In the first episode of Healthcare Innovation Podcast by Healthark Insights, Giuliana Kotikela, the Co-founder and CEO of ChiKeey, shares her journey & experience of successfully running a healthcare innovation business. She talks about the differences between driving innovation within large enterprises and within a startup environment. She also discusses some of the interesting challenges involved when it comes to innovating in the healthcare space, especially involving hardware, as opposed to software.

Transcript

Purav Gandhi- All Right! Hello, everyone. Welcome to the first episode of the healthcare innovation    podcast. Today, as our first guest we have Giuliana Kotikela, one of my good friends from Deloitte. Now, she runs a startup called Chikeey.  She’s been involved in innovation, healthcare and even otherwise, for the last 10 plus years. And I thought, who better than her for our first episode. Jewels, if you wouldn’t mind, if you can start with your introduction first and then there are a number of topics that I want to discuss with you.
Giuliana Kotikela- Sure! Thanks, Purav Gandhi. So, Hi everybody. My name is Jewels Kotikela. I am co- co-founder and CEO of Chikeey. And, Chikeey is actually an emotional management system. So, when you think about smart wearables, we analyse your how you feel, your emotional state at a given point, in real time.

Purav Gandhi- Great…! Jewels, now we will talk a little bit more about Chikeey but I wanted to go back in time, and wanted to hear about your first experience when you started driving innovation within Deloitte. You ran an innovation studio. Can you tell us a little bit about that, and like, what kind of innovation were you driving? What were, and also, I am very keen to talk about how, right? Because, in large enterprises innovation has always been a challenge, and you were one of the few individuals who was able to successfully drive it. So, how did you manage it?

Giuliana Kotikela – So, within Deloitte. For the strategy, for the overarching strategy, for the firm, you know services were how they really generated their revenue and they wanted to start moving away from 100% of services into… to hedge that bet, into 80% services and 20% products and solutions. And, when you think about a large organization like Deloitte there’s a lot of assets. A lot of such that could be reused. I know everybody always thinks that they’re, you know, just nobody else’s business is the same as theirs. However, there’s a lot of similarity across industry. Right? When you think about how you organize, how you identify or increase your profitability or your revenue or your margin.

There’s, there are pretty much three different types of ways in which you can do these things. So, with these similarities, there’s the opportunity to reuse some of these assets that have been created like best in class, for other customers or clients, and have them essentially like white labelled. So, as we started moving into the whole products realm, how do we do this bigger, faster and more effectively? We created what was the inside studio and the inside studio really served to not only just cultivate the talent, right? To, you know, achieve a higher rate per hour but also to build out those assets, and to reuse them, and basically deploy them to other client situations.

Purav Gandhi- Ah…interesting. So, the way I treat it is that Deloitte has virtually solved so many problems so many times. Some of the things could be converted into assets so that you don’t reinvent the wheel every single time. However, that could be challenging, right? Because, each individual, each client also, in general, believes that their problem is truly unique. So how were you able to kind of push this, these one-size-fits-all solutions with your clients. What were the challenges you faced while pushing some of these innovative solutions?

Giuliana Kotikela- Well, it’s not a one-size-fits-all, right? So, an asset won’t get you a 100% of the way there, almost guaranteed it won’t. But it will get you 60%, 70% right? Everybody’s different business, you know, processes and, and challenges within that, that’s all unique to them. So, there are definite modifications as well as what’s their business objectives in the short-term and the longer-term and then how do we, kind of, you know…reassess what we have to be best-of-breed for them. Right? When you think about an asset not all companies are at the same maturity level and so it’s difficult to run if you can’t walk! So how do you take some of those things and break them down into more bite-sized chunks to ensure that you have the impact but also the client receives the value, right? So, there’s not that “reinventing the wheel” per se, but it might not be you know super speed like marathon running.

Purav Gandhi- Understood. But, I found one thing interesting there. You talked about assets or products right? Essentially, it was services converted into assets or products. That in itself is a huge mindset shift. For someone who is not in the product world? How difficult or easy was it to bring that mindset change?

