  So when you talk about regulatory, is that including clinical evidence, or is that would you see that as outside that regulatory framework?
• 13:04
  That's outside.
• 13:05
  This is really talking about the, here we have a joint commission that accredits hospitals and, we are surveyed like any other, medical institution, and they look at how, for example, we clean our equipment.
• 13:19
  The predecessors to some of the older video laryngoscopes had either disposable blades and of course the d-disposable blades for the clinicians in our group were not as good as the reusable blades.
• 13:30
  And a lot of factors need to be, considered when you're thinking about cleaning and disinfection.
• 13:35
  Not just your process, but the staff that you have to do it.
• 13:37
  We have a limited number of, anesthesia techs in our department, and this was something that was regularly being cited, as an area for improvement.
• 13:44
  So in that case, a disposable option is the obvious choice as long as it can give you the same, accuracy clinically.
• 13:51
  And so this, newer, smaller video laryngoscope was able to do that.
• 13:56
  That, really helped 'cause that's predominantly what we use now and we've now essentially got rid of the problem of how we clean, reusable laryngoscope blades.
• 14:04
  That's that's really interesting actually, 'cause clinical evidence, and this is one of the main reasons that I like speaking to clinicians, 'cause clinical evidence in terms of, medical founders, manufacturers, they their view is, "Oh, we just need to
• 14:16
  bombard.
• 14:17
  We need to have as much clinical evidence as possible."
• 14:19
  So they spend, in some cases, millions.
• 14:21
  In smaller companies tens of thousands, hundreds of thousands.
• 14:24
  And all the things you've spoken about in terms of are about your-- almost your personal experience and what you feel that you're gonna get from that pro-- product and especially someone with experiences yourself, 'cause you've got a lot
• 14:34
  of experience.
• 14:34
  So if you had two products and then one ticks all the boxes with regards to what we said, patient first, easy to use, affordability over time, et cetera, and those key things.
• 14:44
  And then there's another one that wasn't that easy to use but had loads of clinical data.
• 14:48
  Where does that clinical data sit in terms of pushing you to make a decision?
• 14:52
  I think a lot of, a lot of, evidence needs to be weighed, right?
• 14:56
  how is it funded?
• 14:57
  In what population- Yeah is it done?
• 14:59
  And I think there's some studies you can't do.
• 15:01
  Yeah.
• 15:01
  There's some studies you can't do.
• 15:03
  So I think the what question are you trying to answer, and what, what are you trying to solve for the patient?
• 15:09
  And in, in some s- in some situations you may accept less clinical evidence.
• 15:14
  Yeah.
• 15:14
  Right?
• 15:14
  And then in others, you really need more.
• 15:16
  And I think you will know about the, the, computer-assisted personalized sedation, system that failed, the Sedassist, many years ago.
• 15:25
  Yeah.
• 15:25
  I was all set, ready to fly to California to learn more about that, and I think there really were, a lot of, obvious mistakes that were made there.
• 15:35
  There was a lot of evidence but timing is also important when you're developing something new.
• 15:39
  If you have, something that is developed just for one drug, if you have something that, doesn't match the expectation of the patient population, and I think the sort of notion that you'd be able to replace physicians was sort
• 15:52
  of swirling around.
• 15:54
  I think that made, those three things at least made things difficult for that particular product, and it ended up never being used.
• 16:00
  I think the other thing about timing is that- You can imagine, propofol, which is a very, very common, anesthetic nowadays, was introduced around the same time a laryngeal mask was introduced.
• 16:12
  And, the laryngeal mask probably would have never taken off the way it has had propofol not been introduced at the same time.
• 16:18
  Those are things that I think are difficult to predict, but I think it's important to keep those in mind.
• 16:23
  Propofol also, was very, is now used widely as a, a medication for, total intravenous anesthesia, where we're not using gases.
• 16:31
  We're now thinking about the ozone layer a lot more, and that's really helped, the widespread use of that medication.
• 16:38
  So I think sometimes timing, and as, as I explained, for us, the pandemic was, was something that coincided with our ability to expand what is now the predominant laryngoscope used in our department.
• 16:50
  so the timing needs to be appropriate.
