CLD talks with Robert A. Souza Jr., Lead Cardiovascular Interventional Technologist, O’Connor Hospital, San Jose, California. A U.S. Air Force veteran, Souza has worked in interventional procedures for nearly 30 years. His ideas for improving patient experiences and care delivery brought 17 new products to hospitals and clinics worldwide. For example, after multiple patients described how uncomfortable radial approach procedures were, he experimented with multiple concepts to improve access to radial arteries. His Comfort Halo invention not only maintains sterility while lessening claustrophobia in patients, it also helps protect healthcare workers during the COVID-19 pandemic.
Rob, you have a long history of working with TZ Medical. Can you share some of the process of getting your ideas all the way to marketed products?
At the time that I was first coming up with ideas for the cath lab, it just so happened that my next-door neighbor was a patent attorney. He told me some of the ins and outs of bringing a device to market. My idea that I shared with him at the time was what he described as a “novel” idea, meaning it was not revolutionary or groundbreaking. I learned that somebody could take my idea, change it 20%, and there was essentially nothing that I could do about it. The cost to go through the patent process is between $8,000 and $12,000. Suing someone for patent infringement costs about $100,000 to open up a case. And if someone else has changed your idea 20%, then you don’t really have a case. This patent attorney’s advice, which was echoed by some Stanford University researchers I worked with at the time, was that unless you have $120,000 per product just sitting around, the best thing to do is to meet with a company, come up with your best finished product, and bombard the market with advertising and a sales force that can represent your product, basically setting the standard. At that point, everything else will be a one-off or a copy of yours. (Luckily, so far, I haven’t had anybody that has copied our products, thank goodness.)
I first reached out to Trent Tribou (VP of Sales and Marketing, TZ Medical) several years ago in order to pitch my product ideas. I have pitched a lot more than what has been approved. I present a concept, sometimes just a drawing at first. Then I work with TZ Medical’s engineers as they create 3D modeling on the computer. The engineers can move the model in all different directions, show me what their thoughts are and then I can throw in my thoughts. They essentially drag, drop, paste, and amend, in order to get the point where we can hone in on what might be the final product. Then there are the growing pains of somebody else actually producing the prototype, which is sent out to me to try. Everything is made in the USA. TZ Medical’s quality control is also very hands-on, as opposed to receiving 100 finished products and only then finding out that something is wrong. We actually had some problems with my very first product that we discovered before the initial launch. It was after it had been exposed to the harsh cleaning solvents that are used nationwide; we found that certain Sani wipes that were being utilized actually broke down the polycarbonate material of the product. As a result, we had to go back to the drawing board and use a different material.
Today, TZ Medical has a product concept committee that meets regularly. They will ask presenters for a mockup, want to know who the target audience will be, and an estimate of annual sales. So they need some homework done on the part of the person with the concept, but are forgiving during this process. The committee will determine manufacturing, packaging, and advertising costs. I think that I was a forerunner as TZ Medical created their process of developing ideas with people. The company has been very gracious and has spent a lot of time with me. The 17 products that I currently have with TZ Medical have totaled revenue in the six figures. I get a percentage, so my reward has been in the thousands and it has helped pay for college tuitions in my family. Even so, some of my product concepts that I thought were going to make it to the marketplace never made it, since the company has to evaluate what will be profitable overall. These concepts are still my intellectual property and listed in my contract, however.
I bet a lot of cath lab professionals out there have ideas.
Yes, the cool thing is that TZ Medical has representatives nationwide. Even if you are sort of off-grid, if you have this wonderful idea that you want to present, they are able to send a rep out to make contact with you and have one of their in-house people talk to you on the phone. They actually have employees who dedicate part of their time and work to following up with people who have ideas. My suggestion to anybody who does have a concept is to reach out to TZ Medical and they will get back to you.
As a veteran, how has your military experience shaped you?
In the military, they taught us that as a manager or supervisor, if you are on vacation or if you leave, and the show doesn’t go on without you, then you have failed as a leader. So, I’m a reciprocator. If I can come up with a concept, then what have you got? If I can think of it, I know you can think of it. That’s exactly where TZ Medical is at. That is their attitude, and I really appreciate that about them. Even though some of my ideas have been pretty crazy, I have to admit, they still sat there with a straight face, contemplated it, and said, “Nah, maybe not.” But they don’t make you feel stupid, penalize you, or make you feel like you were dumb for coming up with that idea.
