Medsider: Learn from Medtech and Healthtech Founders and CEOs - Redefining Stroke Recovery: Interview with Kandu Health CEO Kirsten Carroll

Episode Date: September 27, 2023

In this episode of Medsider Radio, we sat down with Kirsten Carroll, CEO of Kandu Health, and a medtech veteran specializing in neurovascular disorders with nearly 25 years of experience in the field. Kirsten holds a degree in biomedical engineering and dual master's degrees in business and public health. She has held strategic roles at industry leaders like Boston Scientific and Stryker before joining Imperative Care and co-founding Kandu Health. Her startup focuses on revolutionizing post-stroke care and enhancing the quality of life for stroke survivors through tech-enabled healthcare services.In this interview, Kirsten talks about redefining post-stroke care with a comprehensive set of services to improve the well-being of stroke survivors and, consequently, their care partners. From her unique perspective on innovation to her emphasis on a multi-stakeholder approach, Kirsten shares invaluable lessons on breaking down monumental challenges and fostering a culture of teamwork.Before we dive into the discussion, I wanted to mention a few things:First, if you’re into learning from medical device and health technology founders and CEOs, and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.Second, if you want to peek behind the curtain of the world's most successful startups, you should consider a Medsider premium membership. You’ll learn the strategies and tactics that founders and CEOs use to build and grow companies like Silk Road Medical, AliveCor, Shockwave Medical, and hundreds more!We recently introduced some fantastic additions exclusively for Medsider premium members, including playbooks, which are curated collections of our top Medsider interviews on key topics like capital fundraising and risk mitigation, and a curated investor database to help you discover your next medical device or health technology investor! In addition to the entire back catalog of Medsider interviews over the past decade, premium members also get a copy of every volume of Medsider Mentors at no additional cost. If you’re interested, go to medsider.com/subscribe to learn more.Lastly, if you'd rather read than listen, here's a link to the full interview with Kirsten Carroll.

Inventing products, lots of people can do. Innovating means actually getting it out into the world, making the impact, and require so much more than just the good problem statement in engineering. So to really innovate, particularly in this healthcare system and this dynamic, you have got to understand what it takes to get people access to the and actually scale it. Welcome to Medsider, where you can live learn from the brightest founders and CEOs in medical devices and health technology. Join tens of thousands of ambitious doers as we unpack the insights, tactics, and secrets behind the most

successful life science startups in the world. Now here's your host, Scott Nelson. Hey everyone, it's Scott. In this episode of MedSider, I sat down with Kirsten Carroll, a med tech veteran specializing in neurovascular disorders with nearly 25 years of experience in the field. She holds a degree in biomedical engineering and dual master's degree. in business and public health. Kirsten has held strategic roles in industry leaders like Boston Scientific and Stryker before joining imperative care and co-founding Can Do Health. Her startup focuses on revolutionizing post-stroke care

and enhancing the quality of life for stroke survivors through tech-enabled health care services. Here are few of the key things that we discussed in this conversation. First, to optimize for a fulfilling career in MetTac, you need to continuously develop your skill sets. Take a layered approach to your decision-making, build a robust foundation of knowledge, and then trust your gut. Second, when taking on significant initiatives, adopt a process-oriented approach. Break down big challenges into manageable, winnable steps, and build a team around you that is fully aligned with the mission.

Third, innovation goes beyond mere invention. Focus not just on your technology, but on understanding the needs of multiple stakeholders, including end users and their care partners, health care providers, and payers. Okay, so before we jump into this episode, if you're listening to this show, I'm going to make the assumption that you're a dedicated pro looking to learn from the best in the business. If that's the case, which I think it probably is, I've got some exciting news related to our premium memberships. First, let's talk a little bit about Medsider Playbooks, your ticket to going from zero to 100 with your company or your career. You see our team as handpick collections of the most insightful interviews with the brightest founders

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thing. I completely understand that fundraising can be one of the most daunting tasks for any startup, especially in today's environment. That's why we've created a meticulously curated database of investors right at your fingertips. Explore a wealth of VC funds, private equity firms, angel groups, and more, all eager to invest in medical device and health technology startups. Access to this database is a premium member exclusive, so don't miss out. But that's definitely not all. When you become a Medsider premium member, you'll get access to every volume of MedSider mentors, where the brightest founders and CEOs share their invaluable learnings, plus you'll unlock the entire archive of every Medsider interview dating back to 2010. So if you're serious

about advancing your career or your startup and want to tap into this Treasure Trove, knowledge, it's time to consider becoming a Medsider Premium member. Visit Medsiderradio.com forward slash premium to learn more. All right, without further ado, let's jump back into the interview. All right, Kirsten, welcome to Medsider Radio. Thanks so much. I'm excited to be here, Scott. Yeah, like going forward to the conversation. So let's start with your background. I recorded a very brief bio kind of at the outside of this interview, but I always like to start here. If you can kind of give us an elevator style pitch for, you know, what you've done leading up to your current role as a CEO of Can do it. Yeah. So I've spent almost 25 years now in health technology for neurovascular disorders.

