E#40 | CoherentHQ Event: Is Your Clinic Exit Ready - How to Sell Well and Maximise Value

This video is about Event multicam projectWhat really drives the value of a clinic, what quietly erodes it, and what it takes to sell well? We brought together clinic founders, operators and the buyers and financiers who assess clinics for a living, for an honest evening on building a practice worth buying.

Recorded live at The King's Fund, Cavendish Square, London.

Panellists:
 Simon Devane, CEO, Pure Sports Medicine
 Andrea Agnolio, Co-CEO & COO, Skingevity
 Joëlle Rotsaert, Founder, Injectual
 Enrico Ghio, Co-CEO & CFO, Skingevity
 Stephanie Demetriou, CEO, NAMMA Studio
 Shaima Villait, Co-Founding Partner, Chelsea Medics
 Hosted by Jared Aron, with an opening from Thandi Rose (Coherent)

What you will learn:
 The difference between being patient-obsessed and customer-obsessed, and why it shows up at the end of the month
 Hiring and culture: why founders hire on "vibes", and how one bad apple can undo a team
 Greenfield versus acquisition, and what it really takes to integrate a clinic you have bought
 Why exit preparation should start two to three years out, and how to reduce dependence on the lead practitioner
 How buyers actually value a clinic: EBITDA multiples, recurring revenue, growth and concentration risk, and why intangibles show up in the numbers
 Reducing uncertainty and friction in a deal, keeping your data clean, and the real post-sale experience
 Coherent's "leak stoppers": the Sarah versus Sara data problem, why outreach needs to be 10x not 10%, and why the front desk is not a sales desk

Chapters:
 00:00 Welcome
 01:45 Why this room matters
 07:30 Live audience poll: the pipe check
 08:20 Panel 1: Operations, building a clinic worth buying
 41:35 Panel 1: audience Q&A
 53:20 Break
 53:37 What the room told us: poll results
 59:25 The better playbook for clinic growth
 1:08:30 Panel 2: The Sale, what actually moves value at exit
 1:36:35 Panel 2: audience Q&A
 1:42:25 Closing thoughts and community
 1:45:50 Live demo: AI and human patient coordination

Coherent helps clinics grow and run better. Learn more: https://coherenthq.com

Join our next event: https://coherenthq.com/events
Join our LinkedIn group for clinic owners: https://www.linkedin.com/groups/17504048/
Listen to our podcast, The Business of a Clinic, wherever you get your podcasts.

#ClinicOwners #ClinicGrowth #HealthcareLeadership #ExitStrategy #PrivateHealthcare #Aesthetics #Physiotherapy #Dentistry

Transcript

SPEAKER_09 0:03

Hi everyone. Hi everyone. It is so wonderful for us all to be together in this room today, to see some familiar faces, some faces I've only seen on screen up until now, and some new faces too. Welcome. I'm Tendy Rose, one of the founding members of Coherent Healthcare, and I can't begin to express how inspirational it has been to experience the growth and evolution of our company. We are now working with more than 50 clinics globally, supporting over 100,000 patients. It has been incredibly rewarding to witness the impact of tech and AI assisted patient management for clinic growth and capacity. For example, some of the clinics that we're working with are finding that they're they're able to thrive on a much smaller, tether team. And some have also been able to realize their vision of expanding to multiple clinic locations. Up until now, the tech and commercial growth healthcare landscape has been a bit of uncharted territory. And that is why it is so incredibly critical to be having the open discussions that we'll be having to them, building the connections that will be having to them, and sharing knowledge amongst each other, like we're doing to them. Some among the numbers.

SPEAKER_03 2:13

I think usually when when I've gone to these events, um it's usually someone trying to sell something, which we will do in a little bit. But it's also uh exciting because there is a huge mix of people here. We have uh respiratory physicians and orthodontists and private equity buyers and platforms that are helping clinics sell. Um we also have patient advocates, which is an episode coming soon on business of a clinic from today, which is a very exciting story. Um and it's very it's very exciting to have all those people together because I think in our work we work across clinical specialties, but I think oftentimes in your work, maybe less so. Um and we hear and see all kinds of interesting things. I was speaking earlier with Yogita, uh, who runs uh multi-site aesthetics clinic, and we're saying some of the things we see in MSK are hugely relevant in aesthetics, and similarly, some of the things in aesthetics, uh like retention after the first visit, are really wrong.

unknown 3:12

Could you speak uh in front of the mic, please?

SPEAKER_03 3:15

Is that okay, Sean? Um so there's a lot of crossover, which is very exciting. Sean, is that okay? Yeah, you're happy now. Great. Um so so it's great. It's great for you to be here. Um thank you so much. I think to give you a quick sense of what to expect, um, we've done the introductions, the meeting each other, we got the seating almost exactly right, which is awesome. Um, and we'll do a quick hello from us. We'll then go into our first panel. Uh that's going to be all around building a clinic worth buying, very focused on operations, patient obsession, customer obsession, the messy parts of creating something that is ultimately of value for someone else up the chain. Um and then afterwards we'll take a quick break. Um, and then we'll invite a second panel, and that second panel will talk about creating value at exit and thinking more about the transaction moment as well. Um so we will try and be done by nine. Uh if it runs slightly over, it won't be by too much, but we'll try and keep it in in time. Um and then uh for those who want to hang around afterwards, please do. This is me, apparently. I've never worn those clothes before, so it's very strange to see myself that way. Um we uh we are trying to bring together people who believe in what we call the business of a clinic. The business of a clinic is the non-clinical parts of supporting patients. And oftentimes we find that those parts are undernurtured, underattended, and also very, very complex, not because they are um hard, but because they are extraordinarily technically detailed, and we'll talk more about that later, but it is not often just a people problem, it's a people and a technology problem, or it's a people and a technology and a process problem. When you stick all those things together, um it's suddenly not a press button and buy thing. You have to go quite deep. And so the opportunity to do that with our clinic partners is really wonderful, and that is very much what we talk about on Business of a Clinic. Um, before we start, uh just some ground rules. Uh information. Feel free to use the ideas freely, quote as you see fit, but please um maintain anonymity and affiliation. So um please don't say that Jared said this or that John said that, uh, unless it was really insightful, in which case I would love to be tagged and noted accordingly. Uh, but please do um try and uh sort of maintain that that confidentiality in the room, otherwise, this doesn't really work, uh particularly for the panelists who I think will share very openly what they're working with, um, and and hard to do that if if there's uh sort of recording running in the background. Um so thank you for being here. Uh when I was running clinic, uh a mentor said this to me, and I have maintained this as a sort of way of engaging with clinic owners today, is that running a high growth, running, running high growth provider operations is like doing a jigsaw where the pieces aren't constantly uh moving around and very urgent. And we especially thank people who came to this and have no idea what we do. Um and and that's always interesting. There are some new faces here, and we appreciate your attending. So, to those who don't know, um, we are very focused on this uh this idea of patient leakage, the idea that people just sort of drop off and disappear and fade into the mist. Um, we often use the uh the image of a house with pipes that are leaking all over the place. Um, you might see this with your new inquiries, you might see this with your long-standing patients. Oftentimes people will walk into the clinic in the morning and they'll say, hold on, I haven't seen Dev in six years. I wonder what happened. Then they'll send an email, hey Dev, how are you? And then Dev suddenly remembers, yes, I need to do dental hygiene. Bam, right there, there's the moment. And that is leakage, this idea that patients just sort of drift. Um and oftentimes when we see clinics try to address the problem of leakage, it sort of looks like this. This is often what we see is extra front of house hires, more tech, things thrown together, tools, Google Sheets stitched together at the edges, um, the hero receptionist who uh carries the whole show but then goes on holiday and everything falls down. Um and so this is sort of the often state of play, and what we try to do is to bring harmony to that uh engage support book and payment process. And so this was um this was supposed to be a picture of me with green glasses. It's neither me nor with green glasses, but um, you get the idea. Um so before we start panel one, uh we're going to do a little pipe check. You're welcome to participate. Um, for those who have access to Wi-Fi or service, you can actually scan that. And we'll just ask you to uh provide a few answers to some questions. Um and actually, Sean, I should ask you, what is the uh do I just great. Um so you can go ahead and actually just take a minute. Um if you need Wi-Fi, uh there's a card, I think that's um 11 Cavendish, and then red brick red is the password. Brick red is the password, all lowercase. So just to you can just take a minute. For those who don't run clinics, this is not um something that will be immediately relevant for you, so you can probably uh breeze on past it, but you can try and stick with it. Um it's only a few questions, and we'll give you a minute to do so. Well, so I think we'll go ahead and get started. Um Sean. Sean. Sean, do you want me to sit? Is that better? Have to speak in the microphone. Great. Fantastic. Um great. So so panel one, we do have um three uh three folks joining us for panel one. Uh we'll start with two, and then we'll add the third when she arrives. Um so uh we're gonna dig into um this idea of building a clinic worth buying. We'll call it operations. Um we have uh three people joining us. We have Andrea, we have Simon, and we have uh soon to arrive Joelle, I hope. Uh and I think maybe just to start, do you mind just doing quick introductions, sort of background and what you're doing and building now, and then we can sort of dig into it from there?

SPEAKER_12 9:11

Sure, please on. Yeah, okay. Um Simon Devan, Chief Executive of Pure Sports Medicine. Um I have been in healthcare for 19 years. Um prior to that I worked in a number of different sectors, have a commercial operational background. I came to the UK from New Zealand in 2002 to play rugby, travel, and work in the city. Subsequently, I met my wife from Glasgow, uh, got coerced into joining a startup, a healthcare startup, and I'm still here and I'm loving it. Um so my journey with Pure has been quite interesting. I joined as a COO, so spent the first uh six and a half years building the business. Um you don't know that you need a chief financial officer day one, but eventually you will do if you do the right things. Uh, and then moved into managing director for 18 months as we transitioned the founder and chief executive out of the business, and then took over as chief executive uh in January 2015. So we are a specialist in sport and muscular skeletal medicine. Uh we have 10 clinics, eight in London, one in Milton Keynes, one in Edinburgh. Uh, and I'm delighted to be here and to uh to join today's panel discussion.

SPEAKER_03 10:18

Thank you, Salvin.

SPEAKER_12 10:20

Yeah, please.

SPEAKER_06 10:20

Yeah, thanks, Jared. Uh Andrea, I am a former management consultant. I was at BCG for many years uh with a friend of mine, Enrico, who's been gonna be on the next panel. Uh we decided to consolidate the aesthetic space in the UK. So we started last year. We bought five clinics in the last one month uh with a big plan to grow the organization. Uh yeah, here we are.

SPEAKER_03 10:42

Great. So I guess maybe Simon, just to start with you, so you've been in healthcare 19 years. Yes. Yeah, wow.

SPEAKER_12 10:53

Alright, so that's what that's why I've got gray here and less here.

SPEAKER_03 10:58

So I I think maybe just to start, um, it would be really helpful if you could do a sort of uh a time gap 19 years ago today through the lens of clinic ops, building something that scales, building something that grows, building something of value. What has changed and maybe also what hasn't changed?

