The project began through a contact within the University, who invited KA to attend an event and meet several individuals working on different research projects. The University was actively involved in creating start-up companies with these research projects and KA was told to “choose a project and you can be CEO of it”.
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Table 7: KK Interview Quotations and Thematic Coding
Quotations Themes
The Beginning and Origins of the Project “choose a project and you can be CEO of it”
“I was introduced in December 2010 to ProfessorK”
“So I invested….maybe £20,000 plus the opportunity cost of not having a job, to get the project up and running….we thought in August of 2011 that we would be able to spin the company out, but the then lead investor changed the basis on which they were willing to make an investment and consequently it fell apart....I have no income, I do have a mortgage, so I thought ok, what am I going to do? So I cast around and stumbled on the National Innovation Centre website.... he said I think we can invest £200,000 ...as a grant”
“with £900,000 got our heads down and started developing the product”
“we took software out of the University and completely recoded it and reduced the time it took to process a standard set of images from about an hour and forty minutes to about 38 seconds”
“then did some other work to check whether it would work in different clinical settings”
“through the manufacturers” however, “some of the assumptions we had about the market were incorrect”
“we finally figured out how to structure the thing and because the National Health Service through the National Innovation Centre were investing all of the people that we’d been talking to before who were sitting on the fence came off the fence and said yes we’ll invest too!”
“single investment. And it took him 24 hours to make the decision”
Origins/Drivers Funding
NHS Relationship Collaborating Partners Clear Clinical Need Expertise
The Current Situation
“KK is the opportunity, KK now is a much bigger market opportunity than <previous iteration of product>, probably double maybe even three times the size. We thought that we would have a market of about half a billion for <previous>. Well we know it’s much less than that now. The market for KK is well in excess of a billion dollars probably globally it’s nearer to three billion dollars. So it’s a big opportunity.”
“I mentioned to NIC we’ve got this concept KK concept, and he said in his view that that was in terms of value to the NHS massively more valuable than <previous> which just reinforced what we thought.”
“70% of the images were of substandard quality. Which kind of scared them. If you can save one just one you would pretty much pay for intelligent quality analytics for the whole of the NHS. ….impact nationally...reduce the risk of wrong and misdiagnoses”
“got about £150,000 sitting in the bank”
“first funding round in January 2013”, raising “a total of £900,000”.
“through to profitability”,
“about to go out and attempt to raise another £1million”
“going to see any money for at least another year”
Clear Clinical Need External Environment Market Research Champions Funding Knowledge Expertise Implications Collaborating Partners Flexibility
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“dynamics in the market for KK”
companies used to pay developers up front to develop the software and then also pay them to engineer it to suit their operating system and they won’t do that either anymore”
“we made a bad hire and our original Head of Engineering turned out to be a disaster so that was a problem”
were “fully expecting them to say get out of here”
“just getting the company going itself”
“We will be forever in debt to him for pushing this through the NIC”
“I remember very clearly the day that we broke through our record our goal for the processing speed of the images.”
“we always believed KK as it was originally conceived was big…..ProfessorK particularly was very sceptical. And I remember the day when she flipped from being incredibly sceptical to suddenly realising it was huge. Because it would provide the hospital with the information it needs to actively, actively manage the service they provide, which they can’t do right now.”
External and business dynamics NHS Relationship Collaborating Partners Challenges Successes Motivation/Motivators
Set Up and Structure of the Project Working Group “remarkable incredibly intelligent”
World leaders in ultrasound image quality control” “probably in the top few in the world”.
“And that’s pretty much the core team. You’ve then got the Board….So that’s the kind of advisory bit, then you step outside of the company…..we want to keep them you know at arm’s length to a degree….”
“key opinion champions”,
NIC as “proactive, it was creative, strategic”.
“this was a mistake. I still stand by that. I think the concept behind the NIC made a huge amount of sense. I still think it makes a huge amount of sense and I think it was an inadvertent error on the part of the Government to cull it, they shouldn’t have done that”
“it was mooted at the time that we would be it would be suggested that we affiliate with one of the AHSNs”
“they’ve got about £20,000 sort of a bequest in our name from NIC into the AHSN”
“I have communicated with them repeatedly”
“so far the communication has been poor. I think you know you’ve got to give them some leeway with the fact they’re trying to set themselves up and figure out what they are doing. I don’t think they know what they are yet”
“turning this company into a strategic reality”
Political Change Collaborating Partners Expertise Champions NIC Change in the NHS Barriers Team Members Team Roles Role Definition
Team Practices and Processes
“there’s a lot of discussion and we have frequent telephone calls and meetings, we’re in the same room most of the time”
“So it’s quite exciting”
“we’re in the middle of our first audit with the KK product and that’s looking great and everybody’s kind of buzzed about it”
“they are literally making a difference to what’s happening”.
“I would be very disappointed if somebody said I don’t feel like I’ve got any kind of autonomy here”
“I think KK is the product of a group of people it’s no one person’s vision”
“I think we all of us want to have that kind of culture in the company...that positive we can make this happen, when all sorts of stuff is hailing down from on high upon us we’re going to get through it...we’ve got it now, we want to keep it....there’s no
autocracy....you should be able to help shape that culture....would be great to have a reputation of people saying we want to be here, you know this is a good company to work for.”
