Ajay Nair, The Mullings Group - Medtech Search Firm | LSI Europe '24

Ajay Nair 00:00
Thanks, Mike. Hi everyone. Welcome to the post-lunch session, the most riveting session of the day. Just to kick it off, I'm Ajay Nair, present at The Mullings Group APAC or Asia Pacific, and just to kick this session off, we'd like to talk a little bit about something that everyone talks about, which is bringing companies to the US. We've got a little bit of experience in doing this, so I thought this would be a good opportunity to kind of distill some of our experiences and just kind of set the stage for other presentations.

So a little bit about The Mullings Group. We've been in the business for over 30 years, done more than 9,000 successful searches, built more than 900 companies. We have a very, very strong followership on social media, LinkedIn, YouTube. If you've seen some of the stuff, you'll know we're quite media savvy. One of the questions you need to ask when you first enter the US market is binary: Are you building a commercial business, or are you starting with a clinical build? Right? And especially in the medical device market, I mean, similar to pharma as well. Often, people come to the US initially to try and prove that clinical proof of concept.

So the initial question is, when you're building an organization in the US, are you first starting with a clinical footprint or a commercial? What's really important is to have a clear vision of what your organization will start to look like in the US market. This applies to other markets as well, but especially the investment, the cost, the time that you could put into the US if you don't have that original plan. It's totally fine with the evolution of the plan, but you need to have that original plan. That's where kind of the framework starts building.

It's important to have an initial organizational design as you start layering employees. It's important, and especially with the American market, organizational hierarchy is important for employees to understand where they fit in the picture. So org design, clear vision, and then there's nothing wrong with initial employees being fractional consultants. We're talking to companies today about bringing on independent, again, depending on whether you're doing a commercial or clinical. But it's important to understand that when you're first building that team, are you doing full-time employees or fractional?

And this flows into entity requirements, right? Similar to Europe, it's important to understand that, do you have an entity in the US? Are you housing employees under that entity, or are you doing what's called an EOR or an employer of record? So it's more to understand, structurally, what you're doing with employees' governance, especially when it comes to senior-level positions. When you're in the American market, it's very important to understand the hierarchy of decision-making, and when you hire senior employees, especially people who are coming from multinational strategics, blue chips, they have the experience of having run large teams and having been free in terms of decision-making.

So it's important to understand culturally where you are at in the governance and decision-making and the ability to sign off in independence. Now what this truly means is what we call in the US delegation of authority, right? If you're, let's say, an Indian company coming to the US, you have to understand, does this employee have the ability to make financial decisions, banking decisions, employee payroll decisions? So it's important to understand all of these things before you bring these people on board because employees also have expectations given their previous experience, so you need to have a match in that culture.

We talk a lot in this meeting and other LSIs about culture, right? We are truly a global business. Now there is no business without being global, and culture is really important. But I think culture is even more important when you're trying to establish a team in another market. We have clients we've helped and worked with a lot of clients who come with a native culture and then try to understand and imprint that on a US culture. Now if you know Americans, they're slightly different in culture, so it's important to understand the US culture a little bit and how that culture sort of imprints in the US, especially on the coast. Speed, decisiveness, speed of action, speed of decision-making is really important.

And again, this falls into that governance aspect. This is what I was talking about from coast to Midwest. If people have spent time in the US, you'll understand, by the way, the West Coast is the laid-back coast. There are lots of fast decision-makers. I'm from California, so I can speak for it, but West Coast, East Coast people just tend to be really, really fast-paced. The Midwest has a different culture, and the Southwest has a different culture. So it's important to understand where you are placing people or where you are hiring people from, and that sort of imprints that cultural aspect as well.

So relatively towards the end, our recommendation is always start small, but start with good people, right? Especially with sales teams. And I think this equally applies in technical builds as well. You're going to pay top dollar to bring in good people. So you want to start small, you want to start lean, and you want to really pressure test the organization, make sure you're maximizing efficiency. Also, it's not the greatest situation we all want to be in, but it's equally important to understand when employees don't fit that culture, so you want to be able to make these decisions relatively early.

Load the offer, especially in commercial builds, it's important to load the offer with incentives, and especially those that are milestone-dependent, right? Have employees feel that skin in the game, that equity where they are also part of what success means to you in that market. This is something we see quite a bit. I'm sure you've seen it in your experience as well. Someone I know referred me to somebody, and I'd like to hire that person. Nothing wrong with that, but put them through the same process you would anybody else, right? Because we've often seen a referral or someone just told me to hire this person. It doesn't always work out great. You've got to really understand what this person's capabilities are. Do they fit what you're looking for?

Also, it's important to legitimately do background checks and legitimately reference people. And lastly, compensation, you know, salaries in the US, if you don't know it, are much higher. So you want to make sure that you're making the right investments. Bonuses and incentives have specific milestones. It's a very incentive-driven culture. You definitely get what you pay for. And FDA, look, it's a delicate dance with regulatory, right? You have to really understand the relationship. You have to really understand what your approach is. So it's really important that, how are you applying regulatory-wise in the market? And lastly, sites of care, hospitals versus ambulatory surgery centers versus, you know, other models of care are vastly different. So you need to know how you're entering the market.