SPEAKER_12 11:19

Yeah, absolutely. Um day one was a bit of a shock because I I'd left a role with British Telecom where I was a consultant uh and I joined Pure Sports Medicine at our Kensenden Clinic and I had a a cardboard box box box for a desk and a laptop, and and it was very basic. Uh we had uh we had three beds downstairs with a curtain in between them, we had two rooms upstairs, um, so aesthetically it was it wasn't great. But we had excellent clinicians and we had a very strong vision about what we wanted to do. Um we had we were deliberately set up from day one uh uh to separate the business and clinical medical components. So there was a team of people um which I was involved in that was focused on growing the business and building it, and the clinicians, uh lead clinicians involved with clinical quality, oversight governance, etc. So um you I guess one of the things that we that that that meant that we were starting with a growth mindset. So we were gr we were starting from day one to build to a business that had significant scale at some point in the future. So we weren't pivoting part way through the journey. And I and I think in some ways that that is obviously beneficial, um, but it is challenging because you are trying to think far enough ahead to make decisions today that influence the future. Obviously in 2007 AI wasn't a thing, and now it is. So these things change very quickly sometimes. Certainly what hasn't changed terribly much is particularly with the with our our space in healthcare, is that doing the right things by the patient, focusing on getting the best patient outcome, delivering the best experience you can, that hasn't changed. Um lots of things have though. Um I would say systems. You know, back then we were struggling to find solutions for problems. Um and it's not until fairly recently, I would say the last five years things have accelerated. So five years ago, you know, if Jared and I were talking, I would be saying technology is not where we need it to be. Now technology has gone so far and so quickly, so we are struggling to catch up with what's possible. Um but technology is part of the solution. Um but it's all about people. Um so clearly over a period of 19 years, what does change is the uh the demographics that you're working with, both from a patient and staff perspective. So understanding and reflecting on what what those individual needs are is really important. So uh yeah, younger workforce value different things to the older workforce. Uh the same, you know, I'd say the way that you communicate with patients is different depending on the demographic. So you've got to take all of that on board. Umperationally, I think um I think remaining agile is key and uh trying to build in regular, reflective, critical analytical processes to just check that things are still working. Because once you solve a problem, it's quite easy to forget about it and plow on to the next challenge and the next hurdle. But things change and and what you set up five years ago may no longer be fit for business today. Um and and so you've got to have those little triggers in place to to allow you to change things before they become a problem that you've got to go and firefight and solve. So um operationally, it still comes down to people supported by good systems, clearly. Um, but people are still at the heart of it and it hasn't changed.

SPEAKER_06 15:03

Can I add one thing? So I cannot comment on 19 years ago, because it wouldn't be uh but uh since I stuck in the aesthetic industry, I think I completely agree on everything you said. And um when I started a static as a consultant six years ago, we were doing surveys to consumers. The first thing the consumer said was the source, how do you get a clinic such? It was all word of mouth. It's because my mom uh told me that, it's because my friend, it's because of doctor recommendation. I think. And I've seen a survey that BCG did recently, and one of the first uh sources digital. Like people just go online. You need to really have your digital capabilities, both on social media, both on SEO, both on your website, having Jarred making recalls with all these crazy analytics that you have. But if you don't do that, I think you're gonna be light compared to where you were five years. So I think aesthetic, I don't know if it's your industries that way, but a static industry changed dramatically.

SPEAKER_12 16:00

Absolutely. I mean, I I have I have a photo of the first tweet that was sent from our business. And obviously, you know, social media wasn't a thing back in 2007. Um and to your point, I mean you use the word consumer, I totally agree. I would have offended nearly all of our clinical staff in 2007 if I used the word consumer in the same sentence as patient. Now we are consumer healthcare. So yeah, you I mean it it it has changed. I mean, it's a long time, but things have changed a lot.

SPEAKER_03 16:31

And the clinicians are still offended by the word consumer. Well we're working on that.

SPEAKER_12 16:36

Not so much. I don't know, I think I think it's how how you position it. I I just because I'm non-clinical, I come I come at it through a consumer lens myself, and I guess my very simplistic view is that they are consumers, they have choices. They become patients when they come in to see you, but until that point they are a consumer.

SPEAKER_03 16:55

I'm just gonna pause for a minute. Hey Joel.

SPEAKER_14 16:58

Hi, sorry.

SPEAKER_03 17:01

No, that's all right. Um Joel, we we we we we've just gotten started. Um we we you just missed intros. So do you want to just do quickly introduce yourself with the business you're building and then we'll we'll crack on?

SPEAKER_14 17:11

Yeah, how extensive.

SPEAKER_03 17:13

Like they each did about 60 seconds.

SPEAKER_14 17:16

Okay, fine. Um okay, so I'm Joelle. I'm the founder of Injectable. Um Injectable is the anesthetic clinic chain, so we've got two locations now. Um one in Olding Hill, one in Shortage, or about short terms. Um and um we highly specialize in gender affirmative care, also because I'm trying to myself, and um I'm also building sort of like a separate clinic solely focused on gender-affirmed care where you can go as for your full medical transition. So thanks very much.

SPEAKER_03 17:50

Um sorry, you know, you can't even. Oh, sorry, you don't have to do it again, that's okay. Um so so I think uh uh jumping uh on a on a trend just now, this idea of of consumer. Um there's arguably a uh a difference between being patient obsessed and being customer obsessed. There's probably an overlap in that Venn diagram as well, but there might be different things that you think about when you prioritize serving the customer as a pro as a as a counterpoint to prioritize serving the patient. Um if I can nudge the conversation toward how do you prioritize the customer without making sacrifices to the patient care, how do you prioritize the customer, the customer expectation, what is a customer as opposed to patient obsession look like in your clinics?

SPEAKER_14 18:43

Um and just uh Joelle, if you're if you're happy to maybe kick off, um I mean obviously, look, I'm not a medic myself, so I look at everything from the lens of obviously a customer. So uh I think I think it's always like a bit of a struggle between me and my sister. So I started business together with my sister, who's a plastic surgeon. Um, so she's always the medical side, and I guess the patient's the focus side, and I'm always like taking from a consumer and from a customer point of view, like I want to give the best experience. Like I'm obviously, you know, safety always comes first, but I'm always like, you know, how do we make this a really nice experience? Because like obviously, if we leave it up to medics, no offense, it would look like it would look like an NHS waiting room, you know what I mean? Like um, sorry, okay. So um, so yeah, I obviously but I think it's obviously good in in my business that we've got sort of like you know, the fluffy side and then obviously the medical side, and we sort of like always try to meet in the middle. Um but I think you know the customer, I think you know, the industry is evolving, you know, where it was, it used to be fine to have the clinical fence, sorry. Um nowadays, you know, the patients want to have the full experience, you know, and they want the convenience, they don't want to, you know, uh thinking about aftercare and like you know um not just being ushered out on the streets, you know. You know, think about the full experience. So uh I couldn't agree more.

SPEAKER_06 20:23

I never use the NHS, so I think I'm gonna reuse it because I love it. I think it's uh it's the tremendous change that the static industry had in the last five years. I think if we're thinking about five years ago, it was way more doctor environment. It's still run by doctor nurses, etc. But I think the importance of the environment you're in, that that kind of luxury style, etc., I think is is going to be made in the difference on who's gonna win, who's gonna lose in this market.

SPEAKER_03 20:51

Uh Simon, three three beds and a curtain. Yeah. How how has that changed? Um is is the customer experience true in in MSK territory? Do you see the same thing happening?

SPEAKER_12 21:03

Yeah, well, I I guess I think the funding model comes into play here a bit because uh generally musculosketal care is very reactive. You know, everyone knows that prevention is better than the cure. Um, but given the fact that private medical insurance won't fund the cure, it'll fund the fixing the problem. Um when we're talking about how we approach consumers, um it's it's about that customization, that tailored health care. It's about talking to people about things that are relevant to them. So you know what it's like. You have a br you have brands that you engage with. Why? Because they talk to you directly about things that are important to you. And and healthcare is is is no different, really. Um so what we need to do is have have systems that allow us to segment our population, our patient population, so that we understand what they need and what they're interested in, and then use that information in a targeted fashion. With our marketing, to create content, to go after a specific demographic of the consumer market, to talk to them and engage with them in things that we know resonate. You know, if you've got if you've got someone that's interested in running, there's no point sending them a whole lot of information on something that's not running related to necessarily. So, yeah, I mean, but you you you have to invest in in systems to help you do that. Um so you know, when you're small, when we were, as I said, you know, three three rooms in Kensington, we worked hard as you know, a lot of face-to-face contacts, a lot of CPD, a lot of education. But as you get bigger, clearly that that's that's not efficient. So you've got to find, and again, technology's moved a long way. So very focused on trying to understand our patient population in a lot of detail so that we can target our comms to consumers.

SPEAKER_03 22:56

I I think it's interesting, um, and maybe Joel, this is the best place for you. Uh one of the things that stood out in the conversations we've had before is the intimacy and understanding that you have of your particular customer audience, the depth, the empathy that you hold. How does that show up in your practice uh for patients?

SPEAKER_14 23:19

Um, do you mean like gender affirming care specific? For example. Um, I mean, obviously, look, it definitely helps my own personal experience students. You know, I went through everything myself. First and foremost, not just for gender affirming care, but also like I'm an avid Botox user. Like I love it, so I've tried it all. Um and um, but especially I guess with gender affirming care. Um, you know, there are nuances, but that's I guess for every sort of like niche of clientele that you only sort of like find out while you know going through the journey yourself or actually like actively speaking or having a family member. Um you know, there are there's small things like you know, intake forms, the way you're greeted, um being able to choose to have your numbing cream on in a separate waiting area. You know, there's like several nuances that you just um, you know, that are very, very small and make such a big difference, I think. Um but yeah, sorry, that's to answer your question at a little bit.

SPEAKER_03 24:25

Yeah, no, it's really helpful. Uh and and maybe a good a good segue into um some of the details you talked about, uh, intake forms as an example, um, different areas of the clinic used for different parts of the journey. Yeah, these are uh you know most clinics are ultimately assets in the sense that there's a space and you need to move people through that space, and the more people that you move through without compromising the experience, usually that shows up at the end of the month.

SPEAKER_14 24:52

Of course. Well, it's obviously like, look, all of these things are very nice, but it's especially how your clients uh, you know, how your clients are treated by the soft, you know. Um and there's a difference. Like I always say that to my my practitioners, you know, as long as your intention is right, don't be afraid to say the wrong things as well. You know what I mean? Not everybody gets it wrong, correct yourself if I like it's not that big of a deal. But you know, I think you can definitely sense when somebody like me as well. And that sounds like such a fluffy thing, but you know, I think it's really important, and also like that's why I spent really long time vetting the right kind of people um, you know, to work for the business, because you know, one bad apple can ruin your entire reputation, you know, at the end of the day. Um so yeah.

SPEAKER_03 25:43

Andrea, zero to five clinics, twelve months.

SPEAKER_06 25:48

So you've uh I buy them, I don't open them.

SPEAKER_03 25:54

You buy them and don't open them. It's a good point. Uh yes. Um Joel just just touched on um team and the importance of team, and so um it would be really interesting to understand a bit more about your experience effectively inheriting five teams or soon to be five teams, um, all of them with their own uh DNA, their own beliefs about what good looks like, their own uh expectations about what comes next. How has that been for you? What is what does the journey look like in terms of trying to get five appendages to behave like one body?