Giuliana Kotikela – That mindset change was probably the hardest thing to do. Selling a product, a natural tangible product is very different from selling let’s say a fixed fee or a rate per hour to a client. It’s not the same revenue model. It’s not the same business model also, the sales cycle is about 2 years from tip to tail. From the starting like, you know, the introduction to the client to the actual sale. So, if there’s no revenue generation or cut revenue coming in from that asset, how do you realize that there’s been you know movement or momentum in that effort, in that sales cycle, which is two years in duration. So when you think about it again, the rates per hour and all that, is pretty quickly done, Right ? You know 8 weeks or years. Yeah it’s pretty straightforward. So the mind shift, for the partners or the you know, the different individuals that were selling the engagement, the work, it was really challenging for them to kind of get that mindset and also, how does this benefit them.

Purav Gandhi- So, I want to stay with that thing a little bit more. When all of us read about innovation, we talk about unmet needs, about product market fit versus what I am hearing from you is, that those weren’t the real challenges. The real challenge was aligning to the internal business model, aligning to what people were comfortable doing because the size of the company is huge, that the change in direction is more internal driven as opposed to external driven.

Giuliana Kotikela – Completely! I mean you know, from a larger strategic view, you definitely have kind of the guidance and where you’re going. The good thing about the studios, allowed us to, you know, make these fast quick changes, these different types of business models etc., and to see how they really worked, and what worked well, what didn’t work, to make tweaks before we could actually roll them out to the larger engagement.

Purav Gandhi- I see, so that way you were able to at least demonstrate success and feel caution and adapt to it. So now, with that experience from Deloitte in mind, you have been running your own company for a while. How is it different?  How is driving innovation here different from driving it in a larger company like Deloitte.

Giuliana Kotikela – There’s some nuance differences… right?. I mean, you still have to deal with what is a business problem that you’re trying to solve, right? And go back to what’s the problem that you’re trying to address, who’s the buyer, and what are the different touch points, and how are you addressing those. So, that is you know, still pretty much the same. It’s just, now the difference is, you know, you have a hardware and software product. Is night and day different from a platform play, a software solution or any type of rate per hour. Right? The business models are very drastically different, when you have to deal with supply chain and manufacturing nuances that were not there before so far.

Purav Gandhi- So, just for the sake of our listeners if you can elaborate a little bit, right? When you say hardware play is different from software. Because a lot of us by sheer magnitude of numbers, come from the software side of things, from the process side of things. How is hardware different? Where all are the key differences? If you can give some examples, maybe?

Giuliana Kotikela – So you’ve got you know electrical engineers, you’ve got not just industrial design engineers, you have you hardware engineers. All of these different types of people, these different groups together, all the different circuitry so for our consumer product right, it’s a smart wearable. There’s 94 different components on our PCB flax, which is the actual internal board and the size is 17, what do you say…17 mm total in length. So, this is a very small piece double sided and in a ring form-factor. The challenge is, if you know when something goes wrong because of so many sensors that are included it’s not just one sensor, there’s five different sensors. You have to understand where the actual root cause of the problem is occurring so it’s not just one and done you have to go through the full end-to-end testing of everything. The full integration testing from start to finish, which is 9 day different from software. Software you can design it, develop it in your garage in 3 days and push it out. With hardware it’s just not even, it is not possible right? Not at that scale. It takes definitely weeks and months and even years sometimes too you know, I mean think about the generation of just like, iPhones iPods right? How did that start? How big was it? It was like the size of a computer, you know like the size of a large tablet and to make those things smaller and took the minimization process is very challenging and I think that’s where a lot of, I think there’s a lot of underestimation of, if you’ve never done anything with an actual tangible like, a hardware product, people don’t understand that they don’t have any concept of, “Oh, okay. I can do this in a month or three months.” And there’s also a low cost associated with it. With software, it’s much leaner, right? To design and develop that. With hardware, you have so many different rules and so many different users like, to test and to design, develop and create that. It’s just a whole ball of wax different.

Purav Gandhi- I see, that’s very interesting. The number of parts, and the number of stakeholders that you have mentioned. But if, and yet again I think hardware is also a very important area for innovation because only software can’t get you beyond a certain limit, you need better hardware, a better… it enables better utility, better adoption of any new idea. If you were to tell people like who are interested in hardware innovation, especially in healthcare, given healthcare is more complex when it comes to hardware. What are some of the key lessons and precautions someone had to keep in mind?

