would love for you to give an introduction on
yourself to our audience, and then we'll take
it from there. Cool. So hey, everyone, my name
is Josh Lee, one of the founders and the CEO
of seamless MD. Probably my real story starts
over 10, maybe 15 years ago. So when I did my
undergrad, I didn't know what I well, I'll back
up. I was planning to go into medicine, which
I ended up doing. But I think that was largely
because that was sort of the traditional path
that I had envisioned for myself, having gone
through the sciences and all that. But even during
undergrad, I would question whether or not I
should do med school in the first place. I remember
one time I was just talking to my dad when I
was an undergrad, and I wasn't really enjoying
school that much. And I said, Hey, like, what
if I decided to just drop out of school and like
go do something totally different? And, you know,
he was silent for a minute. And then afterwards,
he said, You know what, whatever you do, I'll
support you. And I was like, Oh, my gosh, well,
that didn't happen. I basically didn't find something
better to do during undergrad. So I stayed on
the med school path, did med school. But even
then I was still lost. A lot of my colleagues
knew that they wanted to go into family medicine
or surgery or something else. I did not have
that clarity whatsoever. But I got lucky because
I had some fantastic mentors who said, hey, Josh,
why don't you come spend a summer with us doing
research, not on clinical things, but on broader
health care system challenges around quality
and safety and cost. I ended up doing research
on preventing readmissions back to hospital.
And that got me really energized, I think, for
the first time in medical school. And then around
that time, and this is kind of back in, let's
say, 2011 or so, I started getting interested
in tech and startups. I'm not sure why maybe
just random stuff I was seeing on social media.
But I ended up actually trying to start a totally
different healthcare tech venture. with two friends
from med school. And we quit slash gave up after
four to five months. And I think one of the big
reasons for that was, yeah, we were busy with
med school, but we were all clinical people,
you know, none of us knew how to write code,
build a product, etc. So we had overlapping skill
sets. And then my last year of med school, I
still had the itch to build something. And on
a whim, I applied to the next 36, which is a
startup incubator in Toronto. And what was unique
about this incubator at the time, at least was
you didn't enter the incubator with a fully formed
team or startup, you actually applied as an individual
and they would connect you with other potential
founders. And so I actually met my co -founders
through the next 36 who were both brilliant engineers.
We were all interested in healthcare. And I brought
the readmissions problem to the team and said,
Hey, you know, like, this is a big problem. You
could we build tech to better support and manage
patients outside the hospital to prevent something
like a readmission. And we launched our current
ventures theme SMD through that incubator. While
we were all in our last year of school myself,
my last year of med school, I graduated, got
into residency. but never started it because
I ended up going full -time on the company. And
for the last 12 years, building this company
has been my full -time job. I actually never
started residency. And so despite that though,
if not for medical school, I would not be building
the venture today. But I hope that gives people
at least some good background to how I got into
you know, healthcare entrepreneurship, but happy
to take this conversation wherever you'd like,
Rashad. That's a very interesting choice you
made and one that most people would not make.
And one I would probably advise against making
for medical students. If a med student came to
you and said, Josh, I have this venture, it's
in the current hot thing, AI agents for healthcare
space. What advice would you give them? And would
you advise them to not pursue residency and pursue
their venture instead? Yeah, I think my advice
by level is people should follow their curiosity.
So I would say, hey, if you want to go pursue
and learn and build something in the AI agent
or any other space, you should do that. It doesn't
mean you have to leave score training, right?
There's no reason why if you can find the time
you can learn and build and do stuff on the side,
not easy, but certainly possible. And a lot of
ventures, as you know, started off as side projects.
And it may stay as just a project or at some
point it may make sense because either. you want
to go bigger, and you know you need to give it
your full attention and turn it into a full -time
venture. Great. You can do that. But I don't
think it has to be decided upfront. Is this a
full -time venture or nothing? I don't think
it's a binary thing. I think you could start
as a side project and then decide from there.
That would be my advice. Now, at the same time,
though, I would always caution potential entrepreneurs,
hey, healthcare is really hard. It's really slow,
et cetera, et cetera. And frankly, If telling
you that convinces you not to pursue a venture,
it probably wasn't going to be the right fit
for you anyways. But for the people who hear
that and go, yeah, that's fine. I'm going to
build it anyways. OK, then you know what? You're
probably meant to build this because it doesn't
matter what I say. You're going to just keep
going for it anyways, which is fantastic. You
should go do it. How much of your success do
you think is luck versus decisions you've made?
I think it's hard to quantify. I think both play
significant role. I think the reality is, when
I think about good decisions I've made, probably
I would say on average 60 % good, 40 % bad. And
I think it's like, you generally need to make
more good decisions than bad ones. You generally
need to make better decisions for the more important,
you know, impactful decisions that you may have.
