DGTL Voices with Ed Marx - The Cost of Failure Has to Go to Zero (ft. Nish Khandwala)

Episode Date: July 16, 2026

Nish Khandwala is the Co-Founder and CEO of Bunkerhill Health, an AI agent platform for health systems backed by Sequoia and deployed at Cleveland Clinic, Stanford, UCSF, and more than 25 other institutions. A Stanford CS grad with a Master's in AI and a Forbes 30 Under 30 honoree, Nish built Bunkerhill after a Nature-published research algorithm he helped build at Stanford sat unused on his laptop for two years, then found its real-world moment when his own father had a heart attack. In this episode of DGTL Voices, Nish talks with Ed about the calcium-scoring model that inspired the company, why healthcare has to stop imposing drug-development timelines on modern software, and the governance shift he thinks hospital CEOs need to make: drive the cost of failure toward zero, iterate fast, and stop treating AI like a five-year plan. Plus his origin story from India to Saudi Arabia to Stanford, the difficult-conversations lesson he's learned about leadership, and why he doesn't buy the false dichotomy between clinical and administrative AI. https://marxadvisory.com

If you were CEO, what would you do differently? I would try to come up with some form of governance structure inside the hospital where you can rapidly fail with your AI, quickly catch it and change it. It is pointless to have a five-year plan right now, or even a one-year plan in AI. You just have to be like, how can we be the most nimble and most agile? That's one of the problems is that they will have this structure that's worked for them 20 years ago, and they're trying to impose that same structure on modern software. You can't.

It doesn't work like that. Welcome to Digital Voices, where Healthcare and Life Science Leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marks. Welcome to another edition of Digital Voices, and I'm proud to announce for the first time we're actually doing visuals as well. So Digital Voices is moving from a podcast-only format to also posting on YouTube.

Yeah, Nish, you're the first, and I didn't even tell you ahead of time. I hope you're cool with that. Wow, that's amazing. Well, I'm glad I was prepared for it, I guess, somehow. We're like number four. It depends on the day of the week, so it could be as low as number 10, but number four in the world. Oh, wow. technology for podcast.

And so my kids who are legit social media influencers, I mean, that's how they make their living. They're always pushing me like, Dad, you need to be, you need to post this on YouTube as well. You know,

all of it. Yeah, get it on Instagram wheels and then some TikTok as well, clips from it. Hopefully I'll think a lot of that today. Let's see. Yeah, yeah.

And we already on there, already on IG, on TikTok. Yeah, but now we'll have more visuals than just audio. So I was really curious. know about your company and about what you do. And that's why we're connected.

I know that you're doing some of this work and that's how I know over at my old stomping grounds at university hospitals in Cleveland, Ohio as well, has Cleveland Clinic, which is literally across the street. So it's a lot of fun. But Nish, before we get there, what songs are in your playlist? What kind of music do you like to listen to? Oh, I'm pretty standard stuff. Like right now, I've been putting some nights,

by fun on repeat. It's the song that I used to get pumped up about the day. But then, you know, the usual mix of John Mayer, Taylor Swift fan here as well, and some Bollywood music. Yeah, tell me your origin story. Like, where, where, you mentioned Bollywood? So I'm, I'm Indian. I grew up, I was born in India, but actually I did not grow up there.

I, my family decided to move to the Middle East when I was eight, six years old. So I don't remember a lot of my time in India, unfortunately. But my dad's a chemical engineer, so he moved us to Saudi Arabia, where the oil boom was happening when moved there. Not a lot to do in Saudi. I used to, I remember, so we're also in nuclear family. It's just my parents and I, I don't have a sibling. So I remember just coming back from school at like one in the afternoon and then having absolutely nothing to do at all. Spend eight years there.

And then my parents realized that, oh, Nish is not a total idiot. And so they decided to take me to a place that had a few more opportunities and we moved to Abu Dhabi near Dubai. That's where they still live. And then I came to the U.S. for my undergrad. I went to Stanford. I did my undergrad and graduate studies there. And that's where I fell in love with a problem that then became Bunker Hill or company. Yeah.

So tell me about your languages then. Yeah. So you speak Hindi first, but did you pick up Urdu or any? Yeah, actually did. So my mother tongue is Gujarati. It's a dialect or a language in the western part of India. I also know Hindi because when you're in India, you kind of learn that. I picked up Arabic a little bit of it.

