Hey everyone, this is Kate Stanton, co-host of the Pulse podcast. In this episode, I sat down with Iman Abu-Fayd, MD, CEO and co-founder of Incredible Health. Founded in 2017, Incredible Health, the highest valued tech-enabled career marketplace in healthcare, transforms the hiring process for both nurses and health systems. In August 2022, Incredible Health raised an $80 million Series B round led by Base10 Partners. The company partners with over 600 top health systems across the country and has over 10,000 nurses joining its platform every single week and has reduced the average timeline for hiring a nurse from 82 days to less than 14. Iman and I discussed her background in medicine and how she became a startup founder in the healthcare ecosystem. The current nurse staffing crisis that’s on track to leave the US 1 million nurses short by the end of 2023. How Incredible Health is reducing nurse burnout, improving retention and empowering hospitals to set up their nursing workforces for career advancement and Iman’s evolution as a leader and how she has invested in herself and her team to keep up with the company’s growth. Iman, thank you so much for joining me on The Pulse today. Really excited to dig into this conversation with you. How are you doing? I’m doing well. Thank you so much for having me. Great. So let’s start our episode, how we start all of our episodes, which is with an icebreaker. And the question is, when you were a kid, what did you want to be when you grew up? I honestly didn’t know what I wanted to be when I grew up. I was one of those kids that changed my mind every year. One year I remember I said I want to be a bus monitor and another year I was like, I want to be a doctor and then another time I would be an astronaut. So I think that’s probably indicative of how my career ended up turning out too. So I was interested in a lot of… I was a very curious kid and interested in a lot of different areas. So I could never really make up my mind. Nice. Well, picking up on that, Dr. Paisley, that did become reality. Let’s discuss your path to where you are today as CEO and co-founder of Incredible Health. So you’ve done a lot of interesting things professionally. As I just said, you have an MD, you graduated from Wharton’s Healthcare Management Program, you’re a former management consultant, then you transitioned to working more in healthcare tech and product. So how did important professional moments, experiences, and decisions as well as personal ones lead you to where you are today? My history definitely is what led to where I am today. So I guess just starting from the beginning, like, yeah, I’m originally from Sudan. I grew up in several different countries. I’ve worked in… I’ve lived in Saudi Arabia. I’ve lived in the UK before immigrating to the US when I was 24 years old. And so I come from a family of doctors. Both my grandparents were also entrepreneurs. And so I always just assumed like, hey, you know, everybody else in the family is a doctor. So I might as well just go do that too. So that’s sort of how I fell into medical school, to be honest. And so after medical school, I really discovered that actually, look, one-on-one patient care is amazing, that I really wanted to do something at scale. That’s when I made the decision to not do residency after med school and go into management consulting next. And during that time, I really learned more about hospital operations and hospital strategy. And that was like my first foray into the business world. And then decided to do my MBA at Wharton. And it was at Wharton that I got even more exposed to entrepreneurship because many of my classmates are entrepreneurs. There was amazing programs for entrepreneurs too. And really just got an even deeper understanding of US healthcare and of technology too. After the MBA, I decided to move to the Bay Area to pursue startups. And as you mentioned, I joined as a product manager at an early stage healthcare technology startup. And that’s really where I learned to work with software engineers and data scientists and designers and so on. What it takes to actually build a software product in healthcare and what it takes to scale it too. And so I gained some amazing skills during that time period as well before founding Incredible Health. So each of these areas, whether it was medical school or management consulting or the MBA or working as a product manager at a startup, I was essentially just gaining more and more skills that I needed to become or that I felt I needed to become a successful entrepreneur. I would say the common theme through all of that is healthcare. I am passionate about healthcare and about this industry and having an impact on it and changing the lives of healthcare workers and having an impact on patients at scale. So that’s really why I really pursued both healthcare and eventually used technology as a tool to drive scale too. That scale piece you mentioned, it makes sense because as you said, you went to med school but decided to not pursue residency. So if I’m sort of picking up what you’re saying, really that ability to affect healthcare at scale might’ve been why you assumed to go more of that business technology route rather than being a clinician of that. Was that sort of your thought process? That’s exactly right. Yeah. I knew by the end of med school, I was like, I have to, I really want to make a difference on a larger scale. And I knew that one-on-one patient care as a clinician was not going to