(Transcribed by TurboScribe. Go Unlimited to remove this message.) This technology has been around for 50, 60,
70 years using the same rod lenses, and
so we felt it was about time that
an innovation was made in the space to
help surgeons operate more streamlined.
Dr. Liz McLaughlin is a physician-turned-co
-founder.
She sat in operating rooms, watched surgeons work
around a rigid endoscope that hadn't fundamentally changed
since the 1960s, and decided to build a
better one.
Timpani Medical is redefining how endoscopic surgery works.
Variable angle visualization, integrated cleaning, a single-use
platform, a market worth over 12 billion dollars
in the U.S. alone.
Starting in ENT and already getting clinical feedback
from surgeons at Mayo Clinic, John Hopkins, and
UPenn.
But here is what most people in the
industry would not have seen coming, the former
COO of Carl Storck USA, the number one
rigid endoscope company in the world, is now
the chairperson of Timpani's board.
Someone who spent 30 years selling the product
Timpani Medical is here to replace.
He chose their side, and that is where
this conversation gets uncomfortable.
How do you defend design choices where regulation
risk timelines push towards compromise?
Liz said something in this conversation that I
keep coming back to.
I fundamentally believe that if we stop developing
hardware, we're goosed.
So I think we have to have people
doing hard stuff for hard problems in hardware.
This episode is about what it takes to
build a physical product in one of the
most regulated, most scrutinized industries in the world,
where design is not decoration, where the gap
between an idea and a product that ships
is enormous, and where the people who close
that gap matter more than most people realize.
This is Why Design.
Liz, welcome to Why Design.
Thank you so much for joining me.
Thank you very much for having me, Chris.
You're very welcome.
Looking forward to diving into this.
So, Liz, you didn't start Timpani from a
trend deck.
This began with clinical immersion and seeing a
problem up close.
But so before we get into your background,
take me back to a moment where everything
shifted, where were you exactly when you saw
the unmet need?
Perhaps you could play the scene for us.
Yeah, absolutely.
So the program that myself and the co
-founder did is a program called BioInnovate.
It's a program that's really focused on needs
led innovation.
And so part of that is stepping back
and looking and observing in the clinic, whether
it's the operating room, whether it's the outpatient
department and trying to see where there are
gaps in the healthcare system.
And really for us, some of the real
challenges were occurring in the operating room.
And they weren't just occurring for the patient,
they were actually occurring with the surgeons and
the types of tools that they had access
to.
And really driven by Rory, whose background is
in medical device design, he could really see
that there was an opportunity here around being
able to see around corners, being able to
operate without having to continuously change the angle
of view of the tools.
And so those insights of how the surgeon
was performing the procedures were part of how
the tympani story began.
Amazing.
So to correct me if I'm wrong, so
before tympani, it was to change angle, you
change tool.
So it's lots of kind of in and
out.
And I guess quite a long procedure that
which those cuts down.
Yeah, depending on the clinical area.
So I think one of the things that
really drove me towards the solution in this
company was, you know, the technology that we're
talking about is a rigid endoscope.
Rigid endoscopes are used for lots of different
procedures.
They're used in ENT surgery, they're used in
neurosurgery, they're used in laparoscopy, they're used in
urology, gynecology.
So really lots of different areas where this
issue is a problem.
And traditionally how the surgeons have used the
clinical, the site of intervention was with a
rod lens.
So a rod is a long pipe of
light.
And so that light is at a fixed
angle.
And so they have to change the angle
every time that they use the scope at
the moment.
And so we felt in the modern kind
of evolution of technology that this is kind
of a crazy way for surgeons to be
operating.
And that's kind of how it evolved.
And this technology has been around for 50,
60, 70 years using the same rod lenses.
And so we felt it was about time
that an innovation was made in the space
to help the surgeon operate more streamlined.
And what did the clinicians say when you
guys asked, why is it done like this?
So actually one of the key moments for
us, we were working with some US-based
clinicians and Rory had a bit of a
sketch on the back of this paper around
trying to access and illuminate the surgical site
in a better manner.
And the surgeon said, I was only thinking
about that last night.