When I first met Tom Tribou, the founder of TZ Medical, I had dinner with him and he asked me about my military history. I told him I was a vet for 10 years. He himself is a Vietnam veteran and a two-time Purple Heart recipient. We talked about our military service, and then maybe the last five minutes of the dinner, we talked about my products and concepts. I walked away thinking, well, they are obviously not going to take on my ideas, but it was a really nice dinner. I wrote Trent an email the next day saying, “Hey, totally understand if you guys don’t want to take on any of my ideas, but I just want to let you know that I appreciate the time and the effort that you guys put forward. I appreciated meeting Tom, and I had a great conversation with him. Thank you so much.” And he called me on the phone and was like, “What are you talking about? He wants your first product.” I couldn’t believe it. From there, it took almost nine months until we had a finished product, but it was worth the process.
Out of your 17 products, do you have a favorite?
My favorite product would be the Radial Runway for radial access, because of my family’s involvement in the process. I had both of my daughters lay down on the couch and put their arm out on the ottoman. I told them, “If you can do me a favor, I’ll pay you a hundred bucks apiece just for an hour. Watch a movie and keep your hand in this position, and then tell me if it’s actually comfortable for you.” One daughter, she got little antsy and moved around a little bit, but the other one laid still the entire time. So that’s my favorite, but another product that recently grabbed my heart is the Comfort Halo. I have a vertically challenged doctor who always had a difficult time trying to suture during pacemakers, because of all the rigid apparatus that we used in order to get the drape out of the patient’s face. He could never really get his elbow and his forearm clear, so I made the Comfort Halo specifically for him. The cord that is attached to both sides of the plexiglass is so malleable that it can be put up right up against a patient’s neck, come up right by their ear, and then go up to a foot away from their left or right eye. The doctor can move right into the patient’s shoulder and subclavian area, with clear access to suture in the area in which they’re doing pacers, and still maintain sterility while the patient has that drape two feet away from their face, so they don’t feel so claustrophobic. Earlier this year, TZ Medical called and asked if my cath lab was using the Comfort Halo for COVID (we were not), because of the orders that they were getting. One hospital system in New Jersey ordered 150 and another system ordered 50, just in one day. These hospitals were using the Halo during intubation and extubation in order to protect the anesthesiologist and everybody in the room from COVID. TZ Medical made a video about it, which is on YouTube1 and TCTMD.com also featured it on their site in an article2. I saw the video and I just cried. It was so humbling to realize that a product that I have made is useful and possibly making a difference in whether colleagues can go home unaffected by COVID.
Do you still come up with ideas?
My brain goes at night. I think about stuff at nighttime and it will actually wake me up. I came up with the Halo in a dream and I’m not being facetious, I actually thought in my dream: this is how I can do it. So I do get up in the middle of the night a lot, and then I’ll text myself or write a note to myself because sometimes I forget after waking up the next day. You’re busy, you have to get going, and you just forget.
Any final thoughts about your experience?
At the time I first approached the company, TZ Medical had a lot of history in electrophysiology because of their Booker Box product, and EP catheters and electrodes. My products allowed them to also bring a little portfolio of products into the cath lab. Initially, cath labs would say, “Who is this guy? Another new rep. Hurry up, you got five minutes.” Today, when TZ Medical walks in, cath labs say, “Let me see what you’ve got that’s new,” because TZ Medical has a nice portfolio of products that make a difference in the cath lab — in the setup, in the comfort of the patient, and in the safety of the procedure.
TZ Medical is very human, they make you feel valued, and they are real people. I am not saying that corporations are not. What I am saying is that, even though they are a big company, they are small enough to make you feel valuable. TZ Medical was the only company that took me seriously and gave my ideas a chance. When they say “Sparked by your ideas,” they truly mean it. That is what I really appreciate about TZ Medical.
This article was supported by TZ Medical.
- Comfort Halo Airborne Exposure Solution. Posted April 9, 2020. Available online at https://www.youtube.com/watch?v=q8-dPfMUrzs&feature=youtu.be. Accessed October 12, 2020.
- TZ Medical’s Comfort Halo device can help prevent viral exposure during intubation. TCTMD.com. April 1, 2020. Available online at https://www.tctmd.com/news/tz-medicals-comfort-halo-device-can-help-prevent-viral-exposure-during-intubation. Accessed October 12, 2020.