 Welcome everyone. This is a great honor to be hosting Rajneesh and Dr. Anitha for this session. Back in 2020, I think we invited them to do a keynote that was rated as the best session of the conference. People felt like it was a wonderful story that should go viral from India and we thought, let's bring them back. It's been two years, see how their journey has evolved, what other amazing things they have done and at the least get inspired if not take some ideas back and apply them at work. So quickly, let me introduce Rajneesh. He is obviously background from IIT Delhi. He holds 12 patents and six in the US, a serial entrepreneur. In fact, Rajneesh and I had partnered at one of our earlier ventures back in 2011, 2012. So he's gone on to do several interesting ventures. He's also an angel investor. Dr. Anitha, again, globally acclaimed neurologist, someone who I think is one of the top people in India when it comes to vertigo and balance disorders and probably that was the genesis of the startup that you guys have started. I'm not sure if we should call this a startup. I think now you are way beyond growing aggressively and a lot of interesting things. So anyway, without too much delay, I want to hand it over to Rajneesh and Anitha, a couple from Jaipur, wonderful to hear from them. Over to you. Thank you so much, Naresh for the wonderful introduction and thank you for the kind invite to speak at your conference. It's a giant conference and something which people from all over the world look forward to. So I'd like to start with a brief of what we're doing. We are in the domain of vertical business and balance disorders. And this affects over 15% of the population. And in absolute terms, we talk about 180 million people in India. This is caused by over 40 diseases of the inner ear and the brain. Our company is built at the intersection of innovation in medicine, technology and design. So one of the most fundamental principles of innovation is the ability to unlearn. In most cases, the experts are not able to see the disruption coming. I love to give the example of SpaceX Quest to build a reusable rocket. Elon Musk's idea was that a fully reusable rocket will bring down the cost many fall and will make space travel economically viable. The experts, including NASA, friend space agency, etc. said it is unviable, if not impossible. Even Neil Armstrong opposed SpaceX. Here are a course from some more experts questioning reusable rockets, just as late as 2016. The project was widely ridiculed and lots of memes and others were made. Today, SpaceX has launched astronauts in space and to the space station. The first crewed orbital launch from American soil in more than a decade. SpaceX has flown and landed the Falcon 9 reusable rocket over 100 times. So the baggage of expert knowledge is what prevents innovation and that is what we have to be careful about. So again, talking about how the baggage of expert knowledge can prevent innovation. Let me take you through some interesting examples in our product development journey. The primary function of the inner ear is to maintain balance. And it would be interesting for the engineers in the audience to know that the inner ear works as a gyroscope, an accelerometer, and gravity detector. And some busy patients may have problems with the gravity sensor and perceive the world as still. The test for this is called the subjective visual vertical, which was developed in the 1960s in the form of a bucket test. In this, the patient's head was placed inside a bucket which had a line painted on the bottom. And then they were asked to rotate the bucket to make that line vertical as they see it. The difference between the true vertical and the perceived vertical is called subjective visual vertical. Now various iterations down the line, it was refined over the years and even mechanized and computerized. These are all examples of the iterative improvement. And the latest was a laser projection system from Europe, which costs around $15,000. And this is run by a remote controller. So I was on a long flight back from the States. And while I was dosing off, I suddenly had a eureka moment. The test was simply to ask the patient to move an inclined line to make it vertical. That was what was required. So the solution was a simple PowerPoint presentation that I made during the flight with black background and a white line inclined, which would rotate with each click. And the slide number that you see on the right bottom would depict the subjective visual vertical. So it was a simple PowerPoint presentation, which could work as well as the equipment. So we have a simple PowerPoint presentation as a test replacing a $15,000 equipment, which meets all user requirements. We strongly believe in keeping the product simple and not stacking features for the heck of it. A great example of a simple design is the Amazon Fire Stick. The most difficult part of the innovation is saying no to thousand things. Let me talk about another common disease causing vertical and that is BPPB, Benign Paroxysmal Positional Vertical. The inner ear has three semicircular canals, which are filled with fluid. And sometimes calcium carbonate particles get dislodged into one of the semicircular canals. And this is what you see as the yellow ball. When the patient head is moved, as those crystals strike the balance of fibers, it causes dizziness and vertical. Now, the treatment of this is bringing that dislodged particle back to its correct position. And this is like a 3D mechanical labyrinth or you can say a maze in which the patient has to be taken through various movements to bring that crystal back. So working in three dimensions is often difficult to understand. And different models have been developed to help the doctors understand how the particles would move in the three dimensions. And we saw, again, experts do a great job at iterative