I was like going to sleep thinking, how
on earth do we get more light into
the small spaces in ENT so that we
can do the operations better?
So I think those kind of aha moments
that we're not the only one thinking about
this problem and that what we've seen is
validated by the clinician.
It was really important point for us very
early on.
Amazing.
Was that the first kind of moment where
you thought we might actually be able to
solve this or fix this problem?
I think it was probably the first moment
where I thought it was a problem that
was worth solving, I suppose.
Knowing whether you can fix it or not
is kind of an iterative process, I think.
Before we dive back in, this one is
for founders and CEOs building physical products.
If you're thinking about hiring a VP of
product, chief product officer, or head of R
&D, this is not just another hire.
It defines how your roadmap is set, how
your teams are built, and how your company
competes.
At Kodu, we specialize in securing senior product
and engineering leaders for hardware businesses entering their
next stage of growth.
Focused, discreet, high consequence.
If that decision is on your horizon, find
me, Chris White, on LinkedIn, and let's talk
it through.
Perhaps you could give us the elevator pitch
of Tempany and who you are, what you
do.
For those who don't know.
I'm Dr. Liz McLaughlin.
I'm the co-founder at Tempany Medical.
Tempany Medical are redefining how endoscopic surgery is
performed by integrating variable angle visualization and integrated
cleaning into a single use platform for rigid
endoscopy.
This is an over $12 billion market opportunity
in the US alone across multiple clinical indications,
starting off with ENT.
Amazing.
You've clearly practiced that for the investor pitch.
It's never the same twice, though.
That's the key.
No.
Good.
So long as the call there is relevant.
Design in medtech is often treated like a
nice-to-have, but if something isn't usable,
it doesn't get used.
When did you form your opinion on that?
I think very early on when we were
doing needs-led innovation during the YNB program,
I had a good understanding that there's a
lot more to the process of healthcare innovation
than meets the eye.
So you can have a lovely looking product,
but the end user and the different stakeholders
that interact with this are actually hugely important
in whether that product gets adopted or not.
And that is probably something that's being more
and more acknowledged over the course of time.
And I think it's really important to have
that at the heart of your business.
We're quite a unique founding team, actually, from
that perspective, with my background in clinical medicine
and Murray's in industrial design and medical device
design.
We come from quite a different background than
a lot of traditional medical device teams, and
that has a lot of strengths in terms
of us having very clinician and user-centered
discussions around both the product features, but also
the usability and the human factors of the
product.
Amazing.
And why do you think in med tech,
science still gets undervalued?
I think the complexity of the engineering in
medical devices is front and center, and it
has to be because it has to be
both really robustly designed, extremely safe, and there's
a huge amount of regulatory barriers to getting
a product to market.
And so that's where a huge cost base
comes into it in terms of running programs
within either small companies or big companies.
And then there's sort of an afterthought.
But I think from where we have worked
best is that we have really strong clinician
relationships, which have driven a lot of our
product features.
And so the engineering then can fit into
that nicely after you've had that work done
with the end user.
And there's really not much you can do
if you've engineered the product and then go
to the end user.
So it's probably a legacy issue as to
how products were designed and then handed over.
And as regulatory has increased in its burden,
you've had to just add more engineering costs
that build and test, build and test, build
and test for the regulatory requirements has meant
that it's actually just harder to fund that
design phase process.
And it does mean that you have a
longer time to market.
And I suppose that's the other dance that
you're trying to work out is how fast
can we get product to market?
Yeah, exactly.
And it leads me on to my next
question.
How do you defend design choices when regulation,
risk, timelines, push towards compromise?
Because you want to have a great looking
and usable product as well.
Yeah, absolutely.
I think it's, you have to integrate it
into your processes.
So, you know, we, as I say, we
do every eight or nine weeks we're meeting
doctors around our product.
And we're not compromising on that piece.
Regulation is here.
It's going to always be here.
It has to be here.
So you just have to be creative.
And I suppose work with people who understand
the interface between the fact that it needs
to be well designed and regulations.
So that's where you have to be kind
of a broader thinker when it comes to
your strategy.
