Health Technology Podcast Interview

Recently our CEO Joe Urban recently sat down with Christine Winoto of UCSF Rosenman Institute on The Health Technology Podcast to share fundraising stories, helping Potrero successfully commercialize its product, and how the team is developing a platform to solve a $10B problem.

To listen to the full podcast episode, click here, otherwise enjoy the transcription of the interview below.

Episode #20. Joe Urban: Detecting Acute Kidney Injury at Potrero Medical

[Christine] Potrero medical is working to detect acute kidney injury or AKI. AKI accounts for more than 300,000 deaths each year in American ICUs. But clinical reports show that if doctors could monitor urine output, they could detect AKI early on and reduce the risk of death.

Joe successfully raised a $27 million series C round this past July, and after getting 15 plus polite nos from investors, he thought it would be good to change how he pitched to the investors.

He will share with you what he did that made him successful in his fundraising effort.

Joe started his career selling wine before making the transition to the medical device industry and has no intention of going back to the wine industry. He is ever committed to this industry as it makes a huge impact on people’s lives. Enjoy the talk.

[Christine] Welcome Joe. Thanks for joining me today on a beautiful Friday afternoon, it’s so sunny outside. But anyways, congratulation on your recent fundraising success. You helped Potrero raise $27 million dollars earlier this year. Is it this summer that it will be one year?

[Joe] The summer, June of 2018, we had our final close and it was a lot of fun. We have some very supportive investors and it’s been a fantastic journey so far.

[Christine] Yeah, that’s great. So maybe before we dive into more detail on the fundraising aspect, can you tell us more about what Potrero medical is and what problem you’re trying to solve?

[Joe] Sure. Potrero medical was started by a guy named Dan Burnett, MD, and it was born out of the TheraNova incubator.

TheraNova I believe has 13 portfolio companies now and Dan is a serial entrepreneur — an engineer by background, MD, also spent some time at the FDA and as a VC, so he understands all the different facets of making a device a reality.

Four years ago, this started off with a clinical problem that’s existed for over a hundred years.

The Foley catheter that’s used in the ICU and OR settings around the world was largely not innovated.

It was incrementally innovated over the last hundred years, but nothing that’s significant and urine output is a critical vital sign and also the least invasive way for a medical team to understand what’s happening with the patient’s kidneys in the form of urine production; whether it’s a rapid production or a lower production it can show what’s happening globally with the rest of the body.

The reason that’s important is because every time the heart beats, about 26% of the blood goes to the kidneys, and so an increase or decrease of urine production can very quickly show what’s happening with the patient.

In fact, it’s a problem that is the last of the vital signs to be automated and in this day and age would be like checking somebody’s heart rate with a stethoscope every hour on the hour and expect to have a great patient outcome.

In the ICU and the OR that just doesn’t happen, that would be malpractice. And so Potrero has embedded sensors into a traditional urinary catheter, and those signals are picking up some very unique critical and vital signs such as intra-abdominal pressure, which today is invisible.

Currently, a medical team could put together a tubing set, irrigate the bladder, increase it and they can see what’s happening internally, but it’s highly variable and very tedious and the nurses absolutely hate it.

So what Dan and team created was a pressure sensor inside the Foley catheter that can register the pressures inside the abdomen with a push of a button, and more importantly trend it over time.

So when the pressure starts to increase in the abdomen of a critically ill patient, the medical team of a doctor and nurse and everybody else is consulting on whether to take that patient to emergency procedures to relieve some of that tension.

Right now it’s somewhat of a guess and usually, it’s too late. What we’re doing is we’re catching it early and showing them the trend of intra-abdominal pressure.

[Christine] You’re saying earlier that the nurses now are doing it right, more like when they need to?

[Joe] Or if a doctor asks, like in a trauma bay.

And by the way, this is only one of the parameters that we’re picking up.

We’re also picking up core body temperature and urine output, and the urine output is where the greatest need is.

Intra-abdominal pressure is neat because it doesn’t exist today where you could trend over time.

They put together a tubing set, spike a saline bag, irrigate the bladder, and then they hold a manometer at the bladder level.

If you have a thin patient then you might be able to know where the bladder is.

If you have an obese patient that’s positioned in the ICU such that you don’t know where the bladder is, three people could do the same rating and get three different results.

