“This problem wasn’t new, I merely suffered through it,” said Tiffany Khoo, a top scholar who left a legal career at Bank Negara Malaysia in mid 2019 to become HR manager at iHEAL Health Sdn Bhd, a small medical centre in Kuala Lumpur, run by her father.

She quickly came up against the single biggest challenge facing all medical institutions - made worse today with the acute shortage of skilled healthcare talent after the pandemic - trying to get freelance nurses to fill gaps in service when staff had to take emergency leave, went on vacation, left for greener pastures or took long festive breaks. It was all a very time consuming affair, and stressful.

At that time, this was a manual process involving calling part-timers to check if they were available to fill in. “We had a list of freelance nurses and I had to call each person to ask whether they could fill a particular time slot. Sometimes I would call needing them for the same day.” It was not unusual that freelancers could only take portions of a work shift. It was a real headache. Not surprising that Tiffany described it as “a very unpleasant experience” to find and manage freelancers.

“I felt like I was basically wasting significant parts of my day, scrambling to find someone, anyone, to fill a short term work gap.”

It was all an unfamiliar world for the former Bank Negara associate legal counsel who reluctantly answered her father’s SOS in mid 2019 replacing his HR manager who suddenly left.

The irony was not lost on Tiffany that she took the role as an emergency fill-in herself. Her dad convinced her that she had sufficient legal experience and knowledge to handle the role. Unexpectedly, it was also Tiffany’s experience at Bank Negara that led to the solution to her problem.

Healthtech innovation lagging behind

Tiffany soon realised that other health centres and even hospitals had similar tedious staffing challenges. Thanks to the exposure she had at Bank Negara, she decided the staffing issue could be solved with technology. “Fintech was all the rage when I was at Bank Negara where I had the opportunity to observe the fintech sandbox where various innovative ideas were tested.”

At iHEAL it struck her that healthtech was not keeping up. “Healthtech innovation wasn't a buzzword prior to Covid.”

One of the key challenges in healthtech was about public acceptance, especially when it comes to privacy of patient data in digital format coupled with fears of hacking. But she was reassured by the experience of banking. “I recall the days when fintech was viewed with skepticism by banks which are conservative, but I could see that this had changed by 2020.”

This convinced her that innovation would be welcomed in the healthcare space and led to her launching WeAssist Sdn Bhd as a subsidiary of iHEAL and building Locum Apps which consisted of - Locum Apps User and Locum Apps Staff in May 2020.

In healthcare, getting temporary help is known as locum. Rooted in Latin, the actual phrase is “locum tenens” which means “to hold the place of.”

The two apps allowed iHEAL to connect with medical professionals, such as nurses, doctors and pharmacists, to fill temporary vacancies. Nurses make up over 90% of the pool of talent in Locum Apps Staff which is for medical freelance workers who want to take up jobs on the platform.

Locum Apps User is for hospitals, clinics,  medical centres to book the services of freelance workers.

A dead end with cold calling, snail mail to the rescue

Just launching an app didn’t mean healthcare facilities would discover it, much less adopt the service.

Initially, Tiffany tried cold calling CEOs from all over the country but quickly realised that it was not working. As a HR manager of a small medical facility with 18-beds, no one was going to put her through to their CEO. Then Tiffany had an idea.

They may not want to speak to her, “but they [CEOs] will read your letters. So I wrote and mailed letters to CEOs all over the country, and that’s when I started getting calls from medical facilities, especially in the Klang Valley,” she said.

The first paying customer was a medical center in the Klang Valley in late 2020 that was owned by Sime Darby Australia. Tiffany declined to disclose the facility’s name.

With a business model of charging only the health facilities 15% over the cost of the workers needed, WeAssist ended up hitting US$12,534 (RM55,487) in GMV (Gross Merchandise Value) in 2020.

Not bad for an app that started out with Tiffany mapping the user interface on paper because she did not have a UX designer, and then opportunistically tapping her co-MC at a wedding function to use the app he had initially built for a limo service he was operating.

The cold reality check of being a female founder

Further validation of Locum Apps came in Sept 2021 when Tiffany won the pitch for SEADragon, a competition organized by the National ICT Association of Malaysia (PIKOM) during the World Congress of Innovation and Technology (WCIT).

However, it was at the same event that she got a cold reality check that made her realise the immense hurdles female founders faced. Many VCs posed questions about her commitment – whether she had plans of getting married and having children. It was a symptomatic problem she realised as Tiffany met many Malaysian female entrepreneurs who had the same bitter experience with VCs.

