By Nova a company with 10 years experience working with health technology startups, developing products and services for the NHS, private care settings and direct to consumer markets. In this article we want to share some of the learnings we’ve made along the way, to help you develop your own digital healthcare products that are commercially successful and that your users will love.
Problem first product development
At the beginning of a startup journey, staring into the abyss of “where the hell should I start!?”, many founders’ first step is to focus on their product solution. Resulting in them spending too much time, in isolation, focusing on what they believe they need to build. Building the wrong thing is the number one reason for health tech startup failure. Founder bias directing what is built, without validating it with users, is the root cause of this.
Before we consider a product solution, we insist that founders start their product development journey by gaining a deep understanding of the problem that their solution will solve. ‘Problem first’ product development means founders need to be outside of the building developing a user panel of people who are experiencing the problem that they have identified, and who find it enough of a problem that they’re willing to engage with you, over a period of time, to develop a product that will help solve it. Having people commit their time is a good early validation that this truly is a real world problem that people will pay to have solved.
Starting with a problem and working backwards from that allows you to uncover the motivations of would-be users who will eventually buy your product – what matters to them, and what doesn’t. And by this we don’t mean complete a tick-box exercise of sending a survey out to your friends to justify your development path. Talk to people, in person, about their life, the products/solutions they’re currently using and their pain points. Not your idea. It’s really important that you leave your idea out of all of these early discussions. I’d urge you all to watch this video of Rob Fitzpatrick discussing the ‘mom test’, he brilliantly articulates how to do this without introducing any bias, so you can then start ideating around a product solution.
Timings and Regulation
A poignant consideration when developing digital health specific products and businesses are the unique challenges that come with them; medical products are generally more complicated, time-consuming and regulated than other industries (and in-turn more expensive). Add to this that if you’re targeting the NHS as a buyer you won’t get a letter of intent to purchase. This can make it particularly difficult to predict timings and manage the finances whilst bringing a product to market; this is a big contributing factor to why 98% of digital health startups fail.
Post problem understanding and pre building anything, you’re going to need to understand the financial and timing issues of the product development decisions you’re making. The challenge is that at this stage you won’t necessarily know exactly what you’re going to build. So it’s about achieving a required level of knowledge that allows you to make informed decisions about your product development route. You’ll need to create a product plan that achieves a balance between having the flexibility to iterate and make changes at pace, whilst having something rigid enough to satisfy investors how long you’ll need to keep the lights on whilst waiting for revenue.
Finding answers to things like; what classification(s) will my product be?, can/should I gain IP protection (and when?), what insurance will I need?, do I need to undertake clinical trials?, how long will this take?, how much does it cost!? can make and break your product plans. If this is your first time developing a health tech product I would highly recommend taking professional advice here. There’s a myriad of information online that can help with this, but it’s complex, time consuming, easy to misinterpret and mistakes can be extremely costly.
The scope and remit of these questions is way too big and complex for me to cover here but drop us a line (contact details at bottom of the page) and we’ll happily connect you to the right people to provide advice to support your understanding here.
Product Improvement Cycle
If you’re estimating that the first version of your product will take over a year to make you’re doing it wrong. The key at this stage is to get something into the hands of people as quickly as possible. I love the quote by serial entrepreneur Reid Hoffman “If you’re not embarrassed by the first version of your product, you shipped too late”. Perfection is your enemy here, think of your version one as the first thing that you can give, to the first set of users, to see if it delivers any value. It’s what we call a minimum viable product (MVP) and it’s the start of your product improvement cycle.
Operating in the health industry may mean that your MVP needs to be heavier than in other industries, however often it does not. We’ve created healthtech MVP’s as simple as a spreadsheet, a website with a form builder, a wearable device made completely from off the shelf components – all really simple, low cost and quick to produce. All great bases that allowed us to start learning and moving through the improvement cycle. Here are 5 key tips to keep front of mind when developing your MVP;
- Time box your spec; instead of writing down the spec you want then estimating how long it will take. Start with the time you have available, then let that determine your spec. It will force you to quickly decide which of your MVP features are essential and which can, and need to be, cut.
