Dr Lydia Yarlott is co-founder of Pando, an app that aims to facilitate communication for healthcare professionals. It was when she started working as a junior doctor — after graduating from Oxford University Medical School in 2015 — where challenges with communication in the NHS became apparent. Alongside Philip Mundy and Dr Barney Gilbert, she founded “Forward” in 2017. The company rebranded as “Pando” in 2020. Pando now serves over 60,000 clinicians in primary, secondary and community care settings across the UK. Yarlott is currently undertaking paediatrics training alongside her work at Pando.

Interview

What were the first steps that you took in getting Pando underway, and the challenges you faced at the start?

Some colleagues and I — including my partner who’s now my husband —started Forward Health, because we were shocked by how information is managed in our healthcare system today. When you start off in the NHS, you can feel like there must be a reason for everything. But I could never see a good reason for the bleep system.

Bleeps are a very cumbersome, stressful system to use. You get a high-pitched noise that notifies you of something. You have no idea what that thing is, how important or urgent that task is, and no matter what you’re doing you have to interrupt it, and go and answer that bleep.  And it’s crazy — when the vast majority of us have smartphones — that we wouldn’t be harnessing that technology to enhance communication in the NHS.  I also noticed that all of my clinical colleagues were using WhatsApp, and though some of them had more nous about information governance, I was worried about the consequences in terms of confidentiality and data breaches.

We felt like we really needed a better way of doing this, and the technology existed in the world, but it just wasn’t being harnessed in the appropriate way. So that’s really where the idea of Forward Health started. 

When you start off in the NHS, you can feel like there must be a reason for everything. But I could never see a good reason for the bleep system

How did you know where to begin?

I’d say quite candidly that I didn’t know where to begin at all.  I’m lucky because I happened to meet Philip who is a serial entrepreneur and has worked in mobile before. I admire anyone who goes out there on their own, without that kind of combined experience. Philip knew, for example, how to raise money for an idea, which is very important, as apps are quite expensive to build. If you can’t persuade your hospital or your trust to build it, or another organisation to give you a grant, it’s going to be very difficult to get something going. 

The first thing that we did, which I think is the right way to start, is to see if other people felt the same. A few of my colleagues and I interviewed other clinicians — formally and informally — asking them how they thought things could be better, in a “blue sky” way.  

You’ve got to think about whether you’re solving a real problem, that exists in other people’s minds as well as your own, or whether it is only you that thinks that this needs to change. Being focused on a problem rather than a solution is important because it means that you’re not wedded to any subsequent ideas that you get about how to solve it — you’re constantly looking back at what actually is needed to change.

Being focused on a problem rather than a solution is important because it means that you’re not wedded to any subsequent ideas that you get about how to solve it

We got some statistics that the vast majority of doctors didn’t think that communication in hospitals was fulfilling all of the purposes that it needed to, and they didn’t like the current communication tools. And they were all using Whatsapp as a workaround.  

From then on, we started producing some designs. That was a real learning curve for me, because people often say, “oh, wouldn’t it be great if we had an app for this”. It all gets very complicated very quickly, and it’s always best to start really really simple.  And we did start really really simple.

The journey from that point onwards was of trying to change people’s mindsets. Getting people to download a new app and start using it is a big behaviour change, particularly because when you open the app you want to see lots of other people in your hospital already using it. But I think ultimately we have come back to this idea that if it’s good enough, people will use it. So, we‘ve — as a company — focused an awful lot of our attention on just making the product really useful, really listening to what people say.

I think ultimately we have come back to this idea that if it’s good enough, people will use it.

Once you’d started to develop the app, did you go directly to different hospital teams, or did you approach other parts of the NHS to put it in place?

This is definitely a scattergun approach. You do as much reaching out as you can. Find as many people who want to change things in the same way as you, and try to connect with them and get them on board. Because really to do something like change a communications system you need a small army of supporters.  And then again, going back to what I said before, you’ll only get there if your product works and if it works well.

It was difficult, and it was slow. I think it’s interesting how it’s really taken on a life of its own in a way that is really satisfying to watch as a founder.  It’s not always the ways in which you think it’s going to work, but it does start working. I think the lovely thing about having created quite a flexible tool, is that people use it in the way that they want to use it. It’s great for us to hear about that and be receptive to it, and work out for each particular use-case, is there anything we could do better.  That’s definitely the exciting thing for me.

It’s not always the ways in which you think it’s going to work, but it does start working

You’re currently a paediatrics trainee, and have continued clinical work alongside your work at Pando. Could you tell us a bit about how you’ve managed to do both things simultaneously?

I never imagined that I would be doing this.  You can ask anyone this, and particularly people within Pando — I’m the least technical person by nature and in terms of expertise. But I guess I do care about technology a lot, in that I care about the technology that I have to use.