SPEAKER_06 26:27

Yeah, so this probably has been the most challenging part. Um, first of all, we're not trying to make them behave as one body. So our model is we are buying clinics, we have a brand which is King JVT on top, but we leave the brand, we leave the teams, we leave their behavior, their dynamics, the nuances on how they treat patients and all that will stay with the clinic. We're not gonna demand process, etc. We're not standardizing everything. That's I think is the is the easiest part of the job. I think uh we are very peaky when we do due diligence, when we buy an asset. Uh we really need to like the practitioner. We meet the team, the whole team before signing a deal. We're not gonna ever gonna do a deal without meeting the people, really get to know them because if we don't believe uh they're going to be a good fit with what we're trying to build, then we're not gonna buy because it's not what we want. Uh that said, I completely agree with one point that was said before. One bad person in the team can destroy the completely the team. Um and and we had those kind of situations. Um so it's a matter of uh trying to the the most difficult part of all this balance, all this ecosystem is to maintain the balance within the team and to maintain the culture up. That that's what makes a business successful.

SPEAKER_03 27:42

So can I push that a little bit deeper? Um, Simon, you were talking earlier about tech, um, but also that it's still about people. And I guess Andrea, you're saying it's about people, and Joelle, you're saying it's all about the people, and yet we keep hearing it's all about the AI. So what exactly is Andrea, I guess following that statement, obviously there's a focus on efficiency. Um when you say maintaining, enabling that team, what does it what does it actually look like in practice on a day-to-day or week to week basis? How how how does that show up in your uh in your nine to five or more likely seven to eleven?

SPEAKER_06 28:17

Mine?

SPEAKER_03 28:19

AM to PM.

SPEAKER_06 28:20

Um so uh you touched upon a little thing. So AI, I think, is a great tool. Tools, tag is great, you need to have that to run a practice that that works and etc. But at the end of the day, if you don't have people happy in the practice that they come to work because they're happy with what they're doing, they're gonna transmit that to patient. The patient's not gonna come back, even if you're calling them back with emails, messages, phone calls, etc. So I think that's the most important point. Um the AI and the tech can enable the journey, can bring people to the door, but at the end of the day, for me, for our team, like the magic happens once uh uh they're inside. So that that's a key point of success, I think.

SPEAKER_03 29:00

So Simon, I'm curious. Um ten sites now? Eleven, twelve, thirteen.

SPEAKER_12 29:04

Yeah, yeah, ten and uh one acquisition in that. What everything else is greenfield? Everything else is greenfield. And yeah, I mean it's interesting, so so we have a different approach to acquisition in that we have built a brand that has a lot of equity in it, so it's really important that when we looked at this acquisition, that we we were going to change the name on the door, we were going to change the systems, we're gonna standardize things for obvious reasons. And um, and bearing in mind, I I think this is probably starting from a very low bar. This clinic had six rooms. Um, it'd been in in practice for north of 25 years, one computer, this is this is two years ago, one computer on reception running Windows 7, um paper notes stored in filing cabinets. Um so day one, we turn up with six brand new Dell PCs, and uh and actually the systems and and the that was easy stuff. Changing the name on the door, putting in the systems, training, that was easy. The most difficult piece was the cultural transition. So the hair's a business that had been run as very much a lifestyle, so people could take leave whenever they wanted, and all of a sudden we had a bit of structure, well, a lot more structure than they were used to anyway, and and that created challenges. So, you know, nature of employment law, you've got to choop your employees across, you take what you get as part of the acquisition, uh, and then you work through that change process. And you know, we probably ended up losing um 50% of the staff in the first six months. We were okay with that, actually. Uh, and and the the other 50% were the ones that we wanted to keep and built a team around them. So 100% agree, all about people. And and the the point about the bad apple, again, um our clinics are quite large, so we can have 30 to 40 clinicians in one practice. Um even at that scale, one person can rock the apple cart pretty quickly. So you need to have a strong culture that and again one of the challenges with multi-site is that when you work one site you can influence things quite easily. When you have multiple sites, it becomes more challenging. So you need a strong culture, you need you need good management and leadership around you to help be purveyors of that culture. Um, so it there's no easy answer or magic bullet, it takes time. But you've got to be very clear about what you want your business to be, how you want people to interact with each other, with patients, and have that that bedrock, that foundation that that basically is is your uh the the morals and values for how you operate.

SPEAKER_03 31:46

I think there um I know there are a lot of clinic owners that are probably smaller scale than all three of you uh here. And I think um everybody has that one person when you're running one clinic. If you're running 10 sites, maybe you've got you know those three people who, if they don't show up to work the next day, you are terrified because they know where everything is. I think it would be um interesting to understand, without giving away the secrets. I appreciate everyone has their own secrets, when you are making those key non-clinical hires, um, the operational bodywork, customer-facing people who are not in the treatment room. Um certainly what I found uh running Clinic was that that is not necessarily a part of the clinic where you have a lot of uh bench, um, particularly on the front line. You often find yourself uh working with people who are on an upswing in their career, who maybe don't have as much experience. Maybe it gets a bit bigger if you move into corporate at 10 sites, but for the most part, when you're growing practices on a clinic-by-clinic basis, that operational backbone can be challenging to build. Um, once it takes hold, it usually sticks, but it's hard to build. So I think it'd be really interesting to understand, maybe Joel, starting with you, when you think about your um your operational team that's enabling you to do the work that you want to do, um, how do you how are you hiring those people? What are you looking for? What are you saying, no way to? What are your red lines? Um I know your operations manager director who's who's great. Um so uh but that wasn't always the case, right? So so how how did that how did that journey look?

SPEAKER_14 33:28

I mean, I hired the vibes, not gonna lie. Um, I mean, obviously she also came um, look, I think first and foremost, her recommendations from other people, I feel like it has always proven to be the most you know valuable asset of like hiring people. Um you know, if somebody has had a good experience with somebody, that's always like a really good green flag for me. Um and yeah, then obviously, like I said, you know, you if you want to be close with someone, you've gotta you gotta get along. So I um that sounds really stupid, but I literally hire middle times as well, you know. And uh, you know, sometimes you get it wrong, but um, you know, if you've got if you have got some sort of like um, you know, human intelligence of like emotional intelligence of like getting people, plus then there's a good recommendation of somebody else. I mean that's um that's great. Um but yeah, it's uh it's trial and error as well, right? So um I think um now I'm I'm you know I'm fairly new at this as well, as being you know, being a founder. Um and it's only now that I'm starting to really get a grasp on like you know the hiring process and like what some so you know I can quite easily now see okay this is gonna be good, this is gonna be bad in the first, I guess, a couple of days. So um so yeah, it's um it's hiring on vibes.

unknown 35:03

Sorry.

SPEAKER_03 35:04

Hiring on vibes. That was hiring on vibes. Uh great, no, no, it's it's uh but but your team DNA is really stitched together. Uh so it works, right?

SPEAKER_14 35:13

I I you know I I I don't know if that's the right way to be, but also I think as a founder, I um I think a big part of my job is obviously and I I do that with you know I've learned to really enjoy that as well, is just like trying to keep morale high, you know, yeah, taking some employees for lunch and like you know what I mean, trying to also like get to know them not too personal, but you know what I mean, like to some sort of extent, like that you can also have fun at work because like you know, I think when the moment somebody enjoys going to work, they'll also deliver their best work. Um and then obviously look at it operationally, you just need somebody that's like really good at you know, structural, you know, and like also saying no and like putting structures in place and like you know it's like so important. Um, because I'm like the most type B person ever, so I'm like, you really need something like that. Um so um so yeah.

SPEAKER_03 36:14

Thank you, Simon Andrea. Um, how do you think about building your management team? I think again it probably looks different at different sizes and stages.

SPEAKER_12 36:22

Yeah, I was just I was just reflecting, then just thinking about the journey that that I've been through personally. Um I would say when you when you were smaller, you by the very nature of that smaller business, you are doing lots of things probably. You are a good generalist. And so it's obviously easy when you're a generalist to understand different facets of the business. And so you have some idea about the technical competencies that you're hiring for. But still I think what underpins that absolutely is team and cultural fit. I played team sport my whole life, so that comes very naturally to me, but I would say all of the hires that I've made have been either with some understanding of the technical capability, but the the final decision is down to team and cultural fit.

SPEAKER_03 37:07

Can I call that vibes?

SPEAKER_12 37:08

Yeah, yeah, yeah, it's a different, different, different, different thing. Um but equal but equally you you get stuff wrong. And I would also say that I've got loads of hires wrong. And and one of the things that you've got to realize, because I think when you hire someone, you take it on personally that you want it to work, because that's your core. The reality is it doesn't always work. Uh, and having the confidence, you know, having the process of a three-month probationary period and structures in place to review performance in the first three months, and then the confidence to say, no, this is not working and draw a line under it is critical. And that is hard. When you are small and it's very intimate and you have connected personal relationships because you are you're engaging people to do stuff that they probably wouldn't do in a bigger business in the early days, that is hard. And um, but I would say that that that for me is is a is a point of reflection anyway, when I think back, there were lots of hires that we didn't get right. If I knew what I knew now, would they have stayed in the business long uh uh for less time? Absolutely. We would have called it in three months.

SPEAKER_03 38:15

Andrea.

SPEAKER_06 38:17

I mean they said a lot and I agree with everything they said. I think uh for us, it's been 12 months now. I think I think finding talents to put a corporate level has been more challenging than finding clinics to buy. Um and and hiring, I think has been the biggest headache. I think um I think now we have a good team. Um we made mistakes. Um I think one thing that we learn is when you find the right person that shares your value, that you really like, that push you, that is passionate about that, just keep it very close to yourself in any way you can. Like, of course, good comp package, but like being part of a family, a culture, all of that, I think that's the most important thing.

SPEAKER_03 39:02

Um for what it's worth, Joel, when I was hiring for clinic vibes, 100%. Because I was living in clinic, you know, 5 a.m. to close. Actually, someone who'll be on panel two was someone that I worked very closely with at that time, and uh I think it it much like what you're saying make made all the difference. I'm conscious that there are lots of folks here here with questions far better than mine, but one last uh sort of question before we transition. Um, if you could go back to the beginning, day zero. If you can remember Simon.

SPEAKER_02 39:30

Yeah, we can.

SPEAKER_03 39:31

Uh if you could go back to uh to day zero, if you could do one thing differently, what would that one thing be? Maybe we'll start with Andrea and then go down the line.

SPEAKER_06 39:44

Uh scale the corporate team earlier. I think we waited too long, like we we waited to buy three or four sites before actually starting, and then then it ended up being all me and Enrico to actually manage three clinics and four clinics, etc. So yeah, hired a team. I hired a team and then uh buy.

SPEAKER_12 40:06

Um because we were set up as a business from a growth business from day one, we had investors, so we're very much set up like a private equity structure or effectively a family office. Uh so the one thing I would have changed was asking for twice as much cash for the growth journey and told them it would take twice as long. Uh because that's a reality. Um and then probably maybe more wants to change it. I couldn't agree more. Yeah, yeah. Okay.

SPEAKER_03 40:36

Um Joel, one thing?

SPEAKER_14 40:38

I mean, mine is gonna be so personal, but it's get a good builder. We had the worst builder in the entire world. And he was just awful, and it was just like obviously I went on vibes and like they really fucked me over there. But um, yeah, and also, you know, with with everything, like as stupid as it sounds, like get contracts in place. Like in the beginning, we literally generally went on vibes with our contractor, and then like the we had a contract which was like you know, in in paper signed, it just like it wasn't actually like properly legal and stuff. It was just like the worst, the worst luck, but also just like the worst mistakes ever. So um, so yeah, with me who was a builder. So just invest in a good builder, don't go for the cheapest quote and get everything on paper.

