Why Meaning-Driven Startups Win [Podcast #92]

Ozan Dağdeviren

Hello, and welcome to the Startups of London Podcast. I’m your host Ozan and the founder of Startups of London. Today, I’m joined by a very interesting guest, Joshua Sprigg, founder of enferm.io, which is a nursing workforce solutions, say, digital solution. And I’m quite fascinated by what the business provides, but it’s better if you hear all about it from Joshua, welcome to our chat. 

Joshua Sprigg

Hi, Ozan, and thank you very much for having me. 

So tell us all about it. What does enferm.io does? What’s the business? 

Sure thing. So enferm is– Firstly, the name originates from the Spanish word, nurse or healthcare before it breaks into a feminine or masculine state. And we picked that word because it sort of resonated with multiple countries across the world.

Fascinating, sorry to interrupt. I thought it was it was a wordplay on “infirmary”, which also does make a lot of sense. 

Yeah, exactly that. So I mean, most of the Spanish words are enfermada, enfermedo, enfermedia. And all these words associate to sort of the origin of healthcare. So what we wanted to do was neutralise the word and take into consideration future international expansion, and its adaptability. And essentially, what we do here at enferm is we, as mentioned, are a nursing workforce solution today, and by today, I mean, we are expanding out our services. And by workforce solution, what we mean there is, we are developing and creating an ecosystem for the supply of nurses in healthcare organisations currently in the UK. So our primary focus is supporting a nursing community to be able to identify work in certain areas of the country, where it’s beneficial to them for career progression and so on. The traditional word for ourselves, which is how we originally commenced is a medical temporary workforce supplier.

So my question I guess is, do you help people join the workforce of nurses? Or do you take a look at the existing pool of people who are in the occupation and curate the workforce and bring them together into a single place? So how does it work exactly in that regard? 

Yeah, very good question. So what we do at the moment is we focus on the existing workforce in the UK. So what we do is we try and identify where there are already registered nurses with a license to practice with one year’s worth of experience within the NHS. And our primary focus is on the existing nursing workforce, to improve their ecosystem and improve their access to work and progression within their careers. However, the reason I like this question is that it actually starts to connect the dots to our future. So one of the big topics, which I’m sure a lot of people are aware of other staff shortages. And that ranges global moment, and not necessarily just nursing, you know, this really goes across the full spectrum of every industry. But in the nursing world, there is a big staff shortage. And our future plans are to expand into creating a new nursing pool, the future workforce, so to speak. So currently focusing on existing working nurses, and in the future will be supporting the onboarding of future nurses.

So here’s kind of a saying that I personally like as an entrepreneur, which is “love the problem, not the solution.” And I think founders who take that approach usually are more successful. Because when you love the solution, you’re kind of fixated on a specific way of providing a service your product, and it’s all about you and yourself and your team. In the other version, where you love the problem. It’s about the people you’re trying to help. It’s about the problem you’re trying to solve. And you’re quite flexible in how you provide a solution to that problem. So with that in mind, in your experience, what was the core problem that you have observed? And why are you the right person for working on this one? 

So that’s an interesting one because it’s got two answers to this one. So essentially, when we started the company, or when I personally started the company, I was the sole individual in year one. And I actually started enferm with the intention of pushing a solution into a problem. And that really was, I identified in my previous career prior to enferm that there wasn’t enough focus on customer service and sort of customer success and a people focus. And when I started off, it was primarily to support that community in a more human manner a more engaging manner. And that was very solution orientated. And of course, as the business progressed, and as I matured along the journey, that’s when I started to really acknowledge what the problem was. And the problem didn’t come to light in year one, the problem really came to light for me, in a very clear way, around 2018/19. So I was three-four years into the journey of developing a solution. And it wasn’t until I really acknowledged the problem. And then, of course, the pandemic commenced. And the approach that we’ve had to the problem with this was–  

So just to be clear, this was something you were thinking about you were acknowledging before the pandemic. And as we all are aware, nurses, and healthcare workers, they became a huge part of the national conversation. So you’re saying that it was something that you were involved with before that, is that correct? 

Exactly that. So 2015, when the business started, I was 24, when I started the company. And the intention behind enferm was to replicate the manual processes that exist in our industry, which are staffing and recruitment. And I very much focused on building out a replica of what I knew existed. And from there, over the initial years, I had the ability to assess manual processes, but also to take into consideration the way that I as an individual at the age of 24, operated in my personal life. And that was, let’s say social media as an example. Our demographic, you know, as they call it, millennials, we were very much focused on online community, online engagement and instant gratification, and that just accelerated year on year with the new generations arising. 

