The Game-Changing Women of Healthcare

Meg welcomes Natalie Douglas, an award-winning healthcare specialist, an experienced entrepreneur, CEO, board director, and investor. She is the founder of Lucidity LLC and RealiTi Health, as well as chairman of the board for Entia Ltd and TidalSense. She is also an investor and advisor for many portfolio companies, such as Ceek Women’s Health, RwHealth, Vitaccess. 

In this episode, Natalie shares her experience in various leadership roles in life sciences, pharma services, medical devices, digital, SAS, and data analytics. She discusses various challenges and some of the innovative solutions she’s led as a private equity-backed CEO, building a global market, fem tech, and the next era of the healthcare landscape.

Natalie was honored with “Pharma Voice Top 100,” “Health Investor Power Top 50,” “Ernst & Young Entrepreneur of the Year Award (Finalist),” “First Woman in Business Services Awards,” and “The Sunday Times Fast Track in the following categories over multiple years:  Top Track, Buyout Track, Profit Track.”
 
Further Reading:

Episode Credits: 

The Game-Changing Women of Healthcare is a production of The Krinsky Company. 
Hosted by Meg Escobosa. 
Produced by Meg Escobosa, Calvin Marty, Chelsea Ho, Medina Sabic, Markala Comfort, and Wendy Nielsen.
Edited, engineered, and mixed by Calvin Marty. 
All music composed and performed by Calvin Marty. 

©2024 The Krinsky Company

Creators & Guests

Host
Meg Escobosa
Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.
Producer
Calvin Marty
A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.

What is The Game-Changing Women of Healthcare?

The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.

Natalie Douglas: Just because someone has founded a business and they're an entrepreneur, do not assume that they're going to do as good a job as you did. The journey I went on knowing how hard that is, but I did do a good job. And I'm not saying that it's an easy journey, but don't assume that the founder knows what they're doing and don't assume they're going to make it successful.

And actually, that's one of the reasons why I like to chair or non-exec or provide strategic advice because, you know, some of that advice is really valuable. So that's been part of my learning - don't assume that everyone's a genius or that they're going to make it work.

Meg Escobosa: Welcome to the Game-Changing Women of Healthcare, featuring exceptional women making an impact in healthcare today. Together, we dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers.

I'm Meg Escobosa. Join me in conversation with some of the many brilliant and courageous women on the front lines of the future of health.

Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. A quick note before we get into today's episode, we are currently looking for sponsors for the podcast. If supporting and encouraging female leadership in healthcare is important to you or your organization, help us do that by becoming a sponsor of the Game-Changing Women of Healthcare, reach our engaged audience with a mention by me in future episodes, or we'll produce a short audio spot for your organization. At The Krinsky Company, we believe in female and diverse leadership in healthcare. If that's important to you too, become a sponsor of the podcast and proudly share your values with the world. Reach out to us at podcast@thekrinskyco.com and thank you.

Meg Escobosa: Hi everyone. Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. Today on the show, we have Natalie Douglas, an award-winning healthcare specialist and experienced entrepreneur, CEO, board director, and investor.

She runs Lucidity Health, an advisory firm leveraging her insights. For more than 20 years, creating innovative and visionary solutions. She rose to prominence by establishing the Global Market for Medicines Access Programs and the international infrastructure required to service over 200 countries with operations in North America, Europe and India.

She has also held leadership roles in life sciences, pharma services, medical devices, digital SaaS and data analytics. And Natalie led the turnaround and transformation of one of Europe's largest clinical home care providers servicing over 200,000 patients a year.

Hi, Natalie. We're so happy to have you here. Welcome to the show.

Natalie Douglas: Meg, thank you very much for that amazing introduction, and it's great to be here.

Meg Escobosa: Well, I mean, honestly, when we see people making an impact and doing really hard things, we are just very honored to get to tell their stories and to reveal the learnings and insights that you have garnered over your career.

So, really, it's an honor for us. We're excited to talk to you today, and I know I've barely scratched the surface of your background, so let's get into it. You not only founded that innovative program for enabling patients to get access to medicines, but you also oversaw its managed buyout. Can you tell us that story, and how did you recognize the opportunity for the program and build support, funding, and growth for it?