So that has been my life's work. Educationally, I started majored in biomedical engineering. And then pretty quickly, a few years in my career went back to school, did a double master. So I did business, but I also did public health. That public health background has really spoken loudly in my career, been really important in stroke. And then in sort of chunks of my own career, It was eight years at Boston Scientific Neurovascular, really focused in marketing, product development, product lifecycle management. Our division was then divested to Stryker. So it became Stryker Neurovascular.

And at that point, I moved into strategic development. So portfolio planning, market intelligence, market modeling, and MNA. And then after seven years there, moved over to imperative care, started out as VP strategy, and then moved into an operational role and got to have P&L ownership for the first time. So you've done a lot, to say the least. I can totally see why your NPH probably especially helpful for what you do with Candy right now. You know, I was looking at your bio kind of in advance of this interview. And it reminded me of like when I first moved in in-house with convenience.

So from the field, from like sales and sales management into marketing-related roles in Minneapolis. And I was like surrounded by all of these folks like with incredible. incredibly like robust resumes like yourself right like bachelors from Yale double you know double graduate degrees it's like it's like it's kind of the amazing thing about being in the the med tech space is like you're surrounded by you know really really smart people so um very cool uh that's that overview is super helpful let's talk a little bit about can do and then we'll kind of go back in time and learn about how you know how the how this uh spin out kind of you know came to be but yeah give it give us a sense for kind of what you're what you're doing now kind of in a similar similar similar style elevator style kind of

pitch. Yeah, no, of course. So I always start with our mission, which is really simple, and that's to improve quality of life for people affected by stroke. And we say quality of life very intentionally above and beyond just people's health. You know, if we look at the why of that, there are so many numbers around stroke. The ones we focus on the most devastating statistic is 28% of survivors rate their quality of life is worse than death a year after their stroke. Most people survive stroke, but the quality of life is a major struggle. And then for the economic logic behind it, payers are actually spending $25 billion a year right now in the U.S. on post-acute care, so not even including that acute intervention. And most of that expense is driven by readmissions.

So readmissions are incredibly expensive, but they are also really damaging to recovery as you're finally getting some neuroplasticity and getting function and getting your life back to be back in the hospital with a UTI or pneumonia or sepsis can be devastating. So Can Do is delivering tech-enabled healthcare services to support stroke survivors and their families as they return to community settings after stroke and reintegrate back into their communities. Got it. Super cool. And what was that percentage that you mentioned? Yeah, the 28%. Yeah. So that was a sub-study out of a major randomized trial called the Avert trial, which was looking globally at how early you should start intensive rehabilitation.

But they did a sub-study on access to rehab and outcomes and young stroke survivors, which is about a third of stroke is below the age of 65. And what they found was a 28% of people self-reported quality of life as poor or worse than death. Wow, that's incredible. That's incredible. So you're solving obviously a major, major issue. And I think this is, as we kind of get into the conversation, it's going to be really interesting because most people that are listening are used to kind of more pureplate device, I guess, product development and commercialization. And this is a little bit different, but yet you're tackling like a monster, monster challenge that is obviously sounds like it's highly, highly needed. Before we kind of step inside the old, the old time machine,

as I like to call it, is there sort of a personal story to like why, you know, and I'm sure you'll get into this, like, why you made the jump to imperative, but you've always been focused on this this at home kind of element. And so if there's a, if there's a, yeah, well, and stroke, Right? So when I applied for grad school, I was 23 years old and it said, what do you want to do with your career? And my answer was an essay about why we need to make stroke treatable. And that may be a weird thing for a 23 year old to be focused on. I have always, always gravitated to really big things, really hard problems. I get excited to solve those. And this is one that I don't think there is anything bigger impactful in your life than your brain and your brain health. And, you know, I'm particularly attracted to it because I think it's solvable in so many ways. And it is so terribly underserved. So it's huge. It's important.