Yeah, I'm guessing, especially in your case, you
know, you're competing with a, you know, a
technology that's been around for decades, you know,
and clinicians, I'm guessing, aren't the quickest to
adopt, to change.
You'll probably correct me there.
But, you know, so it's got to stand
out.
It's got to make them want to use
it.
Absolutely.
And so I suppose I've mentioned at the
beginning, quite specifically, that this is a single
use endoscope.
And so when you look at single use
as an evolution, a lot of the single
use products have been just the same product
in a single use version.
From our perspective, why bother?
There's no point.
So you have to have differentiation if you're
going to introduce that real kind of hard
shift from a reusable to a single use.
And that's something that we've worked really hard
on to make sure that moving single use
is differentiated, but it's also at the least
impact as possible.
So you're not just moving single use for
the sake of it.
You're moving because it has better features, better
impact for the patient, and also is much
more ergonomically designed.
So one of the huge pieces of feedback
that we always get is, oh, my goodness,
this is so light.
It's so easy to use.
And that's just a really phenomenal piece of
feedback that we weren't expecting.
We didn't design that in.
We didn't think that that was going to
be the kind of number one thing that
we get feedback on.
But because we've been in market discussing with
customers when we give them prototypes, they really
want it to be that light.
And actually, then you come back to the
engineers and go, it has to stay that
light now.
So then there's a real sorry, how light
was it when you brought them?
So yeah, but that's a really important piece
for us about kind of how do we
get people to change practice?
And actually, ergonomics is a really important thing.
Surgeons are looking to have a professional practice
beyond their clinical training of 35 years, most
of them.
So you can't have something that's really heavy
that causes them neck pain, back pain.
And actually, 80% of the rhinologists surveyed
in the Australian study have neck and back
pain associated with their practice.
So it's actually a really big problem.
And so design and ergonomics and human factors
actually comes full circle as to why they
will change as well.
So it integrates that piece of how do
we compete with the incumbents, but also why
is the design piece very important?
Was that a happy accident that you're solving
that problem as well?
In some ways it was, but in a
lot of ways it's to do with the
advances in the technology.
So when you look at the traditional technology,
there's a rod lens and a camera system
was put at the back end of it.
So it creates this back heavy piece of
equipment.
We're putting a camera at the tip.
And so the system is much lighter overall,
just by virtue of the fact that we're
using a different technology.
So when we started to design it, it
was always going to be lighter because of
those legacy issues that they've had with the
product.
Yeah.
Brilliant.
And then, you know, for someone listening or
watching that works within medical devices, medtech, what's
one design principle they should steal or borrow?
Keep talking to your customers.
So we were around a little while and
we did a first iteration of our product
development during COVID.
And actually we had loads of sessions where
we were sending prototypes to the clinicians.
We were doing video sessions in their temporal
bone labs.
And yet we couldn't really hit the nail
on the head in terms of, are we
getting this right or not?
And so we took a step back, maybe
towards the beginning of 23 and sort of
re-scoped how we were going to discuss
things with the customers and went back out
and, you know, had a lot of interviews,
market feedback, variations on features, you know, how
far do we need to go on the
engineering side in terms of that angulation?
Do they want 10 different angles?
Do they want five angles?
Do they want three angles?
They're actually happy with two angles.
And so by talking to the customer over
and over again, we were able to actually
narrow down how our engineering roadmap looked like.
And then that makes it much more attainable
in terms of your product development.
So you can add all these bells and
whistles and features if you're not talking to
them and you're probably going in the wrong
direction because most of them, if you really
nail down and you say, okay, what will
do 90% of your procedures?
And that's where you can really get things
right or wrong, I think, if you're not.
Yeah, absolutely.
Your first product doesn't need to be the
one that you finish with.
It's the minimum viable product to get out
to market.
It's funny you say minimum viable, right?
So, and maybe I think that's a really
challenging thing in medical devices.
I think it's actually one of the biggest
hurdles because in all other product developments, consumer
brands and anything that's not as highly regulated,
you can iterate quickly and put it in
market.
Medical devices, because you have so much regulatory
to get through, your minimum viable product actually
needs to be, how quickly can you get
a simulated test model to test your minimum
viable?
