What Does it Take to be One of the UK’s Coolest HealthTech Start-Ups?

Sue Rees in conversation with Mike Karim

Mike Karim is the CEO of Oxford Endovascular, an exciting spin-out company from the University of Oxford. They are pioneering work in the prevention of brain haemorrhage by curing brain aneurysms, a condition that affects one in every 50 people. Their flagship product is the OxiFlow flow diverter, which safely diverts blood flow from aneurysms at risk of rupture. It’s more accurate and safe than previous products on the market and uses innovative “origami” engineering principles.

Based at the Oxford Science Park, Oxford Endovascular announced the completion of a $10 million funding round in April 2021 after receiving grants from Innovate UK and EIT Health in 2020.

After meeting at BioForward in Oxford in September 2021, Mike kindly agreed to sit down and chat with me about his management philosophy, his current role, and motivation.

Sue Rees: Mike, it’s lovely to speak with you again. I’m always interested in the back story of leaders in the life sciences industry. Perhaps we can start with how you came to be involved with Oxford Endovascular?

Mike Karim: Thanks, Sue, it’s a pleasure to chat. So this was a role that found me, rather than the other way around! When I was approached, I was working with a California-based medical device company that was gearing up for sale, and we were working on building up the European business in light of that. I was contacted by Isis Innovation (now Oxford University Innovation). My name had been passed to them by someone who had known me for a number of years and knew I had been involved in neurovascular in a previous life as international director for Boston Scientific.

I met with them, and they explained what the flow diverter concept was and who was involved. There were two brilliant academics – Professor James Byrne, a leading consultant neuroradiologist, and Zhong You, a professor of engineering science. I had known of Professor Byrne for ten years as a world leader in the treatment of aneurysms. So I immediately knew that if he was involved, I should be taking a serious look at it!

I had been approached at a very early stage, and the university explained that they were looking for someone to start developing a potential business plan and help them understand the market and see how much of an opportunity there was for this to succeed commercially. So initially, I was involved in an advisory capacity, but as time went on, this grew into something that they and I felt would be worth spinning out.

This coincided with a point where I had more time because the acquisition I’d been working on had been completed, and so that enabled me to get more involved until we got to the point where we needed to fundraise. I agreed to support the academic founders and work with them on the initial fundraising, and this coincided with Oxford Sciences Innovation arriving on the scene. They decided to support us alongside some private investors, and I agreed to take on the CEO role.

SR: You’d obviously impressed everyone with your capabilities, and I’m really interested in what makes a good entrepreneurial CEO. So what do you think it is about you and your background that lets you be successful in what you do?

MK: I’ve always been interested in science and innovation. My original university education was in medicine. I did pre-clinical medicine but then got really interested in how you build things and bring teams together, so I felt that the industry route was the best one for me to go down to follow those interests. So after graduation, I went into the pharma industry, working for Upjohn Pharmaceuticals – later part of Pfizer – for around five years. I was then head-hunted by Boston Scientific, which gave me an insight into minimally invasive device technology. I was lucky enough to spend a lot of time with different leaders in that field, got the chance to travel a lot and meet people from around the world involved in innovation in this area.

So my 12 years with Boston Scientific gave me a real thirst for innovation. When I joined them, they were pretty much a start-up in Europe, although established in the US for a lot longer, of course, so that gave me the chance to build a lot of new processes and procedures and innovative ways of managing the business.

I was doing an MBA at Henley Business School, and combined with my experience at Boston, that kindled a desire to get involved with “real” startups – much smaller and at a much earlier stage in their journey. An opportunity came along to join a genuine startup, albeit not right at the beginning, but just at the stage of getting a CE mark. That was Lombard Medical, and I joined them as an International Director to help them commercialise and build the business.

That took me across all of Europe. This was before the Berlin Wall had fallen, so I had the experience of how different healthcare systems approach bringing new technologies into the market, including in Eastern Europe.

After five years, I got a great opportunity with a Boston-based US company early in their journey with devices to assist with heart failure. Again, my role was to build up their business across Europe, the Middle East and Asia-Pacific. Lots of travel, lots of working through different regulatory regimes, and so on. I was often brought in to help with some of the fundraising, which was a good experience.

