tag:lucanus.blog,2013:/posts Lucanus' blog 2019-05-07T20:48:56Z tag:lucanus.blog,2013:Post/1406571 2019-05-07T20:28:11Z 2019-05-07T20:48:56Z Why we invested in ThinkSono

I am happy to announce that we have invested in ThinkSono, an ultrasound AI company.

There are in fact very few ultrasound AI companies in the world, even though ultrasound is one of the most important imaging modalities currently used in medicine. It is already vital in the developed world, and is increasingly important in the developing world, especially considering that 4.7 billion people worldwide do not have access to any medical imaging.

One of the main barriers for access to ultrasound technology in the world is (a) due to the cost of the hardware and (b) the low number of specialists that are required to use the technology. However, recent progress in ultrasound development means that the cost of the hardware is decreasing rapidly. The most famous example of this is Butterfly iQ, a handheld ultrasound device that connects to the iPhone, which costs less than $2000. Other players in this field are Philips Lumify, GE Vscan and Clarius.

Butterfly iQ


 Philips Lumify 

(image sources here and here)

Due to the low cost and increased need of ultrasound machines, the app-based handheld ultrasound market is the fastest growing ultrasound segment, with 40% growth from 2016-2017 compared to 3-5% growth in the rest of the market.

For us, it is clear that the ultrasound market is changing and is spreading around the world. However, the fundamental problem yet to be solved is the need for specialists to use it. This is where ThinkSono is paving the way.

ThinkSono’s aim is to allow any healthcare professional to use ultrasound to assess and diagnose a multitude of different problems. This removes the barrier for ultrasound use worldwide, while fundamentally creating a whole new market by allowing software to unlock the true potential of ultrasound and building new business models and revenue streams for hospitals, doctors and hardware providers. All this while improving patient outcomes and access to medical imaging.

Thankfully we are not the only ones believing in ThinkSono. Together with Entrepreneur First our preseed team invested alongside AI Seed, WestTech Ventures and Dubai Angels Investors and HPI Seed Fund (as well as other well-known angels).


The world’s first software to detect DVT


The first product that ThinkSono is working on is AutoDVT.

    A normal ultrasound image          Utrasound image with AutoDVT


AutoDVT allows any healthcare professional to detect ‘deep vein thrombosis’ (DVT)  in under 10 minutes. Those of you who come from a medical background will immediately know that the potential of this technology is immense.

For non-medical readers, some context is required:

DVT is a condition where a blood clot forms in the deep veins of the leg. When part of the clot breaks loose, it can go into the lungs and cause a pulmonary embolism (PE). DVT/PE is considered the leading cause of preventable hospital death.

It is estimated that the annual cost of DVT/PE diagnosis and treatment in the UK is £640 million, in Australia $1.7 billion, and in the USA $15.5 billion.

AutoDVT aims to make today's time and cost-intensive diagnostic process more efficient and effective. It can also provide access to DVT screening in rural areas and developing countries, where access to specialist healthcare staff is difficult.

The current diagnostic approach requires a patient to go through a long and expensive process that involves several appointments with different health professionals, including a visit to a radiologist, often a significant distance from their home. This clinical pathway is very inefficient and cumbersome.

Furthermore, up to 88% of ultrasound scans show no DVT, hence many tens of thousands of patients are therefore investigated in an unnecessarily lengthy diagnostic pathway before it is confirmed they are not affected.

The benefits of AutoDVT

The AutoDVT software allows any healthcare professional (e.g. nurse) to diagnose DVT in 10 minutes at the point of care.


AutoDVT aims to disrupt the currently inefficient and ineffective clinical DVT diagnostic path by providing an accurate, cheap and fast evaluation of patients suffering from life-threatening DVT.


Since AutoDVT can be used by non-specialist staff, it can:


1. Reduce the 88% negative rate in radiology departments by allowing early screening by nurses.

2. Reduce the need for anticoagulant prophylaxis. Anticoagulation confers a bleeding risk.

3. Reduce pressure on emergency room waiting times by facilitating DVT diagnosis in alternative venues such as GP practices or minor injuries units.

4. Reduce DVT diagnosis costs by a factor of 10.

5. Improve patient outcomes by facilitating rapid diagnosis in rural areas where there is reduced access to specialist staff.


