Podcast: Delve Talks featuring Jake Leach, Dexcom | Delve
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Delve Talks featuring Jake Leach, Dexcom

September 09, 2019

Delve Talks is a podcast that digs into the challenges around design, product development, leadership and innovation. Our first season focuses on what it takes to create a corporate culture that supports innovation.


Dave Franchino:Hi everybody. I'm your host, Dave Franchino. Thanks for joining us today. My guest is Jake Leach. Jake is the Chief Technology Officer of Dexcom That's a company that's really been a leader and a pioneer in continuous glucose monitoring, bringing assistance to people with diabetes. Last year, Dexcom launched its G6 system to the marketplace and that's been met with really sound enthusiasm both by users and by investors. So, Jake, welcome to our podcast and thank you very much for joining us.

Jake Leach: A pleasure to be here Dave. Thank you.

Dave Franchino:Great, maybe to start off you could tell our listeners a little bit about yourself and your background to provide some context on your thoughts.

Jake Leach: Yeah, of course. My name is Jake Leach. I’m the Chief Technology Officer at Dexcom. We are, as Dave mentioned, a company that develops, designs and manufactures continuous glucose monitors. I'll give you little background on myself and then I'll give you a little background on the technology. So, I'm an engineer by training – electrical and biomedical. I've spent my entire career in the diabetes device industry. I started right out of university at a company called MiniMed which was up in the Los Angeles area of California, and we were developing and manufacturing insulin pumps. So, devices that infuse insulin, which is a drug used by people with diabetes to lower their blood glucose.

And so, it was a pumping mechanism that delivered insulin subcutaneously. So right under the skin. We also in the mid 90s were working on continuous glucose monitors, which were for, again, people with diabetes. But the idea there was we wanted to instead of the standard of care, which was to prick your finger, squirt blood onto a test strip, and make a measurement. We were after trying to do that in a much more convenient way for users, which was from to wear a patch that could detect the glucose. So, MiniMed was one of the companies that launched the very first continuous glucose monitor in the late 90s, and so I had the opportunity to work on some of those systems.

And then I joined Dexcom in 2004. So, 15 years ago, we were a startup company. There were about 30 of us. And very focused on the technology. The vast majority of the company were engineers and scientists and we had one goal, which was to develop an accurate and reliable glucose monitor and it took on lots of different iterations. We focused on implantables and then moved towards a more patch style, which is a similar architecture to what we have today. It’s gone through many generations here at the company as we’re working on different parts of the technology. And today, I lead the research development team. I've been a part of that team since it started at the company and it's just been an amazing opportunity to be part of something that is changing the face of how diabetes is managed.

Dave Franchino:Jake, one of the things that I was interested to talk to you about is the challenges and opportunities of driving innovation in a company that's making medical devices. It’s one thing I think to be innovative in consumer products or application software, but clearly the type of products you and Dexcom are working on have a higher, I’ll call it standard of care. What are techniques that you use to continue to drive innovation in an environment where the products you're working have serious implications and ramifications for people's lives and health.

Jake Leach: It's a great question, Dave. Surprisingly, though, it's not actually too different from the way that technology companies innovate and create or normal consumer-product companies. We do see ourselves as a consumer product because our customers are the folks that use the product. Although it's often paid for by their insurance, we deal directly with many of the customers ourselves and interact and take their service calls and technical support. We manage all of that for them. So, it is very much a consumer device, the differences being those you mentioned. It's a medical device. So, one, there’s a lot of safety implications and two, it's a highly regulated environment by the FDA here in the US and by other agencies across the world. So, it is a unique challenge in being able to innovate and move quickly. I think, some of the keys for our success at Dexcom has been to develop procedures and kind of policies and ways of working that allow us to experiment. Innovation is all about experimenting with new ideas and often that can be challenging in a regular environment where you have to have a lot of proof of safety before you can actually go test something.

So, we have lots of different ways we test. We do a lot of development of bench tests so that we can test something without having to go to into humans. So, a lot of our experiments will be on the bench. But then, we do move to human clinical studies because really the proof is in actual clinical data. We're approached by many startups in the glucose monitoring space and being the CTO, I get to interact with these folks and it's always fun and exciting, but my biggest question is always, “Okay, so show me your clinical data” and often when they don't have any it's like, okay, this is a great idea, great technology, but the human body is so sophisticated and physiology -- often you really need to prove technology out in humans when you're trying to measure glucose. We’ve come up with a lot of our ways of running clinical trials. We have our own internal clinical trials group that's very well-trained and sophisticated and we use those teams to run lots of clinical trials. We run a lot of clinical trials on products that never could commercialize because we're working on testing devices and their performance and sometimes, you know, you still have to prove that it's safe. So there's a lot of testing you have to do, but it's worth it because you get what you need to do to prove the systems work.

