About this Podcast Episode
Social entrepreneur, Chris Robson, is Founder & CEO of Living With — a digital health company focused on remote condition & patient management. A conversation on success, failure + making a difference.
Chris shares his insight on the social entrepreneurial journey and his current venture, “Living With”, which helps patients, doctors and researchers to manage conditions remotely and derive valuable data in the process.
Chris has 20 years’ experience of building fast growth, multinational companies and products, from £0 to £50m turnover. Among other ventures, he built and floated digital agency, Syzygy, on the German Stock Exchange and co-founded Ink Publishing, the world’s largest publisher of inflight media. He holds an MBA from London Business School and a degree from Oxford University.
The following is a full transcript of the podcast episode:
Alberto Lidji: Chris, it's a really great pleasure to have you on the show.
Chris Robson: Thank you very much. It's great to be here and great to talk to you. You've had some really interesting people on your show before. So yeah, it's a privilege to be on there as well.
Alberto Lidji: It’s's great to have you, and why don't we start by finding out a little bit about Living With. What's the company all about?
Chris Robson: So we're a digital health company. And we, as you said, we're focused on remote condition management or remote patient management. And I guess the guts of what we do is we try and make it… we’ve created a platform that makes it really easy for a clinic or a clinician to manage any patient with any condition. Because what I've seen as a patient over a long period of time, I've had ulcerative colitis. And more recently, I was actually hospitalized with a strange condition Guillain-Barre syndrome, and I had to learn to walk again. And one of the things that became clear to me is that lots of people live, like I live with autoimmune conditions or other conditions, and they often don't know what's going to happen, there's no sense of how they fit on a continuous basis into a healthcare system, and there's no sense of them being connected to any form of clinician or doctor and, any form of kind of monitoring. So I used to see my consultant every 6 to 12 months. And, I could have tons of flare-ups between the times when I saw my consultant, and he or she would be oblivious to that, and that just seemed wrong to me. And, madness in many ways. So, I wanted to set up a company that actually did something about this, that kind of connected a patient like me with a doctor, and, you know, gave more stability to that patient. But I also wanted to, because I recognize how many different conditions there are, and some are well known, and some aren't well known at all. So in many ways, I wanted to make it really really easy for a clinician to be able to create a product, an app, a smart app that a patient could use, whatever their condition, and ultimately, that would drive them to have a more predictable and healthier life. And so that's really what we do what we're focused on.
Alberto Lidji: That's great. And in terms of medical conditions, is your technology applicable to individuals who have whatever condition it might be? Or are you targeting specific elements?
Chris Robson: So that's our vision, our vision is that we will cover the whole piece, we'll have literally hundreds and hundreds of products on our platform. Today we have 10, we sort of started in the sort of bladder and bowel space. And in fact, we developed Squeezie, which is now the UK seventh highest-selling paid app. But so outside of sort of bladder and bowel, we then moved into rheumatology and oncology and more recently into COVID recovery. So slowly, but surely, we're sort of spreading out across conditions. And that's the aim. But you've got to start somewhere.
Alberto Lidji: Yeah. And what does the platform look like? So if one is a patient, and how do you find out about the platform, what's it called? How do you get it?
Chris Robson: So the platform is called Living With, like the company. Basically, you would as a patient, you'd find out about it from your clinician or clinic or healthcare provider. And it consists of three parts: there's always an app for the patient, there's always a sort of dashboard or portal for the clinician and there's a third-party portal where, for example, if we're working with a university from a research point of view or with a medical device company, then where they can get the aggregated anonymized data. So typically what happens is you may be talking to or seeing your clinician for whatever condition you're talking about. They may say, “Well, Alberto, actually, I think it might be helpful for you to use this app, maybe help you understand your condition a bit better and track it a bit better. And it allows me to connect with you and to see how you're doing overtime”. And what we're seeing is that patients love that connectivity, they may not hear from their clinician very often, but just the fact that they are connected makes a real difference. And actually, with something like COVID, that's really important, where you've got so many patients now who are suffering all these strange and really unclassified side effects and to be connected to somebody while they're at home, makes all the difference.
Alberto Lidji: Now in the UK, we have the National Health, the NHS, and also private. Is this platform available on both private and NHS?
