Alexandra Greenhill, Careteam Technologies - Founder Journey Series, Episode 7

For most people, being a doctor and creating your own practice would be more than enough. But not for Dr. Alexandra Greenhill. Dr. Greenhill's entrepreneurial drive allowed her to build not just one but two tech startups. Listen in as she gives us a behind the scenes look into the opportunities of building a health tech company, but also the challenges of building a global health tech company.

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Back at again again this week with another amazing entrepreneur, one of my dear friends, Dr. Alexander Greenhale. Yes, you heard that right. She is a doctor and she is a kick ass entrepreneur. She's built two great companies at a launch academy and I've had the privilege of watching grow firsthand. Dr. Greenhill is one of Canada's leading physicians in digital health innovation and she's the CEO and chief Medical officer of Care Team Technologies. We'll get into what Care Team does in a few seconds here, but after 15 plus years as a director and C level leadership role in tech companies and in the medical field, she spent the last few years leading and advising Canada's most innovative technology companies. Alexandra, welcome to Founder Journey. Why don't we start by introducing you to the audience. Tell us a little bit about yourself.

Well, as you said, I am a doctor. I call that my license to heal, not license to kill. But it's a privilege to be put into a place where you can actually help people one on one. You know, conversation like this, somebody shares a problem and you actually have the skills to help them. And so after practicing for a while, you know, in the middle of the digital revolution, we started digitizing the tools I was using. So we introduced some of the first electronic medical records in the hospital where I was practicing and then into clinics, did some of the first telehealth, direct to patient type of tools and experiences. And, and you fairly quickly realize that in as much as there's power in helping people individually, someone needs to step out of that individual rewarding relationship and build the kind of tools, systems and approaches that can help everyone else be more effective. As new technologies get created, how can we make sure that they're adapted to what we need in our clinical work?

So I usually dive into deep questions a little bit later into the interview, but this is something that I want to just dive into early with you because you're such an amazing person and a lot of insight here. So you are a doctor in the Canadian landscape, you're building a technology company or you built multiple technology companies, you've implemented technology, but technology is universal, can be applied around the world. How do you approach identifying ideas and opportunities with the Canadian landscape? Lands on. But build it so that is actually universally deployable. Because in us, healthcare system is very different. Europe is different, Asia is different. You obviously want to build global businesses, so how do you, how do you adjust to that? How do you find a killer idea that can be global?

Well, it's an interesting question because so much of healthcare is very regional. It's not even national. Is the way you treat patients and you organize a healthcare system around them is different within even the same cities in the same region. And so when you look at a system like that is always different. There are certain minimum specs or constant rules that are the same. You have patients who are not well. You have people. They may be physicians, nurse practitioners, dietitians, pharmacists, but it's a human being that's given tools to help that person who's not well. And then you have someone who pays. And so the someone who pays could be a publicly insured healthcare system like Canada or the NHS in the uk, or it could be a private insurer, could be patient paying themselves. There will be variations on what exactly happens and how all of these systems drive incentives as to do you do too many tests, not enough tests, or do you wait until you're really sick till you get the system, or do you use preventative care? But those are just small variations. The constant, though, is the same. And so we looked at healthcare from that perspective. Instead of looking at what's different, we looked at what's common. And the big thing that was common, that we wanted to fix, was the entire system of digital use in healthcare was predicated on recording what has happened. Every acronym of every software we use has an R in it. Emr, Electronic Medical Record. Ehr, Electronic Health Record for hospitals. Phr, Personal Health Records for Patients. Well, the record is important because it tells you what has happened, but it's not that relevant most of the time. What's more important is what should you do next? And not just for the one condition that that one human is seeing you for, but for the combination of health issues that you may have. Because a lot of people, unfortunately, by genetics, lifestyle or things that happen to them as accidents, end up with many diseases at the same time. So how do you put all of that together in terms of a plan of action going forwards? And that's what we wanted to do with Care Team, and that is something that no healthcare system has figured out. And this would be a relevant extension of all of the investment that they've already done into their own health systems. Because it takes what you have, which is a record of what has happened, and it transforms that as the foundation for the plan of what should happen and the tools to ensure that that ideal future actually occurs.