Natalie Douglas: Oh, my goodness. It was an amazing journey when I look back on it and think about the achievement, when I was doing it, I didn't really think too hard about how difficult a process that might be, but it was also at a time where probably many women or women in general were not actually raising capital.

This was back in the early 2000s, and certainly in Britain, I'm probably one of the first women to get private equity backing in any business, let alone a healthcare business that was quite complex to explain. I guess how it really all started was me just seeing such an opportunity and being very passionate about the business model and what we were trying to do.

I came out of big pharma, so the typical model is that big pharma researches and develops a new therapy, takes time to bring it to market through clinical trials, gets it approved with the regulators and it's reimbursed and you're good to go and patients get access.

Where I fitted in with my model, which really was an idea that was born out of my time working actually in sales and marketing within J&J, where the model fits in is in that phase post-clinical trial and prior to drug approval. And what was happening is that the majority of drugs were getting approved in the US by the FDA, and the cycle into Europe, for example, then can take several years and there's a gap of that period of time. And in certain therapy areas like oncology, for example, waiting for approval can be too late for some of those patients.

And I saw an opportunity within big pharma - I saw firsthand when patients with HIV and AIDS were being treated with a drug that was still in development because there was nothing else on the market. There was no other option. So I created the model that was really to enable patients to get access to medicines that were not yet approved.

Now they may well have been approved, in the first instance in one other country, but they weren't approved in the country where the patient resided. And that was the idea of the business and that's what we were doing. And then sometimes what happens is a drug might be approved in one country, but there may not be an approval coming at all in another country and so there was a mechanism that most regulators have in place already to enable access on what's called a “compassionate basis”. So when there isn't a licensed alternative, then there's this mechanism, in some cases, to enable access using that sort of methodology. Coming out of big pharma, I knew that this was, it had to be part of the life cycle of a drug, particularly in areas like rare disease, oncology, infectious disease, and I think, you know, when you look at what happened with COVID-19 and the vaccines, for COVID, it's a classic example where there's an unmet need and you've got to make something happen very quickly or where there's a bolus of patients who need a therapy because it might save their life. So that was the idea, taking that out to private equity and we're talking like mid-market private equity and banks as well because I raised just over £22M at the time.

I'd never ever done it before, didn't really know how to do it. I went out to work with a lawyer and a corporate finance house to help me do it, but what I was really good at was pitching the business. I could explain how we were going to make money and why it was a good idea and I had case studies. The thing that was really helpful as well as that, I was able to show this trajectory of cash generation.

Meg Escobosa: Oh yes. And so did patients have to pay as well for the drugs or was it primarily, how did that work? The financial element.

Natalie Douglas: It's a great question. So in this early phase, sort of a pre-approval phase, there are mechanisms, particularly within most European countries, quite unlike the US, where compassionate usage can be and is often covered by the health funds, the health system. Now that process has changed quite a lot over the years, and in some respects, it's easier than it was 20 years ago, and in some respects it can be harder as well, particularly when you look at high cost medicines, but in general, the cost of those medications is borne by the health system and not the patient directly.

When we built the model over a longer period of time, what you would find in some emerging markets, and certainly in South American markets a few years ago, is that there wasn't a health system that could pay or would pay in these circumstances. And often, actually, it was the families rallying rounds.

You know, trying to find the money to pay, but the other side of that is in some cases as well, we were working on behalf of the pharmaceutical companies and pharmaceutical companies would often provide in cases on a compassionate basis. So in many cases as well, the pharmaceutical companies were making provision on a compassionate basis as well so they weren't really charging for the medicine.

Meg Escobosa: Wonderful. So in the end, the private equity firm essentially took over the company or how did, tell me about what you learned about selling. Tell me about selling the company.

Natalie Douglas: Oh, that was a horrible situation, really. I should I have tempered that with, “Oh, well it was challenging.” You know, it's such an interesting - it's horrible because it was my baby. I built this business and there's lots of value and benefit in working with private equity. And I don't want to be disparaging of it at all, but when you're a founder and entrepreneur and you’re building that business, it's a very personal thing. And it's, I guess it's one of my key learnings.