Then there came a time when being away from family for long periods of worldwide travel meant I couldn’t give the support I wanted to, so I moved to the role in my previous company, which kept me within Europe and helped to manage the amount of time away from home.

So my trajectory since Boston Scientific has been working with smaller and earlier stage companies right up to a point now of working with a university spinout and helping to found the company.

SR: So, did you always want to be a CEO?

MK: No, I wouldn’t say that. If you’re passionate about the technology and sector you’re in and what you’re doing, your career leads you in specific directions according to the experience you build up.

So looking back at the roles I did, I was heading into general management and building up those skillsets, international working, later stage fundraising, and so on. So there was a natural progression, and I felt ready because of the path I’d taken. I hadn’t done any fundraising from scratch, so that was an exciting challenge to have, but everything else I felt I was ready for.

Now, four fundraisers down the line, it seems to be going well! But I’m still learning – and I think if you’re open to learning, you will continually evolve and develop new skills. And people will notice that. As you learn, you begin to better judge what the “right direction” looks like.

SR: You’ve spent quite a lot of time in previous roles working in the US and for American companies. How different do you think the workplace culture is over there compared to the UK?

MK: I think everywhere has its differences, in and out of work. The key is being aware of what those differences are and also being aware of the similarities.

Structurally, risk-taking, available money – yes, the US tends to have more of an open attitude to risk. If you try and fail, that's more often seen as a good thing – you’re building experience and learning. In the UK and Europe, perhaps because there are fewer chances, people don’t necessarily see that as a positive thing if you’re not successful.

SR: So, in your opinion, what do you think are the critical qualities that good CEOs need to have?

MK: Well, I’m not sure I’m too qualified to answer that very specifically after only six years sitting in that particular seat! But I think some key things include being able to plan well and research – understanding the lie of the land, the trends, the market. That’s no different to any project and probably to life in general. Then you can see what direction to go in and know if your plan is a reasonable one.

You have to be prepared to put in a lot of time and make some sacrifices to do that.

Resilience is key. You have to be able to pick yourself up after a tough day, a tough meeting, whatever and have a reserve of energy to drive yourself forward again and to take the people around you with you.

And being surrounded by good people is critical. When you are building your team, every single person is vital. Look for complementary skills and diversity – the more you do that, the more you’ll be picking people on merit rather than your own prejudices. We all carry them just because of the limits of our previous experiences, but the job of the CEO is to execute the plan by bringing great people with the right skills into the business and then supporting and developing them.

You also need to make sure you’re being supported. Surround yourself with mentors and contacts with experience who can give you that support and help you not to feel so lonely – because it is “lonely at the top” sometimes.

SR: That’s something I hear a lot from the successful CEOs I speak to. Who have you turned to throughout your career for that kind of support?

MK: It depends on the situation, but often it will be people from further back in my career. I’ll turn to people I can remember who were particularly good at understanding certain situations or handling specific scenarios. It’s essential to keep in contact with people you meet like that and keep them updated on what you're doing and what challenges you face. Their input can be instrumental at critical times.

It’s also good to build your “internal” networks too. Linking in with your investors and their network can be useful, as is leveraging your chairperson’s experience and contacts, and so on. Keeping a good and open relationship with your investors is vital because they will often point you in the direction of someone they know who has already been through this or is working on something similar and who can give you some insights and support.

It’s why I think choosing the right investors is vital. Now the earlier you are in your journey, the less choice you may have, but as your business grows, your investors shouldn’t just be about the money they bring to the table. If they can bring a passion for your business and bring direct advice or contacts with relevant experience – whether to mentor you individually or bring skills and knowledge that help the company more widely – that can add huge value.

SR: One of the things you mentioned was having the energy to motivate yourself and your team. Given the changes we’ve all had to adapt to with the pandemic, what have you been doing to keep your people motivated during this difficult time?