The best team to solve this problem


Fouad Al Noor (CEO)               Sven Mischkewitz (CTO)


The team behind ThinkSono is also extremely impressive. Fouad Al Noor and Sven Mischkewitz met during Entrepreneur First, and gathered a truly world-class team including radiologists, hematologists, emergency doctors and machine learning engineers. They were part of Bayer's G4A accelerator (selected top 4 among 450 companies from 61 countries), participated at the Vienna Health Hub and won the 2018 Health.Pioneers. In Addition the ThinkSono team cooperates with hospitals from the UK, Germany and the USA and is receiving support and advice regarding clinical trials and pilots.   

The Future of Ultrasound

There are many conditions that ultrasound can be used to diagnose, and AutoDVT forms a great starting point to completely transform the way we use the technology. The future looks bright for ultrasound technology and ThinkSono is helping shaping it.

All of us at Speedinvest are excited to be investing in ThinkSono. We look forward to supporting the team in redefining the future of ultrasound!

]]>
tag:lucanus.blog,2013:Post/1391842 2019-03-30T20:09:57Z 2019-03-30T20:50:32Z The #1 Objective for Early Stage CEOs: be a captain not an officer

Friday night in December*

«Cheers» «Prost» «Merry Xmas» loud greetings resonate, covering the cheerful percussive sound of Glühwein mugs and beer bottles clinking together. Music starts as we turn our heads towards the stage - I immediately recognize the song although one can hardly hear the lyrics:

Oh, what a night    
Late December back in '63         
What a very special time for me  
As I remember, what a night

“Look at him! I can’t believe he’s singing!”, says a loud voice in the crowd, while everybody else starts roaring along. Performing on stage, Sebastian, a brilliant iOS developer. Rather restrained at work, not a marvelous singer but tonight this is not important – passionate execution of a minimum viable product: that’s Karaoke. Once the surprise fades away, I start feeling anxious. I attempt to evade being next song’s performer, before peer pressure swings me up on stage. As I am rushing to the terrace in the hope of being forgotten, the joyful start-up employees slowly turn around and stare insistently. My heart skips a beat, and as I feel the music’s bass vibrate in my ears, I pull out a tissue with the intent of drying my forehead. I usually don’t mind being looked at but being the one who massacres some Schlager music in front of founders and their employees…not my jam. I finally manage to breathe when I realize I was not the center of this sudden attention. Just behind me, Sebastian’s colleagues from the Customer Success Team are rushing towards the stage as the next song starts:

Is this the real life? 
Is this just fantasy?
Caught in a landslide       
No escape from reali
ty


It’s not the strategy

Some context: Other than in my previous blogpost this time I was invited. A Christmas party of one of “my” startups and I couldn’t be happier about attending. By now you know that I love spending time with founders outside the meeting room. Conversations usually happen between representatives sent for their impeccable presentation skills. Team events, however, are different: they are a great way to get to know those who are no pitching experts. Not only do you get to know co-founders in a relaxed atmosphere, you can also see how they treat others, the complicity between them, the thoughtful or silly ‘Secret Santa’ present they picked or the daring karaoke song they chose (the one with the high notes). Is there peer pressure to drink another shot even when it’s obvious that the last one was already too much? Late nights - that’s when for an outsider it’s easier to capture the real power structure of a company. I particularly like to listen to CEOs speeches - most of the time they try to be funny. But more importantly you can tell whether it's all about themselves or all about the company. As an early stage investor, to join a startup team event is one of the rare situations to get a peek under the lid, to take a deep dive into the organization’s “culture” – that is said to be the most important ingredient of success. This is no VC “BS”. You’ll find confirmation everywhere including research results by famous universities. 

“Culture eats strategy for breakfast” - how often have you heard/read that again and again? I commit, me too - can’t stand it anymore. Now that we know that, what is much more interesting is how to build culture? And what follows then? In other words: what’s on the menu for lunch?

 

Is it hard work?

A “lean” office party to save some money, a fancy restaurant to show appreciation, or a cooking workshop before hitting the dancefloor until dawn. I’ve seen startups organizing a full day team-workshop to be ended with a great party. As a founder you are also a team leader, and therefore it’s not only about planning the party. It involves putting some thought about the content, the speech, the values that you want to transmit and yes, sometimes also about the presents. If you struggle choosing a present for one of your first 10 employees, you might want to ask yourself if you put enough effort in getting to know the person you hired and who will build your business.

