Chapter excerpt from the ebook MedTech IP: Lessons and Strategies for Success - view all chapters here.
In this chapter we will follow the remarkable success story of BrainLab AG, which we touched on in Chapter 5. The founder of the business, Stefan Vilsmeier, has much to teach us about how he created this world leading medical technology company employing 2,000 people in 20 offices around the globe.
In particular, success does not always involve following the crowd. Don't be afraid to be different. Don't accept limits for your company - the possibilities are limitless.
Bring people together from different areas of your company to achieve cross-departmental communication and creativity. The solution to every problem always co-exists with the problem.
Push yourself outside of your comfort zone, and don't be afraid of imperfection. Learn from others, including the people you hire, and above all have fun.
Let's dive in to the story, and see how Stefan created this astonishing company from nothing...
If we want to learn about strategies for success in a MedTech business, where better place to start than the story of a successful MedTech business, and who better to tell us about strategies for success than the founder and leader of that business?
We now return to the remarkable story of BrainLab AG, which we touched on in Chapter 5. As you may recall, BrainLab AG is a world leader in digital medical technology, but it was started in 1989 by Stefan Vilsmeier when he was only 19 years old using the proceeds of a book which he wrote at the age of 16.
How did Stefan grow this company from nothing to a company employing 2,000 people in 20 offices around the globe? What can Stefan teach us about the mindset of success and growth? Stefan's story is such a fascinating one that it is worth telling the story in some detail. Much of the advice below is taken from a recent interview with Stefan.
Stefan notes that he is super-shy. He never imagined he would start a company, but he says he is very persistent and he just wanted to see his ideas and concepts succeed.
In 1987 Stefan finished high school. On the strength of his book about 3D computer graphics on the Commodore 64 home computer, he was invited by the University of Vienna to help them in their Neurosurgery Dept. They were struggling with some computer graphics challenges, and he thought he could probably help them.
He had no idea what to expect, but on his first trip to the University of Vienna he was shown some images from Computer Tomography and Magnetic Resonance Tomography. He was struck, and completely intrigued, by the aesthetics and the beauty of the images. As we shall see, aesthetics and beauty were to play a central role in his vision, and we shall return to these later in this chapter.
When Stefan went to Vienna he noticed that surgeons were performing brain operations based on their memory of the images mentioned above. He realised that software could provide a better solution, and he started work on software for more accurately determining precise locations in the brain.
Stefan had to stop this important work to do mandatory national service in Germany. He became quickly bored with national service, and his mind was still on the problems of brain surgery at the University of Vienna. So what did he do?
Stefan decided to do something he says nobody had done before. He wrote a letter to the Minister of Defence in Germany. Stefan notes that his letter caused a certain amount of bewilderment in the German military, but eventually the letter made its way to the Minister of Defence.
Two weeks later, Stefan was given an immediate release from his military service, to the amazement of those around him. It was simple, said Stefan. His letter had explained the work he wanted to do relating to brain surgery, and how it would have much more impact on society than "sitting there cleaning a rifle".
Stefan explains that his parents always gave him a sense of being special, and that always encouraged him to fight for what he wanted. He explains that he was later to take exactly the same mindset into the sales of his products. He says that even if he had no idea how to sell something, he always went to the customer with the mindset, "You're going to buy my product. You just don't know yet - but you will." He had no doubt in his mind that that is what would happen, and as we shall see he was to have some remarkable success.
Having cut short his army service, Stefan returned to his work for the University of Vienna. He was working with stereotactic brain surgery, which uses a stereotactic device mounted on the patient's head. Stefan describes the device as like a sextant, used for accurately locating positions in the brain. He says that previously surgeons took X-rays, and made manual calculations with rulers about positions in the brain. Stefan created software which not only accurately located positions in the brain, but also showed and visualised what brain tissue would be damaged along the way to a particular point in the brain. BrainLab still does stereotactic targeting, but today it is less than 1% of their revenue.
After 6 months he thought he should seek a formal education, and he started studying Computer Science at the Technical University of Munich. Stefan says that, having become passionate about writing software for brain surgery, a formal computer course was not for him. He dropped out of his university course after just 20 days.
