‘A 10,000 per cent increase in page views in 2 weeks’: how to scale up in a crisis

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As a telehealth provider, Coviu experienced a sudden surge in customer demand during the pandemic. Their website saw a 10,000 per cent increase in views in two weeks and their 7 initial staff were answering up to 1000 support requests a day. Despite these challenges, Coviu managed to successfully scale up whilst meeting unprecedented customer demand and uncertainty.

We chatted to Dr Silvia Pfeiffer, CEO and Co-Founder of Coviu, on how she managed such an enormous challenge, her top tips for scaling up a business and building resilience in a crisis.

Tell us about yourself

I’m originally from Germany but came to Australia in 1999. I completed a PhD in computer science and I’ve worked as a research scientist. I worked at the CSIRO, creating new technology. In 2018, we spun Coviu out of the CSIRO. It’s a telehealth platform that we created ourselves and built from the ground up.

Why did you decide to start Coviu?

My background is in computer science so I’ve developed a lot of new technology over the years. I did my first start up in 2006. Before that I worked at CSIRO and invented a lot of technology that ended up on shelves and then was never reused. I was keen to build something that would have an impact and make a difference to the world.

In 2012 when I re-joined CSIRO, I got to develop new video conferencing technology that was based on the web browser and wouldn’t need to use custom applications. Customers could go to a link in their web browser to make a call. We were talking to lots of different people and healthcare was the area that excited me the most. We had an opportunity in healthcare to make a difference to peoples’ lives.

We started in speech pathology. We worked with Royal Far West school out of Manly that has connections to rural schools, helping children in remote Australia access speech therapy and speech pathology services.

That’s how it started. We built them a demonstration system in a couple of weeks. They loved it so much that they didn’t want to let it go. They said it was so much better than anything they had used before. So we decided that we were onto something. We wanted to really make a difference in healthcare.

Recently you’ve faced the unprecedented challenge of scaling up during a global pandemic. What were the first thoughts going through your head?

When the pandemic came, all I could think about was: how could anyone go to see their clinician when everyone is afraid of catching the bug from someone else? We reacted immediately and let the government know that they needed to consider telehealth.

Telehealth is a great solution. It helps people keep away from each other. So the pandemic was a huge call to action to become active and actually help the Australian healthcare economy get through this pandemic.

What did you do to prepare for this?

We had been developing our software to scale so that we could scale to many consultations. We built our software so that we could bring up new servers at the backend and deploy new signalling infrastructure relatively quickly.

In fact, with the bushfires in January, we had already set up a doctor’s directory where patients stuck in bushfire areas could use their phone to reach a telehealth clinician. We had already prepared for the situation where we would allow patients to find a telehealth clinician.

And then the pandemic came and we had to scale in three different ways.

  1. Infrastructure: We had to scale our infrastructure. There were some bugs that we had to fix and like all video conferencing services we had outages. But we scaled very well.
  2. Team: The other side we needed to scale was the team. We had a lot of people coming to our website. We had a 10,000 per cent increase of views on our website within 2 weeks. That meant there were a lot of clinicians asking us how they could change their business and adopt telehealth. We had up to a thousand calls a day with clinicians that wanted to do something. And of course, we didn’t have the support staff. So the next thing was hiring staff. I hired two people on Monday, trained them up and by Wednesday they would have to train the next two people. We hired a dozen people within two weeks and we brought up the number of staff from 7 pre-pandemic to 30 during the whole crisis. So that was the second thing we had to scale.
  3. Business: We also had to consider how we would scale as a business to survive through this crisis. Hiring people was costly. We were fortunate that our business model was already in place, so we were taking payments from clinicians automatically. Everything was set up for scaling already and we didn’t run out of money. We stayed at breakeven throughout this whole crisis.

If you could do anything differently, what would you change?

We did quite well throughout the crisis. For example before the crisis really hit, on 13th March the Government announced the Medicare reimbursement which was a surprise to us. I had to react very quickly and one thing we did was to go from one-on-one demos to webinars.

If I had known that this crisis was going to happen, one thing I would have done is create more training material so that clinicians would have been able to upskill themselves.