be the path for that. Yep. Yep. Makes sense. So Iman, to set the stage for the rest of our conversation, can you give our listeners an overview of Incredible Health and highlight the things that you think are most important for our listeners to know about the company? Absolutely. So Incredible Health is the fastest growing venture-backed career marketplace for healthcare workers in the US today. And it’s also the highest valued tech-enabled career marketplace for healthcare workers. We’re valued at 1.65 billion. Our mission is to help healthcare professionals live better lives and find and do their best work. Hospitals and other healthcare employers, they use Incredible Health’s custom matching technology to hire high quality permanent nurses in less than 14 days compared to the industry average of 82 days. And there’s an interview request being sent from the employers to the talent every 30 seconds. On average, Incredible Health saves each hospital facility we work with at least $2 million per year in temporary labor costs, overtime costs, and HR costs. And then also nurses just enjoy at least a 15% increase in salary and a 15% reduction in commute time as well when they use our platform too. We’re actually the only platform out there that uses automation to help screen the talent’s credentials and preferences and automatically custom match the talent with employers too. And our algorithms, they recognize over 70 specialties, 250 skills, including really specific ones like ICU and OR. We’re used by over 600 hospitals nationally, including major health systems like HCA Healthcare and Stanford Healthcare and Johns Hopkins and Kaiser Permanente and many, many others. And we operate in U.S. healthcare. I mean, U.S. healthcare is the biggest labor sector in the country by number of workers and by dollars spent on the workers. But it’s also the sector with the largest labor shortages. We’re on track to be 1 million nurses short by the end of 2023. So I want to pick up on a number of things that you just brought up. And the first is about the healthcare staffing crisis that you mentioned. So as you shared, there are labor shortages in many healthcare roles right now, and nursing is just one of them. When people hear shortage, and this was definitely true for me, I assumed that there weren’t enough nurses entering the profession. Essentially, we needed more people entering nursing school and really building that pipeline into healthcare environments. And what I learned after doing some research is that it sounds like the key issue is really that nurse… I mean, I think it would be great to have more nurses, but we’re also seeing that nurses aren’t staying in the workforce once they enter it. So can you shed some light onto why we’re seeing so many nurses leaving the workforce? And more specifically, were we on this path before the pandemic or did the pandemic seriously alter it? Yeah, absolutely. So let’s just break down the nursing shortage topic and just indulge me for 30 seconds and then I’ll answer your question directly. So when you think about the different ball necks that are creating the shortage, there’s probably four or five different things going on. So first, the applicants to nursing school are actually at record highs. So there’s an enormous amount of interest for Americans to go into nursing school. However, these wait lists are very long and we don’t have enough capacity in our nursing schools to train more nurses. Some of that has to do with not enough faculty and there’s also just simply not enough schools. And so we’re not able to produce enough nurses. Now there’s another ball neck that happens after that as well, and that there’s not enough hospitals offering training programs for new graduate nurses too. So even after completing nursing school, there actually aren’t enough places to train you. That’s another ball neck. Another ball neck is retirement. This is the nursing workforce and the healthcare workforce overall here in the US is a pretty old one. And so the average age of a hospital nurse in the US today is 52 years old and about 25% of nurses are expected to retire in the next three years. Now layer on top of that, what I think you were specifically asking about and is that we also have a problem of nurses leaving the profession permanently. So the nursing profession already has a high turnover rate of about 20%, 21% of nurses are turning over as in like they are changing jobs per year. A newer phenomenon that has started occurring as a result of the pandemic is nurses leaving the profession permanently. And over the next 12 months, about 25% of nurses are considering leaving the profession permanently. The main driver for that is frankly excessive burnout and stress caused by the pandemic. When you are overworked as a result of being understaffed and you’re being asked to do more and more, that does create challenges, right? That creates acute stress, that creates burnout and that creates a desire to leave the profession. And that’s a huge problem that’s tackling the US healthcare workforce today. Yeah, absolutely. So you mentioned how I think the pandemic largely has led to this increased turnover and permanent departure from the profession. So you obviously launched pre-pandemic, the healthcare environment changed in many ways during that time. But for Incredible Health, it changed in that there were just fewer nurses available. So how did you evolve your product offering or strategy during the pandemic to keep up