“At that point, it made me realize that we should try to do this on our own through bootstrapping. iHEAL then loaned US$67,850 (RM300,000) to WeAssist,” she said.

It was a smart move not to give out equity as WeAssist went on to hit RM1.25 million GMV that year, a 4x growth.

[RM1 = US$0.226]

Faster, easier and safer

To be sure, building an app to solve the worker problem for healthcare facilities was not a novel idea. In her background research in 2019 Tiffany found similar solutions to Locum Apps. These were developed by doctors themselves and Tiffany quickly realised that none were suited for hospital use as they had had much narrower objectives.

For example, one doctor set up an app to help only doctors find jobs. But, it didn’t meet the needs of a hospital like having an invoicing feature. Another came with a subscription-based model but it lacked transparency regarding credentials of the freelance talent.

This transparency, i.e. verified credentials of the health practitioners, was a very critical feature for Tiffany as the healthcare sector dealt with lives, there was no room for error or lax standards here.

Seeing that there was no existing app that solved her problem, motivated her to build a better app.

Her first step was to get feedback from the medical community. “I decided to use the data driven approach by creating a survey, and sending it out,” Tiffany said.

The survey sought to identify very particular pain points in the temp staffing of medical facilities across the board. “Through the feedback, we landed on a formula that I felt was the solution, ie - faster, easier and safer,” Tiffany said.

Key feature - a timer system that keeps track of actual hours worked

One of the features built was a timer system that keeps track of shift times rather than relying on the clock-in-and-out system or even geolocation tracking. The timer system works by checking in with the nurse manager.

This also works for temporary doctors, where instead of the nurse manager, it would be the doctor in charge who they report to, or in the case of radiology, it could be the head of radiology or operations manager they report to.

“Ultimately, it’s a customisable multi-tier system. The medical facility can choose who would provide approval for the shifts put in,” Tiffany explained.

This feature was in response to an issue Tiffany faced where some temp nurses would either arrive late or stay beyond their assigned shift, which made it very complicated for her as a HR manager, because she had to pay them per-hour based on pre-agreed times and not actual time spent per shift.

But this came up against the reality of the job where no nurse or doctor will just stop work in the midst of helping patients just because their shift happened to end.

“Before Locum App, I frequently had to check the CCTV to confirm the shift times of freelance help, down to even analysing them by their hairstyle,” she said. This was during Covid when mask wearing was compulsory.

Locum Staff is a faster and a real-time approach as it’s done in-app.

“Clock-ins can be done on the phone, which can be verified by managers or any other approval authority in real-time; then clock-outs can be initiated by the locums or their managers,” she explained.

Post pandemic growth and buying IP for the app

Malaysia fully reopened its borders in April 2022 marking the country's transition to Covid’s endemic phase.

Seeing strong growth possibilities, Tiffany decided to purchase the copyright IP of the limousine hailing app that formed the foundation for Locum Apps.

While Tiffany declined to reveal how much she paid, the purchase price was in the six figures.

This marked the next phase of Locum with a new version of the app. No wedding co-MC was roped in this time with Tiffany opting for an in-house software team.

“We chose to purchase the copyright rather than continue to license it because we wanted to own the rights to all derivatives of the code and were confident that the subsequent additions we made would be valuable,” Tiffany explained.

WeAssist more than doubled its growth to hit RM2.98 million GMV in 2022.

Reacting to market demand when offering services

2023 was another strong growth year when WeAssist hit RM8.15 million GMV (280% increase over 2022) with 90% of the transaction value going to nurses while the rest went to doctors. Tiffany attributed the exponential increase to the network effect and the country’s economic improvement.

Market demand also dictates the type of services WeAssist offers on Locum Apps. “We have opened and closed different service types when we felt there was demand,” Tiffany said.

For instance, in 2021, there was high demand for vaccination nurses and workstation staff, but those jobs couldn’t translate directly into clinical care.

“We ended up basically stopping those services and trying to convert them into different kinds like post-care, ward nurses and out-patient departments, so one of the ways that we do this is by credentialing through, not job titles, but by skill sets,” Tiffany explains.

However, in 2024, GMV fell to RM4.63 million. While she points to 2023 GMV as being an exceptional year, Tiffany attributes the lower revenue to a number of factors including falling demand for private healthcare and economic factors.

