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Diverse healthcare team collaborating around conference table reviewing financial reports and performance metrics on screen

Tell me if this sounds familiar - you feel like you've had a successful pilot, the champion is happy and the clinical data looks strong. Someone on the hospital side says the next step is value analysis, and the room gets quiet. Everyone nods like that is a paperwork step. It is not.In my experience, that is the moment a lot of companies discover that, while they have strong clinical interest, they're completely unprepared to navigate the Value Analysis Committee. The pilot proved the product can work in one setting with one motivated user. The committee is being asked to approve spend, workflow change, and risk for the institution. Those are different jobs.This is the Adoption Gap in its most concrete form. Product-market fit in MedTech is not the same as in B2B SaaS. A hospital can like the product and still refuse to buy it. If the committee will not approve it, you do not have fit yet, no matter how strong the early cases look.What the committee is actually doingValue Analysis is a formal, multi-disciplinary review. The group is usually some mix of supply chain, finance, clinicians, quality, and operations, sometimes with IT or clinical engineering in the room. They are conservative by design. They care about total cost of care, not only unit price. They want clinical evidence, safety, real-world outcomes, and a clear argument for why this is better than what they already have, including the cost of switching.The process often takes three to nine months, sometimes longer. Requests for more data are normal. A no is common, and it can be sticky. You do not get unlimited retries with the same thin package.That is why clinical enthusiasm from the pilot champion is such a poor predictor of approval. The champion is answering “does this help me do the case?” The committee is answering “can we defend this purchase, this workflow change, and this ongoing cost?” If you only prepared for the first question, you will feel the second one as delay.The path is shorter if you pick the right first siteThe mistake I see most often is treating the first VAC submission as a volume play. Teams pick the biggest logo, or the system that would look good on a slide, and then invent the package under deadline.I would start somewhere more manageable. Use the account where you already have a real clinical relationship and honest access to how that hospital buys. Before you write anything, ask the champion who else has to say yes, what the last similar product had to submit, how long review usually takes, and what killed the last request that looked a lot like yours. You can learn more in two of those conversations than in another month of polishing slides.You also need a map of the buying group, not just the user. The end user cares about performance and workflow. Supply chain and finance care about budget impact, contract terms, and total cost. IT and operations care about integration, training load, and disruption. An executive sponsor cares whether this lines up with quality goals or service-line priorities. Department managers can slow you down even when they cannot sign. If you only stay close to the person who ran the pilot, you will meet the rest of them for the first time inside the review.Build the package from the pilots you already haveMost teams do not lack data. They lack the right data, organized for a buyer who is not the investigator.During the pilot you probably captured clinical performance. What usually never got written down is the operational and economic residue: minutes added or removed from a case, extra staff required, length of stay, complication or rework rates, wasted consumables, time to get a new user productive. Those numbers do not need to be a published health-economic model on the first pass. They do need sources, a baseline, and an honest statement of what you measured versus what you inferred.Before you chase a new study, separate three piles:<ol><li>What you can pull from current sites if you go back and collect it properly.</li><li>What you can only get from the next implementation if you instrument it now.</li><li>What you will not have in time for this committee and should not pretend you have.</li></ol>I would rather see a short, sourced package with clear gaps than a long deck that treats directional estimates as proof. Committees notice the difference. So do the people inside the hospital who have to defend you after you leave the room.What belongs in the first formal packageThere is no universal template. Hospitals vary. The first package still needs to answer the same handful of questions in language a non-specialist can follow.<ul><li>Regulatory status and labeled use, bounded tightly. If the committee’s intended use sits outside what you can claim, say so early.</li><li>Clinical evidence matched to the use they would actually buy, not every study you have ever run.</li><li>Outcomes from real use that touch cost and operations, even if the sample is small, with methods visible.</li><li>Implementation burden: training, IT, sterile processing, storage, support, who owns what after go-live.</li><li>A comparison to the current alternative that includes switching cost, not only device price.</li><li>A two-page briefing for people who will not read the appendix. If finance and supply chain cannot repeat your argument without you in the room, the package is not done.</li><li>Treat that first submission as a learning cycle. Capture every question they asked, every document they requested, and every place they stalled. The goal of package one is not a perfect win rate. It is to stop building the argument from scratch on the next account.</li></ul>Where teams get stuckA few patterns show up so often I now look for them.<ul><li>Evidence collection stayed almost entirely clinical. The team has sensitivity and specificity, or a case series, and almost nothing on time, labor, or avoided cost.</li><li>Every new opportunity restarts the research. Nobody owns a reusable set of claims, sources, and exhibits.</li><li>VAC work lives in hallway conversations. There is no named owner, no date for a first formal package, and no list of what that hospital actually requires.</li><li>The economic story is still a clinical story with a price slide attached.</li><li>The process looks interesting but delayed for months. That delay is usually an unresolved issue in budget, authority, workflow, or evidence, not a scheduling problem.</li></ul>When I see several of those at once, I tell teams to pause the hunt for the next logo and finish one complete package against a real committee calendar. Adding pilots on top of an empty commercial file makes the Adoption Gap wider.How to tell you are actually movingYou do not need widespread approvals before you can say the path is working. A few signals are enough.<ul><li>You can describe the typical review process, timeline, and decision-makers at your priority accounts without guessing.</li><li>You have written health-economic language for the committee, not only for clinicians.</li><li>You have one formal package assembled for a hospital where the clinical relationship is real.</li><li>You know which evidence gaps matter for the next twelve to eighteen months, and you are collecting against that list on live sites.</li><li>Someone other than the founder can explain the economic case without inventing it in the meeting.</li></ul>If those are missing, more pipeline will not fix it. The committee will keep asking for the same things you did not build.A successful pilot is still an invitation. The commercial event is whether a hospital can approve the product, install it without heroics, and defend the spend. That is the work sitting between the last case and the first real purchase order.If you want a structured read on where the gaps are before you assemble that first package, the free 7-Lever Self-Assessment is the starting point we use with teams in this exact spot. It will not write the submission for you. It will show you which parts of the commercial foundation are still missing. If you want to walk through the results and the first-account plan with us, click the Book a Call button to schedule a 30-minute strategy conversation.