A problematic relationship with our dopamine economy, I would say. 

Yes, definitely, definitely. And that, for me was the full intention with enferm from day one was essentially digitalising all of the existing manual processes within the industry. And when we approached February 27, 2020, which was really day one of the pandemic for us here, what was the acceleration of all of these ideas and innovations that we were building up and aiming towards. And the pandemic really accelerated our desire to implement automation, to implement certain technologies and develop what we are now building out today as our ecosystem. 

I think one of the most pleasant if not, what’s the emotion I’m searching for? Encouraging, you know, when you just feel things click, and it’s just right. One of those emotions, I think, is as a founder, when you are in the groove of a business, which has a lot of commercial and financial viability, as well as lots of social value. And sometimes things just fall your way. Sometimes they’re more difficult. But the feeling I get from the story that you’re telling is that there was that kind of a dynamic there, that there still is, I’m guessing, which I think is a huge privilege for any founder, that to feel that what you’re doing is meaningful and at the same time, it’s potentially a great business. So going back to the early pandemic years now, I can’t believe it’s been like three years already. So what was going through your head as someone who’s doing this kind of a business, and there are a lot of issues, and it is just touching people’s lives and health? Well, did you feel the weight of that responsibility? Were you very motivated and driven even more by that, by that mandate let’s say? What was going through your head at those times? 

Yeah. So that’s a deep, deep question because there are several emotions attached to that. And what I mean by that, and I think this is, you know, this is something that’s really come to light as to what our true mission and our true purpose are, and it also correlates to the question around the problem. And just to take it back slightly before the pandemic, I had a personal experience with my son where he ended up in the hospital. And for me, that was the first time that I was in a hospital during a critical moment and realized the ability of the NHS, the ability and the skillset of our workforce within the NHS. And that really honed into me, that when they saved my son’s life during that eight-day period, that, for me was a total commitment. That’s when I had disconnected from creating a personal gain, here for the business, and actually,  really driving this, with total purpose. So my commitment to creating a solution to the problems that we face is, is 100% committed. When I approached the pandemic, again, the day before we were notified of the pandemic from the hospitals, I was in a very delicate situation, for full transparency, a delicate situation, because it was the first time that I built and ran a business. It was the first time that the business was scaling. It was the first time I was exposed to entrepreneurial problems, you know, whether that’s cash flow, whether that’s internal employees, whether it’s, you know, funding or processes, whatever it is. So I had all of these, you know, natural issues that the startup entrepreneurs have. And then I was faced with a national problem in an aggressive manner, right? And what I mean by that is that our day-to-day operations were pressurised by the necessities that the hospitals had. At that moment in time, I clearly remember feeling totally overwhelmed because I had put so much expectation on myself to deliver a better solution to the workforce, and to healthcare organisations. And I’d already taken it on as a priority and a commitment. What the pandemic did was add a whole world of weight, and that enhanced the expectations I had of myself. 

And it can be overwhelming. Sometimes it’s already a difficult journey of being an entrepreneur. And on top of it, you have an emotional connection. And congratulations on that, by the way, not everyone is able to take the best out of a difficult situation as you did. You’ve kind of experienced something traumatic, and I’m so glad it went well for your family, but you’ve turned that energy into something that can help other people in a similar situation. So I do applaud that, honestly. 

Thank you very much. I do really appreciate that. And it’s hard as you know, because, you know, the founder or the startup person is the last person to be recognized and you know, totally fair. So really, I mean, that period during the pandemic, and that period of taking on that responsibility, I’d already emotionally disconnected from the way that I was feeling because it was far greater than an individual, right? So this mission is way beyond a singular person. It’s way beyond that. It is about creating change and disruption for the better. So it’s, yeah, definitely, definitely an overwhelming experience. But it was a decision. And I remember, funnily enough, sitting at home and we were working 24/7 because obviously the pandemic created the lockdown. Being in the healthcare economy, you know, the reliance is on companies like ours to be able to support the NHS and other healthcare organizations where it’s needed. And we weren’t entitled to that break or we weren’t entitled to stop. We had to keep going, no matter what. And I remember it being a very dark period, but also with light at the end because we were a part of, you know, the solution to providing staff to hospitals to get through it. So it was quite incredible seeing how the entire team came together. We practically lived in the office for about a year: we ate here, we drank here, we sometimes slept here, absolutely everything and it was one of the most awakening moments and exciting moments, overwhelming all at the same time. So very mixed emotions during that period. 

