Overnight Success

I've always had a deep interest in really understanding how things work. I grew up programming, testing out different projects almost as businesses before I really knew what businesses were — just trying to see whether you could build something people would actually use, that created value and excitement for them, and then in some way monetise it to keep it running.

At the same time, I was at a crossroads about what to spend the next few years of my life doing at university. I'd really enjoyed some of my clinical experiences — I'd done volunteering and work experience in a hospital setting. It was such a difficult decision that I ended up taking a gap year, partly because I didn't get into medicine, but mostly because I just wasn't able to commit to one career trajectory for the next six years.

In that year I started a business selling high-end audio, which we bought from China and rebranded and marketed in the UK — high-fidelity headphones, custom in-ear headphones, to people who were really interested in that. I had a number of interesting ideas over that year. But ultimately what I decided was that the business opportunity would always be there. The ability to create something that delivers value to people can't necessarily be taught by going to business school or doing a computer science degree — whereas the unique experience you get as a clinician, being able to help people through healthcare, is something that needs to be taught, at least from an early stage. You never really want to teach yourself to be a doctor. So I eventually made peace with the idea: okay, I'm going to commit to the next six years of medicine.

I wanted to do it at Imperial specifically because they had a management degree as well. That gave me the opportunity to take a year out and study at least the theory of what it means to build a business, while in the meantime learning to be a doctor and seeing if I could at some point combine those talents. So I started med school open to the idea that I wouldn't necessarily commit to a long-term clinical career, but I'd use the clinical knowledge I gained to find other ways — more within my skill set — to eventually help people.

Fast forward four or five years into the course: I'd done the preclinical training, done a degree in management, and we'd worked on something I found fascinating — understanding why technology wasn't being more widely used to help people with behaviour change, specifically smoking cessation and addiction. This was just before my final year. We completed the project with a group of friends, it scored incredibly well, people were really impressed by it, and I found myself thinking, okay, we're at this crossroads again.

The traditional path everybody was pointing me towards was: publish it, present it at conferences, end it there, and use it as a stepping stone on your CV to build a career in academic clinical medicine. At that point I was applying for an academic foundation post, and as you know they're super competitive. I could almost play out the next five to ten years of my life — some time in academic medicine, some time in clinical medicine. And then the other side was: we've done this interesting research project, but nobody seems to actually be doing this stuff.

To get into the nuts and bolts of it, we'd realised that the people who really understood technology and how to design great user experiences didn't understand the clinical science of how you use therapies like cognitive behavioural therapy to help someone with an addiction. And on the flip side, the people who understood the behavioural sciences had no clue how to actually use great user experience design and technology in a friendly, user-centred way to help people. We were sitting there with a foot in each road, thinking: if you could combine the two, you could find a way of really building value for people and scaling that value over time.

That led me down the journey of — okay, there's potentially something to be built here. What if we go down the path, at this point just as a project, of exploring what it would look like to turn this into a commercial enterprise? Can we build a new type of digital clinic that helps people with a substance addiction, starting with tobacco, to change their behaviour and totally change the way we treat those addictions? That was a really formative experience, because going into our final year we were treating what would soon become QuitGenius more as an interesting project — let's see if this has commercial legs. We weren't particularly emotionally tied to the outcome. We still had a potential career ahead of us. But we wanted to see if we could turn this into something people actually wanted.

I think that decision — to initially pursue it as a project rather than a business — really helped us, because we didn't have too much emotional tie to the idea, and we weren't too afraid of failure. A lot of the most interesting ideas start out as projects or playthings: you have really low expectations, few stakeholders, you don't have investors, you don't take yourself too seriously. But you can test the fundamental idea — that if you create a mobile app merging great behavioural science techniques with user-centred design, people actually start to use it.

Some of the initial feedback we got was, "wow, this is incredible, I've never come across anything like this, it's totally changing the way I think about my smoking habit." And in many cases, even from an early concept stage, some of those initial ideas were actually getting people to successfully quit. Then came the decision: should we pursue this really as a business now that we've de-risked the fundamental idea, and turn it into what would become QuitGenius? Or should we stop here and go down the more traditional path? It's a bit of a long, winding story of how we eventually ended up at QuitGenius.

That's a good one. It wasn't my first business either — I'd been building different things I'd call projects rather than businesses, but projects that made money, sometimes fairly significant amounts, for a few years before that point.

