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From Idea to Market: Ep 1 - The Spark · AHF Podcast

0:21
Joseph M. Schwab: Hello and welcome to the AHF Podcast.
0:24
Joseph M. Schwab: I'm your host, Joe Schwab.
0:27
Joseph M. Schwab: Over the last several months, we've been working on something a little different for the show.
0:32
Joseph M. Schwab: Instead of focusing only on surgical technique or clinical outcomes, which is what we usually do, we wanted to step back and ask a broader question, how does medical innovation actually happen in practice?
0:47
Joseph M. Schwab: Not in textbooks or slide decks, but in real life, in hospitals and in clinics, in operating rooms, and in the messy spaces between clinical practice and industry.
0:59
Joseph M. Schwab: We set out to speak with surgeons and founders and engineers and clinicians who have all lived this process from different angles, and something really cool happened.
1:11
Joseph M. Schwab: As we listened to their stories, we started to see clear patterns first, we noticed that meaningful innovation usually doesn't start with some radically transformative technology.
1:23
Joseph M. Schwab: It starts when something in routine practice no longer feels acceptable.
1:29
Joseph M. Schwab: Second, we saw that many problems that eventually lead to new devices or companies are often known for years before anything changes.
1:39
Joseph M. Schwab: So the issue doesn't seem to be awareness, but rather, healthcare systems tend to normalize problems instead of fixing them.
1:48
Joseph M. Schwab: And finally, we realize that innovation is less about being brilliant and more about being persistent.
1:56
Joseph M. Schwab: It's about people deciding not to look away, even when looking away would be the much easier thing to do.
2:03
Joseph M. Schwab: That's what led us to create this mini series from Idea to Market.
2:09
Joseph M. Schwab: We designed this series with two audiences in mind.
2:12
Joseph M. Schwab: First, for clinicians in practice today, we wanna make the innovation process more transparent so you can see how ideas actually move from the clinic into real products that reach real patients.
2:27
Joseph M. Schwab: And second, for anyone who might be fostering an idea right now.
2:32
Joseph M. Schwab: You might be a surgeon or an engineer, or a researcher, or even a medical student or anyone listening.
2:39
Joseph M. Schwab: We wanna show you what can happen after that idea.
2:43
Joseph M. Schwab: First sparks.
2:46
Joseph M. Schwab: Now, one thing we've learned is that the path from idea to impact is not linear.
2:53
Joseph M. Schwab: It involves detours and setbacks and long timelines.
2:58
Joseph M. Schwab: Hearing these stories, we want listeners to understand that this complexity is normal and that progress is still possible.
3:08
Joseph M. Schwab: More than anything we hope this series helps people think differently about innovation, not as a single moment of inspiration, but as a sequence of choices and conversations and learning all happening over time.
3:24
Joseph M. Schwab: This is the story we are telling.
3:27
Joseph M. Schwab: Across from idea to Market, you're going to hear from many different voices in each episode, and those voices represent people who have all seen innovation unfold from the inside.
3:53
Joseph M. Schwab: Rather than introducing them one by one, I want you to meet them first in their own words.
4:01
Jared Foran: I'm Jared Foran.
4:02
Jared Foran: I'm an orthopedic surgeon in Denver, Colorado.
4:04
Jared Foran: I'm a hip and knee arthroplasty specialist.
4:07
Jared Foran: I'm the Chief Scientific Officer of ForCast Orthopedics, and I'm one of the co-founders.
4:13
Peter Noymer: Hi, my name is Peter Noymer.
4:14
Peter Noymer: I'm the CEO of ForCast Orthopedics.
4:17
Peter Noymer: I'm also a PhD in mechanical engineering.
4:19
Peter Noymer: I've spent nearly 30 years, developing novel drug delivery systems for improving treatments across a number of different therapeutic areas.
4:27
Leo Whiteside: Oh, I'm Leo Whiteside.
