How to Build and Manage a Powerful Advisory Board

Written By Patrick Kothe
 
 
 
 

In this episode, the discussion centers around the crucial role of advisory boards in guiding company strategies, product development, and business initiatives within the medical device sector. Featuring insights from Paul Hickey, CEO of ReShape Life Sciences, the conversation delves into best practices for forming and managing advisory boards, emphasizing the importance of team involvement and maintaining high-quality standards. Paul shares his extensive career journey across different companies, detailing how advisory boards have provided key insights and contributed to successful product innovations. The episode also explores the fight against obesity and how ReShape is working to deliver effective solutions. Key takeaways include the strategic formation of advisory boards, the need for cross-functional collaboration, and the pursuit of unarticulated customer needs for innovation.

00:00 Welcome and Introduction to Advisory Boards
01:15 Meet Paul Hickey: Career Journey and Insights
02:17 Transitioning from Aerospace to Medical Devices
09:41 The Importance of Quality in Medical Devices
17:17 Forming and Managing Effective Advisory Boards
40:06 Reshape Life Sciences: Tackling Obesity
47:13 Career Advice and Final Thoughts

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Episode Transcript

This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.

[00:00:00] Patrick Kothe: Welcome! Advisory boards can be extremely useful to help guide a company, product development program, or a strategic initiative. In medical device, people have assembled advisory boards of customers. product development, commercialization, or general business experts, or internal boards with key stakeholders from your company.

Some of these boards have been helpful in providing key insights, uh, in helping you to manage your business, while others have been a complete waste of everyone's time. So what's the difference between a well run board, and one that isn't.

Our guest today is Paul Hickey, CEO of ReShape Life Sciences. Throughout his career, Paul has dedicated himself to learning and has utilized advisory boards of different types to help better understand what people are thinking. Paul was the CEO of Ultimate Medical Holdings, CEO of Vertebral Technologies, and Senior Vice President of Marketing and Reimbursement for Enteromedics.

Additionally, he held positions of increasing responsibility at Zimmer Biomet during his successful 17 year career in orthopedics. In our conversation, we discussed the roles of advisory boards, best practices in forming and managing a board, the importance of including members from your own team on boards, why quality is vital in ours and other industries, and how ReShape is helping patients and clinicians deal with the devastating effects of obesity.

Here's our conversation.

Paul, you started your career in a place other than medical device. You started it at McDonnell Douglas. What did you do to, uh, to, to get in and out of that business and why did you choose medical device?

[00:02:31] Paul Hickey: Yeah. Even before that, My bachelor's was in mechanical engineering and, uh, I co op through college with General Motors, I was up at University of Michigan. And, you know, it's a big automotive town and, um, you know, kind of out of college turned down a job offer from General Motors.

Cause I, I. I kind of wasn't feeling it with, the automotive industry, making, windshield wiper blades or whatever it may be. Just, it wasn't a passion for me there. So, um, had a job offer with McDonnell Douglas and at the time,Top Gun had just been released and, Tom Cruise and all the things with Goose, I, I Kind of had, uh, was sold on, the industry and, the excitement of getting to something completely different.

And, so I was there for about four years. part of what I

[00:03:12] Patrick Kothe: and what roles, what roles

[00:03:13] Paul Hickey: yeah, so I started off as a crew station design engineer. So everything the pilot touches and sees. An aircraft that was the A VAB Harrier. It was the vertical takeoff and landing jet that the Marines fly to go into some pretty precarious situations.

And, had a few instruments that I was in charge of procuring from different vendors. But I was in charge also for the escape system, which is the ejection seat and the pyrotechnics that are used to explode the canopy off of this particular aircraft. It was kind of, again, a lot of learnings, a lot of, interesting projects, and a great first sort of, professional job where I learned a lot about how to be really an engineer.

And this isn't, this is back in the day, late 80s where I'm, I'm, I'm working on actual, not a computer with CAD. There was that there, but it was the early stage, no solid modeling, none of the advancements that you have today. I don't think you can learn how to do it. We learned back when I went to college, it's all been so it's advanced so much for engineering.

Um, but I ended up while, down there, I ended up getting, getting engaged, also, went to night school, got my master's at Wash U in St. Louis and, following that,that accomplishment, A, getting engaged, and B, getting my master's, I kind of was, looking around and, saw an opportunity to move into medical device.

And it was kind of a, uh, by luck you know, situation where it was actually a colleague of mine at McDonnell Douglas that was interviewing and told me about the company. And, she offered the contact person at, a company called Zimmer and they're the now Zimmer Biomet, but they're there at the time they were number one pure play orthopedic company in the country.

And located in central, north central Indiana, so a little bit closer to Michigan, a little bit easier, as my wife, now wife of 35 years this year, we're thinking about getting married and starting a family to be in St. Louis versus Indiana seemed pretty attractive. So again, jumped to, jumped out of aerospace and I still have a lot of friends there that love to make things fly, but my head was, I still wasn't passionate about what I was doing.

I was doing well, doing a lot of work, a lot of quality work, but when I saw an opportunity to get into medical device, I was, it really resonated. And, my first job, which is, I think, exciting to any engineer was working as a customs engineer. So most times. Surgeons, orthopedic surgeons of, upper extremity or lower extremity, hip replacement, knee replacement, shoulder, elbow.