From a good pilot to a Value Analysis package

<h3>Why Seed Stage MedTech Companies Stall After Their First Pilots</h3>I keep seeing the same pattern.A seed or small Series A MedTech company lands two or three solid pilots. The clinical feedback is positive. A couple of sites are using the product. The team feels momentum. They start talking about early traction and begin hiring or raising with that story.Then the next six to nine months feel strangely flat. Pipeline conversations stretch. Value Analysis Committee discussions stall or request more data that doesn’t exist in usable form. The two happy sites stay happy but don’t turn into references that open doors elsewhere. Founder-led sales still carry almost every deal. Revenue stays lumpy or nonexistent.This is the Adoption Gap in action.Early pilot success proves that something can work under controlled conditions with engaged users. It does not prove that the solution will clear a Value Analysis Committee, integrate cleanly into existing workflows without constant hand-holding, generate measurable economic or operational outcomes that the hospital cares about, or create references who will actively advocate for you with peers. That distance between clinical proof and repeatable multi-stakeholder adoption is the gap most teams underestimate.<h3>What pilot success actually buys you </h3>A successful pilot is real progress. It is also incomplete progress. Most teams treat it as the main signal that product-market fit is arriving. In practice it is only the starting point for the commercial and operational work that has to come next.You still need reusable evidence that speaks to the questions budget holders and VACs actually ask. You need a value story stable enough that someone other than the founder can deliver it. You need a small set of reference customers willing to speak about measurable results. You need clearer mapping of the full set of people who can slow or stop adoption inside a hospital. Without those pieces, every new opportunity starts from near zero.When companies keep running more pilots instead of building these foundations, the pattern becomes familiar: more data requests, longer cycles, and little movement toward predictable revenue.<h3>Where the stall usually shows up</h3>I see the same weak spots surface again and again.Evidence stays too clinical. Teams collect outcome data that impresses clinicians but does not address the economic or operational questions that determine whether a hospital will actually buy. Every new opportunity requires building evidence from scratch. There is no reusable package and no clear view of what will be needed over the next 12 to 18 months.The core promise is still unstable. Messaging shifts depending on who is in the room. The team has not pressure-tested a clear value story with prospects outside the earliest relationships. Sales conversations stay founder-dependent and hard to hand off.Referenceability is thin. Two or three sites may be using the product, but none are yet willing or positioned to speak credibly to outcomes with peers. Without those references, every new conversation starts from zero.Workflow and multi-stakeholder understanding remain shallow. The solution works in the pilot setting, but the team has not proven it fits day-to-day workflows without heavy customization or support, and has not mapped the full set of stakeholders who can block progress.These gaps are normal right after the first pilots. They become expensive when they persist.<h3>Why this period matters so much</h3>The companies that treat the post-pilot period as a deliberate bridge do something different. They use the early sites to generate the specific evidence and references that later buyers will demand. They harden the value story. They start building a small network of clinical champions who can open doors. They get clearer on the documentation and outcomes VACs will require. They stop treating every new opportunity as a custom science project.None of this is glamorous. It is the work that determines whether early clinical validation turns into something durable.Teams that skip it often look busy. More pilots, more conference presentations, more “interesting” conversations. The underlying conversion mechanics stay weak.<h3>A practical way to pressure-test where you stand</h3>If you are in this window, a few diagnostic questions are useful:<ol><li>Can you point to a simple evidence roadmap that covers the clinical, operational, and economic outcomes needed for the next set of VAC discussions?</li><li>Do you have at least two or three reference customers who are actively willing to speak about measurable results?</li><li>Is the core value message stable enough that someone other than the founder can deliver it consistently?</li><li>When a new opportunity appears, how much of the supporting material already exists versus how much has to be built from scratch?</li><li>Are you seeing real movement toward decisions and implementation, or mostly polite interest that never converts?</li></ol> Honest answers to those questions usually reveal whether the company is still inside the Adoption Gap or starting to cross it.<h3>Closing the gap is a choice </h3>The Adoption Gap trap is common because pilot success feels like progress. It is progress. It is just not the kind that automatically produces repeatable adoption. The teams that avoid long stalls treat the period after the first pilots as the time to build the commercial and evidence infrastructure that later growth will require. They do not wait for the next pilot or the next funding conversation to force the issue.If you are running a seed or small Series A MedTech company and the early clinical signals look good but the commercial path still feels unclear, this is the moment to diagnose the gap rather than simply run more pilots.The free 7-Lever Self-Assessment is designed for exactly this stage of the journey. It walks through the specific foundations that matter after early clinical validation and gives a clear readout of where the biggest gaps sit. You can get it through the form on the <a data-mce-href="https://growthplane.com" href="https://growthplane.com" target="_blank" rel="noopener">homepage</a>. If you want to walk through the results or pressure-test the next 6–12 months of work, I’m happy to do a focused strategy conversation; just hit the Book a Call button at the top of the page.&nbsp;&nbsp;