Because currently a lot of these records just sit in isolation, whether it's in data silos or in different clinics or different physician offices. Especially if somebody that's got a serious ailment probably sees three or four different professionals or practitioners or whatnot that they need to treat them, but they're all collecting data independently of each other.

You did a time study of a patient, and the patients that we studied, 17 logins was the average. You had 17 logins to the digital front door of your pharmacy, of your hospital, of your physician's office, dietitian, physiotherapist. And so even if you were to create a single logon, you still need to repeat your story 17 times. And one hand literally doesn't know what the other one's doing. And so you end up with chaos instead of music. And we have so much capacity and insight of how to help patients. But if you think about it, 10 years ago, we had no apps in healthcare. Today in the App Store, there's like a quarter of a million 250,000 health and wellness apps. But the problem is, how do you then combine them in a 24 hour period? Which one do you use when, or what's the right app for what person? And that's one of the biggest problems we have to solve because that fragmentation you described is getting worse, not better. There's more options for more people and we need to start figuring out the tools that they have to combine them and use them appropriately in their day.

And now that you get, well, you're obviously a healthcare professional, you know the industry, you know what's right and what's wrong. But you're also getting people that have that background creating things, because it's that much easier to create things today. But you get into this issue of data integrity and also data security. What's your view on that? Yes, it's great that people are jumping in and creating solutions, but are they bad actors or people with good intentions but doing things that are harmful?

Yeah, unfortunately, that is. And so people have done studies and simple things like privacy policy in terms of use. Something like half of the apps in the App Store for healthcare purpose didn't even have that published. And so when you've experienced a problem, typically you want to jump in and help. And we see a lot of people with technical business background sort of say, I've lived through this, I can solve this. And they spend a lot of time and energy and money building a product that is unfortunately then another silo in is often not informed by any evidence. And so the number one advice I give to people who want to build a healthcare product is go do a literature search. That means go look at all of the medical articles that have been published on that topic so that you're not accidentally providing a band aid solution when you need a much more systematic, earlier, before the person exhibits the symptoms, type of approach. Or you can learn from all of the failed attempts so you don't start at square zero and repeat the mistakes of others. Look at what's being published, build it into what you're doing, ensure that somebody who is not you is studying your own approach. So I do research, but I can't study my own app that's not scientifically appropriate and build all of that evidence into it. And then the second piece is that management of privacy and security. And a lot of people just talk about privacy. Well, without security, you have no privacy. It doesn't, you know, the two have to go together. And the biggest risk is often people, but the tools you need to put in place. And then there's responsibilities around auditability so you can document who did what and when and how so that if somebody wants to go back and challenge the privacy, you can surface what, what has been happening on the app around each individual user.

So I want to change gears here a little bit. We've talked a lot about the industry, We've talked about care Team. I want to focus in on you. What does entrepreneurship mean to you? You're a doctor, you have a very successful practice. Even building the practice on your own is an entrepreneurial endeavor. What motivated you to start building tech companies and building something outside of your practice?

Well, I mean, so entrepreneurship is both something that you start because you are attracted to a better idea or because you're frustrated with something that doesn't work in your daily life. And so you mentioned the sort of the 15 years of working within the system, implementing some of those massive digital tools. And we started in putting a lot of effort on the premise that this was going to make life dramatically better for the clinicians and patients. And the output was unfortunate because studies now show that the burnout the medical professions experiencing is largely driven by tools that require them to spend four hours documenting for every day of work that they do in a way that is click, click, click, click, click, and doesn't think through their needs or how the workflow goes. And so in my case, it was this. Do I continue to improve things within by trying to ask the people creating these tools to do a better job or to change things, or will that be good enough? Or do I have to jump into the fray and say I can put together a team and influence everything from within that space to start creating tools that are better within the vision that we have for the company that we're creating, but also by mentoring and connecting and advising others in that space and helping them realize the value out of using evidence and creating tools that are not trying to boil the ocean and create and solve everything, but that are meant to collaborate the way clinicians collaborate around the patient.