True leaders give options, and make these events not only possible to attend, but also easy to leave if needed. Not only to your board member. The way out of your team event would be after dinner for example when you change location for the dancing. This is also a need for some employees that can't dance all night as they need to be home to look after their kids or any other reasons. Building a culture and common values does not work with peer pressure – some people just feel uncomfortable to sing. Pushing doesn’t work, try pulling. Building culture is hard work.

 

Is it HR responsibility?

When you built your start-up, you made sure to have a cool ping-pong table and you’ve made sure your employees got unlimited access to free energy drinks. They love to rock the company t-shirt – even outside of the office. Your night-owl developers can choose to sleep-in in the morning and focus on coding marathons in the evening. You have a theme song. You have a theme movie. You feel like you’ve finally gathered the high-school crew you’ve never had. Nothing like your previous corporate job where you had to suit up and sweat the whole day, sitting in boring meetings.

How could anyone be unhappy in this awesome environment you created?

Start-ups can be as toxic and unhealthy as the corporate world and having a raging party at the karaoke bar once a year won’t fix it. The marketing and developing teams need to be able to communicate about the product on a regular basis, not only half-drunk around Christmas time. The employees managed to solve the riddles of that team-building escape room, but only because participants were fighting each other to look good in the eyes of the CEO. Having a positive and ‘always hustling’ attitude is the spirit needed for success, but your employees might not dare to ask for reduced hours to take care of their mental health and will most likely end up burnt-out.

Bringing-in a mediator or a HR consultant for a couple of hours every other month or organizing design thinking workshops where different teams must cooperate is a great and cost-efficient way to observe and assess your company culture. But it won’t work. Building your culture is not another task of your HR department. I have seen many cases of company culture gone wrong, and I know the triggers. For example when the very classical co-founder fight leaves scars and employees are asked to take sides.


It’s the CEO, stupid!

Ask yourself: How did I end up in that Karaoke bar in the first place? How could I find a co-founder or a Business-Angel? How did I convince our first employee to join? All that includes an unusual kind of shared trust. You trust someone to take a huge risk. It starts with trusting the CEO. And if you are the CEO, then it starts in trusting yourself. Trust in my opinion is a result of a (multi) relationship building process. A startup CEO (at least in the early stage) is not an (executive) “officer” nor should he be a manager. He needs to be the captain of the ship.

Real leadership of a CEO is not shown during a presentation. What is real leadership anyways? It’s probably an attempt to get to know yourself and your team: truly understanding your strengths, your limitations, your culture is the only way to be able to help you make powerful changes to your company when things turn ugly. And be certain, they will.

Years ago when I was a managing director of a startup struggling with its culture I read an article by A16Z: “Building a Culture that works”. Writing this blogpost I found it again - I couldn’t agree more. The CEO is the cultural epicenter. The organization reflects the behavior and characteristics of the CEO and that establishes the culture. Ok. A flawless CEO will be able to build the most successful culture? The opposite is true. CEOs who build companies from scratch, like Anadn Sanwal are very much aware of their shortcomings and happy to share them. It’s the self-awareness that counts. If you can’t accept self-awareness, you should not be CEO.

By now you know I love sailing but I believe anyone may relate to this example: Christopher Columbus who discovered the viable sailing route to the Americas must have been a true captain. He convinced investors, sailors and even the pope to sail towards world’s end (!) 500 years later it still sounds unbelievable. Think about the discussions after 4 long weeks of sailing. They were past the point of return – with supplies for max. another two weeks. Little did they know that a few days later they’d arrived. How often do you have a similar discussion in your startup? Runway of approx. 8 weeks, no signed termsheet and the new back-end developer starting next Monday while you spot the CFO purchasing a book on Amazon “insolvency proceedings for dummies”…

A captain builds relationships of trust thereby builds a “culture” that is a competitive advantage. He doesn’t do that by being the best and brightest but by self-awareness and by leading by example. In difficult situations co-founders, employees and investors, all eyes turn towards the leader – who will follow the orders of an officer anyways? You can't be Captain on two boats at the same time - your startup needs 120% of your attention. If the Captain fights with his co-founders all crew members will be on a constant fight losing their energy for the real storm in front of them - out at the waters.Be a Captain, listen to your officers, follow your gut, take decisions! Lead.


