This podcast is brought to you by Squarespace. I talk to entrepreneurs all the time who are looking for a way to upgrade their digital footprint. Well, whether you're just starting out or you're scaling your business, Squarespace is the easiest way to build a great website that stands out. It's an all-in-one website platform that gives you everything you need to claim your domain, showcase your products, and get paid.
Anyone can use Squarespace's cutting-edge design tools to build an online presence that truly reflects what makes your business special. There are templates, intuitive drag-and-drop editing, and even an AI-enhanced website builder. Then, Squarespace's built-in analytics tools help you make smarter business decisions, review website traffic, learn where to focus engagement, and track revenue all in one place. Looking to grow your business?
Squarespace even offers fast, easy business financing through Squarespace Capital. Go to squarespace.com.com.com for a free trial. And when you're ready to launch, use offer code BUILT to save 10% off your first purchase of a website or domain. Loans issued by Celtic Bank and Service by Stripe, all loan subject to credit approval.
This show is in partnership with Airbnb. This past summer, I took my family to Vienna, and it was incredible. We spent our days wandering the old streets, stopping for coffee and pastries, visiting museums, and just soaking up the history of one of the most beautiful cities in the world. And one of the things that made the trip so special was the home we booked on Airbnb.
It had tall windows, beautiful old details, and plenty of space for all of us. And being in that home on Airbnb, right in the middle of Vienna, walking distance from so much of the city made it feel less like a visit and more like we were actually living there. Plus, taking a trip is the perfect time to host your space on Airbnb. Your place, with all of its personal touches and its amazing location, could make someone else's vacation even better.
Your home might be worth more than you think. Find out how much at Airbnb.ca. Hey, really quick before we start the show. The How I Built This book is now a New York Times and Wall Street Journal bestseller.
So thank you to all of you who ordered it and for your support of this show. If you haven't picked it up and you want to learn the secrets of how to develop an entrepreneurial mindset, How I Built This, the book is for you. It's now available wherever books are sold and in most countries around the world, or by visiting HowIBuiltThis.com or GuyRas.com. And thanks.
Hey everyone and welcome to How I Built This Resilience Edition. On these episodes, we're talking with entrepreneurs and other business leaders about how they're building resilience into their businesses at this very challenging moment. And today we're going to hear from Dr. Iman Abusade, the co-founder and CEO of Incredible Health.
It's a digital career platform where nurses create profiles and are matched with hospitals, making the hiring and onboarding process much quicker and much more efficient. It's currently being used by hundreds of leading hospitals across the country. So hospitals and health systems, they use our platform and our custom matching technology to hire permanent nurses in what is 15 days or less right now. Usually the industry average is 90 days.
Now the reason the average is so high at 90 days is because we are experiencing a massive nursing shortage. Even before the pandemic, the shortage was pretty bad. And it's now become even worse. So the few unique things about our platform and the way it works is that the hospitals apply to the nurses instead of the other way around.
And so by flipping it around like that, it's a magical experience for the nurses. They create a profile, they sit back and relax, and they hear from different employers, and they get to choose which interviews to accept or decline. And we also use our software and automation to screen the nurses, as well as to custom match nurses to the right employers too. So it's sort of like a job site, but of course the nurses are not applying for jobs, just putting up a profile.
It's sort of like LinkedIn meets Match.com and is the way I guess. I mean, chief nursing officers refer to us as the Match.com of hospitals and nurses all the time. So how does hospitals applying for nurses instead of the other way around help the shortage issue for both sides? Our demand for healthcare as a country keeps going up.
Our population is aging, of course pandemics don't help, and we just simply don't have enough workers in the system. Like by 2024, we're going to be one million nurses short, and that short it just keeps getting worse and worse. Now what's happening inside a hospital or a health system is the way they hire really hasn't changed since the early 90s, right? It's supposed to job and hope something happens.