improvement. A couple of years ago in Switzerland, a robotic 3D model was developed to help understand the movement of these particles, but with a budget of hundreds of thousands of dollars. So when we were thinking about the problem, we came up with an elegant solution, which was also simple. We created a simulation coupling the head and the inner ear bones Now why would we need physical equipment to mimic the workings of the inner ear? And now we can simulate any kind of movement to understand the behavior of the particle. It's like creating a digital twin for these machines. Today, this is being acclaimed across the globe as a remarkable innovation. And we have published in the top neural large e-channels as well. Now as far as treatment goes, as I said, the treatment involves working, turning the patient's head in different positions and body rotations to bring that particle back to its correct position. The European companies with all their engineering prowess have never recognized chairs to carry out these maneuvers. Once again, our thought was, what did we really need to do? We had to map the proper trajectory of the head in a three-dimensional space. And so we developed a miniature tracking device coupled with intelligent software and we could get it. So here you can see with the band of the patient's head, we are able to exactly map the position and the plane of the head and then the patient is instructed. It's sort of a visual feedback system and you don't even need a doctor to do this. Any clinician just has to follow instructions and meet the position of the head as shown on the screen. When the head position is correct, the next step will be shown. So one of the fundamental pillars of our company is to find simple solutions for supposedly complex problems. This is the kind of a balance lab that you would see in advanced centers like Johns Hopkins and Howard Medical School. We have developed all these diagnostic equipment in-house including electronics, hardware, software, machine learning, computer vision. We have been granted six patents including two US patents. All our equipment is European C certified. We believe that rather than a technology company, we are a problem solving company, a solutions company. At our core, technology-centric companies try to find areas to use their technology and may sometimes end up with building frivolous products basically to push their technology. We on the other hand are open to use and adopt any technology that is best suited to solve the subset of a larger problem. All our equipment is 3D printed which allows us to do rapid prototyping on the go. We use virtual reality for rehabilitation of our patients, machine learning for diagnosis. We use computer vision in many scenarios like you see here to track torsional eye movement. We use natural language processing along with algorithms for digital history taking. We have developed wearable devices for treatment of certain diseases. Digital therapeutics for lifestyle management with a two-way exchange of data between patients and doctors. Drug interactions and contradicted medicines lead to over 100,000 deaths in US alone and this is totally preventable. This is because there are about 7,800 FDA approved drugs and thousands of interactions between them which is impossible for a human mind to remember. Our algorithms prevent drug reactions and contraindicated medication in the prescription that they churn out. The medical experts often work in silos. This is like for diabetic care, you need nephrology, endocrinology, cardiology, but they all work in silos. While what is required is a collaborative multidisciplinary approach. Our remote diagnostic platform ensures multidisciplinary, collaborative approach between ENT, neurology and physiotherapists. At Neurocromb we believe in imbibing and adopting multifarious technologies with a patient-centric approach and a problem solving approach. So while iteration is about doing the same thing better and innovation is about doing new things, the game changer is actually disruption which makes old things obsolete. More than product innovation, it is about disruption of business model and innovation in business model. It is often easier to be 10x better than your competition, than to be 10% better. This doesn't look very obvious, but I think this is something which we have learned and which we have applied. To be 10x but 10% better than our global competition, we would have to compete with them in terms of their against their future sources, years of experience and their wide network. But with the 10x thinking, we can change the rules of the game. So at Neurocrombium, we went on for innovative business model, an asset light clinic and clinic revenue share business model. We believe that every product will become a service sooner than later. I think this is a very important principle on which we have based our business model. And we have transformed the equipment selling business to a health care service business. And with that, we have been able to exponentially grow to our 150 clinics in some of the top hospitals in the country. We have in the last two couple of years, we have successfully treated more than 50,000 patients and we exist in more than 50 cities. So building an innovative company requires cultivating the right kind of culture. The last part of our presentation is about some simple principles we have adopted in building this culture of innovation. We strongly believe that brainstorming doesn't work. There was a survey of about 100 CXOs who were asked to list the top three ideas that they got during the year. And subsequently, they were asked to write what they were doing when they got this idea. You will be surprised that no one of them got the idea when they were in their boardrooms or in a meeting. In almost 100% of the cases, they reported that they got the idea while they were dozing away