From PhD to CEO: Joshua Steer’s Journey with Radii Devices

0:00Welcome back to The Serial Entrepreneur, I'm your host Anna Wood. Today I'm joined by Joshua Steer, the CEO and founder of Radi-Eye Devices. We discuss the importance of clinical feedback, the transition from academia to founding a startup, and the immediate pivot Radi-Eye Devices had to make on launch. Let's dig in. How are you doing? Hi Anna, yeah, doing great today, looking forward to the conversation. Great, it's great to have you on. So to begin every single podcast that we do, we always ask our signature icebreaker question, which is what's your favourite breakfast cereal and why? So I think I was thinking back and I think it's crunchy nut for me was always, always the one when I was in my paper round when I was younger coming in on the morning, bowl of crunchy nut, loads of sugar.

0:47Not so much now, but it was great. Yeah, honestly, anything sugary is a yes. And funnily enough, I also did a paper round when I was younger. So that's funny. So would you be able to introduce yourself and tell me about your background? Sure. So yeah, my name is Joshua Steer. I'm the founder and CEO of Radi-i Devices. So we do software for custom medical device design. My background, I was a mechanical engineer. I did a PhD and then from there spun out the company a few years ago. Great. So what is Radi-i Devices and what is your mission at the company? So as I said, we provide software for these custom medical devices.

1:25So a big focus on assistive technology, for example, prosthetic limbs for people with amputation. So these are devices which have to be bespoke made to an individual. Every single one is different. Someone who's had an amputation and needs a prosthetic will come along to a clinic. They'll work with an individual clinician who will really kind of dial in the fit of these devices. That's what's really important. It's kind of like having a custom pair of shoes made. It's got to really, really work, but it can take quite a while to get a really good outcome. So what we do is we provide software, which is using 3D scanning and data to these clinicians to help them get the kind of the best outcome for their patients.

2:03Great. So what was the inspiration behind staffing the company? So, yeah, I think for me, it was kind of, I was doing my PhD work. We were looking at, as I said, background from mechanical engineering and design engineering and thinking about how can we you know make all of these medical devices perform better and as I was kind of approaching the end of my PhD really kind of thought actually we might have something here that could be of real value to the industry so I wasn't initially kind of as I was doing my PhD like oh I'm definitely going to start a company it wasn't like something in the forefront of my mind but we had a really early demo of what the software would end up being and we were at a conference and we were just kind of showing it to a few of these clinicians and they're really excited by what we're doing and then we're kind of like oh we should you know really try and get this out there so that's really where it came from and it was just kind of one day saying actually you know I think think this really could be a company and it's kind of been a really fun process from there on.

3:03Yeah that's great so how does Radi-i improve prosthetics so how does the technology work? So we don't necessarily kind of improve it directly. We're all about enabling these clinicians to get the best outcome and improve it. So our kind of motto is always providing these, you know, these clinicians who fitting a prosthetic is a really challenging task to do. It's like they're trying to do something really difficult in replacing the function of the limb. And so what we want to say is, can we provide them with the best possible tools to do their job? So So broadly how it works is that we have a big database of these 3D scans.

3:40So we've got scans of the limb and then scans of these prosthetic sockets that have been made. And what we do is we analyze that data and say, okay, for this particular patient that turns up, we found that similar patients have had real success with this kind of socket design. And so then when the clinician starts their process of fitting one of these devices, we then give them that initial starting point and say, hey, this is what the data suggests, and then give them the tools to take it from there and really help hone that individual fit for the individual. So trying to reduce the number of visits that it takes to fit one of these devices and ultimately get a better fitting prosthetic for the patient.

4:21yeah well i'm quite uneducated about prosthetic do they often take a lot of sitting yeah so they can really you know take several visits to to dial in and each one if you imagine they have to it's not like they can just pull another one off the shelves because they have to be bespoke made each one that means it's not just kind of one visit to fit a new one it might be two or three to actually go back and say okay that one didn't fit so we've got to go and manufacture a whole another one again, come back in another week. So each kind of cycle that you go through of trying to get these to fit, let's say the pair of shoes analogy is you can't just kind of pick, okay, the size six didn't fit, let's go for a seven instead, or that one pinched a bit at the heel, or just get one that's slightly wider there.