4:29
Leo Whiteside: I'm an orthopedic surgeon.
4:30
Leo Whiteside: Just, retired last January.
4:33
Leo Whiteside: Uh, engaged in hip and knee replacement, sort of subspecializing and.
4:39
Leo Whiteside: Uh, infected arthroplasty.
4:41
Doug Fairbanks: My name is Doug Fairbanks.
4:42
Doug Fairbanks: I'm the president, CEO, and board member at VISIE Inc.
4:46
Marie-Isabelle Batthyány: My name is Marie-Isabelle Batthyány I'm an board certified anesthesiologist specializing in orthopedic anesthesia and I'm also the founder and CEO of XRSynergies.
4:58
Charles Lawrie: I'm Dr.
4:59
Charles Lawrie: Charles Lawrie.
4:59
Charles Lawrie: I'm the co-founder and chief medical officer of FIOS Health.
5:04
Charles Lawrie: I'm also a high volume, anterior approach hip replacement and robotic knee surgeon in Miami, Florida, and, current president of the Anterior Hip Foundation.
5:13
Charlie DeCook: My name is Charlie DeCook.
5:14
Charlie DeCook: I'm the president of Total Joint Specialists, a 17 surgeon group here in Atlanta, Georgia.
5:20
Alexander Sah: My name is Alex Sah and I'm a hip and knee surgeon in private practice as medical co-director of the Institute for Joint Restoration in Fremont, California.
5:27
Alexander Sah: I was past president of the Anterior Hip Foundation and currently serve as Chief Medical Officer at Think! Surgical and Chief Innovation Officer at Ospitek.
5:36
Robert Cohen: My name is Robert Cohen and I am a mechanical engineer that have worked in the med tech industry for over four decades, and I presently am the Vice President of innovation and technology for the Orthopedic Group at Stryker.
5:51
Joseph M. Schwab: Together.
5:52
Joseph M. Schwab: Their stories help us understand what the spark of innovation actually looks like in real life.
5:58
Joseph M. Schwab: To help us understand, we reviewed hours of conversations with these entrepreneurs in order to find the answer to three questions.
6:06
Joseph M. Schwab: First, how does a problem change from an inconvenience to an obligation?
6:13
Joseph M. Schwab: Second, how do we identify a problem that's not just unsolved but structurally ignored?
6:21
Joseph M. Schwab: And third, why do certain people feel compelled to act while other people simply move on?
6:29
Joseph M. Schwab: This is the spark.
6:37
Joseph M. Schwab: Innovation doesn't begin with a plan.
6:39
Joseph M. Schwab: It begins with attention, with noticing the same limitation again and again until it starts to feel unacceptable.
6:47
Joseph M. Schwab: So let's start at the beginning.
6:48
Joseph M. Schwab: When does a recurring frustration cross the line from inconvenience to obligation?
6:59
Joseph M. Schwab: Most early ideas in medicine don't start in boardrooms.
7:02
Joseph M. Schwab: They start in everyday clinical work.
7:04
Joseph M. Schwab: When something technically works, but still feels inadequate at first, these moments can feel minor, but when they repeat, they begin to shape how a clinician sees their work.
7:16
Joseph M. Schwab: For Jared Foran, that awareness began pretty early in his training.
7:21
Jared Foran: I was actually a resident going back 20, 25 years ago, and we were, uh, doing these cases and my attending was frustrated and I think we were, you know, we were putting in antibiotic static spacers with, antibiotics in the cement.
7:36
Jared Foran: And I was thinking back then, there's gotta be a better way, there's gotta be a better delivery way.
7:40
Jared Foran: And that's what started this whole process.
7:43
Joseph M. Schwab: At that point, Jared didn't have a product or a company or even a formal project.
7:50
Joseph M. Schwab: What he had was a pattern, the same clinical situation, the same frustration again and again.