The Adoption Gap Trap

round mirror with reflection of man standing on the ground

Author and Columbia professor Halle Tecco recently shared a thought provoking <a data-mce-href="https://www.linkedin.com/posts/halletecco_i-recently-spoke-with-a-hospital-cmio-who-activity-7453043817009676288-1O3Z?utm_source=share&amp;utm_medium=member_desktop&amp;rcm=ACoAAAADleoBbUgcAt8rZFR-egBkNo3efiATkhg" href="https://www.linkedin.com/posts/halletecco_i-recently-spoke-with-a-hospital-cmio-who-activity-7453043817009676288-1O3Z?utm_source=share&amp;utm_medium=member_desktop&amp;rcm=ACoAAAADleoBbUgcAt8rZFR-egBkNo3efiATkhg" target="_blank" rel="noopener">post</a> on the power that Epic exerts on the healthcare industry, and on healthcare startups and innovation in particular.&nbsp; Here's the text of the post:"I recently spoke with a hospital CMIO who told me they were switching AI vendors. They were moving from a well-funded AI scribe startup to Epic's native AI ambient scribe, even though he genuinely liked the startup's product better.&nbsp;It came down to money: Epic was $100K a year compared to the startup’s annual cost of $1M.That story is playing out across the industry. SaaS is struggling broadly; software stocks lost over $1 trillion in early 2026, in part because it's easier to build things in-house now.&nbsp;But in healthcare, we also have the disadvantage of having an incumbent like Epic that squeezes out competitors. In Robert Wachter's words: "Epic’s stranglehold on the healthcare system AI market is likely to stifle investment and innovation".&nbsp;I do think the “SaaSpocalypse,” as some people call it, is an overcorrection. But if your entire pitch is a workflow automation layer on top of someone else's data, you're in a tough spot."This is spot on,&nbsp; but while I'm skeptical about the SaaSpocolypse, as I've written before, I would say it's more dire for SaaS &amp; AI startups in healthcare vs. any other vertical because of the stranglehold Epic has on the industry.Healthcare by its nature (necessity?) is massively risk averse, and the explosion in ransomware attacks in the late teens &amp; early 20's have only hardened that mentality relative to technology adoption.To echo what the CMIO told Halle, I've personally heard the following from CIO's, CISO's and CMO's for both regional systems and large IDN's (paraphrasing from memory):<ul><li>- "If I know something is on Epic's roadmap, I'm either not buying from another vendor, or will only sign short term deals so I can switch when Epic is ready"</li><li>"I want to buy platforms, I'm not interested in point products anymore"</li><li>"My CEO won't question my decision to buy from Epic/Oracle" (twist on the old-school Silicon Valley truism that "nobody ever got fired for buying Cisco...")</li></ul>Over $1.5 billion-with-a-B of capital has gone into ambient listening startups in the last couple years, and 2 months ago Epic released AI Charting. I wonder what the return prospects are now for those investors?The advice I'm giving to founders is if you think Epic can build a competitor to you, pivot. Doesn't matter how much better you believe your tech is, healthcare doesn't buy cutting edge or disruption. Plus, you will always be at a price disadvantage. Instead, focus on how you can build a moat that Epic can't or would choose not to try to bridge.&nbsp;In many (most?) cases that's easier said than done, but to build sustainable adoption, that's the only choice unless &amp; until Epic's stranglehold loosens.

