Mark O'Brien:
Hello. I'm Mark O'Brien, and you're listening to Transformational Healthcare Leadership, a podcast series from Oxford University's Saïd Business School, A collection of interviews with leaders from across the globe exploring the five key themes of the school's healthcare leadership program, the personal leadership journey, understanding the evolving environment, effective strategy formation, driving innovation, and improving performance. The COVID-19 pandemic precipitated massive disruption in healthcare. So how have healthcare leaders responded to this challenge? What are they thinking? What personal journey are they on? How did they survey the changing landscape? What strategies have they tried or intend to try to ensure their team, their organization, their country not only survives, but thrives?
In this episode, I interview Annie Flamsteed and particularly explore the themes of the personal leadership journey and driving innovation. Annie Flamsteed is a dynamo. Meeting her, you can't help, but be blown away by her energy and enthusiasm. Annie started her career as an elite competitive gymnast choosing to exit the sport in her late teens due in part to the incredible pressure placed on high-performance athletes. She is currently a second year medical student who took some time off to build a successful international health tech company, iNSPIRETEK, in 2019. As you'll hear, Annie is very open about the mental health challenges that she and many elite athletes face, but how she has responded is an outstanding story of leadership and entrepreneurial business success from one so young. I began by asking Annie to outline her personal journey away from elite sport to becoming a mental health tech solution provider.

Annie Flamsteed:
So I grew up in a regional town in Australia, about an hour and a half west of a major city, and I started gymnastics at the age of six and very quickly was training 35 hours a week. It very quickly became a huge part of my life and my family's life. I had an interesting career in the sport, I guess you could call it. I was the right age. So I was 16 in an Olympic year, which in gymnastics is extremely important, and I'm short. I'm tiny. So that helps from a genetic perspective. I guess everything was lined up for me to be a brilliant elite athlete, and not to be self-deprecating and say that I wasn't, but I definitely didn't reach my full potential, and it was interesting to me because it was never due to physiological constraints.
So I had my fair share of injuries, surgeries, you name it, but none of it ever seemed to really phase me. It seemed, from a medical and a recovery standpoint, very linear. It was have the surgery, do the rehab, back in the gym the next day, whereas what really was the demise of not only my gymnastics career, but a lot of my friendships, and relationships, and I guess quality of life as a young person was my inability to cope with the pressures of not just elite sport, but growing up in this generation, the pressures of that in general.
So when I retired from elite sport, I was pretty broken. I never competed for Australia at the Olympics or the Commonwealth Games, and so that was tough, but it was actually the intensity of the anxiety and the eating disorder that I'd lived with for years, and years, and years without diagnosis purely because it was almost seen as pretty normal in elite sport to struggle with these things that then when all of a sudden elite sport was no longer there, it was very, very evident to my family and my medical team that there was something more going on.
So I very quickly, I guess, became extremely passionate about preventative healthcare, and data analytics, and research, and I got very interested in this whole concept of how it just seems that most things are dealt with from a sports perspective and even just in the general public on a reactive basis. So we wait until people are very sick or we wait until it's too late to intervene with supporting resources or education. So the pivot for me from sport to where I am now was literally to try and I guess hack the system, if that makes sense, around preventative healthcare and using data analytics to predict when or if someone was potentially going to struggle with mental illness, and then intervene earlier before a clinical intervention was needed. Not to replace it, but to, I guess, accelerate access to clinical healthcare. So, yeah. It was definitely a journey. That's for sure.

Mark O'Brien:
That's fascinating. Annie, look, I'm also fascinated by the products and services you've developed, so can you tell us more about them?