5:06You've got to go through this whole process of fitting and it's really time consuming. So anything that we can do to reduce those number a visit is going to lead to kind of someone getting their prosthetic much faster. And ultimately that really improves kind of outcomes from there. Yeah, definitely. And I can imagine a well-fitting prosthetic and getting it very quickly makes so much difference to the people who need it. Yeah, it's huge. I think that's just the kind of, you know, having a prosthetic that someone feels comfortable in and confident in to be able to walk longer just massively opens up what they're able to kind of do the the activities that they engage in so it's just this huge indicator of kind of those outcomes of those quality of life after receiving one of these devices which really do just you know make an enormous difference in in the day-to-day yeah so how did you find yourself within i guess the prosthetic space was there anything that drew you into that space yeah so So I'd kind of always had the interest around assistive technology as a whole.

6:15And when I was doing my undergrad as a mechanical engineer, that was when the 2012 Paralympics were on. So obviously huge visibility around, you know, what this kind of technology could enable. And so kind of always been like, oh, that looks like a really interesting space to apply my kind of engineering skills into. and then when I was in I think my my third year of my of my degree did an internship looking that was kind of like hey let's do some technology development around prosthetics and it was really from there that everything went to so that then led to the PhD which then led to the to the company so I know you speak to a lot of people who've got into this industry they might just have like a kind of a small start a small limb but then kind of opens up this whole world where there's so many different people with different skills working together we're working with doctors we're working with physiotherapists you're working with engineers of all different types and everyone kind of collaborating together in this really interdisciplinary world so there's a lot of people that have this small start but then really actually get so interested in how they can kind of solve these challenges that come up around prosthetics great so earlier on you mentioned about how you were kind of presenting the start of the product and was getting feedback So obviously feedback is so vital from users especially.

7:36So how has that shaped what you're currently doing now? Yeah, I think feedback for us is everything. I mean, you know, when you're working in somewhere that's a very specialist industry and you've got, you know, if you're doing like a really classic B2B piece of software, there might be, there are probably tens of millions of potential users out there who you can just, you know, work with. get huge amounts of feedback. But when you're working in, and I think this broadly across all of medical technology, you're working with often a much smaller number of very highly skilled individuals who are incredibly busy.

8:13And so what you've got to do is to really balance against how much of their time am I taking up and giving feedback because it's so valuable. But obviously, you need that feedback to develop a great product. So that for us has been a real, yeah something really to kind of just embed in everything that we do so we've always made sure that that kind of core principle of showing things really early and making sure that we're on the right track has been really important obviously we're in a in a regulated space so you can't just take the earliest scrappiest version of your software and throw it into a clinic but there are ways around that way and you can say can we still get feedback with a clinician at the end of the day when they're done with all of their busy clinics to give us their thoughts on the products maybe do some simulated case studies and that it's just kind of embedded everything we've done as we've gone along and it's really helped shape the the company and you know many of those first people who we worked with and first gave us feedback are now some of our biggest advocates and they're the ones introducing us to new clinicians and so there's so much value that we've got from from those relationships that we've been able to build yeah I think in in the space you're working it's also so important because you want to make sure that your product is as best as it can be because it's genuinely going to change people's lives so you want to make sure it is doing that yeah exactly and you just I think that you know the quality that you've got to reach in this software is so important as well you know a really busy clinician isn't going to use something that's kind of half-baked and still in very early stages they their time is so valuable across across the day and they don't have time to necessarily come up with loads of workarounds and different solutions so we've really got to you know focus on building that it's got to hit that certain threshold which you know brings challenges around like the time to development but you really then see that in the outcome because then when you deliver it into the market and people are so excited to use it and giving such quantitative feedback that's you know kind of makes that whole journey worth it up to then.