Chris Robson: Yeah, we work with, both with NHS trusts and with private clinics. But one of the difficulties of working in the system here in the UK, is that you kind of have to sign up with each trust or each clinic individually, so it's hard to do a national deal as it is with.
Alberto Lidji: And currently, it's only in the UK; you’re not operating elsewhere?
Chris Robson: So we are in a couple of other clinics abroad, but not many yet. But that's where we're going.
Alberto Lidji: You're working on that. Great.
Chris Robson: Yeah.
Alberto Lidji: Very interesting. you're mentioning about the ability, the platform not only being useful for the patient, and for the medical practitioner, but also from a research perspective from a third party, academic institution, or somebody perhaps trying to run some sort of trial, that they're able to avail themselves of the data in an anonymized manner, I suppose, but that they're able to glean insight from that data.
Chris Robson: Yeah, and that's critical. So for example, with COVID recovery, I mean, you're seeing the government and governments across the world put a ton of money into research around the condition and how it's manifesting in real-time. And so, that is important from a research perspective. So we're working, actually, with UCL and Bart's health, and a number of other trusts on what we're doing, and, and the data we're hping is going to actually ultimately lead to a better digital product and better digital intervention and better outcomes for patients over time. Clearly, that's why we want to do it.
Alberto Lidji: Yeah, So help us understand a little bit the nuts and bolts of how this would work. So a patient showed up at the emergency room here in London, with COVID-19. And they get treated, and thankfully, they managed to make it out of the emergency room, and they're back in home, but they're not fully recovered. So there they have this lone COVID. And you know, it's various symptoms that are a little bit of a mystery still, what is that then look like? So that individual would have an app? Tell us a little bit about how it actually… the nuts and bolts of it?
Chris Robson: Yeah, so what would what typically, and of course, it varies, because each trust or hospital… most trusts have different clinical pathways. And so patients get taken in different steps through their journey. But the assumption is that once a patient is discharged, and assuming that they're sort of triaged and they're not a high-risk patient, then let's say they're a medium risk patient, then they might be prescribed this app to help them track how they're doing at home, and give them useful advice. And so yeah, they'll be invited to register and log on to the app. And then they'll use it as regularly as they want to, but definitely weekly, ideally daily, and the clinician will be looking at this… certainly on a weekly basis, and, seeing how that patient is doing, you know, ‘Are they breathing Okay? What's their levels of anxiety like?’. You know, because there are so many symptoms that you need to track and how, as a clinician, can I then help you, what activities or exercises can I give you, or can the app suggest that might help you improve over time because this is not necessarily quick. So as you say, you may have got out of the worst of it. But you may have long term symptoms that need to be managed.
Alberto Lidji: That's really interesting. And in terms of the research bit, because that's something that I find personally fascinating. And I know within the foundations world and the NGO, international NGO space, a lot of the times it's not easy to make investments that are of substance internationally, that are big investments and track exactly how things are progressing. So the monitoring, the evaluation, the impact assessment — not only is it difficult sometimes to find good investment opportunities, but also to track them is a little bit of a challenge. So the gold standard, a lot of times, the gold standard is the sort of randomized controlled trial, I'm just curious how one might be able to look at this app as a means to assist in monitoring an international intervention in some countries.
Chris Robson: Yeah, so I think it's a great question. I mean, we are working, I can't say who they are formally yet because we haven't signed the contract. But we've won a grant award, which is a formal, very leading research grant. And working with a collaboration of other organizations, including UCL who I mentioned earlier. And, effectively, we will be following research standards as part of doing that. So the product is working both as a real service, in a hospital, but it will also work at a research point of view. So, patients who typically have to, be you have to do a formal research study, you have to go through ethics and make sure that the information you're going to collect is going to be collected in the right way, and all of that. So all of those types of things we are doing as well, to ensure that the data is collected in the right manner, that the patients are recruited and managed in the right manner. And that data, the academic, the clinical academics, who I'm working with, that's what they do. This is their bread and butter in terms of ensuring that the type of data that we collect through the app uses clinically validated measures and can be shared and aggregated with other data sets that might come internationally, let us say, or from other studies around the UK, that helped to inform the wider perspective on what works and what doesn't. Research is a critical part of what we have to do. Because in the end everything, if you talk to a clinician, they require that our products, that there is clinical proof that they work, that they make a difference. So working with academics working with other universities is a critical part of what we do, in, sort of, health technology.