• 16:52
  we have another product that we have used that does, a non-invasive, cardiac output monitoring that again, we introduced at the time of, enhanced recovery protocols, that were, really being pushed throughout all surgical subspecialties.
• 17:08
  And this was a move to really look at how we can improve care with colorectal surgery, and there was a need to have a monitor that was not, was non-invasive.
• 17:17
  And I think had, had the anesthesia community and the surgical community not moved towards enhanced recovery protocols, then some of these non-invasive, technologies would not have taken off as they did.
• 17:27
  And, the one we used really, explains another point about, sustaining something new.
• 17:32
  Something that is easy to use, something that has good support from the company, especially if it's something new and needs a lot of education at the outset, something that needs troubleshooting.
• 17:43
  And I think this is where a lot of, products fail.
• 17:45
  I think you can troubleshoot, but it shouldn't only be the company that needs to troubleshoot, right?
• 17:50
  'Cause then I think if people are troubleshooting too often- Mm-hmm then at some point we just abandon using it, right?
• 17:56
  I think that, this happens very, not infrequently, and then it just becomes an extra gadget that gets in your way of looking after patient.
• 18:03
  I was just gonna say, so I wanna come onto that, that training because I think that's a really important piece.
• 18:07
  But just to close down the clinical studies bit.
• 18:10
  Yeah.
• 18:10
  So when you are evaluating the safety and efficacy of a new med tech product- I mean, you've kind of semi-answered it.
• 18:16
  It sounds like you wouldn't just accept, okay, well, you got clin- you got loads of clinical papers, so I now think it's safe and ethic, effective.
• 18:21
  You're gonna, you're gonna take that and say, "Okay, so that's maybe ticked one box, but I need to then see what it's like in real clinical practice- Yes in my clinical practice- Yeah not just taking- Yeah loads of
• 18:30
  clinical data."
• 18:31
  Yeah, I think, clinical practice is, use is important.
• 18:34
  Every time somebody comes to me, I ask them which other area hospitals are using it, always.
• 18:40
  Mm-hmm.
• 18:40
  And, and when I go to conferences, I also ask, right?
• 18:44
  So just telling me that the, there's an anesthesiologist at a certain university who's helping them doesn't do it for me.
• 18:50
  I need to know which, hospitals are actually using it.
• 18:53
  And quite often that alone tells you everything you need to know, right?
• 18:57
  We have, in our system, we have several different hospitals.
• 19:00
  Yeah.
• 19:00
  Sometimes there's something that's being used at another one.
• 19:02
  So it's easy for me to find out by just picking up the phone, but I know it's passed some sort of sniff test.
• 19:08
  Now- Yeah that particular hospital may not have the same needs or patient population, but it's very easy for me to gauge from them how useful it is, right?
• 19:16
  Or it's very easy to me to decide whether there's some barrier at my site that means we can't use it, right?
• 19:22
  Outside of, things like cost, et cetera.
• 19:24
  Yes, actual practical use i- is important.
• 19:28
  And there are a couple of, there are a couple of, Devices that, my last trip I took before we shut down, before the pandemic, was to a, a conference in Amsterdam, and unfortunately the, the pandemic sort of shut
• 19:40
  down our being able to implement that particular product.
• 19:43
  And what's happened since is another hospital in our system did, and we're trying to bring it to ours.
• 19:48
  And, and really the experience of a colleague down the street, particularly where there's a new health system, obviously makes it much easier.
• 19:55
  When you have similar patient populations, you work with similar surgeons, you have, trainees that work at both sides, and all those things help.
• 20:01
  So what's your advice to someone who's listening to this who's thinking, Yeah, but I want to get into John Hopkins and I'm, and I've really just, launched a product, so I haven't got anyone else 'cause I want John
• 20:10
  Hopkins to be the first one."
• 20:11
  What would your advice to that person been?
• 20:13
  'Cause when you ask them, "Well, where is it being used?"
• 20:15
  Their answer is, No one, nowhere at the moment.
• 20:17
  It's a brand-new device."
• 20:18
  So what- yeah, I think, yeah, it depends on what the product is.
• 20:21
  Are you filling a void?
• 20:22
  Mm.
• 20:22
  And tell me how it, is gonna improve my patient's care- Mm right?