But at the same time, though, part of it is just
surviving long enough so that way, you don't
get killed by the bad decisions and you are out
enough for the good decisions to pay off. Because,
you know, a lot of times, like even for good
decisions, like luck plays a significant role.
I mean, we talked through many different situations
like that. But but both play a role. It's hard.
It's hard for me to separate the two and quantify
it, though. Talk to me about the best customer
you've had, and obviously you don't have to name
names, and the worst customer you've had. And
were there some signals or signs that this is
going to be an easy organization to work with
versus a difficult organization, and maybe it's
not worth it? Yeah, so I would say in our experience,
and I'm coming from the digital health, so software
world. you know, the answer might be different
depending on the product or the venture. But
I would say for us, the most difficult customers
have been the ones where they've prioritized
the research aspect of the innovation over the
practical deployment aspect. So for example,
you know, we had an organization many years ago
where they would bring seamless MD in. And normally
when we implement the product, we have a whole
implementation and success team that project
manages the whole process that manages the relationship,
makes it successful, works closely with the clinical
teams and the operation of folks. And we run
a whole playbook to make it a successful partnership.
But this was a case where the health system wanted
to run it purely as a research study. They had
assigned study coordinators who wanted to control
everything, wouldn't let our team be that involved
in the process. wouldn't let our team interface
with the clinicians after the implementation.
And so unsurprisingly, it didn't go very well
because we weren't able to run the playbook.
And the reality is, when it comes to healthcare
technology, the tech is one thing, but the people
and the process and the change management are
critical elements where if not done well, the
thing could go poorly. If done well, the thing
could go great. And we weren't able to impact
the people in the process side as much as we
normally do. And I think part of that is when
folks care too much about the research and not
about, hey, how do we make this successful as
an initiative and the organization and drive
real results? Our best customer partners are
the ones who don't really focus on their research
and just say, hey, Seamless, you've done this
many times before. What do you need to make this
successful? and we're willing to invest the people
and the resources. So that typically means the
leadership team has to be bought in and engaged.
People have to show up to regular checkpoints.
People have to troubleshoot with us. They have
to care about the outcomes. They have to care
to monitor the data. And it doesn't mean they
never do research, but I would say they tend
to focus on let's make this technology successful.
And sure, we'll do retrospective analyses to
make sure that we're improving outcomes. But
that's not the reason why we're doing this. We're
doing this with the intent to make it work, not
to hope that it works in a very controlled study
setting. Because as you know, the study setting
is not at all like the real world setting either
a lot of the time. Yeah. And I think this has
led to extrapolating from the study setting and
then creating guidelines. different expert advice
that states that this is how we should do things.
It's led to some distrust of medicine as well,
but we'll leave that for a different discussion.
Talk to me about your first sale and how did
you approach the organization and why do you
think you were successful? And maybe talk to
me about some sales that you weren't successful
with and what could you have changed to close
it? So it's funny, when you say first sale, I'm
trying to think through my head, how I even define
that because, you know, I could tell you about
like the first few pilots where it's a sale on
that it got into the institution, but it wasn't
much of a sale of, you know, there really wasn't
much of a dollar value attached to it. And as
you know, as you get more mature as a company,
especially in healthcare, you do less of these
pilots or free pilots and more of these actual
sales and mature deployments, but I can tell
you our very first, you know, implementation
at least, which was more like a free pilot was
still a lot of work, right? Like, this was back
in, you know, let's call it early 2013. We had,
we had a prototype and not much of a product.
We had no proof points, no traction, nothing.
And, you know, I just, you know, code emailed
a couple of surgeons who were who are doing research
actually on preventing readmissions. And people,
people took my call. And we were lucky that we
found some early adopters who said, Oh, this
is awesome. Let's try this, which by the way,
is very different than today where people get
so much email. Now, as you know, there's so much
noise in the inbox that it's very hard to get
through to people back then like you didn't have
a million you know startups emailing everyone
right so back then people got fewer emails they'd
read everything they'd engage um but it took
us 12 months to even just get a free pilot signed
with the institution um and it's crazy to me
because when i think about um how strapped startups
are for for not just people resources but but
money and support if if i were to tell myself
back then hey it would be 12 months before you
got your first user actually trying the product.