with this new changed environment? Yeah, so we had to evolve very rapidly when the pandemic hit. We really, because to be honest, both sides of our marketplace, whether it was employers or talent, were deeply affected by the pandemic. So first is like our product strategy evolved rapidly. We all started offering things like pre-continuing education for every single nurse in the country so they can get accredited quickly and renew their licenses quickly. We also launched a pandemic hiring suite for the employers. This is another suite of features and products that really enables them to hire even more rapidly than before, really brought down the days to hire to 14 days. Things like remote interviewing options and features like that really accelerated hiring. We also started to really publish more reporting and more data on this. So every year we publish a state of the nurse workforce as a result of COVID-19 every single year. So one of our more recent findings earlier this year is that insight that I mentioned earlier that about 25% of nurses are considering leaving the profession permanently. We also had data reports around that indicated that we were going to have significant vaccine hesitancy among the nursing workforce too, and we were one of the first to report that. And so our product strategy evolved, what we were reporting and sharing with the industry overall evolved. And then frankly, we knew we just had to do more. We did have to do more for both sides of our marketplace, whether it’s evolving new products and the way we communicate with them or reporting to them and the features we offer had to dramatically evolve as a result of the pandemic. Yeah, absolutely. And while the pandemic was at large a very much not a good thing, I imagine for the business, it sounds like it made you accelerate your development and growth more quickly and just play a really critical role for both sides of your marketplace. So really interesting to hear about. Picking up on another trend that you mentioned, and that is temporary nurses. So just even reading the news, I think we’re hearing about how temporary nurses have become a pretty common way to fill nursing roles. And these are nurses who are hired for a short amount of time to fill gaps. And these roles can command higher pay, which is hard on hospital margins. Some studies have shown that they lead patient care to suffer for reasons such as they’re not fully integrated to the team, trained, all that, and more, I’m sure. So do you see this role of temporary nurses as being really popular as a temporary phenomenon or one that is here to stay? And you even alluded to how Incredible Health is solving this problem or mitigating this problem, at least on the hospital side. So where do you see this going? At Incredible Health, we only focus on permanent workers, and that’s been a very intentional strategy from day one, because honestly, we view permanent workers are the core of the healthcare workforce. They are 95% of the healthcare workforce is permanent workers. And we want to be as aligned as we can with both users, whether it’s the talent or the employers. The employers see temporary workers as truly temporary, a Band-Aid solution. They are used when there is acute staffing shortages, and executives do whatever they can to remove temporary workers as quickly as they can, too. And the reason for that is twofold. One, they’re expensive. They’re at least two to three times more expensive than a permanent worker, which eats into your bottom line. Plus, it creates all kinds of cultural issues internally, because now there’s accusations of unfairness for permanent worker and temporary worker doing the same job and getting paid very different rates. And then secondly, like you mentioned, is the quality of care, right? So the more temporary workers you have, the lower your quality of care, and the main product of hospital or any healthcare provider has is delivering high-quality care. The other thing on the talent side, nurses and other healthcare workers, they have 30, 40-year-long careers, and they’re going to spend at most, maximum, one or two years of their careers as temporary workers. The rest of the time, they’re like you and I, right? They’ve got homes, they’ve got kids, they want stability, right? And stability does come from a permanent job. I fundamentally do believe that temporary work is a Band-Aid solution. It has definitely increased. It used to be 5% of all healthcare workers were temporary, or 5% of nurses were temporary before the pandemic, and that has increased to about 8% to 10%. We are already starting to see that come down as the pandemic starts to subside. Got it. Really interesting. So picking up on another thing you mentioned, which is closer to what you’re doing at Incredible Health, as you have already shared, your company changes the hiring process to really put nurses in the driver’s seat. And just one way you do this is employers apply to the profiles of nurses. And as a result, they get more offers, but you’re also focused on helping them get better offers. You mentioned that you have a proprietary matching algorithm. So around this idea of a good or strong match, what factors go into creating a strong match between a nursing candidate and an employer? Yeah. So when we think about our matching, it does come into different categories. So first is what are the preferences, and then what is the actual experience? Preferences are things like what are the location preferences, or