10:18Yeah, definitely. So you said that you didn't start out on the mission thinking that you'd start a business. You started out as like in academia. So what was the biggest surprise about transitioning from an academia to running a startup? Yeah, I think what's really interesting is how different people perceive that transition. some people see like the academic background and they see that as something really exciting and really positive because they're like oh you know when we were starting up the business it wasn't we knew people in the space we had this kind of market understanding which was really valuable we knew we had like a list of people that we could go and speak to but and so some people view that as really positive and the kind of the technical depth and but then others are a bit like well are you just you know do you actually just want to do the research do you just want to be kind of an R &D company and not really actually commercialize this product.

11:12And those different perceptions can actually be like really quite stark. Either way, people have very kind of preconceived ideas. So that's kind of, I guess, the external perception. But then actually what I've really found is that what you kind of have to deal with day to day is actually I'm using a huge amount of the same kind of like experiences that I took from the PhD, you know, I think just the kind of the determination that you need and dealing with setbacks along the way. There's enormous amounts in both where you just kind of need to like, yeah, actually, you know, I'm just going to push through this.

11:44I'm going to carry on. I'm going to keep working. I'm going to come up with a new solution. And I think those are such kind of direct correlations in between starting the business and also kind of coming from that academic space. A couple of the already important team members I knew from the research side of things, So we shared an office and those people have just been so valuable in helping to build the company to what it is today. Yeah, great. So you said there's a lot of setbacks on the way, as is usual with startups. So what would you say have been some of the biggest challenges that you faced and how have you managed to overcome them?

12:23So, I mean, the biggest one was almost on pretty much day one of starting the company. So we were going through our kind of process of spinning out the company from the university in early 2020. And the day that we were doing that was in kind of the middle of March 2020, literally as everything was kind of falling apart. And we, you know, and it kind of comes to that moving out from that kind of more theoretical academic world to then really the application of the company. you know you we kind of built this business plan how we're going to grow the company how we're going to develop the product and then just you know day one have to completely rip that up and and start again and actually that that kind of for us really involved quite a significant pivot and and really some delays in what we want to do around prosthetics we ended up doing a large project looking at non-invasive ventilation masks obviously big around that time and looking at how they could fit and we could get make sure they were performing well and weren't causing injury to anyone and it wasn't really until kind of the beginning of 2022 that we're able to actually bring in kind of get back into the prosthetics clinics because it comes to that you know what we were discussing earlier around working with the individual clinicians fitting a prosthetic is a very physical process you you really need to see the thing there and be in the clinic and understand the space that they're working in so it really wasn't until 2022 that we were able to get back on track and kind of start from where we'd originally planned but yeah just a a complete change from where we were so i think you know that was the that was the challenge day one i mean and i think really set but that i think really set like some of the culture and the values of the company because it was like right we've we can get through that now everything else becomes a bit you know more manageable you've always got that reference point of we were just completely sideswiped right at the very beginning of what our what our plan was I think you know since then obviously going through clinical trials very challenging the delays around that but I think all of those seem a bit smaller relative to that first one yeah you really went in with a challenge that wasn't even in your control as well yes exactly I think I hear from a lot of startups who started around that time and it's the same story of we started and straight away something's coming and you have to pivot because you can't do anything about it.

14:50It's not like, oh, we've come into this challenge that we can fix. That just couldn't be fixed. It was like, okay, this is because for so many, this is the new normal and you had to learn how to live with all of that before going into, as you said, 2022, you could finally do what you set out to do. Yeah, exactly. It was just like, right, this is the world as it is now. Let's go from there. So yeah, a big challenge, but I think one that it gives you that grounding and it just gives you that ability to then reference back to that and say, yeah, we got through that. We can get through whatever's coming down the line now.