Nobody was really doing it. And I think we can make a huge difference. Yeah, that's, that's, I'm curious that, and I think I've got a question to hear about how you effectively spun this out. But I got to think that there's like probably a fair amount of people that are listening to this. And I remember we tackled it probably on a smaller scale when I was at, during my time, at committee, but this kind of the service element, right, as a pure plate advice company and kind of getting

into the services, it can be, you know, pretty, pretty challenging, right? And from a business model perspective. And so very cool that you've taken this on, right? And not afraid to kind of like take a swing here. So cool. With that said, before we go back in time and learn a little bit more about this transition to imperative and kind of what you've learned building up Can Do Health, let's talk about your personal career. So you mentioned earlier, spent a chunk of time at Boston and then a fair amount of time, a striker in a lot of different roles. So, and roles that like with exceeding, like increasing responsibility. So I guess kind of a dual question, one would be looking back at like all of those moves,

was there anything like specific that you can kind of look back to and say, yeah, this is what really worked for me in my career. And then the other, I guess the other side of that question would be, you know, when you, when you made the jump, right, from, you know, Boston to Stryker and then do a, you know, a startup at imperative care. Like that couldn't be easy. I want to touch on that too, but let's start with the former first, which is more, a little bit more career. Yeah, yeah, sort of the career growth. And so I'd start, and I'm going to talk later about

imperative care and startups and courage, but courage can't be unfounded. It has to be grounded in experience and in knowledge. And so I'm someone who, as much as I've done, I spent a long time in a lot of roles. It wasn't one of these sort of hopping from one thing to another. So that first eight years, what I learned from Boston Scientific and what I appreciate so much from the mentors and the people who developed me there was that functional mastery and that particular emphasis on what marketing and product management are. Full lifecycle product development, really understanding user needs and design control, exceptional commercialization, the importance of really strong customer voice and validation in addition to verification and

product development. I got to do it all. I got to own products from concept to launch. You know, it was certainly not fun to live through a corporate warning letter, but having no R&D, no product launches for five years, having to remediate a product line while maintaining market share, those are incredible challenges. So, you know, it was five years as an individual contributor and then moving into a group product manager and then moving into a director role, all within that marketing function and really learning what. excellent product management and marketing looks like. So I loved that at Boston. Stryker acquired Boston Scientific and what an incredible experience to stay in the same division

with all of your institutional goodwill, but in a completely different organization. So Stryker, as opposed to sort of functional mastery, was really focused on talent development over functional development and much more emphasis on financing or finance as an area of expertise. And so having to learn to speak PNL, having to understand portfolio management and value creation and tying everything back to an economic logic and understanding how it fit in a PNL, those were conversations, you know, I hadn't had to have and parts of my MBA I hadn't had to use. So seven exceptional years, really an organizational decision making and how you make good decisions. And then move to imperative care. And that was incredibly different.

I think it imperative learning to establish a vision, learning to exercise courage. But it, you know, it's one thing to be an operational leadership in an organization that's been around for 40, 50 years and has all its systems figured out. It's another thing to build GNA from scratch, build your processes, build your systems, figuring out your company and your culture. So imperative has really been about building a vision, building a company, and building a culture. Got it. Got it. And I, just hearing you, you kind of describe those experiences at both Boston and Stryker and then to, you know,

the transition to imperative. It always kind of reminds me of like similar conversations I have with other folks that are at strategics, right, large strategics in there. They may be frustrated about the bureaucracy or how slow decisions are made, but it's like, I mean, even though it can be kind of stifling sometimes, you know, especially if you're ambitious and, you know, want to build, build things. There's such great learning experiences, right? And I always encourage people to like really lean into those.

I mean, it's frustrating, yeah, but they lean in them because it's, you may not ever get the opportunity to kind of learn that one thing again, you know? Yeah, well, and, you know, guilty is charged. I had to run the portfolio planning and decision-making process. So to the extent that people are frustrated by it, I'll have to take some ownership of it, at least at strike or neurovascular. I am actually a really big believer in great process and getting enough information to make good decisions and then moving on to execution.

And so, you know, it's something that I've tried to continue to perfect throughout my career, is building really great processes for organizational decision-making. Got it, got it. And take me back, before we get to kind of more questions around kind of this, the in-home model and, you know, how this came to be with Kandu, take me back to when you were considering the move to imperative. Because I think a lot of people that are listening to this show can probably resonate a little bit with like you're, you've had this upward career trajectory.