I brought in private equity and they honestly didn't need to do very much in the almost 10 years we worked together. I saw it as a partnership. We paid dividends along the way. They got paid back their original equity check very early.

So it was a very, very good investment for them. And I worked really hard, but I was driven more by making drugs accessible to patients, supporting doctors and supporting the pharmaceutical industry, sort of growing the brand and building a market. So I'm very grateful to them for having enabled me to do that.

I didn't, you know, they weren't in the business, owning the business and telling, you know, driving it in any way that was definitely down to me. And of course the management team around me. The horrible part was, in my case, just the exit process. It's brutal and it's not, you suddenly, in my case, you definitely find yourself on a different side of the fence.

You know, you've worked collaboratively with these partners, your investors, for a long period of time, and then suddenly you're on opposing sides. And that, I found that really, really hard. You know, for me, it was just a really difficult process. Especially because in the end, I didn't stay with the business as it was sold.

Meg Escobosa: Were you on opposing sides simply because you're trying to arrive at a fair price that you both agree on? And so it's really down to the value of the company or what would you say causes you to be on the opposite side?

Natalie Douglas: Well, I think in general for private equity, it's all about valuation. It's all about getting the best possible deal because of course they have their investors, which I, of course I understand. And, you know, being so many years later, you do appreciate that. But for me, it was still my baby. And what happens at that point is that you're not on the journey that you still want to be on. You know, I think for many entrepreneurs, maybe they stay with the business, post a new deal, post a new buyer.

For me, it wasn't going to work in that way. I would have wanted to carry on making the choice myself about the investor that was coming in because again, I would have seen it. I did see it as a partnership. And so there's a real conflict or there was a real conflict orI think in this particular case where they need to maximize value, I understand.

I want them to maximize value, but actually for me, I want to be part of the new sort of investment vehicle. And I think it's quite hard to achieve that actually. So I can understand for them the dilemma they're in, but also for me, just how it was a heartbreaking process. But I would say that most founder-entrepreneurs, I think if when they have to part ways or where things change, it's no longer their baby,I would say most of them, would say exactly the same as me. It's just heartbreaking and so it was more about the fact that it was a very emotional situation for me.

Meg Escobosa: I'm just curious if you want to share, you know, what caused you to choose at that moment? Was it a financial need, like you need to grow the business, you need more investment, and so it's just a natural progression of what's needed next. You had some paths that you could have gone down, but you were already partnered with the PE. And so therefore, okay, let's go deeper and let's go further and I'll step away. What was the cause for you to sell at that moment?

Natalie Douglas: Well, it's a great question. So I had moved to the States. So this is back in 2009, I moved and I'd explained to them, you know, this is a British firm. I'd explained to them that the future growth of the business really depended on us being in the United States and at some point, securing US investment or finding a US investor to help on that journey was the ideal scenario, which they did agree with initially. The other part to it is finding a strategic investor, someone that understood the healthcare space and someone that could help develop and grow the business. Probably at that point, having an investor that was much more aware of what was a healthcare specialist, maybe was what we needed.

So it was definitely to fund growth. It was definitely an investor with more healthcare expertise. And also my investors had been in for, you know, nearly 10 years. And that's a long time because most of the time private equity and not in for that length of time. And so it was quite obvious that there was going to be an exit route for them at some point.

Meg Escobosa: Thank you for going there. What did you learn from selling the company or what, you know, what are some of the learnings from that experience? I know you've already referenced some of them just about that passion you feel for your business, and it's your baby going through a different experience selling from founding.

Natalie Douglas: Oh, I hope this will be helpful for people that have to go on this journey. It was really incredibly intense for me and really hard. It's a hard one because life since, you know, has brought so much opportunity and so much joy as well. And I don't dwell now on what might have been, what could have happened, but I think being out of the business, probably the first year was really, really rough because I'd lost something that I was so passionate about and I built it. I mean, I built a global brand. I created a market. So I was bereft actually, that first year.

We also moved back to Europe at that point so life was just a little bit up in the air. And then the other thing that happened in that first year of me coming out of the business is I lost my sister to cancer. Honestly, it was in a way, it was such a godsend because I was back in Europe and I could spend a lot more time with her than if I had still been based in the US.