According to an MOH (Ministry of Health) survey in 2024 May, in 2023, 48.9% of the public went to public health facilities while 51.1% went to private health facilities.

“Apparently in 2024, the burden on public health facilities fell back to the historical 70% with the private sector handling 30% cases. This is why demand for private health dropped, and correspondingly, our revenue as well.”

Another reason was the shift in priorities among healthcare workers back toward stability over flexibility in 2024 with more taking on full time jobs in hospitals.

Tiffany quickly adapted to this trend with WeAssist now catering to those looking for full time roles with its weassistjobs.com.

“We now support healthcare workers as they move in and out of their careers, depending on their needs.”

Transitioning to a marketplace over next two years

Tiffany views Locum as a valuable career enhancer accompanying clinical staff (those who treat patients or provide direct patient care) across their entire career.

“All the way from submitting their credentialing (aka getting their training), they can come on board and every year, renew their license. That's part of clinical work, when you renew your license - nurses and doctors - by taking the CPD (Continuing Professional Development) or CME (Continuing Medical Education),” she said.

“We see ourselves also eventually being a marketplace where these clinical providers can kind of put all their services on the site, this is part of the plan for the next two years, and we are already speaking with some partners to do this,” she added.

Locum currently has 54 registered hospitals and clinics on board, including Penang and KL with 85% being hospitals, while the rest are clinics, ambulatory care centres, and confinement centres.

While the company was profitable in 2022 and 2023, the investment in tech in 2024 hampered its ability to be profitable but Tiffany expects to return to profitablity this year. She also plans to start looking for funding now to help her expand into the region.  

Creating stickiness for the profession through flexibility

With the shortage of medical professionals, Tiffany envisions another key role for Locum ie keep medical personnel within the healthcare ecosystem by offering them flexibility.

Healthcare staffing shortages are a big concern, along with nurse burnout is a severe problem that plagues Malaysia. Clinical staff typically have strict schedules, which are tied to a roster, forcing them to sacrifice time with their family or for themselves.

Despite Covid being over, Tiffany says that the work life balance of clinical staff is still out of kilter with many working long hours and with nursing shortages still a pain point, which then puts pressure on full-time staff.

“They are trying to seize back some control, but everyone seems to have forgotten about them, so it's very normal that they feel burnt out,” Tiffany explained.

Another challenge the sector faces is competition from startups.

“With health startups created by non-clinical people who try to poach doctors to have them work from home to do telemedicine, doctors and nurses are starting to feel the allure of other sectors; you're starting to see clinical people move into non-clinical roles such as consulting or even banking,” she said.

While Tiffany does not see many leaving clinical care for full-time telemedicine in a significant way, there is a trend of clinicians leaving the profession for corporate jobs while doing telemedicine on the side.

Traditionally, freelance healthcare work would’ve been impossible to imagine, but Tiffany is confident that this kind of work style could provide more opportunities for clinical staff.

“If they wanted to look for other opportunities as well, our platform could easily extend that to them via full time work, or perhaps even refer them to international placements, hopefully via contract period so they can come back,” she said. “What better way to keep them within the Malaysian ecosystem.”

“In clinical care, It's not uncommon for workers to take a six-month freelancing contract between full-time jobs, then work full time for two years, and take a break again from full time work and freelance,” Tiffany said.

“Not only would freelance workers want this kind of lifestyle, I believe it is going to extend to full time staff as well,” said Tiffany who sees nurses and general physicians following this sort of lifestyle. On the other hand, she finds it unlikely that specialists will be attracted to Locum Apps as they are already independent consultants, able to choose their hours.

Learning not to give in to knee-jerk reactions

Five years into her entrepreneurial journey, Tiffany doesn’t hesitate to share a key lesson she has learnt. Avoid knee-jerk reactions. “Because I've made the mistake of trying to build something that no one really needed, I just thought that they wanted or needed it.”

There were many times where users would suggest a new feature, which was very tempting to follow, but there’s often a need to question what exactly they really want.

“Now when they ask for something, I would go back to the team and communicate directly to the user who suggested the feature and try to figure out their solution. Sometimes it's not even a technological solution that they needed,” she said.

She also didn't quite believe in networking in the past, but has learnt that it's very important to genuinely build relationships with people with the interest in solving their problems.

Eye on Startups is a new column featuring startups that are under the radar and key startup ecosystem developments.

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