But it often does involve burning the candle at both ends for a bit! During my F2 we were meeting every week in King’s Cross, even though some of us were working in different areas of the country, for an evening. We’d spend about four hours just brainstorming, deciding what we were going to do next.  And I think that you can’t miss that phase, where you’re working out, “Is this something I want to do a bit more formally or not?” Then I took a year out, to do a Tropical Medicine Diploma. I did Pando at the same time, which was hugely complementary, actually, because we were covering some very important topics in Epidemiology and Public Health. It’s all highly relevant, and I’m really glad to have had that little bit of headspace to explore my own interests.

I’m very impressed with Health Education England and with the paediatrics training program, for allowing me to work part-time on Pando ever since then. I do 70% clinical hours and then the rest of the time I spend on Pando, and that’s a really rewarding, luxurious combination. I get to progress my clinical career — as my primary is to be a good doctor and a good paediatrician — but I also get the opportunity to work on something with a lot of risk and a lot of unknowns. 

I think that anything that gets you to use another side of yourself or another part of your brain, is a really healthy thing to have in life. I feel very lucky to have it, and I would absolutely advocate anyone who’s feeling a bit uncertain about medicine — or they have something else they want to try alongside — to think about taking a hybrid approach to it.  It gives me lots of transferable skills, lots of opportunities that are also relevant to my paediatrics career. And I guess it makes me a bit more of a rounded person than I would be otherwise.

I think that anything that gets you to use another side of yourself or another part of your brain, is a really healthy thing to have in life.

Entrepreneurship is often something undertaken by men more than by women. Have you experienced any challenges that your male cofounders may not have faced?

That’s a really good question, and a hard one for me to answer, because I feel so like I’ve fallen on my feet with this whole project. And I was really lucky to meet Phillip and then Barney (co-CEO along with Philip), who was a doctor and now does Pando full-time — as do several other clinicians within our company.

I have the situation where I don’t bear the operational responsibility of running the business, because that does need somebody — well in our case two people — that really focus their whole working lives on that.  I feel very fortunate that I’m in this situation where I get to have the best of Pando — I get to put my clinical acumen into it and continue my clinical career alongside.

I celebrate and admire female founders who can do these things without that support getting everything done — first steps, funding, hiring, raising a profile — on their own.  I think that’s truly something to be celebrated, and I think it can be hard for women, because women (this is a generalisation) can be less willing to put themselves out there and invite criticism for an idea or an opportunity.

Certainly I found that very daunting when we first started Pando. Every single clinician I had to present the idea to, I thought would probably just say, “How ridiculous, don’t be so silly!” I think that is slightly more common in females than it is in men.

But that really brave female out-on-your-own founder perspective is something that I can’t legitimately have because I’ve had Philip and Barney behind me in this project — and now leading it —right from the beginning.

Have you had the opportunity to meet any other female founders in health tech that you can share experiences with?

Yeah, there are a lot and they’re all incredibly impressive. I do think it’s very important that we develop a culture where female founders are as prevalent and as well respected as male founders. I think there’s an awareness that we’re not quite there yet.

It’s the same with women and technology, we’re definitely not quite there yet with that. And even in our own company, we often struggle with diversity. That I guess comes right from the beginning of the education system, making women and girls feel like these are legitimate ambitions for them to have, and really promoting those topics and those areas to women. 

 Because most women that I talk to who are in technology, who are entrepreneurs, absolutely love what they do, and wouldn’t consider doing anything else for the world. So we’ve got a long way to go in that respect.

I think in order to get where we need to be, we do need to give women a little bit more airtime, a little bit more of a voice as often they can be more reticent about putting themselves out there — but not always!

I do think it’s very important that we develop a culture where female founders are as prevalent and as well respected as male founder

Is Pando mainly based in the UK at the moment, or is it serving other markets? What is your vision for Pando in the future?

Yes our product was always marketed and targeted towards the NHS, and I guess that’s because as clinicians Barney and I had grown up in that system. 

We’re at the stage where we have conceptualised and put into practice our pager replacement system which is really exciting — we’re on the Clinical Communications Framework so Trusts can choose Pando as a pager replacement.

So it’s a time of quite a lot of change for us as a company and a lot of new challenges within this particular market. The NHS is one of the biggest employers in the world and it would be great to feel like we had really solved that problem at home before we went to other territories.

We know that this problem exists pretty much all over the world in every healthcare system, and no-one’s actually cracked clinical communication yet.  So that is an obvious reason why we would be potentially be very successful in other countries.

I guess the other mission is to connect healthcare across the world, not only the professional but also the patient. So we are working on ways that we can better engage with the patient as well as between clinicians. And ultimately we’d love to be able to make healthcare and healthcare information democratised in that way that we think it should be.  

We’re coming out of the age of paternalistic medicine, where everything was slightly secretive and where the doctor would only tell you what she or he thought you ought to know.  There are still traces of that within our healthcare system today and that’s one of the things that I really would like to change with Pando.

The NHS is one of the biggest employers in the world and it would be great to feel like we had really solved that problem at home before we went to other territories

About The Author

Alyssa Ralph

Alyssa is a qualified doctor working in an academic foundation post in the West Midlands. Her interests lie in global surgery and public health, and she holds a BSc in Clinical Epidemiology and a MSc in Public Health.

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