I think that would have been very difficult. So, you know, I had other things to focus on at that point. You know, my sister was what was most important. My family was what was more important. So in a way, I mean, it sounds like a terribly perverse thing to say, but it was a distraction.

So it was terrible, the first year. I was really distraught, but at the same time, I had other things to think about. And that really, that really helped me and having an amazing husband and an amazing son and great friends, right? That was life saving for me. And then the next thing that came along is the investors at the business that was called Healthcare at Home at the time.

They knew me from what I'd done with my business and they said to me, “What are you doing? We need some help with our business.” And so actually, I just got involved in that and that was my next journey as a chief executive of a private equity-backed business.

Meg Escobosa: Right, okay. That's how you got there. Well, I just want to acknowledge the loss of your sister. I'm sorry about that. It's very painful.

Natalie Douglas: It's very painful, but many people have experienced it, haven't they? Another of life's, you know, journeys that we can share with others.

Meg Escobosa: Absolutely. Absolutely. I'm happy you had your family to support you and that you had good work to do. I mean, it just also keeps focus on making healthcare better.

Natalie Douglas: Absolutely.

Meg Escobosa: What informed your leadership approach and your turnaround strategy at the healthcare at home?

Natalie Douglas: Oh, you're asking brilliant questions, Meg, honestly, I, look, first of all, I was a woman with nothing professionally that I could put my energy towards, and I've got a lot of energy and I'm very good at solving problems, right?

So I had the time, I guess, and I needed to fulfill my brain. So that's the first thing. Secondly, I walk into a business and ask lots of questions that nobody seems to be able to answer, which to me are very simple business questions. So although I had never run a clinical business before. It was very different to my business.

I knew how to run a business. And so some of those basic questions, you know, like “what's your cash position” and “what are the main issues” and “who's responsible”, you know, but I was able to ask simple questions that were very natural to me because of running and building a business. I had a lot of energy, which was required in a turnaround situation.

And I guess one of the things that people will often say about me is I'm very good at simplifying complexity because I have to get to the heart of the problem and then figure out the solution. So I was driven, I was motivated and passionate about what the business did. That was the other key thing for me, you know, being patient-centered, supporting health systems, payers, the pharma industry, you know, all of that was so familiar to me, although the model was quite different. And I could just see so much potential. I could see walking in there, walking into the drug warehouse, walking into customer services, you know, just visibly, you know, walking the floors and seeing, actually seeing the chaos and seeing the high sense of stress and just seeing, you know, talking to people.

It was very clear to me that somebody had to sort this out and make decisions. It was very clear from day one. And that person was me. I'm very good at making decisions. So I had a lot of pent up energy and this was the perfect place for me to use it, I think.

Meg Escobosa: And Natalie, was it pitched to you as a turnaround or did you recognize when you joined, “Oh, this needs to be turned around.” I'm just curious, you know, it's like, do you just go in with eyes wide open or was it something you uncovered once you got there?

Natalie Douglas: Yeah. I definitely uncovered the extent of the crisis as soon as I joined, but actually I joined the business as a non-exec. Originally, I was asked to look at the strategic options and the direction of the business. The board needed some sort of growth expertise. So that was the start of it, but I only joined, I only joined as a NED for one board meeting. And at that board meeting, it was pretty obvious that there was some significant operational challenges, shall we say, so it was pretty quickly after that board meeting, they said to me, “Would you step in whilst we look for a new chief exec?” And I said, “Look, I'll, you know, I'll come in and, you know, sure. I'll do it for six months whilst you find somebody.” Well, actually I walked into what was a significant turnaround situation, but the good news in all of that is that actually within eight to 12 weeks, there was a lot of the sort of standard daily KPIs that were back to normal. There was a lot more work to do, but I was able to demonstrate sort of effective change quite quickly. through my leadership and finding people in the business who actually knew what was going on.

Meg Escobosa: Yes, and you recognize that it was 2014. What was healthcare at home like at that time in general, the industry and how has it changed?