Jake Leach 2
Jake Leach, Chief Technology Officer, Dexcom

Dave Franchino: That makes a lot of sense. Jake, one of the things, when you're describing your background, I was struck by the fact that when you joined Dexcom it was 30 people and obviously a completely different environment and culture and completely different role for you versus now being a publicly traded company that's considerably larger. How has innovation changed and how is innovation the same at Dexcom as you found the company growing?

Jake Leach: It's changed a lot in terms of the way we organize it. When I started, we were a startup and we did not have any commercial product and we had one mission and the leadership of the company did a very good job of keeping us maniacally focused on achieving our goal of developing a product that could accurately measure glucose. And it was just everybody in the entire company was focused on one thing, one project. And we took a lot of risks in the middle of trying to develop a product, you know, in terms of risks of technology that may or may not work, and we had many different horses in those races, and we were trying different avenues, and everyone's focused on one thing.

And once we launched that first product, it was it was a good product, but it had lots of opportunities for improvement. And so, we've spent many years working on both multiple generations where each generation has enhanced the user experience, the performance, the reliability, really, I mean, I think the biggest challenge was the first glucose sensors were that they weren't very reliable. And so, you get good reading sometimes but not always and so our focus has been on reliability.

And so, the way innovation has had to change is that once you start to grow as a commercial company, there's expectations on your growth, your revenue and basically, your financials are much more visible, obviously, in a public company. And so, what we've done is we've developed a team that has that same maniacal focus on innovation, but we try to do all of that work ahead of product development. Once you move in a product development, things get very expensive because you have very large teams executing on designs and if the technology they're working on hasn't proven feasible yet, you can spend a lot of money and a lot of time very quickly that ends up in a place where the design doesn't work. And so, one of the things I've learned over time is that you've got to have an innovation space where people are safe and free to experiment, and they still have very specific goals they’re trying to achieve but they're able to work on technology and place small bets that are relatively inexpensive compared to large development programs. And you try and prove out the technology. You never burn the risk all the way down to zero, but you can take a lot of the risk off in the beginning and you can really prove, okay, this is going to work, it’s just going to take a lot more engineering to make it a product, but fundamentally the technology is sound and it works. That's how we've tried to keep it separate from product development, so that our product development schedules are much more predictable because most of the risk has already been burned off in those early innovation cycles.

Dave Franchino: I think that's really interesting and the kind of idea of disciplining your organization to develop the technology ahead of product development makes a lot of sense. But one question – without diving anything too specific for Dexcom – what advice would you have on governance procedure for deciding where to place your bets? You know, how would organizations saying, “It makes sense to pull our product development separate from the technology development” decide where are they going to place their bets in technology? Because it's a pretty broad world out there.

Jake Leach: It is. That's a great question. I think the advice I'd give is that for any innovation group where you're going to peel the innovation group off separate from product development, which particularly in medium-sized companies to large companies, I highly recommend doing that. But the advice is that innovation group, there's a number of rules you’ve got to follow. That group has to have a very clear focus and goals. It's not like let's just set up any little innovation lab and let everybody go experiment. Everything has to be for a purpose. So being very clear on what you know user needs or issues you want the innovation to solve for and then you set the team off on those. That's your number one. Number two is you have to start looking at the criteria you're going to use to measure the success of the innovation lab.

We here at Dexcom we call it feasibility exit criteria, so it's basically what is the technology need to prove before we consider feasible and the folks who have input on that are the development teams that are going to be working on the technology and turning it into a product, the innovation folks themselves, and then some of our commercial team members, and kind of product management, those folks. Everyone has input on, okay, what does this thing need to prove before we would take it into development. So that's a having rigor around that process is important, you know, so you need some process. You don't want to over constrict the innovation, but you do need a process of, okay, here's what we're going to look for when we are evaluating whether we take this to a product. And then you need a feedback loop so that you're always kind of reviewing what the innovation group is doing and are they making progress towards the goals you have or do you need to make a correction?

But the main thing for the innovation group is they need to have multiple avenues. If you're trying to solve a problem in a particular amount of time, you need as many options as you can come up with so that's important. And I guess the last piece of advice is diversity amongst that group is important. So, it's often helpful to have some folks that have a lot of history with the company and so there's deep knowledge of the problems that are trying to be solved, but then you also want some really fresh folks with new views from outside. We recruit from outside the med device industry. I would say I can teach anybody medical device rules, but you know engineering and science and innovation is something that, you know, I look for in individuals. So, diversity within that innovation group is important. Diversity of backgrounds. Diversity of experience and diversity of skill set.