There were a few fundamental lessons. The first is to pick your co-founder really wisely. I'd actually had great experiences with co-founders up until that point — I used to work on these projects with very close friends, and in at least one case one of the smartest people I ever knew. But what I probably didn't appreciate was that while it's great to have shared personal history with your co-founders, you also need to be complementary. In some of the early projects we were basically the same people: we enjoyed the same things, we were good at the same things, we were bad at the same things. That sometimes caused clashes, because we weren't able to complement each other's strengths.

So I developed a theory: when you're picking your co-founders, you want as much shared personal history as possible, because you really understand each other on a fundamental level — you know what motivates them, you share the same core values. But just as important as the commonality is having a lot of differences. Same core values, but a different worldly outlook, so you're good at different things and your strengths complement each other. That was really important in understanding how we'd move QuitGenius from the project phase to actually building a business, and what would make a successful co-founder relationship. We tried to be as intentional as possible in those early days about setting that up.

The other lesson is just persistence. A lot of people look at what we've done and say, "oh, it's an overnight success — they've had a lot of success as a result of market timing, they've been lucky to start a digital health business at a time when digital health is burgeoning." But we embarked on that journey years before people were spending much time on digital health. The lesson is you've got to be super persistent and never give up. But there's a difference between persistence and patience. Patience is trying the same thing over and over again without really adapting your approach. Persistence is understanding the hand you've been dealt and really trying to iterate and improve over time, trying different things until you get to product-market fit. That was drummed into me early on, having tried these projects and realised how much critical mass and activation energy it takes to get something off the ground.

I'd hesitate to overemphasise any truism — that you have to start a business with your friend, or that you should never start a business with your friend. People come up with these truisms on the back of their own personal experiences, and I know plenty of examples where it succeeded and where it failed in both cases. So I definitely wouldn't say you shouldn't start a startup with your friends as co-founders. In many ways it can be a competitive advantage, an unfair advantage.

What I'd say is that you want enough that's similar between you so that you don't clash on fundamental beliefs — the long-term outcome you're building towards, your method of working together. You need enough tying those people together. But the last thing you want is two or three doppelgangers who are basically carbon copies of each other. And that's a really difficult question to answer, because you can't actually know until you've spent enough time with that person.

In the early days many people would look at myself, Maroof and Sarim and say, "you guys are exactly the same — you're South Asian young guys, basically the same age, you went to medical school together, you've literally done the same degrees. How are you going to specialise in the different roles it takes to build a company?" I think that's a bit misguided. People who've worked with us — our investors, the board, our employees — would agree that while we're similar in many ways and share the same long-term objectives, we're actually very different in the way we work.

I tend to be more long-term strategic, with a more commercial hat on, quite quantitative — better suited to running the commercial organisation, so I can sell the company, sell to employees, sell to potential stakeholders. Maroof, my co-founder, is a lot more operationally minded; he's always in the details in a way I struggle to be. He was the guy in medical school sitting at the front of the lecture theatre who'd memorised his notes backwards on every single lecture and never missed a day — really, really detail-oriented. And Sarim is different again, because he's really good at washing out a lot of the noise that typically exists. As head of product at QuitGenius, he's good at dumbing down the requirements — what's actually needed, what's not — and working from first principles. So as long as there's enough tying the founders together but with complementary skill sets, and a clear idea of how you'll divvy up responsibilities and reinforce one another, it can work really, really well.

Definitely. The first thing I'd say is that most of the time the CEO and founders get a disproportionate amount of the credit for what goes on — and it works both ways; we also get a disproportionate amount of the blame when things don't work out. It's an insane amount of work to found a company and create value, but even that is just the tip of the iceberg in terms of the total work needed to get a project like that off the ground. So I caveat this story, where people usually overemphasise the role of me as one person within the whole environment.

As we came towards the final year of medical school and moved from the project phase to the startup phase — okay, we've got to build something people want and deliver value to our end users — the first nine months were probably the most gruelling. We'd just graduated, finished our final exams, and went pretty much immediately into working on the company. The first thing we decided was: ship a product, get it into the hands of users as soon as possible. It was tough. We didn't pay ourselves the first month. We'd raised very little money, we were looking at our monthly expenses trying to figure out how to survive month to month, literally raising money on a rolling basis — just enough to pay the previous month's salaries. That was a time a lot of people would give up, because we were making very slow progress. And when we did eventually ship, it was clear we still needed to do a huge amount of work to fix some of the fundamental initial problems.

The turning point was almost getting into Y Combinator. Just before we got in, at the start of 2018, we'd started to recognise that we were building something of value — people were using QuitGenius, they were actually changing their habits, and we were getting really good feedback. But we hadn't figured out what a scalable business model looked like. We had a consumer approach where people paid a very low fee, and that fee wasn't necessarily covering the true cost of delivering the service, because we were starting to add other components like human clinical care and coaching. We knew there was something there, we just needed to figure out how to monetise it.