Giuliana Kotikela – So regulatory and risk considerations, right? So, that can push you back a good year, easily. And then, you think about compliance like if it is a med-tech device for FDA, any type of class 1, 2, 3 device, you have to make sure that you’re a GXP compliance. So there’s a lot of stuff that if you haven’t done that already or you’re not doing that currently to go back you can be heavily fined or face consequences from regulatory instruments. So there’s definitely some challenges with that you also want to make sure that when you’re designing and developing there are different quality standards, which are loose to the GXP and if you don’t have those already in place to change or restructure your whole supply chain to ensure that they have the proper certifications needed, it could not only just be costly, because small batches are extremely costly to run.

You can’t just choose another manufacturer really simply and say okay I’m going to go with you know, this person over here and they’re going to be half the cost. It doesn’t work that way with clear devices, medical clear devices. My biggest gotcha or recommendation for anybody going into this area would be to definitely have those right people on board in terms of, from a risk or regulatory standpoint, early and often and then also potentially an innovation or accelerator or partnership, strategic partnership with some of the big pharma or tech companies would be ideal to help navigation, where they have some stake in the game, right? Because you’re going to need that type of exposure so something like you know who else is building the Medtech devices today, you know, either Medtronic, you think about some of these different things or even Johnson & Johnson, you can even say Procter & Gamble (P&G). There’s some different players out there that offer different accelerator programs and I think it would behoove the person to definitely sync up with him

Purav Gandhi- I see. Got it. Makes sense. Fair enough. Jewels, another thing I personally, strongly, believe in, is that for anybody who wants to innovate and also run their own business, persistence is the key. You have to hang in there. It’s a game of time. I heard you say that as well. So, how do motivate yourself and what keeps you going and persist on the problem statement for such a long time?

Giuliana Kotikela – You know, you have to have some small tangible wins. Small wins will help you keep moving when things are very bleak, dreary and tough. And also, when you start seeing your product come to life, I have to say when I got my first ring, I was in New York and I was giving a presentation and a speech. And the package came and I opened it, and I literally cried. I sat there with an investor and I cried and he’s like…..( laughs). I just said, you don’t understand like, what we’ve gone through, to get to this day, to actually feel it in my hands, to sit here like with you, now. I was just overcome.

And even though software that I’ve designed and developed before has been wonderful and I’ve seen people, leaps and strides and what they’re able to do and the impact, it was nothing compared to that moment. Nothing. Right? To have something that you birth from conception like from nothing to something, to something tangible in the world and to see people actually able out there to use it, is huge. But it’s a long journey and so I think you need to step back into what are the small wins that can help not only just keep yourself, but the team motivated right? Those quick wins that can illustrate and triangulate not only what’s possible but the value that you’re bringing.

Purav Gandhi– I see. No, that makes a lot of sense. I think small wins are a key to surviving any longer marathon, I guess.

Giuliana Kotikela – And people always think, you know, it’s always about the white space. But, the white space…it doesn’t have to be outer space. I think you have to, you know…what are the small chunks that you can start working on in seeing those results quickly, that can keep everyone together…right? It’s hard to stay together when you start losing that momentum.

Purav Gandhi– Got it. Jewels, that was quite insightful to hear your innovation story. Any…any parting thoughts or words for our listeners, especially who want to play in the health care innovation space on the combination of hardware and software?

Giuliana Kotikela – I think if anybody you know, needs any help with any of that, please reach out, let me know. I’d be happy to connect anybody if I could and in addition it I would love to just impart with or you know, and if any of the listeners that, you know, Med tech needs more innovation and I think that the only way that we’re going to get there is by people taking the time to start investing more with medical devices. Right? Early and often. Like, small, smaller startups that have the ability to do something much more dynamic.

Purav Gandhi– Got it.  Well Jewels, thanks for taking the time. Really appreciate you sharing your story and words of wisdom. Thanks so much, bye!

Giuliana Kotikela – Bye guys!