This week I am talking to Rachael Grimaldi, MD (@cardmedic), Founder and CEO of CardMedic and an Anesthetist working in the NHS who founded the company while stranded out of her home country at the height of the pandemic on maternity leave. Born from a desire to help and long term desire to improve health literacy and health inequities that were laid bare by the pandemic and made worse with the introduction of PPE in every clinical setting and beyond.
We talk about the original idea – which took about 72 hours to pull together at the beginning and how it took off quickly as the media caught on and she started to get interview requests and interest from around the world with over 50,000 users in more than 50 countries. Poor communications affects as much as 50% of the population for a variety of reasons and the pandemic made matters far worse, requiring increased usage of personal protective equipment (PPE) that introduced additional barriers and problems.
The tipping point from great idea to business came as she received funding from Innovate UK that put more pressure on making this a persistent solution that lasted past the initial flurry of interest and continued to help solve the problem. Up till this point it had remained a side project but with the focus, money and attention now increasing Rachael found that her career and research had prepared her well to get to this point and continue leading a brand new company.
She was fortunate to have family members with business experience to help navigate the path to launch anew company and her built in character was the perfect match to allow others to be her Yoda and counsel through the challenges of learning while building. She was open minded to the other resources bringing her own set of transferable skills from medicine to the corporate table to bring to life an idea that while simple is unique and lacking till now and evidenced by the recent successes – first NHS trust contract,
Listen in to hear the key incremental tipping points from Rachael’s journey, the importance of listening and how Rachael found herself on the sidelines in another country unable to contribute clinically, despite having some highly valuable and relevant skills for the Pandemic. No reason to quit, rather double down and surround yourself with talent and even as a technophobe found a path to use technology as a driver for good.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Dr. Rachel Grimaldi. She’s an artist out of the UK who set up a new company. Rachel, thanks for joining me today.
Rachel Grimaldi
Thank you so much for having me, Nick. It’s It’s an honor to be joining you from the other side of the ocean. Well,
Nick van Terheyden
let’s start off. People will quickly gather from your accent that you hail from a different shore the other side of the pond, we might confuse people with similar accents. And I’ve got to be honest, it’s always fun to talk to you because I get lots of memories talking through some of my experiences back there. But if you would share a little bit of your background and your journey, you’re underneath the test. I’ll translate anesthesiology.
Rachel Grimaldi
Yep. Yeah, absolutely. So from what kind of my more of my personal background, I actually lived in the States when I was younger, I was born in the UK, moved to the states when I was eight, and lived there for eight years, went to school there, and then moved back to the UK again, and then went to medical school in the UK. And as you said, I’m an anesthesiologist, and have been for the last qualified 12 years ago, I’ve been practicing anesthetics for the last 10 years. And my kind of other hats are an associate Medical Director for the Brighton marathon. And I lead the research group and integration of ECMO, which is a sort of heart and lung bypass into our advanced cardiac arrest team, and then founded carb medic last year.
Nick van Terheyden
Interesting. So 12 years. So that’s the sort of two years I think they call it foundational. Now it was, you know, house dogs as in, in my era, it was only a year to be clear. So I feel lucky in that sense. But you started to do some other things. So despite what I would consider a pretty significant progress and career towards anesthetics. I think you have a specialist area that you’re looking to get into. You’re doing a little bit more than that, right?
Rachel Grimaldi
Yeah, so yes. So in terms of anesthetics, I really love pediatric anesthetic. So I’ve done some training, I’ve been to the Evelina London Children’s Hospital, I did six months pediatric intensive care. And I’m going to Great Ormond Street Hospital in February next year to do my advanced pediatric anesthetics. And after which time, I’ll finally be a consultant or attending in American language. And last year, founded car medic, which never had any ambition or intention to run a business feel very much like an accidental entrepreneur in that way, but co founded car medic, with my husband, actually, at the time, in when we were visiting family in America, and we’ve kind of built it out from there. So he’s the CEO, and I’m the CEO. And it’s been a definitely a wild ride and a bit of a journey going from clinician to becoming, you know, a business woman or a clinical entrepreneur to kind of bridge that gap.
