Stephen Mackenney

Steve graduated with a law degree from Cambridge University before qualifying as a barrister with a specialist interest in medical law. During a ten-year career in central Government, Steve became Head of Quality, Safety and Clinical Governance in the Department of Health and led the development of the country’s first National framework of Healthcare Standards.

Steve has also lectured and worked on healthcare quality internationally, including time with the European Commission, the World Health Organization, and Health Care Sans Frontières. He has a degree in modern languages and is fluent in French.

Steve’s passion for helping to improve quality and safety in healthcare inspired him to launch C2-Ai with co-founder Graham Copeland. Their mission is to provide solutions that offer a truthful, detailed analysis of front-line clinical practice and support the journey towards zero harm.

Where did the idea for Copeland Clinical AI come from?

Copeland Clinical Ai (C2-Ai) started as a passion project, I suppose. What we do now is based on the life’s work of my good friend Graham Copeland. He and I worked together in the Department of Health in the UK, where he was the National Director for Clinical Audit and I was Head of Safety and Quality. At the time, we were looking for ways to support physicians’ ongoing professional practice evaluation (OPPE) and measure their performance in a way that reflected the complexity of their work. We got so frustrated at seeing doctors’ careers blighted by inaccurate statistical data. One example was a fine surgeon who was suspended for having one of the highest mortality rates in his area. Closer investigation revealed that he was specializing in emergency surgery on patients with ruptured aneurysms (where the chance of survival is already low). It was no wonder his death rates were higher when he was being compared with other surgeons just doing cosmetic surgery on varicose veins! In looking at the circumstances, he was saving a lot of lives and turned out to be one of the best surgeons in the region.

Graham’s work was all about adjusting for the individual risk of each patient, to give a true picture of performance – reflecting on complications and good results as well, not just mortality. This was not about being an apologist for doctors to cover up malpractice. The key was to identify potential issues much earlier, before mortality became an issue. This would allow us to help people identify opportunities to improve and make recommended changes.

We then went on to figure out how we could digitize, automate, and ultimately refine the algorithms Graham originally developed. We found ourselves building an Ai system that could combine his 30 years of clinical experience with a huge dataset we had collected over time from 46 countries around the world. The result has been a system that genuinely reduces avoidable harm and mortality to patients across the globe, which is hugely fulfilling. As we continue to grow, expanding our footprint now into the U.S., it’s still a passion project for everyone on our team!

What does your typical day look like and how do you make it productive?

I don’t really have a typical day – perhaps a subconscious rebellion against my time working in government! I also don’t run a standard office. We work with hospitals, so we wouldn’t want to disrupt our clients by asking them to come visit us! I love to travel, experience new cultures and new ways of thinking about problems in delivering decent hospital care, so in the recent past I would alternate my time between periods of travel overseas (sometimes completely round-the-world) and working from home.

In these times of lockdown, things have changed slightly and working from home all the time I have more of a routine. Start early – around 6.30am. Coffee. Clear the emails that have come in overnight from other time zones, then get some exercise to clear my head, have breakfast with the family – plus coffee – and crack on with the main business of the day. Some days it’s big reports, some days it’s all calls. I find I’m most productive in short, intense bursts of a couple of hours, punctuated with stepping out round the garden (with, obviously, some coffee…). Going out round the garden or some green space is great thinking time. So is cooking. I’ll finish early evening and cook dinner for the family, by the end of which I’ve usually sorted out a few other plans and responses in my head. I try to log those for the following day rather than work late into the evening (although it happens sometimes, of necessity), as too much late-night screen time makes my head and eyesight fuzzy – but also stops me sleeping. That’s a killer. I’ve never slept more than 4-5 hours a night anyway: less than that for a sustained period and I’m a zombie!

How do you bring ideas to life?

With a team! We’re in contact daily and constantly bouncing ideas off each other. It’s a safe environment where we can ask any and all questions and get reactions to our latest ideas. In the process, they get refined and crystallized to the point where one of us can write them up succinctly and we can specify a new product.

What’s one trend that excites you?

The idea of quality-based purchasing in healthcare. In other words, paying for healthcare according to how good the outcomes are, rather than purely how many can be done and how quickly. For a long time, the management trend was to introduce factory-style lean, efficiency processes in hospital service delivery; and this was all governed by purely quantitative performance indicators. Efficiency is good, but the trouble was along the way, people forgot that patients aren’t production-line cars and the keyword in healthcare is “care”. It’s really heartening to see a return to those basic principles – and it means for the first time in a long time the objectives of the managers can be aligned with the objectives of the clinical staff, who went into their profession because they wanted to look after people. The challenge then is that with that new paradigm, managers don’t have many tools to measure quality, and that’s where we come in.

What is one habit of yours that makes you more productive as an entrepreneur?

Getting up early. It’s that quiet part of the day before anyone else is around when there are no interruptions. You can think clearly and get all the difficult stuff done.