MK: If we go back to early 2020, despite the noises being made from the powers that be in the UK, we had seen what was happening in China and what was happening in Italy, and it seemed to us inevitable that lockdowns and other measures were coming. We discussed this, and we agreed that we would gear up and be ready for this. We had a small team, but our engineers really couldn’t do anything concrete outside of a lab, but they came up with the idea of relocating some of our crucial equipment into people’s homes! We got everyone’s agreement and had the plan in place when the lockdown did come.

In terms of morale, one thing I knew was important was keeping spontaneous interactions going. So we instigated twice-weekly 30-minute calls with no set agenda where people could just talk about what they’ve been doing and what’s going on in the same way they would have done over a coffee in the office. We also tried to take advantage of various online educational events to keep the team’s development going, maintaining structured quarterly reviews and feedback meetings. We tried to find ways to use technology to keep the spirit of normality going, and it seems to have worked for us.

SR: That’s great to hear! How much of that successful navigation of the lockdowns do you think was down to the culture you’ve built?

MK: I think it demonstrates the importance of having that complementary and diverse team I mentioned. As well as looking for the right skills, the right personality and cultural fit are vital. You need to make sure that the people you bring into the business are aligned with your ethics and contribute to the team chemistry you are building. Especially so in the small teams that most early-stage companies have. You want to bring people in who fully buy into your culture and want to engage with it actively. It’s not always about the qualifications and hard skillsets – it’s so important not to overlook the cultural fit, and the soft-skills people can bring.

SR: I couldn’t agree more! I know that you’ve already said that you’ve also had the support of great investors and that they are also part of the broader picture of support and culture you need. What advice would you give to any early-stage CEOs to help them attract that right kind of investor?

MK: I think the first thing is to have a well laid out plan that will allow investors you approach to get excited about your business. You need to be able to articulate that in different ways according to the time you have. You might meet a potential investor for just 5 minutes – can you communicate your plan and your vision and get them excited about it off the cuff? You might be at a formal pitching event and have a 15-minute slot – again, can you translate what might be pretty technical and complex scientific information into something that will excite a non-expert so that they give you more time. Remember, the whole purpose of any kind of pitch is to “sell” more time – you need to capture someone’s imagination and generate excitement which warrants them giving you more of their time to get into the details. So develop the ability to pitch your business or idea at different levels to suit the kind of opportunity you may find yourself in.

You need to understand the investment landscape. This will allow you to target groups that will have a genuine interest in what you do and where you are at in your journey. Quite a few investors will describe themselves as “early-stage” investors but aren’t. So make sure you clarify what they mean by early stage, as some won’t be interested if you are pre-revenue. Make sure you’re not wasting a lot of time with anyone who isn’t going to be interested in your stage. Make sure you’re doing your due diligence about potential investors. Look at where they are in their cycle: have they recently spent all their money? Have they just got new funding and are now looking for the kind of opportunities you represent? I find it very useful to build up your own database of investors and who you are targeting.

And finally, remember that investors can’t take advantage of every opportunity. They may love your pitch but already have two other opportunities that they are looking at, and it simply might not be the right time. So what I always advise is that if an investor says no, ask them if there is anyone in their network who they think may be interested that they can introduce you to. It’s a people thing – by and large, most people are happy to help and indeed want to help if they can.

SR: Finally, what does the future hold for Oxford Endovascular over the next few years?

MK: Well, of course, we’re in a highly regulated industry, so we’ve got several short- and medium-term goals around first in-human studies, more extensive trials, and so on. But those are steps we need to take to get our product to market – and ultimately, that’s what it’s all about. We want to bring life-saving technology to people who don’t have access to it right now. So that’s our goal, and if we do that effectively, we’ll make money for our investors, we’ll do well as a company and reward the team for their hard work.

But I think we must never forget that we are developing a life-saving technology first and foremost that, if successful, will bring lots of other benefits to lots of other people who are involved. It’s a bit of a cascade. But my advice would be not to get derailed by focusing on anything but your fundamental goal; that way, the rest will follow almost automatically. It’s a bit like life – focus on being happy, and it’s highly unlikely you’ll end up following dark paths you shouldn’t have gone down.