15:26Yeah. When something bad happens straight away, it's like, well, if we got through that, we can kind of get through anything at this point. Yeah, exactly. So what would you say have been some of the highlights so far? I think that the real highlight that I mean there've been so many but one of the big ones was so our first clinical study where we were doing a direct comparison with how well the the software and the model that we were had built was performing I was actually on I was on like a long weekend so I was kind of in Europe on a on a Friday and I got a phone call from Jenny who's our clinical lead and she kind of phones up and when they one of the kind of the key metrics for how they evaluate socket is the prosthetic socket is something called a socket comfort school and so they say how comfortable is this prosthetic so obviously very important measure for us and it was maybe the third person that had gone through our clinical study and the first two had looked pretty good and then jenny phoned up and said oh this person's giving it a 10 out of 10 which for like our third one and i just remember being you know obviously away and just thinking okay this is like i think we've really we've really got something here that really felt like because you do so much work but until it's really being used in the real world on yeah on patients you just you don't ever quite know and so I think that was the really big the big aspect for me I think another one as well was we were so we're really fortunate we were on a work on a fantastic project with the department for veteran affairs in the US looking at providing a whole new way of providing prosthetics across to to all of their patients and i remember the first project meeting and they kind of picked us up as quite an you know pretty early in our in our lifespan and remember that first project meeting and like you know working with all these brilliant people across all of these different sectors there are people from hewlett-packard and their 3d printing team there who are doing amazing stuff around what you can do with this new manufacturing technology and yeah kind of being in that room and working with those and really bringing that value was like, okay, this isn't just something that is of interest kind of in the couple of clinics that we've worked with in the UK.

17:36This is something that's got real global appeal and we can really see how this can scale. So, you know, as a company, you can, you do it. I think especially in medical technology, you do a lot of work, which is all behind the scenes. And then you just occasionally have these small points where kind of, you know, a switch flips and then you're like, okay, I thought we've now like moved into a new space and I think those two were those real points where it moves from one thing to the next thing along the along the journey but they also both kind of come back to feedback in some way of how getting feedback from a customer who's like from a client even who is saying like yeah it's 10 out of 10 it's it this is perfect this is exactly what I want but also kind of having that backing from people who are like we want you to work on this project with us because they see what you're doing I think it's it's really kind of exciting for a startup to get there yeah I think it's kind of it's really everything that you work towards and I think you know in startups there's a lot of focus on like you know maybe an investment announcement and that's you know that's that's great validation in some senses because it's like the the markets the you know the investment market saying yeah we think this is a really good idea but to me it's like nothing beats that kind of that real concrete customer feedback of hey we're really providing something of value here and those are the things that you really hold on to as you know when it gets into a bit more of a difficult time you're then like okay remember those just push through yeah because it also shows you that you're kind of hitting your mission you are making people's lives better and it just makes you want to carry on because i think i hear from a lot of founders how kind of celebrating the small wins is quite difficult because usually it is kind of like oh look we just raised this big funding round that's a really big thing but they don't think about all those little things in between but getting that kind of feedback where it shows you're doing exactly what you want to be doing that is the the kind of win that you want to celebrate yeah and i think for the rest especially about celebrating those for the for the rest of the team as well because you know for the people especially like for you know it's the product team it's the clinical team that are counting together they've put so much work into that and that is really where they get that you know that broad kind of satisfaction from the work that they're doing that's where they see it so directly i think you know investment can feel like it's very externally profiles very well but it can feel like quite abstract i think to the to the team so really focusing on those those wins and saying hey guys that was that was amazing that that happened and celebrating that as a as a whole team I think is so important.