7:57
Joseph M. Schwab: One thing research backs up here is that clinicians are among the most common sources of innovation in healthcare precisely because they experience these repeated frictions at scale in real environments.
8:10
Joseph M. Schwab: Studies of clinical innovation show that many breakthrough ideas begin not in labs, but in daily practice when routine tools no longer match clinical reality.
8:23
Joseph M. Schwab: in fact, decades before Jared Foran was even thinking about infections, Leo Whiteside experienced something similar, but driven by evolving science rather than just frustration.
8:35
Leo Whiteside: back in the 1980s, um, I was involved in arthroplasty and doing the usual, um, thorough washout, clean out debridement exchange, arthroplasty, and then antibiotic spacer in, in most cases.
8:53
Leo Whiteside: back then we were starting to learn about how important biofilm is in infected arthroplasty and the minimum biofilm eradication concentration, uh, is in the thousands of micrograms per milliliter, not 10.
9:10
Leo Whiteside: and there's only one way to get that, and that's direct infusion into the joint.
9:16
Joseph M. Schwab: Here practice had not yet changed, but the underlying science had the gap between evidence and routine care is a common starting point for innovation.
9:27
Joseph M. Schwab: Scholars who study medical change, call this the knowledge practice gap.
9:33
Joseph M. Schwab: What we know scientifically is ahead of what actually happens in clinic, and all of these elements come together to create an environment for innovation.
9:44
Joseph M. Schwab: In combustion science, this is known as the deflation threshold, a fancy term for a minimum set of conditions under which a combustible mixture will ignite and sustain a flame.
9:57
Joseph M. Schwab: Without those conditions, nothing happens, but in our case, this is the moment when accumulated tension or insight or discomfort reaches a state where change almost becomes inevitable.
10:13
Joseph M. Schwab: If properly triggered.
10:15
Joseph M. Schwab: It's not the spark, it's the instantaneous moment.
10:20
Joseph M. Schwab: Just before it.
10:21
Doug Fairbanks: It's the on entrepreneurs,, plight to realize or appreciate what everybody ignores, it's your goal to say, Hey, when there is a problem, that's not a problem.
10:32
Doug Fairbanks: That's an opportunity.
10:34
Joseph M. Schwab: Doug describes an important mental shift.
10:37
Joseph M. Schwab: At first, problems seem like inconveniences.
10:40
Joseph M. Schwab: At some point, they start to look like responsibilities.
10:45
Joseph M. Schwab: That brings us to our second question.
10:47
Joseph M. Schwab: What signals that a problem is not just unsolved, but is structurally ignored.
10:59
Joseph M. Schwab: In healthcare, structural neglect isn't an accident.
11:03
Joseph M. Schwab: It's woven into how symptoms adapt to complexity, how they distribute responsibility, and how they normalize workarounds problems persist, not because people don't care, but because the system learns to live with them.
11:18
Charles Lawrie: FIOS Health was really born out of a simple observation I made in my clinic.
11:23
Charles Lawrie: Uh, patients don't struggle because their doctors don't care.
11:27
Charles Lawrie: They struggle because they don't have access to the information when they need it most.
11:30
Joseph M. Schwab: Sociologist Diane Vaughn introduced a concept normalization of deviance when she was analyzing the 1986 space shuttle Challenger disaster.
11:42
Joseph M. Schwab: She noted that small deviations from expected behaviors accumulate over time.
11:50
Joseph M. Schwab: The system can really become tolerant of unsafe or inadequate practices until those practices no longer feel wrong, but actually feel normal.
12:01
Joseph M. Schwab: This idea is pretty simple but profound.
12:05
Joseph M. Schwab: Everyone agrees patients should get all the information they need to prepare for their surgery, but when that doesn't happen.
12:12
Joseph M. Schwab: There's no immediate problem or catastrophe.
12:15
Joseph M. Schwab: Say the patient does great with their surgery, that deviation starts to feel well validated.