They can take components off the shelf and use those for any given surgery. But there are patients that have, tumors or it's their, second or third implant and the bone quality and the difficulties in putting a off the shelf implant into that patient just doesn't work. It's not suitable.

So that's where custom implants, um came to be and how they, how we served individual patients with one time implant designs. And I absolutely loved it. And, for a couple of reasons, one,every case that I did, I had a patient name, had a surgery dates and had the design, had people supporting me on the manufacturing floor, quality.

Everyone was attuned to that patient, the story behind the patient. And I've always loved sharing, this patient had, this is her fourth knee revision or this young 18 year old has a tumor. Here's why we're doing it. And, it really,kept me invigorated day in and day out and what we're doing there.

So that that job I think was, where I really cut my teeth in the orthopedic space. I, by again, by luck, I say luck, but I know you got to work your butt off. You've got to do quality work. And then there's a bit of luck with every job transition. But I had another opportunity that came to me by surprise to jump out of this custom engineering role where I was interfacing with the customer, which is the surgeon, as well as, working, around the organization across organizations to get things done that, uh, the marketing team looked over and said, Hey, you want to come on over to marketing?

And I

[00:07:11] Patrick Kothe: The dark side.

[00:07:12] Paul Hickey: dark side, right? Well, I, and truth be told, I was probably a hired gun for them because the dynamics in a large company, sometimes there's silos between the marketing and development and sales and whoever. But I was able to jump over and compete or defend what the marketing needs were based on my background in engineering.

So I, you know, engineering team would say, we can't do that. And the reality is they could, they just didn't want to sometimes. But politics aside, marketing is where you really figure out, customer needs. And, I thought it was doing a great thing by helping, I'd say, 35 patients at any given time.

I have these cases that I've worked to get done and shipped out. And these surgeries would largely go on successfully. But once you get into a role like marketing, you've got all of a sudden, you've got a brand of products that are serving, thousands of people every year, and, you realize you're having a, a, a a role doesn't seem as intimate.

But you're having more of an impact and that's how a career would normally progress. You're thinking you're doing this, it's important. And then as you progress, you can ultimately feel like, Holy smokes, we're affecting, millions ultimately of people, based on the work, that you do, but from the hip marketing role, I ended up getting on a couple, special projects, which is really where my, ability to work cross functionally, I think, helped to, accelerate my career into sort of, uh, advance leadership roles, Did a short stint in Europe to try to corral the countries in Europe to not see the U S based company as the evil empire.

And, that was short lived based on, a change in leadership, back in the US. But, when I came back, I actually jumped onto another special project and, ultimately worked my way,out of hips and knees where I was primarily for 14 years into the spine division in Minnesota, where I now live and, again, careers progressed from there to, advance roles up until.

In the peripheral vascular space, spine orthopedics for a good eight years, and, now I'm in the obesity space, running a company called Reshape Life Science,

[00:09:17] Patrick Kothe: I always find it fascinating how people move from different areas and they pick up different skills and different perspectives and the international perspective is certainly an interesting one to pull in there as well, but also moving from, primarily in one industry,the,orthopedic space and then moving into other spaces. there's a lot more similarities than we think, but I want to go back. Yeah. To a similarity as well, because we in medical device think that, that our quality systems and they are there, they're so important and the cost, you know, the, the cost of quality and the, the quality,systems that we build, that we manage to, and that we've got inside our companies, we think that's kind of unique, but you are in aerospace and quality is important there.

The Harrier is a, is an example of that. we're dealing with some issues currently with that.Other types of, uh, you know, uh, issues that we've got with different aircraft, that point to quality issues and Boeing's going through some of that right now.

So how did you view quality moving from aerospace into medical? More important,

less important, equally important?

[00:10:31] Paul Hickey: Yeah. I think, uh, you know, cost equality. it's, there's a metric, you'd look at it like you have more, sometimes more quality, staff than you do engineering. so it's, sometimes becomes lopsided, but the risk, depending on the size of the company and the product, especially either, either case, either scenario, it's a risk of having a poor quality controls is devastating and sometimes life threatening.

I've, I learned to appreciate, quality is, it's based on the individual within the quality team, based on the individual, even outside of the quality organization to support that policy of, you know, nothing's good enough for the customer if it isn't perfect, and, I saw that in aerospace and definitely had experiences when I moved to medical device where it wasn't necessarily the quality director or vice president.

I had a little old lady that, saved my butt, who was in the last final inspection of a custom implant that I referenced, earlier. And, she called me up because she knew me and she knew I was friendly and she ended up, asking me, are you the guy that I talked to every so often, the tall guy?

And I said, yeah, so can you come down here? I have a question to ask. And because she, knew who I was and, or felt she knew who I was, and, she was committed to making sure she did her job right, she ultimately found a mistake in the implant that I didn't see, nor did anyone else that touched the implant before then, and she, literally in that case, saved, that patient a surgery where the patient would have been under, the box would have been open, it would have been the wrong implant, and so I can't, I can't emphasize enough, like you, quality just has to be a given, you can't shortchange quality,especially in the field of medical device, you can, Be smart about it, but you have to, reward,find a way to have the culture of the company and those individuals who do what they need to do to sustain, that standard that they're recognized and they, they feel good about it.

