A Startup Story on How to Manage Rapid Growth

Intro 00:01
Welcome to Startup Success, the podcast for startup founders and investors. Here, you’ll find stories of success from others in the trenches as they work to scale some of the fastest growing startups in the world, stories that will help you in your own journey. Startup Success starts now.

Kate 00:18
Welcome to Startup Success today. We have Oriana Papin-Zoghbi in studio, who is the founder and CEO of AOA Dx. Welcome.

Oriana 00:28
Thank you for having me.

Kate 00:31
I’m excited to talk to you. Your company is doing something pretty remarkable with finding detecting ovarian cancer earlier, which is key, and we’ll get into that in a little bit. But if you wouldn’t mind kind of walking us through your background and setting the stage and what led to the founding, I think that would be really interesting.

Oriana 00:51
Yeah, absolutely. I started my career right outside of college in an early stage women’s health company, before they were called women’s health companies. Diagnostic startup, working on a test to be able to diagnose premature rupture of fetal membranes – basically when a woman’s water breaks too early in pregnancy. And I was involved with that company from its early days until we were globally selling across the world, and we got acquired. And when we got acquired, we were acquired by a German biotech called QIAGEN, and they offered me a role to move to Germany and work on sort of a more broad global diagnostics health portfolio. So I worked on all things like HPV screening, infectious diseases, women’s health. So that was a fantastic experience. I’d gotten to see early stage to essentially acquisition. And then the part of the team at AmniSure was going to spin out a new company, and essentially, I decided to join them again. I’ve never been a founder, so I wasn’t a founder at the time, but I joined as a very early stage employee. And was with that company until FDA approval, and then we got acquired. And so at this point, I overconfidently said, I know how to start a company. I worked at places where they successfully started companies, built really amazing products in women’s health, successfully returned to the investors. How hard can this be? I’ve seen it done. And I’d worked with my co-founders that entire time. So from AmniSure to QIAGEN to Parsagen, we’d been working together for 10 years. So we came together and said, how can we continue to have big impacts in women’s health, and we decided to co-found AOA with a lot of optimism, a lot of passion and a little naivete on how hard it actually is. But I always say, I’m really glad I didn’t know how challenging it would be, because it might have deterred us from starting, and then once you’re in it, you just can’t turn back anymore.

Kate 02:39
You know, I’ve heard that a lot – founders say, If I had known, I might not have, but I’m so glad I’m here. So why this product? First of all, let me just say your background is amazing, and congratulations on all your success, so I think you’re poised to do what you’re doing right now. So why this product? Like what inspired you all to look here?

Oriana 03:00
Yeah, absolutely. When we started the company, like none of us are researchers or academics, so we weren’t taking our PhD work and deciding to spin a company up. Instead, we looked at it from where are there big problems in women’s health, specifically, where a diagnostic could be part of the solution, because we’re never been in therapeutics, you know, hadn’t done anything with digital health at the time, and so really we focused on diagnostics. And we mapped out a number of different health areas where the status quo was really terrible for women, diagnosing ovarian cancer, diagnosing endometriosis, diagnosing preeclampsia, amongst many things. And then we went to academic offices and tech transfers and research and poster publications and patent filings, and we said, Where is there something really interesting and novel and groundbreaking that could help solve for one of these problems? And so we essentially ended up meeting Professor Saragovi. He was introduced to me by one of my mentors, and we learned about his novel biomarker approach and how his early work had started in ovarian cancer. And that got us really, really excited, because, number one, ovarian cancer was really, really a big area that we had identified as needing better solutions to. And number two, his biomarker approach was really novel. It wasn’t taking that’s been something that’s been done before, and improving on it, you know, a little bit more sensitive, a little bit less expensive. It was groundbreakingly novel. Nobody has really untapped the potential of lipidomics in cancer detection. He was looking at gangliosides, and that led us onto our work, more broadly speaking, into lipidomics and our multi-omics approach now, but that’s what got us really excited. And then we built the business case around how we were going to deliver innovation into a clinical product, and how we were going to have a big impact on women’s lives.

Kate 04:45
Wow, that’s really inspiring and exciting. So you, and I’m asking this for the people listening, you build the business case. You know you’ve partnered with someone who’s doing amazing work. What are the next steps after that? Is it funding?