12:23
Joseph M. Schwab: Over time the boundaries of what's considered acceptable patient education in this circumstance slowly widen.
12:31
Joseph M. Schwab: And what makes this normalized deviance So concerning.
12:36
Joseph M. Schwab: That it's not usually intentional.
12:38
Joseph M. Schwab: Everyone sees themselves as adhering to local norms.
12:42
Joseph M. Schwab: This isn't perceived as deviance.
12:45
Joseph M. Schwab: It's perceived as just getting the job done.
12:48
Joseph M. Schwab: Charles Lawrie and his team didn't have an issue with clinical expertise.
12:53
Joseph M. Schwab: It was how information moved or didn't.
12:57
Joseph M. Schwab: Between patients and providers, the biggest challenge for someone in Charles's position is to help those around him understand that the problem he suddenly sees with fresh eyes and with greater clarity is the one they need to pay attention to as well.
13:14
Robert Cohen: You have to establish a need for something.
13:17
Robert Cohen: Even though if they may not understand what your solution was, you first have to understand the need.
13:21
Robert Cohen: If you don't understand the need, you're not gonna be able to present the solution and people readily adopt it.
13:27
Joseph M. Schwab: What Robert is getting at is something well documented in innovation research.
13:32
Joseph M. Schwab: Before you solve a problem, you have to clearly define the need the system has been tolerating.
13:38
Joseph M. Schwab: Sometimes the structural nature of a problem only becomes obvious in deeply uncomfortable moments.
13:45
Marie-Isabelle Batthyány: I collected so many issues in patient communication and actually medical communication during my medical career.
13:53
Marie-Isabelle Batthyány: But what stuck with me was the situation really early on in my anesthesia training.
13:59
Marie-Isabelle Batthyány: I was still a resident back then.
14:02
Marie-Isabelle Batthyány: A lady who was scheduled, she was around 60 for very extensive gastric surgery, and I visited her in her room at the hospital the day before to tell her what we would be doing to her during anesthesia.
14:17
Marie-Isabelle Batthyány: And she was sitting there, all her documents were already signed, and when I got to the part of telling her that she would need a gastric tube after her surgery, she looked at me and she said, why would I need that?
14:30
Marie-Isabelle Batthyány: And I told her, because you won't have a stomach left after surgery.
14:36
Marie-Isabelle Batthyány: And that was the initial situation where I thought.
14:40
Marie-Isabelle Batthyány: That the issues in patient communication are so evident in practice and in literature that I'm still amazed how little has changed since the Helsinki declaration in 64.
14:51
Marie-Isabelle Batthyány: Um, and I wrote my MBA thesis on the topic of eligibility of virtual reality in patient education and informed consent.
15:00
Marie-Isabelle Batthyány: And that's where I found my scientific confirmation that the whole consent sector really is in trouble.
15:07
Joseph M. Schwab: In Marie's case, the process had been followed, the paperwork was correct, the consent signed, and yet the patients still didn't understand, uh, frankly, life-changing reality across healthcare.
15:22
Joseph M. Schwab: Studies consistently show that communication failures like this.
15:27
Joseph M. Schwab: Can persist for decades, even when they're well described in the literature.
15:32
Joseph M. Schwab: Normalized Deviances Marie came face-to-face with the power of a normalized deviance in that moment, and that's when she first realized that a problem doesn't become a true innovation opportunity.
15:48
Joseph M. Schwab: Not just when it's difficult or unsolved, but when it's widely known and still tolerated.
15:55
Joseph M. Schwab: Just a part of everyday practice.
15:58
Joseph M. Schwab: Well, once a problem is recognized as systemic awareness alone isn't enough, at that point, the real question becomes why do some people act while others move on?
16:15
Joseph M. Schwab: Nearly everyone can see the same problems, but not everyone pursues solutions.
16:21
Joseph M. Schwab: Research on clinical innovation shows that individual interests, including obligations to patients and personal motivations, play a significant role in driving innovation.
