Founder stories: an Unleashed Q+A with Stephen Bourke, Co-founder and Chief Strategy Officer at Echo

This month, People + Culture partner Ginni Lisk spoke with Stephen Bourke, Co-Founder and Chief Strategy Officer at Echo.

Echo fulfils prescriptions and works hard to bring peoples’ medicine to them, but as you’ll discover their purpose is far more profound. Their dedication to that purpose is palpable; the Echo team believes that health is about people, not pills… They’re on a mission to not only simplify pharmacy but to make it altogether more human.

As you would expect, Covid-19, lockdown and social distancing have all meant that Echo’s services are currently very much in demand. Read on to find out how Stephen and the Echo team have responded and why, whilst it could be suggested that for Echo business is ‘booming’, that certainly isn’t the language they would use.

GL: It would be great to start by hearing a bit about Echo’s founding story and mission.

SB: I founded Echo as someone who takes medicine — I have done so my entire life and have felt so underserved. I have generalised anxiety and panic disorder and while CBT and talk therapy have proved useful, meds have had the biggest impact. They’ve enabled me to go from cowering in my bed to helping lead Europe’s fastest-growing pharmacy.

My meds are incredibly important but before Echo, there wasn’t an easy way to manage them and that was a constant cause of concern. Things got so difficult one time that I had to make an emergency trip to A&E. I met someone in a similar position, and we launched Echo to ensure people have sufficient access to medicine at the end of each month.

Ensuring sufficient supplies and fulfilling prescriptions is so important all the time, but the current context must have made you incredibly busy. Would you mind describing what coronavirus has meant for you and the Echo team?

Life after Covid-19 has been a rollercoaster. On 16th March we were given the advice to cease non-essential travel, and the day after Matt Hancock announced self-isolation for the over 70’s. It’s been bonkers since. So many patients can’t get to a pharmacy to collect their meds and are vulnerable and scared.

In response, we saw an immediate spike in demand, with many of our existing patients (roughly 100,000 at the time) panic ordering. Our user demographics suddenly and dramatically changed too; our average age increased from early 40’s to early 60’s, and carers now constitute 15% of our user base. We’re growing by 10,000 patients per week.

Our patient numbers are up 180% since Jan 2020. No business expects to experience growth at that kind of rate. We were previously running one shift per day and we’re now running three shifts daily, three times a week. Since 16th March we’ve dispensed over 1.5 million packs of medicine. It’s been humbling to see the Echo team’s response. They have, and continue, to pull out all the stops.

We know that we have to help people who are self-isolating and that even after lockdown relaxes, people will still need us. Sure we’re not in the Nightingale in our scrubs, but we are a small army working day and night to get medicines to people during lockdown, We are key workers, and we’re doing everything we can to support over 200,000 patients.

Some would argue that this is the kind of growth, increased market share and overall ‘boom’ that scaling businesses can only dream of. What’s your response to that perspective?

While it’s been exciting to see the rate of change and how much shit we’ve managed to ship, I definitely wouldn’t call this a ‘boom’. Boom is positive. Covid19 has been hell.

There’s so much panic in the system, the whole UK pharmacy supply chain went out of kilter and all pharmacies had to cope with knock-on effects of shortages. We hired a data scientist during this period to do some predictive modelling on how much we need to buy in order to effectively anticipate demand and stay ahead of a potential future lockdown, so that Echo becomes known for stock availability.

We’re not an eCommerce company, we’re an NHS pharmacy, albeit one with a lot of tech. Right now patients are anxious and scared; when they can’t get what they need they’re understandably furious. And everyone at Echo feels that emotion. As a patient, I take it personally.

The team have been working bank holidays and weekends; from patient care to pharmacy to tech. I would never have wished for growth like this over such a short period of time nor would I have ever chosen this kind of additional pressure; this pace wears you down.

We’ve always been a service working with the NHS but slightly outside it but right now, we are the NHS, we’re 100% part of it and we are motivated by that responsibility… not by bullshit business optics.

Through a lot of hard work from the team we got things under control quickly, and are fortunately now in a position to grow again.

It would be impossible for any business to enable all of this additional delivery without also quickly evolving their People strategy, both in terms of team structure and culture. Could you share what that has looked like?

Where to begin. Let’s start with the team size… we’ve had to grow significantly and quickly; pre-lockdown we were a team of 93 and we’re now 230 people.

We’ve had to adapt to meet the challenges of properly onboarding all these new hires; how do we know that 137 people get our culture, for example? We’re operating in a regulated space which adds complexity; patient data and patient safety are crucial and we need to ensure these standards are understood and embedded across a business that is scaling so fast, and across a team that is working remotely.