I don't know if I would have signed up for this,
right? That's a crazy amount of time for a startup
to get its first user and not even a paying user,
by the way. So I think we were, I think we were
lucky to have been, you know, first time naive
entrepreneurs who didn't know any better because
then you can tell yourself, Hey, like it's just
around the corner. It's coming anytime now. It's
just part of the process. I mean, now it would
probably drive me crazy that it took 12 months
just to get a user, you know what I mean? And
do you find the ecosystem has evolved where now
it doesn't take 12 months? And if so, what's
changed in the ecosystem? Yeah, I think probably
there's a lot more maturity in just being comfortable
with third -party software products. I mean,
especially cloud -based products that are not
installed on -premise. Even back in 2012, cloud
was not technically new, but I don't think there
were that many third -party cloud -based solutions
being used at hospitals and health systems. That
was probably part of the challenge, getting people
comfortable with that concept. The other challenge
we had back then was we were initially back then
a mobile -only software product. And back in
2013, only, let's say, 50 % of Americans or Canadians
had access to a smartphone. And so we had a lot
more pushback back then around a mobile first
product. Now we're obviously multi -channel,
and now penetration is over 90 % for mobile.
It's much better. But back then, it just wasn't
as accessible a product. So I'm actually looking
back kind of surprised that we even got anyone
working with us. But I can see why looking back,
it was not an obvious solution to have. In fact,
if I were working at the hospital, I probably
would have pushed back on this product now that
I think about it. I'm happy not everyone did,
and you had some of the adopters. One of the
hardest things about growing a startup is knowing
who to hire and kind of honing down your hiring
process. Talk to me about your hiring process,
and if you can talk maybe about the best hire
you've had and also a bad hire you had to let
go of. Yeah, so I think I'll share a couple of
the biggest things I've learned about the hiring
process. I think one of the things that ends
up being difficult about the hiring process is
a lot of the traditional methods, I think, don't
very well capture the information we actually
need to make a good decision. So, you know, one
of the things that you care about as a company
is, well, you know, what is that person's actual
performance gonna be like? And the reality is
an interview helps you assess communication skills,
but it doesn't actually assess performance on
specific competencies, right? So interviewing
an engineer purely verbally will not tell you
much about their ability to code, right? Or even
interviewing a salesperson, yeah, you could see
if they had decent communication skills, but
that tells you nothing about how would they actually...
do customer discovery or do a big sales presentation
or negotiate something. And so one of the biggest
success tools we've used is actually as part
of the hiring process, have the person do some
sort of assessment that's reasonably close to
the type of work they're doing here and see how
they do. So for example, if we're hiring a salesperson,
we'll have them We will actually give them, hey,
here's like a scenario, like an event. We're
going to give you a scenario with you work here
at Seamless. Here's a hypothetical customer that
you're going to meet. Here's their current situation.
And you're going to pretend that you're presenting
to the head of surgery and the COO of the hospital
and one other person. And we're going to spend
30 minutes with you role playing being a salesperson
at Seamless presenting. us role -playing the
potential customer and having dialogue about
it. And what's powerful about these assignments
are that it tells you a lot. So for one is how
prepared the person is for that sales presentation
tells you a lot about the effort they'll put
into anything they do. So we've had people who
basically showed up like totally unprepared,
which is like an indication of like what would
happen in real life. We've had others, when I
asked them afterwards, how many hours did you
prepare for this? And one person told me, who
did a great job, by the way, told me 10 hours.
And that was not a requirement. We don't ask
people to prepare a certain amount of things.
We intentionally don't even give them that much
of a guideline around how to prepare, because
we want to know what they would do, what kind
of initiative and agency they have. And so I'm
always surprised by how there are people with
fantastic resumes who totally bomb the assignment
part and others who are just like who are early
in their career, have less of a track record,
but do so much better on this. And we've seen
very high correlation between performance on
these sort of assessment assignments and actual
performance at the company. And I think the other
biggest thing we find is that the people who
are really good They can't help but be excellent
at any work that they want to output. They can't
help but do a great job on the presentation.
It would kill them to do a bad job. And it shows
the quality of work they even do in this random
assignment in the interview process. I've got
more, but I'll stop there. Yeah. Yeah. SeamlessMD
has a few different products. and reducing readmission
rates, it seems like that's the key metric, but
you also work with surgeries and post -surgical
follow -up. Is everything under the umbrella
of reducing readmission rates? And how do you
decide what product to focus on first? Is it
more of a customer -led kind of process or? Yeah,
so we have a single flexible platform that works
for many different. um surgical procedures or
health conditions so we can support anything
from like orthopedic surgery to the pregnancy
journey to the cancer journey to chronic care
and everything in between and so um when we work
with the health system we not only determine
okay what are the conditions or procedures we
cover within a specific clinical area we work
with the clinical and operational staff to understand
well what are the kpis your program cares about
so it could be the case that you know, orthopedics
in one hospital wants to reduce readmissions.
And so we'll kind of configure the workflows
and implementation to focus on that. But there's
another orthopedic program and a different customer
who might say, well, I'm trying to reduce length
of stay. And so it's the it's generally the same
technical platform. The clinical side gets configured
based on the specific specialty and then the
workflows and the implementation approach and
how we support them. look at further kind of
tailored based on what goals they want to achieve.