Dave Franchino:Those are some great points. Jake, let me take the conversation in a completely different direction. One of the things as I was reading the reviews on the Dexcom G6, learning more about how the product has been received, I was really impressed by the feedback Dexcom is getting on the customer experience. It's clear that there was a lot of thought and action taken on the experience of individual users. I think that's particularly interesting because there's clearly a lot of deep science and technology related to the product, but your team had to have focused on making that accessible and easy to use. Can you talk a little bit about some of the opportunities and challenges, or maybe your philosophy, on blending an organization which has to execute technical excellence on extremely complicated products, but still keep the human at the center of the product itself?

Jake Leach: Yeah, very, very important aspect of consumer products. And so, it's a great question. User experience when we started developing our products was mainly about let's make the device reliable so that the glucose readings it provides users can take meaningful action off of that. And that was a great guiding principle for a long time. But as we started to look at our G5 system, and in particular G6 system, we started to see some of the pain points that users had. And a lot of it was around the device that's used to apply the sensor to the body and so it actually was quite a challenge. The direction we took was to take on a lot more engineering challenge within the device to make it a lot easier for the user. And so, working with Design Concepts, now Delve, working together for multiple years on this device doing human factors evaluations and also a lot of very rigorous engineering. And the device, our Gen 6, within the internal device of this sensor applicator, the internal device is quite sophisticated compared to our previous generations, but what that results in is a much better user experience, whether it's a simple push of a button instead of a manual injection, like previous generations. And that has really been a great advancement of the product and it takes a lot of the kind of inhibition that folks have or the scariness of the device because, you know, no one likes to give themselves an injection. But when it's as simple as pressing a button and it’s all over in 15 milliseconds, that is a really important improvement the user experience. But you know, it cost a lot of money to develop and time and a lot of effort, but we're very proud of it and very proud of the work that we've done with the team from Delve and our internal team working together on it. So, that was a big risk I'd say we took, which was “Hey, let's focus on making this much more complicated but better for the user.” But it definitely paid off and in the end our users are very happy with the experience they get with the G6.

Dave Franchino: Excellent. One thing I wanted to kind of ask you about is I think in many aspects Dexcom is a proxy for a challenge that a lot of companies face in that the technology and experience of your product is split between a physical device and a digital experience. Obviously, many companies are grappling with having grown up in the hardware space and suddenly realizing that a lot of their competition, a lot of the experience that users have, and a lot of the value that can be created exist in the digital world. Can you talk a little bit about some of the challenges and opportunities of running both a hardware and a software organization? What that means for your philosophy in focusing on the innovation space within Dexcom.

Jake Leach: Yeah, absolutely. So, we have a very healthy software group that we've developed over time and they do everything from mobile app development to cloud server infrastructure development and web views. All of this is in an effort to ensure that the glucose information that our device produces is provided to both our users, their caregivers, and the medical community, all the places where they need it. And so, the most kind of challenging work that we had originally was developing software for mobile devices that connected up to medical device hardware. The mobile device is mobile phones, right? Years ago, it was kind of prohibited for those devices to be used in medical device because they, you know, Apple would not, you know, they're not claiming their iPhones is a medical device and we're not testing it to medical device to standards and so we worked very closely with the FDA. So, another place where I'd say, we've been pretty innovative as a company, not just on the technology but also with our dealings with the FDA in terms of creative ways of solving problems with them. And we were the first glucose sensor company. I think actually one of the first class three companies to ever launch – class 3 being an FDA regulatory classification. Class three device on a mobile phone use for patients. And so, we had a remote monitoring system we developed. But you know, I think that some of the challenges we have with software and hardware is that they move at different speeds. So, my hardware team is developing products that generally are on a three-to-five-year cycle. When you start working on the innovation at the beginning. Software can turn much more quickly and so implementing an agile software process where you can do rapid releases, bite-sized releases, that add user functionality and extra infrastructure –

trying to marry those two can be a challenge and we're always working on how we improve that because software you could do 12 releases a year quite easily. And you're not going to do 12 hardware releases because, you know, as you look at manufacturing of our hardware, we manufacture millions of sensors a year and you can't just change out your automation all the time.

So, it's fun. It's a fun challenge. The teams work side-by-side. We're co-located in the same campuses. We’ve got a couple remote offices, but a lot of our folks are co-located and, yeah, we work together. That's a very intimate connection between the cell phone app and our devices because they communicate via Bluetooth directly. And so, yeah, it just takes teams working together, project teams. But our software team is actually at this point larger than our sensor team just because of the amount of software we manage.