I can't write, but I can't understand it that well. And I gave up on trying to say Arabic because I couldn't just get the vocal course towards the way I wanted them to. But I did learn Urdu for eight years. Beautiful language. The script is so beautiful. And then obviously English. So yeah, I think I've missed out on some of the major languages, like Mandarin and then Spanish.

Yeah, yeah. Of course, AI is the most important language of all. But, you know, the way to work with AI is through English now. So I think everyone's kind of saved there. Yeah, that's true. Before we jump into what you're doing today, are there any words that you live by, any quotes or mantras or, you know, things that sort of guide you? I think I've been very fortunate in my life to have found a cause or a problem worth getting out of bed for. And I think if you find that, what I've realized, like, is that if you find something like that, one, you're really lucky because it is really just like you kind of need to stumble your way into something like that.

You can't, you know, work your way into that. But once you do that, everything else seems to fall in place in life, you know, like you find a purpose. And so I think that, you know, if I had to like give any advice to my younger self, that's probably what I would say. It's like find your purpose in life somehow. Yeah, I love that. Was there a pivotal moment in life that fundamentally changed your trajectory? Yeah.

For the longest time, well, there are two things. One was when I moved from the Middle East to the U.S. like imagine a kid who grew up in Saudi Arabia devoid of opportunities there was nothing you know nothing to do there to someone who then

the first place he landed in the US was Palo Alto California and then just like the sheer you know I've seen both sides of the spectrum at this point you know and I am very grateful to be living in this country and the

kind of opportunities that it allows, but also the people you surround yourself with. Like, I, you know, I, it was really grateful to the fact that the people who I was around always encouraged, you know, like, you could have the craziest ideas. And rather than try to put you like, oh, no way that's not going to work or like stay in your lane, it was always like, oh, that's kind of interesting. And then you sort of like, you know, work your way into that through curiosity. So that was, that was life changing for me. I think. that was an environment, like all the opportunities plus the encouragement and the support system. Like that's something that definitely, like it's my life before the U.S.

and like after I moved to the U.S. That's one thing. But I think a lot of immigrants share that. You know, I think a lot of us would appreciate that. The pivotal movement that really like, oh, I can definitely see a life before and after that was my dad's heart attack. He's fine, thankfully. but it really knocked the set of priorities into me. I think when you have a life event like that,

it just sort of, nothing is ambiguous. It hits you directly, and you have a rank list of priority suddenly, and your value system is incredibly clear, just the moment of clarity. Very sad moment, but it just lends incredible clarity. And so I, that definitely, had it not been for my dad,

a heart attack. I don't think we would have embarked and continued on this journey that we've built Bunker Hill on. Yeah, yeah. So let's talk a little bit about that. I mean, you went straight from Stanford, right, into Bunker Hill. That wasn't the plan. For the longest time, I think I wanted to be a PhD student who, like, did more research. I was a part of an applied AI group and in my preparation to potentially one day become a PhD student. And we used to build AI models for different use cases. In fact, one of the models that I last built in my role there was for a preventive cardiologist at Stanford.

He came to us with an idea that we thought was like very cool. I was like, oh, I see patients in my clinic usually after they have had their first heart attack and my job as a preventive cardiologist is to prevent the second one. And so he told us, and this was shocking to us as people from outside of healthcare, that he would routinely see patients after they have had their heart attack and noticed that the same patient had come to the same hospital four or five years ago, entirely unrelated reason. Maybe they had pneumonia and went on to see a pulmonologist. Maybe they had a car accident and went to the ER.

They got a CT scan of the chest. And on that scan, it was very visible that there was a lot of plaque built up in the coronary arteries. But unfortunately, the patient just fell through care gaps. you know and so his idea to us was hey you AI guys like could you build us an AI model that could comb through every patient who is coming to the Stanford hospital see who's at high risk who's at low risk and for the ones who are at high risk get them in front of a cardiologist as opposed to waiting for an event to happen and so we build that model you know it worked really well as well. We published a paper in nature and we boasted, bragged about how this is going

to revolutionize cardiology, how this is going to save hundreds of thousands of lives. I know you're smiling because I know where you know this is going. It went nowhere. It was collecting dust on my laptop two years later. That was my first experience of you build something that you really think has value. But it then goes nowhere. Of course, it was just embarrassing because, you know, we had made all these bold claims in the paper. But it was also very demoralizing because it's like, why work on something if you never really, you know, had a plan to get it out into the real world? Yeah. And so, you know, that really had me second guessing.