So it's actually a slightly different thing of
getting to market with your minimum viable.
It's how quickly can I get to the
customer to test it, be it a simulated
model, an animal model, a cadaver specimen.
That's the real MVP cycle that I think
people need to really think about and get
that piece correct.
Because if they get that wrong, it can
cause a lot longer term issues.
So identifying where and how you get that
so-called MVP tested in a medical device
roadmap is key.
Yeah, because I'm guessing that will unlock funding
and customers because you've proven.
Exactly.
Yeah, exactly.
Well, okay.
Well, let's talk around kind of some decisions
that defined Timpani then.
People romanticize startups like it's all instinct.
Your path sounds more disciplined, more disciplined de
-risking.
Perhaps you could talk me through a moment
where it started to feel like a real
company.
You followed, I think, the Stanford biodesign approach.
What was the hardest filter for your idea
to pass?
So I think understanding markets that are not
really, really hot and sexy effectively is really
challenging in MedTech.
So you'll always be able to get data
on heart failure, valve replacements, stents, neurovascular, peripheral
vascular.
They're all really well-defined areas of medical
device development and have really, really strong data.
So I think when you're going into more
of an area which is around tools and
instruments, that becomes actually much more tricky to
quantify numbers and strategize around that.
I think I had a little bit of
a leg up advantage in understanding that coming
from a clinical background, having sat in many
operating rooms, watching lots of different procedures using
rigid scopes that I was able to, even
if I didn't have the numbers, I could
go, these are used in a lot of
cases.
Even if I can't pull exact numbers, I
know when I speak to an orthopedic surgeon,
a general surgeon, a neurosurgeon, an ENT surgeon,
they all handle these scopes.
And so you get that validation more easily
from that community.
But I do think that market and market
quantification is very challenging and you just have
to keep chipping away and trying to get
as much detail as possible.
And as you said, like I think that
for me, I was using some instincts to
make some of those decisions because I had
knowledge.
So I think instinct is a combination of
gosh, knowledge and maybe the community around you.
So I don't think it happens in isolation.
No, absolutely.
I'm guessing, you know, on those areas where
there is more data available, that's because there's
obviously been a lot more research done.
There's a lot more medical devices in that
area.
So is it harder to therefore get funding
in that area or in, say, an area
like ENT where there's not as much data?
Yeah, I think funding in medical devices is
challenging.
I think we're in a situation now where
hardware is really difficult.
I suppose this is why you have this
podcast is talking about hardware.
Hardware is hard.
I fundamentally believe that if we stop developing
hardware, we're goosed.
So I think we have to have people
doing hard stuff for hard problems in hardware.
But funding is difficult in medical devices, full
stop.
So I would not like to say, you
know, just because you're doing a vascular device,
it's easier.
I think it's just a more known pathway.
It's the structure of your road map is
clearer and your go to market strategy is
clearer.
And then the also piece that is important
is that you've got a clear line of
sight on strategics and acquirers and kind of
how they're playing out in the market.
So that's the difference.
Doesn't mean that there is no funding.
No, but it does take a bit more
work and a bit more creativity.
Yeah, absolutely.
So what's, you know, you're gaining funding.
So what surprised you most around turning the
clinical need into a fundable business?
How many hours I would spend on the
phone to solicitors?
Have you kept a tally?
No, I haven't kept a tally.
I'm fairly good friends with them though.
No, I think medicine and clinical practice is,
and analyses in particular, it's all go, like
it's quick decision making and then you're done.
And I think what I, what always surprises
me in this, in, I suppose, the more
business side of things and the more company
development is there's nothing that happens really quickly.
So it is just a case of like,
you just have to keep showing up every
day and keep moving things onwards.
And so there's, I suppose, a resilience piece
there that just because it didn't happen yesterday,
doesn't mean it's not going to happen today.
And so you have to keep motoring like
that.
So that's probably the biggest surprise.
But also one of the things I think
medicine probably prepares you for more, because there's
so much uncertainty in medicine and you have
to make decisions without all of the information
at the table.
So in a startup, you're always making decisions
without having 100% of information.
So I think there's synergies from that piece.
Yeah, absolutely.
And you went through the Enterprise Ireland pathway.