where do I want to take my career? What do I want to do next? Why am I even leaving the current job? And then there’s actual hard skills and facts, which is the experience, right? What are your licenses, your certifications, how many years of experience do you have? So we’re matching on, honestly, over 90 different data points. And then the other thing is our matching continues to get smarter and smarter. So we now have a machine learning team here at Incredible Health. And so in our early days, in our first couple of years, what we originally thought would make a strong hire has evolved, because we’ve unleashed machine learning algorithms, machine learning on it now. And so now we can predict what’s going to result in a strong hire or not. We’re learning more and more new things about what makes a strong hire. And it’s really changing some of our initial assumptions. I’ll mention a few examples. So we learned that showing the current location of a nurse actually produces more human bias to the hiring process, because we noticed that recruiters were biasing against nurses that were living further away, even though the nurse had expressed a strong desire for relocating or being in that location where the hospital is. So we end up removing things like current location and making sure that’s not visible and not doing matching based on current location. So that’s one example of key assumptions that have changed. And so when we talk about things like our screening algorithms and our matching algorithms, this is an evolving thing that continues to become stronger and stronger. It’s a core piece of our R&D effort here. And it really does drive incredible health differentiation and our value in the market too. Yeah. So it sounds like the matching plays an important role in pre-interview phase, figuring out who would be a good candidate for what this hospital or health system is looking for. And then on both sides, retention then also is really important in creating what I would say would be a long-term strong match, someone who’s going to stick around for the hospital for a while, which we know the hospital wants. And then presumably, to your point about stability, also great for nurses in a number of situations. So I imagine that this retention piece is kind of outside of your control. As to my understanding, you’re not necessarily playing a super active role in figuring out how to help nursing teams build their structures and create a great workplace. But based on data you’ve collected or anecdotally, what infrastructure are you seeing that needs to be in place for hospitals to retain nurses? And I imagine you probably have pretty interesting data on this just because you can see when a nurse is looking for a job and then when they’re looking for a job again and can see what types of institutions that might happen more or less frequently at. Yeah, so one thing I’ll just clarify is that actually we do have a play. We do play a role in retention and increasingly so over time, because frankly, the CNOs and the chief nursing officers and chief HR officers, and even the CEOs, this is a very top of mind problem, especially because turnover is increasing. It has gone up by over 2% in the last couple of years. It used to be an average of about 17% naturally, and now we’re up to close to 20%, 21%. So a hospital and health system incurs massive costs when the cost of turnover is massive. So it’s estimated as at least $40,000 that you lose immediately when you lose a nurse. And it equates to about $4 to $6 million lost per year per hospital just because of the nursing turnover. So we launched this thing called the Nurse Retention Suite. It is a suite of products and tools that helps hospitals and health systems retain more nurses. So when they’re using the Incredible Health platform, the retention rate is actually 15% higher than using traditional channels at the one-year mark. And so we really developed a suite of tools to help with that. And really, when a nurse is able to consider multiple opportunities and has multiple options, and it’s a very well thought out and thorough job search, like it is on Incredible Health, and they select an employer, actually just that matching piece alone results in higher retention. So on the larger topic of what is driving nurse retention or nurse turnover as well is we had quite a lot of proprietary data on this because when nurses could sign up on our platform, you ask them, why is it that you’re leaving your job, right? And by far, we see that the number one reason is they’re looking for career advancement opportunities. And career advancement might mean wanting to be more specialized, or wanting to cross-train, or wanting to move into management, or it could mean a whole range of things. But this is a, if I had to generalize, this really is a group of workers that does care about advancing their career. And when they are not getting those career advancement opportunities, or it’s unclear with their current employer, they do choose to leave. The second most common is they’re looking for a more flexible schedule. Historically, before the pandemic, schedules were so strict. It was usually three days a week, 12-hour shifts in most hospitals, and most roles were only full-time. And unfortunately, that’s not what the talent wants anymore. And you can see this across all generations, not just Gen Z and millennial generations. And so we’re seeing that the hospital and health systems that are offering more options for