Time is your most precious asset” Dr Elin Haf Davies
Podcast transcription - 3rd April
Alan Cowley: Welcome to another Invested Investor podcast. I'm sat here with Dr Elin Haf Davis. Elin enjoys combining her professional career with extreme adventures. You're a former Welsh rugby player. You're also currently focusing on your company Aparito, which ties you into your clinical background. What led you to healthcare?
Dr Elin Haf Davies: I grew up in North Wales and my mom was a nurse. From a very young age, so sort of three, four years old, I always knew I wanted to be a nurse and there was never any other career path that I considered really. Becoming a paramedic instead of a nurse was as far off that I went throughout my whole sort of childhood in thinking what I would do, and I often say that becoming a children's nurse is by far the best personal and professional decision I ever made in my life.
Alan Cowley: Okay, how long were you in nursing for?
Dr Elin Haf Davies: I started my training in '95 I was still nursing up until 2007. I moved from clinical nursing after about six years of qualifying to do research, but still very much as a nurse, but with some of the added research sort of phlebotomy skin biopsy, GCP sort of obligation as part of that.
Alan Cowley: What changed?
Dr Elin Haf Davies: It was more opportunity to be honest, there was never ever a plan to leave clinical nursing. It was more of an opportunity came up, which sounded quite interesting. And it was more than I guess, a combination of serendipity and opportunities and things that led me into research and then the career pathways that followed. And as I said, never ever thought that I would have ever left clinical.
Alan Cowley: So, the research you went into was?
Dr Elin Haf Davies: Looking after children recruited into clinical trials. So around 20 different pharmaceutical funded clinical trials across four different therapeutic areas. And then that experience motivated me to do my own masters and research methodology. That led on to then my PhD, so I turned out to be a part-time student for 11 years as well.
Alan Cowley: You've got your masters and PhD, and then you then went into the European Medicine Evaluation Agency?
Dr Elin Haf Davies: Yes. In 2007, Europe launched its paediatric regulation which forced pharmaceutical companies to consider the needs of children and their drug development lifecycle. By 2007, I'd been looking after children in these clinical trials for quite some time, getting increasingly frustrated at how inappropriate and un-child friendly these clinical trials were. Couldn't get my head round why pharmaceutical companies weren't doing better clinical trials and kept being told, "Oh, it's the regulator's. They're making us do it this way," sort of lying. And so, when I heard that the paediatric regulation was being implemented in Europe, I met the head of paediatrics in a conference and had a chat with her, expressed my huge enthusiasm that I thought finally the regulation could lead to changes and clinical trials for children. We had a follow up email, follow up meeting, and then I was amazingly, offered the opportunity to be part of the paediatric team to implement the regulation in Europe.
Alan Cowley: Did you manage to make those changes?
Dr Elin Haf Davies: Yes, I think that's where naivety comes in, much like I thought that completing my PhD would have the influence I wanted, and then you realise that only two people read your thesis. The paediatric regulation was a huge success in terms of finally changing the mindset that it's more ethical to protect children through research than it is to protect children from research, and if we protect them from research, we end up with widespread dosing of drugs that we don't know what their dosing efficacy safety profile is. What I think shocked me was that as a regulator, you actually have very, very little influence on a lot of the decisions that you want to do in terms of the overall study design, and you are sat waiting for the pharmaceutical companies to knock on the door and tell you what they're planning to do and you have no way of really intervening in the way that I had naively thought.
After six years which was a fantastic opportunity, I was leading a part of the WHO essential medicines list for children working group, had fantastic opportunities but still, in my impatient way, very frustrated that we weren't seeing the changes I wanted to see in clinical trials.
Alan Cowley: Do you think what you originally believed, that regulation would change it was the pharmaceuticals or as a combination of both?
Dr Elin Haf Davies: I describe it as this sort of standoff between the two, where they're both staring each other out to see who blinks first really. But the most of the risk aversion I think is at the pharmaceutical side. They are far more risk averse and prone to legal interpretation of everything by their lawyers than regulators are. The adaptive pathway pilot for example, was the one that was saying, "Come to us with innovative solutions, come to us with proposal, be open to be transparent." Nothing really innovative emerged from it. So I think the pharmaceutical industry is inherently risk averse possibly for the wrong reason, I'm not all convinced this is because of patient safety, and it's just such a big beast of an organisation to implement any change.
Alan Cowley: You've had your civil servant background as a nurse, and then in European Medicine Evaluation Agency. What drew you to become a founder and start-ups?