Unfortunately, that process and that kind of outdated technology is not sufficient to operate in such a competitive talent market like this. That's why by changing the model so they're applying to the nurses, adding the screening, adding the custom matching has really accelerated the hiring, and why we're used to over 250 hospitals and health systems across the country today. My step sister is a nurse, and this shortest crisis that you've mentioned is obviously an acute crisis. Before we talk more about how incredible health is kind of streamlining this process, let's just talk for a moment about this crisis in nursing.
I know maybe people watching don't know you are a doctor by training your MD and also an MBA. How do we even begin to change this? Presumably you have to attract more people to the nursing profession. How do you do that?
Yeah, that's a great question. Yes, we have to, as a country, have to solve the underlying supply, and we need to not only attract more people to the nursing profession, but even for the nurses that are graduating, we need to expand the amount of training that we have for them as well, because there's bottlenecks in both places. There's a few ways to do that. So one is really, I guess, promoting the profession as a fantastic profession.
Like at the end of the day, yes, nurses are, I think you work a lot. Sometimes they do feel underappreciated, but this is a relatively high paying profession after you complete your education. It seems to me that we should pay or subsidize their education. That becoming a nurse should essentially be free.
I 100% agree. So for incredible health specifically, you know, we provide free continuing education to every single nurse in the country. Continuing education is needed to renew and activate their licenses, and they usually have to pay out a pocket for it. You know, just on continuing education, which is, you know, those are courses that you do after you become a nurse.
You know, we figured this is crazy. Let's just give it away for free. It's accredited in all 50 states, and they can simply get it done inside the incredible health application. So there needs to be more programs like this across the board that essentially make the education and the training of nurses cheaper and cheaper and ideally free.
I just cannot believe that you've packed so much into your life already. You have a medical degree and an MBA. Did you, by the way, did you ever practice? I actually did not.
So I finished medical school, and I always wanted to make an impact kind of on a more system level, and don't get me wrong, look, one-on-one patient care is amazing, but it's not very scalable. Things like software and technology are highly scalable. You can literally transform an entire industry. The genesis of incredible health came from my background, right?
So I am an MD. I have a lot of friends and family members that are doctors as well who are often complaining about understaffing. At the same time, my co-founder, who is a software engineer from MIT, Rome Portlock, his sisters are nurses. And they were saying, hey, I'm experienced and I'm qualified, and it still takes me two to three months to get my next job.
I applied at 10, 15 places. I often don't hear back. This is a very common experience for nurses by the way, even today. And so we just figured there just has to be an easier way to solve this problem.
So essentially, the problem you identified was this kind of the process, right, of hiring nurses was broken, which doesn't make sense, right? Because you would think, you know, with a shortage of hospitals needing nurses, they would bring them on. But hospitals are also big bureaucracies with lots of different challenges. So I guess it does make sense.
You identified this problem, which was the hiring, the onboarding process and all the bureaucracy involved. You decided to figure out how to streamline it. And that was the genesis of incredible health. That's right.
And it's now expanded beyond just the place where a nurse finds a job. It's a place where he or she manages their career. I mentioned continuing education earlier. We also have free salary estimators.
We have a couple more services that are launching at the end of this year as well. That's exclusively for nurses. You know, so it's really become the place where you can manage your entire career on incredible health. Well, I'm wondering, how does the business model work?
Do hospitals subscribe, pay a subscription fee to the site? Or do they pay, you know, every time they hire somebody, you get a fee, sort of like a zock-dock model? Yeah, it's designed as a subscription. And within that, you know, the hospitals are selecting different tiers that are based on volume.
But it's of course 100% for you for the nurses. When nurses go and work at hospitals, do they tend to stay at the same hospital for a long time? Or is there a high turnover? Are they moving around to different hospitals?
Yeah, so for our platform specifically, we only do permanent workers, right? We don't do any contract workers. Now, what nursing in general is known for high turnover, right? So usually it's 17% is a national annual turnover right now.