Alberto Lidji: Are there any constraints in terms of scalability? So I imagine the fact that it is a digital platform means that in terms of the marginal cost of deployment should be fairly low.
Chris Robson: Yeah, so it's cloud-based software. So it could be, yeah, somebody in Australia could use it. Indeed, we have talked to a couple of clinics in Australia. We haven't got anybody using it yet. But yeah, it can go anywhere in that sense.
Alberto Lidji: If somebody in Australia were listening to this they could just as easily just engage with you — there’s not a huge hurdle to try it out.
Chris Robson: No there isn’t , that's the great thing about technology.
Alberto Lidji: Yeah. And tell me a little bit about your background. So I know you've been in technology for quite a while. And you're a social entrepreneur; you’re an entrepreneur. And you've done a lot of interesting things in the digital space. But also you find yourself at a stage in your life where you have certain health conditions. And you put everything together, and you launch this really interesting app. How easy is it to embark on that to connect the dots and take a thought and a need and actually see it materialized as a technology platform in reality? I'm curious again if somebody's listening to this, and they think well, you know…
Chris Robson: So I think... I mean, anybody can have an idea. And indeed, we all have ideas all the time, I think, and it is really quite easy these days, much easier than it was, let's say 20 years ago to start a business. And to use the internet, for example, to be the driver of how you distribute and sell what you do. I think the challenge is really to have something that scales, so to have something that people are prepared to pay money for, and that you can then sell to a lot of people because ultimately, that's what drives the success of your organization. And, I've started, I think, eight different businesses in my time, and, and some have been really successful, and some haven't. And I think that's kind of the nature of the beast. But certainly, in technology, having a clear view of who your audience is, and how you're going to provide something to them specifically, that they'll pay for that does something better than something else that they could buy is the name of the game.
Alberto Lidji: Yeah. Now, in your case, and we're looking at business know-how, and you have an MBA from London Business School, if I remember correctly.
Chris Robson: Yeah, that's right.
Alberto Lidji: But you don't necessarily know how to code?
Chris Robson: No, I definitely don't know how to code. If only I did, but I don't. But yeah, different people do different things in any business. And so it's, you have to find good developers or engineers who you can work with who can provide that resource.
Alberto Lidji: Without revealing too much of your internals. Do you get your coding and all of that done here in the UK? Have you found that it's more cost-effective or better to do it elsewhere?
Chris Robson: Yeah, no, we do do it all in the UK, we have our, you know, in my time, I've outsourced to India, Ukraine and various other places. I think it’s kind of horses for courses; there’s no right answer to this question. But it isn't necessarily much easier, or much more cost-effective in the long run, in the round to go to the other side of the world, as it were to get your development done.
Alberto Lidji: Did it take… the journey itself, from having that initial thought of connecting the dots and saying look, I have this health condition, I can see how this platform could benefit others and the journey to making that a reality. How long did that take from that initial thought, and also getting the funding?
Chris Robson: For us, it was a longish journey, because, in fact, we tested out... I was doing something else. I have an educational technology business and we were doing that. And then actually, we saw this opportunity in healthcare and we launched an app, around incontinence, which I mentioned earlier, called Squeezy. And that became, in fact, the top paid medical app in the UK. And from there, we then started building the platform to connect it to the clinician, and the whole idea of Living With came to life. And, that's taken several years, although the business has only really been going for two, three years.
Alberto Lidji: Right. Well, that's maybe a little bit discouraging, right. If you're listening to… and you have this sense of urgency… you want to get something?
Chris Robson: Well, I think, you know, people, you know, that there are a lot… you can start as a business in a month, you can set up a company immediately. The point is that people tend to believe that you can start and then sell it and exit a company within a couple of years. And, in general, most people don't. If you look at the stats of successful companies, actually, they tend to be more like five to ten years, not two to three years. So you know, what I say is about how you build a business that really has legs and has stamina, and can become, you know, go from being a startup without revenue to making revenue to making a profit to exiting generally takes time. We all hear about the outliers, who do it in a year or so. But they're the exception rather than the rule. And another key point is whether you take funding, so we've done three rounds of angel funding. But we haven't taken VC or institutional money yet. You know, that's maybe another step on the road. But you know, I've done different things at different times. And there's no right answer for this.