SPEAKER_03 41:29

So thanks. Um we have a few minutes with um this uh group of uh panelists, happy to take questions. Um yes, sir.

SPEAKER_05 41:38

Yeah, um, yeah, what was a mic coming? Um just one for Simon. Um when you were growing pure sports medicine at the start back in 2007 with three treatment beds and a curtain in between, and you had great clinicians. What was your first priority when hiring a non-clinical member of staff, bearing in mind that you knew that was probably going to take time for them to provide revenue for you? And what could you briefly go through the systems and process that you went to to achieve that?

SPEAKER_12 42:15

Well, the bearing in mind the um bit of context, so the the business had been founded in 2002, saw its first patients in 2003, proof of concept for three years. So technically, I was I was their first big hire of a non-clinical individual. Um and I guess with that growth mindset, I was coming on board to to double the size of the Kensenden Clinic. We were looking to take space in the square mile, we eventually found five and a half thousand square feet on Thread Needle Street near Bank. And so it I guess you know it's very much in investing ahead of the growth curve. You know, we were very growth focused, and it's difficult because you are taking quite considerable cost ahead of that growth being delivered. But it does focus the mind, particularly when you're reporting to your investors, about what you're doing with that capital ahead of the growth that you've been talking about delivering. Um so I think I just think being very, and then again, if I sort of step away from my position and think about the other non-clinical key people that were hired in the early days, being very critical and analytical about what you are expecting them to do. Um not just today, but tomorrow as well, and making sure that that they are able to do that, not just today's job, but tomorrow's job. Um and yeah, I mean, again, time is money, so you want to deliver growth quickly and effectively. Uh so yeah, I mean, everything was everything in those days was very much time driven. So it was it was it was time outcome, uh, and the and the outcome was was multifactorial, how how quick to get a new clinic open. How much did it cost? Was it on budget? How is it growing? All those things that come into play. But yeah.

SPEAKER_03 44:05

Thank you. Thanks, other folks? Yes. Dave. Shout or wait.

SPEAKER_11 44:14

Thank you. One for Simon again, I'm afraid, mate. Nine greenfield sites, brand, notoriety, infrastructure. Why acquire? Why not go to war?

SPEAKER_12 44:26

Well, the acquisition was a strategic one. So effectively it was a clinic based at the Roehampton Club. So you can't just walk in off the street and set up a clinic there. So it was an interesting acquisition because we we not only had to agree terms with the seller, we had to basically get on side with the club. But to sort of step back from that experience and look at market opportunities and greenfield versus acquisition. The pros and cons. Obviously, greenfield, you can dictate this the space to a degree, and you can dictate your team from day one. But you are standing still when you start, so you've got a bigger cash drag. And depending on where you're at, you might be able to sustain that. The benefits of acquisition, clearly, you are buying, you should be buying a profitable business. And you should be buying a business that you can add value to, either with your pricing or growth into the space. And so the benefit is that it's generating cash from day one, but you've got all the cultural challenges that we we've talked about. So both have their place, and I think it is dependent on the opportunity.

SPEAKER_03 45:38

Was there a motivation behind that question, Dave? You got a war. Other questions? Yes.

SPEAKER_07 45:46

Hi, another question for Simon, I'm afraid. So when a clinic or any business for that matter starts scaling from being a startup, things start falling apart really quickly because what works in a startup may not essentially work in a scale-up. So for specifically in the context of clinics, what's the advice you would give to anyone who's deciding to move into that phase?

SPEAKER_12 46:18

But to sort of condense that all up, it comes down to two things. Having the right people, number one. So this is having people that can scale with you. So being very clear about what you want with your journey, and and I think that goes back to skill set. If if the individual that you've got is not right for the job, have the courage to make that change. And then secondly, I would say a lot of times it's the systems that fall apart. So think very carefully about I mean I I I some people think of systems as a cost. For me, they're business critical tools. So when you think of it in that context and you're investing for you should be looking at, you know, if you if you really want to scale, enterprise level solutions that can give you that flexibility, that scalability, that resilience, um, but does cost money to deliver those solutions. So those are the the two things, people and systems, yeah.

SPEAKER_03 47:11

Maybe if I just before the next question, if I can just nudge, so I I think um it'd be interesting uh without putting words in your mouth, Simon, um it sounds like PureSports Med is sort of in machine mode right now. You have your playbook, you have your you know your your execution more or less, um, and now it's a question of speed. I think uh in the work that you're doing, it's congevity, both the approach that you're taking and also obviously at injectuals. I think you're opening now site three. Um it would be interesting to hear, I guess, the same, maybe the same question, but at different stages of that journey where you're sort of acquiring it like in a in a growth uptick, and Joel, you're now going into this is Greenfield site three, um, with a good builder. Very good builder, excellent builder. Um so maybe uh starting with Joel and then Andrea, sort of thinking about um how are you, to Simon's point, like thinking about the systems that you want to take into site four, site five? I know you have ambitions to go to the US. Uh sorry it's private or not, but you have ambitions to go to the US. Um so you're starting to think about the infrastructure to do that growth. So how do you think about that? And then Andrea, similarly to you.

SPEAKER_14 48:20

I wanted to ask as well, is systems you mean like CRM and stuff? Yes, yeah. Um sorry, so how am I thinking about opening the dirt runner and the four tone? Um, I mean, look for me, it's indeed like I need to get operationally and like sort of like SOP-wise, and like that's now you know the first you know, the first two clinics you don't operate in data, you know, you notice that as well, like you can get away with like not everything every having everything of that like unperfect. But now it's like yeah, it's becoming just too big of a piece now that we need to protocols and no proper you know SOPs and like you know, operationally just everything needs to be sent in these, and it just needs to everything just need to be titans because otherwise it just um it just becomes unanimous, you know, and that's like obviously something that we are now um actively dealing with, and that's also I guess what I see as the biggest um uh like it fall, you know, that's like if that's not you know 100% or at least 99% structure that's all in place, um there's gonna be issues, you know what I mean?

SPEAKER_03 49:38

So I'm curious to all because I know Jekyll's quite a high volume clinic. You you you have a lot of throughput um uh compared to most aesthetics uh clinics. When did you start to sort of feel I don't know if it's number of patients, number of appointments, whatever the number is, when did you start to feel that sort of pinching of actually it can't all be in my head? What was that sort of roughly point in time?

SPEAKER_14 50:02

Um a while ago. Um yeah, I mean, I think um I yeah, I think obviously now that we're like serious about the third, you know, that the third location is about to open. I that's to be honest, yeah, that's also just when um and also just like I guess theme changes and like you know what I mean, you can't rely on just only one person. Like you just um there just need to be structures in place in order to like you know rely on like one clinic manager that manager, your entire business, you know, troubles. Um so um so yeah, like it's it's it's yeah, it's been a while obviously, and we're things, you know, we're obviously always making components and stuff. So um I think it's now becoming very apparent that it's like uh essential uh to make a way to get it.

SPEAKER_03 51:00

Andre, I guess you're sort of in the middle of that journey by locations at least. Um how are you guys thinking about uh systems for growth?

SPEAKER_06 51:07

Yeah, so well from a system perspective, uh we tend to standardize across location. So we have our CRM, our cutting management systems, and I think we have it all. So that's a non-negotiable deal. Uh Xero, like all the finances, all that is not really client-basing guys or clinic management, so we standardize that. We are at that phase in which we're starting to build processes, policies, HR, etc. But everything that really is patient focused, customer experience, uh pricing of the clinic, all that is the manage of the clinic. How do we control that? We do have a pretty good earnout structure or bonuses on the lead clinician, manager, etc., that are incentivized on whatever we want to do, which is correct.

SPEAKER_03 51:58

Makes sense. Any other questions for um this group of speakers? Yes, sir.

SPEAKER_00 52:08

Andrea, I just wondered what your criteria was for buying practices.

SPEAKER_06 52:13

Uh so we have a list of I think 15. Uh, but in the first that we present to the board where we need to approve a deal. But the first one is do we like the practitioner? Yes or no, how much do we like it? Uh that's the key one. Then we have the usual stuff, so it has to be certain size, has to be profitable, we prefer growing business stats, uh turnaround situations. Um and then as I said before, we really value the culture, the culture that we see. So before making the deal, we really spend a lot of time with the practitioner. Before signing the deal at the end, at the very end, we meet all the staff, we do a 30 minute reach, each one of those, we get like a feeling on what they will do better, what they're struggling with, etc. Um key.

SPEAKER_03 53:02

So the first criteria is vibes. Any last question just before we wrap up panel one? Nope. I'm getting uh turn it off. Uh signal from the back. Um great, folks, thank you so much. Really appreciate it. They'll all be hanging out just everyone for the chat. Thank you so much, guys. Um take 15 minutes, snacks, drinks. Um thank you so much for coming back, joining us. Too close. Not close enough, be closer. Grab the mic, speak like this. Is that alright? Too close now. Back here is better. Um so we'll just do a quick review of uh the responses, uh, which for us, given the work that we do, are already terrifying just on the first slide. Um but we'll see what comes out. And some of these are, in quotes, uh easier to answer, some of them are a bit trickier to answer. Um so we'll see how we go. So, how many new inquiries did you get last month? The uh customer hat wearing people in the room will call these leads, um, and everyone else will probably call them new inquiries. Um so it seems like 45% of us probably know this number right now, uh, those who answer it, so they can probably tell you that number. Another 45%, which is a very big number, have a sense, um, but it feels a bit more like art, not like science. And then 10% of us do not know. Um maybe those are the 10% who don't run a clinic, that would be, I think, a best case outcome. Um, but I think it is interesting because this is in many ways blood flow for the clinic, um, and not knowing that number is it is a bit scary. Um, but it is often the case that that uh that that happens. So um, how many new inquiries did you get last month? We asked, oh, this is a number. Oh, we asked you to give us the number, exactly, right? So to prove that you knew. Um and uh this is the range. So we've got some seeing zero to fifty new inquiries um all the way up to 500 new inquiries. So that's a lot of new inquiries. Um I would argue that uh those numbers might even get into the thousands for some of the larger practices 500 plus um multi-site operators. Uh we certainly see clinics that have well in excess of thousands per month. Um of all appointments completed last month, how many were new versus returning patients? Um so this is this is an interesting one. So uh some know the answer to that question, that's cool. Uh 28%, 65%, that's a lot of people, um, don't know but feel that they can find out. I would ask you the question, how would you go about doing that? Um, which would be very interesting to know. And then a smaller number uh don't know how to find out the answer, also concerning, but that's not a that's not a big number. Um what is actually that uh that split? So the uh how many don't excuse me, of the new starters, I should just read the slide. This is the easy part. Of the new starters, how many don't have a next appointment? Um I don't know the answer. 25%, 55%, I don't know what I can find out quickly, excuse me, I know the answer, 25%, I don't know what I can find out quite quickly, 55%. I don't know how to find the answer, 18%. That's that's probably scary. Um if the people that you just paid to go out and get may not have a next appointment and you can't figure that out. That's a that's a little bit of a scary thing. Uh but 18%, okay. How many cancellations last month still uh don't have a next appointment? This is usually what we see as you sort of go deeper into the patient journey, the knowledge of what's happening becomes harder and harder to see because patients move around like bowls of spaghetti, not like straight lines. So it can be a bit tricky. So only 13% know the answer. Um 66% feel like they can go find out quickly. Again, I would ask the question how exactly you would do that, um, and then 20% um are not really sure and don't know how to find out. Uh again, that's that's probably concerning if you're trying to build efficiency in the practice. Um how many hours does your team spend per week following up with patients? Um hours, 6.9%. Okay? Uh less than 10 hours, 72%. For some of the higher volume practices, that I don't know if maybe that's a good number, maybe that's a bad number. It means either it's really efficient or you're not doing it. I don't I guess it could go in either direction. Um 20 hours, 15%, less than 50 hours, that's a full-time person, 3.54%. More than 50 hours, 3.45%. So um people are hiring effectively a full-time employee or more in terms of hours per week just to do follow-up. That's a lot of following up. Um we'll see why that's the case in a few minutes. I don't know if those results are shocking or not. Um, as of today, how many patients across your entire database don't have a next appointment that should? 13% know the answer. Um, a lot of people, again, this is the lovely thing about middle responses. Everybody kind of knows, except when they have to put a number against it. And then about 20% don't know how to find out the answer. Again, this idea of a lot of our focus on patient leakage, um, not knowing the answer feels again a bit scary. Uh what time of the day are patients most likely to reply to recall message? This is a sort of trick question. Um, and we get all kinds of answers. Uh, early morning, mid-morning, early afternoon, mid-afternoon, early evening. No one thinks mid-afternoon. Everyone says, oh, they're at work. Turns out lunch break is a good time. Probably not a surprise. Um, and late evening. Um, this is a trick question because um the answer will depend enormously. Uh I knew it. Of course it will depend. Um, are you reaching out on email? Are you reaching out on WhatsApp? Are you calling them? Um, is it the first day of the week? Is it after payday? Is it before payday? Is it rainy? Is it sunny? All of these things go into does the sorry, does uh does the person actually answer? Um and so we see huge in the data that we see huge variation um in some of these things. Um so I don't have an answer, unfortunately. There's no there is no silver bullet, um, but it's interesting to think about. Um I think that is probably the end. So I'll jump back quickly.