20:25Yeah definitely so what would you say have been some of the lessons that you've learned on the startup journey so far? So I think one of the really interesting aspects that I've found is kind of how much those those kind of decisions that you make in the early days and I think you know particularly for us where we had to just completely pivot how you build that company in the early days just you can see the effect of those like several years down the line when you're not even necessarily consciously making those decisions i think you know that kind of having to really pivot some change just brings that like culture of adaptability into the company and there are so many things that you set up around culture that you aren't very early on and then down the line you've got a company where you say oh this is our culture you know we're really collaborative and you kind of said well we didn't necessarily say that consciously but you realize that you set that up in the very earliest stages so i think you know you're often thinking okay what how would i do things differently again but i think being so conscious at the beginning around culture and how you want how you want to set up the company i think that feedback discussion goes back to it again as in this space with it things are regulated it is very easy to just kind of sit in a lab and develop something and then kind of hope it works but having that culture of saying okay we're going to show someone something that we know is really really far away but we we need to get this this feedback that culture of actually saying you know here's something early we're not completely happy with it but we need to learn something to be able to go on to that next step just embedding that right from the beginning is just so critical to how the company's being built otherwise you can spend so much time developing something which doesn't necessarily quite hit what everyone's aiming for yeah and talking about lessons what is one lesson or piece of advice that you would have known before you'd even started the company that would have kind of changed the way you would have done the whole thing yeah i think i think for us it's that kind of be really true to who like how you want to build the company i think there are so many different ways and i think we're kind of there now and we've built a lot of self-confidence in like who we are as a company and how we present ourselves in the market and how we talk to ourselves about investors but i think particularly early on especially when you're writing the earliest stages and you don't you know it's all quite theoretical it's quite easy to start to optimize, almost optimize the company for a pitch deck and optimize it for investors rather than thinking about, well, what's the company that I as a founder and as a leader really want to build?

23:09And actually what we then found is that if you focus on that, if you really focus on to like, well, I know this is the kind of the typical wisdom about building a startup and I can draw from some of that, but then ultimately we know this industry better than anyone that we're going to speak to externally because we've kind of been it for several years and we've got a clear vision as to how we want to kind of provide our technology and to be able to change it actually if you kind of really stay true to that then that's often when the you know investors become more interested because they're like oh i can see how you've built it but i think it's very easy and i i think you know probably spinning out from academia makes you kind of particularly susceptible to this because you're kind of going well this is how everyone says we should create it's a startup and so you're like okay let's let's follow that must be the best process and there's so many great learnings in there but ultimately you've got to kind of take that and really make it your own and then hold on to that even if you've got lots of other people's advice saying actually you should do this or you should go down this route that's the best thing you've got to say because when it gets difficult you need to have like that real conviction in the kind of the core decisions that you made yeah there's also millions of startups out there everyone will have their own way of starting a company of running a company but what you said about having conviction in the way that you're doing it is really important so you can take people's advice if you don't truly feel that way inside when it comes down to it are you really going to be that committed to what you're doing if you start taking other people's advice yeah i think one of those the big things for us early on was that as i say although we're kind of in the in the process of delivering these prosthetics where we don't manufacture them ourselves they often get manufactured at clinics or in kind of different fabrication you know units that might serve a whole different range of clinics and really early on we had a lot of advice from people saying that you know you should be trying to not just make the software to fit them but you should also then be selling them yourselves and you should be manufacturing them and you know early on that sounds tempting because you're like oh yeah well that that kind of means you can capture more of that value but actually the kind of the more that we've seen the market and the more that we've looked at how other people have gone and the approach that they've taken we're like really really happy that we kind of stuck to that value of saying no we're going to do the software we're going to do it really well we're not going to try to do the software and the fabrication and the hardware together because those are two very very separate things and yeah it goes back to there's so much uncertainty on the startup and often all you can have is like in within that uncertainty often one of the only things you can really hold on to is that original conviction that you had in how you wanted to build the company and what you thought was right yeah definitely so i think you mentioned funding quite a bit how has your funding journey been especially as kind of like working within the med tech space yeah so we've we've not actually had any venture capital involvement to date i think the work that we did as i kind of say right back from when we spun out around the niv masks that actually was you know obviously revenue generating that was a commercial project and i think that really embedded in us this kind of wanting to balance between revenue generation from kind of bits of work that we can do through the product development cycle obviously grant funding the uk is an amazing space for medical and health technology around grant funding and then balancing that against angel investment and that that for us kind of not being completely reliant on just one of those kind of pillars having this nice balance between revenue grants and angel investment has allowed us to it's given quite a lot of freedom to in terms of how we want to build the company and the decisions that we want to take and you know has helped particularly on like time to market because there is a real challenge within this space you know taking venture capital money very early on with then the the time to market there's you need to make sure there's a really good alignment between the company and the investor and we've been you know we've got a fantastic group of angel investors that supported us through that who are incredibly highly valued i think it's quite rare to for me at least to speak to a startup that hasn't got venture capital funding i think it's the expected route, which also kind of comes back about advice.