[00:12:22] Patrick Kothe: Paul, that's such a great point. And quality is not just the people who work in the quality department, and it's not the quality engineers, but it's everyone who's involved in the company. People off often ask me, when do you put a quality system in? Well, when do you want to have a quality product?

So you can't wait until the tail end, you know, you, when you're defining the product, you have to have your quality system in place there, because you're following good processes in order to get a good result. So it's everyone in the company and at every point that you'd have to make sure that you have a good quality product.

[00:12:56] Paul Hickey: And you can layer in the regulatory department, as, as part of quality and in the med device field. But it, it's, it's as important. again, it's all about the patient, right? I mean, the med device, it's all about, what do we need to provide, as part of our commitment and promise to the individual who ultimately will be having this implants or device or therapy, and it's a team approach.

And,I don't tolerate, I know it's said jokingly in some organizations that, the quality group is a sales preventative group or some, some phrase like that, you probably heard them as well. And it's, it's like. it's hard to tolerate that. I don't, and tolerate is maybe too strong.

I, it doesn't, nothing really stops me from correcting that individual who may say that to me these days, that, without quality, we'd be, we wouldn't be a company.

[00:13:43] Patrick Kothe: Absolutely. And then that's a great, it's a great point, whether you tolerate or not, because if you say it. even in jest, there's something of truth in

[00:13:53] Paul Hickey: there,

right? Yeah.

[00:13:54] Patrick Kothe: and I did it earlier in this conversation when I said the dark side, moving over over into marketing,

that that is the perception in many, in, in many companies. And I always fought against it. My background came up through sales and marketing. I, you know, self deprecating, we're the dark side,but, Yeah, that, that is, it's very true whether, whether you're going to tolerate those types of conversations in there or not, because I always had the same thing with sales and marketing, and there's always a, a natural,resistance between the two groups.

There's some. Static, between those groups. But when people would continually talk about it, I would make sure that I corrected them because if you continue to perpetuate the myth, you're building the myth and you're building the reality. So I'd always try and tear that down. We're sales and marketing.

We're not sales.

[00:14:47] Paul Hickey: Yeah. Yeah. It. You can tell companies that have the culture that where it works. If they do have one person that owns sales and marketing versus a sales executive and a marketing executive, that it's always this clash or it could be a clash. I've always tended, I've had my battles with sales, but I've, through the battles, you learn how to become the brothers, sisters from another mother where it, it, you have, you understand the, that you can't get there without each other. And,you both have blind spots. You both have, you both can improve. No, one's perfect. But in the heat of it, hitting a quarter, hitting a month or whatever, and you've got some issues that customers are. complaining or articulating that it's, it's hard not to look across that wall if you're two separate, silos and kind of point fingers and, you're not selling, you're not designing correctly or whatever.

You know, number of those battles. And again, the solution to it is, it's all about the team. It's, it's kind of a soapbox and cliche, but it is truly, um, One mentor I had to speak on the point as a CEO that is actually still a mentor to me today who pulled my VP of sales and I was running R& D, marketing, clinical and reimbursement at the time and he brought us in and said if you two don't get your act together and figure out this one of you will be gone.

And it just, you know, threw it out there and he, you said it kind of in jest, but not really. And so you, you kind of realize,let's be one voice, regardless of, our differences before we go into our executive staff meeting with our CEO, let's have one voice and talk about the problem and the solution that we want to provide for the company.

[00:16:27] Patrick Kothe: And that, that seems to be the, the best practice that I've tried to keep in mind as you go forward. what he was probably saying is both of you will be gone because if that's your attitude, if each of you have that attitude, the next person that's brought into that mix, that attitude is still going to be with the remaining person.

[00:16:45] Paul Hickey: yeah. And again, that's trust, right? you have to, realize that, whether you're with the CME, he caught both of us talking to him individually about issues with the, sales or issues with R& D or marketing, whatever. And that's when he brought us together. So our, our, performance, it wasn't, to the level it needed to be as executives, and he called us out, and that was fair.

And I've always respected that of him, that he, doesn't hold punches. he hits, pretty quickly when he sees there, it needs to be corrected.

[00:17:17] Patrick Kothe: So I want to focus on, the, something else that you talked about and you moved from, individual contributor, in the R& D department into marketing and having a greater view of developing products because a lot of people think that, R and D is the people, those are the folks that develop the products, But they don't do it by themselves or in most organizations they shouldn't do it by themselves. They need to involve other people. So let's talk a little bit about,getting an idea,identifying an idea, and then getting to more proof of concept. So when you, um, uh, have had, you Ideas from products. how, what happens, where do they come from?

Where do they come into the organization? Who takes a look at them?

[00:18:05] Paul Hickey: Yeah. so I've had, groups and departments,in my team of responsibility, teams of responsibility that were called the emerging technologies and, where you do the very rapid prototyping and try to get to proof of concept. But the ideas can come, from anybody.