I mean, I know the post-pandemic or during the pandemic, sending more patients home, keeping patients at home, serving them at home, has obviously become more commonplace and a necessary operating principle, but not everybody provided care to patients at home. So can you give us sort of a paint-the-picture of what it was like in 2014 and what are your observations today and what's the potential future, you have a point of view?

Natalie Douglas: So a lot in there, but I definitely have a point of view on home care and clinical care in the home and, more broadly, making provision for patients to receive more care in the home. And I think that the pandemic was potentially transformed. I think the key transformation was the broader recognition and more globally to that home health care was an option because back in 2014, what we saw is very specific use of home health care, not as broadly as we need to see it.

You know, we've seen the emergence of virtual, what we call virtual wards since the pandemic. Well, back in 2014, healthcare at home was doing some of that already, but it was emerging and there was a lot of resistance within the payer system. They didn't want to release patients into the home, into the arms of a, actually in our case, a private company. That's sort of quite a challenge in the UK in particular, and where you've got state-funded health systems. There's a bit of an arm wrestle that goes on in that situation. And we were very specifically managing a lot of high-cost medicines into the home. Some of which was more what we would call a dispense and delivery service.

So it was a medication being delivered to a patient at home and there'd be a level of service there. And then, you know, helping patients administer their therapy or training them, largely with nurses, but training patients, particularly those with rheumatoid arthritis, for example, to inject themselves.

So there's a broad level of home care within that one you. model. So healthcare home was doing really complex work back in, you know, almost 10 years ago. And it's doing a lot of the same today. I think that there's still work to do. And I think a lot of the work is to do with the payer systems, appreciating how to value a home care model, and to look at what the return on investment is over a longer period of time.

So I think the pricing of these services still needs some work and the industry itself needs to create more of a value proposition as well. I don't think the industry does itself many favors sometimes, so there's work to be done.

Meg Escobosa: I was going to ask, do you see any examples where something is being served, you know, care is delivered at home and it is being paid for at the right level? Or is there any example that you can think of?

Natalie Douglas: The simple answer is no, I can't think of a single example off the top of my head. I think there's some research that probably needs to be done in this area and I think there's some research underway in the UK, which would be helpful because it goes back to my point about people not really understanding how to value this kind of service versus what it costs.

So the cost-benefit analysis is the piece of work that really needs to be done because it was easier to determine what the longer term impact was. So for example, improve patient outcomes, adherence and persistence to therapy. You know, we know that home health care and intervention, whether it's physical in the presence of a patient at home or whether it's virtual, you know, there's, there's various models now.

It could even be the use of medical technology in the home that enables us to monitor through data analytics, you know, how a patient is responding in real time.

Meg Escobosa: Whether they took their medication at all.

Natalie Douglas: I mean, this is the key thing. And, you know, when I was at healthcare at home, a lot of the, we were able to collate all sorts of data very valuable data about patient behaviors, and that was before we had sort of higher level data analytics that we have today, but health systems, I mean, if I use the NHS as an example in Britain, you know, it's a very reactive service, and it doesn't really think about it. think long term about, especially for chronic disease, how to manage chronic disease long term and how do you measure the impact of something like a home healthcare service over time.

So I think that that's very nascent and I think with the payers themselves, the pharma companies, you know, opening up the dialogue and starting to look at this as part of the health system, not as a nice-to-have, but a need-to-have because actually There are improved patient benefits and better outcomes that in the end will drive efficiencies and lower costs.

Meg Escobosa: I wanted to get to your view of the role of AI in healthcare.

Natalie Douglas: I think what excites me is what you can do to help diagnose disease. I think that, to me, is super exciting to think about how all of that data can be consumed more quickly or extrapolated more quickly to identify patients within a broader pool, you know, to, to identify disease.

And I think that that's going to be a game-changer and how ultimately that will lead us to, we'll be able to, you know, keep people well for longer. And that in itself will just reduce the significant pressure points we see in all health systems across the world at the moment. So I think that really excites me.

And I think part of it as well, or alongside that, is, you know, if you identify patients with, that have the potential for disease progression, you're also going to be identifying patients that might be suitable for clinical trials more easily. I think the fact that drug companies can more rapidly bring drugs to market, I think that's going to be super exciting as well. It is super exciting, right?