Nick van Terheyden
So there’s a couple of things to unpack there, first of all, working with your spouse. present at least some challenges, although maybe not. I’m interested to hear about that. And, but more importantly, what what is carb medic? And how did you arrive at that? What was the story?
Rachel Grimaldi
Yeah, definitely. Well, I’ll go into carpeting first, and then I will very happy to chat about working with Tim. So um, so yeah, car medic is essentially a communication tool. It’s a website, an app, software as a service that improves communication between healthcare staff and patients across any barrier. So that could be a language barrier, visual impairments, hearing impairments, learning disabilities, or a range of cognitive impairment, or literacy issues. So in the states that impacts nearly 50% of the population in the UK, it’s 35% of the population. It’s essentially an library in a to z library of pre written scripts that replicate clinical conversations around common healthcare topics. And the member of staff can choose the script and show it to the patient to guide the clinical interaction. And then it can be flexed at the point of care two different languages, presented as sign language videos, or easy read with pictures or read aloud. And then we also have an integrated speech to text translation tool as well. It’s access from any device, we’re building it to integrate into electronic patient records. And really excitingly nothing like it exists before. So yeah, it’s been a journey, developing that. And then kind of setting it up with Tim, we come from very different backgrounds. We’ve been together 20 years, I’ve kind of absorbed some business knowledge and skills from him. And he’s absorbed a bit of medicine from me, but in my background, obviously very much medicine, his his via building global e commerce company, background, as well in graphic design and things like that. So he, he was able to build a website and do some of the branding and things while I wrote the content at the start. So yeah, like you said, obviously, working with your spouse is definitely an interesting one, we’re really enjoying it, I think, you know, probably the biggest challenge really is just lack of time to spend with each other, which seems ironic when we’re working together. But we’re almost so siloed because it’s so busy. And we’re both doing work. We’re both working flat out all the time. And we’ve got three young children under five and a half. So between juggling business, you know, I’m still working clinically and the children, there’s just no time left for each other. I think that’s probably the hardest thing to be honest.
Nick van Terheyden
So I gotta say it I mean, you know, I feel like there’s a supersuit somewhere in your life, because I can’t even imagine all of those things playing in but you clearly love it, you clearly enjoy it. Was there a point in time where you said, Gosh, I see cosmetic, as it’s called now, what what was the triggering event? Did you see something? Was it associated with the recent pandemic? Or was the more to it than that?
Rachel Grimaldi
Yeah, that’s a really good question. Well, kind of, I mean, under underpinning at all, I’ve always I’ve had an interest over the last decade plus in communication, healthcare, patient safety and human factors. That’s always been really important. I’ve done a lot of work around that over the last decade. But actually, that wasn’t the trigger for car medic, I hadn’t thought of it. But when I was on maternity leave last year, visiting family in the states and COVID, struck in that first wave, we couldn’t get home I had at the time, my children were five months old, two years and three years, but I would have gone back to work if I’d have been in the UK. But you know, as it stood, I couldn’t get home, our flights were canceled seven times. And we ended up in the states for nearly six months. But I was really desperate to help. You know, being an anesthesiologist, my skills were definitely relevant for the pandemic. But But I was essentially just obsessively watching the news and read an article about a patient who’d been to the ICU with COVID, and was terrified because he couldn’t understand healthcare staff through the PDP barrier. So I thought, you know, what are people doing? Are they writing notes on paper? And how are they communicating? What if I put those notes on a website and A to Z list, and then staff could choose the notes, essentially, the flashcard, if you like, and show it to the patient to guide the interaction. And that’s very much where it started. And that was the idea for it, I genuinely did it to help some friends, I really never thought it would get to this point, I never thought I’d be running a business. And what happened actually, within those first, it was concept to launch in 72 hours. So I wrote the content, Tim built the website, and then we launched and shared it with friends. But then in those first day, the first 24 hours, I was encouraged to join Twitter, which I sort of was a bit skeptical about I didn’t I wasn’t you know, not been on Twitter before. I’m not really on social media. But I did and actually within those first three weeks, we had 8000 users in 50 countries. And then we got some media coverage and it kind of went a bit crazy from there but that just that through that organic growth, actually the feedback we got was that there are so many long standing barriers to good communication and healthcare stuff that we know from practicing on the front line Anyway, you know, almost daily are encountering patients with language barriers or who are deaf or blind or or have a learning disability for example, or, or literacy issues. And although there are services to support them, actually there are massive gaps in service provision and it’s not possible to always have a translator when you need it or a speech and language pathologist or a learning disability nurse and so people rely on friends family or staff to translate or children or Google Translate for example so so actually, the feedback we got was this is such a useful tool and please can we have this to stay after the pandemic? And so it was kind of very much like you know, that realization of Yeah, actually no, that’s right. You know, we do struggle normally and, and, and how can I make this into a helpful tool going forwards. So it was kind of although inspired by the barrier created by PP which creates this kind of global crisis in communication. In the pandemic, actually it just shone a light on a massive health inequities faced by those patient groups who have communication needs, and it’s kind of the rest is history almost from there.
