I'm a firm believer that the gap that we have in care providers and people who need care is only going to be solved through technology.

I would hate for anyone out there that says, my gosh, I had that idea, but I never took it forth. I wish. Get out of your chair, get out of your comfort zone, find the community around you that can help you build the team that you need and move forward.

Another barometer that I use is when I ask them who else is trying to solve this problem. The minute they say no one, I'm like, yeah, you're out of here.

Harvey always says in a gold rush, don't go for the gold and sell pitches and shovels.

Good morning, everyone. Again, welcome to Signals and Symptoms Podcast. I'm so excited to see Sally Anne Frank, who is actually the Microsoft startup head for driving healthcare innovation. She has written two amazing books. We're gonna talk about her journey and then go from there. And she's gonna introduce herself and books, everything. Sally, why don't you introduce yourself and then we can start the conversation.

Great, thank you so much. Thank you for having me and thank you for that great introduction. So I am Sally Ann Frank. I'm the global lead for health and life sciences at Microsoft for startups. So what that means is that I spend my days helping early stage companies grow and scale using our tech and leveraging our customer network for go-to-market opportunities, bringing them to like HIMS and health and then also connecting them directly with customers using our account teams and a variety of other go-to-market activities, which I think is the surprising side. Everyone expects the technical enablement, but it's the go-to-market that really is valuable for our startups in addition to the technology that we can offer. I've been in this role for a little bit more than five years. Prior to this role, I was doing IOT and healthcare a lot with remote patient monitoring, cold chain tracking, connected factory, connected product, all that stuff. I've been at Microsoft a little more than 10 years. Prior to that, was with a Microsoft partner for 16 years and kind of went on that journey from really small company to a mid-sized company where you were really trying to get the attention of Microsoft and I understand what it's like to do that.

I wanted to add something that you're not gonna find in her LinkedIn or her profile. And that is the human aspect. I had the honor of meeting Sally in Dubai in October. And I have to say I was a stranger and she treated me like family. And more importantly, her passion for what we're doing in AI and healthcare is sincere. And you won't find that out there, but I wanna say firsthand that that's the person right there. All right, Sally, well, there's so much to cover know you have things that you want to share, but as a founder, I've started over 40 companies and a lot of those have mistakes in them. One of the biggest things that really attracted me to what you're saying is I'd love for you to kind of share with others out there. What is your startup protocol? Kind of give us the 10,000 feet high. How does that help us?

So one of the things, and this comes from kind of having similar conversations over and over and over again with founders. And that was really the impetus for the first book is that there were the same questions that everyone was asking. And so we put together, I put together this framework where, know, what you need to think about at the ID8 stage, what you need to think about when you're building, what to think about when you are launching and then as you go to scale. And one of the things that often happens, particularly with first time founders, is that they invest all their time in the product, or they invest all their time in the go-to-market strategy, or they invest all their time in understanding the regulatory pathways, which all of that is important. But there has to be a measure of equalness across all of that. I always talk about the fact that your product development roadmap your go-to-market roadmap, and your regulatory roadmap should all be threaded together in a way that you are working on them simultaneously. Because if you over pivot in one area, you will be caught flat-footed. So let's say you develop a really great product, but you've done no customer discovery. You've not done any of the early go-to-market work. Well, you go to launch and nobody wants it. Like you haven't really confirmed that people are going to pay you to solve that problem.

Yeah, I love it. As a physician, I know I guard my guidelines really carefully and when they're updated, I look at them very, very carefully and it is exactly what I'm hearing from you is how can I be successful? The other thing is that you just mentioned my favorite phrase is let's work backwards. And to me, this is what you're doing. And I love that this, protocol is basically here's the end product. Here's what I want to do, but how do I get there? Let's work backwards. And it's kind of showing it now.

Your framework is so spot on because one of the things that you know as an investor is an Asian investor. The one thing I wanted to ask was that do you have a holistic ideation policy that actually joins all the five you know problems right. Team you know scalability all of that from initials pre-seed round to seed round and all of that. So question number one for you is that within the last three months things have changed dramatically. 2025 was where agentic AI was introduced. Now agentic AI is in the workplace. How do you see the market shift? Is it going to be helpful or is it going to be hurtful? Are there going to be only big winners? How do startups need to restructure using your framework in the age of agentic AI?