As a doctor already live very stressful life, and we all know very well that being an entrepreneur and just starting one business is stressful enough, let alone the business of running your practice, the business of running a startup, but also the stress that comes with being a doctor and dealing with pandemics and things that are happening all around you. How do you, how do you do it? How do you handle this? I mean, and you've got a family and you've got, like you do volunteering, you work with other entrepreneurs. Like, I'm waiting for you to whip out your superwoman tape here.

But a few things that are really important. There's the visible elements of everything you just described. But when we set up this talk, you said, be real and authentic. And so for a moment, I'm gonna go and be real and authentic. In the time since we've known each other, my younger brother was diagnosed with terminal cancer and passed away four months after being diagnosed, after being misdiagnosed with symptoms for about a year before that. And so we kind of missed the window to get them treated. My husband's parents went through some heavy two to three years health care issues and passed away. My stepfather passed away in March, right before the pandemic happened. And thankfully, I could actually fly back home and help my mom organize things. But that's now the stress of her living all by herself, really, really far away. And, you know, three kids, you know, one had a concussion, the other one had a lot of issues in school. And, you know, and the third one is just young and has a lot of demand and time. And so we all carry a number of these sort of life events that happen, and they challenge our systems, they challenge us to change, to renegotiate, to discuss things. And whenever all of these things happened, part of my ability to continue to actually be present in the workplace and be positive came from several things, including an incredible network of support. And so, you know, a husband who is just a rock, number of friends who stepped in and said, how can I help? What can I do? And helped me to deal with not just the ins and outs of this, but the incredible emotional devastation that came with that sort of a terminal cancer diagnosis and somebody who's so young and promising. And so, you know, without that network of support, I would be crumbled in a wall in sort of a corner somewhere, crying. But because they were there, they offered help and I was willing to accept their help and assistance. I could maintain a fairly productive work life and travel through all of these difficult situations without losing my sanity. And then the last and the biggest piece around this is, as physicians, you witness so many life dramas and you see humans overcoming them with incredible inspiring integrity. And so having seen people die informs you that you have to live fullest. It informs you that you have to show up and be your best in the relationships that you have, that you have to be courageous and open and honest and say no to things that otherwise people are pressuring you to say yes to, because otherwise you're going to live someone else's life, not the one you are meant to be living. And there's opportunity to be helpful because when you have capacity, it's your obligation to help, because one of these days you may need help and someone else who is too busy to do it otherwise will step up and help you. And so it becomes a virtuous circle. And with the pandemic in particular, my first patients were people who survived the Holocaust. There were actual former intern of the camps in Auschwitz that were being treated as a Jewish general. And so meeting people like that and knowing that they had encountered things that are worse than any one of us is going to encounter hopefully in our lifetime, and yet they could them with grace and rebuild life and see the positive in others just gives you such incredible encouragement to be the same.

Yeah. First of all, thank you. So honest and transparent and sharing this with our audience here. But you and I work with a lot of younger entrepreneurs as well, and we see the fire and drive and a lot of them think, I'm going to raise a lot of money, it's going to solve all my problems. But we know that money doesn't solve your problems. And even if it does address some, there's things that are going to happen around you in your personal life or in the industry or pandemics things that you're not expecting that you have to be prepared to deal with. And like you said, you got to deal with it with grace and dignity and realization that there's no magic pill. You can't just take a pill and see everything disappear. That requires a lot of work, no matter what you're going through to overcome it. And the more you try to do it on your own, the harder it's going to be. Open up, ask for help. I think that's the biggest thing is people, especially entrepreneurs, type A personalities. I'm a perfect example that somebody that never asked for help that should be asking for more help than he does or she does. And that support network is very important. And I've had this conversation with a few people. Tech is like a unique industry where you've got people that are volunteering, jumping at the bits to give you advice, go for a coffee, make a connection, connect you here and there. Doesn't happen as much or as often that we'd like to see in other industries. What's your take on that? The power of the network.