Nick van Terheyden
You know, once again, the COVID amplified inequities it amplified it, you know, challenges that existed throughout And once again, a silver lining. And I’m always pause when I say this when we talk about the pandemic, because it’s had such terrible impacts around the world. But, you know, this is another silver lining where we’ve started to address it, you know, I can truly relate to being sat on the sideline. I mean, I’m nowhere near as qualified as you but I have equal levels of frustration because your license is essentially worthless in the United States, because you don’t have us licensure. I couldn’t even take tests. I couldn’t do PCR testing, sticking a swab up somebody’s nose, because I didn’t have a license to do that. So I was unable to sort of sit in, but I didn’t have quite the insight as you develop this. So clearly, it took off. I mean, I just I think, as you develop things that people go, Well, that makes sense. It’s useful. What sort of change where, where did you see the the tipping point to, this is no longer just a side hustle, which it sounds like it still is relative to, you know, anesthetics and you know, career and all these other things. But where was the point that you go, huh, this is actually a business. And not just because it’s a business, but because people need it, which is where you’re coming out?
Rachel Grimaldi
Yeah, that’s a really good question. So it, it kind of it felt in the beginning of it, like a speeding bullet train, you know, I sort of created something to help friends, it just kind of spiraled. And I suddenly thought, I just need to grab stuff left, right, and center to try and stabilize it all. And then at that three week mark, when we got the music coverage, and we had feedback coming in from all over the world, I mean, it was TV radio, and then ended up kind of webinars and podcasts and, and all sorts. And you know that in the last year, we’ve had 50,000 users in 120 countries and a lot in the states actually and 20,000 app downloads. So yeah, I think that tipping point essentially came when we were getting all that feedback. And people saying this is a really useful tool, we really need this after the pandemic, and I kind of thought, wow, I can see how busy I’ve been, I can see that I’m working 2448 72 hours straight, almost without sleeping. And this is really relentless. I have a decision, you know, a bit of a tipping point, I have a decision to make, is this something that I want to pursue, you know, I’m on maternity leave, I was meant to be on vacation. And suddenly here, I find myself in a global pandemic, as did everybody else, obviously. And that kind of impacted us very much personally on a family level as well. trying to juggle all of that and the children and thinking, right, well, I now feel like I have a responsibility to, to my friends, colleagues, peers, healthcare professionals, allied health care professionals at home and across the world who were and for patients who were kind of asking for this, do I go down this path and pursue this route of trying to create something that’s sustainable? Or do I say you know what, this is just too much I’m I didn’t kind of plan for any of this. But my personality being what it is, you know, I don’t kind of shy away from a challenge and and I also felt like it was there were kind of you know, I believe in signs and kind of there are a few signs and I thought, this feels like maybe it’s meant to be like you talked a little bit about silver lining. So definitely some obviously a lot of awful things that have happened as a result of COVID. But you know, if this is something good to come out of it then also that felt like it wasn’t something I could just walk away from. So I think there was a lot that I thought I then applied for some innovation. So from the government, UK Government innovate UK grant funding. And I thought, right well, if we get the innovate UK grant funding because you know, without proper funding, I can’t really do anything with this. I can only get so far because it’s all completely free for users. So that was quite lucky. Well, if I get the innovate UK funding, then that’s a sign and we have to do it and we got the innovate UK brands. And I thought, right okay, well that you know, I said that that was going to be my point. And we got that quite early on last July. So we kind of that was a bit of a flag in the sand where we thought, okay, we, you know, we definitely need to commit to this. And we also had so many people volunteering and helping us as well, who were still part of the team that I couldn’t bear the thought of letting anyone down. And so I guess that was kind of the tipping point. And then that sort of aligning with our vision of wanting to better humanity as well. You know, globally that that’s been very much a driver for this.