scheduling, whether it’s weekend options, part-time options, breaking down the shifts from 12 hours to eight hours, or even four hours, has really, they’ve really been able to not only hire more, but also retain more talent. And then finally, the third most common reason that they change is something to do with geography. They’re aiming to relocate or reduce their commute time. So those employers that really support relocation assistance and things like that, and are open and flexible to nurses coming from other geographies have benefited more. And there is a huge amount of geographic movement in the permanent labor market, nurse labor market. And then finally, it’s pay. There’s a desire for more compensation. I find that many executives focus a lot on the least common reason, which is looking for more pay, which frankly, is just table stakes to keep up with market benchmarks. They don’t spend enough time on some of the key areas, which is career advancement and flexible scheduling. We work with many hospitals and health systems that are really investing a lot more in career advancement. They’re putting in more training programs and more leadership development programs, and documenting career mobility for every nurse, and really just making it very clear that they can build their careers and advance their careers inside that hospital, or inside that health system. They really are winning in terms of hiring more and retaining more. Going more into another area you mentioned that’s very closely tied to retention is burnout. And there are many stats floating around about the percentage of health care workers that experience symptoms of burnout. But just to highlight one, the National Academy of Medicine has reported that burnout has reached crisis levels among the US health care workforce, with 35% to 54% of nurses and physicians reporting symptoms of burnout. And as you’ve shared, it’s one of the main drivers of why nurses are leaving the profession permanently, or searching for new jobs, leading to turnover, all that. Sort of beyond the things that you have mentioned, or just doubling down on those, are you seeing any specific solutions or areas of research that make you hopeful about reducing nursing burnout, either in more narrow circumstances or more at scale? When it comes to the topic of burnout, I’m generally, just as far as the topic of burnout and the shortage overall and so on, I think this is probably one of the most hopeful times in US health care, because there’s so much attention on the topic. And frankly, it’s market forces that are driving us to change. And so what that means is that there’s more and more attention, solutions, so on coming out for very tough topics like this. On the topic of burnout specifically, it is quite prevalent among all nurses. But even the new graduate nurses, in one of our recent reports, 65% of new nurse graduates report feeling burnout in their first six months of employment. So I mean, it’s impacting every generation of nursing. There’s five generations of nurses right now in the US health care workforce. So there’s going to be key things that alleviate it. So for example, investing more in on-the-job training, ensuring that units are fully staffed or staffed appropriately, having things like career mobility plans and career advancement programs. So there’s hope for the future that your career is advancing. You’re not just working for the sake of working. And so we do play a big role in that we have specific features and tools for, say, new graduates. We have a new graduate suite where they can use our platform to identify the right roles for them. And they get access to career coaching as well. Every nurse on our platform also gets access to what we call talent advocates or career coaches. We see our hospital partners investing more and more in this area, too. They are overhauling their new graduate training. They’re overhauling onboarding processes. They’re investing more in career advancement and on-the-job training. And so I guess I’m hopeful for the future because this has reached such a tipping point in terms of just the crisis that we’re forced to pay attention and forced to change. Yeah, this area of new nursing graduates, I should remember what I was reading. But in preparation for this, actually, I was reading about, in contrast to physicians, which are more revenue-generating, mostly just due to the historical fee-for-service system where their services can get reimbursed, nursing has been seen as a cost center because they don’t have that reimbursable function. Obviously, some NPs do in certain areas. So that’s a bit different. But the traditional RN is not in that role. And therefore, at least according to this source, that’s one of the reasons why there has been less investment in nursing development and training within health systems as opposed to something like interns where that really is considered a training ground for future physicians. So I don’t know if I have a great question coming out of that. But I guess any thoughts on that or if you’re seeing, it sounds like you are seeing nursing teams and leadership start to rethink that a bit. Yeah. The whole topic of why physicians get more investment attention historically than nurses is a pretty multifaceted, complex topic. I don’t think it’s just because physicians were perceived as revenue-generating. I believe there’s some gender aspects to this too. At the end of the day, even today, 90% of nurses are women. Historically, in