Dr Elin Haf Davies: As I say, it was not the plan, and so nearly five years later with Aparito, it sounds like the most insane thing to say but I never actually planned to start my own company. My head looked towards going back to academia to try and develop the technology and the concepts in academia. And then thought well, even within academia, you're still bound with a lot of organisational bureaucratic grant writing things. So maybe another way to do it would be distinct myself as a legal entity, as a company. In all honesty, I registered Aparito to start with as a legal entity in which to legally operate as opposed to thinking, "Yeah, I'm going to be a start up."
Alan Cowley: But your passion is clearly in healthcare. So, Aparito, obviously it came from not necessarily an entrepreneurial mindset, but do you feel that your background in healthcare has been massively beneficial?
Dr Elin Haf Davies: For me, having now been in the tech start-up med-tech digital health space, I think we have seen a huge amount of explosion of interest in the space particularly in the last two years. Four years ago, it was just a bit of a rumbling and now it's a massive beast if you like. I think what's key is that I'm really driven from the patient need, the clinical perspective and the regular demands, as opposed to thinking, "I'm coming to it from a tech product, tech capability thing." And then saying, "I've now got a product let's look for a problem to fit it," sort of thing.
Alan Cowley: So, could you give listeners a little bit of insight into the company. What is the company and what do you produce?
Dr Elin Haf Davies: We are are a tech enabled company, which we've developed a software platform for capturing more patient generated data. What we wanted to do is validate new endpoints, new outcomes that can be captured remotely and passively by the patient's themselves to illustrate what the disease burden and the symptoms and the impact of the disease really is, from the patient's point of view in their day-to-day activities, and not from a clinical medical diagnostic tests way. And so that technology enabled utilising your smartphone apps, integration of wearables, videos, photos, those things.
Alan Cowley: So, patients wear your tech and you collect the data. What's been the biggest drive of the business?
Dr Elin Haf Davies: It's just important to distinguish, I think wearable, much like blockchain and AI is like this hot topic. Unless you've got wearable AI or blockchain in your business plan, some people think you're nothing. Wearable is one tiny piece of the picture. There's lots of other patient generated data like your medication adherence, your real time symptoms, your adverse events, which can be captured in videos, photos, voice text. The wearable can, in some instance add value, but I think much like anything the pendulum now swinging far too far, and people are thinking, "Oh, let's just put a wearable on anybody and everyone, and then we'll get some data." I think we are just drowning in volume of data rather than really thinking what's the value of that. More importantly, what's the real patient centric right thing to do from a patient perspective. Is it right to be expecting them to wear the wearable for the right reason, the right type, the right direction, and things like that.
Alan Cowley: Is it?
Dr Elin Haf Davies: Not always. There is a huge balance to be had in terms of considering the quality of data that you need from the wearable. Tends to mean that you need medical grade wearables, which are very big, very clumsy, very short battery life and not Bluetooth enabled, very cumbersome, very expensive. Whereas the wearables that you could integrate, you're more Fitbit sort of consumer grade ones can be fit for purpose if it's sort of general patterns over time, but there're no medical grade scientific data. And so that's where you have to balance what do you actually want in the context of use? Is it fit for purpose and is it right to be expecting the patients to be doing that all the time?
Alan Cowley: Have you raised?
Dr Elin Haf Davies: We've done two investment rounds, which yeah, I think from my background was a massive culture shock and adjustments and took some sort of getting my head around. But yes, we have closed on two rounds.
Alan Cowley: What sort of culture shock and challenges have you noticed from that?
Dr Elin Haf Davies: Well, I guess I was one female, there's not many female entrepreneurs. There's certainly not many female entrepreneurs in the med-tech digital health space. I had no previous corporate industry business background, very much a civil servant and people just either considered that I was trying to set up a charity or an NGO. So, it was quite difficult to stick to saying, what I wanted to achieve and not change the pitch to suit what investors seemed to want to hear.
Alan Cowley: What sort of help have you had along the way?
Dr Elin Haf Davies: We were lucky that we got Bethnal Green Ventures right at the beginning. Bethnal Green Ventures invested in us when we literally just had a few pages of PowerPoint ideas and nothing else. They've been instrumental in giving me an overview of how the space works. And then there's obviously been people along the way, we were very lucky that Development Bank of Wales and Bayer Pharmaceuticals were early investors for us, and they helped a lot. We had a couple of accelerator incubator programmes between the B2B and the Bayer one.
Alan Cowley: As I said before, you come from a healthcare background. Do you feel that because you've come from that industry, it's made it easier or do you think that just doesn't really matter when you start your first company?