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Rachel Grimaldi. She is the founder and CEO of cosmetic she’s also an anesthetist, and spans the pond found herself in this extraordinary circumstance of being frustrated on the bench as a very experienced clinician who couldn’t contribute because she was in the wrong country, founded a company that essentially solved not only a local problem to the pandemic and a communications issue, but essentially exposed the significant challenges that we experienced in medicine from a communication standpoint, and formed the company. Oh, and by the way, she was on maternity leave. So you know, my superhero reference comes out again, as I keep, you know, interacting with you and learning more about what you did, and the timing of this. So you were just talking about the journey, that inflection point, this became a real business. It sounds like the grant funding, and I want to be sure that I understand this, I’m gonna use the term free money. And by that, I mean, you didn’t have to pay it back. Was that true? Do you think that was a critical aspect to this in terms of making it happen? Because at some point, these are unsustainable activities relative to doing other things, right. Yeah,
Rachel Grimaldi
100%, I think you’re exactly right, in terms of grant funding, so sometimes you get matched funding, where you have to put in, you know, 15%, or 25%, whatever it might be. But this was 100%, equity, free innovation grant funding from the UK Government. So you have to spend the money, and you have to spend it within a certain timeframe for us, that was six months. And then of course, you have to report back and everything so. So yeah, I think that was, that was definitely the kind of the fact that we were given that grant money, and we felt like we, you know, it’s going towards a really good cause. And we have to spend it. And that kind of that in itself, like you said, it’s unsustainable, doing these things without some kind of funding. And, and we need to be able to generate revenue, because we need to build a product that people are now asking for. And so the whole thing kind of, sort of fed into itself what we thought, right? Well, we now we also have a commitment to the UK Government to to kind of honor their grant funding, which they’ve been so generous to give to us so so I think all of those things kind of came together to to mean that we, you know, that, that it kind of pushed us along that path of this needs to be a business, you know, we need to be able to create this to be a business. But But actually, what’s really important to us is the social impact side of what we can do at car medic, and that this very much feels like tech for good. So whilst we want the business side to be very successful, yeah, we’ve had we’ve had some obviously the grant, we’ve got to grant funds grants in the end, both from innovate UK, and some angel investment. We really want to support the cosmetic Foundation, which helps, we want to be able to fund community health workers for refugee camps, subsidize cosmetics use abroad in developing countries support humanitarian crises and female entrepreneurs or healthcare entrepreneurs in developing countries. And so I think having that kind of mission and passion to to help staff and patients in the UK, the US and beyond, but also to help in developing countries improve, improve health equity, globally, and health literacy globally has meant that it’s drawn together a really passionate and driven group of people to help make this happen. So I think it’s been a whole combination of amazing, an amazing team that have come together some funding as well. And I think just a common drive to better humanity.
Nick van Terheyden
So, you know, clearly on a trajectory, I think you’ve had some good news positive, you know, feedback. And actually clients, you know, this has to be a economically viable enterprise. You know, you can’t just continue to give it away for free. We see lots of examples of that being essentially a failure in the long term because if it’s unsustainable, it won’t sort of persist. So you We’ll try to address that while still addressing the tech for good as you describe it you’re you’re a technophobe you know not somebody that I’m that’s a little bit unusual for anesthetics I would say to be you know the the gadget people you know have all sorts of things going on but you know, I think you you would self described that way as you look back to that time and you know, this journey which is relatively short. Is there anything that you wish you’d known that you’ve learned along the way as part of the sort of experiences that you go wow, that would have made a big difference if I hadn’t known or understood that at the time?