SPEAKER_02 59:20

Press the wrong button.

SPEAKER_03 59:22

Um so uh I spoke earlier about what we do. Um, this is not the sales pitch part, um, but I am going to share a little bit about what we've learned. Um, this idea of uh leak stoppers, if you will. Um you can steal these. Uh we have seen lots and lots of data, and if you want to take them, use them, apply them in your business, great, feel free. Um we are very much of the belief that we'd like to give the knowledge away for free and then charge you for it when you want us to do it for you. Um so this is very much uh stuff that we see and do every day. So the first one is is the data. Um and the data that we see is often a complete mess and may often be a mess in inside of clinics as well. Um and so this is one of the examples that we love to give, and we see this in a lot of our lead handling work, inquiry handling work. We call the Sarah or Sarah problem. Um and the Sarah or Sarah problem is very interesting because you might get, and this is from our production environment, so you might get 4,296 new inquiries. And maybe you closed booked, so how many people actually moved through to a first consultation? Let's say you booked 10%, making up the numbers. Um we often find that inside that audience is the Sarah without an H, who last came into your clinic when her name was Sarah with an H. And as it turns out, your systems don't talk to each other, and so when Sarah with an H comes in and Sarah without an H come in, you think they are two different people, but actually Sarah has been in before. We had this happen earlier with a clinic uh where we reached out to uh a patient based on their phone number, and it turns out there were six patients in that uh database with the same phone number. Um I don't know exactly how that happens, but it happens. And so why is that interesting? Why is it a problem? Because um the marketing spend is going to the wrong people. The marketing spend is going to people who have already been in. Um and so why they are finding their way back into your clinic through the marketing spend um doesn't really make much sense. You can probably get uh people back in a different way. That's one problem. The second thing that's really interesting is that what we call these these sort of recall leads, these patients who have already been in, they're actually what we see four times more likely to actually convert. Um so, in terms of who you should be engaging to come back to your clinic, unsurprisingly, people who have come in already are probably the right people to focus on, uh, oftentimes, not always. Um, and uh, how much more likely are they to come back? It turns out that it's four times, at least from what we see. So the Sarah Sarah problem is an interesting one. Um the second one is this idea of intruding, and you can hear from the accent, I uh was not raised in the UK. Um I was I'm American by by birth and and childhood. Um many of our team, uh by coincidence, not choice, um, are also from the US. And we always talk about the sort of cultural differences and the extent of forwardness or lack of forwardness in different parts of the world. And certainly I think in the UK, as an outsider, but having lived here for 10 years, there is absolutely this sense uh from what we see of we don't want to intrude on the patient. Um and that probably makes sense if you're sending Black Friday deals. Um that can be very forceful when it shows up, but uh we often find that that is not always the case. Um you should, as it turns out, intrude. Um, intrude is a is a very strong word, obviously, don't intrude, so to speak, but show up. Um and I'll give you an example. This is a clinic that we work with in New York, so no one's data is being shared. Um we found and what we think about is this idea of how do we compete for a patient's attention? And oftentimes their attention is uh consumed by Netflix, by Meta, by companies that are far better at keeping people's attention than any clinic is, uh, because they have the resources, the know-how, the technology, the expertise. This is who you are competing with when patients start to drift off. It's Netflix, because that's what they're watching at 10 p.m. or at 6 p.m., etc. And so what we often find is that clinics will sort of do a little bit more, 10% more, to get back in touch with their patients. And it is just not enough. We always say it needs to be 10x, not 10%. You need to be 10x more proactive in engaging the patient. And there is always risk that somebody says, okay, like enough. And what we find is very rare. Because if you're reaching out in the right way, with the right tone, at the right time, people perceive you to be offering and extending care and not necessarily pushing them to do something that they wouldn't otherwise do. Um, and so here's an example. Um, May 18th, we um we sent a message to a patient, patient based in New York, 18th of May. Uh, we sent an SMS. They were interested, they reach out to a clinic that we work with. Um, we send this this response. Uh, this response, as you can see, is um labeled by Sonia. Sonia, for those who work with us in the room, is a very real person. She is sitting in the back uh of the room, uh, all the way from South Africa. Um, and so we reach out on the 18th at 3.15, we reach out on the 19th at uh 3.21, we reach out on the 21st at 3.26, we reach out on the 24th at 3.31, we reach out on the 28th at 3.36. Now you would think to yourself, this is really intrusive. And then we reach out on the 2nd of June at 3.41, and then suddenly something happened on the 2nd of June at 4.11. Turns out this person is interested. Now, why? Of course, the rational brain, why on earth would this person need eight different points of communication just to do this? I have absolutely no idea, but what we do know is that people need a lot of love to go from I'm thinking about something to okay, I'll engage with it seriously. And the thing that's crazy is that this particular, I was told to make it shorter, this particular point of conversation required 14 more outbound communications to move them through to a consultation. So altogether it was 20 points of correspondence to get someone who said, I'm interested, to actually show up. It's a huge volume, and suddenly when you start to think, well, it takes 20, sometimes take 25. We have clinics that we work with where it takes 121 days to move someone from inquiry to a booking. 121 days. When you start to think at that time scale and at this volume, you suddenly realize this is not a it's not a human problem. You cannot reasonably expect someone to be sending this volume of communication without sound, hey, just checking in on you, hey, just checking in on you. That will piss people off. When we launch a new clinic, we will sometimes pre script, and Saskia, who's also in the room, will lose her mind doing this. We will pre script 120 touch points per journey. And that is because it takes volume. So this is the other sort of thing that we learned. So if you're launching new marketing campaigns, you're launching new recall campaigns, write a lot of communication in advance and prepare for that to go out in real time because it will take a lot to move people through the journey. The third one, and I had some conversations with folks earlier today, is that the front desk is not a sales desk. And this is a sort of final thing that we share. So we talked earlier about team. Hiring front desk is is uh a very challenging thing. I live that reality many of you have lived that reality it is a very, very hard role to hire for. When you find someone who's great, it is like a drug. And you will do anything to keep that person, you will pay them more, you will buy them a dog, you will do anything to keep them there and keep them happy. But it's often not the case, especially as you grow and as you scale. And so what we often say is that front desk is not a sales desk. And the reality is that they're just two different people. One person is biased to administration, to service, to hospitality, they're very procedural. They are not waking up in the morning and at night thinking about conversion. And not to say that we should be selling in healthcare because people shouldn't be soldier if they don't need support, but 20 touch points to move someone through to a booking is ultimately a sales process. We can call it whatever we want but it is ultimately a sales process. It's a soft sell, it's a consultative cell. These are different animals. And if you think about in a business environment if you're selling to other businesses, you don't go out and hire someone with two years of retail experience who you can train on a system and go be a salesperson. You hire people who have sales experience and so this is a different animal altogether. We want to show you very quickly what bringing together data, technology and engagement looks like this is the sales part of the presentation. So we'll do this very quickly and that's the end of the sales part of the presentation. I think we're I think we're coming up cold on the internet piece. So we might jump to panel two absent uh the demo part is it live yet? Nope this is not live yet.

SPEAKER_04 1:07:56

Oh I see I think with the internet.

SPEAKER_03 1:07:59

That's a good point. We might have the wrong although I don't think that's probably the case. We'll give this one shot and if not we'll move on. We'll move on. So if I could ask um the second panel to come there's a bit of a punchline after the demo by the way sell your clinic mold free leaks in the pipe could have joined up really nicely and we've just totally ruined it. Panel two if I could ask you folks to uh to come up that would be uh thank you already coming yes already coming great but we have all of you know who you are um and so we have uh three folks joining us they'll introduce themselves in a minute um and uh welcome please do speak into the mics because we didn't get almost the any of the first panel because everyone was way too relaxed to do that so be very forward in your mics. Great so I think um the second panel is meant to be uh this idea of creating value so we talked about operations culture some of the plumbing some of the day to day um maybe we can think more about the the money moments in this panel for the sellers the buyers and the people have sort of gone in and done some quite uh deep plumbing in thinking about the finances so just to get started maybe I can ask um you to introduce yourselves and then we can get going maybe starting uh if you don't mind Enrico and then going down the line sure uh I'm the co-founder and co-CEO of Skinjavity.

SPEAKER_04 1:09:23

I was an investment banker for many years at Goldman Sachs so buying selling and IPOing businesses and we now have uh five locations and looking to acquire more um I'm Stephanie so consulting background used to work at Bain and company doing mostly private equity deals and then also a mix of helping businesses understand their highest value customers so they could obviously go out and get them.

SPEAKER_08 1:09:49

Post that worked with Jared for a very long time and um joined a clinic as interim CFO and then moved up to CEO.