Annie Flamsteed:
Yeah. Absolutely. So, in sport, in elite sport especially, and this is global. In fact, in the UK and the United States, they're a lot, I guess, more innovative and forward-thinking than we have been here in Australia for some time. Some years ago, a bunch of companies emerged in the sports tech space all around athlete management or athlete performance management, and this platform called an AMS was developed. For those listeners who have used an LMS or a Learning Management System maybe in their careers, it's not dissimilar, although there's no content involved. So, literally, the athletes will report if they're in pain, or if they're menstruating, or what their mood is like, or anything that they need. The concept is that the coaches and the medical team of these elite athletes look at this data, and then they intervene by changing the training load or progressing it for them to see a medical doctor, or a physiotherapist, or something like that.
Now, I had one of those, although never got a diagnosis for my anorexia, for my chronic anxiety. A lot of my injuries, once they were found out, they were so far down the line that the only way to fix them was with serious rehab or surgery, and all of them were overuse injuries. So these athlete management systems that we had access to were not really doing what they were set out to do. Now, that's no fault of the products on the market. It was just that we were given these systems very late in our careers. If you think about medical intervention and you think about the healthcare system globally, that's actually pretty consistent. We intervene with these brilliant systems, and processes, and resources, and tech solutions when things are really chronic, or when people are very wealthy, or when people are in elite sports. So, at the top, crème de la crème, if you will.
So the context of that is important to talk to the product suite that we've built here at iNSPIRETEK. So when I was doing my studies, which I plan to go back to, I realized that all of the research we were looking at was I guess on certain subgroups, which again, no fault of anyone's, it's just available, and I thought, "What if we could just capture data on huge amounts of the youth population globally, and instead of selling it to big pharma or doing something like that, we actually used it to create data-driven policy decisions and interventions at a governing level or an individual level to drive positive human behavior change?" So our product suite started off trying to, I guess, be an AMS or an Athlete Management System for kids in community, sporting clubs, and schools.
We started off with a single product. It was a mobile app. Kids would go on there, and we built the infrastructure such that it was GD... Well, it is GDPR-compliant, COPPA-compliant for the United States. We've got all the correct TGA and FDA things in place should we need to go or want to go down the clinical arm, but the front-end experience for the child or the end user is gamified. We use emojis, and we ask them, "How you feeling today?" They can log if they're in any pain. This was back in 2019, we launched this. Originally, it was going to be like a consumer product on the App Store, and we launched it, and we got great success, but we very quickly realized that just tracking the wellness of young people wasn't enough. These young people were screaming out for help and support, and so we built a content feed, an educational component into the app for them where we built a clinical board, psychologists, dieticians, sports scientists, et cetera. What we would do is we would then create educational resources based on the biometric entries we were asking these young people to enter.
So an example would be mood. So if they were saying that they were in a really poor mood, we would then create a course around how to lift your mood or very, very basic things. If they're feeling anxious, some meditations or some mindfulness, but all clinical-grade and evidence-based educational resources. Instead of giving them to them like they were sitting in a doctor's office, we would put cool music behind them, we'd get athletes to talk to, actually read the scripts, and all of a sudden, we had this incredibly captive audience of young kids tracking their wellness, engaging in educational resources, and dare I say it, turning to our app instead of the usual social media platforms.
That was great, but then we realized that actually, "Oh my goodness, we've got all of this data, and we've got this really captive audience. Imagine if we could build an algorithm that instead of the kids or the young people just tracking their wellness, and then having to look for the education in another part of the app, imagine if we could build an algorithm in our tech stack that allowed us to automate a clinical intervention or an educational intervention to our end users based on not only their subjective biometrics that they're putting into the app, but their objective ones as well, as well as automated biometrics from wearables."
So we set out to build this, what's now called our Automated Intervention Algorithm, which is getting interest globally, which has made me so proud. I mean, it's not rocket science. If you want to think about it in a simplistic way, you think about Instagram. You look up weight loss, and all of a sudden, your Instagram feed is full of weight loss and really harmful sometimes videos. Our algorithm is not dissimilar to that, but we look at people's behaviors, their wearable data, their mood, and then we analyze that, and our clinical board will be able to recommend an intervention that can truly help that person.
That started these waves. Our engagement rates were going through the roof. We had kids highly engaged and now telling us that, "I love that if I put a sad mood in, I actually get something out of it." So, all of a sudden, we had these young people, and I say kids, but it was 11-year-olds up to 27-year-olds, I would say, was our main user demographic. The feedback was that they didn't feel comfortable talking to the school counselor, or they'd been to their doctor, and their doctor didn't refer them to a psychologist. All of a sudden, our app was allowing them access to support.
But then, to go, I guess, one step further, I realized that to have the impact that I wanted to have clinically on our potential user base and just in general, we needed to build out some other products to really allow us to do that, and those products were not going to be end user consumer apps. They needed to be big data analytics platforms where the organizations we work with like schools, and allied health clinics, and youth sporting clubs could look at the data coming through the app from the young people in an ethical way, and then they could actually distribute their own content and resources out to those young people as well.
So we built Infinite, which is the end user app, and that talks to Insight, which is the platform that organizations can see the end user data. They can upload videos, and surveys, and PDFs, and communicate with their end users in an ethical way as I said. Then, Insight Plus is really the, I guess, impactful platform for us and what I'm very excited about in the next few years. That's our platform that governing bodies and organizations such as the NHS could use to look at big data analytics on entire cohorts and make data-driven policy decisions with data insights they may never have had before. In Australia, trying to get 3 million kids to fill out a survey about how they feel or if they feel safe at school or whatnot is virtually impossible. But with our technology, it's absolutely possible, and we're getting that data over 10,000 data points from Australian users alone every single day.
So it's been a really incredible journey because what started as just a sports mental health idea very quickly became a platform for schools, sporting clubs, state and national sporting bodies, research organizations, and now actually to be very... It's the first probably time I'm announcing this publicly, but we've got incredible interest from leading medical organizations globally to utilize our technology to not replace healthcare and not replace in-person medical intervention, but to accelerate and distribute or expand the distribution of those things purely through the automated intervention and our algorithms that we've built.
So looking a roundabout way, Mark, apologies for the long story, but we've built this, I guess, my lived experience of not having access to the support I really felt that I needed, then realizing that, "Okay. We could do something with this from a data analytics perspective, and now we can do something with this from a clinical intervention standpoint." It's been a very interesting journey. That's for sure, and I think we're very quickly going to turn into a med tech organization just by the demand of what our technology can do.