So at the start of 2018 we got into Y Combinator, and that was definitely a turning point — mainly because moving the company, still only six or seven people, to Silicon Valley resulted in a mindset shift for everyone. Being surrounded by really smart, ambitious, determined people making phenomenal progress week on week motivated us to be the best version of ourselves. The value of YC was really drumming a single lesson into us through a thousand different methods — through the fireside stories and the weekly dinners — that the only thing that really matters is delivering value to your end customers and getting to product-market fit.

That's when we realised the consumer approach wasn't really working. People aren't comfortable paying the true cost of their healthcare — they always want to pay a more subsidised cost, because that's how people have been conditioned. But there's a huge amount of value we're generating in the healthcare system by getting people to change their behaviour around smoking, and we needed to find a different way of capturing it — going via the healthcare payer, going via employers, really understanding the value chain of who benefits when someone successfully quits smoking, and how we could capture some of that value in a way that let us go at-risk and be value-additive.

That eventually led us to switch the business model and tilt from consumer to enterprise, and to focus on the US healthcare market versus the UK, cementing ourselves as working towards becoming the leader in addiction medicine among US healthcare payers, which is where we are today. There's a lot more to the story, but we then started to see a lot more velocity as we focused on a business model that was actually showing real signs of working — and then it comes down to hard work to make all the different parts add up. That was the start of the real growth journey for the company.

I think so. I wouldn't underemphasise a lot of the luck and opportunity we were given by being at an institution through university that enabled us to meet co-founders and build a really strong relationship before starting QuitGenius. And then, of course, having the opportunity to go to YC and surround ourselves with some of the best investors and product builders of our time.

But a big component is also just being willing to learn and having a learning mindset. What we didn't learn from YC or our mentors, we'd constantly try to re-educate ourselves on — through books, articles, blog posts, sharing those learnings and building a mental network around us. You are a product of your environment at the end of the day, and if you surround yourself with great, ambitious people who really want to do things, it's a great way of optimising for success. But that alone isn't enough. You also need to adopt that learning and growth mindset, constantly reading and putting the ideas and lessons you get from those books into practice, experimenting to continually improve yourself. There's a quote I'm quite fond of: you are the average of your five closest friends, so choose wisely who you surround yourself with. But on top of that, you should also be trying to make your friends better by self-improving.

I truly believe in the truism that it's 1% inspiration, 99% perspiration. People often come to me to discuss a business idea they have; it sounds great on paper, and they never really take it anywhere. So it really all comes down to execution. Ideas are a dime a dozen. Most people will have ideas that end up becoming hugely successful — by somebody else — and it comes down to executing, building a sense of urgency, and prioritising what you actually want to do.

I also don't believe all the great business concepts have already been done and it's just getting more difficult over time. If anything, it's getting easier, because all the ingredients it takes to build a successful business — the cost of launching one — are coming down so precipitously. When you combine the tools available, the much lower cost, and how much easier it's become to raise capital in this day and age, there are so many opportunities to improve things. In retrospect everything is straightforward and seems like it should have happened even earlier. But I think we're in probably the greatest age for executing on these ideas — and everything does come down to execution at the end of the day.

The most difficult part is holding myself back — recognising that I can go in and solve a problem in my own way. Things are surfaced to me and it's very easy to look at a challenge and say, okay, let's break that down, here's a ten-step framework for how I'd do it, let's go and solve it that way. But what that often leads to is a slippery slope where you end up micromanaging basically everybody on your team, and it creates a dysfunctional culture that results in poorer decision-making. By contrast, stepping back and letting other people solve their own problems — working with them as a coach and champion rather than doing it for them and handing them the task to implement — can be a challenge, but it has a much greater payback. You get better judgment and decision-making, people feel more empowered, they feel you're on their team, and you're able to really listen to their problems and add value. So being able to step back, listen and be a coach is a challenge, but it's incredibly rewarding as you find more success through those decisions.

It's a very different kind of stress. I was never particularly stressed during medical school. There was always pressure to perform, and I was definitely one of those students who left the majority of their work to the tail end of the year — and then it'd be a mad dash to revise, download everything and get through the exams in one piece.

As a startup founder, managing your own psychology is a real challenge you have to get on top of. It's very easy to get too emotional and personally tied to specific outcomes, to feel emotional every time things don't go your way. Failure is often a very loaded word for people in general — it has a big taboo and sometimes stops people from taking risks. But being able to manage your psychology, to manage failures by getting used to hearing no's — from investors, customers, potential employees — and recognising that your own personal self-worth isn't tied to the outcome of your company: that's really crucial, and being able to disconnect and not let work stress get to you in the first place.