So most organisations focus on employer branding, as you know, or there’s this term that I despise, which is “meaning marketing.” I don’t know if you’ve heard of it, because it just toppled something so valuable into something that is just commercialized in such a synthetic way. This is why hate it, the meaning marketing people, it almost feels like an exploitation strategy. How do we find the things people are genuinely interested in and turn them into ways for people to be engaged in companies? But in some other cases, which I think are closer to yours, I’ve seen some founders and some businesses, who already started with a purpose and genuinely are behind the purpose. And it does actually shape the conversations and the relationships, that a startup company has with its employees, partners, and also investors. So could you tell us a bit about that part? How did the meaning behind this business translate into what people who joined your workforce have felt? How were they connected to the business? And also talk about the investor side. Have you had any investors? Yes, so the team and the investment and how it’s been shaped by this meaning that you put behind things, that’s what I’m really most curious about. 

Yeah, indeed. So I mean, that’s a topic very close to my heart, as well. So I think, just to give a bit of an understanding as to who I am as an individual, and as to how I’ve developed the team and the culture here. So I was born and raised in Southern Spain, and my mother’s Australian. She’s, I’d like to think, you know, raised us really well, and with a very strong work ethic. And, you know, it was from a young age, my mum was actually driving in the discipline of work. And that, you know, that started off cleaning boats, then I was labouring on construction sites, and I moved to London in 2009. I was 19, at the time, and I worked in the London underground for years, doing night shifts and day shifts on Network Rail, and train lines. And I’ve always had this discipline to work. And it’s really, you’ve really got to be embedded into the team to be able to lead it. And that’s one thing I did here from day one, I’ve never shied away from the floor, I always sit in and amongst the team, unless I need to do isolated work. 

The way that people joined the business was on the basis of my commitment to the team when it initially began and the development of those teams obviously scaled and scaled and scaled. And now we’ve got multiple offices and a lot of stuff. And even today, I’m very involved with every new joiner and very supportive in giving them knowledge transfer, being able to empower those people that do join us. 

We’re very much a collaborative organisation: we solve problems together, not in isolation. Everybody is of different age and a different background. And I think that diversity really allows for different thinking. And that’s something that’s encouraged people to show their true personalities, their true ways of thinking. And being able to absorb all those different points of view really allows us to shape what our solutions will be to these problems. And that level of collaboration has really brought us together. We always say to each other that energy attracts energy, you know. If we operate with the right attitude, and we operate with a level of integrity and respect, we will attract those types of people naturally, and I won’t sit here and say it’s perfect, I won’t say it’s been a smooth ride. And I won’t say that we haven’t had bad apples, you know, with the company will be eight years old in January. And it’s gone through a lot of different types of people good and bad. 

But I think the encouragement that I get from the team is the fact that I act fast, you know, we hire slow, fire fast. And it’s an uncomfortable situation to be in, at times. And you do have to learn how to handle, those conversations and those decisions. But we’ve always said you can be excellent at what you do, but have a bad attitude or personality and that bad approach is poisonous because it scales a lot quicker than positivity. Negativity travels a lot quicker. And you’ve got to be able to have honest conversations and remove negative situations at speed, regardless of the outcome because the outcome after that is a lot more positive and scalable. So I think, from a cultural perspective, I’m very, very proud and I truly mean that. I don’t just say that for the sake of saying it. 

I think the people that we’ve got here are incredibly talented, have incredible potential, and everybody’s learning. And I think one of the things that I’ve always done with the people here is very transparent. And I’ve said, this is the first business I’ve built, the first business I ran, I will not get it perfect, and I will not be able to execute every time. But what I do have is the determination to keep going. And that’s something that shows vulnerability, and everybody can relate to vulnerability, you know. 

I think sometimes you don’t realise the impact of a title. And a title sometimes can be three letters, like CEO. And that gives an interpretation that isn’t necessarily true, you know, because, at the end of the day, everybody is a person. And I think if you can have personal conversations, you can connect to people. So I think, a hard work ethic, transparency, and the ability to make decisions fast for the collective is a must, in our view anyway. And then, you know, I think that that level of energy and that level of excitement and commitment to our cause, and really started to attract healthcare professionals. You know, for example, I see oh, she herself is a matron, she spent seven years at Google Brain, Google Health and Google DeepMind. You know, there are people that sit on our board that have sat on NHS England’s board, we’ve got ex-nurses, and ex-healthcare professionals, such as healthcare assistants, and hospital volunteers that sit here today and are within our operations team, or our compliance team, our marketing team, and so on. So we all come from similar backgrounds. 

