nehme_1348002418_71Jean is the CEO of Touch Surgery, a mobile surgical simulator enabling users to practise surgical procedures on their smartphones. A registrar in Plastic Surgery, Jean combines his NHS job with working on the company. His co-founders – Andre Chow, Ad Gandhe and Sanjay Purkayastha – are all NHS surgeons and between them the team have expertise in surgical simulation, 3D animation and programming, as well as over 200 academic publications. They are one of the current cohort of startups working with the NYC digital health accelerator Blueprint Health. Jean spoke with Claire soon after arriving in NYC, to discuss their company vision, why they chose to join an accelerator and what they are hoping to achieve during the 3-month programme. We’ll be catching up with with Jean again a few weeks down the line to find out how they’re getting on…


January 2013

Jean, great to meet you and congratulations on being accepted onto the Blueprint Health Programme in New York. Can we start with you telling us about the background to Touch Surgery and who the team is?

IMG_3540-225x400Sure. Well, I’m a Plastics ST3 registrar. Andre has just finished his PhD this year, in tissue engineering at Imperial College and has now gone back into training, he is currently an ST4 registrar in General Surgery. Ad Ghande is an Orthopaedic consultant and Sanjay is a lecturer and consultant Bariatric surgeon at Saint Mary’s Hospital, Imperial College London. The way it all came together was that I was working as an SHO for Ad. At the time Ad was working on the iOS platform. He had coded something which was very interesting, it was what was to become a key component technology in what we ultimately created. I had recently completed an MSc in Surgical Technology and simulation at Imperial and was looking at metrics and objective assessment. So we got together and built part of Touch Surgery. Then, having worked with Andre before as his house officer, and often being inspired by him, I called him up and said “Andre, where are you?” He replied telling me he was playing with some cells in the lab  (laughs) so I went up to Imperial College and saw him and said “look at this”. He saw it in the elevator and said “Oh my god, I can operate on my phone!”. So together we called Sanjay, who was someone both myself and Andre looked up to in surgery and academia, he’s published over 250 peer reviewed articles. He came and sat down with myself, Andre and Ad and together we further refined the product. We introduced more analytics and Andre learnt to code and developed out website and together we built a new interface. We released a minimally viable product that we subsequently redesigned based on our user feedback and metrics.


That sounds like a powerful combination – 4 practising surgeons and you can code as well?

The best coder in the team is Ad Ghande, he’s a phenomenally inspiring individual who puts hips in by day and codes by night, often until 3 in the morning. The other thing is, Ad is multi-talented. He can also animate in 3D – he did a BSc in medical imaging when he was a med student and got honours. It was all about 3-dimensional imaging and how you can interact with a CGI of human anatomy. Andre can also code, and he designed and developed our website and user experience (with help from his wife Regine who works in this field). I don’t really code but I understand what we can achieve with code and have mainly been involved in introducing functionalities and execution.


A doctor with a BSc in 3D animation – that’s great…

Ad is very passionate about art. He’s a surgeon and a passionate artist and he’s loved that throughout his life. He found through technology a way to express himself artistically.


Did any of you have previous experience of starting a company?

No.When I met Ad, he had some code and so at the time I was like “We can channel this into a product with objective assessment and metrics…. it can do so much more”. Initially it was “What do we do with this product, do we sell it to doctors?” This was something that didn’t appeal to any of the founders. Instead we believed the best thing to do would be to deliver education that’s free and accessible to the world, which would help make surgery better. I think one of the core missions of the team was based on the idea that we’re all very privileged to be in the UK and to have our experiences in surgery – however, surgical education has changed. It’s not what it used to be – there’s budget cuts, reduction of working hours… and patient safety is so important, so how can we make this better?  By not restricting this product and putting it in a locked room away from the people who need it. Instead, let’s put it out there and make it accessible to the world so we can make the world a better place.


You didn’t start out trying to build a business then?

Yes, it’s true to say that at first that we didn’t build a business – we had a vision, and based on that we built a product that we felt would make surgical performance, training and patient education better internationally. We then had to develop a strategy, and we knew it wasn’t sustainable to have just a product without the business model to allow it to grow. We also knew with our research background that we needed to validate this and make it academically viable. Having a background in simulation and how it can be used, we developed the product further to allow it to grow and also to gather data that would be useful.


So who in your team is responsible for what right now?

These are arbitrary titles for now, because when you’re in start-up you tend to cross over and do many things. I’m the CEO, and Andre is currently our COO, and Ad is our CTO and Sanjay is our Academic Director. It’s all available on our website you can see it on the ‘About us’ section. We have these titles – however it’s important that I say there is no boss. We’re a team that’s very democratic. We have weekly meetings where we go through the next steps and address different parts of the agenda and it’s a shared input from multiple members of the team. Myself and Andre work closely together on strategy, and together we take it to the other guys. With Ad we sit and design new product features.  Sanjay leads from the academic point of view, but everyone pitches in.   So ultimately the roles are arbitrary, we all have shared decision making in what we do and the fundamental vision is a shared one.