And, the important thing is what's the environment that you need to have ideas, surface and, and to your point, it can't be, it can't be one person. For young marketeers and engineers, I use the example of, if you just talk to a surgeon and you say, how to do the surgery and they just say, this is how I do it. This is how it works. This is the, the one, two, three, four, we're done. you're not really going to get much out of that. If you have four surgeons in a room, five surgeons, you're gonna get some dynamics that you have to, you almost have to observe the interaction and look for efficiencies.

It's almost industrial engineering, mechanical engineering. And as a marketeer, you have to think through the broader, not just those four, but the world of surgeons that you're working with. And I, I tell the young, again, the young team members that come on, I said, you, it's like having those first surgeons, you ask them, you want to be able to ask them like, what is your favorite beer?

And then if they come up to the bar with you and you want to, they'll give you maybe three different answers. You want to go back in the kitchen, get the beer that no one mentioned, but they all think is their favorite going forward, and so it's, it's an unarticulated kind of need because most surgeons deal with what they've had to deal with, because that's what ndustry provides them with, and if. if you can't improve it, then let's just shut down development and we'll just copy everyone else. And so your challenge is to figure out how can you improve what they've done. And don't expect them to tell you how, because if it's easy, if it's a difficulty, likely everyone else is focused on that already.

So that the more advanced a specialty gets, whether it's orthopedics, hip, knee, spine, the more advanced that those instruments and implants get for those specialties, the harder it is to find that unarticulated need because the surgeons already feel like they're doing okay and your job isn't just to, hear that from them. Your job is to hear what they're not saying and try to understand what they're not saying and try to figure out, what is it, what innovation, and that then rolls into, how do you take the innovation and see if it works and try to really, fail fast, with the idea and move on if you fail and start to explore how to develop it if it's a, if it's a winner.

[00:20:34] Patrick Kothe: Understanding that unarticulated need is really interesting because the, as you said, If you've got somebody who's doing something, they may say, give me something a little bit smaller, a little bit lighter, a line extension. we're just do something a little bit different than what they're doing.

But to listen carefully and to watch carefully what's going on during a procedure, during a surgery, and then to have some ideas in your mind and start to build bridges between, what's going on and what's possible. That's a unique skill and that, that's a unique way of thinking and looking at opportunities. How do you train your group to do that?

[00:21:28] Paul Hickey: Yeah. But yeah. Great question. I think there's a, an element that you have to make sure the team is the right team. And, and that's not all superstars. I'm not, saying that you got to make sure you have those individuals only on the team that can come up with those ideas. you have to have a team that has, those that can, Are better at conversing with the customer and talking and figuring out things.

And you have to have those that are just, all they do is think and they don't say much. And we've been around individuals, in our lives like that, where, sometimes the silent ones are the ones that will come out later when it's a more comfortable environment and really kill it with a breakthrough sort of lightning strike idea.

So the team is critical and not just all engineers. You've got to have marketeers. I've actually pulled manufacturing people into the engineering, initial design and conceptual phase because they always feel left out. it's concurrent engineering, a lot of articles written. You can look at it and say, okay, yeah, that's best practice, but it's rarely where an engineer is forced to be around manufacturing and marketing at the same time when they feel like they should be at their computer developing on their own and that's the hazard of it. So having that the team is important and recognizing that you can all have bad ideas, don't have thick skin.

It's hard to, and you're, you're young at it, but the second element is getting them around the audiences that can best provide that back and forth and that's where I've used, surgeon panels, where we pull in usually design team of surgeons could be anywhere from four, I've had the largest 22.

It could be US centric or global and I've had both. But I also, another element is, marketing. You mentioned marketing and sales. I've, I pulled together the first sales panels when I was with Zimmer, back when I was much younger, had some hair and, sales panels were made up of, sales reps across the country.

Some that again, had a great experience with the products that we're developing in terms of their customers and others that had minimal experience and they just struggled getting a foothold with the products we currently had. Someone could say about, talk about the problems today and others that were, feeling pretty good about what we had on the shelf.

But those two factors for me, and then someone who can,be, and usually it makes one or two people that can observe the dynamics between, that internal team with those, one of those two external teamsand just make sure we're, you're capturing it.

We actually videotaped, these meetings that I mentioned with the surgeons and the sales associate, panel that I pulled together because everyone hears things differently.

And it wasn't like we reviewed it, but they knew that we were taking their feedback, seriously, that everything they said you want to just capture and not, not to call them out. And, but it built trust. It built,dynamics in the room,

but it was just a way of validating that, okay, you heard this, I heard this, let's go back and check the tape, now you joke about on television, let's drop the flag and do the replay with some of the commercials that are out there now.

And we're, we had to have some way of, putting those teams together, getting all the dialogue and then making sure as we walked away as a team, that we all heard the same thing. We knew the direction that we should take and,and run from there.

[00:24:48] Patrick Kothe: Those two advisory boards, so to speak are so important, but they're different and they're,they could be run differently. So let's take them one at a time. So the physician advisory board or clinician advisory board, because you may have not only physicians, but it could be you know, advanced APPs, NPs, RNs, supply chain people, the users of your product, you're going to have some people in there. So you talked about a design team once you've got a project going, but there are also advisory boards that, companies have that kind of go across a number of different things. So let's be a little bit more general right now and talk about that advisory team for the company. because many companies have them and they're up on the website and it's the president of this society and the past president of that society and everybody looks at that and it's validation, which is fine, but that's really not. the best use of advisors. So when you're looking at an advisory board from that standpoint, how do you choose the members?