27:40It's very much, I feel like online, there's a lot of talks about how you need venture capital funding and you need that kind of investment and that back-in. So I always find it really interesting talking to startups that took a different path because like you said, when people take it so early on, it can really stifle a startup as to what they want to do. Yeah, I think The way I think venture capital, you know, it really sets a company on a very specific path because you've got to hit a very particular outcome for the venture capital investors. Like it's very, in some ways, it's actually very clear what that kind of venture capital transaction looks like in terms of what they're expecting.

28:26But that, as you say, if you're just starting a startup and you then look at the advice online, that's not really clear. you just think it kind of almost comes across like oh yeah there's just this venture capital money out there and you kind of apply for it and someone gives it to you but you know that's not that's not the case it comes with expectations and it comes with a very clear path for how you want to build build the startup and you know in some cases there can be fantastic alignment between the the VC and the startup and it can just absolutely take off and fly but in other times there's that divergence of expectation so yeah I think it just comes back to growing the kind of the type of company that you want to and bringing I think it really comes down to bringing on the right kind of capital at the right stage so as we're kind of now into this looking forward and scaling up then you know it opens up different financing options for us that we maybe haven't taken before but I think we're really happy with the approach that we took around that kind of product development and go-to-market phases yeah definitely so kind of talking about scaling what do you think is next for the company and what goals do you have for this upcoming year so for for us it really is in terms of next stage i think i think scale is just the kind of that's the big operative word i think we're really happy with where the product is where it's performing how we've built our processes around that and what it now comes down to is how many clinics can we get this our technology into you know not just in the uk and the us but but wider but then also So new applications of our technology, I think folks lost about prosthetics and that was always the first one.

30:03But there's several other of these kind of devices in orthotics, wheelchair seating, bracing, all of these, you know, assistive technology devices, which kind of our customers have the same challenges around fitting. so for us it really is about thinking how can we scale in those kind of those two different ways both in terms of the number of clinics but also the number of applications that we can provide into those clinics so yeah i think the next the next few months for us is going to be very interesting as we kind of work out who do we want to work with and who do we want to partner with to kind of resource us through that that journey and so yeah it's going to be an yeah an exciting few months for us i think yes sounds really exciting kind of expanding what you do and essentially how you operate really but that comes to the end of my questions is there anything you wanted to add or plug at the end of this podcast oh we want to i think we kind of covered everything that's thinking of i guess you know one of the one of the areas that i think we're you know so we're a company based in Bristol we've got a whole group of different companies that are actually in medical technology and health technology can a huge number of things sepsis diagnosis yeah um yeah all sorts of these different uh applications of uh medical technology and all of us are at that stage around how we can get our our technology and really kind of scale up within the within the NHS and make it see as many patients as possible and I think that it's going to be one of those really interesting things that's been moved forward is just how do how can startups you know get their technology from this stage of being like well we've developed the product we know it's safe and effective but how do we get it to patients in the NHS and I think we're seeing that a lot across the board so I think how and the government's making a lot of exciting noises about that and wanting to do that so I think that's going to really how that kind of gets dealt with over the next few years is really going to dictate how the kind of the med tech community thrives over the next few years.

32:07Yeah. It will be really exciting to see how you grow and kind of where the company ends up. It's been amazing talking to you today and learning more about what you do. Yeah. Hopefully we'll see some more big news soon, hopefully. Yeah. Let's hope so. Thanks very much. I really enjoyed the conversation. Yeah. Thank you. Have a nice day. Thanks, Evie. Bye. If you like this episode, be sure to subscribe to the podcast and check out Startup Magazine's socials to stay up to date on the latest startups news.