And that started to attract the attention of investors, which did start to attract the institutional desires of backers. Believe it or not, we are self-funded and organic to date, we haven’t taken any external funding or institutional investment, and we have grown and generated our own revenues and our own profits. In 2020, we identified a technology company based out of Switzerland, which was operational in nine countries, and we actually used the profits that we were accumulating for the merger. And we managed to conduct a merger, that closed last year, and it took approximately a year. And really what I’m trying to work towards here is to be in a position of power when we go into a negotiation because one of the things that I’m very conscious of and aware of is that institutional investment too early on, can create issues. It can remove pressures, for example, if we were to introduce a high level of funding, we would eradicate the necessity for our urgency to be able to deliver against our budget. And what we don’t want to do is create any complacency by introducing cash for vanity or cash for aggressive growth, when I honestly believe in an organic, long-term approach, and that will put us in a position where when we do go for institutional investment in the future, which we are planning to, that we sit on the side of the table, where we are in control of what our destiny looks like, instead of being reliant on the funds, and then having the expectations from anybody sitting on the other side of the table. We are very calculated in our approach to funding at the moment. 

I really appreciate and agree with that approach. Companies that have been able to bootstrap, and grow through their own means have a different dynamic to them, for sure. And that’s always a difficult thing to achieve. But once you do, it’s also an advantage. So kudos on that. What you said I think, was insightful, especially about knowing the weight of that three letter titles when you’re having conversations with people as organizations grow. And I think this is a pit I see a lot of founders who are behind the helm of growing businesses fall which is like, the company grows too rapidly 30, 40, 50, 100 people. And then it’s like a big organisation. And then from the perspective of the founder, it’s just a short period of time, since that happens sometimes. And the maturity of that title does not always keep up with the scaling of the business. As opposed to a larger organization. You join an FMCG company, for example, it takes years, 10 years, 30 years to be to come to that level. And by that time, you’ve learned more politics perhaps than skills. That’s kind of criticism on corporate life perhaps but the good thing is you have understood very well what that title is, and what kind of an effect it creates on people. 

And within a startup that might be missing in, I see a lot of founders making the mistake of not showing their true personality, not showing the real person behind the title. And sometimes being not as careful and as diligent as they should be in their communications with people within the company, unaware of the negative effect it might create on people’s lives and emotions about the workplace. So your awareness of that I think is valuable for any business. 

I was going to ask you about the first big win. But you’ve also you’ve already mentioned, you’ve touched upon it, we are running out of time. But if you could just go into what led up to that. You said a Swiss company was that because those big breaks are, I think, really important for the business. So if you could just spend one or two minutes telling us the details of how you achieved that very first big win and how it’s changed the business, it would be a good point to wrap things up. 

Of course, of course, it’s a bit of a funny story, to be honest. So essentially what happened, was the pandemic hit, and we had the intention, of course of digitalising, the business as mentioned. And when I went on that journey of digitalisation, I started to realize that building technology and identifying the right technology staff is a lot trickier than first anticipated. And I had to make a judgment call as to whether I was going to be able to build our own technical team and develop our own product, or whether it would be quicker and more efficient to actually identify a solution in the market. And I spent about a year researching technology platforms, workforce management platforms, CRMs, and so on. And I came across this company, which was three years old, it was already operational in nine countries as a solution. And it was about 40-50% of what I envisioned enferm becoming. And so what I did was the approach was to engage as a potential customer to identify what the product touring guidelines were like. And then as I started to fall in love with that product was engaged with its founders. 

And initially, I’d made them an offer for an acquisition, but I didn’t have the money at the time, and I didn’t have the understanding of how an acquisition would work. But I knew that I needed it. So what I essentially did was identified the tool, and made them an offer to acquire their code so that I could build upon it. And they very quickly realised that we were a healthcare organisation and realised the potential of the two businesses coming together was more valuable, becoming a merger. And the journey took about a year to a year and a half. And it was an incredible experience. It was one that I learned a lot from. It’s, you know, combining two countries together, or multiple countries together, culturally, bringing in the top level leadership, under one leadership was an interesting task as well. And so all around quite an interesting and exciting experience, one that I know I will be able to optimise and be more efficient at the next time, which there will be one. 

So it’s a very interesting and insightful experience, the merger, and that was definitely our big break in the sense that we had now gone from being a service company with aspirations to be a digital company to actually being a technology-enabled business and now transitioning into a technology-driven business. The acceleration was incredible and the deal that we came out with for both parties was very encouraging as well and very fair. 

Thank you for everything that you shared many insightful comments, very sincere. I do appreciate it. Thank you for taking the time. 

Likewise, Ozan, I really appreciate being invited here.