So it’s really intriguing the doctors and nurses that have used it this year and are super impressed with it. Urine output: so urine output is a vital sign. This is something that is interesting to me because I was at C.R. Bard for years and we tried to solve this and we couldn’t.

It seems pretty simple. You have a Foley catheter and you’re trying to make sure that the bladder is empty so you can see what the kidney is producing.

It’s a deceptively difficult fluid dynamic problem that had yet to be solved until Potrero and Dan Burnett created the Accuryn® Monitoring System, and now we’re able to measure with very precise measurements what is happening with the kidney.

What we’re focused on right now is taking this information and applying it into a machine learning algorithm so we can predict the future status of the patient.

We’re in our clinical evaluations and validation of that right now and it’s very promising.

We presented to the military back in August and with our algorithm, we were able to detect and predict Acute kidney injury three hours before the gold standard. 97% accurate.

[Christine] That’s fantastic. And why is that important?

[Joe] AKI, acute kidney injury, has five stages: risk, your kidneys are at risk of injury, injury, failure, loss, and then end stage.

When you get to failure or kidney failure, it’s catastrophic. You have a one-in-four shot of dying.

The number of patient deaths from renal failure a year is 300,000¹. Now when you put that in perspective, and we throw around numbers, but these are 300,000 people with families and they are no longer with us.

That’s more people than what lung cancer kills a year. You don’t know of AKI, right? You don’t hear of it, you know, everybody knows lung cancer. It’s more than breast, colon, and prostate cancers combined.

It is a silent killer that is just accepted because there has been no great pathway to address it.

The cost to the US Healthcare System is 10 billion dollars for AKI alone. So the problem we’re going after is is pretty sizable, and the hospitals that we spoke with are very excited to at least address the shortcomings.

[Christine] So you’re now on clinical and you mentioned that you are working with the military. Why is your technology important for the military?

[Joe] The kidneys are the first responder.

There’s a study that was done where a patient would give a liter of blood and the first indication of anything was that urine output dropped immediately because the kidneys are so sensitive.

They’re the canary in the coal mine. So we have a DOD Grant right now to study with the pressure balloon whether or not we can detect a hemorrhage.

So if a soldier is injured in the field and they’re ex-filling that soldier out of a combat theater to a hospital that isn’t either Germany or the US they can monitor with precision what’s happening in their abdomen. Right now it’s just impossible.

That’s why the DOD is interested. We have an NIH Grant to study in sepsis patients acute kidney injury, but we are a commercial stage company now, so we are selling to hospitals all over the United States.

So it’s not just the DOD. I reference that because this was when we presented the data after it was gathered over the last two years.

[Christine] Okay. So you’re commercial already?

[Joe] We are. We’re in hospitals and we’re scaling the organization.

We closed our fundraising round in June or moving to a new headquarters, 17,000 square feet.

We have more demand than we have supply. Our board of directors calls them “champagne problems,” but they’re still problems and so some of the challenges as a CEO that I’m dealing with is how do we scale fast enough without burning too much cash as we cut in some of our cost-saving measures. So that’s the biggest driver for me right now.

[Christine] Can we talk about your fundraising? That’s the series C? How big is the round?

[Joe] $41 million in private placement and we have seven million in grants from the NIH and the DOD. So $48 million.

[Christine] Wow, that’s sizable and in the last round, many of the investments come from the Chinese investors?

[Joe] We did. We had a group called GT Healthcare and Sonder capital.

GT and Sonder led the round, and people realized how big of a problem this was globally and that we have a pretty clear shot at executing from a commercial plan.

And so it was it was a neat experience for me as a first-time CEO to raise money and it was very humbling.

I did not realize how difficult of a challenge it is to raise money and to get the message across. It was a great learning experience and I wouldn’t trade it for the world.

[Christine] What did you learn from that?

[Joe] You know, when I first went in, I was one month in, we worked very hard in August to get the pitch deck ready, which is the presentation that you present to venture capitalists.

I worked with my team and a creative agency to put together this presentation of what I thought they should know. And I was sure of myself.

I went in and I presented 15 times and 15 times I got the same answer. And the VC, the Venture Community, was very very gracious and polite and they politely passed and I think I learned that you need to seek feedback.

And you know, I was coming in as a first-time CEO and I had no idea if what I was saying resonated.