Meg Escobosa: And bring down costs.

Natalie Douglas: Of course it's going to bring down costs. So I think those are the areas off the top of my head that I feel most excited about when we look at AI.

Meg Escobosa: So today you serve on and lead several boards of directors. You’re Chair of the Board for Global Pricing Innovations, a UK-based price and market access insights company providing data-driven market access and pricing strategy research to the pharma industry. And your chair of the board of TidalSense, a respiratory technology company headquartered in Cambridge, UK building an AI driven diagnostic and monitoring technology for COPD and asthma. And Entia, a remote patient monitoring company, leveraging innovative self-testing blood analyzers. So this remote patient monitoring company uses all these different technologies to help cancer patients at home.

Natalie Douglas: That's right. It monitors patients, particularly at the moment with breast cancer, enables patients to monitor their bloods at home. The data gets fed back to their key clinician. And it's really fundamental in helping patients and helping the doctors actually determine patient readiness to receive chemotherapy. And then it monitors the patients over time to evaluate any adverse or serious adverse events, particularly in the area of febrile neutropenia, which is particularly significant in patients with cancer. So it's a really cool, neat device, actually.

Meg Escobosa: It’s really interesting. You've got a nice variety of companies that you're engaged with, and these are just the ones that you're chair. What do you look for in a company when deciding whether or not to serve on its board?

Natalie Douglas: I think there's several things. One is, what is the business trying to do and where can I add value to that?

So if you look at TidalSense, the respiratory model, and Entia, the oncology model, for me, it was really understanding the patient journey, looking at the impact this technology could have on the patients. If you look at, you know, the pricing and reimbursement model or Vitaccess. These are services that support the pharmaceutical industry in patient engagement and pricing, you know, the reimbursement side of pharma.

So I understand those models, but what I'm also looking at, particularly looking at Entia and TidalSense, as well, is the AI and machine learning element, which of course is, I mean, I'm learning about that stuff from working closely with the teams. And so for me, it's feeling like I can add value, but also for me to learn what's interesting to me, I'm quite a curious person so I like to learn. So learning about machine learning and AI. I'm getting that definitely there. And to some extent as well on the pricing and reimbursement side.

Looking at the quality of the team, you know, is this a team? Is this a culture I fit with? Is this a CEO that's gonna, that needs my advice and will take my advice? I mean, this is something you find with a lot of entrepreneurs, you know, sometimes they don't want to listen and sometimes they do. And I think that it's got to be a good fit. It's got to be a good cultural fit.

Looking at the investors, you know, are the investors good investors? Do they have a good reputation? Are their goals achievable? Are they likely to continue to support the business? And do I see the potential for the business to scale because growth and scaling is quite important to me. So any business that has an international market opportunity, those are the factors that I look at. They’re fun. They've all got to be fun. Otherwise, it's hard work. It's hard work with venture businesses, right? No matter, even if you're non-exec, there's a lot of work to do.

Meg Escobosa: Yeah, right. Well, that's great. And you're also an investor and advisor. I know you're advising RwHealth and Ceek Women’s Health.

Natalie Douglas: Yeah, I'm an investor in Ceek Women's Health, which is an American business, women's health. I was really impressed with this business, which is why I invested in it. Fahti Khosrowshahi, who actually founded the business, created a new vaginal speculum. It's the first time it's been redesigned in 120 years.

Meg Escobosa: Are you kidding me?

Natalie Douglas: No, I'm not kidding you. You need to look at the website. It's a fantastic business. And actually I invested in that business, it's probably about, four or five years ago, really early stage. So the business has come a long way in the last few years. It's been quite exciting to be part of that journey. And it's an American business as well. So, you know, we've got to make that grow significantly in the next few years.

Meg Escobosa: I'm curious if you look for something different in a company that you're investing in, is there any difference between when you're choosing to be on the board or invest?

Natalie Douglas: Well, I've invested in a few models over the last few years. So the way I invest today is very different to the way I invested in the past. I think that, well, my husband would say that I've actually invested in my portfolio is very high risk. That's what he would say. You know, and to be fair, you know, I think he's right. And you know, health care investing takes a long time. There's a lot of factors. COVID-19 has had a significant impact on a lot of early stage businesses.

