Interview Series: James Balmain, CEO and Co-Founder of Zesty

In our latest interview, we talk with James Balmain, CEO and Co-Founder of Zesty.

Zesty have spent the last 2 years building a new type of patient portal, in partnership with Milton Keynes University Hospital. More recently their technology has been chosen by various NHS Trusts including the Royal Wolverhampton NHS Trust to support their population of around half a million people, over the next 5 years.

The Zesty platform empowers patients to manage their own care, right from their smartphone.

We start be asking James about his career up to this point and background information on Zesty as an organisation:

My background has been completely digital, in retail through the e-commerce side, followed by mobile/telecoms and onto healthcare for the last 7 years. I’ve held senior positions in large companies and I’ve also started a few of my own companies; a couple of which were relatively successful and a couple of which completely disastrous.

What we discovered was when the service expanded beyond cities and moved to more rural areas, the demand for those private services fell off quite sharply, which pointed to that particular business model not really being sustainable in terms of growing a really large business. The analogy that was used at the time was ‘Just Eat’ which had grown rapidly; and so, the theory was that the same could be done in healthcare. It turned out that wasn’t true.

There turned out to be a version of Zesty that wasn’t us in territories around the world. The most notable one at the time would have been Zocdoc in the US. At about the same time, I was invited to talk at an event in Sweden and I met Joe Harrison who is the Milton Keynes University Hospital NHS Trust, he was really keen to allow his patients to self-book and self-manage their outpatient appointments in a complete end-to-end digital way.

His desire was really clear, to offer patients the ability to self-serve and self-manage their hospital appointments. He didn’t want a request-based system meaning a patient uses an SMS platform, website or portal to request a change to their outpatient appointment in the form of a message which ends up being manually processed on a worklist by a hospital administrator.

What he wanted was the same as when you book a restaurant or movie ticket for example, where it becomes a complete end-to-end integrated solution, where when the patient changes their appointment it was done live. We accepted the challenge.

At that time, the technology didn’t exist anywhere. Fast forward to Milton Keynes 18 months later and a live portal was developed essentially becoming Zesty Mark 2. We now have a patient portal product that allow patients to manage their outpatient appointments but also access a digital copy of their correspondents instantly, store a local copy of their clinical record and increasingly complete patient questionnaires, which is becoming increasingly important to our acute provider clients. We also have a video consultation product, and that’s where we find ourselves today.

How has Zesty responded over the past few months to the Covid pandemic?     

It has been a game of two halves for us; we’ve been really busy supporting our existing clients and I think it’s important to understand the Zesty platform is an integrated platform. It is not something we can just switch on; it typically goes through a 10 to 12-week project. So, Zesty isn’t something conceptually you can stand-up really quickly to help hospitals deal with Covid, but for those customers who already had the product, we have played a meaningful role to manage, in particular their outpatients.

We very quickly began to use the outbound portal with email and SMS, to inform patients as to what was going on, transition them to virtual appointments; and this was not just using our platform, we support any 3rd part platform and we’ve done some work with AttendAnywhere and MS Teams too.

If you think about Zesty being a mechanism to efficiently onboard a patient into that environment, if you’re going to have an Attend Anywhere consultation with your consultant in hospital, there’s a process where you have to be informed by having a link sent, joining instructions, the time of the appointment, dropped into a waiting room and so on, there’s all of that pre-appointment process. It is hard for hospitals to do this process, there hasn’t been the time scale to be able to post a letter as that is the normal method of communication. Our platform has been used quite extensively to create a dynamic and a rapid communication channel with patients and that has worked very well.

The degree of organisational drag that we are used to in terms of getting a hospital to procure our platform certainly hasn’t disappeared but it has been repressed. We’ve had about twelve trusts approach us over the last couple of months, where two or three of them in quite a short space of time have started to go through procurement with us. I think a lot of larger hospital groups have realised that the old methods of communication particularly during a pandemic but also more generally, is just not sustainable; it is inefficient and also expensive. There has been this dawn of realisation if you like that digital is the way forward.

To be fair to the NHS, we are entering a time when there are some mature solutions; we are not the only ones, there are some really good credible solutions that have got some evidence of solid working practice.

Could you tell me about one of your customer projects over the past 12 months?

One of the projects I’m really excited about is the Royal Marsden, we started work with them just over a year ago. The portal went live to begin with in neurology, and it was actually really successful with patient engagement levels. Patients started to find new and inventive ways to use the portal; they were beyond engaged. They were going back to the hospital saying “why can’t we have everything through the portal?” Which was completely unprompted by us and the hospital, and there was a really positive reaction to it which spurred the Marsden on to do more work with us. We will have the portal live across the whole trust quite soon and there’s a really ambitious programme of work in part by Lisa Emery; we are big fans of Lisa!

The project is really interesting because they are a specialist cancer centre, and I’ve always believed that those desperately ill people, being able to get information quickly and admin removed at a time of your life which is obviously really traumatic, is significant. I’m really looking forward to helping more patients at the Marsden and it’s a really exciting project. In terms of the project itself, it was quite challenging technically; we had to figure out new solutions that we hadn’t had to think about before for a bunch of reasons. I think both sides did some really great work, their team and ours; I’m really proud of our guys and girls, they have done some great work at the Marsden. Watch this space at the Marsden, I really do think it will become a big deal.

What are the successes and challenges you’ve experienced?

I think anybody who has tried to sell into healthcare, not just the NHS but healthcare around the world, be patient, the sales process is very long. In our case, I think we followed a standard pattern; we got a customer in Milton Keynes, and that became our anchor. To go from one customer to two or three is very hard work traditionally. The theory is you reach critical mass, where you get to perhaps fifteen customers. If you have a service like we do, twenty is the number where you can define yourselves as ‘motoring’ and you are moving into the realms of becoming an established supplier with a credible established product. One of the successes we’ve really had, is going from one hospital to fifteen in 15 months.

What’s the best piece of career advice you’ve received?

There’s always the temptation to come up with something somebody hasn’t said before, but I’m with Suzy from EMIS; I got this advice early in my career too, ‘be authentic’. I was in my 20s when somebody I really respected gave me that advice. There’s always the temptation to try to be somebody else or to try and mould yourself to your audience.

Also, there’s always the temptation when running a small business to shield staff from the challenges and problems; personally, I think that’s a mistake. We are pretty open as an organisation and where we are going, also with how we are doing financially and I think more small businesses should do that – it empowers your team, you make them feel like they are part of something.

What’s your go to entertainment at the moment in lock down?

Recently I re-watched the last few seasons of the West Wing. Lock down started so I had a bit more time so I also started reading; I started a book called Principles by Ray Dalio – he is one of the top 100 successful people in the world as a hedge fund manager. I would recommend that book to anyone in business. I’m rediscovering books right now.