Have there been any key mentors outside of the team who’ve helped you shape the vision and get to this stage?

This has been a vision and a mission that we have generated ourselves. Of course we have met lots of interesting people in the journey. Some have been very supportive, whilst others not as much.  I think the fact that we are subject matter experts is very crucial. We’ve got registrars and consultants in our team so we know about some of the problems in education and training. I know what’s important in simulation and analytics and so really in terms of the first minimally viable product, we just developed that ourselves and we tested it.


What stage are things at now?

We released Touch Surgery not too long ago and in terms of traction we’re growing. We’ve got over 50,000 downloads in three months. The reviews and press have been great. It seems to be something that’s satisfying a need in the market. Touch Surgery is available in the app store and is free. We get lots of good feedback from twitter and other social media. People are using it and they’re using it in the way we set out for them to use it – to learn how to operate, to use it before operating, for rehearsal. And they can use it anywhere, like on the train. I’ve had people on twitter say “Oh, I was on the bus and just did an operation before I got into theatre”, or “Just using it to help understand and visualise what my boss is doing rather than standing there and being the retractor”, which is often what happens in those situations. One of our major criticisms is volume of content- every speciality wants modules – but we should be resolving that soon (laughs).


Who is using your product?

The whole world is using it. You can break it down to the major players though, the US is one of the bigger ones but we are also doing very well in emerging markets. Touch Surgery is everywhere and the world is being exposed to it. Every time I think about it, it’s very inspiring and rewarding.


So, you’re getting a lot of interest amongst surgeons?

I think in medicine what happens is someone downloads something cool and they go to their mate and say “Oh look, I can operate on my phone and it’s really great”. Then someone else downloads it and it spreads by word of mouth.  We’ve even had professors use it to teach their students, and we’ve had great support from various surgical organisations.  We think the fact that it’s free also helps, because you’re not introducing that barrier of “Should I buy this?” The problem in the app store is that people create a lot of things that are useless and there’s no way of really knowing. I’ve downloaded things that I had to pay for and they’ve turned out really useless. In addition to surgeons, we’ve had downloads from medical students, nurses and patients.


Have you taken on any external funding so far?

We’re all self-funded, so no funding!


How did you divide up the equity between you? Have you got a vesting schedule?

Ad and I were the original founders so we took the larger portion of shares. Then we brought Andre and Sanjay on board. The decisions about equity were easy and straight forward. There is no kind of vesting… look, we were naïve to all of this stuff! Vesting and the like… this is something we’ve learnt along the way.


What made you decide to apply to Blueprint Health in New York?

It was a very sporadic decision, at the time we were looking at what’s the best way to take this forward. There were a lot of options on the table for us, but I guess we looked at the US and what was happening there and the interest in this area. Blueprint Health was recommended, and I applied. I think everyone here wanted to be in New York – it’s a fantastic and exciting city to be in right now, especially regarding the Healthcare Technology scene. The guys in Blueprint are also very well-networked. Being in a space like this you really have access to the mentors and resources you need to create something that’s going to be great. Going through Blueprint we just thought was a great avenue. We do feel in some ways that the UK is further behind in this space.


You didn’t consider an accelerator in Europe?

We were approached by some of the other guys in Europe, but we made the decision to apply for Blueprint. We met with Brad Weinberg and we got on well. There’s been a lot of interest in what we do. I think in a way, what we’re doing with our vision is exciting to other people. Giving people the means to learn and educate and putting it in everyone’s pocket in such an engaging and interesting way excites a lot of people. The other thing to say is that the guys here at Blueprint are the kind of people you’d work with and then have a beer with! It is an amazing atmosphere.


It sounds as though you really felt Blueprint was the right fit for you?

I think the way Blueprint has looked at us – well, the first thing is they flew out to London to meet with us. They were making an exception to their own rule. Plus, they’ve never had a UK team, so we’re the first. When we first had our discussion with Brad, he said “I’ve done this thing for a while and you guys are definitely very exciting, and what you’re doing is very exciting”. Brad is also a doctor, so it’s a completely different conversation. It’s one of those conversations, like you said with Doctorpreneurs – you’re combining doctors with entrepreneurs – it’s just a completely different discussion with a medic compared to a non-medic, I think. So we quickly established rapport and a good relationship with Brad.


You’ve just spent your first full week in NYC… how has the whole experience been and what have you learnt so far?

It’s been pretty interesting from the learning point of view. Let’s start off with accommodation – never book anywhere without seeing it yourself! We’ve managed to move but nothing’s really working here – there’s no heating today. We’re going to have to sort that out which is what we’re doing right now – that’s the first learning point. Secondly, walking into an office space the first day and sitting down at a desk and thinking “Oh, so now we have to get to work”. It’s different to being in the hospital. We’ve very quickly had to adapt our strategy in terms of how we work. We’re very used to having to go on ward-rounds, and having a list of patients etc. so we’ve had to transfer some of our skills. We start off our meetings in the morning with a white board and make a list of what we’re going to achieve today and we prioritise, then we go away trying to tick boxes.