Should I go down the route of academia? Because, you know, this is what it's going to be like, then I don't think I have the, innate capability to beat that wish your cycle of you build something it goes nowhere but yet somehow you get back to working on something new with it's like insanity uh in my and so i i had become disillusioned and i was pretty much searching for like okay what's my purpose in life uh it's like do i sell my soul go work at facebook optimize ads you know uh a lot of a lot of stanford c s kids do that you know um and i don't blame them it's like what are you going to do?

But that's when my dad had the heart attack. My mom rushed into the ER, the physician in the ER order, the cardiac CT, and the cardiologist gave me a call from the other side of the world, saying like, hey, your dad's calcium score came out to be 139. 100 is like high risk and like, you know, I'm like, I, like, it is such a coincidence that I speak the same language. I understand exactly what you're saying. Because I spent a year of my life building that algorithm, right?

So that's when it all started. It's like, that's how I got into building Bunker Hill. It's like, hey, this is not the last time someone's going to have a hard time getting their innovations to the market. And so. Yeah. Yeah. Well, tell us about the name. Yeah.

Behind the name. Could we play a quick game, maybe? Of course, of course. Okay. So I'll give you three stories. Very quick ones. And you tell me which one's right. So obviously there's the Battle of Bunker Hill.

It's the little guys against the big guys. In this case, the little guys are the researchers who are building all these wonderful AI use cases. And the big guys are the healthcare monolith that is like providing you friction and things like that. So that's the first story. The second story is if you drive up from Palo Alto to the San Francisco, which is what we were doing, you would come across this road called Bunker Hill Road. And so we were like, hey, we need a name for the company. and so we named with that. The third story is around a TV show called Pure Genius.

I have yet to meet anyone who has watched that TV show apart from me this far. Maybe you will be the first. Your viewers might be the first. But it was centered around a hospital named Bunker Hill where research that was done in the morning was used in clinical practice in the afternoon. And we thought that speed of clinical translation was pretty cool.

So which story do you think is? I'm going with the one you just told, the last one. The last one? Well, you're right. You're right, actually. Wow, that's one of the few times people have guessed that to be the right. And most people go for the second one, the one where you're just driving up the road. Yeah, well, that's too random.

The first one's very plausible because that makes total sense. But then I'm not from America, so. You know, yeah, you know your history. Yeah, exactly. But, no, I like that. That's the way it should be. Absolutely. Not this, you know, back in the day, it was 17 years, bench to bedside, you know.

Yeah. The thing was discovered before it got into practice. I think it's about half of that now, but it's like way too long, especially in this day and age technology. Yeah. I don't know much about pharmaceuticals that takes that long. But, you know, for software, you've been a CIA. You know what I'm talking about. It's like, why are we treating software the same way drugs are being treated?

You know, let's capitalize on the fact that software is software. Yeah. Yeah, it's frustrating. And that's one of the reasons we started digital voices, our podcast and some other things that we do. Yeah, tell us some key outcomes. So you've been in this now for a few years, six years, right? Yes. We've been actually found this for quite some time.

We had a pretty slow start. Our first, we spent the first couple of years trying to basically create this consortium of academic centers that would let, would allow researchers within the consortium to share data with each other, share algorithms with each other. So Cleveland Clinic's part of that consortium, Stanford, UCSF, and 25 other health systems are a part of that consortium. So it's been very cool to see someone who has an idea be able to get, you know, collaboration in place, data in place for that collaboration within like two, three days of embarking on that as opposed to a year as it would previously take. What I'm most proud of is what happened after we actually built that consort.

which very fortunately coincided with LLM's becoming large language models becoming a thing. So since then, we've been able to get so many use case out the door. We have health systems using us for over 15 different use cases across different departments, some for clinical use cases, some for administrative use cases. I'm obviously more proud of the clinical ones because they're cooler. So like with this calcium scoring algorithm, for example, the one that I had worked on, We actually brought it to life and we are deployed at several health systems now. At one of them, we found this police officer who got flagged by our system.

He got a snail mail. He went back to the hospital. He saw a cardiologist for the first time. And turns out his younger brother recently had a heart attack. He has a long family history of heart disease. And guess what? like he himself was having chest pain, but he had dismissed it as heartburn.

So we found this patient such at a point in time. You know, he didn't get through the stress tests and the diagnostic cat successfully. So then he ended up getting a triple vessel bypass surgery. And the physicians on the other side, they were pretty confident that we, like, prevented a heart attack here that had it not been for this kind of solution, then he likely would have had a heart attack in the next couple of months. And who knows if it weren't be fatal or not.