It's sort of. It stems from a culture that San Francisco successfully sort of created and is sort of encouraging others to. To adopt. And it's that idea that innovation happens within that flywheel that exists of people helping each other, of people who figured out the basics of building a business and can help somebody with a different idea travel that journey easier because they're paying it forward. And that really powerful concept other industries definitely should adopt. But even within this industry, it's something that not everyone knows how to tap into or feels that they know who to ask and how to access the kind of people that they need to access. In particular, women. You know, I meet a lot of people who say, well, the networking is optional. You know, I have family at home, it's set at hours where I can't show up. It's evenings or early mornings, and I have other duties and obligations. And the networking is the piece where you run into somebody and they tell you something that is actually useful that you didn't even know was necessary, but is that random, seemingly random exchange of ideas and connections that creates the capacity for you to have insights that otherwise you wouldn't. And when you have, when you have a need that you've identified, know who to call to either take a coffee with you and tell you the information you need or refer you to someone else. And so not everyone realizes the importance of this and not everyone knows how to tap into it, but it's absolutely essential.

Being a female entrepreneur in North America and Canada, the US Is difficult, it's not an easy task. But our audience here is international and I've been traveling around the world as you. And we see entrepreneurs in Africa, we see entrepreneurs in Asia, but more importantly, female entrepreneurs or females that want to be entrepreneurs, international women, how would you encourage them to go out and take that risk, be an entrepreneur, whether it's come to Canada, use our startup visa program. Launch can help you with that. But you have to get in that mindset of I'm going to take this risk, I'm going to take this challenge on. I need to see this problem solved.

Well, I've been fortunate to be part of several global networks. And so the Cartier Women's Award runs a competition every year and you're a.

Winner, you're a fast winner.

That was an amazing experience because you compete globally, right? And so there are people from all six regions of the world in the competition. The Black Box by Google for Entrepreneur ran a program where they invited 15 founders from all kinds of different countries to a residential program on campus in Palo Alto. And you got to meet people. And then the Global Entrepreneurship Summit, you know, that Obama hosted in 2008, I was part of that. And you really meet many people from different places. And the difficulty changes somewhat, but it's still difficult. And so it's difficult for anyone to start a business. It's easier than it used to be, but it's still a challenge because there's so many unknowns. And so you're jumping into something where there is no path usually. And so you have to create the path and you have to convince a number of people around you that that path is worthwhile. So they join your effort, fund your effort, buy your product before it's even built. And so on that journey for women in particular, one of the big things is following examples of leadership. And so listen, looking at Michelle Romano, who had been a competitor in the Cartier foundation competition before me, and, and looking at all of her achievements and now what she's doing with ClearBank inspires. And there's a number of leaders like that around the Canadian and international ecosystem that are talking about their experience, their raising profile and they're giving a different path forward. And so I was just interviewed for a report and I'll send you the link so people can download it and read it, that interviewed a number of women who are leading high power growth companies. And one of their conclusions was that for women in particular, the path forward is not the same, it's a lot more. Different versions of what success looks like and how they choose to go about it. Because some of it is you have no choice. So you have to take a sidestep relative to others who have access to funding or other means faster. But sometimes it's a choice to do a sidestep because you care about the output. And the output needs to reflect a certain vision of the universe that is not the one that the investors want or see or believe in at the early stages. So you need to find another way of proving out your thesis and then getting the investment. And then last but not least is that for women, confidence is not bravado. That there's a bit of a myth out there of the entrepreneur who arrives and who's like slash and burn and so cool and like the hip rock star are. And you can be very confident, but in a quieter, more subdued way that is much more effective in the long run.

Yes, success is measured in so many different ways and success is in the eye of the beholder. But the challenge that we have as a society is up until now, the Internet and social media has kind of changed this and starting to evolve. But. But what success looked like was basically what was shown to us by those successful people. When you talk about the Rockefellers, you talk about the Iacocca and the ones that all the books written about, those are very embellished and skewed views of what success was. And that then became the benchmark that everybody just kept using moving forward. But it's not realistic, especially for female entrepreneurs, because they would not do that. No way in hell would they treat people the way that some of these other people did because that's what it took to get them to the top. Like, no, that's not how you need to get to the top. Yeah, that might have worked for them, but it came at a very specific cost. And you don't necessarily have to do that to be successful. And that's what we're coming to this realization now. It's taking slower than I'd like to see, but people are realizing that path to success is capable in very different ways.