Oriana 05:00
Yeah, yeah. So originally, we started with a scientific hypothesis at the academics lab. And we started with grant funding to continue to prove out the scientific hypothesis a little bit more so that we had a relative level of confidence that scientifically this could work. Then we use sort of all of our experience and kind of our network to really assess what would be the regulatory pathway? What would be the product pathway? What would be the reimbursement pathway? How much time would that take? How much financing would that take? Whatever we came up with, you got to double it, because, you know, your best laid plans never actually go. And then we went out to raise our first sort of friends and family, angel funding raise, about two and a half million dollars, to really focus on, how do you translate this from an idea into a concept. I don’t even say a product, then it’s like, into a concept. Because in life sciences, in something that requires, like, what that work? You’re not in the SaaS business. You’re not in something where you can just take an idea, iterate for three months, put it on the market, and see if it works. You have to take, like, biology and see, can I turn this into a concept that will actually translate into a product? And then from concept, you go into Okay, feasibility, which is like, is this like technically feasible? And then you go on to develop your product. And so we learned that along the way. Raised my thought about, sort of, how do we do this conceptually, first with development partnerships. And so we didn’t build our own lab or go all in on hiring scientists, yet, we worked with other experts in this space and said, Okay, can you take what we’re doing at McGill University, and can you replicate this? Can you improve upon this? Can you really tell us, is there a concept here. We got a yes to that question. Then we went to raise more money to say, Okay, well, how do we build out the clinical infrastructure to prove this out by doing a clinical study. And we hired a couple of folks to help us on the clinical side. We’re really, again, focusing with a CRO to think about our clinical study concept. And then once we figured that part out, we went and raised almost $20 million to say, Okay, now we’re going to build out our lab. Now we’re going to hire the team, we’re going to run our clinical study, we’re going to develop our product and eventually get this to the FDA.

Kate 07:12
Okay, that was really helpful. Because I think that’s where those of us on the outside looking in, we’re always like how do they go from idea to – and so I like how you explained it was first a concept.

Oriana 07:23
It’s very incremental. I think sometimes you’re, you know, renowned anybody, and you can raise $100 million off the bat, and then, you know, you can do that. I wasn’t, I didn’t have a network. I’d never been a founder, I’d never been a CEO, so I had to kind of build it up from the ground up. And it’s incremental steps that show that you’re de-risking along the way until eventually ending up somewhere where you have something that you can really go out and develop.

Kate 07:49
Yeah, and congratulations on your raise. So where are you all now?

Oriana 07:54
Yeah, we’re in the product development and clinical study stage. That’s exactly what we had essentially raised the money for. And we’re hopeful that we’re about two years away from putting our FDA submission in, out to the FDA and eventually coming to the market, and so we’re technically further along than we were a few years ago.

Kate 08:12
Oh, that’s so exciting. Seriously, yeah, any surprising challenges along the way?

Oriana 08:19
Oh, hundreds, yeah. I mean, transferring any technology outside of academia is painful and surprising and really, really hard. Once you’ve gotten it out of academia to then translate that into a clinical product is 100% harder as well. Everybody tells you, conceptually, hire slow, fire fast, but practically, that’s actually really hard to do, because you’ve just gotten money. You need to hit milestones. You’re going to run out of time, so you want to hire somebody as quickly as possible. So you feel nervous about waiting, and so you’d kind of turn off your gut intuition a little bit, and then it bites you because you not the right fit, and then you take far too long to do something about it. So, yeah, that was reality a few times.

Kate 09:11
Yeah, I think we’ve all learned that about you have to fire a little faster than you want to. But you mentioned something to me that you’re very people centric in like who you hire and who you serve. Let’s delve into that, because I think that plays into what you just talked about. Like you’re under pressure to hire because you got the funding and you need to have results, but then you know to hire correctly can sometimes take longer than you anticipated or want.

Oriana 09:41
Yeah, absolutely. So at AOA, we say that we’re people first, and the way that we define that is we’re people first with our patients. So at the core of what we do is our mission to serve patients with ovarian cancer and then to build a product that is accessible to them, and build a product that is accurate for them, and to build a product that’s going to fundamentally change the clinical impact. And then the second thing is, when it comes to our team at AOA, we have three values. And the first one is, we are a team. We are results driven, and we are critical thinkers. And at the core of it, what do we mean by that? Is we hire just as much for technical fit as we do for cultural fit. If you have done the most you know, incredible things scientifically, or you’re the top notch clinical operator, and you are, quite frankly, not a nice person to be around, we won’t hire you. You have to mix in with our culture. You have to have a go-getter mentality and a startup mentality, and you have to leave your ego at the door, otherwise you won’t be a fit at AOA. When we think about being a people first organization as well, we really think about, how do we enable success at AOA by looking after people. Something as simple as early on in the company, we thought about, how do we provide health insurance. Even when we had no money whatsoever. It was something that was so fundamental to us. We work in health care, and we’re asking employees to not have health insurance like for us, that was fundamental. So we looked at like, how do we provide health insurance on like, local markets? How small do we have to be until we’re on a plan? Because when people are their best self at home, when they’re compensated fairly, that was another thing we never said the Oh, we’re a startup, so we can only pay you, like, half of market value and like, believe in the faith of the company. Absolutely, we don’t pay a 100th percentile, or, you know what the big companies do. But we always have a conversation with the individual, and we say we want to make sure you feel valued, and we want to make sure you’re never worried about paying your home expenses. From there, there’s probably a range above that, and will incrementally grow as the size of the company grows, but at a baseline, do you feel valued, and are you not worried about your expenses? And then from there, we know that you can show up to your best self at home, because if I’m worried about paying rent, I can guarantee you I’m not doing a good job at work. If I’m worried about my kid getting sick, I’m not gonna show up to work, right? And so those, I think we thought about those things so so early on, that don’t necessarily cost the company a huge amount of money, but that enable the company have such a great and loyal team.