- Avoid feature creep; write down your agreed spec, consult it whenever someone has a great feature idea and keep a separate ‘possible feature additions’ list. Stick to the original plan until it’s been in the hands of users.
- Never ask users what features they want; this is the fastest way to a huge list of functionality that’s not required. Their job is to give you problems, your job is to understand them and decide feature requirements.
- Have a really big vision with a really small MVP; if your ambition is to eliminate obesity or world hunger, that’s absolutely great, but be comfortable that you won’t do that with your MVP. Don’t try and solve everything with your MVP, think about what functionality to start with that can deliver the biggest impact with the smallest effort.
- Don’t fall in love with your MVP, the product you commercialise and start monetising from will probably look nothing like your MVP. By its very nature it should be designed to be dramatically changed or thrown away.
Once you have an MVP, the products and businesses that win are the ones who can move through a product improvement cycle really quickly, multiple times. The cycle consists of four key stages; launch something quickly, get initial customers, talk to customers and get feedback, iterate and improve. The premise being that through each loop of the cycle your product will improve, and move closer to what your product should be.
A great example of this in practice is Owlet’s product development. This video covers their journey and encompasses a lot of what I’m trying to advocate, and how it’s possible in the health industry to make huge progress without burning masses of time and money. Building and learning need to be going hand in hand and happening continually. Your users need to be right at the heart of your product development – consulted and engaged at every step of the development process. If you’re doing this right, and you’ve been iterating enough, you won’t know when you transition from your MVP to your full product.
Reach gatekeepers and leverage your network
A challenge when targeting sales through healthcare systems is that often the user is not the purchaser, or the purchase decision maker. For example every patient and nurse you speak to may love your new ‘needleless blood sampling device’, but this can have little bearing on its implementation and success. There’s several ‘gatekeepers’ whose needs must be satisfied, in addition to the user(s), before a purchase can happen. Involving each of them in the product development process is essential.
When considering who this product is for, and who the early adopters are likely to be, it’s imperative that you understand and start building relationships with each of the gatekeepers to purchase. Generally in non direct-to-consumer settings there’ll be a minimum of 3 people; the user(s), a technical head and someone senior in finance. You need to understand what each of their goals, targets and motivations are and address them in your sales and marketing materials. Showing how your product can move them closer towards their goals will significantly improve your chances of success.
If you’re unsure who your gatekeepers are it’s generally easiest to start with the users (i.e. nurses in the example above) and ask them directly who you’d need to speak to to get a purchase decision. They may not know and may refer you to their manager, keep asking until you get to the decision makers. This sounds patronisingly simple but over focusing on users rather than decision makers is a really common problem we encounter. There’s an old Steve Jobs quote that I’ve found to be very true – “most people don’t get those experiences because they never ask. I’ve never found anybody who didn’t want to help me when I’ve asked them for help.”
We are big advocates of those working within the healthcare industry being best placed to develop the products to help improve it. First hand experience of the problem space and infrastructures the products will live in, industry specific knowledge and expertise, access to users and also the contacts to make it happen – all big advantages. If you’re a startup founder from outside of the industry make sure you enlist industry specialists as advisors or members of your early user panel.
When working on a product or startup either from within, or alongside those within the industry, be sure to leverage your network. This is really important when making the connections that will bring you early users/testers, reaching gatekeepers and securing your first purchasers. In our own experience networking has been core to the early success of several of our digital health startups. Attend events and meetups, join and post in relevant facebook groups, speak to people in the canteen, put up info in staff rooms, connect with people on Linkedin – the NHS employees 1.5 million people, your connected network is already huge, make sure you’re taking advantage of this.
Remember 98% of health tech startups fail, this is not easy by any means. Though by following the advice above you’ll be giving yourself at least a fighting chance of success. When developing products that will improve the health, care and quality of life for lots of people all over the world, we believe that that chance is absolutely worth pursuing.
As an advocate of my earlier advice about asking for help, if you do have any questions about any of the above please feel free to contact me on the details below.
Paul Dodd, NOVA, Mob: 07791003434 email: paul.dodd@wearenova.co.uk, website: www.wearenova.co.uk