And so retention is also a hot topic and a very important topic for these employers as well. And we'll try to do whatever they can to keep their nurses. So let's go back to the beginning of this year. And what point did you realize that this pandemic was going to be a major problem and that the service you offer was potentially going to be in high demand?
I figured this out, put this all together probably in January, early February, and that was because I was on Twitter. And honestly, the most amount of information was coming from epidemiologists and MDs and public health experts around the world, because we weren't getting real time data here in the US, so Twitter was actually my source for figuring this out. I know you've got a team of about 30 people. You're based in San Francisco, right?
We are headquartered in San Francisco, but our team is in different parts of the country. So when you realize that this was potentially going to be a huge issue, did you see an immediate spike in demand for your services? We did. Certainly by April, there was a spike in demand for specific types of nurses.
If you were an ICU nurse or an ED nurse, the hiring for that increased by 3x on our platform right away. And we saw a drop for some of the other specialties because, you know, surgeries were getting canceled. But since then, since July, August, the demand for every single role has dramatically increased, because not only are hospitals operating at full capacity, they're also dealing with this pandemic. So how did you start to position your company and your business to meet that demand?
So there were a few things that we did. A few months ago, we launched what we call the pandemic hiring suite, right? And what that is, is a range of features and tools that even more dramatically accelerates the hiring and really helps the hospitals reduce costs because they had gone through some various of your financial hardship, right? So a couple of the things that we did was we added an automated interview scheduling, remote interviewing, because that's just what you have to do during a pandemic.
In-app chat, you know, enhanced our matching algorithms. All of these were the goal of accelerating the hiring even further. So we got it down to 12 days now. And on average, we save every hospital that we work with at least $2 million, because they dramatically try to reduce their travel nurse costs as well as their overtime and HR costs.
So essentially last year, or the year before, if you were a nurse using your platform, you would have done an in-person interview at least one. You would have traveled to the hospital. And that, of course, has gone away. That's gone.
So that's not even a feature anymore. Now everything is happening virtually. Correct. And that has accelerated the process.
So now it's meant that the average hiring period is just 12 days, from the time that somebody identifies a nurse they want to the time that nurses offered a job. From the time the nurse successfully offered. Yeah. How are the interviews happening?
Do they go through an interface on your site or is it just like a Zoom call? Yeah. The first set of interviews are all facilitated through our software and our site. And we have automated interview scheduling built in that requires zero integration with all sort of IT teams.
So that it was very rapidly adopted by both recruiters and nurses. Did you build that this year? Yeah. At the beginning of this year.
I mean, it was in our roadmap. We just have to accelerate it, because of the pandemic. How did you ramp that up so quickly? It's just a case of prioritization when it comes to product road maps, right?
You just kind of shift things around and you prioritize what your customers most urgently need right away. Half our team is software engineers. And so we are able to ship products, honestly, and ship code every single day and do product launches every single quarter. So when you release that, that's a pretty sophisticated feature right on your site where you can now interface and do an interview through the site.
When it was initially released, was it perfect? Has it been improved upon? Was it legit first? Yeah, of course.
It was not perfect. The priority was to release it fast, even if it was imperfect. And then we dramatically improved it over time. Do you think that you could have done something like that so quickly without the urgency of the pandemic?
Honestly, yes, because one of the values of our companies is speed. I just believe one of the only competitive advantages you have as a startup is you can operate and you can execute far faster than any of your incumbents and anyone else. So we generally move as quickly as humanly possible. And so the improvements to our platform are rapid, even before the pandemic.
Tell me about your workforce. I mean, your base in San Francisco, but you've got a distributed workforce or pre-pandemic where most people coming to an office in San Francisco. Yeah. So half our team is in San Francisco and we do have an office here in San Francisco, but half the team are in other parts of the U.S.
That's been really helpful because we do serve clients all over the country. And of course, at the moment, we're fully remote. We are going to keep our office, so we're likely going to do this hybrid model. So people will kind of work from home or come in a couple days a week, depending on how it works with them.