16:31
Joseph M. Schwab: While contextual barriers or incentives and structural constraints can deter it.
16:38
Joseph M. Schwab: Another way to think about it is like a chemical reaction.
16:41
Joseph M. Schwab: While some happen spontaneously, many require a catalyst.
16:46
Joseph M. Schwab: Something that plays a critical role in making the reaction go forward.
16:51
Joseph M. Schwab: In chemistry, catalysts typically help reactions by lowering something called the activation threshold or the energy required to push the reaction forward.
17:02
Joseph M. Schwab: For Doug Fairbanks, getting others involved is one way to lower the activation threshold.
17:09
Doug Fairbanks: you can have an idea, but you can only take the ball so far right.
17:14
Doug Fairbanks: And it's really about taking your idea and building a team and taking idea to the next level through getting people to invest themselves in it and to also believe in you.
17:23
Doug Fairbanks: And it's that process of vetting idea that kind of starts the very early spark of a company to move from kind of zero to one.
17:32
Joseph M. Schwab: For some innovators that commitment isn't only professional, but deeply personal.
17:37
Joseph M. Schwab: Moral salience can be a powerful catalyst when your primary driver is simply recognizing that solving a problem means doing what's right for patients, especially when you are once a patient.
17:50
Joseph M. Schwab: Here's Peter Noymer.
17:52
Peter Noymer: But I also have two hip replacements myself.
17:54
Peter Noymer: I had them done about five years ago.
17:56
Peter Noymer: Um, so I have sort of a personal understanding of, you know, how transformational, um, the joint replacement procedures can be, right?
18:03
Peter Noymer: I went from, um, having quite a bit of pain and limited activity levels to now being kind of back to where I was, I'd say even 20 years ago.
18:12
Peter Noymer: Um, and I'm thrilled about that, right?
18:14
Peter Noymer: In the idea of somebody suffering even more with an infection.
18:18
Peter Noymer: Um, it really compels me to want to do better for them and, and come up with a better way to, to treat these PJI patients.
18:26
Joseph M. Schwab: For others, intellectual curiosity, the desire to build new systems, and just the opportunity to upend an apple cart is enough to lower their activation threshold.
18:38
Joseph M. Schwab: Charlie DeCook and Alex Sah both surgeons and serial entrepreneurs describe this mindset.
18:45
Charlie DeCook: To be honest with you, my main passion now is about, disrupting markets, creating new technologies.
18:51
Charlie DeCook: I think that's gonna be kind of my lasting legacy, is that, so I'm super focused on that right now.
18:57
Charlie DeCook: I mean, this is just what I love doing is learning from other founders.
19:02
Charlie DeCook: Learning, uh, what's in the market and kind of developing new technologies, that's what really drives me.
19:08
Alexander Sah: These early experiences created a lot of excitement and interest.
19:12
Alexander Sah: So it's really that initial spark that you refer to and inspired me to be involved in the process of bringing products to the orthopedic market.
19:19
Alexander Sah: Being involved gives you the chance to make an impact.
19:22
Alexander Sah: It gives you an opportunity to interact with other KOLs and educate and learn from your peers.
19:27
Alexander Sah: That's what makes it so much fun.
19:29
Joseph M. Schwab: What ties these stories together isn't charisma or raw talent.
19:34
Joseph M. Schwab: It's how long someone's willing to stay in the room with a problem once they've seen it.
19:40
Joseph M. Schwab: Plenty of clinicians notice the same cracks in the system and then simply keep moving.
19:47
Joseph M. Schwab: Pulled forward by schedules or metrics or the underlying message to just get the job done.
19:54
Joseph M. Schwab: Others can't quite let it go.
19:56
Joseph M. Schwab: They circle back to the same question again and again, even when nobody else is asking, let alone noticing, and there's no obvious way forward.
