Founder-CEO Interview Series

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John Klepper

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John Klepper is a serial entrepreneur and Founder-CEO of Pipra AG (short for Pre-Interventional Preventive Risk Assessment) which is developing a cutting-edge AI-based pre-operative test to assess patient’s risk of suffering from cognitive disorders after a surgery

John brings 16 years of experience founding and growing technology-based companies. He is experienced in lean startup, operational management, structuring, strategic planning and raising capital.

John has had 1 successful exit and has 3 ventures at various stages of growth.

Founder-CEO Interview Series

With: John Klepper

Tell us more about PIPRA and why did you decide to found the firm?

We’ve developed an A.I.-driven risk assessment software for stratifying patients prior to surgery for risk of post-operative delirium. Post-operative delirium (POD) is the most prevalent post-surgical complication which affects 20% of patients over the age of 60.

It has serious negative outcomes which can double nursing home admissions, cost insurers billions annually, increases the risk of mortality by 25% and it has long-term consequences where 38% are still suffering 9 months after surgery.

I was doing stakeholder interviews in the hospitals whilst on another project related to Alzheimer’s disease when I kept hearing about this topic. I didn’t know much about it at the time. It became apparent that this was a huge problem to hospitals, patients and society.

Surprisingly it was virtually unaddressed. The main reason why; you can’t treat POD once a patient is symptomatic, but you can prevent it. Clinicians need to be able to assess which patients are at risk prior to surgery as it’s too expensive to roll out these preventive measures to every surgical patient.

There have been many efforts over the last couple of decades to create a tool like this and I think that our approach of using AI, trained on the largest database in the world that we’ve spent almost two years gathering, collating and harmonising, gave us an opportunity to create something with a high enough degree of accuracy to be considered useful and beneficial to clinicians.

I decided to move into this area because of the possibility to really impact lives – particularly the elderly. The 60+ population is our target, as the older you get, the higher the risk. It’s very sad when you have a loved one leave the hospital worse than when they arrived.

At the time I met my two co-founders, Nayeli who is an anaesthesiologist and intensive care specialist, and Ben who’s a cell biologist PhD graduate from Oxford and has worked in big pharma and biotech.

Where is the company at today?

We’ve gathered this database, which took a huge worldwide effort together with Academia. We’re very fortunate to gain access through an individual participant data meta-analysis to studies that have been conducted around the world. Studies that had the specific endpoints, the predictive risk factors we needed and P.I’s that were willing to share that with us.

That was quite astounding. I think in part perhaps because we have five key opinion leaders from around the world that are advisors to our company, who are well known to most of the researchers and principal investigators of these studies. So, the database is something that we’re most proud of because it also allows us to have a really robust tool that can be used not just in one type of patient population, but also globally.

We’ve certified our product, which is a medical device. And we are just about to launch two paid pilot projects and actually have our tool used in clinical setting. That’s very exciting.

You’ve won a number of awards. Tell us about them.

We started the company by winning the EIT Health Award which got us our pre-seed funding. We’ve won a few more since then, such as getting first place in the Brain Innovation Days Award, the Oxford Saïd Business School Award and silver place in the Value-Based Healthcare Dragon’s Award.

We’re trying to raise awareness about what we’re doing, and some of these platforms and competitions allow us to do that. We’re also raising capital at the moment.

Your background is not in life science. How did this shift happen?

I love challenges, learning new skills, and most importantly, I love the intersection of innovation and impact where you can create something that’s never been done before that has meaningful change.

In my earlier career in art and film I was always on the technology side. Then, I started a company where we were innovating things in virtual reality and augmented reality which I’ve exited. Next, I founded a social enterprise software company that supports charities around the world with about 40 NGO’s in the portfolio.

One day, I had coffee with a neuroscientist, and I soon thereafter found myself working in healthcare.

How did coffee with the neuroscientist lead you to where you are today?

I was having a coffee with a renowned neuroscientist, Dr. Ioannis Tarnanas who built a prediction tool for early detection of Alzheimer’s, and we just hit it off. We spent ages just talking. I’ve always had a love for brain health and neuroscience – I don’t know why, but I’ve always found it fascinating.

Towards the end of the conversation, Ioannis told me that he’d been wanting to create a company focused in Alzheimer’s prevention, and would I like to start it with him. I thought he was joking. Soon thereafter, I started working with him on a project at Trinity College, and thereafter founded Pipra.

What drives you?

Doing things that have never been done before and getting an incredible team together to meet that challenge and figure it out. And if, where possible, to be able to make a difference in people’s lives – in this case, to save and improve lives.

What has been some of the biggest challenges you’ve faced so far?

Where do I begin? *chuckles* I mean, it’s a start-up. Every day is a new challenge.

The big challenge was the actual EIT Health Wild Card programme because it was almost nine months of an intense accelerator programme with all kinds of vetting and pitching in front of different types of experts and juries.

And then came a 10-week accelerator programme from CIMIT, a Boston-based accelerator. It was very challenging and fiercely competitive with only two winners. My co-founders and I were very pleased to win the prize.

Soon after that, we had a professor who wanted to join our team with a lot of value that he could potentially bring, but we discovered quite early on that there were complications around personality and some of the requests that were coming from his side that were outside of what we had earlier agreed on.

At that early stage, we had to make decisions about changing who we were as a team and agreeing to give up those benefits that came with having him on the team, in favour of having a team that was more cohesive and aligned. That ended up being a great decision.

Getting this data together was another big challenge. Covid has also been a big challenge for us. We had a multi-centric trial, that we’d written protocols for, received ethics’ approval and had hospitals lined up. We were ready to go but then elective surgeries were cancelled at these hospitals. So, we had to postpone that.

Despite having an incredible culture and being able to get along very well, having a company that’s just been founded and not being able to sit and work together, has been perhaps our  biggest challenge. While there are a lot of benefits to working from home, we miss the interpersonal connections – those coffee breaks, beers after work on Friday, or team building activities that can keep a team feeling connected.

Best and worst part of being a CEO?

The worst part is the responsibility that you bear on your shoulders – needing to make sure that the company always has money and everybody’s okay. Despite what you might be feeling as a CEO, you have to show strength to the rest of the team, your clients and to everyone else – that everything’s fine, and you’re great, despite the worries, fears or lack of sleep.

That’s fine for a while, but it can build, particularly when you’re going through something like Covid. Also, not being able to take proper vacations and travel to decompress. I don’t think I’ve met a CEO that doesn’t share that kind of challenge.

One of the best things about being a CEO is the pride you feel when you have a team that just gels and works really well together and creates something of value. It’s a great pleasure when you see that the team is happy and loves what they’re doing, because it’s a big part of their lives and it should be enjoyable. In part, it’s my responsibility to make sure that they like coming to work, enjoy getting out of bed and that they look forward to what they’re creating – to feel motivated and rewarded.

What are your hopes for PIPRA?

I hope that we are massively successful and internationally recognised – because if we are, then we’re also impacting a lot of patients’ lives.If our software is able to be adopted and used all around the world, then the impact we’d have created would be phenomenal.

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