Rachel Grimaldi
Oh, wow. That’s such a good question. I think um, I think in a way it’s really good that I didn’t know the the amount that’s involved in running a business I mean, Tim’s always run businesses you know, he’s very experienced and you know, his run multimillion dollar business global businesses so I’ve very much seen him you know, my mom’s run businesses my brother runs businesses so I very much seen and lived the life of an entrepreneur and never wanted it. So I think in a way if I think if I’d have known exactly what was in store thus far I probably would have said no way Jose Am I kind of going down this route? I think I think if I would have known that you know, we’d get to this point so quickly would have just provided me with a little bit of a short you know, reassurance when you’re kind of slugging away in those early days thinking you know, we’ve just signed a five year contract with the beacon site and a large trust in the UK which is amazing to have got from where we were to where we are in you know, 18 months and I’ve got lots of proposals across the UK and working with a couple of hospitals in the US as well now and I think if I think just having you know, I remember saying to Tim yesterday I was like I just want to know how this is all going to go in the next five years you know, you just want a bit of a crystal ball someone to kind of look back and say it’s going to be okay you know, it’s gonna be all right you’ll you know, you’ll you’ll get you’ll make a success of it or you’ll you’ll get to where you want to be your your vision will be realized I think um, I think that would that that would be really nice for me to have that knowledge. Now, I think a year ago, it would be really nice if someone said, you know, you’ll do your duties accelerators, I’ve done to an Oxford I’ve done a US mass challenge accelerator, which we’re currently on at the moment. NHS clinic entrepreneur program, if someone said, Look, you’ll do these, you’ll get the skills, you don’t need to keep feeling like an imposter forever, which is definitely a thing imposter syndrome. I think it’s just the reassurance of you’ll figure it out. It’ll be okay, you’ll get there. And yeah, I mean, definitely being a technophobe. There’s there’s lots of gadgets and gizmos that I love in anesthetics. But I’m definitely not the first person to kind of, you know, download a new app, or something, you know, just to really be like at the forefront of adopting new technology. I’m just sometimes much rather a pen and paper, which is, which has kind of been ironic for pursuing this path. But but that I think the great thing is that I’ve been surrounded by people who do know about these things. And I’m very, very willing and open to say, you know what, I have no idea about this area, I’ll learn a bit. But I know what I don’t, I don’t know what I don’t know, I know what I don’t know. And I just want to surround myself with people who do know about those things, and I want to learn from them. Because there’s absolutely no way that I can do it all. So I think that’s hopefully maybe been a strength and kind of building out a passionate team that I’ve made sure I’ve surrounded myself with amazing mentors and really good people who understand this space like the back of their hand.
Nick van Terheyden
So if I was to pick out some things there, I think having the right additional experience, you know, the business experience that plays to and you know, if you’ve got the business experience, I would say having the clinical experience because that obviously played that was where you brought in, surrounding yourself and also being open to not recognizing or not knowing all the answers, which you know, I think we many of us struggle with. So you know, for me, those are sort of key elements in the remaining time that we’ve got. Tell us what you’re excited about. You know what’s coming up and where you think this is going and
Rachel Grimaldi
Yeah, definitely. Thank you so much. And we’ve got a couple of awards we’ve been shortlisted for which we’re really excited about coming up with masschallenge finalists as well in the US and I just want the UK finals if she loves tech and we got the global semi finals coming up in Singapore on it later this month or next month. So I’ve got lots of exciting things on that front. And then with car medic itself, building out our EPR integration I’m really excited about and doing are kind of continuing on Our journey with our sales and, and moving into the US as well next year and working with hospitals in the US currently to kind of continue along that journey. So yeah loads, loads to do and lots, lots of exciting things and growing our team really and kind of continuing our mission.
Nick van Terheyden
Fantastic. So just a quick translation EPR EMR EHR, it’s just because that’s not always well recognized term, certainly over here. I think great times as a part of me that says that, you know, the contribution of two sides of the pond helped you as part of this that, you know, gave you the personality that allowed to persist and, you know, not knowing what was going on in the future, I think, what it contained as activity and then bringing together folks into this amazing team. Unfortunately, as usual, we’ve run out of time, so it just remains for me to thank you for joining me on the show, Rachel, it’s been a pleasure.
Rachel Grimaldi
Thank you. Thank you so much for having me. I’ve thoroughly enjoyed it and I’m really, really honored to be a guest