The Epic Threat to Innovation in Healthcare

I just read Pete Flint's piece, <a data-mce-href="https://www.nfx.com/post/infinite-game" href="https://www.nfx.com/post/infinite-game" target="_blank" rel="noopener">The Infinite Game: What Artists Know That Founders Don’t,</a> and it got me thinking...again.&nbsp;Pete's thesis: Software is having its daguerreotype moment (yes, I had to look that up too) thanks to AI. When photography first appeared in 1839, painters thought it was the end. Who needs painted portraits when a machine can capture IRL perfectly? But in reality, photography freed artists from spending time on literal reproduction/documentation and instead allowed them to focus on creative expression...the 'art' of painting. At the same time, photography itself exploded through photojournalism, artisitic photography, instant Polaroids. The world of visual expression didn't contract. It expanded in directions no one predicted, creating new professions, markets, and industry segments.<figure id="figure-wy5axfvqpmonjqoak"data-full-width><img id="wy5axfvqpmonjqoak" src="https://cdn.durable.co/covers/30SoRpiPpkaRMGC3SRHV4bEy9rLTyo7S9y43lUkekEb0qvnyD2mHEuaoRerrEX3b.jpg" alt="" title="" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 16/9; object-position: center center;" data-corners="default" data-aspect="16:9" data-caption="" data-positionX="undefined" data-positionY="undefined" data-fullWidth="true"/></figure>I believe we are at an identical inflection point with AI. The doomsayers focus on what's being commoditized - basic coding, rote tasks, operational patterns - but that's not destruction, it's liberation. AI handles the execution layer, which frees up cycles for humans to exercise creativity and tackle more opportunities.&nbsp;Interestingly, the speed of adoption in healthcare has so far been mind-boggling given the industry's historical aversion to deploying new innovation. IMHO, that's mainly due to existential threats to the industry that threaten its financial viability (posts for another day) and ability to provide the services our society needs.Take AI scribes. They've very quickly gone from 'what's ambient listening?' to standard-of-care level tools because the data very quickly showed them to be effective in countering one the most significant existential threats - provider burnout. A study published in JAMA Oct-25 titled <a data-mce-href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839542" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2839542" target="_blank" rel="noopener">Use of Ambient AI Scribes to Reduce Administrative Burden and Professional Burnout</a> found that after just 30 days of use, providers experiencing burnout dropped from 51.9% to 38.8% because AI scribes drive meaningful drops in after-hours charting and cognitive load, and ultimately free clinicians to focus on patients instead of paperwork. I have even heard from C-level execs from the largest hospital systems that even though AI scribes are a net-loss, they invest in them anyway because it's the only way to recruit and RETAIN the best physicians. Significant statement in an industry with low single digit net margins.And it's not just about provider admin automation. There is massive innovation happening in diagnostics, drug development, personalized medicine, and all over the back-office.&nbsp;I'll go out on a limb - 10 years from now, there will be more people in healthcare than there are today, but they will be focused on clinical tasks that actually improve patient outcomes, instead of EMR charting, compliance, coding or other 'AI-able' admin tasks. In retrospect, EMRs will be the daguerreotype of the healthcare stack.Read Pete's piece and come back &amp; tell me what you think.