SPEAKER_01 1:10:00

I'm Shirma Baleith I'm a private GP co-founder of uh Chelsea Medic's um private GP Clinic with uh two uh branches um also work um on the BMA Private Practice uh committee deputy chair and the independent doctors federation uh GP Chair thank you um a lot of ground to cover uh I think um maybe just to start uh Chama if you don't mind we'll start with you so uh you you direct set up two uh GP sites um GP is a slightly different perspective than what we heard earlier um so I guess it'd be interesting to start uh when you think about creating value at a clinic level what does that look like in a GP context um probably different than in other contexts so from a GP perspective how does value creation happen? I think initially it's all about um obviously patients uh very very important um and it's also about um I think there's lots of things I learned afterwards I will say um so um we we actually went into joint partnership with um uh a top um uh American healthcare um company in the UK uh last year um so it wasn't a typical uh acquisition it was a joint venture so we still hold equity but sold a large proportion of our practice um and they approached us and we'd been running our clinic for nine years um and had been thinking about selling but hadn't actually weren't sure whether we were going to do it or not whether we were going to expand um and when they approached us we then started looking at you know kind of that side of things and um in hindsight if I look at it I think the important things are um definitely you've got to have the right number of patients you've got to have the client base whatever we want to call them patients, clients, consumers that's what people are looking for. You have to make sure you've got SOPs in place. You have to make sure that the people that you've employed are employees so in general practice things are different. You can actually have self-employed doctors who work with you because a lot of doctors work um both in the NHS and the private sector and um so you know that's a very big big factor as well probably those are the three most important things I think when you're looking at trying to um you know think about um uh selling a practice yeah maybe just building on that so Steph um you've done a lot of financial transformation if we can call it that um fixing the books not cooking the books fixing the books uh in in practice and uh it sounds like Shabi you're saying what I'm taking away from that is er go early start early start thinking early um Steph what has been I guess your experience taking a clinic on that journey from uh maybe a bit too loose financially to a much tighter operating model?

SPEAKER_08 1:13:11

I think it well it depends obviously on the clinic but I think in terms of driving value it's always either at the top line so sales or costs so assuming your fixed costs are quite like you're quite a lean business and you want to rather focus on you know the top line it's probably looking at your customer lifetime value which is basically made up of how long your customers stay um how much revenue they give you and how much does it cost to acquire them and obviously you may have great economics like they give you a lot they pay you a thousand pounds it only costs you 200 to serve them but you're paying like 800 pounds to buy the client which obviously doesn't make sense. So it's definitely about looking at sort of the unit economics of your customer base and yeah like I said it's a it's it's a bit too much of a broad question because I think it depends like some clinics maybe are actually spending too little and therefore will never get the growth they want.

SPEAKER_04 1:14:16

So yeah I think it's depends on many things in a natural Enrico on the on the I guess on the buyer side um stitching together some of the things that I've talked earlier just now unit economics how deeply are you looking into that level of performance in the clinic when you're thinking about buying we would love to look at the level of performance but I think in reality a lot of the small businesses don't quite have the level of data. But I think the most important thing that has been said is the value isn't created at the point of sale the value is created by all the folks that were on the first panel. We just try and crystallize that value and you try to understand it. So it's the things that we care about when we look at it is that we are buying a business so don't make it dependent on you. If you are the sole practitioner you don't have a team I'm not buying a business I'm buying you as a person that's great but that's a different value proposition.

SPEAKER_03 1:15:12

So in the lead up to that I think that's the most important thing to to focus on really got it so um you use the word lead up how far back does that go?

SPEAKER_04 1:15:23

Preparation should start two, three years before really because when we look at it is if you want to have built that team you don't build it quickly. It takes time we look at what's the how long have people stayed with that business. If it's a whole new team that creates more risk for us. So I like to see that the team has been there for a while and so you need to prepare that early you need to diversify the concentration from the lead practitioner to the others that takes time you need to move the patients there. And then the other bit that's important is we don't buy businesses when the seller wants to exit immediately so if I'm thinking about someone I I want them to stay at least three years with us. So if you want to be gone in three four years you need to start planning now for it. Otherwise we'll be too late.

SPEAKER_03 1:16:06

So if you clinic owners in the audience sort of go two years, three years four, five I have to be six years from now I have to be thinking about when I get it's a long time.

SPEAKER_01 1:16:15

Yeah a long time Sharmi is that does that match your journey um so maybe I totally agree I I should have said that as well I think one of the biggest things is um particularly if it's a doctor-led clinic is um if you've got this kind of lead practitioner and you're worried about them leaving and taking all their patients and you know even no matter what kind of lease something that you sign that says that you're not allowed to work in the area the you know the restrictions and the covenants I think you can't stop someone from working. And so um so it's one of the biggest things that you know when we went into this process that we had to prove that um uh that our GP associates would be able to take over that and our patients were t weren't totally dependent on us.

SPEAKER_03 1:17:00

Drifting away yeah I I think it's interesting so um in both of your well the practices I guess that you acquire uh which are oftentimes backboned by a principal of some kind they may not be doing all the appointments but there's a principal child in your practice as well they were sort of lead uh practitioners Steph in in the clinic environments that you've been in it's a bit more I guess uh therapist or consultant led consultant to do that differently but uh therapist led um I think it'd be interesting to understand how do you think about workforce in that context because you have a recruiting issue if someone leaves but they're usually not holding 80% of the book.

SPEAKER_08 1:17:39

How how do you think about sort of value and team that's in the treatment room in terms of uh creating creating that uplift and that's yes I think it's your performance is so correlated to how people feel especially because clinics are normally quite small so there's normally like 10 people sitting with each other every day. They talk to each other they're friends with each other um so I think it's definitely creating an environment where they feel safe so you know you know job security etc and giving them opportunities to grow it can sometimes be difficult because it's very limited in a single site setting. So obviously the bigger you are the more opportunities there are for growth for example a senior consultant could become a manager somewhere or you know move on to start another clinic. So I think that retention piece and at the end of the day it's human beings I mean we're more an aesthetics practice so we selling is very important and obviously when morale's high and if you motivate people properly with the right KPIs they will sell and support you no matter what but if you don't that very quickly slips and it's it's I think because the teams are so small it like um really impacts the rest of the team so it's a new it's um I find it quite tricky in those small environments but I think yeah just figuring out how to motivate people and what motivates them.

SPEAKER_03 1:19:17

It's amazing to me that we've been here for two and a half hours and we only just hit KPIs. I guess that was going to be the first thing I was talking about. So I I guess Enrico to you so the three lovely letters KPIs how do you think about um performance around sale what what are you looking for to say your point you don't have great data in some of the smaller clinics but what do you have what are you working from what are the key numbers for you?

SPEAKER_04 1:19:41

Yeah well the first one as we said earlier is not a number of this divide so that is actually criteria number one look revenue and recurrency of that revenue because it means you have good customers that keep coming back so they're high quality growth rate of course we prefer a growing business and means it's doing well it's uh it's easier to keep on the momentum rather than uh turn the momentum. Uh we do look at the the concentration points that we said earlier if a practitioner is doing 80-90% of the business it's incredibly concentrated it's incredibly risky because if that practitioner gets bored after the sale or gets the flu we have a problem because the sales are not coming through. So I think those are really the the three four key things that we look at.

SPEAKER_03 1:20:27

Shama having been on the I guess being the queen practitioner as it were for at least the at least in the early days you you were I guess when you're starting out you are the thing that Enrico just described eventually needs to sort of transition this idea that it can't all be with a single person and their relationships etc how have you I guess enabled that transition in your practice how have you sort of gone from founder operator patient facing to slowly gradually moving further away and creating more I guess distribution and equity in the other practitioners who are seeing patients. What does that journey look like for you? What what should people be thinking about?

SPEAKER_01 1:21:10

I think I think it's it's quite difficult in general practice because um you're seeing patients the same patients all the time and what they like about general practice is that they know their GP. So it does make it quite difficult to um to do that. But what we did um because you build up your patient base I've been doing private practice since 2006 right and and so you're gonna have uh your patient base and you're not going to tell them oh by the way I've been acquired you need to go and see another GP now that's not going to happen. But what you are going to do is any new patients that come in are going to see your new GPs and that's how we did it and that's how we are doing it. So I'm a co-founding partner so my other partner both of us were the main obviously patient base you know earners as such for the clinic but all our new patients we don't see any new patients unless it's specifically requested by someone that we know and what we focused on was branding the clinic and not us. So our clinic was not named after us nothing was branded in our names and so people saw our clinic and hope still see our clinic as a clinic that's got good integrity and good medicine and it's not because of myself and my partner and that's what we've we started creating that probably about year three, four. Quite early on so we did that quite early on we knew at some stage there was going to be some sort of exit strategy and so yeah we've got down that path.

SPEAKER_03 1:22:47

Interesting I think um you've you you've been quasi acquired ish aligned there's a relationship now with uh another person or entity um uh and Enrico you're acquiring now quite rapidly um there's obviously a lot of excitement interest the holidays they all come into view when people start talking about exit it's rarely that pretty after the transaction uh what does post sale look like for you things are signed then what very little change so we have we take our time in doing a deal and during that time we discuss with uh the sellers their transition plan and so we agree with them and some of them want to stick around and do exactly as much as they were doing before some of them want to decrease over time and we factor it in.

SPEAKER_04 1:23:41

So by the time the ink is dry everyone knows exactly what the role will be. And I think in aesthetics a lot of practitioners have other commitments if not many spend six days a week in the clinic anymore and we respect that. I think that's one of the common fears I think we're selling and it's gonna become a nine to five job and I need to clock in and clock out. We're very clear that's not what we need. The clinic was successful with them being there two days a week that's great let's continue let's continue that that's absolutely fine. So not much changes for them really over time they might want to go down and we're very happy to accommodate that I I think uh this idea of accommodation is that like a real thing or yeah yeah some of our practitioners have changed their days okay we've changed the days we've allowed that changed the hours gone down gone up ultimately with our model the lead practitioner is still key to the business and if they're not happy the business is not going to work. We neither Andrea nor I are doctors we don't come into the clinic and manage that relationship with the patients so we need the lead practitioners to be happy. If a practitioner is spending five days a week in the clinic and suddenly says the day I sell I want to go down to one that clearly doesn't work. So we need to be reasonable within that it's it's very real and we've done that.

SPEAKER_08 1:24:58

Can I ask um Steph uh your I have the luxury of knowing this because we work together um part of your journey in clinic leadership was cutting things reducing not people open but just cutting things uh one can say making things more lean um you talked a little bit about revenue uh that's usually where people like to spend time and attention you did a lot of work on the other side of the house I'm wondering in the context of creating value um where do you look where do you go looking for things that maybe don't belong there that can be leaned out that can be made more efficient you have a sort of here are my top three things if I'm going into a new clinic that I would I'd cut first you're not a surgeon so it also depends sorry I'm gonna say this again um I think I'd I mean you'd hope that you know by the time you want to sort of start to get to think about exiting you've got a very good view of your numbers because like you've said yourself you most um PE businesses etc will only buy profitable companies so they don't want to go and inject more money unless you're maybe on the borderline and they really think it's a growth story. So I think it's having a lean mindset early on and maintaining that it can hold you back like I know your team mentioned that you didn't set up your corporate team fast enough for example so I think it's a fine balance because you can also overspend in the beginning and then you're kind of stuck in that cycle it's very it's much harder to cut spend later than increase spend. So I think it also cutting spend would take a massive toll on like the team the company you know it's like it's it's not a a fun job I would say so I think I prefer the much leaner model prove something then sort of speed up but I think all so many practices are so different.