Stefan says that he had now, in effect, created an artificial crisis, and he had no choice but to drive BrainLab forward. He continued to write software for brain surgery while living in his parents' basement, and the money from his book success carried him through the early years.
In 1992, after 5 years, he had all but run out of money. Things were getting desperate. What would this young entrepreneur do next?
Stefan knew that the Congress of Neurological Surgeons held an annual scientific meeting in Washington DC. Could he sell his software at such a congress? If so, he would need a sales booth at the congress, and sales staff, but he didn't have either, and very little money. What to do next?
Stefan looked around his parents' garage. How hard could it be to build an exhibition sales booth? Could he build one here, in his parents' garage? It had to be worth a try.
Stefan built a booth in his parents' garage, and loaded it into suitcases, far exceeding the airline's luggage weight allowance. He was to tell the airline that he was a student, and needed this extra weight to transport his thesis to the US, thus avoiding the airline surcharges. Well, maybe this was true in a way, but it was also hugely ironic coming from a man who had dropped out of university after 20 days!
He still had no sales staff, so he took his sister with him. They couldn't afford the hotels in Washington DC, so they stayed out of town. Nor could they afford the union labour rates for staff to set up their booth, so they waited until after hours, and set it up themselves.
The next morning, at the 1992 Congress of Neurological Surgeons in Washington DC they arrived at a booth which looked much like most of their competitors. They got their first sales from customers around the world, including North America, Germany, Taiwan and South Africa. Stefan jokes that BrainLab immediately became a company with global sales!
In 2019 Stefan had an experience which transformed his vision for the company.
Stefan has a love of both technology and art. He says it is important to address the right and left sides of the brain equally. The left side of the brain is more associated with logic, whereas the right side of the brain is more associated with art and creativity.
In Chapter 5 we mentioned that the BrainLab buildings in Munich contain a hall seating 440 people which is used for performances by the Munich Philharmonic Orchestra and the Munich Opera Company. What we didn't mention is that Stefan is also a keen collector of art, and the hall houses part of his art collection.
In 2019 Stefan was profoundly impressed and moved by the art of Anselm Kiefer, who he describes as the most interesting German artist alive.
Anselm Kiefer moved to France in 1992, where he created a 35-hectare studio compound from a derelict silk factory. He created buildings and a maze of huge underground caves and tunnels, which all formed part of his art, alongside his paintings. Anselm Kiefer's studio complex in France was the subject of a documentary film, Over Your Cities Grass Will Grow (2010), which opened at Cannes in 2010.
When Stefan visited the 35-hectare studio complex of Anselm Kiefer in 2019 he was staggered by the scale of what this artist had created. But that was not all. Anselm was in the process of creating another building which was large enough to allow Anselm to paint a 50ft high painting.
Stefan was struck by the artist's incredible vision. He said, this artist is "limitless" - he just doesn't accept any boundaries or limitations whatever. The experience of visiting Anselm Kiefer's art compound was to move Stefan so intensely that he describes feeling the adrenalin from the visit for a full two weeks after the visit.
After the visit, Stefan describes feeling ashamed of his own limited vision. He had just seen an artist who did not accept limitations or boundaries. Why should BrainLab be different? He realised the limitations of what BrainLab could achieve were just in his head.
Stefan says, sometimes we just need an external trigger to grow our vision bigger.
When he returned to BrainLab from his visit to Anselm Kiefer's artistic compound, his colleagues didn't know what had hit them. Some of them thought his ideas were crazy, but he was much less willing to accept restrictions. As we saw in Chapter 5, Brainlab AG now occupies a former airport control tower surrounded by a 240,000 square foot facility containing advanced operating rooms, a concern hall, Germany's best gym, a restaurant with a dedicated pastry chef, and Munich's most expensive party location. The "limitless" imagination of the German artist, Anselm Kiefer, are indeed in evidence at BrainLab AG!
Stefan hires people of all ages, but he likes hiring young people because they haven't learned what the limitations are. If you have somebody experienced, Stefan says, they can give you all the reasons why something can't be done. Younger people have a different perception, and things that seem impossible can be accomplished by people who "just don't know any better".
Stefan explains that, for every problem, the solution to the problem always co-exists with the problem. You need an expansion of your horizon, to discover the solution which was always there.