Software's Daguerrotype Moment?

The letters ai are displayed on a blurred background.

Harken back to a post I wrote a few months ago titled Is SaaS Eating AI?, Tomasz Tunguz nails it again in his <a data-mce-href="https://www.linkedin.com/posts/tomasztunguz_in-1908-253-american-automobile-manufacturers-ugcPost-7421658103433211904-O1cp/" href="https://www.linkedin.com/posts/tomasztunguz_in-1908-253-american-automobile-manufacturers-ugcPost-7421658103433211904-O1cp/" target="_blank" rel="noopener">analysis</a> of the likely impact of AI on jobs - especially tech sector jobs.TL;DR the sky isn't falling (I'm pretty sure...).Here's the crux of the analysis - In 1909 there were 253 auto manufacturers. Then Henry Ford introduced the assembly line, and 20 years later only 44 manufacturers remained. But jobs in the industry over that same period went from 76K to 471K.&nbsp; That's over 6X (??) increase of jobs in the sector.&nbsp;<figure id="figure-94vdvrhu4monjbqok" data-full-width=""><img id="94vdvrhu4monjbqok" src="https://cdn.durable.co/blocks/27LsYCo7dZgASOjUMueXRo99NTnNuPeuTA3LMRskdjR6qusQ5UPNdyWMZI3UeoQe.jpg" alt="" title="" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 3/2; object-position: undefined undefined;" data-corners="default" data-aspect="3:2" data-caption="" data-positionx="undefined" data-positiony="undefined" data-fullwidth="true" data-mce-src="https://cdn.durable.co/blocks/27LsYCo7dZgASOjUMueXRo99NTnNuPeuTA3LMRskdjR6qusQ5UPNdyWMZI3UeoQe.jpg" data-mce-style="aspect-ratio: 3/2; object-position: undefined undefined;"></figure>What happened? Automation fundamentally changed throughput, supply chain and unit economics. The industry not only shifted to feed the new beast, but jobs in it grew by 6X+ over the same time.&nbsp; Jobs didn't go away - they shape shifted &amp; multiplied.Feels familiar. Secondary &amp; tertiary effects of industrialized AI are just barely beginning to emerge. But they will. And they'll likely follow the same pattern that followed the assembly line.&nbsp; As factory automation drastically reduced both the production time and cost of cars, AI will do the same for technology (coding, devops, etc.).&nbsp; But the resources that would have otherwise been operating in pre-AI type roles will redeploy to&nbsp; build and build the ecosystems &amp; supply chains necessary to support the post-AI dynamics of building and operating technology.<figure id="figure-wlxl94ktc9monjgyfr"><img id="wlxl94ktc9monjgyfr" src="https://cdn.durable.co/blocks/26w8OUkbMKlBnvVkhf1nZAK3rwEjN7MgOKYvRQSLTAPyr6Q2jfq9VqNUAvMpDqS3.jpg" alt="" title="" class="object-cover bg-gray-100 rounded-sm md:rounded-md lg:rounded-lg" style="aspect-ratio: 3/2; object-position: center center;" data-corners="default" data-aspect="3:2" data-caption="" data-positionx="null" data-positiony="null" data-fullwidth="false" data-mce-src="https://cdn.durable.co/blocks/26w8OUkbMKlBnvVkhf1nZAK3rwEjN7MgOKYvRQSLTAPyr6Q2jfq9VqNUAvMpDqS3.jpg" data-mce-style="aspect-ratio: 3/2; object-position: center center;"></figure>I'm old enough to remember the cries that the cloud was going to destroy the enterprise hardware business. Nvidia would like a word.&nbsp;From Tomasz' original post here - <a data-mce-href="https://www.linkedin.com/posts/tomasztunguz_in-1908-253-american-automobile-manufacturers-ugcPost-7421658103433211904-O1cp/" href="https://www.linkedin.com/posts/tomasztunguz_in-1908-253-american-automobile-manufacturers-ugcPost-7421658103433211904-O1cp/" data-mce-selected="inline-boundary">https://www.linkedin.com/posts/tomasztunguz_in-1908-253-american-automobile-manufacturers-ugcPost-7421658103433211904-O1cp/</a>