What are the objectives that you've got for that group? And then we're going to talk about how do you keep people involved.

[00:26:09] Paul Hickey: Yeah, great, questions. the advisory board for that design team that had 22 surgeons, the CEO at the time actually said, shoot, I need an advisory board. So he, siphoned some of those members off to his kind of a strategic advisory board,with clinicians, surgeons and researchers alike.

With the dealing with our current roles and even my past role, it, I kind of position, the boards as sort of multi functioning boards where I have a scientific advisory board and a subset of them could be used for different, different discussions. Yeah. and so, um, you know, having some of the, certainly the ones that are tied to the associations and are, you know, have moved through the ranks of different societies, the orthopedic societies or other societies, they're important to have, but,they're not, It shouldn't be all inclusive where that's all you have.

I've had surgeons that are, big advocates and,the warriors of your product and defend your product have used it all their career. And they'll, look for, not much in terms of change. And then I have also members that are, Really not interested in our products. So it's the, you'll want to have it just like any board, a public company that I run now, I have a board of directors that come from varied backgrounds, they're really independent and you want that independent, without bias, board feedback to help drive, your strategy as a company.

Believe it or not. I think you, I'm not speaking to you. I'm sure you believe it, but the listeners, the advisory boards that you have, they want to hear about the strategy of the company. They want to hear about the market, the size of the market, how they really are fascinated with the business world. Um, given they, right out of college, they got into medicine or the science side of their career path without. some of them have done both, or they've ventured into their own surgery centers or other things, but by and large, they love hearing about that. But to have a group of individuals as I've managed them, I'll use a, it's a four of a 12 member team to help address a certain issue.

So we don't get everyone involved at once. and I do believe, as you said, like there are some that are just really good at, looking through that crystal ball and helping us with our strategic intent. And,I've, you, you have to have a board that you can trust and they'll provide you the feedback and you can always alternate the members based on, members not willing to participate or just having too much, too many other,balls in the air to help you out.and then there are those who did an engineering undergrad and those are the, put them with the engineers and they're happy as can be. And then there's, again, it's gotta be a mix, as I said earlier, about your internal team, your advisory board for whatever you're going to do, so that you get the right feedback.

But I think the, probably the thing that's missed the most is don't surround yourselves, don't surround your company with an advisor board, with a bunch of friends, a bunch of allies. You want to bring in, those that are well respected by the rest of the members of the board. But they have not been involved with using your product, advocating your product.

And they may be, part of the association in terms of professional association of orthopedic surgeons or otherwise, or they may not. They may just be, not a lot of respect for the politics with those associations. So there may be private practice. Important to have that mix. And we tend to, before you select a board, put all those, criteria on a spreadsheet and say, what do they have? Are they well published? Are they academic? Are they a private practice? What geography are they? Are they Northwest? Cause there's reimbursement issues with different devices and therapies that are regional. So you think it through enough, you'll have the right sort of dashboard to be able to select a really good board that each member has differences and similarities, that just feed off each other.

[00:29:56] Patrick Kothe: Yeah, I couldn't agree more about choosing the makeup of your board based on what you're trying to accomplish. So in my experience, the first thing is, what are you trying to do with your board? What are you trying to accomplish? What are the objectives of the board? You have to start there and then have to say, okay, based on these objectives, how are we going to make up a board?

What kind of diversity of thought, of, age of, experience,do we want, in this board? How does it fit with our culture of our company? Are there dissenting opinions in there? Are there political issues? If I leave this guy off the board and he's a designing surgeon, is there going to be an issue? Is this designing surgeon going to dominate a conversation in our board and it's going to be a problem? Are we better to, handle that, handle that outside of the board and do it a different way. So the board makeup is so important. But the other thing that, you, you mentioned it quickly was, how do you rotate people on and off the board? because the boards,are, should be, Fluid because there are going to be some board members who are, stellar and some that aren't, and you don't want to have people tied into the board as well. So how do you deal with the makeup of the board and rotating people on and off?

[00:31:19] Paul Hickey: Now, part of the best practices with healthcare professionals, based on everything that came out, probably a decade ago with, ensuring there's no anti kickback and other related, things with, surgeons is to have contracts that are one year. And, we essentially renew the board every year.

And that was an opportunity to have that dialogue, on a frequent basis. whether you. Whether you want to keep a board member or not, you can have that dialogue. I've always been clear with the board because of the issues that you mentioned with, some are overpowering, some are, and I've seen it even recently, where you just don't want that person to be on the board.

You can't find the role that's best suited for them. So you just don't want to continue with them being a part of the board. And it's, it's, You don't want to have that be the responsibility of someone who's, engineering director or someone who's gonna potentially have a backlash.