What I should have done is ask for their feedback and when I realized that we needed to get a hold of the message and make sure that what I was meaning to say was being articulated correctly, I asked a favor of a friend.

I was put in touch with a guy named Rick Klau at Google Ventures and he was a CEO at one time and he agreed to meet with me for an hour to hear my pitch.

I don’t know if you’re familiar with Google, but they have a very transparent, honest, raw, and unfiltered feedback system with their OKRs and their objective key results.

It’s what has made Google great something. I had never experienced in person to that level, even being a military veteran, and I presented to Rick and he was focused on the screen for probably 30 minutes as I went through my presentation.

I tried to make eye contact with them. I tried to have conversations and he was so focused and he wouldn’t do that.

He just listened and looked at what I was presenting, and when I finally made it to my last slide and I concluded he turned to me and he said: “Are you finished?”

I said, yes.

“Go to slide one.”

And it was gut-punching feedback, but it’s the feedback that I should have had and I didn’t and so I credit Rick.

Now when something great happens with Potrero, I send him a note and I thank him for the gift he gave us and gave me: that honest, hard-hitting feedback.

[Christine] What was the feedback that he gave you?

[Joe] That my message was meandering and that I was going in and out and I needed to focus. Just trying to describe one thing from a clinical standpoint and realize that I’m talking to a layperson in clinical. He knows a little bit but he’s not an MD and everybody on Sand Hill, all the venture capitalist that I’d met with, are either syndicates or they’re Venture groups or family offices or investors. They, for the most part, were all laypeople.

Because I understood how big a problem this is. I’ve traveled the world. I’ve seen it. I’ve seen the patients. I’ve seen how catastrophic it can be, but my message was all over the map and Rick’s feedback was so hard-hitting and it was 20 to 30 minutes of feedback that no one had ever given me.

Before, I was working in an echo chamber where I would present to my team. I’m the new CEO and they’re saying well, “it sounds great,” and even Dan Burnett is like, “sounds good.”

Rick’s feedback was helpful because I was so overconfident and I should have been overly humble, especially in the first one.

So what I learned is to actively listen to and seek the feedback to present to those like I should have practiced with a handful of venture capitalists first.

So what do you think? How can I make this better? And so I think those were the biggest learnings for me as I walked out of Google.

 I sat in the parking lot and it was a pivotal point for me. I sat in the car and I just stared at the steering wheel for a good 10–15 minutes processing what I just heard.

I took five pages of notes and I realized my overconfidence, and I would even say arrogance, coming in and I use that.

And I’m saying it wasn’t necessarily intentional but should have gone in with it greater humility.

And that’s the point where I stopped selling and started listening, and I’m tightening the message.

I met with lots of venture capitalists and I listened to what they were doing and what their goals were. Instead of continually driving into the point of what Potrero is doing, I’m making sure there is alignment between that person, their firm, and Potrero because this is such a mutual street and we’re taking money on the promise that we’re going to return it times x.

So for me one side, I listened to that and I heard it.

As a young first-time CEO, that was so critical and I know it was a day that I’ll always remember.

I’m forever grateful to Rick Klau at Google for spending that time with me.

[Christine] When you meet with the venture firms here, I’d like to hear your story and what you’re doing to understand where they are coming from: what their needs are and how do you navigate the conversation so that they talk more about what their own needs are rather than you telling them about your project.

[Joe] So what I started doing is I would research and understand who my target audience was if I was going to go present to them.

It was such a whirlwind when I first started, you have so many things happening and you’re learning so fast.

So when I first came in we were going from a science project to locking in V and V and getting ready for commercialization.

So I had a lot of activities, and after that moment with Rick when I would schedule a meeting, I would research on LinkedIn to understand who I’m sitting down with and having conversations with people that may know them and then when I would come in just ask some baseline questions:

  • What is important to you in your firm?
  • What type of investment what are you looking for in a portfolio company
  • Tell me about some of the successful portfolio companies.

And when I came in I just said look, I’m figuring this out because I’m a first time CEO, and I thought that that would make it a bad thing to say but people would open up, and that’s the ethos of Silicon Valley that everyone’s been there.

They know how hard it is to be here. And you know, it’s a great place to be but it is hard.