But it's stories like that. You know, stats say one thing, like numbers say one thing, but the stories are what powers us so much, you know? Niche, you know, a lot of the audience are hospital administrators. If you were CEO of Cleveland Clinic, what would you do to sort of speak? up this whole, it's very time-consuming slow and all these great ideas and great technologies die, you know, and we could be saving more lives. What would you do differently? I can only talk about the software aspect of things and AI as it pertains to software. On that front, I think I would try to come up with some form of governance structure

inside the hospital where you can rapidly fail with your, use cases with your AI, quickly catch it and change it. Like if you make the cost of failure or cost of you try something and it doesn't work, go as close to zero as possible, whether that's monetary cost, personnel cost, clinical cost, what have you, if you create a low risk environment, you can iterate very quickly. Like it is pointless to have a five-year plan right now or even a one-year plan in AI. You just have to be like, how can we be the most nimble and most agile?

And I know that's usually not within the DNA of a large organization, like a health system. But I think there are ways that you can do that for AI and software specifically, where how can you create the most low-risk environment where you can rapidly test something? And if it doesn't work, who cares? Just move on to the next thing. Just, yeah, sandboxes, governance structures, platforms, partnerships, working very closely with vendors, likely all contribute to it, but it does require some kind of shift in how you think about these things.

Yeah, a lot of the individuals who are sort of are responsible for those areas today come from a more traditional background and mindset. And I think that's one of the problems is that they will have this structure that's worked for them, you know, 20 years ago. And they're trying to impose that same structure. on modern software, modern capabilities, and you can't. It doesn't work like that.

I'm not advocating for the move, fast, break things, you know, thing from Silicon Valley. I'm talking much more of, let's say, like, why do we need 25 meetings, space one month at a time, to discuss something that, like, helps you automate registry submissions. You know, it's an administrative task.

One could even argue that the standard care is pretty, pretty low today. Not even going that deep into it. It's like, no, just what's the harm? Like, why are we spending so many cycles trying to evaluate something like that? So it's things like that. It's like there are lowers things that are occurring at a high enough frequency that you can quickly iterate and catch mistakes if there are mistakes. Okay, I'm also not advocating for having lower tolerance or I guess higher tolerance, sorry. It's just more like creative. and environment that can help you iterate very quickly. I am actually for both the things that you talked about.

I, you know, I speak to boards quite a bit. I was just with several very high-profile academic medical centers on the East Coast. That's why I told the boards. You know, you've got to change, shift the mindset completely. You've got to increase your risk. Billioners safe ways of doing it, Nish. You already mentioned what is sandbox, digital twins. There's all sorts of things.

But, you know, I make fun of HR structures as well where we still operate. modern companies, but modern companies like Silicon Valley companies don't operate this way, but hospitals still operate in the same way that the same structures that when they built the pyramids, right? You have what person, they've got a span of control of five to ten, and they've got five to 10 and these big monolithic, of course nothing can get done. You got to think more agile, you know, and so until you do that, you can't really, you know, embrace modernity and some of these rules. So I don't, it's like if you, you ask me if what I would do if I was a CEO of a hospital. And, you know, I would imagine that the CEO of a hospital has bigger fish to fry in today's

environment with all the budget cuts and things like that, that they can't be the one to spearhead a lot of the AI initiatives. So one another aspect is I think if you find a trusted person to be your quote unquote your chief AI officer, your AI czar, whatever you want to call them, to be like the trusted person like, hey, I will focus. on putting out the fires and making sure that we have a tomorrow, while you go focus on the vision and like what it could be, I think that could potentially work. Maybe. Again, I don't have, I've obviously never been a hospital CEO before. So I'm definitely speaking way out of turn, but I think no, no, no, no, no, no, it's good to have your insight. It's not out of turn at all.

It's good to have your perspective and insight. That's why I asked a question. But yeah, but again, we have created these AI positions, but a lot of them, not all of them, there's a lot of great ones out there. But a lot of them, they were CIO and with old, old thinking, old structure, and now they added AI to title. So it's the same, you get the same nonsense, you know, and it requires, it's not that a person who's been doing a job for 20 years a certain way can't become that. But that's why you need to make sure whoever you hire, whether someone external, someone younger, older, whatever, they just have to have this mindset of, you know, being agile and being quick and and moving things along, but yeah, not tolerating sort of the lack of progress we've had in health care for so long.