Dr Elin Haf Davies: I think coming from the healthcare background, it's given me a very good grounding to stick to what I know with healthcare. Healthcare will really not be disrupted by tech in the way that other industries will be because of patient safety. When I look around all the other start-ups, med-tech digital health companies that are all going, "We cannot disrupt healthcare." Well, they just seem to not be understanding either the clinical pathways or the regulatory compliance. My combination of understanding clinical pathways, but also understanding regulatory compliance obligation meant that I was able to just crack on and do that, and not get too lost in the hype of tech mindset, scalable, fail fast, disruptive, which culturally doesn't work in healthcare. I think this is hopefully one example that people can finally click and go “Actually, if we're investing in healthcare, this is more akin to investing in pharmaceutical drug development diagnostic product, not in scalable tech start-ups."
Alan Cowley: What are the biggest challenges you faced and how can this help other entrepreneurs?
Dr Elin Haf Davies: It's an incredibly difficult question because we've had problems in terms of getting contracts. Being a new start-up and persuading big companies or anybody to trust us. When you need to go through procurement, RFPs, and due diligence. They go, "Well, you're only two years old. We don't work with start-ups that size." There're problems on that side. Then there's problems on trying to explain to the investors what the vision and the big goal is, and to keep investors on the same page as you're trying to achieve.
What I mean by that is, a difficult one. It's really tempting to just say what the investor wants to hear if they're getting very excited about certain things. And if your investor is new too helpful, not necessarily familiar, and they want you to explore some things and push certain things, it's obviously quite tempting to agree with them and go, "Yeah, yeah, yeah." And it's much harder to say, "Well, actually, no, that's really inappropriate for healthcare," or "That's really not likely to fly." So, it's that balance of being honest and saying no to investors. You're thinking, "Oh, I'm going to offend them," or "I'm going to lose that investor," but in the long term, I think it's a better way to be.
Alan Cowley: How many staff have you got now?
Dr Elin Haf Davies: We're a team of eight, but not all full-time, so the techies are now more part-time.
Alan Cowley: How have you found that? Did you ever have to do any hiring or firing in previous job?
Dr Elin Haf Davies: Yes. I had done people management in my role in the NHS and I'd sworn that I would never do management again. It doesn't necessarily play to my strengths. So yeah, obviously you need to do the whole management, recruitment, payroll, HR, it is really time consuming as well. And as a start-up, you can set some of the objectives and targets today, and get it through, and then something will happen tomorrow that you need to completely change that. Some people are okay to understand that it's a start-up and that things change on a day-to-day basis. Other people, especially if they've spent the, majority of their time in big corporates. That sort of change and having to balance 510 balls in the air at the same time is not everybody's cup of tea.
Alan Cowley: Do you find that your staff are all on board because of the mission, you've gotten the culture you've created?
Dr Elin Haf Davies: The tech team, the majority, of them had never worked in healthcare before. And they'd come from a contact of a contact, and I do think they got excited and behind the bigger concept, having worked in say, more financial tech related services before. I think they are proudly enjoying the opportunity to be in the field we're in now. And of course, then my other colleagues they'd already worked in healthcare. So I think they're buying more into the concept that we need innovation to start changing these clinical trials experience.
Alan Cowley: I know you've touched on some challenges that you've faced, but do you have a main tip, or a couple of tips that you could give to entrepreneurs?
Dr Elin Haf Davies: The two biggest aspects are time and stubbornness. I know people tend to refer to stubbornness as being determined. But at the end of the day, I think it comes down to just being inherently stubborn. I did not mean stubborn as not changing your mind about things. Definitely not. But be stubborn, so like a dog with a bone that you don't let go.
Alan Cowley: Resilience?
Dr Elin Haf Davies: Yes, resilience plays a part. All the resilience, perseverance, determination, stubbornness, they're all part of that bigger picture that you just know that you want to carry on doing it. And then I think the other absolute fundamental thing is time. I don't necessarily mean time as in, "It's going to take me three hours to write this investor deck or eight hours to write these financial forecasts." It's more to do with a time duration from start to finish. Because by the time you send it to somebody, and then they read it, and then send it back, and then you have a meeting, and then they have to have another meeting. It's that combination of cash flow and time, that’s where the biggest problems happen because things do not ever work as quickly as you anticipate. So I've tried to adapt it all, now I add a bit to what my expectations of time is, and then anything that comes through quicker than that is obviously just a bonus magic thing.
Time is your most precious asset. I didn't take any salary from the company for the first two years. And so my time really was valuable at that time and you realise that other people then don't use your time as wisely, who appreciate or respect your time in quite such way. That's why for your own thing, really protect your time.
Alan Cowley: Do you think, back a little bit that the runway is a real factor that eats up entrepreneurs or can eat up an entrepreneur?
Dr Elin Haf Davies: Yes. That's why runway is really the key thing that I think is what kills some start-ups. And also it's the long runway that can kill an entrepreneur's sort of determination because it's really hard to maintain motivated and passionate about something into months, years kind of thing. When you're exhausted and still have no cash and stuff like that.