Is AI Kiling Jobs?

smiling girl in black and white striped shirt

To my fellow entrepreneurs, CEO's, marketing and Cx leaders, I'm sharing this as a cautionary tale of 'how not to' provide outstanding service. But I'd guess most of you already know &amp; feel this.An adversarial customer service experience is one of the surest-proof ways to destroy your brand along with any possibility of ever winning back a lost customer in the future. Take it to the bank and build accordingly.Here's the set-up. I've been a Cox Communications broadband customer since I moved to AZ. 11.5 years and easily over $20K spent with them over that period. They don't offer fiber in my neighborhood, and have increased rates by almost 65% in the last 5 years for the same speeds/service level for HFC. So did some digging and turns out not only is there a fiber provider in my neighborhood, my house is already prewired for it.3X the speed and it costs 60% less than what I'm paying now. No brainer.Install was today. Seamless, 45 minutes and the tech was smart, polite and my dogs liked him. Bonus.Spend 5 minutes searching cox.com for how to cancel. Finally find it, and click 'chat with us'. Here's how it should have gone, in 5 minutes or less:Cox: It's great to connect with you today Andrew. How can I help you? Me: Thank you. I'd like to cancel my service. I've switched to a different ISP. Cox: I'm terribly sorry to hear that. I see you've been a loyal customer for over 11 years. Anything I can do to change your mind? Me: No, the service has had spotty reliability, I'm looking for higher speeds and you don't offer fiber in my area. Cox: Understood. Let me process your request. ..... Cox: OK, the cancellation is complete [insert confirmation info]. Would be OK for us to reach out to you once we do have fiber in your area to see if we can win you back? Me: Absolutely. Thanks for your help. Cox: My pleasure. Thank you again for being a loyal customer for so long.Brilliant. You can't offer me what I want at the moment, but the positive exit experience leaves the door open for you to win me back when you can.Seems so obvious. But, what followed instead was an excruciating 57 minutes of argumentative offer hounding (clearly with google translate in the middle based on grammar &amp; response times) that p*ssed me off and felt more like I was negotiating with a street hawker in Marrakesh to buy a fake Rolex vs. dealing with a multi-billion dollar communications company.In a world of Cox Communications, be Chick-fil-A

The Perils of Bad Customer Service

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