So, you know, I'm a firm believer that the gap that we have in care providers and people who need care is only going to be solved through technology. And so when we look at agents and we look at just the last few years and this rapid change in how we're applying AI, the thing that is, I think, most important besides making sure it's safe and ethical and all of that is to sure that you are designing for the end user. Sometimes that's a patient, sometimes that's a clinician or staff member. One of the things that we are really focused on with our startups is making sure that not only can you talk about the value, but it's documented, that you can look at previous customers, previous implementations, and walk away whether it's Agwntic or just an AI solution and say, save them. 15 hours or we save them a variety of other metrics. Yeah, I think one of the other things that's really important that I call out in the book is that if you are building for a doctor, a nurse, a staff member, a scientist, a patient, then build your set of what I call proxy customers. These are people that are agree that you're building something of value and want to be along for the journey and we'll give you feedback along the journey. So they're not customers yet because you have nothing to sell, but they are the archetypes of the people that you want to use your product. So the idea is really to start building a network of people around you who believe in the mission and who will give you that hard feedback early and often and throughout the process.

I love that. It's kind of like that friend that tells you, hey, dude, you got something on your teeth. know, you're like, thanks. You care about me. It's the same thing. It's a silly analogy, but it's

I'm using AI agents. My user experience is changing on a daily basis. Like we experiment insanely fast. We have to build integrations that are building in three days as compared to three months. We are so me as a startup. Now I'm encroaching on things that I was not even thought about. This was out of school. This was out of school because startups all about focus. But no matter I can say yes to customers so fast what was going to happen to another Junaid or a 20-year-old who's a neurocritical care physician and then wants to do a startup. What do see the future like?

Yeah, I think you both bring up really excellent points. And the thing that I think about is that we talk about AI and we talk about agents and in three to five years, it'll just be stuff we do. Like there won't be, we won't talk about AI, we won't talk about agents, we'll talk about how you got something done faster or how, you know, this was super easy to do or how to take a really complex problem and break it down into parts that are easily solved. So it really, when I think about what's gonna happen in five years from now in the startup space, we'll still be innovating, but it'll be very different because you can't just carve out this little tiny niche because it won't exist anymore.

We have a lot of startups and other organizations that are really trying to work on the governance side, trying to work on improving the veracity of these models, trying to improve the lack or trying to diminish bias and improve safety and all of that. I think that's always going to be there because the technology will continue to evolve. And because of that, those guardrails will have to always evolve as well to

I want to talk to you and see if you could chat about the unicorn standard that you talk about in your book. I love that. It like blew my mind when you met when you said it. And I kind of wanted you to see if you could just expand a little bit on it.

And so the unicorn protocol is really designed, if the startup protocol is designed for early stage founders, like at the ideate stage and, and, know, MVP or prototyping, this one is for people who are a little bit further along so that they can understand those kind of seminal moments when unicorn founders really had to make hard decisions. And so the idea is that these 10 now unicorn companies that are kind of household names in the industry, Amwell, Athena Health, Innovacer, Omana Health, what were their journeys and what can we learn from them? What can we learn from those that went before you? But the point is that several of them came up with really interesting business models. Several of them pivoted in a way that they didn't expect. Like Athena Health, Jonathan Bush was building maternity clinics and he had to build an EMR for the maternity clinic. And that is like, well, maybe the money's over here and we're having a hard time over there. So, it's just really interesting stories. And even to the point where I'm hoping people see themselves and go, I struggled with that. Abhinav Shashank from Innovacer. He talks about the fact that he doesn't hire for what he needs today. He hires people that he thinks he's gonna need in two years. That's brilliant. Like that should be in a plaque in every manager's office. Like it's perfect. It's that kind of thing. And those kinds of lessons that you can only get from people who have been there and have the bruises and scars.

Harvey always says in a gold rush, don't go for the gold, but sell pitches and shovels. So that's one. So one of the things that you have to understand and why we are concentrating on governance part because FDA has relinquished some responsibility and we're gonna have to be selling pitches, shovels in a gold rush. That's important to understand that that's where exactly she's telling that. He was concentrating on a problem, which is gold, but understood that if you have shovels, that's gonna make more money. Understanding this, this is where these amazing masters come in like Sally and Harvey that go, lets you go through. I had to adjust some of my strategies given the feedback that I got.