And sometimes it's like, I want to reduce like
all the above and that happens too. And what
was this? So the usual advice is, you know, focus
on one specific thing and get really good at
that and then expand to, you know, so maybe focus
on hip surgery, length of stay, and that's all
you do. Don't worry about readmission rates.
Don't worry about length of stay for knee surgery.
or for shoulder surgery, or for heart failure,
or for COPD, just focus on one thing. It seems
like you did follow that advice, and you have
been successful, it seems like, partly because
you didn't follow that advice. Tell me about
what your thoughts are on, you know, what would
have happened if you said, all I'm doing is length
of stay for hip replacements? Yeah, so what's
interesting is that we went back and forth on
that for many years, right? So we had moments
where we said, Hey, we should, let's say, only
do orthopedics, be world class orthopedics, get
orthopedics in every single institution, let's
say North America. And then, and then from there,
then start to expand into, you know, cardiovascular,
and then get and they get every cardiovascular
program using it and then later expand to women's
health, then basically almost like verticalize
each one and then grow horizontally across the
health system. We ended up not doing that. We
ended up actually going down the whole land and
expand route where, hey, we might start in orthopedics,
but we might start in cardiac, or we might start
in women's health. And part of the reason for
that was it was hard to predict, depending on
the health system, what would be the first one
or two use cases that they wanted to start with.
Now, there tends to be a common set, but it's
never just orthopedics. And if we if we refuse
to do that said no no no we're only going to
do orthopedics. Then we would lose that initial
we lose a customer to someone else was willing
to start in cardiac for example. And so we had
we realized we had to be flexible and broad enough
that we could support whatever use cases health
systems want to go with first. But then the other
thing that we uncovered was that health systems
over time just want one. Platform partner for
all the conditions because they didn't want.
a fragmented patient user experience where there
could be a hundred different point solutions
that all look and feel different for the same
use case, just in different clinical areas. And
so I can tell you, we have some competitors where
they're world -class at one solution like orthopedics
or women's health or cardiology or something.
And their struggle has been that, you know, they
get pigeonholed into being, well, you're only
an orthopedic solution. Our health system needs
an enterprise product and Yes, seamless orthopedics
might only be 80 % of what you do in ortho, but
seamless is 80 % for every single specialty.
I'd rather have that than 100 % in ortho and
then needing to buy 99 other products. And so
once we understood that from the customer perspective,
we had a clear path to, okay, we got to be a
platform product. We got to support everything,
which is not easy, but that's the only path to
winning the long -term partnership and making
it manageable for the health system. Let's go
back to your hiring process. I'd love for you
to talk me through what it looks like from the
idea comes to you where we need a CEO or a CFO,
or we need a new sales rep. And I realize there
are two different hiring processes. What's the
path from that idea in your brain to someone
physically working for you? Yeah, so step one.
And I'm annoying about this now, but it's all
about whether it's hiring or some other initiative.
Is there a problem to actually be solved first
and foremost? And the number two, does this solution
which might be hiring someone actually solve
the problem? Because to your example there for
sales, right? I think there's often a misconception
that the solution to sales is to hire more sales
reps. That might be the answer. but it might
not be depending on the root cause of why sales
are not growing as quickly as you want. So we
can park that conversation because that might
be a whole other interesting topic of when does
it make sense to even hire a salesperson. But
once you've decided that, yes, the right solution
for this problem that exists is to hire someone,
then it comes down to, okay, do we actually know
the right profile of the right hire for this?
And so kind of what I advise folks now is to
come up with almost like a hiring scorecard for,
OK, for this role, what are the important traits,
track record items that the person has to have?
And then very importantly, what does success
look like six, 12 months after the hire? Because
we have to know what we're hiring for. And then
once you build that out, then you go down to
actually sourcing and bring the right people
into that funnel. But if you don't do that upfront
work right, you tend to end up bringing the wrong
people into the funnel. And then people have
no idea how to screen people properly. And then
once you're actually bringing people in, I think
a very important thing is realizing that interviewing
is a two -way process. So let's say there's a
role that I am personally hiring for. and I'm
managing the process, I'm taking the first call,
et cetera, et cetera. Typically in that first
call, I intentionally share a bit about myself
and Seamless First. And before even asking them
about themselves, I say, hey, do you have any
questions about Seamless or the role or anything?
I do that for a few reasons. One is I'm putting
the effort to sell Seamless First and giving
them a chance to get educated. But two is, What
I found is that there's a very hard correlation
between the quality of the questions that the
candidate asked me and how good of a candidate
they are. So our best hires are people where
in that first call, like they are grilling me.
They are asking me really tough, complicated
questions about seamless. They're like, who are
your biggest competitors? How are you differentiated?