Look at some of the other folks that we met back in the day when you started Launch Academy. And so you think about the success of Thinkific and Greg Smith or, you know, you mentioned, I think one of your other guests was the founder of Clue, Jason Smith. And so, you know, these are guys who are not your flashy, I'll be rude to everybody type of people on the Contrary, they're fantastic. They're just real human beings. They create a culture where humans thrive when they show up at work. And so I think that a lot of times, some of those skill sets that are sort of focused and described in women are starting to resonate across the full ecosystem because it's the perception of what's a sustainable entrepreneur. What is somebody who doesn't just sort of raise a lot of money and then crash the company four years later? And wouldn't that be a better outcome for everyone who's investing in that organization?

Yeah, and it goes a whole long lines of there should be female. Female parity on boards because. And I take that one step forward. So you should have a fine balance of male, female and lgbtq, but also ethnic and demographic and geographic backgrounds, because you're getting the best of everything by getting different perspectives to the table. Because we now live in a global world. There are global opportunities. It's not just about how can you get the fastest path to making a buck. It's about how can you make the deepest impact in society, in your customer base, in your geographic location. But you can't get there without all these different perspectives, because an entrepreneur, even a executive team, only has certain viewpoint.

And it's about diversity and also listening. And so wisdom of crowds. James Surowiecki actually did research on the diversity and sort of the importance of that to make good decisions in health care. We've come to realize that there was a bit of a hierarchical approach, and Atul Gawande and checklists show that it's the same as in the airlines industry. And so you need to empower every member of the team, down to the orderly, to point out that the surgeon is about to operate on the wrong leg or otherwise mistakes will happen. And so we need to create much more of that perspective of the world is flat and everyone can contribute and everyone's perspective is different but must be listened to. Because one of the things I run into is people have these good intentions. They put together a board that has all this diversity, but then you have these clashes of cultures because you're using slightly different words. You're coming from a perspective that the other person doesn't understand, and therefore that creates tension. And so if we can think about diversity, but also the fact that, you know, in our team, for example, we love disagreements. And so when somebody disagrees, usually there's an air of caution and you're like, oh, you know, do I dare speak that out? Well, the reaction is very different if somebody disagrees. And you say like, yes, we are about to have a breakthrough. People pay attention. This person seeing the problem from a different perspective. So if we've selected good, trustworthy people who believe in the mission and the vision, we're not doing it just for the sake of disrupting the conversation. Now is a good time for us to listen to what the person's really saying and understand it, as opposed to try and say, how can I convince them of my perspective? And it takes longer and it's more difficult and it's frustrating because in a startup you want to get it done quick. And you're like, what do you mean? I need to now argue with my junior employee who's saying, like, wait a second, you have a B2B product, but why aren't you selling it to customers? I don't understand. Well, let's unpack all of that. And one is share what we know and why we've made that decision and make it easier for them to understand. But also maybe they see something that we don't see that we need to take into account. And let's, in the busyness of everything, take a minute and have a proper conversation. Or we've come up with language. We often call it crack it open, which is one of our advisors who gave us that term. But crack it open means we don't have time to deal with this right now, but we commit to finding a time within the next week or so to sit down and have a proper conversation about that.

That's the magic that happens when you genuinely embrace diversity. But there is obviously this high profile desire to do diversity and expectations. Some people are just doing it because they feel they have to, which is the wrong reason. And that's where you're going to see a lot of heads butting, because you got different clashes of culture. People are not put in positions because they're a good fit. It's just because, oh well, I needed to diversify. Alexander, these are awesome conversations. I love talking to you. Deep conversations. Kind of got a little bit away from you and your founder journey, but talked about the industry, which I still love. I want to kind of wrap this up with our two standard questions that we ask all of our founders. The first one is, what is an app or a tool or maybe even a philosophy or a way of thinking that has been instrumental in making you the entrepreneur that you are today.

Well, so everyone who knows me knows that I'm a hacker of tools. I love stacking them and combining them and adapting them to whatever I'm doing. But probably the book that has influenced me the most is Good to Great by Jim Collins. And is that idea of if you align something that you're deeply passionate about that you are incredibly good at, and not just like good, but great at, this is your unique ability, you're better than everybody else at that. And then figure out how does that drive your financial engine. If you unite those three things, you will win. And then he's got a number of other sort of books that build on that concept around how do you structure the right team, the flywheel effect, the choice to be great, et cetera. But it all starts with if you're pursuing anything you're doing really, really hard, there's a danger, and I've seen that in my patients who get depressed, is they've accomplished a number of accolades and objectives, but something was missing in that triad and it wasn't something that they were passionate about or they didn't end up at a level of greatness and they literally missed out. And so in all of my projects, I always look for that triple alignment of passion. What are you great at and what makes financial sense? And that has served me really well, that trifecta.