For scaling, so I'm going to go back to those proxy customers that we talked about. One of the easiest things you can do if you've actually built that network of people around you who believe in your mission and what you're trying to build, they should be your first customers. So they should be the early adopters and they should be part of that initial feedback on how you deploy. Number two is documenting early wins carefully and thoroughly. Why? Because that's going to be the marking material of the future. So making sure that those early wins, if they are successful, that you get video testimonials, that you build case studies, and all of this stuff is available and open to your prospective customers. The other thing that I encourage when it's feasible is to do some kind of interactive way to get people to understand what you do. So sometimes it's like an ROI calculator, or sometimes it's a brief demo online that they can self-service. If they can put in like their own data that gets anonymized or they make it up, whatever, and then you can show them what happens, super, super powerful. And one of the things that I see frequently is a pilot goes well, and then they don't know what to do next. Like how do we go from pilot to full implementation? It's incredibly important to plan and have ready what that full implementation is going to look like the moment you kick off the pilot. Because the other thing that happens, and this is something I've said before, is there's this law of diminishing interest. If you have a successful pilot and you're waiting a week, a month, two months, before you can get up and running in a full implementation, you're going to lose them. So the minute the pilot is over, you need to say, and here we go, we can just turn this small implementation into the larger implementation. Here are the steps. Here's how you can pay us. And here's the resources that we're going to need from your team as well as our team. Have that all mapped out.

I really would love to see if there's any other things that like, my gosh, Harvey, X, Y, Z, or I want to tell the world X, please share whatever those things are.

gosh. something. Yeah, you know, I think one of the things that is unique about this industry, and I think it probably is the same in the education industry, but that there is a desire to work together and there is a desire to learn from one another. And so one of the things that is important, if you are a founder and you're trying to build something, do not be shy. If you know that there are people out there that you think would say you were doing something in space and you're like, if I could only get to Harvey, if I could only get to Harvey, it's like, well then ask. Like if you don't ask, you don't get. So I think the surrounding the right people around you and being bold enough, not arrogant, that's something different, but being bold enough to get out there and put yourself out in front of people that you think can really make a difference is really important. The flip side of that, of course, is to be coachable.

And it is so important that you remain humble and bold. Bold is important. I mean, I reached out to Harvey and said, dude, I need help. And he literally then became, okay, I'm going to invest in your company. I'm going to be your advisor. going to... He said, wow, not to talk about Ed Marks and everything. These are not people I knew from birth. And now we have friends from like, from another mother, right? We are basically brothers. It's basically, it was insane that how just reaching out, hey, I need help and be clear. And as a matter of fact, when you send a message on LinkedIn in capital letter, first say A-S-K ask, and then give the context. Because people love that.

Yes, yes. And I've heard from investors time and time again that they invest in the team. That's their investment is in the team, not the solution. And to the point where they will take a mediocre solution, they will invest in a mediocre solution and a top-notch team versus a top-notch solution with a mediocre team. Because you're investing in the people to marriage.

Yeah. Love it. putting on my investor hat, often when I ask founders things, are they in love with their baby? Are they okay with pivoting? Or I hate to use the word, are they so arrogant that they won't see anything but one thing? And if you say anything, they won't pivot because they just can't still see it. Then I don't invest because I'm like, they have to be humble.

Another barometer that I use is when I ask them who else is trying to solve this problem. The minute they say no one, I'm like, yeah, you're out of here. Because if you thought about it, there are hundreds, perhaps thousands of people trying to solve the problem. And the other thing I encourage people to remember is that when they're selling to a customer, regardless of what segment it is, their biggest competitor is doing nothing is having a customer do nothing. So not only do you have to compete against others that are doing something similar, but you're competing against the fact that these people may not want to change what they're doing. And how do you prove to them that changing is important and valuable for them?

Harvey Castro, MD, MBA:

You know, there's this fear of fear of starting. I would hate for anyone out there that says, my gosh, I had that idea, but I never took it forth. I wish get out of your chair, get out of your comfort zone, find the community around me that can help you build a team that you need and move forward because this is the place to be read the book. We don't know what we don't know, but now that we have this book, we know more. And so my encouragement to everybody out there is go out there and do it.

You are so so right. mean the first step is the hardest and I love it. Sally, if you have to say one last thing, go ahead.

One very quick story that relates to the free pilots. So there's a company called InStockRx. They help with inventory across independent pharmacies. Really cool startup, but their founder read my book, their CEO, not founder, read my book, was in conversation with a prospective customer and they said, okay, we'll do the pilot, but we don't wanna pay for it because we don't do free pilots. Like what? Yeah, we don't do free pilots. Well, if you don't do it for free, we're going to walk away. Okay. So he stood his ground because he read the book. They came back a month later and said, okay, we'll pay. I really want one