And then I would ask about their fund and the targets for their fund, where they are, and what they’re looking to do. And so what I found was that some people want to stay in the loop.

“Look I just want to know so I can keep tabs” or “We’re usually an earlier seed” or “You’re raising your C, and C is a little too early for us, we want commercial stage companies.”

Then I say okay, why don’t I provide just an update and then I’ll put you on our quarterly newsletter and then it was an opportunity for them.

It was an opportunity to understand what was happening and for me, it was a great opportunity to keep refining the presentation on our pitch.

Afterward, of course, I’d say, “okay, I know you’re a later stage company. What do you think, is this making sense? Am I articulating it?” So when I go to somebody that is a serious investor I do articulate it correctly and I just kept tightening it and tightening it and tightening it.

So I think that those were the jewels in that experience, at least they’re jewels to me because it was such a humbling and wonderful experience.

[Christine] That was good feedback. So Rick Klau, do you know him personally or did you come in cold?

[Joe] I was introduced to Rick and sent him an email.

He scheduled an hour, and you can only imagine, Google is hearing every pitch in the world.

To give me an hour of his time was worth more than any gold that you could ever get.

And it’s not just that it was an hour of his time, because I could tell you he didn’t check his watch or his phone once, his eyes were intensely focused on the TV where it was being projected.

He did not even look at me until after I finished the presentation, then the feedback was rapid fire and hard and raw.

[Christine] So did you go to the 15 VCs that you pitched to the first time and come back with another presentation?

[Joe] No, you know I realized that with them, I probably set the wrong tone.

My message was too meandering so to go back and say this is what we’re doing now?

My preference is to just keep them informed and I asked for permission, I did go back and ask can I keep you informed of our progress?

It’s one of those things where as we progress and go through this I’ll keep them informed, and if it’s the right time for them, like if we do a series D, then so be it.

They were very polite and gracious to me and for that I’m thankful.

[Christine] Yeah, so you keep mentioning that your message was meandering and then at some point, you mentioned about how you deliver the message from a medical approach rather than more layman terms.

[Joe] Well at that point it would be very clinical and then other points it would be very commercial.

I look at the presentation now and ask myself:

  • What do I want to communicate to them?
  • What’s the most important thing that I need?
  • Whether it’s a doctor now that’s buying the product, or an investor, or a potential employee. What do I want to communicate?

And before I was telling a story that just wound through the hills and people would pay attention but it was not compelling, so just tightening that and understanding that each slide needed to be driving to the point.

So eventually the presentation went from like 30 minutes to 6 and it was: “this is what we’re working on at Potrero.”

Six to ten minutes, somewhere in there because we tightened up our message. People don’t want to sit there and listen for 30 minutes to a PowerPoint presentation.

I don’t want to and I know they don’t want to, and so I tightened it. I used more visuals and then I would just drive home the point and not waste their time.

[Christine] Then you can use the remainder of the time for discussion.

[Joe] 100%. And questions. Then if there’s a “hey, can you tell me more about the in-depth clinical aspect?” then I can pull up a presentation that was geared towards that question.

But get through the first 10 minutes first and just focus on what you’re doing. Why are we here? You know, maybe there are organizations that can pitch for 10 minutes and they write a check that is just the permission to go another five minutes.

So I wanted to be very respectful of their time and present the information that, over time, we learned was mutually interesting.

[Christine] So if you have to give advice to somebody who’s going to pitch to a VC firm, and they need to tighten the slides to the 5 to 10 minute mark, what needs to be included in that?

[Joe] Yeah, I think our pitch deck went down to probably ten slides, well with the intro maybe it was 15 at the most. When we first started we had 30 to 35 slides, and we didn’t even show the product until like the tenth slide.

So they’re sitting there going, “wait, what am I here for? What? This is frustrating.”

They’re very busy. Right? So right off the bat, the new title slide had the product pictured and I would introduce the company and Potrero and our mission so they’d see it.

Then the next slide was the clinical problem, why this is important and the cost it poses to the US Healthcare System.

The current status quo of why this technology is better, for example, than the Foley catheter is that a foley vapor locks and creates a barrier to where the bladder can’t empty.

If you’re pushing fluids based on what you see in the urine drainage bag, you’re hurting patients. You’re overloading them and it spirals the kidney.