Mark O'Brien:
Annie, look, it's absolutely amazing what you've achieved. So, Annie, as you were speaking, I'm sure many of the people listening might be thinking about the data security access and confidentiality issues around such sensitive data. How did you go about addressing these issues so that your clients and end users have confidence in your trustworthiness and integrity?

Annie Flamsteed:
It's a great question, and I hope a lot of people are thinking that because it's a huge point of focus for us as a company and for myself, as the founder, something that is extremely important. So the three areas that we really focused on were... The first one was making sure that our business model was supportive of ethical data analytics, and data consumption and aggregation. So what I mean by that is it's tempting and it was tempting to build a consumer product, and go and get millions of users and all this data, and potentially, make more money earlier, but that didn't feel right for me because to do that, we'd just have an app on the App Store, and we couldn't have any control over who was using it, and how they were using it, and what jurisdiction they were in, and how old they were.
So the first decision and point one was our business model. Actually, instead of doing consumer and going down that path like a lot of tech companies do, we decided to build a business-to-business software as a service model whereby we actually sell to schools, sporting bodies, clubs, research organizations, and universities where we can have a watertight agreement around child safety and data privacy with that organization before we even get to the end user. So that was the first thing we had to do was to make sure our business model was supportive of ethical and legislative, I guess, inclusions.
The second thing we did was build our infrastructure in such a way that was supportive of that as well. So the GDPR, the COPPA compliancy laws in the US, and the Australian legislation as well, of course, they have really clear guidance for organizations as to what you can and can't do with data and with identified data versus de-identified data, and everything that we've built and we've architectured is in line with those legislations from a data perspective. So that was number two.
Then, number three was making sure that how we're communicating this data to our end users and giving them the power to delete, or remove, or have complete control was paramount in our user interface and user experience designs. So making sure that yes, we've got a solid business model, yes, our backend infrastructure is supportive, but step three is actually making sure that the young users know how to deactivate their accounts, so actually putting it in front of their faces, which a lot of organizations don't do.
So I guess in rounding out those three points, it was really important and it still is that we only do business with ethical partners. So making sure that who we're licensing the de-identified data to, they're not going to do the wrong thing with it. Through this, we've actually learned that data can be very scary to some people, but usually, these big organizations don't want to know Annie Flamsteed's mood or anxiety answers or scores, but knowing a 27-year-old from Australia's mental health scores can be very helpful to medical research, and data-driven policy decision changes, and things like that.
So it came down to those three points, and then still to this day, whenever we do business or get in bed with someone, it's about what are their intentions? Are their intentions aligned to ours, and are they going to be utilizing this data for the purpose of iNSPIRETEK, which is to drive positive human behavior change using research and data analytics? So I know that's a big answer, but it really came down to those three simple principles, and then every single business relationship, making sure it's in line with those three principles.