I don't think there's any business that I've invested in in the last few years that hasn't been impacted by that, and certainly I saw models significantly increased during the pandemic as well, and I wasn't an investor in any of them. So, darn, you know. What a missed opportunity. But that's the point. You know, when you're investing, especially at an early stage, you don't know what's going to happen.

So you've got to have, you know, I think a good understanding of what you're investing in, you've got to be prepared to take the risk. I think the quality of the management team or the founder is what you really have to look at and have they got capability.

So, you know, in the case of Ceek, You know, that's an investment I made a long time ago. It's quite a sizable investment. You know, am I still happy with having made that investment? Yes, I am. YThere's other investments I've made. A couple haven't worked along the way, and my learns from that. Especially when you've been an entrepreneur, actually, this is my key learn: Just because someone has founded a business and they're an entrepreneur, do not assume that they're going to do as good a job as you did as an entrepreneur.

That is actually my biggest learn. The journey I went on knowing how hard that is, but I did do a good job and I'm not saying that it's an easy journey, but I made investments in people. Not all of them, but this is, you know, if we're going to try and teach people anything, this is a key learn for me.

Don't assume that the founder knows what they're doing, and don't assume they're going to make it successful. And actually that's one of the reasons why I like to chair or non-exec or provide strategic advice, because, you know, some of that advice is really valuable. So that's been part of my learning. Don't, don't assess that everyone's a genius or that they're going to make it work because there's lots of failures.

Meg Escobosa: Yeah, I was gonna say to those would be entrepreneurs or new entrepreneurs, what words would you like to say to them as they look to engage board members, investors? What advice do you have to them to set themselves up for success and attract the right people to their organization?

Natalie Douglas: I think my key point is going to be you've got to have your market product fit really securely underpinned and you've got to be able to prove it, which is quite maybe difficult to get your head around, but I think that's really important. The commercial, the route to market, how you're going to make money.

You know, I've reviewed a lot of businesses in the last few years, pretty early stage. And I think there's, there's this particularly seeing this in health tech, it's a great idea, lots of, you know, amazing people, but the key question I ask a lot is how you're going to make money. When's the revenue gonna start?

At what point are you going to start generating cash? That's my starting point today. Probably when I was an earlier stage investor or a few years ago, I would have been a bit more enamored with, you know, the big story and, you know, the vision and all of that. And I'm like, right, where's the cash?

Because if you're going to borrow money to do this, You know, there's got to be a return. And it's not all about the altruistic model, right? In healthcare, of course, we've got to drive patient benefit. There has to be value. We've got to save lives. All of that is vital and really important. And I'm still passionate about all of that, but if you're borrowing money, you want to be able to pay it back. And so that's where I start with entrepreneurs.

Meg Escobosa: So you raised money 20 years ago as a woman and founder.

Natalie Douglas: Yes, crikey. I'm old.

Meg Escobosa: How has it changed? How has the investment opportunity for young women entrepreneurs changed? We've talked about this on the show.

I have an ambition to do an episode or series on helping women founders. learn more about getting access to capital and getting access to that investment. I'm curious if you see any kind of changes over those 20 years, how can young women or any woman be successful in attracting the investment they need to grow their business?

Natalie Douglas: Did I sigh at that point?

Meg Escobosa: You can sigh because it's a minor, like a tiny amount. It's like 3 percent or some 3 percent of available capital is invested in women founders.