Our technology clears that line every 1 to 2 minutes, and it’s important to articulate that but not spend a lot of time on the technical or the deep clinical details.

Instead, we just share with the audience why our technology is important and then going on to discuss how we’re going to execute our commercial plan.

Back then, it was just us sort of saying, “we are going into commercialization.” Now I can say, “Here, we said this and this is what we did. And everything we’ve said we’re doing.” So that’s been really gratifying thing.

Then there are the financials.

So Venture capitalists and investors are interested in helping the world, but they’re also a business that is in it to make money, and that has to be clearly articulated.

They have LPs that they answer to, limited partners, that have given them money to invest in companies.

So they ask, “How am I going to make money for my customers, the LPs?” and articulating that and the pathway was critical.

[Christine] That’s good. I think that would be very helpful for a lot of people.

[Joe] I hope so because I look at it in a different way now.

When I first started with 20 years of sales and marketing experience, I thought let’s get this over with so I could build the company or we can build the company. And now if I could help someone else or another CEO, well, it’s not easy.

Even if it’s just one thing I say, if it can help that one person like Rick helped me that day, it will be worth it.

I feel that this is probably what has created this fabric and ethos here in Silicon Valley where you are always wanting to pay it forward, I feel like I owe it to others to do what Rick did for me.

[Christine] Let’s get back to what the reason behind that is. It’s all that great tapping of a lot of people like you who are willing to give back and coach and mentor the young entrepreneur.

Well, the other things that we hear a lot about are entrepreneurs coming in and seek funding from these “Pirate Chinese” investors. Oftentimes, people don’t know how to work with them.

Obviously, you’ve been very successful in getting funding from the Chinese investors. Can you tell us about how you navigate that and how you make sure you work with the right investors?

[Joe] I was introduced to this group by another investor, GT Healthcare, and we had conversations with them.

Our goals were aligned. They had LPs that were there based in Hong Kong and they are very very sharp Business Leaders. And so when they came in they did a full diligence the toward our facility multiple times.

They interviewed me. We worked side-by-side. And you know it was it was really interesting.

I was fortunate to be introduced to the right investors, and I wouldn’t say there are “wrong investors” but we were aligned.

I can’t speak for the other Chinese investors, but I think it’s just like here in the US, you have great investors and then the not so great ones… I think it’s everywhere.

We were fortunate to find a series of very good investors for our round. At one point, of the $27 million, after everything was factored in, what was left after the pro rata, we had 10 times that amount trying to push in. Anytime you have that situation that’s the best situation you can be in so we’re very very blessed and fortunate. Once it happened it was fast.

[Christine] So now what, what’s next? You got the $27 million but now the real work begins.

[Joe] You know, it’s one of those things where you expect to feel wonderful when you raise your fund.

Like I thought when I first started raising $27M, and it’s awesome. It is a great feeling like, good, now the weight that I was carrying on my shoulders is just different. Instead of having to raise the money, your job is to keep the company going now.

Now I have to build the company and keep driving forward tremendous shareholder value.

We are in the process of moving to a new HQ in Hayward and our HQ will be 17,000 square feet.

We have a clean room, we have IQC, we have a giant Warehouse because we’re building a ton of these devices, and we have our R&D teams very excited because their space is so big and it’s the same thing with the other departments.

And so that’s at the top of my mind right now, the move.

We’re doing a tremendous amount of work on driving down the cost of the product and validating that everything is operational because when you cut in a new product or part you have to make sure that it doesn’t affect the quality of your product, and we are doing that with tremendous diligence.

I know that as we squeeze out the manufacturing inefficiencies and we focus on scaling the organization and we drive down our bill of material costs, it’s a highly profitable company. It provides those investors that value.

While I’m doing these activities, we’ve segmented and separated the engineers into two groups: a group that’s focused on R&D-so research and development, they’re testing all the materials and they’re making sure that the device is still functioning as we look at cost-saving projects.

Then there’s the research and Innovation group (R&I), and these are the teammates that are focused on stuff that will be going to market 12 to 36 months from now so that, to me, is pretty fun.

We continue to scope up and drive value beyond what we have right now and that is really neat, and I think the team agrees that it’s wonderful.

Then the global expansion; we’re in talks with a Japanese multinational strategic to distribute our product in Japan and we have conversations ongoing in China, South America, and Europe, and also with Africa in South Africa.