You could probably kind of make your own moves at this point, right? Like you could probably stay at Stryker. You can maybe go to another strategic and a different, a different, different capacity, but you chose to go to an imperative. And, you know, what, I'm sure there was a little bit of concern, right? This is kind of a startup. I'm pretty safe. I live in San Francisco and I'm the primary income earner in my family. So, so yeah, you know, I think some people have this luxury of two people with careers driving and one of them gets to take the risk. That was not this situation. So yeah, and I really had to, had to believe in this.

I think I'm maybe unique in the extent to which I really do feel like I have a life's work and a thing I'm supposed to be doing in the world. I love Stryker and I have immense respect for Stryker. And the thing I was supposed to be doing in the world was not the thing they were going to be doing. And that was really hard to work with people you love and respect in a job you're doing really well and also know you can't stay there. So, and we can talk later about CEOs and people who have influenced me. there was an extraordinary group of women leaders from MedTech women who took me into their fold and spent months, if not years, counseling me on understanding what I needed to be doing in the world and how I needed to do it and getting me sort of psychologically prepared to make that move.

I'm a big believer that you can't have a five-year plan. You need to know what you are going to do in opportunities present themselves. And you actually have very little time to make those decisions. when the opportunity does present. So having yourself figured out and your priorities figured out matters. So I am forever grateful that the opportunity presented itself and that I was in the right place in that moment to say yes. Yeah, that's good stuff.

Really, really strong words of advice, right, for other people that may be, you know, kind of staring down at potential move or maybe it's not even on the near-term horizon, but the fact that they should probably be thinking about that, right, and knowing kind of where they want to, you know, potentially move when the opportunity presents itself. That's really good stuff. Let's talk a little bit more specifically about your move to imperative and then, you know, Can Do specifically.

We touched on this earlier. It's different, right? This kind of services model, it's a huge, huge opportunity, huge challenge, but it's very different for, you know, a pure play device company. So just, you know, maybe you can touch on like your interest in the at home care model. And then like how this came to be over the past, yes, five years.

Have you been with imperative almost five years? October 2017 is when I joined imperative. Yeah. Okay, okay, got it. Yeah, so almost six years now. So yeah, talk to us a little bit, kind of like how this has evolved over the past, you know, half decade or so. Yeah. So imperative was founded from day one with this purpose of addressing the continuum of care and stroke. Imperative was not going to just focus on thrombact to me. Imperative was going to look at can we create a company dedicated to this need? And that's now expanded. And you probably saw, the press release. So there's there's a vascular component to imperative now as well, but that commitment to stroke hasn't wavered. So as VP of strategy, my initial task was not in defining how we were going to win and thrombectomy. They had an incredible team working on that already. It was, what does it mean to be a stroke company? If we're really going to deliver on this promise, where else should we be innovating and what should we be doing? And that was something I probably spent a year looking into. So post-acute and rehab and pre-hospital and ICU, where is the opportunity?

And the resounding message that came back, if your purpose as a company is to serve stroke, who does that resonate with? Who really cares about a stroke company existing? The biggest group of people who cared about a stroke company existing were the stroke survivors and their families. and it didn't take many conversations with the actual community affected by this to realize that's where the biggest need was, but also that's where our biggest support was going to be from people who were going to want to do this alongside us and advocate for us. So the initial request was, can we start an exploration and eventually a business unit that, for lack of a better term, we'll call patient at home, but we're going to center it

on that community and what they need. So there was never a, we need a digital health play or we need a services play. It was we need to serve the biggest problem and team up with that community and understanding what a solution would look like. Got it. That's really helpful. And so when you think back to how this is, you know, to Kandu now versus like what it, like how it was beginning to take shape, yeah, four or five years ago, I'm sure it looks a lot different now. And so, you know, thinking back and maybe frame this, I guess, I guess maybe frame your answer around. helping other, you know, MedTech, life science, entrepreneurs, founders, CEOs, as they're kind of trying to be as lean as possible, as capital efficient as possible, as these programs kind of develop, you know, is there anything that you think back and, you know, you look back and we really did that right or we could have probably maybe iterated or pivoted a little bit differently along the way?