Mark O'Brien:
Annie, that's terrific to hear. As I'm listening to this, I'm thinking about your journey both from identifying the need, designing a response, and then making sure that you've got an ethical approach to implementation is really a terrific story. Annie, there are many great apps and tech solutions out there, and most don't go anywhere close to achieving the market penetration that you have. Can I ask you to talk about the journey you took to repair and then raise the capital to expand the business?

Annie Flamsteed:
Absolutely. It was definitely a journey. The first step for us was actually aligning to an organization that was running an accelerator program. They taught us and taught me how to raise capital and those steps to take. The single most important thing I did at the start was raise capital from people with skills, so medical doctors, dieticians, researchers, and other founders, or ex-entrepreneurs, or entrepreneurs that could not only add capital, but also smart capital. They could help me make strategic decisions, and that allowed us to be very capital-efficient in the early days.
We soon realized though that to build the infrastructure we wanted to do and have the penetration that we needed to have in this space, we really did need some capital. So we set out to raise what we'd call a seed round, so $2.5 million, Aussie dollars, and that was all, the use of funds, that was all about product development and deployment. What that did for us, Mark, was allowed us to raise capital. Yes, it meant I was diluted, but it allowed us to build a really good product that then we could immediately go to market and start generating revenue to sustain our growth.
So I'd be lying if I said it was easy, and I could talk for hours on capital raising, but what we did really well, I think, less about the amount that we raised or the time it took us to raise it because it was interesting raising in the middle of a global pandemic, but what I would say to anyone out there who's got an idea and is thinking, "Oh, gosh, I really need some capital to leverage me forward," try and find people who can help you as well as provide funding. That was the biggest thing we did and probably more impactful, to be honest, than the big $2.5 million raise we did last year because it just put that infrastructure around me as a young sole founder to say, "Great. We've got the capital. Now, what's the best way to deploy it?" Look, I think we'll be capital raising for another year or so to get us to global expansion, but the journey was definitely helped by having really smart people by my side, which I would recommend to anyone going down that journey.

Mark O'Brien:
Oh, that's fantastic, Annie. Look, again, listening to you, I know you've told me that you've had no formal training as a leader. To what extent do you believe being an elite athlete prepared you for leadership or perhaps not prepare you for leadership, and what other factors do you attribute your success as a leader at such a young age to?