It’s a lot of things happening at once, so we are making sure that we keep our regulatory pathway going with our predictive algorithms to make sure that we have our label by the end of 2019.

[Christine] That’s great, your experience. You have a lot of sales experience, and I I learned that you were at one point selling wine before you came to the device world.

[Joe] That’s right.

[Christine] How did you make that transition?

[Joe] It’s interesting, I was going to be a lawyer in college. I went to Colorado State University and I was the student body president at CSU.

The way I found Gallo as the student body president was related to our big rival, which was the University of Colorado. And we had a bet that year between the student body presidents of both schools: the loser had to let the winner shave a mohawk into their head. And this is back when I had lots of hair and, you know, we lost. We got creamed that year. It was… it was bad.

So he came onto our campus, TV cameras were there, and he literally shaved, to the skin, a mohawk into my head. It wasn’t just in a mohawk, I had a whole have it for a month. That was the deal, so I couldn’t just like immediately shave my head. He didn’t do it even, so it was slightly offset and I looked ridiculous because I’m the student body present with a mohawk.

I was a political science major, so I was about to go to law school at either CU or DU, those were the two that I was looking at.

Then my brother came in one day, he’s a freshman and I was a senior, and he came into my office and he said, “Hey, the career fair is happening. Let’s go mess with them.” And so we walked upstairs and I was walking from booth to booth, in shorts and a t-shirt with a crooked mohawk.

I’m saying to them, “hey look, are you hiring?” and they’re looking at me like they can’t get me away fast enough and my brother is dying and he thinks it’s hilarious because I’m going to all these employers and they were just they were looking beyond me, you know it was fun.

Then when I got to the Gallo table, they were very gracious. Like “what’s up with the Mohawk?” and they were just chatting with me when somebody walked by and slapped me on the back and said “hey pres” and walked off.

And they said “what was that” and I explained that I was a student body president. The next day the national recruiter is in my office and he’s like, “listen, we’ve found your resume” (cause back then you had resume books) and I fit their profile.

I was student body president, fraternity leader, and army ROTC. So the student leader started having conversations with me about coming into their National recruiting class. They recruit three each year, and I went through with like hundreds of students and made it to the final three, then the competitive side kicked in and I wanted it.

The more I looked at this the more I realized I would be miserable as an attorney and thank goodness that my brother came in. Otherwise, I’d be an attorney and it’s not, like, I have lots of relatives who are attorneys but for me, I know me and I would not have been happy. I would have made it happy but I know what I’m doing now is very purpose and mission-driven.

And so I ended up at the Gallo Winery in the sales and marketing team. Five years progressed through the leadership, and then I got a call from Boston Scientific.

[Christine] That’s random…

[Joe] Not necessarily, 25% of Boston Scientific’s sales organization comes from consumer packaged goods and the majority of that 25 percent come from Gala.

[Christine] They must have really good training.

[Joe] They have incredible training. So it’s Procter Gamble, Pepsi, Xerox, and Xerox isn’t consumer packaged, but Xerox and Gallo was the bulk majority of the people because if you have to fight for an inch of shelf space you’re going to go in and fight for your business every single day.

And so it was a tremendous training the people who bought Gallo had screened to get to that point. It was a winning model for Boston and it was a fast way to get very well trained salespeople that they can transfer clinical knowledge to, so when I went to Boston Scientific, the clinical training was intense.

We spent months just for the initial training, and twice a year we would go to Boston and make sure that our training on the product and the technical aspects, as well as the clinical aspects, were completely up to date. That’s how I ended up in Med device 20 years ago.

[Christine] And you stayed, so no going back to the wine industry?

[Joe] No going back to the wine industry, I’m just a customer now. I am a customer but that’s it. I still buy Gallo wine, Gina Gallo is a tremendous leader. She took over the business and she’s just a fantastic leader.

So I think the Gallo’s have grown their business and I wish them the best of success. It’s a great company with a wonderful culture and they just treat their people very well.

[Christine] You shared some of your advice with us earlier, but if you have to give 3 bits of advice to early entrepreneurs, what are they?

[Joe] Don’t fall in love with your idea. And I did that.