• 20:28
  And then if it's something that has, that is something that we think can add, then we start with a trial.
• 20:34
  Yeah.
• 20:34
  We start with a trial, and we really get, feedback from our staff about it, right?
• 20:39
  And then we make a case.
• 20:40
  Sometimes it is answering a question because we've had a couple of, patient safety reports, and this particular product can help reduce those.
• 20:48
  Sometimes it's because the previous, product we use is no longer being supported by the company, or they've decided to, to stop making it.
• 20:56
  And so we start with a trial first, and then go from there.
• 20:59
  I think that most, most of the time though it has to be, obvious reason why our patients will need it and then all the other considerations that I mentioned earlier.
• 21:07
  Yeah, that make, that makes sense.
• 21:09
  And then, and that then leads us on to what you started to talk about, and that's what I've come back to, is that education and training.
• 21:14
  what role does that take, in terms of the success, of a new product?
• 21:20
  I.e., If it...
• 21:21
  even if it's a great product and you think it's a must-have, would you still take it on if the trai- I'm assuming it needs training and education if that company was basically not giving the support that you felt
• 21:31
  it, it required We didn't, we wouldn't because I think relationships are important.
• 21:35
  Mm.
• 21:35
  And as I mentioned, the non-invasive cardiac monitor we used, the rep for that particular company is extremely dedicated.
• 21:42
  And when we rolled out that product, he came in for every single case, stayed, gave people his phone number if, if something happened during the case, would check in later and, and, when he was in the hospital for
• 21:55
  another department would always pop by to see how things were going.
• 21:59
  So there really wasn't any, concern about not being able to get hold of, the rep.
• 22:03
  I think as you onboard more people and it's even more important in today's environment where many, many facilities are using non-permanent staff- Mm then you really have to be available for, continual education and training.
• 22:16
  And in the world of anesthesia, this is now almost a norm that most, most facilities are using, per diems, locums, and some of these, staff may not, may not have exposure to these new technologies at their other, sites
• 22:30
  of practice.
• 22:31
  So it's a bit cumbersome, but really that's the best way to ensure that we continue to use your product, right?
• 22:37
  There's and I think, depending on what the product is, you can decide that you're gonna use something that's easy to use, or you can decide to make something that you're going to have to keep going back to- tell
• 22:47
  the staff how to.
• 22:48
  And I think that's a really important, consideration when things are, being developed.
• 22:53
  And it's an interesting thing, it's an interesting point actually, 'cause I speak to med tech founders all the time, and I think, and I don't know if you see this, but I see people who've developed a product and
• 23:02
  they think it's really easy to use- Yes and I can tell them already that's not gonna w- fit into the workflow- Yeah easily, and therefore, this would be said, if you wanna put that in, you need to think
• 23:10
  about your resource 'cause you're gonna have to keep training and training and I don't know if that's something you see yourself, that some companies come in thinking it's easy, but what you're thinking actually you need to train everybody
• 23:18
  to use this.
• 23:19
  Yes.
• 23:19
  We do see that, and I think though, it, we know that, the ones that are difficult to use are just not gonna stay.
• 23:26
  Mm-hmm.
• 23:26
  Right?
• 23:26
  They're just not gonna stay.
• 23:27
  In our specialty where we're a 24-hour operation, anything that happens in the middle of the night and there's no support, I get multiple calls and emails about it from my staff.
• 23:37
  So that sort of product, it really poses a problem- Yeah for us.
• 23:41
  And the easier it is to use and the less if it's something where there's a leaflet that you can do.
• 23:46
  We had one, one product where people expected us to go on the website and look up the video.
• 23:50
  In the middle of the night in emergency, you're not gonna be able to do that.
• 23:53
  So I think it's important for people to understand that, particularly when you have high stakes, physiological situations, you don't really want something that's tricky to use.
• 24:02
  And I was chuckling because I worked with a company exactly like that.
• 24:05
  They had a QR code and they had an app And I was like- Yeah So when exactly that you're expecting the clinician?
• 24:10
  In, what, in the middle of an operation they're gonna say, 'Oh, just a minute.
• 24:12
  I can't remember how to do that.