or while they were in the shower or they were taking their dog for a walk. The first MVP that we showed, I also got that idea when I was on a long flight back from US and dozing off. As for neuroscience, if you are thinking about a problem, it is highly unlikely that you will get a solution right then and there. Because innovation is about literal thinking and connecting the dots. It's about that Eureka moment which cannot be forced by putting 20 people in a crammed meeting room. This is a brilliant paper published by Howard Business Review on why brainstorming doesn't work. We have small teams where the individual members may be working on multiple projects simultaneously so that they are not just thinking about one problem statement at a time. But they will get a flashback of some solution when they are working on some other problem. We do not apply rules on how our maker space is managed and maintained. And you can see here, we like clutter because it does not bring in efficiency if everything is very well managed. It can bring in efficiency but not innovation. We use various tools that allow for experimentation including 3D printing and various other tools. We strongly believe that having a massive transformative purpose helps align the team to think and give beyond their normal capabilities. Our massive transformative purpose is to treat 100 million patients in the next 10 years. We believe that limited resources catalyze innovation. They are never a hindrance to innovation. And we are and will keep disrupting ourselves. If we don't disrupt ourselves, somebody else will. Here are a couple of quotes that I like and with that, thank you. We end our presentation and we can now discuss the questions. Thanks for that quick lightning talk I would say. It just went through very quickly and so many insights you've packed into such a short talk. So that's pretty amazing. I think there's some very profound things I would like to just kind of quickly recap just for the benefit of everyone. So kind of starting with the culture of innovation that you just talked about and I think there were some very important things that might be very counterintuitive to what is the common belief at least in the agile ecosystem. So let me try and just take a stab at summarizing. You can correct me if I'm wrong but I'll do a quick this thing. So I think you started with in terms of the culture of innovation, brainstorming doesn't work. Why you should stop brainstorming? And I think you referred to Tony's article about the brainstorming doesn't work. So I think that was a very interesting thing. Small teams working on multiple projects simultaneously. Again a very counterintuitive thing for at least people in the agile space where you believe that you should focus and work on one thing at a time and not context-switch because context-switch leads to not very efficient working and which is your larger point that innovation is not about optimizing for efficiency and you can see that. I think you've touched upon the whole celebrating the failure piece and if you want to innovate then you will kind of fail and then it's important to accept that, acknowledge that, even celebrate that more than anything else and kind of embrace that while you're innovating not everything will go as you expect. There was a very interesting image you had about your lab where you talked about again, you don't try and organize the lab and keep it very neat. You kind of keep people to work in the natural habitats and people who like to experiment will have a very cluttered workspace and that's perfectly okay to embrace. You talked about 3D printing, AI, various other things that you've been leveraging to allow tools for experimentation and that again the ability to iterate very quickly is important and I remember back when we were working on adventure labs we went from the physical abacus to iPad based because that allowed us to iterate and try out various experiments very quickly. So I think we are having allowing tools that allow you to experiment, I think it's again very important. You talked about the massive transformative purpose which helps to align people and that is a very important thing from an innovation point of view because if it's something really transformative then I think it naturally pushes people to think beyond what they think today is possible because you're looking at a 10x and just incrementally trying to do that you will not get to 10x and you had various examples from other folks who've also done something similar so I think that was pretty cool. You talked about... I just wanted to add here that having the transformative purpose and telling stories about the journey within the company motivates them like how they helped someone who had to quit her job and now leaving the country everything and not being able to work is now able to lead a fulfilled life. Stories like that are really transforming and really motivate the workers that yes I played a part in making that patient better so that is really what gives that the extra push. Absolutely, absolutely cannot agree. Then we talked about the frugal innovation and I think in India a lot of people use the word sugared as not necessarily the same in my opinion but I think frugal innovation where I think what you highlighted is I just want to I think that's Craig's quote which says limited resources are not a hindrance to innovation in fact limited resources are a catalyst for innovation you know how by putting certain constraints you get people to think out of the box right like if you had abundance of everything then you would just be happy with it and not bother pushing the envelope. So there's a beautiful book by JD Prabhu, he's my batch mate from IIT he's a professor at Cambridge on frugal innovation and jugart so you may have seen that on various airport shelves so I think it's a good read for everyone. Cool okay