Annie Flamsteed:
I would say being an elite athlete was extremely helpful, not from a leadership perspective because actually, as elite athletes, you're not really that great of a leader. You're always told what to do. You've got to coach. People tell you what to eat, when to sleep, what medications to take. So I don't think the leadership side was necessarily helped by that. I think the sheer determination and ability to just have a goal and not waiver from that goal was probably what's been extremely helpful to me with my experience as an elite athlete. I did grow up in a family of business people, and there was a lot of business talk around the dinner table. My father is in earth moving and mining equipment with his own company that was his father's founded company. So a lot of business chat around the family, not just the dinner table, but in our broader family. My mom was the same.
I guess a lot of modeled behavior for me was around if you want to achieve something, then really, you're in complete control of that, and the leadership there was I guess just modeled for us, which was great, but I do think athletes make great entrepreneurs. They make great founders. I think they make great... A lot of my friends who went on and finished medicine that have done really well were not necessarily elite athletes, but loved sport, or academics, or music. They had something else that meant they needed to train, and practice, and sometimes skin their knees, and lose or fail, but then get back on the horse to use a figure of speech. So I think the leadership side of things has been more around just my ability to be so passionate about something and put whatever time is needed into it.
To your point about success at such a young age, again, I attribute that to... What I'm learning is sometimes seems like I'm being self-deprecating, but actually, having enough humility to ask for help has, I think, been the single biggest thing that springboarded iNSPIRETEK forward and my career as well. I don't have any shame in saying to people, "I don't know the answer to that question," or, "Oh my goodness, I don't know what to do." It's been incredible because I originally thought even as an athlete that if you said things like that or you asked for help, that it was seen as weakness. But now, I'm finding, even when I met you, Mark, saying, "I just want to learn off you," or, "What do you think of this?" and rather, "How can you help me?" Or, "What can you do for me?" More so, "What am I missing? What are the holes here? What can you help me identify that needs work?" So, yeah. I think it was helpful being an athlete from a hard work perspective, but I think the leadership thing has been around the behaviors that were modeled for me by my parents as well as the people that I've been able to and fortunate enough to meet early in my career.

Mark O'Brien:
Oh, that's a great answer, Annie. Obviously, there's a lot of influences that have contributed to your success. I suppose it leads to the question. Many healthcare workers at the coalface at the moment are struggling with their mental health. The COVID pandemic, as you know, has led to increasing levels of burnout, stress, exhaustion, even depression, and anxiety. Healthcare leaders everywhere that I speak to are searching for ways to support their staff to be more resilient in the face of this pressure, and you've shown incredible resilience in your lifetime. What have you learned as an elite athlete, as someone who suffered from mental illness, as a successful entrepreneur, as a businesswoman, and now as a budding healthcare professional about how leaders can support the resilience of their workforce?

Annie Flamsteed:
It's a brilliant question because I think what I learned as an athlete was more around this whole win-at-all-costs mentality, "Work hard, work hard, work hard," and that was okay as a 15, 16-year-old, super fit athlete, but my career didn't depend on it, I guess. Some athletes, it does, but that was the grit side of things that I learned that I think helped me get through the eating disorder at a young age, and my anxiety, and whatnot, but it wasn't really sustainable. So I think that's probably something I've learned in the last three or four years is that actually, support for mental health in any kind of intense situation, whether that be high-performance sport, whether that be high-performance careers like nursing, medicine, even outside of the healthcare profession, is that actually, people love to raise awareness for mental health, but no one actually really wants to do anything about it.
So I think something that I've learned that could be really impactful for organizations trying to support their staff in that sense is what are we actually doing to mitigate the risk of these things escalating rather than having mental health awareness days, and cupcakes, and things like that. I know that sounds a bit harsh, but I think healthcare organizations and professionals can do more and talk less, and that would be really impactful. So things like using a platform like iNSPIRETEK or something similar to actually provide healthcare workers with a means to track and monitor their wellbeing in a safe space, and then access education or support resources rather than having to be extremely public about it I think could be really beneficial, to be honest.
So I think there's still a fair bit of shame. I think no one has shame in talking about mental health in the workplace or burnout in the workplace, but there's still a little bit of, "Yeah, but I don't really know if I want to ask for help because I don't want to be seen as weak," especially if you think of a young nurse on the frontline or a young doctor on the frontline. They're trying to build a career, and they don't want to seem weak, and that's not dissimilar to athletes or startup founders, to be honest. I'd be lying if I didn't have a meltdown every now and then. My eating disorder is still present. It's still tough, and I still have to work through it, but stopping myself from just talking about it, and raising awareness for it, and actually implementing something in my own life and now for my own staff has really allowed them to turn a corner.
So I know it's a bit of a loaded answer, but I think we can do more, and it's not just the direct lines of report that are supporting these healthcare workers like their registrars or the hospitals and organizations they work within. It's not just their responsibility. I think real change at a governance level can happen using tech solutions. It's really hard for a big medical organization to say, "We're going to support every single frontline healthcare worker. I don't know anyone in this sector that doesn't want to do that, but the harsh reality is that's very, very hard, and it's not very scalable. It's also very expensive.
So I think if we had the governing bodies looking at how can we use technology to better support or accelerate access to care to prevent burnout rather than dealing with it once it is already upon us, I think that's a change that can happen at a high governance level and something that... for those listeners out there working in that space, something that iNSPIRETEK would love to partner with, to support, to help facilitate that. It's hard to go and build a big tech company like we have, but it's there, and we'd love to support as would other tech companies, I'm sure, support these organizations to achieve what they want to at scale without having to spend millions and millions of dollars in doing so.