• 24:13
  Let me just get my app out and, start looking at the video'"?
• 24:16
  Yeah.
• 24:16
  I said, That's not gonna work.
• 24:17
  You need to find a different solution."
• 24:18
  Yeah.
• 24:18
  So I think it, it is really trying to, and which is one of the reasons for these sorts of conversations, to get people to really think of, as, as we say, from cradle to grave, when you introduce that
• 24:28
  product- Yeah what are the processes it goes through?
• 24:30
  Who are the people it touches?
• 24:31
  And how are you making sure that actually that product, that service is easy for the clinicians, and then obviously has the impact on the patient?
• 24:39
  'Cause I think that's sometimes, what med tech companies have a problem with.
• 24:44
  And actually even adding to that, when you have clinicians who develop products, one of the biggest challenges I have when I'm speaking to them is that they use it in a specific way, and they might've spoken to one
• 24:53
  of their colleagues, "Oh, that's a brilliant idea," and then they then assume that every single person across the world does everything in exactly the same way as they do.
• 25:00
  And they find it very hard to have any feedback that, maybe this is not scalable.
• 25:04
  It might be perfect for you, because you do it- Right in a specific way, but actually you need to, as you just said, you need to now start going and doing trials in other places to make sure before
• 25:12
  you spend all your money, your hard-earned money to develop it, that actually it fits and, fulfills a need.
• 25:18
  Yeah one of the biggest challenges I, I've seen.
• 25:19
  So let's say for example you've got three or four, well, hundreds actually on this, but three or four med tech founders sitting there saying, "But Dr.
• 25:26
  Rutherford, I'm thinking of developing a product.
• 25:28
  What would be the practical steps that you would say that I need to take to ensure that whatever I bring to you, I would get clinical adoption?"
• 25:36
  What, what product w- would I get to do what?
• 25:38
  Sorry, I missed the last part of the question Oh, yeah.
• 25:40
  Sorry, yeah.
• 25:41
  So I was just saying if someone came to you, a, a, an innovator, and they said, "Look, I've got a product that I want to put into the theater, and I want to know..."
• 25:48
  Obviously that's hypothetical, so I'm not giving you what the product is.
• 25:50
  What, what would be the almost like the basic steps you'd have to, I would have to take to get you to take it on board?
• 25:56
  You would have to tell me, first of all, is that, are you filling a void or you're replacing something that is, that's, already available but your product is better, right?
• 26:06
  The second thing is, we would have to, you'd have to show me how this would improve the care of our patients.
• 26:14
  You'd have to show us how easy it is for us to use.
• 26:18
  I think in today's era, compatibility with existing equipment's very important, and I'll give you an example at the end of that.
• 26:26
  And then, we've already talked about clinical evidence and use elsewhere and then, we would assess the cost obviously.
• 26:33
  What we do is we discuss amongst our group, we have an equipment committee, and if we feel that it rises to the level that we wanna trial it, we would, right?
• 26:43
  And then based on the results of the trial, we would then, if favorable, we would, put in a request, for purchase.
• 26:51
  And if approved, then we would select which areas, depending on what it was, we would wanna use it first, get feedback before expanding it to other areas.
• 27:00
  And if it was addressing some sort of problem where we had adverse events, we'd obviously go back and review any sort of, you know, if we're still having the same problems, if it's made any difference.
• 27:10
  Okay.
• 27:10
  So yeah, that's...
• 27:11
  So what I wrote was, is it filling a void or is it doing something better/ solving an adverse event type issue, ease of use, compatibility, evidence of use, then the cost, and then the trial.
• 27:21
  And then obviously again, all those things, it's how they present it, isn't it?
• 27:24
  'Cause if someone's just presenting you unit cost, for example, and I'm hoping that not many people do that anymore, rather than the use and the outcome that it's delivering, and therefore then hopefully the cost effectiveness of it- Mm-hmm
• 27:35
  that makes it easier for you to, to look at it and e- evaluate rather than them saying, "Well, what you're using at the moment is $50, and this one's gonna be $40 or whatever."
• 27:45
  Yeah.
• 27:45
  That doesn't really benefit you at all, does it?
• 27:45
  No.
• 27:46
  No.
• 27:46
  No.