that's a good one and I think last point which I thought was very very interesting which was disrupt yourself if you don't disrupt yourself someone else will and you know you talked about how you've maybe now had two or three iterations of your own product by teams within your company which are disrupting your own products are kind of coming up with better versions of the same and again that is something that a lot of companies are very afraid to even go in that territory right and it's interesting to see how you kind of pushing the envelope on that so I think I'm sorry if I've missed anything I was just making quick notes as we were going through but these were kind of the eight key mantras I would if I would for the culture of innovation that you are embracing at your company. Yeah I think a great summary better than what we did. Cool so awesome now with that out of the way I think there are a few other kind of questions where I wanted a deep dive on behalf of the audience here and if you will like I'll just you know I'll just take a stab at a few questions and along the way I'll also keep an eye on people if they're asking questions in the Q&A section and I'll try and pick few from there. MVP right I mean so this this term you know Steve Blank originally quoted it Eric Ries made it very popular with his own lean startup and you know nowadays it's very very openly and dare I say loosely used that you know this is our MVP this is the you know and the idea of MVP is optimizing for learning but that is something that anytime you talk about applying that in the medical diagnostics or in general in the medicine space right people are very afraid of right because you can't experiment in that sense because there are lives at stake but you talked about in fact your very first product that you actually sold right was a example of MVP right like how you can you know optimize for learning and do the simplest possible thing to validate your hypothesis whether someone's willing to buy it and whether this will actually solve the problem right and to me the essence of MVP so I'd love to actually hear a few more what stories where you've applied this MVP thinking in your journey. Yeah so you know basically building an MVP is about thinking on first principle basis not trying to reverse engineer something you know you there are solutions already existing those are complex solutions and then if you have to improve on those correct you can't look at them and improve you have to start from scratch what is the problem statement and then improve and then build a new product or an MVP and that's what disruption is about so in our talk we gave an example of for BPP a chair which is a very complex chair which is developed by a European company costs more than 100,000 dollars where the patient has to be moved in certain ways so that the particle through gravity that Dr. Anitha showed comes back to its original position so we basically used a miniature tracker put on the head as we showed and for a few thousand dollars the software is intelligent to tell you how to move the head and primarily that leads to you know an effective solution in terms of solving the problem and in fact this is much more easier for the patient and for the doctor than that complex machinery so if we would have seen that chair and tried to you know innovate that chair would have still remained in our mind and then we would have you know so a more shiny chair or a you know more better looking chair that is all what we would have arrived at but if we are looking at the problem statement what is required to be done and built from there that is how I think innovation and disruption should happen awesome awesome so that's more like a thinking from the first principles and trying to do but when we talk about first principles right one of the big challenges and I think you test upon this also is the baggage of expert knowledge right that gets right as experts we are so rested in in our working that we don't see anything wrong with it and obviously we don't see disruption coming in so I think you talked about to avoid this right one needs to concentrate on learning you know again now that your company itself has been around for I don't know six years now if I'm not mistaken yeah five years yeah five plus yeah six plus years right so now I think your company also would have built a lot of expertise in several areas so I know what is your advice or what are you trying to so that you don't fall into that expert trap and stop unlearning right like just inside of that very very interesting question so I think three things the first thing is that if you are aware that there is this expert trap I think half the problem is solved correct so you know that you are aware of the codec story you're aware of that there is an expert trap then that solves part of the thing so bringing that culture in the company that you know we can also get into this trap I think is a very important thing the second is we are not wedded to a technology as I said and this is a very important point instead of pushing a technology we are looking for a solution and for that solution whatever new technologies are coming we are open to imbibe them so we because we are looking for a solution and solving a problem we will probably not fall into this trap because the evolution of ecosystem of technology we will keep embedding into our system and the third is basically to encourage you know development of competing products and business models and as I said try to disrupt ourselves so that keeps us on our toes and you know hopefully we will not fall into this trap all right beautifully summarized the three I think awareness you know just being aware of it I think is the first starting point and acknowledging that happens so at least then you can do something about it if you stay in denial then probably you know that's the worst thing