Kate 12:21
I love that, and a lot of startups don’t think that way, but you’re right. Then you have these employees that are working a ton. They’re stressed about those things that you mentioned. They can’t give their full selves. I think people listening should take note of that. When you go to hire after what you’ve learned is your hiring process a little more robust? Or how did you change that?

Oriana 12:44
Yeah, absolutely. So now I won’t even tell you where we started, but now we have a hiring process which includes the first sort of 15 minute check in call with our People Ops manager. After that, we have the hiring manager does an interview on technical fit. Then we have a panel interview, usually in person, with multiple stakeholders from across the team to also assess for cultural fit and just general understanding of sort of cross-functional work across the company. So like, you’re not just working in a silo for R&D, you’re actually working on a product team. And then we have the final call is usually from me, and usually I do the ‘This is what it takes to work at a startup.’ Startups are over glamorized. Startups are not what you know social media is telling you. This is what it looks like if you were offered this job. Are you sure this is how you want to spend your time? And that we go into an offer from there. Oh, and we do reference checks. That’s also something we learned the hard way, is always doing reference calls.

Kate 13:46
Thank you for walking us through that, because I think a lot of startups really rush, and I think you make a good point, and especially in your industry, not everyone’s a fit for a startup where you wear many hats, you have to do lots of things, the processes aren’t perfect yet. Do you find that a lot in your space as well, that some people…

Oriana 14:07
Oh absolutely. And it’s really hard, because in a startup, I recently read a really great article that you have learners and you have guides. And learners are typically novices in the field, but have so much go getter attitude, right? And they’re always, usually a perfect fit for a startup, because they’re willing to roll up their sleeves, they’re willing to try, they’re not as scared to fail, and they’re just, they’re just sponges, and they want to learn. But if we’re all a bunch of learners, and there’s nobody that has done this across the team, then that can really slow you down. So you need a good balance of guides, right? Somebody that’s done something similar elsewhere. If you’re truly disruptive and innovative, what you’ve been done has never been done before, but like somebody in our case, who’s built a diagnostic, who’s taking an oncology diagnostic, FDA, right, even if it’s not a lipidomics-based diagnostic, but who has that. And often your guides are more seasoned in experience and are already at top tier companies, where you’re trying to get them from. And a lot of the time, by that point in their career, they’re not active doers, they’re people managers. And so having a balance of that when, especially when you’re 20 people. When you’re 20 people, everybody’s part doer. And finding people who have that attitude is not always easy.

Kate 15:23
I like how you describe that. That’s spot on. You cannot hide out in a startup like you can in a big company and just push emails around and attend meetings. You have to be a doer. You have to contribute, yeah. So that’s really important, I think, for everybody listening, people first, I like that. You also mentioned something to me about scaling conscientiously, and I had never heard it put that way, if we could delve into that, because I think that struck a nerve with me as well.

Oriana 15:56
Yeah, I’ll give you the true story, which is, we scaled unconsciously, and then it forced us to be conscious. (Okay.) Which is we were three co-founders, and then we hired about three people. Then we were six people. And but six people is still really, really small. And everybody’s still in all the meetings together, and you’re kind of still doing everything together. And then we went from six to 12 and 12 to 20, really quickly, and everything broke. The way we communicated, the way we used Slack, or the lack of Slack actually, the way we email, the way we did our meetings, the way we summer. Like everything broke because all of a sudden, 12 and 20 people can’t all be in the same meeting together, and you need information to flow so people can effectively do their job, and people who were decision makers were now part of a team, and they were no longer decision makers. They were contributors. And so we did not pay attention to that. And that was the unconscious part, and it forced us to pause, to literally pause, especially the management team at that time, to pause like tactically operating on the product, to go back and tactically build the company, and rethink our processes, and rethink who we are as a team, and rethink our value systems, and rethink how we actually go about to do our day that it taught us that now every time there’s a big change coming, whether it’s on the on the product itself, or whether it’s on the team itself, to be really conscientious about it and and to plan for change in what we do, because otherwise it’ll take you by surprise and usually won’t work.