20:06
Joseph M. Schwab: A true spark is different because it doesn't die out after the first sting of frustration, it lingers.
20:15
Joseph M. Schwab: It colors how a person sees their cases or their team, or their institution or their practice, until the problem is no longer just a detail to work around, but an obligation to work on at that point, walking away starts to feel like a personal compromise.
20:36
Joseph M. Schwab: That's the moment when all this goes from being background noise to a fixation front and center.
20:43
Joseph M. Schwab: And that's when everything starts to behave like the first step of innovation.
20:50
Joseph M. Schwab: Putting this episode together.
20:51
Joseph M. Schwab: We kept coming back to the same realization.
20:54
Joseph M. Schwab: The spark is not a single moment of insight.
20:58
Joseph M. Schwab: But a process that unfolds over time.
21:02
Joseph M. Schwab: Three things stood out to us as we reviewed all of our conversations.
21:06
Joseph M. Schwab: First, the spark begins long before there's a solution.
21:11
Joseph M. Schwab: It usually starts with repeated exposure to a problem during real clinical work as opposed to in a lab or in a conference room, more like an operating room or a clinic or during a patient encounter.
21:25
Joseph M. Schwab: What transforms a frustration into obligation isn't novelty, but persistence.
21:32
Joseph M. Schwab: When someone stops seeing that a problem keeps appearing, despite good care and strong intentions and growing evidence, it begins to feel like something that just shouldn't be tolerated anymore.
21:44
Joseph M. Schwab: Second, we learned that many sparks are born from problems the system already knows about.
21:50
Joseph M. Schwab: These aren't hidden issues.
21:52
Joseph M. Schwab: They're documented in the literature or discussed at conferences.
21:56
Joseph M. Schwab: They're out in the open for everyone to see, but many systems are built to normalize these issues, not to change them.
22:04
Joseph M. Schwab: They spawn workarounds, normalize, deviances, not solutions.
22:10
Joseph M. Schwab: The spark often appears when someone stops accepting those workarounds as normal and starts asking, why do we tolerate doing it this way?
22:20
Joseph M. Schwab: And third, we saw that people who act are the ones who connect the problem to a catalyst.
22:29
Joseph M. Schwab: For some, the catalyst is personal experience.
22:33
Joseph M. Schwab: For others, it's sharing the idea with a team.
22:36
Joseph M. Schwab: And yet even for others, the catalyst is simply seeing the same failure pattern again and again and again in practice, creating a deep sense that better care should be possible, even when the path to that better care still remains unclear across all of our guests.
22:55
Joseph M. Schwab: The spark looked less like inspiration and more like responsibility, not the kind that comes in a job description, but the kind you pick up yourself and decide not to put down.
23:15
Joseph M. Schwab: If there's one idea we want listeners to carry forward from this episode, it's this innovation doesn't start with technology.
23:23
Joseph M. Schwab: It starts with attention.
23:25
Joseph M. Schwab: If you're a clinician, we hope this helps you recognize that your everyday frustrations aren't trivial.
23:32
Joseph M. Schwab: Many of the most important medical innovations began exactly where you're working right now, and if you're someone holding onto an idea, wondering whether it matters, this episode is meant to reassure you of something simple.
23:46
Joseph M. Schwab: You don't need a company or a grant or a prototype.
23:50
Joseph M. Schwab: To begin.
23:51
Joseph M. Schwab: You need clarity.
23:53
Joseph M. Schwab: Clarity about the problem and the willingness to stay with it.
23:58
Joseph M. Schwab: Because noticing the problem is only the beginning.
24:07
Joseph M. Schwab: In the next episode, we follow what happens after the spark into the stage where curiosity starts to take shape, where first hunches harden into assumptions where a direction begins to emerge, and where innovators decide what to chase and what to let go.
24:26
Joseph M. Schwab: Because once a problem becomes impossible to ignore.
24:30
Joseph M. Schwab: The next question is, what do you do with it?