all industries, women have not gotten the same amount of attention, the same amount of compensation, and so on. And there’s other things going on. However, regardless of the history, now in the present, the game has changed. And nurses are now perceived and understood as the backbone of US healthcare. You cannot run a hospital without the nurses. And you do lose revenue if you don’t have enough nurses. For example, you can’t run your ORs if your OR nursing team is understaffed. You will not be able to see as many patients. And so the way they’re treated, perceived, the programming, et cetera, is really, really changing. And like I said, it’s market forces that are driving the change. Yeah, absolutely. Another question that focuses on this younger generation of nurses is actually around TikTok. And I have read that Incredible Health has used TikTok as a marketing platform. And I know I, myself, as someone who tries to not go on TikTok too much, but goes on it once in a while, I’ve definitely gotten stuck in this healthcare worker spiral. In fact, like last weekend, it might have been because I was researching Incredible Health. I was purely getting healthcare worker TikTok. So it’s in a deep spiral. But I’m curious, what impact do you think that TikTok or other social medias where nurses are showing to spend time is having on the profession, either positive or negative? Yeah. So social media has been a core piece of our strategy from day one. And frankly, the reason for that, and whether it’s Instagram or TikTok or Facebook, pick whatever platform, it’s been a core piece of our strategy because at the end of the day, that is where the healthcare workers are, especially the Gen Z and millennial workers. And so being present and being there and being active and engaged and part of the conversations is critical. And yeah, we do have a very robust social media strategy here, which includes TikTok. We even work with Charlie and Dixie D’Amelio are some biggest TikTok stars who have, I think, well, Charlie D’Amelio has 150 million followers, I believe, and they’re investors in the company. Right. So we’re very serious about our social media strategy. The reason it’s critical is that’s where the healthcare workers are. It’s a key way to engage the Gen Z and millennials. And to be honest, it’s become a competitive advantage. I mean, the hospitals have very strict marketing policies, messaging policies. They can’t do the level of creativity that we can on social media. It’s been very important to our success. Yeah, that totally makes sense. I hadn’t thought about it as hospitals, health systems, not having the even permissions to do that. So that’s a platform that makes a lot of sense. One other thing I’ll say, Kate, about it is that social media is not just the place to just, you know, we don’t just use it as a place to promote our products, right? But it is a place to educate, is a place to share data, share information. It is a way to engage with key advocates in the nursing community too. Like it’s multifaceted. And I think, honestly, any tech company that has any consumer bent to it has to be like social media must be part of your strategy. Yeah. And it seems, I mean, I’m not super educated on this and older than Gen Z, I can say. So not totally in this. But it also just seems like it’s a place where community building can take place. Sometimes for better or worse, but I think there are definitely worthwhile ways to build community on those sorts of platforms. Incredible Health has grown a ton over the last few years. These numbers might be a bit out of date at this point, but you’ve signed up over 600 hospitals, have 10,000 nurses joining the platform each week. So when you think about expanding to other segments of healthcare, which could be roles or sites of care, I’d love to hear about which opportunities excite you most. Yeah. I mean, our vision is to help healthcare professionals live better lives. And the mission is to help them find and do their best work. And yeah, we’re defining this category and aiming to be market leaders in healthcare labor. So what that means is that we have to operate in all of healthcare labor. We’re taking a very focused approach. We’re very focused on nurses and hospitals today and doing our geographic expansion over the next year. But then after that, we definitely want to add more roles beyond nursing. You know, there’s doctors, physical therapists, pharmacists, respiratory therapists, etc. Like so many different professions in healthcare that can benefit from a product like this and where there’s massive shortages too. And then also, even on the employer side, we’re very focused on hospitals today. You mentioned the 600 hospitals that we work with, but there’s also urgent care, surgical centers, skilled nursing, like other segments in healthcare that can benefit from a product like this. I mean, they struggle with hiring as well. And so the goal ultimately is to take it all. Our goal as a company is to IPO as well. But we do have to be very systematic with our growth and be very focused too. Yeah. When you think about those different roles, places where care is delivered, what stands out to you as things that are specific to the nursing profession versus what’s more generalizable? Yeah, I think a lot of aspects of this are generalizable. I mean, the desire for career advancement, the desire for a better work-life balance, the desire for more pay is probably quite prevalent among all the healthcare