Boundedness Communication Leadership Team
Shared Objectives and Vision Motivation/Motivators Role Definition Culture Team Work Role Definition
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“democratic, there’s a lot of discussion”
“final say so depending on what subject it is down to me”
“to continue as best we can with that kind of philosophy as we grow and that’s going to be hard….how as we build the company we can ensure that everybody feels like they’re part of it”
Psychological Safety
The Future of the Project
“an immediately obvious and recognised need”
“I would have approached NIC earlier”
“I would definitely have gone after TSB funding and grant funding much much more aggressively”
spin-out company process with the University which he believes is not “structured in a way that makes it easy”
“nice piece of independent validation”.
“It ought to be. Yea, we’re looking more internationally. The reason is because the way the funding stream works the way the benefit of the service accrues to the system it’s going to be difficult to get it paid for I suspect.”
“NHS to a large extent leads the world in clinical audit it doesn’t do a very good job of it but it does a better job than a lot of other places….our expectation is that in a market driven environment where insurance plays a part....will probably confer a significant competitive advantage.”
Hindsight Reflexivity
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After managing to gain investments from a range of sources, they began to develop the product and initially presented it as an add-on for existing ultrasound machines. This was designed to provide support and advice, as well as auditing for ultrasound scans and it was decided that obstetrics was the best clinical situation to target initially due to the uniform nature of measurements and scan positions. However, after a while the funding became difficult and by chance KA came across the National Innovation Centre who offered some seed funding to the company.
2.1.1 Summary
KK has more recently changed the product that it is focussing on, having further developed the product in line with both market demands and also bearing in mind the external environments. In the face of emergent market research this demonstrates that their business plan is flexible and adaptable, and the product has been developed in order that it can be implemented in many and various useful applications within the healthcare environment internationally. Whilst not only working on this capability, the company has been extremely proactive in approaching investors and applying for funding, amassing in excess of £900,000 to see them through the first round of development.
KA, CEO of KK has previous experience of project management, working with the NHS and running small companies but has no knowledge of the technologies. However in the interview he is convincing as a non-specialist and this has clearly been borne out during presentations to potential investors as well as fully engaging with the activities of all of his team members. Following the initial phase where the project was held within the University, the pace of the project was slow, but with dynamic changes to the project and the company being rolled out of the University, there is now a greater emphasis on seeking funding and making required developments such as increasing processing speed.
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The commercial environment has played a large role in the need for change in direction, with potential manufacturers no longer providing seed-funding software developers to deliver on projects, a change coinciding with economic changes. In addition KA mentions political change as having a heavy influence on the funding available and the NIC’s closure as having a detrimental impact on the NHS’s collaboration with SMEs. The NIC had saved KK at a time of crisis, where the business was on the verge of folding.
There is a very strong sense that KA wants KK to be a good place to work and also wants individuals working in the team to be active, engaged and involved indeed he says that he would be “disappointed if people didn’t feel like that”. There is a clear culture of creativity and psychological safety within the team, indicating that all contributions are valued and that communications and discussions are always occurring both informally and formally – the majority of the team work on the same site.
With regards to leadership, KA is pleased with the environment and culture that is within KK at the moment and shares concern for maintaining it as it is when the inevitable growth of the business occurs. His expression of disappointment if individuals felt they had no autonomy mirrors his preference to run a democracy. He is infectiously enthusiastic and although he doesn’t necessarily understand the technology and software is keen to absorb as much information as possible. He is an enthusiastic leader and is driven by the outcome and potential of the product. The motivation and drivers of the team and KA is demonstrated in the speed of more recent developments.
There is a clear sense of a common and shared vision of where the product and team is aiming for which is regularly reviewed. This is articulated by KA but also evident in the rapid change approach to the external environmental barriers that have been encountered. One internal barrier has also been identified – the hiring of the wrong person. Although the team
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culture is highly valued within KK, KA is not afraid of making final decisions and identifying when individuals are not performing their part in the team according to KK expectations.
The team is extremely clearly defined, but overlapping roles and areas of expertise enable the team to work interdependently on the project. There is a huge amount of respect expressed for the Professors involved, whose knowledge and gravitas both add weight to the organization but also to the foresight of the product development. In addition the idea of having product champions on the periphery allows the company to spread the word in the many healthcare environments internationally and garner support and interest without a conflict of interest.
Lack of clarity over the introduction of the Academic Health Science Network has left the organization unclear of its position with the NHS and consequently seeking out markets abroad. However, KA is able to articulate a holistic view of the potential implications and impacts that the technology could have on the NHS thus demonstrating a clear clinical need. Indeed he suggests that when the issue that the device could tackle was presented to the NHS Trust “it kind of scared them” indicated that the requirement for the technology is accepted by the NHS.
2.2 Case II ~ Fracture Neck of Femur Splint (Interview 1 with Managing Director of II Design