Stefan believes it is crucial to expose everybody in the company to "the problem". People in, for example, accounting should go to the operating room once a year, and see how the company's technology is impacting their customers and their patients, so they can understand how their work is part of that.
To solve problems you need to get people connected. You need a lot of space for informal communication. That's the idea behind why BrainLab has the best gym and the best restaurant - because those are areas where people meet.
Stefan says employees do small group training in the gym. They work out with a personal trainer and colleagues from different departments. That breeds cross-departmental communication and creativity, and that's where the best ideas are born.
Stefan says, always talking to the same people is like committing mental incest - you are just feeding what you already know, and what you want to listen to.
He says everybody should make an effort to push themselves out of their own comfort zone. He has to do that all the time, as he is naturally very shy. Push yourself out of your own comfort zone, and you never know what the day will bring.
On the question of perfection, Stefan says you need to accept that you will not be perfect. What you need is the "courage for imperfection" - the courage to try things anyway, even if you are not perfect. Interestingly, he has sometimes not hired people because they have been too perfect in the interview! He is always looking for something that is a bit "off", which makes the person more personable and authentic. Being authentic is the most important thing, he says. We need authentic people to build meaningful relationships between employees and with clients. It's the same with jazz and many different types of music. It is the imperfection which is really the "spice of life".
Stefan has been in charge of the company for 34 years, which he says is very unusual. He has never worked at any other company. Everything he has learned, he has learned from people he has hired. Hiring people who could do certain things better than him made it easy for him to let go of those things.
There's hardly anything in BrainLab he hasn't done at some point, but he feels privileged to have worked with the people he has hired, and they have been his mentors and coaches. He looks for people who are outspoken and open - people who are willing to disagree with him and have debates.
He takes management associates, who have done an MBA, for example. They are there to work on corporate projects - but what they don't realise is that they are teaching him about new ideas at the same time. He says that is a great coaching and mentorship program for him, although he doesn't like to openly admit it all the time!
As well as art, Stefan has also been influenced by films. In the early 2000's Stefan saw the movie Minority Report, in which Tom Cruise uses a special screen. He thought, that's what we need for surgery!
He gave the idea to one of his best project managers. He gave him 18 months and a budget of $1m. In 2006, they launched the product, which is a large touch screen for surgeons. Touch screens are more common today, but the product was released about 6 months before the iPhone was first introduced. The BrainLab device and software is now in thousands of operating rooms.
Stefan still does a lot of customer demos himself. He says you shouldn't buy software from a company where the CEO can't give a decent demo of the software.
More recently BrainLab has created Buzz Virtual, which is a small box which can be used with any screen. They have software running on a server which they can bring to the screen, which can for example bring AI labelling of anatomy.
BrainLab's technology is now in 6,300 hospitals in 120 countries. BrainLab considers there are about 7,000 hospitals doing serious surgery, and BrainLab is therefore in 90% of these.
In 2020 Brainlab announced the acquisition of Level Ex, a Chicago-based company that creates medical video games designed to advance the clinical skills of physicians and surgeons.
With a user base of more than 600,000 medical professionals, including half of all medical students in the US, Level Ex creates mobile, AR and VR games which allow surgeons to practice and develop their skills. The games are super-realistic, using the latest computer graphics from the gaming industry.
Stefan says that as an entrepreneur you must expect lonely moments. You may have received a lot of advice from people, but ultimately you have to make the decision.
There is never a right or wrong decision. You need to make sure that the decision that you took ends up being the right decision.
Stefan says sometimes we get mentally stuck with plan A. Sometimes you have to give plan B a little more love. He would encourage everyone to spend a bit more time thinking about plan B.
Stefan gives an example. They once ran an advert in a journal for a new product, even though the product was not yet ready and they didn't have a photo of the product. As they didn't have a photo, the advert showed somebody walking through the desert, with the caption "unlocking possibilities". The advert was criticised as being "childish", so they decided to turn this criticism to their advantage by running a new advert showing a picture of a child holding a can-and-wire telephone to his ear. The caption read, "Curiosity without constraint, always exploring, always growing, youth isn't wasted on the young." So the criticism was turned into a strength, and made into a successful marketing campaign.
Stefan says, whatever we did we had fun. Life is short, and having fun with what you do is key.