Alberto Lidji: Yes, And have you found that.. I mean, it's a little bit of a digression, but not entirely, but have you found that the age element is a component or a constraint? So you're not in your 20s anymore. You're, you know, a little bit further along without dating you too much. But you're, you know, you’re…
Chris Robson: Yeah, no, I mean, I think I definitely experience ageism, people sort of expect that entrepreneurs are going to be 25. Or maybe even 20 or 16 now. But I think that you just have to roll with that. That is just the way that life is; I may not like it. But the one beauty about being older is that you may, you may well have, you know, be wiser and have more expertise than somebody who's only 25. You may have made more mistakes, and you've learned from them. So, there's no right or wrong again, in age, it's just about getting going, creating something, and then getting a customer and then going from there. And if you have a vision of where you want to go, then that makes life a lot easier.
Alberto Lidji: Yeah. And I do believe the statistics are such that, in actual fact, it tends to be the older entrepreneurs, who tend to have higher success rates with their entrepreneurial ventures than the younger ones.
Chris Robson: Yeah, I think that is true. You get...well, you just have more battle scars. So, you tend to be able to navigate the system a little better…
Alberto Lidji: With the exception of our friend, Charlie Delingpole.
Chris Robson: Yeah. He’s done very well, yeah, he knocks him out. And so there, he really is at the other side of the spectrum on that.
Alberto Lidji: Yeah, whatever he does, it’s the Midas touch… I think we should have him on at some point as well. And, so, what are you looking for in the next ten years? So what would success look like to you, if we’re having a coffee next ten years, what is it that you would ideally love to see happen with Living With or with the platform and whatever, guise, it sort of, whatever shape it takes?
Chris Robson: Yeah, I mean, my vision for the company has always been a world where any clinician can basically configure their own smart medical app in minutes to support any patient with any condition to live a healthier life. So in many ways, what I'd love to see is that we get to a place where our platform is being used internationally. And it is really easy for doctors, without any knowledge of coding, as you asked me earlier, to be able to create something that can help every individual patient. And that goes back to what I said to you earlier about why I got involved in doing this, why I wanted to do this, it's because every patient's in a different place than you know, they're in a different place, and they need their own support. And in a world where technology has really revolutionized so many other industries, we're still relatively early in the days of technology revolutionizing healthcare.
Alberto Lidji: Now, I dabbled a little bit with databases, and I'm not a coder. But I remember seeing some platforms out there that it basically enabled you to drag and drop. So what is that you want… how do you want the data to behave… you drag and drop, and everything looks very clean and crisp on the screen. And in actual fact the result is very good, so I'm able to give certain instructions on the platform that I would not have been able to do simply by coding. I'm just curious; you envision that? Is that how you sort of think…?
Chris Robson: Well, I think it's a combination of things. So I think it's a combination of the ease of use, either for a clinician or a doctor or for a patient, as well as the smart technology that underpins the platform. So what you want to do, and we're working on some of this in rheumatoid arthritis, actually. We've got the ability now, we've worked with, in fact, the University of Bath, and the IUH to create a model, a predictive model, that can predict the outcomes of a patient over a period of one to eight weeks in advance. And when you start to be able to create that predictive technology, now it's not fully clinically validated yet, but when you start to have that technology, and you can really see, okay, so it looks like you may go into a flare, in a period of time, then you can do something about it, you can manage it. So if you can combine an easy interface from a user point of view with that smart predictive technology, then you have a very powerful piece of kit that can make a real difference to patients and doctors.
Alberto Lidji: The foundations world, the NGO world, so a lot of the times there might be an idea that comes around for a specific type of intervention in a given country, and you look at the numbers, and it's a lot of scale required. And sometimes you need to tweak things because it's going to be very specific, would somebody be able to come to you and say, “Look, Chris, we love what the platform is doing. We are looking at a pretty strong intervention in a specific country, in Sub Saharan Africa, for instance, we need to do X, Y, and Z, we actually need something that's similar to what you're doing but slightly different.” With that sort of conversation be something that you'd be open to, I mean…
Chris Robson: Yeah, I know, that's what we do. I mean, in fact, probably, you know, we haven't got to the perfect user interface yet that I'm dreaming about and that you may be dreaming about. But what we have got is the very modular platform, the ability to create new products on our platform very easily. So, if somebody… we do literally have companies coming to us and organizations saying, “Can you do that?” So that's our bread and butter in many ways.