It's gotta come from the top. And it's just like with,any other discussion of that nature? There's a lot of feelings involved. There might be some egos that I get bruised, but you have to, ultimately, talk to the physician and give sort of the feedback like any coaching you, you likely could mention before you get to that level. Talk to each physician that you have an issue with. Say, look, this is what I'm seeing. And I'm sure if I did a survey of the rest of the team, I could do a 360 if you want, I could get, I could feedback from the rest of the group, but you have to understand this is how you're coming across. And it's not helpful.

and that they appreciate discussion and they likely have heard it at home as well. So they have to, at least listen to you. And if it doesn't, the behavior doesn't correct, then you just, you gotta make the, make the move.

[00:32:51] Patrick Kothe: So best practices, who manages the board and who's involved with the, with the board members? Because, you said there's one, one person that's going to have that discussion. So there's one person, I think you're saying that, that is responsible for the board, but. Yeah, just

answer that, answer that first, and then we'll get

into the next part

[00:33:13] Paul Hickey: know, it's easy being a CEO to say I, I run, I've run the boards that I've had as CEO and I've done it because I know it, it always comes to, they want to hear from me and they, it's, or in whatever company, I think the CEO of that company, they want the same thing.

They want exposure. They want that direct line. The important part is you have to understand that you've got, Your team should be able to manage the activities of the board on specific projects and that interface, building that relationship and helping to have your team grow based on feedback with a surgeon.

That's how I grew with my confidence with talking to surgeons was back when I did the custom engineering and talking to all those surgeons every week, I realized I actually want to go to med school. I felt like I could be a surgeon and just about got there until I got into marketing. But the idea of having your team be able to interface with the board is important. I always have enough interaction from a leadership level that the board knows that your feed, their feedback being observed and they don't feel like you've just. put them on a life raft with a bunch of engineers or marketeers. And they're because they will want to hear from, from the CEO most likely. Now in my past, that hasn't been the case. Larger companies, vice presidents, others are easily replaced, can replace the CEO's presence, but it does come back to if the. People on the individuals on the board are not happy. you just got to make sure you manage up as a team member and say, we better give the CEO a heads up.

So this phone call might, come his or her way.

[00:34:42] Patrick Kothe: In my experience, the, um, uh, the best boards way, the way they function is there is one person that's responsible, but that person is also responsible for setting the expectations of the board members, because I've been on boards before and I'm sure you have as well. And if you're not, if you're on the board and nobody contacts you or nobody involves you in what's going on, it's like, you know, why am I a member of this thing?

I'm not involved in it. And then they back out just, because you're not involving them. So setting their expectations is important. But also setting the expectations of the people in your company.

It's okay for you to reach out to a board member. You don't have to go through the one person. It's okay to invite that board member on.

You've got to make sure that you communicate to your team how you want them to, to, uh, to be involved in those board members as well.

[00:35:38] Paul Hickey: One experience to, to, that happened that emphasizes the point of anyone can speak to the board and anyone can send the message. I had one, meeting, a group meeting of that 22, member advisory board and developing a HIP system at Zimmer. And we had one meeting and there was a very contentious issue.

And, you know, I always kick off every meeting the same way. I go back to the mission of the team, the scope of the team and try to, have the,re recommit to what the team's trying to do. And what happened was, the, Contentious issue. I essentially put it on the slide and had it front and center when I did the opening and said, this issue is not going to be discussed today because it's a company decision and we need to go in this direction. we cannot spend time today talking about this. We have a full agenda. Do I have buy in from the team? and got the acknowledgement there that, and a surgeon came up to me later and said, you really took the bullets out of our gun with your presentation. which is a good thing because we probably would have spent all day on that issue. But, some things you just have to know about the board that they're going to want certain things. You have to be able to, steer the board and make sure your team knows that. It's okay to say, Hey, timeout, procedural suggestion.

Let's move into direction or way off time or wherever the case will come back with another proposal. There's a. experience level with managing that I don't know how to describe the learning curve, but sometimes those discussions with those boards, you can listen and listen and think, Oh, this isn't getting nowhere and you want to stop it.

And which is your gut feel, but if you let it go just another five minutes, you might get that breakthrough. And it's, that's always, I think the most rewarding part about running a board or watching a board and having someone else run it, it's when they let the dialogue just mature. And it seems like, we're off schedule and we're not getting anywhere and you just let it go because there's, it's still not, it's not quite finished yet.

You just have a sense. And then it does come to a conclusion that is what you've been looking for. And you may have spent twice the time on it. and maybe the point I'm making it's the hardest thing ever with running a board is to set an agenda and keep to it because, because of, because of that dynamic.

And that's just, it's wonderful. It's you know what, we're not on time, but I don't care. I, we could spend all day on this topic because it's important to the company. And that's, I think the board members would appreciate that as well as, certainly if you reach a conclusion and you get a solution for what you're, discussing, it was all worth it.

[00:38:11] Patrick Kothe: There's a reason why there's one moderator. So that moderator needs to make sure that they're getting out of that meeting what they intended to get out. So it's important to do that. So really fascinating. And I think, the rep advisory boards, many of these best practices are the same as when you have the rep advisory board, as well. And any major differences there?

[00:38:34] Paul Hickey: They're not used to being listened to compared to the surgeons. That's the big difference. And when you give them that audience, they're hugely grateful and, and maybe a little bit more timid about, providing negative feedback about people in the company that normally support them.