That's a good goal to attain. It doesn't come easy, but when it hits, it hits. It's amazing. Last question is a piece of advice that you'd give to entrepreneurs that are listening. Young entrepreneurs, old entrepreneurs, first time seasoned. What's your advice for somebody building a company in today's world?

Today is an exciting world because you can accomplish so much more and so much faster than you could in the past. You can prototype, you can discover, you can reach out. And now with COVID in particular, the world has gone completely flat and you have access to conferences that would have cost you thousands of dollars to attend in the past. And so learn and engage. Don't think that you have all the answers and you're just going to sort of do what, you know, think of yourself as the growth mindset combined with sustainability. Sort of a component of how can I sustain my energy to overcome of the odds and how can I learn the fastest I can? But not just learn, but also apply the learning and create that flywheel.

Well, it's solid advice and I love that you brought up conferences because as you know, we run Traction conference. That's traction conf IO normally be a thousand dollar ticket once a year. And if you're not in Vancouver, you'd have to pay for airfare and hotel and whatnot. So that could be very expensive. Like, I go to conferences in Hong Kong and San Francisco. It's not cheap, but right now everybody's doing them online, everybody's doing virtual conferences. We attraction decided to do our weekly webinars. And so once a week, you get access to these key, amazing speakers that you can tap into. And the other hack is that you subscribe to them, and if you can't attend it live, they send you a recording and you can listen to it afterwards. It's awesome.

That is awesome. But the most important thing in all of this is applying what you've learned. And so, like I discussed, predictable revenue from impossible to inevitable through traction. And I've religiously applied everything that they've ever published, and it works. And so, you know, the number of people that I ran into who were in the same room listening to the same person who's like, oh, yeah, I still have to read the book. And you're like, get on with it, man. You don't have to read the book nowadays, just watch the video and do what they say. But apply that. Learning from these conferences is key. And Tractions, you know, huge fan. Every video I actually rewatch, you probably didn't know that, but I rewatched the videos because as you've applied, whatever they said, you learn things that you otherwise miss in the presentation. There's nuances in the small things that they mention.

There's only so much you can absorb live at the moment. And all of our videos are up on. Live on. You are up on YouTube for free. But we've also created Traction University, which is a subscription that's got all the videos and categories, and we try to build some resources around outside of videos as well. Alexandra, this has been awesome. I want to kind of flip the chair here. You've been instrumental with distilling advice to our entrepreneurs and valuable with or contributing your valuable time. What can our audience do for you? What's your call to action?

Oh, that's a lovely question. One of the things we're trying to do with Care Team is something that not many attempt in healthcare, which is create a horizontal tool across. Across the acute care to community, from doctors to patients from different diseases, and sort of almost create like a project management tool that people can say all of these other tools, how do I activate them? And so we need champions. We need people who, who don't think that the status quo is good enough and would like to see something that is a completely new way of empowering people to be much more in control of their healthcare that are coached by the medical teams that had access to different tools and apps and people who are interested in seeing that future state of healthcare today as opposed to in 10 years, and who can introduce us or connect us or help us understand who is really interested in change in whatever geography they're in. And so we're starting with Canada, US and the uk, but looking at, you know, getting to know the world beyond that. And so identifying people who are champions has been really key for us. And any suggestions for folks we need to have a conversation with would be welcome.

Alexander, this has been rewarding for me, been an awesome experience for hopefully you as well. And I definitely know our audience is going to really enjoy this conversation time and time again. They're going to watch the video over and over again. Thanks for taking the time for doing this today.

Thanks, Ray. I appreciate that. And most importantly, you didn't say it, but you know, get shit done, do.

Something, get shit done. That's our model and you lived it for eight years that you're at Launch Academy and you're still doing it.

Absolutely. Thank you.

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