You said half of your workforce are engineers, so presumably they are kind of self-sufficient. But what about the rest of the team? I mean, you are the CEO of the company and even the best of employees are, it's a challenge this year, right? So there are lots of challenges that people are dealing with, whether it's family issues or just loneliness and isolation.
Morale, how have you been handling those challenges with your team? You're right. I mean, it's been a very challenging year mentally, right? We had done a quick survey of our team and it was like 50% who were experiencing some kind of symptoms of anxiety or depression.
I think that's pretty common across the board, across the country. So there were a few things that we did. So the first thing is just in the acknowledgement and communication of the problem. Everything from just like, hey, we understand everyone's going through a tough time right now, and just saying that explicitly and saying that we understand.
And then also for certain groups of employees, like the parents were the young kids, right? Or the person in an apartment with three other roommates. I mean, they were under even additional strain. And saying that, hey, it's okay if we're on a Zoom call that your kid shows up, right?
That's perfectly acceptable. The second thing we did is just really invest more time on just improving the setup, right? So everyone got to work from home, like stipend to set up their office space at home. For some employees, they'd have to like scale back a little bit in terms of their hours and switch from full time to part time, which is completely understandable.
And then the third major thing we did is just kind of dramatically improve our communication and our interaction as a team in a remote setting. So whether it be like our weekly hangouts or coffees that we do every Friday or game afternoons, you know, just adding more of these intentional communication touch points was really helpful as well. When we come back in just a moment, Eman describes the biggest changes she's seen in the healthcare industry during this unprecedented year. Stay with us.
I'm Guy Raz, and you're listening to How I Built This Resilience Edition from NPR. And one more thing. The New York Times best-selling book, How I Built This, is now available. It's a great read and a great gift for anyone looking for ideas, inspiration, wisdom, and encouragement to have the courage to put out an idea into the world.
It's filled with tons of stories you haven't heard about how some of the greatest entrepreneurs you know and respect started out at the very bottom. Check out How I Built This, the book available wherever you buy your books. Hey, welcome back to How I Built This Resilience Edition. And I'm talking with Dr.
Eman Abusade, the co-founder and CEO of Incredible Health. And she says the healthcare industry has had to adapt very quickly to meet the increased demand for services during the pandemic. The biggest change I've seen is the rapid decision-making and rapid adoption of whatever solution there is, right? So, you know, historically the healthcare industry has just been known for lots of red tape, bureaucracy, like, you can't get anything done fast.
And this year, just like really dramatically changed all of that. Whether it's the adoption of telemedicine, adoption of operational infrastructure like Incredible Health, and others, like it was the speed in which they started to move and operate and make decisions has been, and we've never seen anything like this before. I've had two consultations with my doctor this year for minor things, like a skin issue and I got a COVID test just out of safety a couple months ago. You know, the doctor that I used to go see, she was just a remote call.
And as you know, CMS is now reimbursing doctors for consultations with Medicare patients, which is a new feature this year. Do you think telemedicine now is here to stay and will actually be the predominant form of medical care in the future? I think it is here to stay. At the end of the day, the healthcare industry as a whole needs to really focus on customer service, which is like basically the patient experience or many phrases for that.
And if patients are adopting telemedicine and you're going to get reimbursed for it, like as you described, then there's no reason why it would not be fully adopted. Now, there's a few, you know, areas that need to get figured out. You know, there are entire communities in the U.S. They don't have access to these devices and don't have internet access and so on.
So it's not a solution for everyone and every single location and every person, but the adoption of it, the dramatic adoption of it is here to stay. Anyone who's been to a hospital for any reason knows that you interface mostly with nurses. And nurses are the people who make your experience better. There's a bunch of questions coming in.
I'm going to ask, this is more of a comment from Patty McLachlan. She says that she is a registered nurse. She went to a refresher course at the age of 63, but nobody would hire her. And she believes it's blatant age discrimination.
You know, she says she had great references and did really well in her refresher course. She got certified in BLS and ACLS. I don't know what those mean, but you do have to find colors. And apparently we're getting a lot of nurses responding to that comment on Facebook course saying, yes, same experience.