• 27:47
  We had a, a product many years ago that, we wanted to implement and, it makes total sense to use it, and it was gonna make our lives easier because, it was a continuous, monitor for, again, neu- neuromuscular blockade
• 28:00
  And it was very simply that the company were unable to do whatever integration step was required so that we could actually see the results on our screen, right?
• 28:11
  So unfortunately, we didn't use it.
• 28:13
  It's not something we didn't want to use.
• 28:15
  I, I don't know whether they were sending somebody who didn't know what they were doing or w- we're not really sure what the gap was.
• 28:20
  So this went on for several months and, if we can't actually see the results of what it's measuring, then it's obvious, that it is really of no use.
• 28:27
  Nowadays you'd think it's easy 'cause we- we've come a long way with technology, but there are obviously still a lot of, different companies providing, electronic medical record, et cetera, the actual monitoring, the anesthesia machines, the, the physiological monitors.
• 28:42
  And if those all don't talk to each other well, then I think it makes it difficult, difficult to implement.
• 28:47
  All those things we're measuring are supposed to just flow into the medical record, right?
• 28:51
  So if you're on paper, then it's different, but we've moved on many, many, many years ago from paper.
• 28:56
  And so those things need to, flow into the medical, record seamlessly, in order for them to be, really useful.
• 29:02
  Yeah.
• 29:02
  So that comes down to that point you were talking about compatibility, isn't it really, with what's going on around you and understanding how it fits into the whole system that people are using, rather than thinking of this just
• 29:11
  an individual product, service, whatever it may be.
• 29:13
  Yeah.
• 29:14
  Yeah.
• 29:14
  Okay.
• 29:14
  Yeah.
• 29:14
  Yeah.
• 29:15
  And then the other one, this is gonna be our last one before we get into our decision scenario and we wrap up.
• 29:20
  But, as, clinician, not clinicians, salespeople who are coming in, we all talk about decision-making units, making sure you speak to the right people, et cetera.
• 29:27
  And obviously you're quite senior, so most people will always go, "Oh, I wanna go to the chief," or the assistant et cetera.
• 29:31
  They're gonna go to the person who they think is the highest person.
• 29:34
  Now, if that...
• 29:35
  'Cause obviously from a sales point of view, we always think, yeah, we'll start there, but then we'll see who else is gonna be influencing the VAT committee, et cetera.
• 29:41
  We're gonna go speak to everybody else.
• 29:43
  From your perspective, a clinician's perspective, is that the right thing to do?
• 29:47
  Or do you find that irritating when you find out they're speaking to somebody else?
• 29:50
  How do you perceive a salesperson trying to speak to all the, stakeholders in an hospital?
• 29:54
  Yeah.
• 29:54
  I, yeah, I don't think that's a good thing to do.
• 29:56
  I think it's important to know who's making the decisions about what equipment, or what new devices to bring on.
• 30:03
  So we have a, a manager, an anesthesia manager, and we also have, one of our physicians who's, dedicated to equipment.
• 30:10
  So the two of them will assess and, present if they think it's feasible, something new, if they think it's something that we should consider to the department as well as to myself and my administrator.
• 30:22
  Going to the boss who has, a lot of other things on their plate and also is not going to make a unilateral decision- Yeah Is not good.
• 30:28
  And, depending on what department you are in, there's some, I do, I am fairly clinical.
• 30:33
  There are some that aren't, so that's not necessarily the best person to go to.
• 30:36
  And you also need to get the, buy-in from the people who are going to be using it day in, day out.
• 30:41
  Yeah.
• 30:41
  The managers know very well what hasn't worked before, and they also know, a they have a lot of knowledge about compatibility.
• 30:49
  They have a lot of knowledge about the regulatory requirements that will, condemn a project from the get-go.
• 30:54
  So it's very important to have good relationships with those people.
• 30:57
  They're also the people who are gonna get you in for a trial.
• 31:00
  And so those really are the people to start with.
• 31:02
  Cause that's not gonna be the same in every generally it is, but it's not gonna be the same in every hos- in every hospital.