Dave Franchino: That's fascinating. I'm sure a lot of companies are grappling with some of the same things and finding themselves inadvertently becoming software companies. There are some great nuggets for our listeners in there. Jake, I'm kind of curious when you reflect on your career, you know, having started out as an engineer doing and then presumably leading teams and now leading people who lead people who lead teams. How do you reflect on your role as CTO as it extends to innovation? What do you think the role of a CTO is in a large, complex, dynamic company in terms of creating an innovative culture within the entire organization?

Jake Leach: Yeah, another great question. One of the important parts of my role, I see, is to ensure that the technology that we're developing and the innovation we're investing in is well aligned with the business strategy or corporate strategy. And so, as the corporate strategy evolves as you grow and get larger, our experience now is there's a lot of opportunity for glucose sensing. Continued opportunity within diabetes, but also outside diabetes, for this technology to help people in many different aspects. So, aligned in ensuring that the right technology is being developed to take advantage of the opportunity. So, I think that's one of my key overall objectives is to ensure that my team's doing that. The other thing is, you know, being a kind of the cheerleader and coach for the development organization. I love to stay close to what we're doing – all of our projects, review them all the time – and just ensuring that our team has what they need to do the innovation. They have the space to be able to innovate. Our product development teams have the tools they need to develop. They have the resources they need. We work with outside firms when needed and in particular in areas where they have more expertise or can really help us. So, just trying to make sure that the teams have everything that they need to do that. And you know, the other aspect of CTOs—. there's also a number of kind of outward facing responsibilities to making sure that the investment community and the diabetes community customers know where you're headed and what you're doing. And I think that's another important aspect being vocal about it – making sure people understand that you're there and you're developing technology for them.

Dave Franchino:Sure, that makes a lot of sense. Jake, not specific to anything going on at Dexcom, but I'm curious about what keeps you up at night relative to ensuring that your organization remains innovative?

Jake Leach: I think a lot of things that keep me up at night, but mostly just because I'm so invested and passionate about what we're doing, but I think the number one thing is that as you grow and you get bigger and, you know, our R&D team is quite sizable now – many orders of magnitude larger than it was when I started – and just ensuring that the size of the organization and the culture and process doesn't move towards being too restrictive. Often what happens, right, as companies grow you start putting more processes in place and processes can be restrictive. And so, you have to be real careful with processing culture that you still are able to move quickly. One of the things, I think, that has made Dexcom successful is our ability to innovate and move rapidly. And so, that's a very important part of our culture that we do spend time ensuring that we keep, but it gets harder. It does get harder as you grow to maintain that culture. And so, I think communication to the broad group is important and something that we focus on. Making sure people have what they need to innovate and they're not too restricted. So, I think that's a number one thing that I think about when it comes to how do we keep innovation going is how do we keep a culture of innovation.

Dave Franchino: Really interesting. Jake, one last question before we sign off and that was you know, having successfully navigated the transition of your company from startup status, what advice might you give to somebody who would find themselves in the same position: Wants their company be more innovative, but perhaps right now, they're small and don't have as many resources, have technical challenges confronting them. Any words of wisdom looking in the rearview mirror that you could offer to people who might be in a similar position, wanting to make sure that the company stays innovative for the long haul?

Jake Leach: The way that I've seen us be most successful, even when we were doing it early on, and in some of our more innovative things we've done even as we've gotten larger – it's all about focus of the folks that are working on the innovation. They have to know it will be very focused, kind of suspend disbelief that what they're working on is not going to going to work. There's a lot of that in early technology development and innovation. You're not quite sure, so you're experimenting. So, these guys stay very focused on what you're trying to achieve and if you're a leader in an organization, then you want that you need to create the environment where those folks can do that. And when often if there isn't as much innovation, sometimes that's caused by, you know, people like doing the way things have been for many years and so anyone who's kind of seen as a trying to test the waters on new ideas could not always be received well by others. I think you need to generate a space where people can be creative, innovative and try things, and it's okay to fail if we fail fast and move on and learn from it. I think creating that environment is the most important – that has focus and space.

Dave Franchino:Jake, thanks. I have really enjoyed and appreciated the conversation. Congratulations both on your success with the company Dexcom but also on bringing a really important technology that I know is helping a lot of people in their lives. We really appreciate the conversation. Once again, this is Dave Franchino, the host of Delve Talks and my guest today has been Jake Leach, the Chief Technology Officer at Dexcom. Jake, thank you very much for your time.

Jake Leach:Thanks Dave. I appreciated being on and really enjoyed it. Thank you.

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