First of all, do you think that is a common experience? And then the second question I would have is if there's a shortage in nurses now, wouldn't hospitals want to hire somebody like Patty at age 63? Yeah. So unfortunately it is a common experience.
Not only older nurses get hired less. Even if you took a gap from the workforce, right? Like you had to raise your kids or, you know, you just have to take a few years off. That also reduces your hiring, you know, chances and opportunities.
And you're right. And we need every able body we can get. You know, a lot of that has to do with just the existing, I don't know, bias, right? That just exists among employers today.
And that's across all industries, not just healthcare. And so this is one of the really important topic because it's something that we track really carefully because we're a software platform. We have so much data on this. Like I'll give you another example of a human bias that's been introduced or that we noticed.
We noticed that nurses that lived further away from a facility were less likely to get interview requests on the platform, even though they wanted to, you know, live in wherever it was LA or Dallas or whatever it was. And what we did is we just removed the current location of the nurse, right? And we just saw that human bias just removed. It's gone.
You know, hiring in general, you know, there's a lot of preconceived notions and biases and so on that just have to constantly be addressed in order for it to get better. And the great thing about a software platform is it can really highlight this data at scale. And so we can have more informed discussions about it. Could you also remove age from the site?
The tough thing with age is that, you know, work experience, of course, is required. And so absolutely age is not part of the nurse profile, but work experience is. And so sometimes, you know, employers can tell from that. I mean, I would rather have a 63-year-old nurse than a nurse just out of nursing.
Not to say that a nurse who wasn't great, but I mean a 63-year-old nurse or 65-year-old nurse is coming with decades of experience. I mean, to me, it would seem like a no-brainer that you would want somebody with that experience at a hospital. And you do. Look, and that's not to say that older nurses don't get hired.
Look, there is a huge cohort of nurses that is approaching retirement, which is going to be another string when they do retire. So regardless of what age you're at, like nurses are needed. Whether you're a new graduate, 10 years experience, 30 years experience, like you're needed. Yeah.
Here's a question from Mark Monroe. It's more asking you to put on your entrepreneur's hat for a moment. He writes, as someone who's built a hiring platform, I'm wondering what your best interview practices are. Oh, that's a great question.
Well, there's interview practices for a nurse specifically, and there's an interview practices for technology workers, and it's all this answer in two different ways. So in terms of interview practices when we're hiring for our team, the most critical thing is to get phrases like cultural fit and my gut feeling. These kinds of phrases need to be removed from any kind of process. Totally.
They're nonsense. They're in a complete nonsense, right? So what we've done is really improved on this and got really diligent with our hiring process. So every single interviewer has specific questions that they must ask.
Like literally there's a guide and they have to follow the guide, right? The rubrics that the interviewers fill out afterwards are very regimented. We do training for the interviewers as well. And then we think through a hiring process, it's not just like asking behavioral questions, but you have to ask case studies or you have to do a presentation to kind of test a range of different skills.
Now for nurses specifically, I don't think nurses should assume because they're very experienced that they know how to interview. And we've just seen it time and time again that, you know, very experienced nurses can sometimes bomb interviews. And so we have put together pretty detailed interview preparation and guides that are available on our site and free to everyone that have the do's and don'ts for nurse interviewing. Everything from like, you know, don't bash your former employer.
Don't say you're looking for the job because of money. You should be saying it's because it's about patient care. And you know, just things like that. You just need to present yourself in an extremely professional way.
How do you, and I'm sorry, I keep calling you a man. I should be calling you Dr. Abhizade. I know, please.
That's totally fine. How do you prevent or as best you can systemic bias in hiring? The nurses come from diverse backgrounds and there's incredible need. For example, nurses who are bilingual who speak Spanish, et cetera.
But how do you build in barriers to prevent the kinds of bias that happen in the hiring process? Yeah, that's a great question. I mean, look, there's several tactics for addressing bias. A huge one is just acknowledging it and measuring it.