They need to be frustrated, you know. Yeah, I don't think that this technology is forgiving enough where one could just say, hey, you know, we'll just wait for the dust to settle and we'll figure out what to do next. Because it might be too late. And especially in competitive places where there are many health systems competing for market share, I would imagine that it is very possible for one health system to lap over the others if one embraces it for a faster. You've given three or four great ideas. And before we leave Bunker Hill, and I ask you a little bit about leadership, before we leave Bunker Hill, what's next?

Like, how do people find you and what's next real? So we have a website called BunkerhillHill.com. You can also reach out to me directly. It's my first name, Nish, at BunkerhillHell.com. I'm always interested in talking to health system partners who are excited about advancing this field forward. We are a very collaborative company. A place like Cleveland Clinic not only is a customer of ours, but is also, for example, contributing their own algorithms to our platform.

They are helping work with other institutions through our consortium. It's really a wonderful collaborative where it's not a vendor customer partnership, but I'm a lot more of, hey, we are a true partner. And so I'm very excited about extending those kinds of relationships and growing those to other health systems as well. So what are one or two key things you've learned along your journey in terms of leadership? Difficult conversations don't become easier with time.

You know, I'm surprised as to how much we as humans lean on trading. Like, we will be fine with a lot of chronic pain, but not be okay with a higher order of acute pain. We'll avoid that. And this is like, I've learned this at work, but I've then realized that it applies to every facet of your life, whether that's a difficult conversation with your partner, with your parents, with your siblings, or what have you.

And it's just like difficult conversations don't get easier over time. And so we better just get it out of the way. And so if I found doing that typically leads to faster resolutions and fewer things, you know, becoming the problems later down the road. So that's one thing that I've tried to implement very significantly, and I've learned that throughout my leadership career. Yeah, those are good things. What about where, you know, what do you do when you feel like your creativity stifled a little bit?

You know, you're thinking about what to do, but, you know, everyone runs into that brick wall. What do you like to do to just get out and clear your mind? I go on runs. and during those runs I like to daydream a lot. It's like, what could you do? You know, it's like, for example, a quick tangent, but we have tried to impose how we should bring a drug to market onto AI. But if AI delivers its problem in drug discovery,

what if we imposed how we bring software to market onto drugs? again like you know we could have like a five-hour discussion around this but it becomes very cool when you just start like daydreaming about if technology works and you could get the society to behave heard optimally what could be different and it's very fun you know then it's like oh the the the opportunities are boundless like where the world could be is very it's still very far away so even if we had a setback recently it's like there's just so much to be excited about still. And then I typically like to do that. I found it that I need I need to be motivated in order to do creative work. I can't just force myself into that. Yeah, I'm going to carve out,

you know, 5 to 6 a.m. to be creative. Yeah. Doesn't fight. Hey, Nish, this has a bit of fascinating discussion. We talked everything about like where you grew up and how you grew up, which is pretty cool. And then some of the songs are your playlist, like fun. I haven't heard that song in a long time. Now it's actually going through my mind right now, especially the beginning. part the acoustic or what's it called? No music. Just the vocals. Yeah.

Yeah. And yeah, it's a great start to a song. And then we talked about Bunker Hill, a lot of the different things that you're doing. We talked about leadership, gave a lot of great ideas, like what you would do if you were a hospital CEO. What did we miss? Or is there anything you want to double down on? I'll give you the last word. I think one thing that we didn't touch on is that today it seems like companies like

ours, or not like ours, but companies in general seem to want to pick a lane. Like, we are either a clinical AI company or an administrative or an operational AI company. And I find that to be kind of weird in today's day and age. Like, wouldn't you love if, like, you could take care of a patient's journey throughout start to finish? Like, find a patient who is currently undiagnosed, get them triaged under a referral queue. When they do, get to see a physician make sure that the physician is equipped with all the information they need very, very quickly. And then when the physician, for example, prescribes a medication, how do you make sure that the prior authorization is done in an agile way? And once that is done, how do you

ensure that the patient is properly put or not put as a part of a registry to monitor downstream outcomes. It's like, I don't see the reason to believe in this false dichotomy. I think we could potentially have companies doing both. So that's one thing. Yeah. That's awesome. Nish, we'll check back with you, see how you doing. But yeah, we'll put all your information that you talked about on how to reach you in Bunker Hill in the show notes. Thank you so much for being our guest. Thank you for having this is very fun. Thank you for listening to Digital Voices. We help today's conversation sparked ideas reflection and connection.

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