Yeah, going through that programme.
First, before I get into the question, if
you could outline what that is for people
that may be listening in Ireland.
Yeah, so everybody in Ireland who works in
startups knows who Enterprise Ireland is.
So for those who aren't familiar, Enterprise Ireland
is a state agency.
It is actually one of the biggest backers
of startups globally.
I think it's top three under of early
stage businesses across the world.
That might be old data, but that is
definitely something that was in place a number
of years ago.
They have a number of different programmes.
Some of them are university based.
Some of them are based on funding as
part of equity rounds.
And then some of them are funded through
partnership programmes with the Department of Trade and
Enterprise.
We have tapped into all of those.
And we're really lucky here to have access
to those programmes.
And there's a myriad of businesses based, a
lot of medtech business based on the West
of Ireland that have worked with Enterprise Ireland
to get their businesses up and going.
And a lot of products now either very
close to market or in market as part
of that support.
So very successful agency overall.
And so we've been really lucky to be
able to work with them.
One of the quirks, I suppose, is that
at the beginning of a lot of these
projects is you do what's known as a
commercialisation fund that's based in the university.
So there's a university hold the budget, and
then you have to be founders effectively, working
through the project, trying to de-risk their
technology roadmap, their opportunity.
I think it's an interesting one for a
space like life sciences and medical devices.
To raise initial capital for an idea from
friends and family is really, really tricky, especially,
I think, in Europe.
So this allows you to have a kind
of period of two years de-risking opportunity
and then going to specific angels or seed
funds with not just something on the back
of a piece of paper.
And I think that's a really important piece
of how do we get hardware products from
inception out into the marketplace.
So that's the first step.
Subsequently, then, we were very lucky to get
a disruptive technology innovation fund.
This is a partnership project.
So how it works is there are usually
one research performing organisation, so a university or
an academic institution, then another industrial partner, and
then the lead partner effectively is generally either
the startup or the SME.
And so you have this consortium and you're
working on a defined goal, but it's really
a kind of industrial research.
So it helps companies that are trying to
be very innovative and, you know, not just,
you know, taking the next step on their
own, but really trying to take big leaps
in terms of technology.
So we've had two of those funds awarded
to the company and it works with the
National College of Art and Design and RCSI
and UCD in Vermont and then Gentian Services
down in Shannon.
So have had a very broad base of
collaboration across multiple institutions through those projects, which
I think is really powerful as well.
And coming back to kind of how complicated
medical devices is, you know, you just need
as many levels of expertise as possible to
get you to the next phase of development.
You can't hire it all.
It's not possible.
No.
So you get to tap into the hive
mind, so to speak, you know, then there's
an advisory side, is there, or is it
more of a kind of go out and
seek advice or experts within the community?
There are advisory mechanisms through Enterprise Ireland as
well.
And so there are smaller grants you can
get to support very early stage projects to
kind of tease out ideas, get some mentorship
and that as well throughout the lifecycle of
the business.
So I think where we're at now, actually,
as an ecosystem is that we're all starting
to kind of outgrow what supports were there
now and private capital isn't where it needs
to be to get these companies to the
next phase.
So we're kind of looking to figure out
how you can get companies to a certain
point.
Everything's going later and later.
M&A is later, like Series B is
later, Series C is later.
We now have another funding gap, but I
suppose that's a positive outcome of how the
ecosystem is maturing, that you're not just having
lots of seed projects that are going nowhere.
You actually have quite a number that have
gotten quite far and now just maybe need
the last little leg up to get to
the market.
Yeah.
Awesome.
What have you learned about yourself through that
process?
I like moving things forward.
I like the progress piece.
Yeah.
Also, I think I love building something from
nothing.
So we first kind of got offices in
a place called the ATU.
I hope this is kind of a university
co-located incubation center effectively.
So we started out there and kind of
in the last year and a half, we've
moved into our own offices.
And it's that kind of forward momentum of
like, okay, we're not just a project anymore.
It's actually building something that's more robust.
And so I really enjoy that part.
Other things I've learned about myself, I became
a mom as part of this whole process
as well.
I don't know which I've learned more from
actually.