SPEAKER_03 1:27:14

You could be spending more on marketing you could be spending too much on your overheads your rent some things are harder to fix for example your lease agreements um so yeah it very much depends unfortunately again it's not helpful at all I think uh uh Enrico something you said earlier is helping to uh crystallize yeah which I I imagine there's some form of storytelling in that exercise how do you think about storytelling in the context of transacting how do you um at some point think about your own storytelling what what does that look like so there's two things that impact value

SPEAKER_04 1:28:00

Uncertainty, so I want as little risk as possible, and friction. If you make it hard work for me, I become uncomfortable, I take time, spend time, get less excited. So I think those are the two things. Then you can weave the narrative about it, but make it as risks as possible. So know your numbers, as you were saying. Um have your CRM clean, that's a key problem in aesthetics. Um and if you have any skeletons, just tell me up front because at the beginning I can work around it. I have a board. If I go back to my board three times for new skeletons, they get nervous. If you tell me up front, we can we can work around it during the business plan phase. And then the other part is friction. And here I can't stress enough the importance of good advisors. Wrong advisors take time, cost money, and we get less excited by the day. So you want to keep the value, you want to move quickly and frictionless. So those are the two things that I would say focus on. But the last bit in that is uh you want to the clinic needs to keep working. So if during the deal the revenue starts dropping, that's a problem. We need to justify it by the to the board. So again, the good advisors mean they can do the deal, you can focus on your clinic. That's important, that's key.

SPEAKER_03 1:29:14

Um Shima, you have lived through this on the operator side, and Rico's talking about it on the on the buy side. Um to the extent that you are comfortable to share the sort of highs and lows, um, what were the what was the roller coaster like for you? What were the things that totally caught you off guard? What were the things that made it really easy? Um you can sort of take us into the experience of selling, um, or whatever it is that you did with uh said organization. Uh, positive selling.

SPEAKER_01 1:29:42

I'm not sure that's even a sentence. Yeah. Um no, I mean there's nothing easy about it. I think everyone knows that. Um it's um it's the biggest headache ever. Um I think if anyone says I thought it's flying. Um I think particularly if you're um medicine-based and you've been to medical school and not done an ounce of business before and you've just, you know, you built your clinic, but this actually took me to a different level, I will say. Um but um the process itself is very arduous. I think we were very fortunate that we had very, very good um record keeping. I mean, uh we kept everything to it. We had we had spreadsheets and spreadsheets. So it did make it very, very easy for us in that respect, particularly with the due diligence and you know, putting all those things in that data room and you know, the never-ending. So that was probably the biggest kind of headache. Then you think it's all over, and then you go through the negotiations, which you know, they throw something at you when you think you're just about to close. And you know, so it's it's it's it's a it's a constant. Um, and what I think, you know, you almost need to double the time that you think it's gonna take, um I would say. Um but afterwards, when it was all done and had a bit of a holiday, um I think uh there I think there's advantage and disvantages. Obviously, look, when you've had your own company, you've been able to make decisions and just make them and do things. Um when you're working with another company, which is a much larger organization, you are having to um it takes a bit longer to do the things that you want to do, which I think would be expected. Very diplomatic. Yeah. Very diplomatic. It's true, I mean that's how it works, right, and Big Corps, and that's how uh and you would expect that, and it's not what we didn't, you know, we wouldn't not expect that. Um I think the biggest thing is that it's taken away the headache of HR and admin, which has been amazing, and that's probably our biggest, biggest headache doing running your own business, and having that taken away, and you know, I'd pay I'd pay them for that, you know. It's just probably it's just it's it's a it's a huge, huge relief because the you just have to you you're already doing it. Well, I was working full-time, seeing patients and looking after them, and you're dealing with that stress. And then running a business and doing HR and doing uh you know, accounting. I mean obviously you had your own accountants and all that, but you were still doing all those things and it's all taken away. Um and I wouldn't go back. From that perspective. You're terrified.

SPEAKER_03 1:32:11

Um you said HR and admin. Could I ask you just to be a little bit more the admin feels like a what's what are the what are the things inside?

SPEAKER_01 1:32:19

When I when I say HR and admin, I mean I I I mean kind of, you know, uh they well, a lot of all the HR they've taken away. So we don't have to deal with anything, you know, any any complaints amongst data, nothing. We don't have to do anything like that anymore. Um, you know, payroll, everything from that perspective. Admin perspective, in the way that we send out newsletters, we do, you know, there's all these other things that we do, um, and they do that all for us. So um they help us monitor um all the kind of accounts and numbers and things that we need to from uh kind of even from a marketing perspective of patients. Um so it's yeah, it's it's good. It's good. I'm enjoying it. But I've it's been only a year. Ask me next year.

SPEAKER_03 1:33:05

Yeah, we'll ask you next year, exactly. Um I think it's interesting the the um the idea of admin. Um I imagine uh Steph, you would have seen a lot of admin given your role. Um Enrico, I imagine that at least from what Andrea was saying earlier, a huge amount of your job has become admin, uh which must be wonderful for you. Uh so can you um can you maybe tell us a little bit about uh without going so deep that we all want to kill ourselves, uh into the admin, uh help us understand why is admin in healthcare, because in healthcare in particular is remarkably painful in a way that running a coffee shop is just not that painful. So on the admin, the non-clinical, why is it so ma why is it so hard? And what have you done to try and make it easier? Because your job is effectively to compress all of that admin. How do you how do you keep it in its box uh rather than let it become all consuming as it often is for clinic leaders?

SPEAKER_04 1:34:03

So we have hired in a central team by function. So we've said what are the biggest headaches? HR. I have a very good HR person, finance, and marketing. Because those are the typical headaches that every clinic has, and so we said we can take it away. We can we can do it better, we can keep the clinicians happy, they can focus on managing the patients and on the culture of the of the clinic rather than having to deal with it. So we built a team around it, which is Andrea's point. We wish we'd done it even earlier, because it does take time to find the right people, it does take time they've all been into the clinics, everyone knows them, they know everyone, so they're really integrated, and that takes time because if you have three clinics and fifty people, they need to go and meet fifty people um while doing their job. So that's how we've done it. We build a team of professionals.

SPEAKER_03 1:34:47

Steph, you didn't have that luxury, but um you were that team of professionals?

SPEAKER_08 1:34:52

Well, I think uh delegating a lot, which actually is good because it makes people feel like owners. Um so there's obviously different segments uh in healthcare. You have to be like you said, your record keeping, your consent forms. It's not value driving, but it dramatically de-risks um and doing that kind of stuff wrong can be, I wouldn't say business ending, but you could obviously have a lot of um claims, etc. So I think there's fundamental things that have to be done and have to be done properly, even though they don't create that much value for you. So I think delegating those just to someone reliable, um, and then there's the more value-driving things, which I would say are things like marketing, um, HR can be also very value-driving, um, where you maybe need more innovative thinkers that can, you know, it's just a different kind of person. But um, yeah, knowing your team and what they're capable of, because you may also have a team that's not capable of that, and it's ultimately gonna set them up for failure as well as your business. So I think it's um, yeah, you have to balance the two and also know when you need help externally, pretty much.

SPEAKER_03 1:36:14

I want to pause there just for a minute. Um to see if there are questions. If not, I have one more, but I just want I'm conscious of time and want to give folks the option to uh lay into these good people if you so wish. So are there any questions that um that jump off the page? Uh if not, we can crack on. Yes, please.

SPEAKER_10 1:36:36

Um a question for you, Enrico. Um you've acquired five businesses. Um how do you go about valuate evaluating the purchase price of those?

SPEAKER_04 1:36:44

Classic answer is we look at Ibita. The answer is actually a bit more nuanced than that. So before we do an offer, we need to sit together, understand the business, understand where's the trajectory, the concentration that we discussed uh earlier on on revenue and all that. So the ultimate metric is a multiple on Ibita, where the the declination is is what does that multiple look like? And that depends on the things we said. So a larger business and more diversified commands a bit of a higher multiple, a growing business commands a bit of a higher multiple, and based on all of that and the fit and the conversation, that that is how we do it.

SPEAKER_07 1:37:26

Um again, in regards to valuing a company, the numbers are pretty straightforward. You have a beta revenue, all it's all basically applicable to all clinics or businesses. The waters get really murky when we start talking about intangible assets. So would you say that intangible assets essentially play a role in terms of the valuation only in the storytelling aspect? Like how would I as a buyer, or rather I would as a seller, prepare my clinic and use those intangible assets to raise that valuation and negotiate a better price for my clinic?

SPEAKER_04 1:38:04

The look the it's a bit of a bank currency, but the value of those intangibles is reflected in the performance of the clinic. So if you have a strong brand, you'll have a large clinic, so large revenue, and it declines down to large Ebidah, you'll be more profitable because you can have better pricing. And so it's all reflected ultimately in Ebida. Again, we look a little bit at we could tweak that multiple, but ultimately if you have a strong brand, it means you're big. And that's already reflected in the valuation through the financials.

SPEAKER_03 1:38:33

I think that's code for it shows up in the numbers.

SPEAKER_13 1:38:37

So, Shamer, this is for you. Um if you could um redo your admin, what would you prepare like three years in advance to make the sale more palatable now or later? What as a clinic and a as a healthcare clinic? Medical clinic?

SPEAKER_01 1:38:58

Yeah, I think I th I think I would have prepared in advance. You're right. I mean, I think everything. Um I think you need to make sure that everything, all of your SOPs are in order, you need to make sure that all of your uh HR records are in order, you need to make sure I mean finances anyway, the accountants are always there, and you've got the bookkeepers who are doing that side of things. Um I think you you you look more at how you would look at yourself. Um and so actually maybe more looking at kind of what your growth is expected to be. We didn't do that, we didn't s give our own growth, we just did it and saw what happened. And we went, oh yeah, wow, we've grown this much. But it wasn't kind of, we didn't project ourselves, we didn't say we need to hit this KPI. We didn't, we only added KPIs much later on in our kind of clinic. And and I think I I think our mistake was that we didn't get a BD person in at the beginning, and we just thought, oh yeah, we were typical doctors, ran a clinic, we were doing well, we were happy, we were growing, which was great, and that's all we thought about. Um, but I wish that we had actually got someone in earlier to do a whole BD thing from maybe year two, you know, um because I think we would have probably well, we definitely would have grown much more, and I think understood more when we actually came to do that. So I think my biggest thing would be investing in someone early to help with that side of things and just making sure everything's in order and everything admin-wise, HR records, everything, everything needs to be in order. Because they go through they go through the last uh five years in quite detail that you need to make sure it's all there.

SPEAKER_03 1:40:41

Any other questions? Well then there's the last one for me, and maybe we can go down the line. So um I will ask the same question I asked at the first panel, which is uh what one thing would you do differently if you could go back to the beginning? The beginning will be different for each of you, I suppose. But what is the one thing? I guess I would just sort of just say get everything in order, but maybe give us the one thing of the everything, uh, and then we can come this way. What is the one thing that you would do differently in the beginning?

SPEAKER_01 1:41:17

Business development. I would have got a business development person in earlier.

SPEAKER_03 1:41:25

The business of a clinic, you might say.

SPEAKER_01 1:41:27

Yes. Yes.

SPEAKER_03 1:41:31

You would help with it.

SPEAKER_08 1:41:33

Um maybe make more bolder decisions. I think you can get quite like stuck in your routine and oh, if I change pricing like this, it's gonna like disrupt my whole business. But you know, um often that's not the case. So I think maybe being not drastic, but trying to full pull levers a bit um without being so fearful of what the result would be probably.

SPEAKER_04 1:42:02

Build a team earlier, same as Andrea said ultimately. So that's something. That's also what we're asking of the clinics, but we're but we're telling clinics you need to have a team, we should probably be doing the same thing.