How are you thinking about your roadmap? Tell
me more about the market. What's the most difficult?
part about selling the product right now. They're
grilling me and I love that. I'm like, oh my
God, they're intellectually curious, they're
smart, they're already thinking about the business
because that shows me the types of questions
and intellectual curiosity they will bring into
the team. The lowest performing candidates have
been ones who are like, have no questions or
asking me things like, oh, so like, is there
an office? you know, like, like super basic things
that show no curiosity about the actual business.
And so they don't realize it, but I'm actually
evaluating them from the moment they actually
start asking me questions. Cause I've found very
high signal in that data. And then from there,
I started asking them questions. I have a list
of like screening questions based on what I'm
looking for, but I could tell pretty quickly
early on, like based on that, even that first
interaction, like how likely it's going to be
a good fit, just based on And I think maybe because
we just care about curiosity in our company.
But but that's a very big signal. And then we
have a whole like we have a screening process,
the assignment, we have like, I can go more detail
if you want, we've interviews with our team members.
But I think I would say the first screening conversation
and their curiosity, the assignment. And then
the last piece, I think that's very big is actually
the reference calls. And not even necessarily
the ones they give you, if you can kind of as
you probably know, like you can backchannel references
and get candid information. Or even if it's not
backchanneled, doing references the right way
with the references they give you, that makes
all the difference. Because I think what we found
is that what other people tell you about their
performance and how they get compared, gives
you more signal than most of the things they
would tell you about themselves in the interview.
Because everyone who's reasonably good at interviewing,
especially executives, Like know the right things
to say. Like the people who are executives are
so seasoned in an actual conversation that you
don't learn that much in the interview actually
in terms of the traditional interview. But like,
do they show up for the assignment? Like I'll
put executives through an assignment and some
will just like completely implode or not care
and not put any effort into it. You'd be surprised.
Do you think it would make sense to do the interview
last? once you've kind of almost made the decision.
Because there are people who are very charming,
who can charm themselves through an interview.
And it's almost as if the interview is just to
evaluate to see if you can hold a conversation
and have okay communication skills. But as you
said, it doesn't, it's not an indicator of performance.
So it's fascinating. Yeah, it's fascinating because
like, if you don't have a traditional interview
component where you ask about like their background,
their upbringing, like their hobbies, whatever,
it kind of feels like you don't care about them
on a personal level. But it's interesting because
what I found is that the biggest signal comes
from like almost like non -personal things. It's
like, like, like how they like when they actually
do the assignment or when they ask us about the
company or they give us feedback on what they
would do if they worked here, like all of those
have been better signals to us than their hobbies.
or like, you know, what their upbringing was
like and all these other things. I would say
the difference is that if they are early in their
career with not much of a professional track
record, then how they did in like school tends
to be more useful. But if someone has like a
20 year track record, and they're an executive
hire, like, I don't learn that much from what
they did 30 years ago, and they're like their
whole life story. That's just been been our experience
though So if someone is a has a 30 -year track
record, how do you evaluate them? It's all the
other things I mentioned. So it's it's it's how
intoxicated curious they are. How good are their
questions? the other thing that I do with an
executive is I'll actually Walk them through
so let's say I was hiring like a I don't know
a VP of something, right? I would actually walk
them through something similar to like an investor
deck, which is like here's a a deep dive into
the company, the market or business model or
biggest challenges. And I would, and I'd say,
Hey, I'm going to walk you through it, but like,
please like interrupt, ask questions anytime.
I want you to get educated on the real estate
of the company and our biggest problems and same
thing. Like, do they interrupt with like really
smart questions and comments? Because again,
if we were collaborating in a real setting, I
want to know what our conversation will be like.
Are you going to jump in and actually dig into
the details? Or are you just going to sit there
for 10 minutes and have no commentary, no questions,
nothing? And that's also correlated very well
with performance. It's like, yeah, do they dig
in right away? Do they have good feedback on
this? Are they thinking about it? How do you
screen? So say you've put out a job application
or you've asked your friends to recommend people.