Right? So there's a whole set of best practices around just measuring your entire funnel, how you're sourcing, and like almost like tagging every candidate that's coming through based on some kind of demographic data. Right? And then that way you can quickly, based on the data, acknowledge and realize where the bias is happening.
After getting that information, you know, then it's time to implement some best practices to reduce the bias. That could just simply be training that's needed for the interviewers. That could be completely adjusting your sourcing methodology and like attracting candidates from different sources. You know, for incredible health specifically, there's a few things that we do.
Nurses can pick avatars instead of the profile pictures if they don't want to kind of reveal how they look. We absolutely do a random sort inside the application on the employer side. The nurses are randomly listed. So everyone has equal opportunity to interview requests.
You know, there's a few other things that we do to kind of constantly reduce the bias that can be introduced. You can imagine working with like, um, social scientists, for example, to experiment with, you know, not using names, for example, because as you know, names are often a source of bias, right? It's often where the bias begins. We've tried, you know, removing names, even removing pictures.
The number of interview requests you receive drops. Yeah. It's kind of about software where like it's, there's almost like a human connection that you're trying to enable inside a software platform. Things like names and pictures enable.
I mean, how do you think that this year has changed your company's overall strategy? It's changed our strategy in a few ways. So one in terms of just, we talked about the product changes as a dramatically reprioritized and reconfigure things and really double down on what's it going to take to help hospitals and nurse each other faster and interview remotely and just, um, and dramatically reduce the cost for the hospitals too. The other thing that's changed is just like where we expand geographically.
You know, when the pandemic first hit in, you know, April, you know, we just have to delay all our New York expansion plans, basically, right? And, and as a pandemic has spread throughout the country, we have to adjust to where our different expansion plans. At this point, hospital and health systems have honestly become quite accustomed to the pandemic and they're very prepared and they have the, you know, the personal protective equipment and they're making adjustments needed and they're not, they're just a lot better prepared now. So we haven't, we've been able to kind of really roll out our geographic expansion plans as normal.
Last question for you. I'm going to ask you again to throw in your entrepreneurs hat for someone watching this who's looking at you now, an MD, an MBA from Warden. I believe you are the child of immigrants. Am I right about that?
I am. Yes. Um, I think your parents came from Sudan. That's correct.
So if somebody, somebody looking at you now and you know, looking at you as somebody who's inspiring them, do you think it's a good time right now to start a business or maybe go to business school or to, you know, to dive into this uncertain world of entrepreneurship? Okay. So obviously I'm heavily biased here, but an opinion I have is the epitome of what you can do with your business career is to start a company. And that's just, that's not a fact.
That's an opinion. The, the excitement, the learning, the skill development that comes from entrepreneurship is, is dramatic. Now, of course, with that comes an intense amount of resilience that's needed and, you know, manage your mental health pretty carefully as well. But, um, it's, it's the quickest way to learn as much as possible.
And sometimes we need to, you know, evaluate the risk and the perceived risk a little more carefully. It's not, you know, they're having a lot of layoffs this year. So like just working a normal job is not necessarily like foolproof either. So yeah, I highly recommend it.
That's an excerpt from my conversation with Dr. Imman Abusade, the co-founder and CEO of Incredible Health. To see our full interview, you can go to Facebook.com slash how I built this. And if you want to see all of our other past live interviews, you can find them there or at YouTube.com slash NPR.
And if you want to find out more about the How I Built This Resilience Series or other virtual NPR events, you can go to NPR Presents.org. This episode was produced by Liz Metzger with help from J.C. Howard, Will Mitchell, Bruce Grant, Matt Adams, Elmanian, Gianna Capadona, John Isabella, Julia Carney, Neva Grant, and Jeff Rogers. Our intern is Ferris Safari.
Thanks for listening. Stay safe and happy Thanksgiving. I'm Guy Raz, and you've been listening to How I Built This Resilience Edition from NPR.