• 31:06
  So how, if I was new and I knew nothing about working in hospitals, so I've just devi- I've devised something and I'm coming out to speak to someone, What would be your advice in terms of how I would
• 31:15
  approach that so I don't pee people off and I get to the right people quite quickly so that I'm not going just all over the place, but I'm speaking to the people that can really make an impact?
• 31:23
  Yeah.
• 31:23
  So I think if you didn't know what the, architecture of the- Yeah organizational chart is, then the administrator for the department or i- whoever's, in the sort of supply chain of the hospital are good people to start with.
• 31:37
  Okay, that's perfect.
• 31:38
  Yeah, that's a really good advice.
• 31:39
  Yeah.
• 31:39
  Because I think that, people go in and they don't know where to start, they're running all over the hospital, and before they've actually got to the right person, they've peeved, most of the department off because it's, "Oh, you're
• 31:47
  here again.
• 31:47
  Who are you speaking to today?"
• 31:49
  Yeah.
• 31:49
  As opposed to- Yeah going to the right people, getting an understanding, as you said, of the architecture, and then- Yeah speaking to the people that you've been advised to speak to.
• 31:55
  So no, I really appreciate that.
• 31:56
  So- If you're doing a, a, like a surgical project, then I think the actual surgeon is important.
• 32:03
  Yeah.
• 32:03
  And most, most, most companies will have their points of contact, right?
• 32:07
  Yeah.
• 32:07
  Because they're in those the same time, yeah.
• 32:09
  Excellent.
• 32:09
  So before we go and before I wrap up, we're gonna do my decision scenario question that I, ask everybody at the end of the, podcast episode, just to bring it to life and, although it's a hypothetical, just to
• 32:21
  give people to think about.
• 32:22
  And of course, you're gonna have to listen to the next episode, if you wanna hear what the answer is.
• 32:26
  So this is the scenario for today.
• 32:29
  Imagine you're leading the evaluation of a new medical device in your department.
• 32:33
  The products have excellent clinical evidence, but several clinicians are reluctant to adopt it.
• 32:37
  What would you prioritize first?
• 32:39
  A, would you ask the company to provide more clinical evidence?
• 32:42
  B, would you identify the workflow barriers preventing adoption?
• 32:45
  C, find respected clinical champions to lead implementation?
• 32:49
  Or D, delay the evaluation until more hospitals have adopted it?
• 32:53
  And of course, you're gonna have to listen to the next episode, if you wanna hear what the answer is.
• 32:57
  So Just to wrap up, I think, you've given some very good advice, and I'm hoping that everyone listening has really started to get into mind 'cause I think it's very easy when you're, a med tech founder or you're
• 33:08
  working in an organization to think about what you want.
• 33:11
  And I was always taught very early on, in my sales career that to actually sell to somebody or to implement a new product, you need to look at the situation through that doctor's and that clinician's eyes, rather than
• 33:24
  focusing on what you're trying to do.
• 33:26
  And I th- I think that's what I was trying to bring to the audience today, but the, I think the key thing, for me that was going, the clinical adoption isn't just about having the best product.
• 33:34
  Of course, you want a good product, but it's about understanding the people, the behaviors, and more importantly- as you've just, you said right at the outset, the realities of what the clinician's environment is, and- Right those clinicians and
• 33:49
  what you're actually asking them to change and understanding those things.
• 33:53
  So Dr.
• 33:53
  Tangwan Asifor, I appreciate your time and all of your advice.
• 33:57
  Thank you very much.
• 33:58
  Have a great day.
• 33:59
  And you.
• 34:00
  Thank you very much.
• 34:01
  Hakeem: And if you're building a MedTech business and you're not sure whether your next move should be around evidence, market access, commercialization, distributor strategy.
• 34:09
  Hakeem: Or adoption.
• 34:10
  Hakeem: Do not guess.
• 34:12
  Hakeem: Book a healthcare export accelerator diagnostic Call with me.
• 34:15
  Hakeem: Use my link in the show notes.
• 34:17
  Hakeem: And in that session I'll help you identify the specific constraints blocking your momentum and the commercial move most likely to unlock your progress.
• 34:27
  Hakeem: Thanks for tuning in.
• 34:28
  Hakeem: Until next time, thanks for listening.
• 34:30
  Hakeem: Keep challenging your assumptions and keep growing.