Alberto Lidji: Right, And ideally, I guess, if you could do it internationally, then you start getting into just a broader consumer base.
Chris Robson: Yeah, exactly. I mean, there are other healthcare companies that one can see that are working internationally, some are working in Africa. And you can see where that technology can really have a much greater impact. Because so many people have phones, they may not actually have necessarily a doctor or hospital anywhere near them, but they will have a phone. So technology that can work on a phone can revolutionize the way that people get treated and looked after, in different parts of the world.
Alberto Lidji: You should connect with Jonathan Rosser who runs World Child Cancer. He was a guest of ours last year, and they are a UK based charity, but they do a lot of work in Sub Saharan Africa, helping families who have kids who are suffering from cancer. And a lot of times, geographically speaking, you have a hospital that's 500 kilometres away from where you live. And even basic things, just like getting to the hospital is a challenge. And then having doctors who are assessing things, and again, I'm just thinking how one might be able to deploy the sort of technology platform to benefit, in this case, families who are suffering from that sort of...
Chris Robson: I think you absolutely can. Even in England, we are working with a trust, where you have patients who might have to come in for a six-monthly appointment for their rheumatoid arthritis. And they might have to drive an hour and a half. And they might be elderly, and that's like a whole day out. And they may actually be in remission at that stage. So, it's a waste of time. And if you can save that time, then you’re improving the patient's quality of life, as well as saving time for the doctor. And that's got to be good because then you can make that time for those patients who really need the help.
Alberto Lidji: Exactly. And I'm just thinking out loud here. But a lot of the time if you have a kid who needs to travel 500 kilometres to go to hospital. A lot of times, it's not just that 500 journeys, not even the whole day, it's like you got to stay overnight, you got to travel with an adult, you got to do a few things if you can sort of minimize the need or make sure that those visits are as fruitful as possible when they do happen. Again, I could see how this could be really, really interesting.
Chris Robson: Yeah, no, agreed. Totally.
Alberto Lidji: So how did you… give us a little bit of the entrepreneurial journey? So you did your MBA, and then you went into finance and then entrepreneurship or.…
Chris Robson: Actually, I started my first business at Oxford University when I went to Afghanistan many, many years ago, but I was a kind of nonprofit business to report on the war there. But I have, I guess, I've created a number of businesses after I went to business school, I got into the internet, and I built and floated a digital agency. And then co-founded a company which became Ink Publishing, the world's largest publisher of inflight magazines. And then I ran a strategy and innovation consultancy because I loved innovating. And then I've created a number of other businesses since… which some have worked, and some haven't. So yeah, it's been fascinating. And I think what you said earlier, that ability to create, to have an idea and turn it into a business that makes a difference to people is an amazing feeling. When it goes right, it's truly one of the great feelings.
Alberto Lidji: Yeah. And now, I always ask guests, what's the key takeaway that they'd love for the audience to keep in mind after they finish listening to the episode. In this case, though, let me narrow that a little bit. And say, what's the key takeaway you'd love for any of our listeners, who are interested in starting up some sort of social enterprise or being social entrepreneurs. What's the key takeaway that you'd love for those folks to keep in mind.
Chris Robson: I think, finding something that you're really passionate about, that you can see would make a difference to you, but would also make a difference to somebody else. And, think about that and think about how you could create a business that does that. So really have a clear view of who that user is, and why it's going to make a difference to them. Be as precise as you can about that.
Alberto Lidji: Very well said. So before we wrap up, if somebody wants to get ahold of you, what's the website address? Just search for Living With or….
Chris Robson: It is livingwith.health
Alberto Lidji: Okay, great. Perfect. Well, you've been listening to Chris Robson, Founder and Chief Executive officer of Living With. And Chris, it's been an absolute pleasure hosting you on The Do One Better! Podcast today. I know we could easily have a conversation that goes on for another hour. But that'll have to be for your return visit.
Chris Robson: Well, Alberto, thank you very much for having me. It's been an absolute delight, and I look forward to talking some more.