Back to the Karaoke bar

I made it. Somehow still managing to balance a glass in my hand, I fled the singing and stepped outside joining a few guys busy discussing and arguing about some work projects. I was eaves-dropping, but they brought me into their circle, treating me just as any other team member. Breathing fresh air while they are smoking a cigarette in the muffled sound of snow, I understand between words how critical it is to develop this new app feature or which difficulties they faced earlier this year. Each team member gets to give you a piece of the puzzle and in a startup each team member is critical to success. Although I can smell the dawn and I’m still afraid of signing I do not leave. Tonight, I get to meet the ones who never stand in front of a PowerPoint or design a pitchdeck. And after a while you can see it: the sparkle in the eye, the true passion. The reason why they are doing all that, far away from their sometimes all-too-rehearsed pitch. It can be a sick relative, a documentary that made them think, a motivational speaker that pumped them up. In this split second, you find their true why. I accept this revelation like a present, my true Christmas present.

 

Truth is, every board member will be flattered to be invited to your team event. But not everyone will show up. Yes, there is a difference. And yes, Investors should certainly not try to change your culture. They can grasp it and take it into consideration when helping the founders taking decisions. First Round is right, 80% of your culture is your founder. It’s the driving force of a business in the early stage. It’s your only competitive advantage to hire talent. Choosing your investor, actually means hiring a board member. If you want a board member to fit your culture, think twice before you sign.


please help 

Have you ever seen a perfect startup culture - what was its secret source? Have you tried offering "TVA" (take vacation anytime) or any other Google-Style perks to attract talent and this strategy worked/failed? Do you agree that 80% of your culture is your founder?

Leave a comment or write me directly whether you agree, disagree or simply if you think there is something that needs to be added.


*The story is based on real events. However, I merged, shortened and defaced them to respect the privacy of the characters.

]]>
tag:lucanus.blog,2013:Post/1375335 2019-02-17T19:58:09Z 2019-02-20T10:35:31Z The #1 Objective for Early Stage Startups: Sailing not Drowning

On a lake in Austria, in the afternoon*

The flappy mainsail looked almost bored, blown by a weak, tired wind. All this rolling and pitching couldn’t shake off the tense atmosphere aboard. No one spoke a word, I could hear myself breathing, gathering up the courage to break the awkward silence. As the wind died and our occupation with sails and ropes stopped, the tensions between everyone on board were crippling, without any sign of resolution. This fight was happening without words, without a glance at each other. Everyone knew the trust was lost, and we all felt rather uncomfortable. I took in one big breath of humid air and heard myself saying: “One of you tells a mind-blowing story with a clear vision where to go but has no clue how to navigate, the other is an amazing technical expert but does not believe the story and therefore isn’t committed. You tell different versions, can’t reconcile to a common direction, nor accept who is in charge to decide. Actually, you can’t even talk to each other anymore. Without a new captain - steering your boat - you will sink this ship”.

As an early stage investor, I define myself more as an advisor than a capital provider. Thus, I invited them on a scenic sailing-trip - “recreational activities might distract you guys from the otherwise prevailing startup worries” - little they knew that my actual aim had nothing to do with a lovely sunset cruise but to reveal the inevitable...

unresolved co-founder conflicts kill your startup

If the situation seems unique to you, the opposite is true. Years ago Paul from Y-Combinator revealed that fights between founders are surprisingly common. Every startup will eventually demonstrate some co-founder frictions. Not only will 2 out of 10 see a co-founder leaving but these conflicts are a real poison for growth and the main factor of failure. For his great book “The founders dilemmaNoam studied 10,000 founders: the results showed a clear picture: 65% of startups fail because of interpersonal tensions between founders. One could argue that by now this is common knowledge in early stage investing. But why do we still constantly fail to solve these situations? Maybe because when the hostility is clearly visible it’s already too late. It is an absolute priority for me to sense this as early as possible and get them out of it without drowning the company all together with the relationship. But the tough question is how?