How do you screen who to take forward from the
very initial stage to interviews or these case
studies you're doing with them? So for the first
conversation, there's usually just some very
basic screening criteria for that role. So that
could be as simple as numbers of years of experience
in a certain... uh for that specific uh skill
set so like let's say it was sales it's like
we might just say i'm making this out might be
like oh you need five years of sales experience
in healthcare tech or whatever it might be right
so that's more basic um but i would say when
we get to the actual conversation part of it
is just like confirming details about like okay
like when you say that you were doing sales like
what does that actually mean like were you a
bdr versus an account executive or something
else But if after that first screening call,
we're keen and they're still keen, then after
that, we typically put them through what I call
skills interview, which depending on the role,
this could vary. But let's say for a client facing
things like sales, customer success or something
else, it's typically like a 60 minute, just a
phone call where we'll ask them specific questions
about competencies in that role. So for customer
success, it might be like, hey, imagine you were
implementing a customer here and you were running
a kickoff meeting for implementing that customer,
what would be your agenda for that meeting? So
there'd be a number of questions to basically
find out, okay, do they actually have the basic
competencies for this role? And there's a number
of different questions there. One of my biggest
signals when doing those skills interviews is
actually coming away thinking, okay, number one,
yes, do they were they would answer the questions
reasonably well, but two is, I've always found
that our best hires, I would learn something
from them in that skills interview, like they
would give me an answer or say something where
I'm like, Huh, I actually never thought about
it that way. Or like, that's a really good idea.
I never occurred to me to do it that way. So
typically, if I'm learning something from the
person, I'm like, Oh, that's a really good sign.
if they pass that skills interview, then we take
them to the actual like assignment that presentation
or something else. And then from there, we put
them through a final interview references. Now,
some people actually don't like that. Some people
say, wow, there's so many steps in the interview,
or like, gosh, I have to do an assignment that
seems like real work. And my answer is like,
see, this is not for everyone. But what I tell
people is like, look, like, yes, it's a rigorous
process. What this means is that If you get through
this and you actually want to work here, all
your other colleagues here, you know they're
really good because they all had to get through
the gauntlet and they're working here now. So
if you want to be working with really great talent,
it takes work to filter people through that.
But that's the opportunity here. And I think
what you find is that most high -performing people
are attracted to that. They're like, oh yeah,
I want to work with A plus people who got through
this process. Yeah, I'm cool with that. And a
lot of people who do really well, they're like,
oh, yeah, I actually enjoyed that assignment.
I didn't find it to be an annoying thing. It
was kind of fun to put this together or do a
great job in all this. So I think it's just having
clarity around, OK, what type of culture do you
want to have? And what process do you need to
build that? And the people who are attracted
to that will self -select. And those who don't
want to be part of that will self -select out.
And that's totally fine. As you're growing seamless,
how do you think about the decision to raise
more rounds, give up more equity versus raising
or getting a loan or getting venture debt? Yeah.
Um, so, I mean, regardless of the instrument,
like the question is, should I raise? And if
so, how much and why? And I think the biggest
mistake entrepreneurs make, which is the mistake,
a mistake that I've definitely made too is, um,
and it's gotten better now, of course, with the
change in the markets, the last few years. But
there was just almost like a momentum to just
raise because you're supposed to and everyone
else is. And the thinking I come around to as
well, if I'm going to raise, I need to have a
very clear idea that raising solves the problems
that need to be solved because the reality is
money does not solve every single problem possible.
So a very common issue entrepreneurs run into
is I need to grow faster. So I need to raise
capital and hire a lot more sales and marketing,
et cetera, people. But here's the reality. For
some companies who don't have real product market
fit yet, hiring more people does not solve product
market fit issues, right? Like hiring salespeople
does not create demand. Salespeople can convert
demand into sales. But if you don't have enough
demand for your product, enough leads coming
into the company, like your salespeople would
just be waiting for opportunities. And so I think
what I found is, okay, are you crystal clear
on the problems, the biggest problems you have
to solve to grow? And does money solve that?
Because if the answer is no, actually, I have
to fix product market fit before I can invest
in in growth, then fix that first. And the answer
to that is probably not money. It's actually
probably potentially becoming a smaller company.
and figuring out why you don't have product market
fit and getting that first. And I think there
were a lot of companies who unfortunately thought
money would solve product market fit problems
and it does not. That's probably the biggest
challenge, especially companies in healthcare
face. When did you achieve product market fit
and how did you know? Gosh, part of the challenge
of product market fit is that it changes too,
right? Like you could have product market fit
with a specific subset of the market. and then
reach a plateau and the need to refine product
market fit. So it's almost like a never ending
question because depending on the on the size
of the state of the company, you can gain it,
you can lose part of market fit. I would say
probably the first time we had real product market
fit, where, you know, if you listen to the original,
like, like market, I think it was market recent
description, which is like, you feel like Your
product is just being pulled by the market like
you're getting requests all the time Like it's
hard to keep up with demand all that first time.
We really felt something like that actually was
probably around You know 2021 or so so this is
like, you know eight nine years into the company
I'm saying I didn't really feel like I had true
part market fit. We had customers, right? But
it was a grind and it was really only then when
especially actually especially in in Canada where
the government started investing more money in
digital health and hospitals were being funded
to procure solutions. So it's just like CMSMD
that all of a sudden, people were just coming
to us instead of us knocking on doors. That was
the first time I felt real private market fit.