that so and it's interesting so you're talking about you know moving out of this expert trap and then you also touched a little bit about one of my favorite topics is simplicity in fact in the agile manifesto one of the principles they talk about is the art of simplicity is basically maximizing the amount of work not done and I think you touched upon a very important topic right like the most important part of innovation is actually saying no to thousand things right stacking features or becoming a feature factory you know rarely helps anybody so now that you are kind of out of that product market fit phase and you're into a growth phase if I if I can call that that way you might be having like customers who are using your products and probably asking you for a lot of features right so how do you manage to keep things simple and how do you keep that simplicity at play yeah so I think one difference is that we are not trying to push a product or a technology correct and we are trying to we are basically giving a service so when we give the service we have the control on how the product will look like you know UI UX product innovation and other things so it is now about communication or communicating to the doctors or the users about our simplicity of our product correct so nobody is asking us for features because we are not giving them equipment we are giving them a service correct so they are bothered about patient outcome rather than about how the product looks or you know you need four more features so I think this change of business model helps us in you know and with effective communication helps us in keeping the product simple I think you know an analogy that I can give is that for almost 10 years iPhone had just one product or one model at a time while you know others in the android space would have at least a dozen you know models so I think till the time that Apple was in a unique space they could push for one product or one model and then they could still grow very quickly and very profitably talking about business model and profitability right I think you talked about every product is a service waiting to happen right that's a very interesting way to look at things and focusing on product innovation is not enough anymore right like what is required as business model innovation so can you tell us I think you talked about one for philosophy that you know how you're tying up with the hospitals and you know like disrupting this whole space from perspective are there any other examples you know that you have that can help us in terms of business model innovation yeah so we are coming up with a variable device for one of the diseases I showed that in the presentation also so again there we are not selling the device it's a paper use or in fact a paper episode kind of a business model where they only pay when they have an episode and it has to be you know corrected or requires the variable device so again a very unique business model that we have come out with would you like to add on that so I think it's a it's a device which we wear and then you know whenever they have an episode they will basically use that our app tracks that when it was used for how much time it was used and paper uses how it will be built for interesting how do you get people to like trust that you know this is the right thing you know like it's I'm I'm only going to be charged fairly or things like that like one of the things is if I have a fixed fee I bought a I bought a device I know I put a X amount of money and that that's it right in this case it's a paper use so how do you kind of you know I'm just kind of trying to get a sense of like from a business model perspective how do you convince your buyer yeah so it's sort of maybe rationalize a in the sense that suppose the device were to cost maybe 15,000 rupees and now they have to pay maybe 500 rupees for use so it's easier to convince them and because they can return it at any point so rather than a bigger investment it's a smaller one and once they see the benefit of it they usually then they continue so if they have four episodes in a month they still have to pay just 2000 rupees so that is how we normally that that makes it more easier on the pocket maybe not in the long run but the short term they are more ready to use it. In fact, Amal was telling that you know the whole model with the doctors is kind of lopsided right like we pay the doctors whenever we fall sick instead of paying doctors not to fall sick. So I think a good quote is by Singularity University you know we have to move away from sick care to healthcare. Cool I think those are a few of my questions of course I can keep going on but you know I would also like to maybe take a few questions I think we have about five six minutes left so if you know we could just take a couple of questions if that's okay. Yeah cool I think Pradeep has asked saying instead of brainstorming what is the suggested way for teams to discuss on various ideas what are your suggestions? Yeah so you know basically what we are saying is that or what research has proved including neuroscience research is that when you put people in a room and ask them to come up with a solution the solution will not come up will not be you know derived because it's about connecting the dots it's about lateral thinking current so lateral thinking does not the brain when it is under pressure cannot do lateral thinking lateral thinking happens when you know the brain is not under pressure and when the subconscious brain is working so what we do is we will give the problem statement to the team and then end the meeting there and then you know maybe in a couple of days or something we will then assemble again where people can come up with ideas correct so we are not trying to brainstorm but trying to let people go home you know think over it consciously subconsciously and then come up with