But in the end, the clinicians wanted to talk to a person. They also wanted to be talked through it and calmed down. It wasn’t just online training that was important during the crisis, one thing that was important was personal contact.

You’re a technology and software company that seeks to replace a lot of personal contact. So what do you mean by personal contact and why is it so important during the crisis?

The clinicians reached out to us via text chat and via video calls and so they were able to talk to people – that’s the human contact. They weren’t just told to go on a website or to watch a video. Their questions were answered and were taken care of by our customer service team.

I’m a firm believer in a combination of technology and human contact. This is why we do telehealth as a video calling platform.

Human empathy is fundamental to providing a good service and to making a good business. If we can’t feel comfortable and trust that there’s a human person at the other end, it becomes mechanical. In healthcare that’s the last thing you want. Clinicians have to take care of patients, and patients always want to talk to a person when they’re in trouble. I’m a firm believer in the value of emotional contact and empathy in a business connection.

What steps are important to remain resilient during a crisis?

The team was in a pressure cooker. Funnily enough it worked quite well because everyone knew that they were helping people and everyone was trying to do their best.

I was lucky to hire a group of young people who were quite tech savvy. My training was rudimentary and they picked up on the technology very quickly – which showed that we built the tech well – and they onboarded very quickly.

We used Slack because we couldn’t sit together anymore. People could chat to each other whenever necessary. If anyone had a question from a customer that they couldn’t answer, they could ask it there.

The other thing we set up was Discord, which is an audio connection that is always on. If someone wanted to ask a question, they would ask into the ether and someone else could reply.

We really tried to stay in contact and maintain that human connection in the team. We had meetings – short meetings in morning and evening to check in on everyone and any big problems that people had – to maintain that human connection.

That’s a lot of tech. Is your team comfortable with all these different tools? Have you seen any instances of ‘zoom fatigue’?

In my team, we’re doing well. I don’t think we have zoom fatigue. We are getting tired because we’re working long hours but I do encourage my team to take breaks and to get away from the screen. You have to get up every couple of hours to look after yourself.

We do yoga sessions via video once a week and we think of different ways to create fun moments for people to be with each other. You just have to create different opportunities to talk to each other.

We had to build the team completely online. We built it from scratch through online connections, so everyone buys into this online environment. We never really were an in-person company.

What future challenges and opportunities lie ahead for Coviu and the healthcare industry?

Telehealth is only at the beginning of its integration into healthcare in Australia and across the world. People are still very much focused on seeing their clinicians in person. For some types of consultations that’s necessary. You can’t get an MRI sitting at home in front of a computer or the clinician can’t listen to your chest by sitting in front of a computer.

However things are changing. More devices and different tools are being developed that will make it easier for these consultations to move online.

I foresee that every person will have a number of small clinical devices. Let’s say it would be a stethoscope through which the clinician can listen to your heartbeat from the other end. It could be devices that measure your blood pressure. I foresee a small clinic from home. You could have a box that you open if you wanted to talk to your clinician. The clinician tells you what device to use and they could get all the information that they would have if they saw you in person.

We’re still a long way away, but I do believe that this is what COVID-19 has set us up for. More consultations via video are held from home. We’re already seeing a lot of GPs doing phone calls. These are not digital transformations, they’re just a first step towards video consultation.

Do you have any final tips for businesses who are thinking of or need to scale up?

We always built our platform for scalability. Scalability is a construct in your business that you need to think of at the start. If you don’t build it into your busines at the start and the market catches up on you, you have to be prepared for it and you have to be ready to scale. If we hadn’t built our platform ready to scale from the start, we would have been dead in the water and wouldn’t have been able to service our customers.

The other thing I would recommend is building resilience. We were lucky that the crisis was good for us. But it doesn’t mean it was always easy. We’ve been running for a couple years and it was very hard work to convince healthcare businesses to pick up digital technology and try video consultation. No one was prepared for it and very few people would pick it up.

We were quite successful. We were doing 300 consultations a day. But it was hard work and at times it was like we were pushing a barrel up a hill because the market wasn’t ready yet. And then suddenly the market was ready for us and fortunately so were we.


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