And, that's the, the big difference for me. I, I've had, advisory panels. The first one I put the first ones I put together, we had the, the product development, we had them in several times. They give some reference to that, orthopedic implants, hip or knee come with large, they're very, capital intensive in terms of instrument sets, right?

Or you've got to design the instrument trays. Those instrument trays are used day in and day out by scrub techs to get instruments in and out of those trays. And the sales reps are there. They see the inefficiencies. They see. the real world experience of those things. They jumped all over, the trade design and all the other things that, involves them.

And we're extremely grateful. Also had a surgical tech or RN, panel to help validate their feedback. But at the sales meeting, when we launched the product, I had, a guy got on stage and talked about the project was actually in tears and talking about how he's never in his professional life of, whatever number of years at a chance to provide feedback and never felt as listened, right? And that's, what the goal is, if you can get people to try to be a part of this and involvement builds commitment and all those other, principles that, hold true. But his emotion was, off the charts,for me in terms of, validating what we did was right.

[00:39:58] Patrick Kothe: Not only are you getting great feedback, but you're helping to build a culture, your company.

[00:40:02] Paul Hickey: yeah, for sure. Well,

[00:40:05] Patrick Kothe: reshape. Tell me, uh, tell me what you guys are doing over at, at reshape. what's the problem that you're solving that, most of us or many of us in the country, I will speak for one, many of us in the country have, and, and how you're solving

[00:40:18] Paul Hickey: So for the audience, Reshape is a, company that is focused on helping those that are, fighting obesity and, it's a global,epidemic, roughly 40 to 50 percent of the world population is obese or clinically obese. It doesn't take much to get clinically obese.

You can be, I think, 5'11 and, 2'15 and your, 30 and that's where, intervention is probably warranted. But we have a product and I joined the company, roughly, almost two years ago, but we have a product called the Lap Band, which has been around since, 2001 and just recently launched a second generation called our Lap Band 2.0 Flex. Pretty excited about it, and that's,we've taken what an issue has been for patients and think we've have a solution now to make the journey with the lap band more, more effective for individuals. Again, a quick, Description, I think I may have shared this with you before, but the lap band essentially is taking a five lane, six lane, superhighway, your esophagus and tightening around the top of the stomach with a band that can be adjusted by a port that's off to your side or are placed a little differently.

And that. increase or decrease from six, five down to four or three or two lanes, depending on the tolerance of therapy, allows the individual to slow down their eating, not eat as much, not eat as fast. And that's essentially what you want to help an individual who doesn't have a healthy relationship with food, to be able to get some, a tool in the toolbox to help them work through, their journey, to have weight loss.

So as a company, Reshape is public. we've had, a really interesting year, given that GLP 1s, you, you know, the, you probably just may have heard Oprah, not too long ago where she talked on a special about Wagovy and Ozempic.. And, what wasn't mentioned, during that, session that she had on television was that those prescription drugs, the GLP 1s, are just another tool.

They all do the same thing. they're trying to restrict your eating, give you more satiety, trying to readjust, your relationship with food so you can, again, have a successful, sort of weight loss progression. But you, you tend to max out, and statistically, individuals that are on the GLP 1s will lose a percent of total body weight, excess body weight, that will plateau.

And, if you're at 300 pounds or some larger weight and you lose, 20%, you're going to need another tool in the toolbox. And that's where, as you move down this continuum of care with obesity, the lap band, is, the first. laparoscopic procedure that can be done that, is less invasive, doesn't change your anatomy, essentially goes around the top of the stomach.

The lap band also has limitations, and is not the most aggressive treatment. So you have to look at the lap band as part of the continuum that surgeons will use, including the gastric sleeve, where you take out 80 percent of the stomach, or the bypass, which is the rerouting of the, the plumbing, so to speak.

And As you move down, you get more aggressive, but there's disease of obesity is a really aggressive disease. It's adaptable. It's plastic in terms of it adjusts to the environment. And it's I think we're in a, about a decade or so where we're really going to start to fine tune that care path for individuals based on understanding a little bit more than we do today about what type of obesity do they have?

Are they a hungry gut, a hungry brain, an emotional eater? There's certainly the food industry is driving, I think, the disease rate as well as,mental health issues that are prevalent worldwide. To answer your question simply, yeah, we're fighting the fights.

We have a new product that we're, starting to get early data on with our limited launch, with our advisory board members and others. And we're excited about the future. It includes that product as well as really moving aggressively to find from the M& A standpoint, find the right partner for us. With the tools we have in our mission and hopefully find someone who's aligned that we could combine as companies, we can make a larger company that is really well suited to help more individuals around the world.

[00:44:27] Patrick Kothe: The, recognition of obesity as disease and not as choice is a very important piece in there. You mentioned there are a lot of different tools, to be utilized at different things and understanding of where you stand on that. On that spectrum of disease, but we also have to come to terms with reimbursement.The ozempic of, of the world right now, it's an expensive long-term proposition, although it works very well, but, if you're a, if you're a type two diabetic. Great. You can get that and you can get that paid for. If you're a pre diabetic,it's generally not going to be paid for because it's a weight loss drug at that point. so wait, wait until you get diabetic, then come back and we'll,and then we'll help you out.So this whole reimbursement issue is helping to drive some of the decisions or non decisions that are made in the space as well.