professions. The challenges we have with the shortage of these professions and the financial impact it has for healthcare employers is quite prevalent as well. And then honestly, the free services and tools that we provide, things like free continuing education and the free salary estimators. And we have a community for nurses built into our apps where they can give each other advice. That’s very applicable to a lot of many other healthcare professions. I think now having said that, I don’t want to be naive here. There are nuances with each one too. We’re definitely not going to assume that the way we do screening and matching, for example, for nurses is going to be exactly the same as how we do it for doctors or pharmacists or whoever in the future. And there’s enough nuance in each of these roles and each of these types of employers that will require additional R&D investment. It’s another reason we raise capital too, right? Because we know that’s going to be another R&D investment and another go-to-market investment too. Yep, absolutely. So as you think about growth and expansion, I want to bring in the fact that incredible health, to my knowledge, is profitable and you can correct me, but I think I read that publicly. And in healthcare tech, that’s likely not as common as many would like it to be because especially healthcare services, because those models are expensive. So the fact that you’re more of a tech platform, I think the scalability of that is pretty clear. But when you think about your growth and scaling strategy, which it sounds like there are tons of opportunities, but the team is being quite disciplined in how you think about that. How does the fact that you’re profitable play into that longer-term strategy when you evaluate opportunities? Yeah. So to clarify, we’re cashflow positive. I can’t necessarily say profitable because being profitable has all these nuanced definitions. But we are cashflow positive. So it’s the same general point. The finance strategy of a company, especially a high-growth startup, is so critical to its success. And I’m not sure all entrepreneurs, CEOs, founders, et cetera, appreciate that. And it’s something that has to get figured out very early on, as opposed to just punting and delaying it till later. I’ll mention a couple of specific examples. The entire topic of unit economics. When you have a unit, in our case, it’s a hire. For other companies, it’s a different unit. You do actually have to measure what’s going on financially per unit. What is the cost to deliver that unit? What is the profit you’re making per unit? And unit economics is something we focused on from the very beginning. We knew and we’ve thankfully driven a very profitable model here because we were able to make profit per unit. Whereas others really delay this focus on unit economics. And another example is the way we structure our enterprise agreements. There are upfront payments. And that does help with cashflow. So what you choose to prioritize as CEO does influence… Basically dictates the financial outcomes of a company. If I, as a CEO, am prioritizing things like unit economics and the structure of enterprise agreements, and as a result, our goals, our objectives, and key results, and so on, and what each team is prioritizing has that in mind, then of course, we’re going to end up being a cashflow positive company. So it’s very intentional. It’s not accidental. Yeah. And that segues really well into my next question, which is around leadership. But actually before I do, and I should have asked this earlier, but can you just clarify for listeners how you make money? Is it a recurring SaaS fee? Are you paid per hire? Are you paid on long-term outcomes of that hire? Can you shed some light onto that? Sure. I can share some detail, but I can’t go into too many specifics. It’s proprietary. So the entire platform is free for healthcare workers. So any healthcare worker can use all of our software tools, services, all of it for 100% for free. We never charge them. It’s the employers that pay for the platform. And we do close large enterprise agreements with them. And yeah, it is success-based. So I can’t really go into much more detail than that, though. Yep. Makes sense. I’m very interested in value-based care and staffing seems like it doesn’t totally fit into that value-based model, but it sounds like you are still being held accountable to outcomes. So that’s really awesome that that’s integrated into your model. As I said, I wanted to spend some time talking about leadership as it’s something that I’m super interested in. Iman, could you share a bit about your leadership style and how you came to figure this out? And also how it’s evolved over time based on lessons you’ve learned in your career, key moments, or various environments you found yourself in? My leadership style at its core is very direct and transparent, almost to a fault. And also, I am definitely… When it comes to my leadership style, I’m much more like a systems thinker or try to understand the underlying problems before we start crafting solutions. And that’s really what I drive teams and leaders towards as well. But my leadership style has evolved over time in a few different ways. First, I think in the first few years of running this company, I was much more operating like a COO and communicating like a COO, which is very task-oriented, detail-oriented. Just like, what are we doing? What have we got done? What has shipped, etc. And over time, my leadership