SPEAKER_03 1:42:13

Makes sense. Um folks, thank you so much. Thank you for your uh contributions for sharing. Um just before we wrap up, uh you can sit here if you'd like, or if you don't want to be in display, you can whatever you prefer. As you wish, you're welcome to stay in any any any seat you'd like. Um just before uh just before we wrap up, so I I think um we uh very intentionally brought together people who probably wouldn't end up in a in a room together. Some of you might. Uh we have a strange amount of concentration in MSK for some reason. Uh but there is definitely uh a blend and and we also wanted to um invite and open doors to uh folks who are doing other things in the space. Um we're uh very excited that the tech is ready per Simon earlier, or at least we think the tech is increasingly ready, and so we're very pro-tech as a tech business. Um, but there are also other people who are sort of enabling the ecosystem. Um I'll recognize a few that are here tonight. So uh Joshua with Varillo, who's helping people sort of do some of this transacting, which is very exciting, also has brought some absolutely gorgeous water bottles and fortune cookies. And fortune cookies for those selling, good fortune, of course. Um thank you for contributing and for helping to pull this together. Um we have the EFRA team as well, for those who do anything in insured billing and want to jump out the window. Um, you should instead go speak to the EFRA folks uh who are doing some really exciting things in in the space. Um so I think anything that we can do to try and uh foster community around clinical and commercial working together is very much what we believe in and want to do. Also, I just noticed actually the HMDG folks in the back as well uh go talk about oh yeah hey Michael as well, that's great. Uh for marketing needs, uh, who are excellent. Um so I I think uh where we can um bring people together, we obviously will try to. Uh we apparently do a podcast now, uh, which is news to me. Uh but um please do feel free to listen. We're trying to bring uh people on to speak. Um, some of the people who are in this room have already come on to speak, uh, mainly about surfacing perspectives earlier today. Dale joined to share what was a really amazing journey through um terminal diagnosis to uh cancer-free in the course of a year. So we try to just bring together different perspectives. Um, to the extent that you want to contribute, uh, you are very welcome to. We would love to extend our conversation to your conversation to the extent that you want to listen. We would obviously invite you to do that. To the extent that you have feedback for us, we would also very much welcome the feedback. Um so thank you very much for joining us. Um I think that's where we end. Um we will hang out. Uh feel free to spend some time. There is dessert. And there's a demo. Right on time, guys. Excellent. So I think um for those who are hanging out, uh, maybe we'll get a dessert, take a dessert, please do. For those of you need to leave, because I know there are some people who need to leave at 9, um, please do leave, maybe in like 15 minutes. We'll come back if you want to uh stick around. We'll show you what the AI looks like in how it's like the AI, the AI, and we'll show you a little bit what it looks like because um we have one Sonia and a team of patient coordinators. Um, they support hundreds of thousands of patients, uh, which is a very hard thing to get your head around when uh you think at that kind of scale. So we'll show what that actually looks like in in real time if it works. And it works, and it works, that's great. Um so thank you so much for coming. Uh please have dessert, and if you want to hang out in 9.15 or so, we'll do a quick sort of show and tell and then uh send you off with water bottles and good fortune courtesy of the world. Um so, folks, I'll just take two minutes. This was supposed to stitch up really neatly with the conversation earlier, and we missed the moment. So if you're still here, um I assume it's because you want to see the the highlights real. Um the interesting thing that we find about uh AI in healthcare is that it, unlike software, is often invisible in that you can't really see things happening. Um, and so what we've tried to do is create a sort of show reel, if you will, um which shows, helps us to visualize what is happening um under the hood. Uh and I think the important thing to say is that we, much like everyone else here, have seen a lot of AI stuff, uh, some of which is great, some of which is more concerning. And and the thing that we're really interested in, and the problem that we're trying to solve, and this is not to encourage mass unemployment, but how do you actually take people out of the equation? Um, and what we've found is that AI alone does not get you there yet, at least, uh, because there is always an edge case in healthcare. Oftentimes the edge case is the case. And as soon as you have uh these issues, somebody needs to be there. And as soon as somebody needs to be there, um you have to keep them, even if they're only there for those uh fringe issues. And so what we have done, which um many days we wake up and regret this decision and then go back the other way and feel like it was a great decision, is we're actually uh trying to build all the way through um AI and human together. Uh and it's uh an interesting challenge because um how do you make people and tech actually uh work together rather than uh bolting things on here and there? So we'll just show really quickly um some different patients. For the practitioners in the room, this will look very familiar. So, patient number one, as an example, um, this is the patient. Um, and said patient uh sends a message, hi I had to cancel last time, can't uh it can I get back in soon? Now, you imagine the normal flow of this kind of interaction. Uh a patient uh writes in, someone may need to be there right away to handle it. If they're not, they probably have to wait. Um maybe there is an AI agent there and they can do the initial correspondence handling. Um the nice thing about a question like this is that it's pretty um friendly, it's not scary. There's nothing in here that makes people say, oh no, um the bad things are coming. And so what we do is uh we throw our lovely elephant at the problem, and the elephant helps us say, hey, this is actually not scary. Um and just figuring out that it's not scary is very hard, as it turns out, um, because some things may be scary, especially in healthcare, that actually um are in fact not scary and vice versa. So uh this is the first step that we uh we focus on. The second one is this idea of data. Um so how do we take this patient and verify them against the the clinic? Um the clinic has a practice management software, um, that practice management software, going back to the Sarah versus Sarah problem, um, may look funny. So we try to figure out if this person asking a question is real. Um oftentimes, particularly in new inquiries, we find that it's just spam. Um so your marketing funnel is full of spam, as it turns out. Um and so we uh we look at the patient, we retrieve their uh history of appointments, we say, oh, this person came in these times, they canceled an appointment, they came in for a consultation, they had an initial inquiry, whatever it might be. Um we check, really importantly, this clinic knowledge base. Um so we uh we document extensively um the SOPs of the clinic. What do you charge? When do you charge? What's your cancellation policy? Which of your practitioners is most likely to convert an initial assessment? All of this data is informing what comes next. So we check this knowledge base, we say, hey, we have we found a cancellation policy. Now we know how to handle this question. Um it's approved because it's within this rescheduling window, and it's not scary, so we're gonna check and confirm that availability, and we're gonna send this thing on its way. It's gonna be friendly, it's gonna be consistent, it's gonna be professional. Those are the brand uh archetypes for the clinic. Um and then we're gonna get this nice message that says, Hey, uh you're you're very welcome to reschedule. All of this will happen without a human. Um the human will then have a little look around and most likely will just say, away you go. We will then throw some more verification at that because if If it's Sarah and not Sarah, and it's actually the wrong Sarah, not the right Sarah, there's all of this checking that needs to happen. So we do lots of checking, lots of checking, and then we're ready to go, and off it goes. But it goes with a human patient coordinator sitting there looking at it and saying, Yeah, that looks fine. And because it's low risk, the checking that they need to do is actually very low. And so you can move through a massive amount of volume because oftentimes this administrative work is administrative, it's not complex. Yay. Our patient coordinators do that. They throw up confetti and they say, yay. Patient two, they write in here's Charlotte. She writes in with a question. We've used Sonia because oftentimes they will be speaking to Sonia. They say, I'm interested in a consultation, but I'm not sure which treatment I need. Do you have the price for your shockwave therapy? And so here we are looking at this message, we're saying, there's nothing scary here, but there's some uncertainty. The patient is not entirely clear on what they want. They probably need some support, some consultation, some nurture. They might want to speak to somebody, not to a robot. And so this is a message that comes through, and we say, Oh, hold on a minute, like it's not green here. It's actually a different color. So again, we need to do some thinking and we say, hey, there's moderate complexity here. There's nothing that's jumping off the page that we need to be very scared about, but we need to think about and qualify this response differently than can I just move this appointment from A to B? And so the same thing happens. Hey, in this case, it's not a new patient, there's no match found. And so we check the clinic knowledge base, we see that there are these different consultation types, stock wave therapy pricing, et cetera. So we pull this information, we check the practice management software, we pull all this information together, all of this is happening automatically. So the patient coordinator is not going anywhere to find anything, it's just happening in the background. And again, we get this nice message and it says, hey, um something's going on here, thanks for reaching out. Um I'd love to help you, this is our pricing. And this will then be escalated into a patient coordinator flow. So the human is now going to be responsible for handling this patient rather than just approving, because the human in this case says, hold on, we need to do more here. It's not just a send a message and away it goes. Um reviews by Sonia. Oftentimes it isn't Sonia, other patient coordinators as well. Um, and then away we go. Um and this is where it gets interesting, and this is often where we find um this promise of AI uh falls a little bit short at the edges because in healthcare um you get things like Daniel. And in this case, Daniel says, Hi, I woke up this morning with a very with very itchy skin. Is this normal? Now, this may happen one uh one out of a hundred, but that one out of a hundred means you have to put someone there to handle it because it's not yet ready to do it on its own. The risk of getting it wrong is too high. And so, again, we do some thinking, we say, hold on a minute, this is very, very high risk. We're detecting in this communication there are problems, and we need to address this in a different way. So the AI falls away, not relevant anymore. This is purely immediately escalated to a patient coordinator. Patient coordinator again steps in, Sonia is again in the flow, uh, and steps in and says, human coordinator is now handling this. The context is ready, so Sonia again is not able to go check why is this saying this, what was their appointment history. We pull up the information about Daniel, we pull up the information about the clinic, we pull up the information about the appointment history, we pull up their previous activity, we do a lot of pulling up, and then we show the escalation reason. Hold on, patient reports, new symptom, itchy skin, and require some kind of clinical assessment, which we don't do, and this immediately goes back to the clinic. So we will not ever put AI in the firing line of something clinical because we just don't think it's ready. We could be wrong, but we just don't think it's ready. Um, and so the human resolves uh the problem um and away it goes, Sonia sends a message. And so for us, we have found in this, and we're now doing tens of thousands of interactions a week, maybe more, uh, in the USA, in Canada, in the UK, what we find is that um this is a data and governance problem. And so when we see clinics that want to throw AI receptionists in the mix, we get very scared because we want to know like, how are you governing the data? How deep are you on the SOPs? Do you really understand what the clinic would say? Are you governing it? What happens when it goes wrong? And these are questions that oftentimes we've found that clinics will sort of pay the price for after they've made an implementation decision and it gets very scary. Um, to give you a sense of scale, so in our very early days, we had one patient coordinator supporting about 10,000 patients. Right now we have a team of patient coordinators supporting well in excess of 100,000 patients, and we don't really see those two things scaling linearly because we're able to not get rid of the humanity and the empathy, but get rid of the mess. And the mess is what slows things down, and it's why you need to have three people on the desk instead of two people on the desk or one person on the desk, because all of that gets lost in this sort of messy middle of checking three systems, moving patients across this spreadsheet to that spreadsheet, and then messaging your friend, hold on, did this patient come back in and then get the WhatsApp back? Oh, yeah, let's do it. All of that is what eats up the time. So this was supposed to fit very neatly into stopping the leaky, uh, the leaky journey for the patient, but um, this is what we're doing. Obviously, we're very happy to chat more about it for those who are interested, um, and thank you to those who are already working with us for entrusting us uh to partner with you on the journey. Um, hopefully we don't royally mess it up. Uh but so far we've been okay. You might tell us otherwise. Uh, but it's been really fun um and we really enjoy working closely with the practices. So again, thank you uh for staying extra to have the dessert and to see the show reel. Um and if you're interested, obviously, in learning more, this is the sales pitch part. Um, you should go talk to Saskia, who is uh standing at the back. Uh you know, who should uh obviously come chat to us, uh anyone on the team, we'd love to share more about it. Thank you so much, guys. That's the end of it. So have a great night. Thank you.