Isla: Why we’ve had to bend start up rules for healthcare…

James Jurkiewicz, co-founder of DigitalHealth.London Launchpad company Isla, shares their learnings from the company’s first six months of developing a product in the health tech space…

We’ve all read (or at least heard of) Eric Lees’ The Lean Start Up. His guidance has become start-up law: Keep lean. Find your early adopters. Don’t spend money until those early adopters have validated your assumptions. Always test. As the world struggles to get back to normal after COVID, markets have been turned upside down, making this advice more important than ever. But it isn’t easy.

ISLA care is a visual information clinical case presentation tool that allows anyone involved in a patient’s care to review and contribute photos and videos into a shared library, in a secure and convenient way.

Here are three learnings from our first six months of developing a healthcare product, which show that sometimes you might have to deviate from the The Lean Start Up laws: 

Learning 1: Early adopters won’t use the product, but that’s ok.

Healthcare systems are complex, there are a host of considerations that a Trust needs to make before they adopt a new technology (see learning 2). As a result, individual teams in hospitals aren’t allowed to start using your product immediately after your first demo. This makes it very difficult to see how they use it, or even if they use it. We’ve learnt that there is a big difference between someone saying something will be useful and actually using it every day! In order to continue building quickly, getting feedback and following Lean Start Up advice, we have been staying as close as possible to those engaged clinicians (our early adopters). We’ve achieved this through shared Slack channels, through asking them follow-up questions and we make sure to show them every new feature we build for feedback. 

Learning 2: Think about enterprise measures from the start.

As I mentioned, before a Trust can actually start to use a new technology, there are Procurement hoops, Information Governance hoops, Security hoops, Privacy hoops and Operational hoops they have to jump through. Any one of these can delay or even destroy a go live in a Trust, so it’s worth thinking about them from the start. The longer you leave it, the harder it is to retrofit. Some things that we did which I would recommend to other SMEs: 

  • Complete the NHS Digital Data Security & Protection toolkit: A framework for providing evidence for important protective measures – great to highlight any areas you may not have considered
  • Complete Cyber Essentials: A nationally recognised accreditation for attaining a base level of cyber security
  • Get advice about privacy measures and GDPR, understand whether you’re a data processor or a data controller for different sets of data that you may process. Take your responsibilities seriously.
  • If you’re using Cloud services, ensure you adhere to NHS best practices

Doing these while we had no customers and no real users felt like it was a waste of time but now we are getting adoption it’s a) Not a blocker, and b) One less thing to do!

Learning 3: Don’t simply ask people what their problems are.

While doing discovery, we tested our ideas with Doctors, Nurses, Therapists, Hospital execs, patients and anyone else who would listen. We would often start these discussions with “is X a challenge” or “talk us through the challenges that you face day to day”. Unfortunately, we didn’t find this to be very effective. Try asking yourself those questions and see what you come up with – it’s really hard. We are all busy and we all fall into our own frame of reference. What we actually brought to those conversations was a different perspective and a set of assumptions which we thought could make things better. Much more effective and insightful conversations started with “talk us through the process for…”, “why is it done like that”. This allowed us as a group to identify challenges and inefficiencies through examining how and why we do things.

So our main learning has really been that we have to bend the normal start-up rules slightly in order to work in the healthcare space. We’ve been building for six months and are at the point where we are now launching pilots with multiple Trusts across the NHS to allow our target users to actually go live. As founders, we’ve felt uneasy about continuing to build without the explicit validation from usage, but it has been what’s necessary. So I hope these learnings will help other early founders mitigate risk and feel more comfortable as they go through the journey… 

Isla joined the DigitalHealth.London Launchpad programme on the January induction to better understand the market and regulatory landscape before launching their product. They have since obtained partnerships with four NHS Trusts across the UK and have recently applied for the Accelerator programme.