5 steps to solve a co-founder conflict

1. break the silence

In my youth I spent every spare minute racing sailboats thus I am well aware of conflicts within a squad. I encountered them again when I was leading a startup. It needs only a few bad decisions and you are stuck at the “wrong side of the lake”. Just like business circumstances, winds change direction quickly: once comfortably pushing you from the back, now blowing fiercely in your face. You can see your competitors overtaking. You, the helmsman steering the boat, are well aware of the bad choices you made. Your crew is busy playing the blame game. You can’t make them go away. And there it is – the awkward silence. Silence is oppressive for most human beings: they try to escape it. Unfortunately, on the water and much like in a startup jumping off is not an option. There is more at stake: it's not only about losing this race but it’s about sinking. If you want to stay afloat there is only one choice: break the silence.

2. ask for help

I got this message from one of “my” founders: “for weeks now my co-founders disagree what to do, we are stuck. I expect from you, as my investor, to decide”. Unfortunately, I can’t. I can help you come to a decision. However, most entrepreneurs shy away from asking for help in the first place. It might seem weak and damage your funding efforts. In my opinion this is a wrong assumption. Every founder needs help. Don’t be afraid of personal failure but talk to your investor (if you have the right one). For me this is not a sign of weakness rather one of strength.

3. win the race

Strategy shouldn’t be about the ego. It should be about winning the race. As an early stage investor, that is my daily job. I could provide you with funds but more than that I can serve as a point of reference or help you to reflect – like a coach - if you want. From the sideline, however, I can’t steer your boat – that’s your job (!) My job is to try to help you navigating through unknown waters. Much like on a boat, in a startup, you need to adapt the course quickly and constantly, but you need a clear destination otherwise you go around in circles. And yes, there is a quick fix to buy yourself time to solve problems you encounter with your co-founders: win the race.

4. move ahead

In fact, more than 50% of founders will hire a CEO by the time they raised their third round of funding. In order to build a big company, founders need to end their fights and the company needs a helmsman. Stepping down as CEO must feel like putting your baby up for adoption. If you continue without major change that baby will not make it to kindergarten. Moving ahead sometimes means swallowing your own pride and beat your toughest enemy – your ego.

Stepping aside is often a step up (!) to the board where your story and vision may be of better use for your baby. It’s definitely a better way to stay involved in the company’s future than leaving for good. When founder-CEOs step down to let a new CEO take over, they change to the board most of the times. If, however, the board need to initiate this change that number drops significantly. Taking the initiative, understanding your responsibilities toward the vision and sometimes concentrate on your strength is the best way to contribute to your own vision.

5. stay friends

You can agree that you disagree. But it’s clear that you can’t always solve a conflict. You should, however, never lose your style - after all we are just humans, prone to make mistakes. Even after tough fights and fierce disagreements keep an open mind that your perspective is not the only one that exists. Consider the fact that even disagreement can make you grow as a human being. And no matter what happened in the past: stay friends or at least offer your (unconditional) friendship. Invite your co-founder to your wedding or if you don’t see each other anymore - at least tell him when you're expecting a child.

On a lake in Austria, in the evening

Without a new captain - steering your boat – you will sink. There is no possibility to jump and swim – you will both drown! All of you will drown. Your team doesn’t deserve this." I thought this was too hard, now at least someone will fight back? But no one replied. The awkward silence stayed on. Suddenly the wind picked up again and we were busy with sailing until we finally came ashore. At first, I thought our little sailing trip (call it an intervention) has not worked out at all. I was mistaken. An irreversible process had started this afternoon. On the way back home in the car one co-founder finally raised his voice: “I need to get out”. He could not suffer the unspoken anymore. Tense shoulders fell and a heavy head suddenly felt light. This feeling of relief was physically visible. Finally, everyone became honest. The company got a new CEO, one co-founder became a board member, all three of us were finally able to sleep again.

As brilliant as the idea of this startup was, I have the strong belief that success comes mostly from execution. Some founders are visionaries. Others are makers and doers. There is no shame in realizing which one you are.


please help 

Have you ever seen a perfect co-founder relationship - what was their secret source? Have you ruined all future family gatherings because of a fight with your co-founder (that also happens to be your brother)?

Did you try something else to fix your co-founder relationships that worked really well? As an early stage investor founder conflicts are my daily business and I would like to get better in dealing with it day after day. Leave a comment or write me directly whether you agree, disagree or simply if you think there is something that needs to be added.


*The story is based on real events. However, I merged, shortened and defaced them to respect the privacy of the characters.

]]>