a solution the other thing is to have multidisciplinary teams so you know basically it is not again because experts experts will think in a certain way correct but others may be able to ask stupid questions and come up with actually stupid solutions which may actually be very good you know initially they may look stupid but actually they may come out to be very good again simple solutions may not be possible by experts so if it is a multidisciplinary team correct then the others who are not actually experts at that problem may be able to do better lateral thinking or ask the right question or ask the right question cool okay I hope that answers your question Pradeep I have a question from Usha she is asking the transformative purpose in the attempt to cascade it to everyone often gets understood differently by people in organization any tips on making sure every everyone is aligned yes so I think two things one is we are a patient-centric company and then so this is one important thing that we want to communicate to everyone and the second is the massive transformative purpose so I think what helps is two things one is that it has to come from the top correct so in every occasion that I get every speech that you know I give to the employees we reinforce the massive transformative purpose or that we are a patient-centric organization and then it has to be communicated in every form so let's say the increment cycle is happening correct and we are giving the increment letters we would base at the end of that there will be a line saying that you know you thank you for being with the company in its journey to help a million patients or help you know 100 million patients over the next 10 years so in every communication in every form we need to reinforce that cool I think last time you also talked about you know when you are you know you take every opportunity to try and talk real world stories and share that with people so when people hear real world stories that reinforces the transformative purpose and I think that's a great way of not just putting a poster or just talking about it but actually seeing that life every day kind of really helps people aligned correct so you know especially in the IT world there is a lot of churn and other things and we have seen that when people who are developing software when they actually hear stories about patient benefit and as Dr. Neeta gave an example where you know lives of people are changed somebody who had to leave the job after the treatment is now fully you know cured and back to work and things like that those stories when the employees who have seen those patients correct they tell those stories I think it's a very powerful statement of how we are changing lives and it's it's you know that connect with the whole team the whole family the new recruitment family of how we are improving lives of people how we are changing lives how we are making them better I think that's a very important you know part of our journey. Cool I think there's a lot of questions but I'll take one last question I think we have two more minutes left so this is from Abhay he's saying at any point in at any point of time you face the challenge of being held back by expert opinion like in case of Elon Musk and how did you handle that yeah so probably it was I was the first one who raised the objection so seeing patients throughout my career he said how will you give a diagnosis if you do not see a patient and my first reaction was it's not possible and then he said then we started working on it like without seeing a patient what do you need to know what do you need to see and that was how building algorithms building the history taking all those things started from there. So I just to add so basically we are we are you know we have 150 clinics where the tests are happening when the patients are coming and then all the data comes at the back end and then we you know use experts machine learning computer region to provide diagnosis and interpretation so you know initially when I said this then you know Anita and the other top doctors said that you know without seeing the patient we how will we be able to you know give a diagnosis and so that's the story that she's even seeing and some of the other doctors said that even seeing the patient we can't give diagnosis how do you imagine doing it without seeing the patient and then by with the equipment with all the inputs we got was how each step helps to reach final the correct treatment management things whatever is required. I think what I understand is the key thing is to try and figure out you know like ask the right question in some sense right like if you didn't have a patient in front of you what would can't you do right and then you show a way that hey this is possible technology is to be able to do this and then slowly you start basically going from the point of view that this is not possible to maybe today and correct me if I'm wrong but today you know seeing that hey actually this is far more better than. And this is the only way that super speciality care can be taken to the masses a democratization there are very few people who are at the top super specialist in every single field everyone cannot reach them but this is the way technology can help every person to be treated by a super specialist. Awesome so I think again reinforcing the transformative vision right like is using the right tools to try and make it accessible to and democratize it so that it's accessible to as many people in need awesome. I know we've run out of time you guys are changing the world so we will wrap this up again I want to thank both of you for taking the time today and joining appreciate and helping us kick off the Agile India conference this is the 18th edition maybe it would be an adult. All the best for the conference. Thank you so much and it was a pleasure being here and talking to you.