Natalie Douglas: It’s ridiculous. So what's changed? I think there's been a lot more investment at very early stage, still not anything compared to male-led businesses, but in my day, I mean, I can give you an example. You know, my business, I went out, but I was very profitable at that point. So I didn't really feel that gender imbalance or all that gender preference at all. I didn't, I didn't ever notice that maybe I just wasn't focused on it, but it didn't, it didn't happen to me per se, but I think you are treated differently as a woman in business anyway. And certainly as a founder, as a CEO, you are definitely having to prove yourself every step of the way. Once the money's come in, you're still having to prove yourself. I met a journalist at an event. He said to me, “Oh, it's really interesting,” because I was pregnant at the time with my son. I was at this enormous belly. And he said to me, “Wow, how are you running your business?” You know, he was interested in me as a person, pregnant CEO, you know, of a private equity backed business. And he said, “I'm going to write an article about it.” It was in the Daily Telegraph in Britain. And he said, so he went out for a few weeks and he came back to me and he said to me, “Natalie, I can't find anyone. I can only find women running a lifestyle business or somebody running a public , you know, part of the public company can't find anybody,” so that was in a way that might prove your point.In those days, it wasn't that easy. I think today we definitely see more women getting funded at early stage than we probably did in those days.

I had lunch today with another business I'm invested in, tiny business. I've been doing it for over 10 years in healthcare. The female founder and CEO just said to me that she is so exhausted with having to raise money. She's constantly having to raise money. She gets little tranches of money. What she needs is £5M and she's getting, you know, somebody writing a check for £75 and then she's not taken seriously in board meetings or, you know, she has to jump through so many hoops and jump over lots and lots of hurdles.

And it was just exhausting listening to her. I mean, I'm one of her sort of mentors. So I think there's a long way to go. And I don't know what the answer is. We're definitely seeing more women in private equity. So, you know, I engage with private equity loads and loads still, loads of men in private equity.

And actually some of the - I actually had a conversation with one the other day and I, we were talking about opportunities in healthcare, and I said to him, “What about women's health?” And you could see he was just squirming because he, you know, he was obviously, he, you know, you could tell he's like, “Oh no, I don't want to go there. I don't want to talk about any women, lady bits,” or, you know, he, you know, you could tell all of a sudden, you know, hardcore tech, anything to do with AI. You know, so I think health tech, if it's run by a woman or founded by a woman, they're interested because that, that hard core stuff, they can get their head around.

And maybe if, if you attach the menopause to that, or, you know, periods to tech that that's probably where they, women are getting their investment in healthcare at the moment, but you know, we can laugh about it, but honestly, you know, there's definitely women decision makers in private equity, but still nowhere near enough.

And I think women have, you know, still challenging for women. I would also say just because someone's a woman, it doesn't mean you should invest, right? Everything else I've already said, like get your business models, right. Still got to have good leadership skills. You know, all of these other things you have to be able to do, but that to me, that's an equal playing field, whether you're male or female.

I still think that it's hard for investors who are men to fully understand and trust women leaders. That's what I think. Maybe we're just a puzzle. They can't figure it out.

Meg Escobosa: Well, Natalie, this has been such an interesting conversation. I could talk to you for a long time. I would love to learn more about your work. And I know we didn't really cover Lucidity. Would you like to share a last sort of, kind of description of what you're doing as an advisor today. I mean, I know we covered a lot of what, you know, and perhaps that's the lane in which you are serving as an advisor, but please tell us a little bit about Lucidity.

Natalie Douglas: Well, in brief, Lucidity is a consultancy and strategic advisory practice. I work primarily with private equity, venture capital companies, investors looking at life sciences models, pharma service models. So when you think about my experience, the experience I can bring to help them evaluate new business models and make investment decisions.

And I also work with bio pharma companies who have some commercial challenges, particularly in the rare disease space, or when they're looking at sort of patient-centered models, patient support programs, that kind of thing. And sometimes I get asked for my opinion to sort of solve some obscure challenge in a healthcare business. So that's what I do. It's advisory, strategic advisory really and due diligence. That's what Lucidity does.

Meg Escobosa: Wonderful. Well, I wish you the best of luck with this business and we are very, very grateful for your time and for hearing what you've done and you're sharing your story. Lovely to meet you, Natalie.

Natalie Douglas: Thank you, Meg. Thank you so much for the opportunity. I've really enjoyed speaking to you too. I hope we have the opportunity again.

Meg Escobosa: Yes, me too. Thank you.

Natalie Douglas: Thank you.

Meg Escobosa: Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho Medina Sabich, Wendy Nielsen, and me, Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts. It really does make a difference and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions, please email us at podcast@thekrinskyco.com and visit us on the web at www.thekrinskyco.com.

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