and communication style has evolved to be much more visionary and much more aspirational and inspirational. So I’ve really had to change the language that I use with the team to really emphasize the vision, the mission. Why are we all here? Because frankly, that’s just far more motivating. As we were evolving, I had other leaders that were handling the hardcore operational aspects of this. Another way I’ve had to evolve is… To be perfectly honest, Kate, my job does change every 2 to 3 months. And the reason for that is because of the high growth of the company. In 5 years, we’ve gone from 2 people to 200 people. In a single year, revenue will grow 400% and grew 400% in 2021. The teams are evolving, the processes are evolving, etc. And then the other… The biggest thing is that I’ve been hiring a senior leadership team, especially over the last 2 years, to take over core functions of the company. Sales leadership, customer success leadership, product leadership, and so on. And so I’ve had to… Professional development for myself has been so critical in that I have to… Running a team of 10 people versus 200 people versus 1000 people, etc. requires a completely different set of skills. And I’ve had to really double down on my professional development, including coaching. I have an executive coach. I also have to care a lot about my mental health too. So do you have access to a therapist that I see regularly? I have an amazing board who are my advisors, as well as just engaging in CEO… What I call support groups, right? With CEOs who are further ahead of me who can really empathize with what I’m going through as well. So I’m big on learning and professional development. Try to be an aspirational or inspirational leader. And just have to vary… My leadership styles are very rapidly evolved too. Yeah. Your point about how just your role changes every 2 to 3 months, I imagine that must affect the entire organization. And after all, Incredible Health is a company that strives to help the healthcare workforce engage in the best career opportunities for them. So I’m curious about how Incredible Health is doing that internally to ensure that you’re creating an environment where people want to stay and grow and continue working there as well as also sourcing the best talent in an unbiased way. So what are some of the systems, processes, or culture you’ve built to successfully do that? Yeah. I think the core piece of it is the mission, the vision, and the values. So I mentioned our mission and vision earlier, but we have a set of values here, which are essentially the operating system of the company. They’re how we work together. They’re how we make decisions. These values are assessed during hiring, they’re part of employee onboarding, and they’re also part of performance reviews. That’s how we implement these values and make them real. I’ll mention a couple of them. So one is customer obsession. Do whatever you can to delight users. Everybody’s accountable to that. And you really do have to do whatever you can to delight users. Another one is speed. Move as quickly as humanly possible, because that’s one of the main competitive advantages you have as a high-growth startup. Another one is ownership. Everybody here should act like a CEO. When you’re a CEO, the buck stops with you. I have no one to complain to. Neither do they. And so if you’re really operating like an owner, it means you’re going to exhibit very strong proactive behavior to solve problems and to delight users. And then we also have the commitment to learning here, where we invest heavily in learning and development, and internal mobility of our peers as well. So those are just to name a few. But these values, which are on our website and so on, are essentially our decision-making framework, and they are the operating system of the company. And they’ve been critical to retaining our team, as well as attracting talent for our teams as well. Yeah. I like what you just said about the operating model for the company based on value. So I like that a lot. Final question. Last but not least, any advice you have for people considering starting a digital health company? Oh. Specifically, for those that are considering starting a digital health company, please realize and appreciate that the number one most important thing you got to figure out is your business model. It’s not your product. It’s not who your team is. It’s not all these other aspects, which are important too. But your most important is your business model. And the reason for that is because U.S. healthcare is convoluted. It’s complicated, especially when it comes to how the money flows and what the incentives are and who’s paying who. And so figuring out how you’re going to make money and figuring out a product that’s at least 10x better than anything else that’s out there, better defined as faster, cheaper, more compliant, whatever it is, is going to be critical to cutting through all the noise. So come up with a product and an idea and concept that’s at least 10x better than it’s already out there and make sure you nail the business model. Love that. Simple but clear. Well, Iman, thank you so much for joining me on this episode of The Pulse. It was a pleasure learning more about how you got to where you are today and discussing a lot of interesting issues affecting the healthcare staffing environment and how incredible health is trying to and being successful in changing that. So thank you so much. Thank you so much for having me.