It's definitely been a journey, and I by no means pretend to be an expert. But we're at a point now where — sure, there are lots of stressful things going on in an organisation, lots of audacious goals to meet, high expectations — but it's become important for my own personal functioning not to tie my self-worth to that or get personally stressed about it. I've become quite good at taking a step back and saying, you know what, I'm not going to get stressed by that. I'm going to try to experience the moment to the best of my ability and do what I can, but also recognise it's not the be-all and end-all whether that particular thing works out.

My journey is one of lots of micro-failures. It's so important to normalise failure and help people recognise that if you're failing, it's because you're taking risks. Then it's just a question of consistency — making enough attempts for some of those risks to pay off — but not taking risks where the downside outcome is overwhelming and can knock you out of the game altogether.

One example was actually switching our business model from consumer-oriented to enterprise-oriented. We worked for probably 12 to 18 months trying to figure out how to make the consumer channel scale. And while we were delivering value to our customers, it wasn't something they were willing to pay the true cost of. That was really challenging at the time, because we were seeing some success — it was one of those situations where you have very mixed KPIs. Some things are working incredibly well, others aren't, and it's not a case where nothing whatsoever is working.

At that point, being able to think in terms of bets — okay, let's just change our hypothesis and go and test an alternative way of doing business, an alternative B2B2C model that lets us capture some of the value being generated — was enormously helpful. The fact that we could use an experimental framework, come up with a number of different ideas, know some of them would probably fail but keep trying different things until it worked, made it a very comfortable transition for us as an organisation, because we weren't tied to any one particular outcome. That's where some of the challenges get created — where you're emotionally tied to a particular outcome and you take that failure personally, as a failure in your self-worth as an individual.

I can wholeheartedly say no. I don't believe you need to be a dick to be a good leader at all. There's one talk I return to in my notes on a regular basis, given by Ali Rowghani, who was CFO at Twitter and at Pixar and worked with Steve Jobs, Ed Catmull, Jack Dorsey and Evan Williams — some of the most successful leaders, all of whom had a very different leadership style. The thing that stands out to me is that leadership needs to be authentic — authentic to your own personality, and in many ways it can be optimised. There's a way to be a very compassionate leader that involves actively listening to your team, aligning yourself with their own personal growth trajectory, and doing so in a way that builds community and camaraderie and shared values around a set goal.

People often immediately go to some of the most extreme stories — from Steve Jobs, or Elon Musk — and cherry-pick, saying, "this guy's a great leader, and he also did X, Y and Z." I definitely don't think that's a necessary prerequisite at all.

The lesson is that decision-making velocity really matters. It's easy to sit on a decision for an unreasonable amount of time because you want to optimise for making the right decision. Three out of four times, whether it's the right or wrong decision doesn't really matter — it's more about making the decision and then learning from it. The framework I use is a fairly common one; Jeff Bezos at Amazon has talked about it — the concept of one-way doors and two-way doors. I think of it as a two-by-two matrix of how reversible a decision is and how big its magnitude is. Apart from the case where there's low reversibility and high magnitude — a one-way door, where once you make the decision there's no coming back — which warrants a lot more consideration and the right stakeholders involved, every other decision can pretty much be made very quickly, knowing you can course-correct and learn from the data in the real world. High-velocity decision-making is a competitive advantage if you can embed it into the culture of your organisation.

You'll recognise it when you're in those situations. If you're ever in a meeting with lots of stakeholders and it turns into something that leaves you with a sense of distaste — people personally attacking one another, no alignment on what you're trying to accomplish, hidden agendas, it feels almost political, very palpable in the air — and you get a sense that there's no progress being made, that it's boiled down to who's got the loudest voice in the room, that's a classic example of bad conflict. It's when people aren't optimising for the same intended outcome, and there isn't a sense of healthy respect and psychological safety within the group.

You also get a palpable sense of good conflict, where there's healthy respect for all parties involved in the decision, and everybody is thinking from the same first principles — we want to optimise for this particular outcome — and there's just a disagreement about how to get there. In those situations it's fine to have an impassioned debate about the different opportunities. It's more about managing healthy conflict: ensuring everybody has equal voice, not just optimising for the extroverts but giving introverts an opportunity to have their say, people being concise and respectful, and psychological safety — which in those situations is table stakes for good, healthy conflict.