Mark O'Brien:
Annie, it's been fabulous listening to you today. Such an inspiring story of great leadership. Finally, I'm asking all the contributors to this podcast series the same two questions at the end of each interview. First of all, Annie, what possibility in the healthcare ecosystem most excites you as you gaze into your crystal ball for the next 10 years?

Annie Flamsteed:
Wow, that's awesome question. I think what excites me the most is the crossover and co-development potential of real-time in-person medical and clinical innovation and intervention that we could and we are seeing develop in the hospital settings, and in clinics, and telehealth, and whatnot, but just medical intervention in general and innovation in general, really combining and I guess maximizing its potential with the introduction of innovative technology. I think for a long time, they've operated in silo. What excites me the most now is that we're seeing medical practitioners, and medical boards, and people in this area actually go, "Maybe technology can help us accelerate what we do already, what we do really well. It can help us do it exceptionally better at scale and reach people who may never have had it before." That's what excites me the most is the collaboration opportunities that I'm starting to hear less about and see more of, which is just brilliant.

Mark O'Brien:
That's fantastic. My second question is, as a leader yourself, what is the one piece of advice you would now give to, say, your 10-years-younger self about becoming a powerful leader?

Annie Flamsteed:
I wish I started earlier. So I would say if you have an idea, go for it. Start it earlier, even if you don't necessarily know exactly how. I spent a lot of time trying to make things perfect. So I would definitely say that, and I would also definitely say ask for help earlier. You don't have to know everything. You don't have to be the smartest person in the room all the time. In fact, sometimes it's really great to be the dumbest person at every table. I try to be the dumbest or least experienced person in every room in my career at the moment, and I wish I did that earlier. So start earlier, and don't be afraid to ask questions and fail.

Mark O'Brien:
That's fabulous. Annie, I can't thank you enough for your interview today. It's been fascinating hearing your story, and you truly are an inspiring leader, so thank you very much for your time.

Annie Flamsteed:
Oh, thanks for having me. I really appreciate it.

Mark O'Brien:
You have been listening to Transformational Healthcare Leadership, a podcast from Oxford University's Saïd Business School, where we speak to outstanding healthcare leaders from across the globe who share their insights on healthcare leadership as we navigate the complexity of modern healthcare delivery. For those interested in furthering their healthcare leadership journey by joining us at Oxford for the executive education offering that I and my colleague, Eleanor Murray, have the privilege of leading at Saïd Business School, you can find details about the Oxford Healthcare Leadership Program in our show notes. We'd love to see you at Oxford. Transformational Healthcare Leadership is produced by Chris Ashmore Media, and if you enjoyed listening, please subscribe to hear further episodes, and tell your friends. Thanks for listening.