Yeah, great question and opportunities for pivot. I'd say what we were doing with Can Do was particularly novel. This wasn't we think we can go in and digitize something that's already being done brick and mortar or we think we can make a better version of a device to solve for this. This was really asking our leadership to rally around a problem that needed to be solved and take that journey and figuring out where to go. And so when you're doing something that new, there's this balance in establishing a really big vision that excites people, but breaking it off in the right sequence and increments and building on wins and building confidence that there is a there there, right? That you know, that you really understand the problem and that your solution might

work. And so this was a sequence of let's start out with some exploratory spend. Let's turn it into a building, sorry, into a business unit. Let's turn it into a wholly owned subsidiary. Let's spin it into an independent company. And that happened over time in lots of little tests, right? And, you know, big pivots along the way. So we actually started out in this question, one of the biggest problems in stroke is people don't actually seek care because it doesn't hurt. The average person having a stroke wait seven hours to go to the hospital. So was there something we could deploy in a consumer ambulatory environment that would actually get people to seek care? As we started working with those people, this post-acute problem presented itself.

And the initial question was, could an app help them? And we very quickly realized it's not just an app. It's a whole set of services around an app. So, you know, as potential solutions presented themselves, we did lots of sort of scrappy bakeoffs, ways of learning quickly, low-cost, low-tech. We have always had a foundational value to be grounded in evidence and not experience. on vulnerable populations. So building an advisory board of stroke survivors and including them every step of the way and designing the product, validating the product, interviewing our

personnel has been really important. But building on these small little proof points to gain that confidence and direct the product. And so I guess I'll end with as we identified, okay, we want an app, we want a software back end, we want to deliver clinical services. Now, you're this career med tech person going, holy moly, how is any of this regulated and done? And it, you know, turns out product management sits in engineering in tech companies and they work in agile instead of design control. And you're not regulated by the FDA unless you're Sam D. You're regulated by data governance laws and practice of medicine laws. And so understanding the consequences of each of these decisions and knowing the product you're developing, this was a really thoughtfully built

company with a lot of work put into infrastructure. Hearing you kind of describe that reminds me, or like it, like you mentioned earlier, like one of your superpowers is like process, right? And I can see that, right? You took on this monster challenge, but somehow we're able to kind of break it down, right, into steps, winnable steps, right? Or at least steps that where you could learn a lot that would serve into kind of this broader, you know, ladder up into kind of a broader, broader mission in order to get

more people on board, get the organization excited about. it and to push ahead. Yeah, yeah, I don't, I don't really get scared of unknowns. I think majoring in biomedical engineering got me very comfortable with having no idea what I was doing. And that's another story, but it is a thing to bringing people along with you and not having them terrified by how big it is or how much is unknown, right? And pacing the learning so that people can walk along with you as you do it.

Yeah, I want to touch on some of some of your learning specific to, you know, clinical data and right, how that's different versus kind of the various clinical affairs initiatives that you're involved with at Boston and Stryker. But kind of one follow-up question with respect to just kind of the evolution, you know, from spitting this outside imperative down to its own, its own standalone company. You touch on this where this is, you know, this is different, right? And you had to get people on board. So for other device leaders that are in, that are having to, you know, face that challenge, right?

They've got the challenge of like building this product and building a team around it and pushing kind of that boulder up the hill. But they've also got, you know, some other stakeholders that they need to convince and they need to, you know, get on the same team. Any kind of pieces of advice that that was like that really worked well for you or looking back, you could, you know, you offer up to other people that are kind of the same boat? I mean, a huge part of the reason that we've been able to do this. and we fundamentally couldn't have done this without this, is that we had a board and investors that were wholly bought into this mission. This isn't something you're going to do if you're not surrounded by the right people who have said this is actually what we want to be doing and who we are.

So, you know, you have to know your customer. You have to know a lot of people, know your investors, know your board. You know, to the extent that you have the luxury of picking your money, right, bring in the investors that really are aligned with your vision and can help grow it. So, you know, again, in that decision to leave Stryker and sort of the love of where I was versus the absolute surety of what I needed to be doing, I never would have been able to build this internally at a big multinational corporation public, you know, with all of those pressures. It never would have happened. And you can spend far too much of your career

trying to fight for something and build something when you were fundamentally in the wrong place or with the wrong people. Hey there, it's Scott, and thanks for listening in so far. The rest of this conversation is only available via our private podcast for MedSider Premium members. If you're not a premium member yet, you should definitely consider signing up. You'll get full access to the entire library of interviews dating back to 2010. This includes conversations with experts like Renee Ryan, CEO of Cala Health, Nadine Miarid,

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