I thought that our presentation was white hot and it was a dud, you know, just our message was off. But I’ve seen a lot of entrepreneurs fall in love with their idea, engineers fall in love with their project and so on, and I think that it’s important to understand when you need to seek feedback.

Know when to take it, know when to pivot, and know when to adjust, because that’s critical.

I think it’s also important to empower people to make decisions and to look at things creatively.

That’s why I strive to create an environment at Potrero where people can be fearless, but not reckless.

Fearless in the sense that they can try things and not worry about something like getting fired, and I say that because, with some companies, there’s a concern that “I don’t want to stick my neck out because I’ll get thumped.” You know, I’ve lived that, I’ve seen it and I just don’t want it at Potrero.

So I encourage the team to try things, to run things in parallel, and to ask for feedback. I’m just one of the people of Potrero, I don’t have an office, I sit with the team.

We have 50 people and I believe that everybody has a role and that’s how I look at it like every single person’s important to the organization. I take out the trash because I believe that if I ask somebody else to do it, I had better be willing to do it myself. So really it’s about treating people right.

We have a team meeting at 1:00 today and I always like to kick it off and take a moment and just let everyone have a little fun.

I like to start by giving two puns, today one of them is “how do you put a baby alien to sleep?” You rock it. It’s a chance just to kind of get people to unwind a little bit.

I’d ask every employee five questions that are unique to them, and then they ask me the exact same questions. We scramble them and every week I present the answers for and the team and the entire company has to guess whose answer it is.

It allows me to get to know people and similarly for them to get to know me, and it’s amazing what you find out and people.

You wouldn’t expect it but our lead data scientist, I found out that he loves speed metal. You would never guess it seeing him, but he has got his earphones on and he’s listening to speed metal. But it comes down to people and culture and a happy environment will create long-term success, I’m convinced of that.

So that was kind of a rambling, “meandering” story. It’s Fearless, not Reckless, and I would just say that don’t fall in love with an idea.

[Christine] So I always ask people, what book are you reading? And is there any book that you can recommend for me?

[Joe] Well I’m dyslexic and so are my two kids, and so for me, I can and I do read books, but what I’ve found that has been a complete life changer is Audible.

I listen to audible books at two-speed, just that’s the way I process it and over the last year I listened to 70 books.

One of my favorites is Happiness Advantage, and that’s about how to drive an amazing culture. It’s about how people are wired, and that’s I think just a fantastic book.

I look at some other books, like Extreme Ownership, which is a great book written by two former Navy Seals. It involves them relating their experiences in Iraq to business and how to approach problems. I actually bought 10 copies and I asked the entire company to read them and pass them when they were done, and they did.

There are certain things, like, we had a business emergency happen and I remembered a part of the chapter and so I flipped to it and I sent an email to read page 238. This is how we’re going to do it, and that extreme ownership and that mindset, the Power of Positive Thinking and the words and visualization and the critical nature of that makes it a wonderful book and reminder of how to do it.

I also bought the team the book called Endurance, and Endurance is the book about Ernest Shackleton.

Ernest was going to cross Antarctica in the early 1900s and it’s a story about how he put up an ad in the UK in London that said, “50 men wanted, incredibly dangerous, many dark nights, the chance of return: near-zero, pay: terrible.” Right? But he posted this thing and said: “Glory upon success: guaranteed.”

There were 50 spots and he had two thousand people show up. So he went through and he picked people that were positive in nature because to be in those extreme conditions, you have to have a positive mindset, an optimistic mindset, and it proved to be very important because the ship was locked in ice and crushed.

He brought everyone back, not to ruin the book, but it’s well-known. But it was important because there’s a lot of commonalities between Ernest Shackleton and the Endurance and a start-up like Potrero.

It’s dark.

You don’t know what’s going to happen.

The wages are lower than other places.

Excitement is guaranteed, and fame and glory should we be successful.

So the team really enjoyed reading it. Anyways, those are some of the top picks out of the 68–70 books I’ve read in the last year.

[Christine] Great. Well, thank you so much. It was really fun to get to know you and I learned a lot from you today.

[Joe] Well, thank you. It was a lot of fun.

Disclaimer: Currently, Potrero Medical is developing a predictive health platform to help medical teams better predict adverse outcomes in critical care settings. The Accuryn® Monitoring System is not cleared for prediction of disease states or clinical conditions.


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