How we recruit has been changed too — we went from “we need a new Head of Patient Care” to that person starting two weeks later — and she has made a huge impact. What’s clear is that now is a time for decision making. Covid has accelerated needs and removed the usual recruitment fence-sitting that can happen.

Tell me more about removing that ‘fence-sitting’ from your hiring process…

I think the context in which we’ve been hiring has prompted some doubling down in a couple of areas; both our interview process and embracing that ‘gut feel’ you get but also combining that with leveraging the power of networks and doing some bolder reference-taking. There can be some bias in references, but I think the recent context has prompted me to get good at identifying the right person to ask the right questions, to ascertain if they’d genuinely work with someone again.

In addition, it’s been about paying more for amazing people. Lockdown has made gaps in everyone’s org structure very clear, My advice is don’t waste time chipping away at salary; get the people you need and pay them what they need.

I imagine you’ve seen a similar increase in the pace of decision-making outside of hiring… How have Echo’s culture and ways of working adapted?

Definitely. A great example is that we’ve enabled patients to access Echo using their NHS login, massively improving interoperability. That kind of product update would have previously had some PR effort and a big marketing push, but in the current climate, it just got shipped on a random Tuesday.

On another day we added an additional 36% of GP practices that we weren’t previously connected with. I’ve been waiting four years for that integration!

We’re a scaleup and have properly embedded in the scaleup phase, but recent events have taken us back to our startup roots. At the moment decades truly are happening in weeks.

How has this all felt as Co-Founder?

I’m a startup person and thrive in a crisis. But I am too emotionally attached to Echo and that’s the reason I cannot be CEO. We are 230 people, who need context, stability and continuity. Fortunately, Benoit Machefer (Echo employee number eight) has stepped up and provided calm, focused leadership. He has been a huge source of inspiration and strength for myself and the team.

As a start-up person lockdown has played to my strengths, working crazy hours and just getting shit done. But the pace has to be sustainable, scalable. My old boss Rachel Carrell (founder of Koru Kids) once shared Paul Graham’s blog ‘do things that don’t scale’ and I think that I took it to heart. But burnout is real and can tank productivity and team welfare.

The flip side of this is that it feels like we’ve done more in the last two months than in the previous twelve. I’m really trying to understand how to find the right mixture — and then bottle it.

Right at the top of this interview, you mentioned the broader impact caused by a lack of a reliable supply of medicine. I’d love to hear how everything you’ve discussed here is fueling Echo’s ultimate purpose and mission.

I want to use all of this as an opportunity to demonstrate the positive role we play in society.

Online pharmacy has historically been associated with negative, seedy ‘black market for sleeping pills’ type stuff in the public consciousness, and I want to change that perception in as many ways as I possibly can. For me, that’s about empowering people to take their medicine regularly and properly, and also a motivation to remove all health-associated stigma.

The truth of the matter is this; nobody likes taking medicine. For those of us who do so on a daily basis (and there are a lot of us, roughly 50% of adults in the UK take medicine every day) medicine is a constant reminder of our mortality. Taking medicine is an essential part of our routine, but where you’d get a sense of satisfaction from other routine acts like brushing your teeth or having a shower, you don’t get similar feelings from taking medicine.

Furthermore, roughly half of all medicine isn’t taken as directed in the UK; part of that is a supply chain problem, so we fix the logistics, but we also nudge to better compliance. On the Echo app, we provide information to empower people towards concordance and we convert GP’s directions into reminders, because if you’re more likely to take your meds and take them as directed, you’re more likely to be well and you’re more likely to be happy.

When you’re dealing with medicine, you have to get it right 100% of the time and that’s what I’m aiming for. For example, Echo’s Trustpilot score is 4.6 now, and a ‘get your pizza to you’ app would probably be very happy with that. For me that means 8% of our users are unhappy and if 8% of the time something as fundamental as your electricity supply didn’t work, you wouldn’t use that electricity provider, would you? This isn’t eCommerce, it’s healthtech, it’s healthcare. We’re not helping you to get a pizza delivered to your door, we’re helping to improve and save lives; we have a duty of care and we take that very seriously.

It’s also worthwhile mentioning that I don’t believe in pushing technology onto people who don’t understand it or where it’s not the appropriate channel. A lot of clinical services are best suited to happening face-to-face and what I imagine is a context of individualised, blended care where you always have the correct access to your meds and you always get the most appropriate support to make sure you’re taking your medicine as directed.

I also want that to be the case regardless of what someone’s medicine is treating. There is absolutely still a judgement attached to taking medicine for a mental illness that there just isn’t in the scenario of, for example, injecting insulin for diabetes. I want Echo to play a pivotal role in removing that stigma.

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