Kate 17:34
Yeah, no, I appreciate you sharing that. I’ve heard other founders talk about having to go through something like that. Was it difficult to take time away from, like, your concept, your product?

Oriana 17:49
Like fall, two years ago, and all of a sudden everything would just seem so difficult and so painful. I remember talking to my co-founder, and I was like, Why does it feel this way? And we looked at each other, and we’re like, we got to fix this. We got to fix this, and we got to stop what you and I are doing, and we got to go in and fix this.

Kate 18:08
Yeah, what are some of the things you did? Did you like communication policies around Slack, or more team meetings? What were some?

Oriana 18:16
Well, first of all, we didn’t even have Slack, so we brought on Slack. So, tools –what tools were we using. We streamlined and created consistency around how we were using the tools. We revamped how we were doing meetings, both like who was in meetings and what was considered an effective meeting and how we were you know, whether it was sharing notes or etc. We worked a lot on our organizational infrastructure, everything from like, how our files were saved on a SharePoint folder, naming conventions to where information is stored. We talked about sort of, what does, what makes a leadership team versus what makes it a junior team? Right? And like, who sits on the leadership team and who’s decision making authority and how are decisions made? All those things.

Kate 19:02
Okay, that is so great, and I appreciate you going through those examples, because I’ve worked at so many startups where no one thought of that, and like you said, things started to break down, and it can get really out of hand.

Oriana 19:16
And then you blame the people, right? (Yes.) They’re not doing a good job, and they’re not doing a good job. No, they just haven’t been equipped to do the best job, because they’re spending far too much time looking for where files are, or wondering who they need to be communicating to, or asking three people for a decision when it only needs one, because they haven’t been equipped to do better. And so we have had almost no turnover in the five years that we’ve had AOA. We have, I’m trying to think we’ve had one person that decided to move on to start her own company.

Kate 19:46
Oh, so that’s good turnover, yeah.

Oriana 19:50
And so we have an incredibly loyal workforce, and I think it’s because we take care of our people. And we are conscious to build systems, and we’re conscious also to look at our systems when they stop working, and fix them right, other than letting them skirt by. Like we’re going through a growth stage right now, and then we’re like, you know what, the way we’re doing our meetings, it’s not working for us. We’re finding ourselves repeating things. We’re not making effective decisions. We’re rambling way too much. Like, how do we fix this? So I literally, right before this, I just got off a two hour call with my C-suite, and two hours were thinking about, how do we optimize operationally how we work at AOA? And if you’re not constantly doing that and constantly revising, you will have a sub-optimal team, and it won’t be because of the people.

Kate 20:39
Gosh, I love this so much. Just so many startups out there don’t do this, and it’s just a real problem point. Good for you all. That is amazing. I love it. You’ve shared a lot of advice. We always wrap up the show with last words of wisdom for those startup founders out there. Anything else you can share?

Oriana 21:02
I’m going to steal this from somebody else’s playbook. I listen to the Acquired podcast. (Oh, great one.) And I was recently listening to the Costco episode. And there was something from there that really, really resonated with me recently, which is, do the hard things the right way. A lot of the time, and you saw that in Costco’s competitors, people were trying to push down the cost of their employees, or, you know, negotiate hard with their suppliers or do whatever they could to increase their profit margins. And Costco did it. And Costco did it the hard way. And one would call Costco one of the most, if not the most successful retailers today. And so that had me really reflecting, because sometimes I feel under an enormous amount of pressure to cut costs and to do things faster and to do things more efficiently, and to get to the timeline faster. And if I remove these features, then I get to the timeline faster. But, you know, and so, and for me, it was really helpful to be reminded to do the hard things the right way. And you apply that to what’s relevant to you. And I think you will win. And I think AOA is going to win because we’re going to we’re going to do that.

Kate 22:19
I guarantee AOA is going to win. I’ve been doing this for three years, and there are some founders that I talked to that just like they get it. And the hard work you’re doing around processes and organization and people is going to pay off in spades, I can tell right now. And I really appreciate how candid you weren’t sharing it all, and it gives back to the founder community, so thank you. Your time is valuable. And also just taking on ovarian cancer, because I don’t know a woman out there who wasn’t impacted, you know, by someone who caught it too late. So thank you for that. Where can listeners go to find out more about AOA?

Oriana 23:02
Yeah, absolutely. Follow us on LinkedIn. Mostly LinkedIn is where we’re most active. We do have an Instagram and an X presence, but LinkedIn is most active. It’s AOA Dx.

Kate 23:11
Awesome. I really appreciate you taking the time to be here today and wish you continued success. Thank you.

Oriana 23:17
Thank you so much. It was so nice to chat with you.

Intro 23:22
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