And I was like, oh my gosh, it's so much easier
when you don't have to convince someone so hard
to buy this. But again, it could be gained and
lost. It's not a one -time Oh, you passed go
and your product market fit. Some of the biggest
companies in the world have gained and lost part
of market fit over and over. Yeah, I think there's
lots of examples here. Kodak being a famous one.
Talk to me about, you know, there's a philosophy
that building a startup is an all in adventure,
is there is no balance that exists in life when
you're doing this. And this is kind of all encompassing.
Do you share that philosophy? If not, how do
you find balance in your life while being all
in on seamless? Yeah, I think what I've come
to realize is that the right answer is very personal.
So for me, I don't believe in work -life balance,
but I believe in work -life harmony. And I think
probably a lot of startup founders do. And I
think it's because a lot of founders get a lot
of both purpose and energy from their startup
and their work. And that's true for some people
who are not even founders who just get a lot
of energy and purpose from their work and careers.
And there's others who get much less energy and
purpose from their working careers and get that
purpose from other places in life. And there's
no right answer. But I think the right answer
is very personal in terms of like figure out
what's right for you. So for me, it's hard to
separate the startup from like my identity and
how I spend my time. And that's not me complaining
because I get a lot of energy from working on
our company. i don't expect everyone the company
to get the same amount of energy and purpose
so that they're spending as much time thinking
or working on as me that wouldn't be a fair expectation
um but but i'm not like upset about it i'm not
complaining about how much time i spent on it
because i actually enjoy and get purpose and
energy and so it works for me and i think that's
true for a lot of founders but i think that the
disconnect is when founders don't understand
why others don't feel the same way And when others
who aren't founders don't understand why a founder
or someone who like spend a lot of time working
on stuff, like enjoys this sort of life, it's
just everyone's different, right? We all exist
on expect and a spectrum. So I think you just
have to be honest with, okay, what gives you
energy? And for me, it's this, right? We talked
previously about. the customer driven path to
building your offering when you first started.
How do you think about that now, especially as
you grow? I'm sure thoughts come like, well,
I could build an EMR better than this. So how
do you think about what the future holds and
kind of staying within the brand you've built
about reducing readmission rates versus branching
out into other technical products that the hospital
might need? Yeah, the really tough part about
having existing company and product line is that
it is very hard to just branch off and solve
completely brand new, different problems. It
is much easier to solve adjacent problems to
your core product and problem space. And so for
better or for worse, that's what we focus on.
So, you know, we At least for now, we don't even
think about the idea of, hey, could we build
a completely new operating system for health
systems? Because that would be too much of a
brand new problem space than what we're solving
today. But we do think a lot about adjacent things.
So for example, right now, we focus a lot on
patient care journeys going through a surgery,
a cancer journey, or something else. But it's
not hard to imagine that we could branch into
other non clinical patient facing interaction.
So at some point, maybe we do get it more into,
you know, appointment scheduling, payments, or
just anything, any digital interaction with the
patient clinical or not, maybe we get into at
some point. And there's other adjacent things
that we can explore. But I think for us, given
our size and stage, we're thinking a lot about,
OK, how do we stepwise build out from the core
right now? But that's a tough thing, right? Unless
you're a huge company, it is very hard to make
bets that are not adjacent to what your focus
here is. You just don't have the bandwidth to
do it. A question some investors ask founders,
which I think is a lazy question, is What if
Google did this? Or what if for our industry,
you know, what if Epic did this or Cerner or
Oracle? No. What do you think of that question?
And how how did you answer that question when
it was posed to you? It was funny because that
that's the alleged reason that we got rejected
by it, by YC app, our interview, like, you know,
almost 10 years ago, they, you know, we had this
interview and then we got an email saying, hey,
sorry, sorry, we didn't accept you. We think
the EMR is going to build this. And I was like,
That seems like a very non YC thing to say, because
YC's whole thing is that like, it's a lazy question
to ask, you know, why won't the incumbent do
this? So I thought that was kind of funny. But
but I think the reality is like, look, the incumbent,
whether it's an EMR, someone else may very well
try to build this, they may have some they may
or may not they may have, but they may have an
overlapping product or plan to. But that's true,
whether in healthcare or not. And the reality
is, and I always tell people the same thing,
it sounds easy, but it's hard. It's, is your
product going to solve it 10 times better than
the incumbent on a dimension that actually matters
to the customer? And that might, and that can
be anything that could be the customer wants
this product implemented 10 times faster, or
they want 10 times better support, or they want
it 10 times cheaper, or some combination of the
above. But if you can figure that out, and focus
on that, You could beat the incumbent largely
because the incumbent has so many other things
to care about, right? Like you can take a big
EMR who has so many other core products. Unless
you're competing to displace the EMR, it's very
hard for them to focus and do your product well.