What advice would you give your younger self?

Drop the ego: seek advice from as many people as you can and beware of the sharks. You don’t need to jump at the first big offer that comes along and if it looks too good to be true, it definitely is!

Tell us something that’s true that almost nobody agrees with you on.

Patience is not a virtue.

Other people rarely move or make decisions as quickly as I would like them to so I just try not to get disheartened when they don’t. And success doesn’t happen unless you keep pushing.

As an entrepreneur, what is the one thing you do over and over and recommend everyone else do?

Exercise daily. Mens sana in corpore sano! It really helps for combatting mental fatigue and for keeping a positive outlook. I also have my best ideas after a hard workout.

What is one strategy that has helped you grow your business?

Working with local partners. Unless you’re aiming for big global corporation status and have substantial VC backing at the outset, this is a great way to grow into new markets and expand the business overall while keeping overheads down. It also maintains the agility of a small central team who can make decisions quickly. We launched at a time when it was virtually impossible to raise capital, so we took the decision not to recruit a lot of staff, focus our expertise on creating the best possible product, and then use channel partners to do the heavy lifting for us on marketing and sales. Keeping the small team also meant it stayed personal, personable, and fun!

What is one failure you had as an entrepreneur, and how did you overcome it?

This is back to the advice I’d give my younger self. We got approached early on by a big corporation who said they wanted to buy into us. Flattered by the approach, I was taken in! I believed it was their genuine motivation to invest in us and help us grow with a plan to ultimately take us over. In a further show of building trust, they promised a light-touch, goodwill deal, as they knew we were a start-up with no spare resources to deal with protracted and expensive due diligence. Rookie error. After 12 months, we were still fielding their questions, whilst it became increasingly clear they were trying to use the exercise to gain access to our IP. When we finally worked that out and the deal fell through, we were stretched to a breaking point (which I am sure was their fall-back strategy). Bouncing back from that was really just an exercise in tenacity. I drew no income for a couple of years, and in a real show of loyalty, my main team member offered to do the same (I didn’t accept!). We were salvaged by the fact that our clients also trust in what we do and buy into multi-year contracts, so the relative stability of revenues from that model really saw us through.

What is one business idea that you’re willing to give away to our readers?

Bring back Superstars! I grew up with this TV program in the ’80s, that pitted the nation’s favorite athletes against each other by leveling the playing field with many different challenges. Sport is a great way to motivate kids, and it’s filled with positive role-models that they really need, especially now. Just look at the success of Joe Wicks on the other side of the pond during the lockdown.

What is the best $100 you recently spent? What and why?

During the lockdown, our local restaurant has been really suffering. It’s a fantastic eatery, and no one wants to lose it. They launched a morning bakery takeaway service, which I use pretty regularly, and a few weeks ago, started gourmet takeaway meals. I bought the three-course special for myself and my wife. Nice to help our local restaurateur, and we had an exceptional meal! The perfect formula for us to relax together for an evening during these strange times…

What is one piece of software or a web service that helps you be productive?

Pipedrive. We’re in 11 countries now, and this is a really great piece of software to keep a handle on all the moving parts in the sales and account management process.

What is the one book that you recommend our community should read and why?

One Day MBA, by Richard A D Jones.

Given patience is not one of my virtues, and my family motto (see below!), I like to get to the heart of the matter quickly. I don’t know many (any) entrepreneurs who have lots of spare time. Richard’s condensed pretty much everything you need to know into a single volume. His style is accessible and chatty so it’s an easy read, and it’s structured well to dip in and out of. Luckily for me, I now also work with him! Richard recently came on board to help us grow rapidly into some key new markets and he’s already making a big difference, so I can say from first-hand experience that the principles in his books can be applied to a very positive effect.

What is your favorite quote?

Our family motto: “if a job’s worth doing, it’s worth doing quickly!”

Key Learnings:

• Integrity. Don’t lose your moral compass. You’ll meet plenty of monumental shits in business, but you don’t have to be one of them and you’ll feel much better about yourself if you don’t. Some of them are successful but all of them are completely miserable.
• Kindness. Be kind to people – especially the ones you work with. It’s really rewarding to have a team that sticks with you and even does extra to get the difficult stuff done – not because they have to but because they want to and feel part of something. I’ve been really touched by the many ways they’ve helped me out over the years – and they’re all still with me.
• Perseverance (to the point of stubbornness). Jesus, starting a business is hard, and unless you’re incredibly lucky, you’re not going to find yourself an overnight millionaire. The hockey stick growth projection is a myth that amuses many investors when they’re presented with it, but then most of them only invest when they see you’re already successful. Or they want to own your idea outright. Or both. It’s important to expect that there will be an extended period of knockbacks (“learning points”), and financial hardship. But I’ve found the mantra “they’ll prise this business out of my cold dead fingers” seems to have paid off over time.