[00:45:19] Paul Hickey: Yeah, I think you're right. With 50, 40 percent of the world potentially, could use a weight loss drug, it, it would suffocate, a lot of the health systems, national or private,payers, so to speak. And again, Lap Band has been reimbursed as these other procedures I mentioned, and broadly reimbursed today.

Most all major, insurance companies, but it, I think things will change. I think, we talked that, each of these GLP ones that will go via Zempik, ZepBound, they all have,20, let's say 20 patents around each of them. And those will last to 2040 or thereabouts. Manufacturers has some leverage, but I think the way reimbursement works is you know there's prevalence of loose societal support. the data which is real world data is yet to really be seen with these drugs because they're newer and it's the influence of the societies and the politics and everything else that you think would go into a major decision like that.

So I think we got five at least three to five years of understanding how the toolkit for surgeons and healthcare professionals who are helping those along that weight loss journey. They may have more tools in the bag, with some approvals of reimbursement, depending on, the state of obesity for individuals.

The other thing I'll mention quickly, it's not a, it's not a take one or the other. A lot of these weight loss drugs can be used, whether if you currently have a lap band or a gastric sleeve or bypass, they can help you when you plateau to kickstart you again. so they're, again, they're pretty They're helping a ton of people,very, glad they're in the market, long term.

They're just bringing more people off the sideline and saying, you address your health, address, this disease because the consequences of not, there's plenty of data talk about increases of cancers, heart disease, other issues, joints, a lot of areas that are, problematic long term if you don't,manage your health by way of reducing your weight.

[00:47:01] Patrick Kothe: Good luck. it's a tremendous, need in the marketplace and really glad that you're contributing to some solutions in that space.

[00:47:09] Paul Hickey: I'm having a blast, so it's been fun.

[00:47:12] Patrick Kothe: Great. Last thing I'd like to just, wrap up with is you've talked about, the moves that you made in your career and you've had a very successful, career, in medical device. Some people, when they start off, they've got a master plan. Oh, I want to be a CEO by this age. I want to manage a public company.

I do. Some people don't, don't have that. they, they capitalize on opportunities and different things, areas of interest that they've got as they're doing it. So looking back on your career, how did you manage it or not manage it, so to speak, and what are some of the things that you did to help you set yourself up and prepare for future opportunity?

[00:47:53] Paul Hickey: I, I gotta start with, been married 35 years and I, if I didn't have the home support that I need to make changes that I've made, it would have been very difficult. I probably would be working, with General Motors up in Michigan, straight out of college. So a lot of these,moves require transition and change, which is hard, hard on, individuals at the home front.

So that, check that box with a big green check.Beyond that, it's for me, it's I've always pursued, endless pursuit of knowledge. keep hungry, pursue advanced degree, get yourself, up the leaderboard in terms of demonstrating outside of your career, in terms of what you do at work, you're trying to improve yourself.

There are a lot of different ways to do that, and everything is so much easier today than it was back in the day when I had to do it. And maybe the third thing is, don't, let your self worth be defined by your employer. I think it's easy to get into, a mind where you're just, your boss loves you and you're thinking this is the best and that's just not a healthy environment.

And in my mind, you have to always have in your head, where you see yourself and regardless of what you're being told, I, again, I came from seven of eight children in my family growing up and, I had a lot of older siblings tell me things that I necessarily didn't like hearing, but I had to, you have to build that toughness at some age and maybe it comes after, this generation comes after college and you get into your role.

Just be cautious of, not losing who you are and, validate, that with certainly the work you do, but don't let a person, or a, manager or, whatever, define you. And, setbacks like, being laid off for other things are not really. they're opportunities and you just have to,keep that mindset and,I think things, doors open because you're, because you knock on them, they sometimes the doors hit you as they open, you're not even thinking about them and they're there and that's because of the hard work you put in, the attitude of, being open to opportunities and having confidence, regardless of what you may feel, like how you're struggling, whatever, just have that.

Sort of undying,endless, confidence that you can do more.

[00:49:57] Patrick Kothe: Paul's experience in product development and marketing prepared him to listen and learn. Critical skills when coming up in your career, but also critical as a leader.

A few of my takeaways. First advisory boards require thought to put together and to manage. Paul put together spreadsheets to track key variables on how he wanted to construct a board to get the most out of it.

Then he managed the process internally and externally to make sure expectations were in line. And to assure productive meetings and interactions.

Second, the importance of working together and not building walls or reinforcing stereotypes. Leaders identify this and put a stop to it. Paul's story about how his boss pulled him and a co worker together and told him to cut it out was a great lesson in leadership.

Finally, digging deep and looking for the unarticulated need. If you rely on people to tell you what they want, you may be waiting a long time. Or worse, develop another me too product. Paul mentioned putting together teams with different strengths and those who may think or communicate differently. Give them the objective of discovering unarticulated needs. Then provide enough time and resource to let them find it.

Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the Mastering Medical Device podcast wherever you get your podcasts.

Also, please spread the word and tell a friend or two to listen to the Mastering Medical Device podcast as interviews like today's can help you become a more effective medical device leader. Work hard, be kind.

 
Patrick Kothe
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