Alan Cowley: No, no. I've heard investors say before that one of the key things for start-up failing is investors not giving them any more money. There's a lot of reasons for that. But again, that's hitting that end of the runway. So you talked about stubbornness, I want to bring on the adventures. You've rowed across the Atlantic, you ride across the Indian Ocean, you've sailed across the Pacific, and you've run across Central America.
Dr Elin Haf Davies: Yes. Well, I was more walking in a shuffle and then I'd run.
Alan Cowley: How do you think that the adventures that you've done have influenced your start-up life?
Dr Elin Haf Davies: Yes. One of the key things, I think, when you ride across an ocean, it does give you a mindset that says, "Actually, if I apply myself to it, I can achieve anything." So successfully rowing across an ocean does give you a confidence or belief that if you apply yourself, then you can go out and achieve anything. That was a key factor I think.
Alan Cowley: Do you think that an entrepreneur should row across an ocean to become successful?
Dr Elin Haf Davies: It is a very good question. I think every investor before they invest in a company should get an entrepreneur to an ocean to prove that they really want to do it. Yeah, a very good test of steely character. But I think it's also to do more with demonstrating that if I start something, I really try, and follow it through to the end and finish it. And whether it was from my nursing days of working night shifts, 4:00 in the morning when you're really sleep deprived on your fifth night shift, and you're cleaning up bodily fluids and tears and emotions, you really need to want to be there, to carry on doing that. Rowing in an ocean, you're broken, a storm comes and hits you, you really need to want to be there. I guess it's being the same way at Aparito really, when it's not been so enjoyable, I remind myself that I really want to be here.
Alan Cowley: No, no, I think that's sound advice for any entrepreneur that would soften you at 9:00 to 5:00 for what can be endless nights, lack of sleep, and that stubbornness you said is absolutely, vital. How do you adjust to normal life after a big challenge?
Dr Elin Haf Davies: Yes, it's a good question. I used to call it sort of holiday blues of an epic scale. It takes a long time to readjust. You've been through what on your personal level is this monumental experience, and you've got so much emotion to process and experience to share. And of course, within two days of coming back, none of your friends and family really care in the nicest possible way. They prefer to talk about the fact that next door's cats up a tree and things like that. So, it takes time to process and readjust to community, into work, and paying bills and things like that. Which I think is why I then always set another challenge, that was my way of readjusting, so it is quite addictive. You get some feelings of pushing yourself to the limit that makes you feel alive in those environments, that you don't get in a day-to-day existence.
Alan Cowley: What is the next challenge?
Dr Elin Haf Davies: I had always said, I really wanted to do the bustle in a world race, which is sailing around the world with just one other person. That's still very much what the real next big adventure I would really throw myself into. The problem now is that I'm getting older and everything's getting more expensive, and Aparito is becoming an all-consuming existence that certainly for the near future, I'm not going to be able to step away from. Maybe a slower, gentle cruise.
Alan Cowley: Investors are going to tell you this is all for now.
Dr Elin Haf Davies: Yes, I mean, it's interesting. On the one hand, I think some investors see the fact that I've rowed oceans, sailed oceans, and done various things as a sort of indicator that I'm determined and things like that. But it was interesting on the last investment around, they had slightly more of a panic, saying, "Well, you have to give us commitment that you're not going to go and do another adventure for the next three years, at least." Because they were panicking that I was going off to do another adventure, which I thought was interesting and my slightly devil's advocate provocative mindset was going, "Well, you'd never asked me if I was planning to have a child in the next three years and go off from maternity leave. Would you?" And it's like, "Oh, no, that's obviously very different." I get that, but equally unpaid leave for three months for an adventure, then it's quite different to nine months and maternity leave. But I think it is investors, that are obviously wanting to protect their interest, and the idea of me going off on an adventure doesn't reassure them.
Alan Cowley: Well, you still got that investment round?
Dr Elin Haf Davies: Yes.
Alan Cowley: Well, Elin, it has been absolutely, fantastic to hear from you, hear about your adventures. We're recording this with the last day of tAhe Six Nations coming up, so we probably have a different view on that.
Dr Elin Haf Davies: Grand Slam.
Alan Cowley: Yeah, it's been brilliant. Thank you very much.
Dr Elin Haf Davies: Thank you very much.
Peter Cowley: Thanks for listening to another Invested Investor podcast. You can subscribe to all future podcasts via our website Investedinvested.com or via a number of podcast platforms online. Remember, you can order our book online and be sure to follow us on Twitter, LinkedIn and Facebook to get the most up-to-date, interesting and insightful content from the Invested Investor.