Well making a list and ticking off the boxes… I used to spend most of my day doing that on the wards! Doesn’t sound so different… ?!

You’re right. These are all very transferable skills. Look, in the first week we had an introductory launch day in which we introduced ourselves and people were, I think, impressed by our first sentence, we were saying “We’re 4 surgeons who can code, animate and have over 200 publications between us”. In fact, we’re the only doctors here right now. There are no other doctors here so people come to us from the other teams for medical advice. Again, we’re learning about lots of things, about how to really focus and make sure that we’re achieving our specific goals. To be honest, this is also the first time we’ve actually spent so much time together; we work and then have social-time together. We sit down together have a beer, talk and form those relationships. We’ve done that before, but doing the same thing in a house with no heating makes it feel like one of those camping trips we used to have (laughs), so it’s good I guess!


What’s the programme like? Is it structured?

It’s very structured and there are regular mentor meetings. Mentors come in and we have a 1-on-1 session. The other thing is that you get lectures on things like ‘how to write an e-mail’ (laughs)… some of those things you’ve never thought of as a medic such as how to structure the right e-mail, I’ve never had to think about that before. Other things we have kind of known, but it’s also been shared experiences from other teams and things that we’ve been learning about. There are people who have been here for a while and it’s like a family or a community. We’ll then end up being part of this family or network (or hope to be). Some of the people are still around from the first groups, and they sit down with you to give advice and share their experiences. We found it very structured and well organised, its run very well, better than any other educational programs I have attended. I think what Brad, Mat and Josh have done here is awesome.


How do you compare with the other teams in terms of what you’re doing and stage of the company?

We’re pretty far along. We have a product that’s out there with good traction.  However different people are doing very different things and it’s very difficult to try and compare different companies with each other.


So, one week into the programme… how are you feeling about everything?

I can summarise it in three words, we are learning! Every time we meet with someone, they’re like “wow, this is amazing!” then people give you lots of different opinions. It’s about mining that data and seeing what people are really trying to tell you. We have so much thrown at us we’re taking different points from different people. We’ve just spoken to some US simulation experts, and people come out with different valid points and it’s about understanding those points and bringing them together.

Right now I’d say we’re inspired by all these different ideas and mentors’ opinions and it’s about focusing and channelling our aims. Part of the first month is about getting there, getting your head around your strategy, choosing to focus on one thing. As you’re aware what we’re doing is a big mission, it’s about how you get to the end-point without falling apart.


Are you looking to raise money at the end of the programme?

Everyone here is looking to raise money in some way, right? Of course, we’re going to be open that. It’s very easy to take a cheque, but it’s harder to take one from the right person. Again, I think we’re looking for the right people to take this forward with us. I think that’s the reason we’re here, more so than raising money because we could’ve just raised money back home. It’s about finding that right fit, people say it all the time you know, when raising capital do it with someone that’s the right fit. Maybe the right fit may be in the US, or the UK, this is just an avenue towards trying to find that fit.


What have been the biggest surprises so far (apart from the accommodation)?

Yeah, the accommodation was one of the major surprises! One of the other big surprises was the view of doctors in this space. In the UK people are like “Oh doctors and entrepreneurs, that’s difficult to digest”, but in the US they’re more open-minded about it and like “Oh, you’re doctors and you’re doing this amazing start-up that’s going to help change things”. It’s a very different mentality, and that was a shock to us.


That interests me too. I think it’s fundamental that medical professionals should be involved in driving how technology reshapes healthcare over the coming decades.

I think you’re right about this Claire, and this is one of the first reasons I sought you out. I think we both share this fundamental idea that you can’t really innovate in a space without understanding it. You can’t make a solution to a problem without knowing the problem. I think, if you want to innovate you just need to understand the problem and build a solution to it. It’s not about holding an MBA or having some finance experience, it’s really about addressing problems that will make a difference, that’s why I think doctors should be in this space.


So, my final question for today… What do you want me to ask you in 6 weeks’ time when we talk again?

Well, right now Andre’s question is “Are we still changing the world?”(laughs)… dude, that’s a big question! I think the best question to ask us is “have you grown up?” and also “what’s changed about your ideas or concepts?” because right now you’re talking to two guys who are saying things like “We want to change the world!”… is that naïve? I don’t know, but it’s a good ambition to have. We do want to make things better. It’s founded on some truths, but you know 6 weeks down the line will we still have that vision? Ask us about that.


You can follow the team’s regular updates on their blog

Follow Jean on Twitter @Jean_Nehme

Follow Touch Surgery: @TouchSurgery

Follow Andre: @88andre