Where startups fail is that they focus on a product
that's a nice to have for the customer. And if
it's a nice to have, then the customer has no
urgency to pick. the product that will get to
market the fastest or deliver the best value,
whereas the highest performing, because if it's
just a nice to have, they are happy to wait for
the incumbent to maybe at some point deliver
that same product that could be 10 times worse.
But if it's a nice to have, there's just no urgency
to buy anyone's product, let alone the startups.
And that happens because in healthcare, there
are just a lot of products that can help patients
and care teams, which is why we want to build
them as entrepreneurs and innovators, but just
may not be important enough of a problem that
a health system will pay money for tomorrow.
And that's the disconnect. That's the weird thing
in healthcare. In any other industry, the startup
will say, okay, I'm going to pivot to a brand
new problem that actually will make money. In
healthcare, you're like, no, no, no, like, I
really want to solve this problem that is so
important for patients. You wouldn't get that
in accounting. The entrepreneur would say, no,
I'll just move on to construction or some other
accounting problem. You know what I mean? Yeah.
If you had to build a direct to consumer product,
what would you build? Oh my gosh. I actually
would have to think about that because I don't
spend that much time thinking about the consumer
space. That's a good question. I mean, to be
honest, it would probably be something that is
very, very disconnected from the traditional
health care system, because I generally believe
that clinicians do questions things well, and
the right consumer product that, you know, doesn't
impact the clinician patient relationship or
the other consumer products that will win. But
I have to think about that one. Yeah. If you
do raise a next round, a common question from
VCs would be around how are you using the latest
AI? And how do you think about that? What are
your thoughts on AI agents and their place in
healthcare? And are you thinking about leveraging
them? And if not, why not? Yeah, I mean, I'm
a big believer that any tech AI or not is just
a tool to solve a problem. So investors might
not like that, but I would try to figure out
what's the problem I'm going to solve and the
best solution to that, which may or may not involve
AI or agents or any other things. I do think,
and I agree that I think AI opens up the opportunities
for what solutions are possible and that accelerates
a lot of things. I think that could very well
be part of the pitch because it would open up
some opportunities and accelerate things that
make it a much more attractive startup. I think
that's very, very true. And I would probably
look for a way to apply AI, but I wouldn't say
for me it would be necessary to use AI to build
a new startup. Although I think it would be very
likely that we would. I would say for us though,
what's interesting is that the lowest hanging,
most common use cases for AI in healthcare right
now, as you know, are less clinical, more back
office administrative things that pose less of
a safety concern, that get more easily approved,
et cetera. And so because Seamless is very much
in the clinical patient journey space, our customers
so far have not been enticed by applying AI to
the patient interaction. And so no one's really
saying, hey, Seamless, we really want you to
have you know, agents to guide patients through
these journeys instead of, you know, using mobile
and web today. Now, I do think long term what's
going to happen is like there will be some patients
who don't like agentic experiences who actually
prefer the curved version of seamless. And that's
the best way to engage. But there will be some
and maybe it will be a growing percentage of
the population who eventually will want agentic
experiences. And we will have to build agents
to guide patients through, let's say, a surgery.
But I don't think it's going to likely be agents
only ever, or at least not for a very long time.
And so the question is, well, when's the right
time then to introduce things like agents? And
I think for us, most likely it will be a stepwise
path to getting there, not because we could not
just go and build agents, but because I think
we want to match the urgency of the market. So
building a bunch of agents now that customers
won't use is kind of pointless to me. So I think
we see some middle ground. So for example, In
our product, we have all these clinical pathways
and content that have been vetted by the customer
and configured by the customer, let's say, for
heart surgery. And I could see a world where
we embed a conversational interface, like a chat
bot, into the product where it's using retrieval
augmented generation. It's basically trained
only on the customer's pathways and clinical
content and can answer questions about that.
with, you know, minimization of hallucinations.
So I could see something where it's like, okay,
it's not totally like agentic at all. It's just
like a, you know, like almost like a, a custom
GPT, if you will, trained on the customer's content
that can answer the most common questions, but
in a way that clinicians will feel comfortable
because it's like, Hey, it's only going to produce
content that you have vetted that specific to
your, your care team and institution, but still
has that like, AI sort of chatbot experience
that's kind of cool that you want to do. So I
feel like there may be a stepwise function between
what we do now and actual agentic experiences.
We're still trying to figure out the timing of
that and the right way to do it. But that's why
I feel is like probably for us the best way to
do it. Thanks so much for sharing everything,
if I'm being frank. And I think founders will
learn a lot from this. Any last piece of advice
for founders building in healthcare? No, just
don't do it. And if that doesn't stop you, you're
meant to do it. Awesome. Thanks, Josh.