Through those processes you're able to get to decisions very quickly and agree a shared set of principles for making them. Sometimes not everybody will agree, but if you have a good decision-making framework — and there are a lot of them out there — somebody takes all the arguments, uses them to make a decision, and then you revisit that decision as soon as you can: were the assumptions that went into it correct, are we on course to reach our intended outcome, and if not, is there new information we should course-correct on? People enjoy those situations, and it's quite obvious when that's happening versus when the unhealthy version is happening instead.

That goes into the concept of mental models, and the frameworks you can use to look at a decision from different lenses. Regret minimisation has definitely been instrumental to me at different points in my life. In deciding to pursue a career outside clinical medicine and build something that could deliver value at scale for a lot more people, it really came down to: to maximise my long-term happiness, let me prioritise the projects I want to pursue based on where I would feel the most regret. And it's worked out pretty well.

It's one of those cases of one-way doors and two-way doors. If I didn't take the opportunity at that point in time, I'd probably lose it and wouldn't have it in the future. Whereas the ability to pursue a career in clinical medicine is something potentially open to me at some point in the future — I'd have less regret about not pursuing that, because I know I can come back to it if I really wanted to. That's one type of mental model, but there are lots of types, and there's a lot of value in analysing potential decisions from different lenses — probabilistic thinking, the Pareto principle — things I try to return to as frequently as possible when analysing a really difficult decision.

I definitely agree with that. As humans, we always look for causality in what we do. There are so many business books out there — which is why I try to be as picky as possible — because they can give you a false frame of reference. They cherry-pick specific success stories and outcomes, then try to work backwards and look for common factors. It's definitely not scientific, and I wouldn't want to be in a position where I say our success is the result of these specific decisions and tools, because overwhelmingly there's a huge amount of luck and serendipity involved.

But I do think there are certain things you can do to optimise for a particular outcome — taking consistent risks, having an experimental perspective, being able to make decisions fast. Those are some of the first principles and accepted norms that help you optimise. So there's a lot within your control, but there's also a huge amount of luck involved in any success story — and usually the person or company at the centre of it will have the most myopic view of understanding what really happened. I'd never want to distil things down to a recipe book of "do these five things and this is where you end up." But there is value in looking at commonalities across success stories and trying to optimise for some of that, because there's some truth to be gained from the process.

I'll caveat this. Early on I used to think the volume of your reading was the most important thing — being exposed to lots of different ideas — and I read voraciously on the back of that. Then I realised the concepts weren't sticking; like a lot of people who read a lot, you forget one book when it's two books behind. Now I try to optimise as much as I can for quality: understanding who's recommending this book and why, whether it's broadly seen as a good book, whether it's been around long enough to be generally interpreted as valuable. And as I read a book, I always try to take a couple of concepts I can put into practice immediately, and see whether they actually yield results for me. Certain concepts from certain books may be valuable to some people and not others, but that process of reinforcing and testing it is quite valuable — you're actually getting something out of the experience. And if not, you had a good experiment, it didn't work out, and you move on to the next thing.

In terms of specific recommendations, I'm a bit reluctant to give too many specifics, because there are great books for lots of different things you want to do. I can speak to a couple of recent ones. Working Backwards, which distils some of the principles from the early days of Amazon, was probably one of the best books I've read this year — there were a number of concepts we immediately put into action at QuitGenius that have yielded really interesting results. Generally, writing from Amazon as an organisation is quite valuable, and getting as close to the source as possible is valuable too. One of the most interesting readings I did a while back was the shareholder letters — you're getting directly from the source what the CEO thinks are the most relevant concepts for the owners of his company to understand about how Amazon works. But if you're tactically trying to optimise for sales and marketing, there are great books just for that — and if you go down that route, I'd always recommend putting some of those concepts into practice.

That's an interesting question. I'd say probably not — not because there aren't great potential ideas, but because I wouldn't have validated and researched them to the point where people should feel comfortable taking my word that a market exists if they pursue them. The idea is probably less important. Not that it isn't important for building a valuable company longer term, but at least in the shorter term, rather than optimising for the perfect idea, just go out there and execute — create a value hypothesis for any given idea, find ways of getting user feedback, validate it and iterate.

In many ways it doesn't matter what you pick as a starting point, as long as you treat it as a project and a plaything, don't take yourself too seriously as a business, and cycle through lots of different things while being as data-driven and experimental as you possibly can. That's far more important than waiting for the perfect idea with a huge total addressable market and a killer business model that's really going to get it off the ground. That very rarely happens. Occasionally those opportunities come along, but at the time they don't look like sure bets — it's only in retrospect that you can make that distinction. What's most important is getting out there, testing these ideas, and figuring out what works and what you'd enjoy working on personally, where you'd find fulfilment and purpose.