Stop Pitching the Institute — Pitch the Stack

A vendor came to my team last year with augmented-reality captioning glasses. The sales representative was enthusiastic and knowledgeable, authentically excited about the product he was pitching and the benefit he believed it could provide our communication-impaired patients, and as engaging and glossy as you’d expect from a med-tech vendor. Top-notch all the way around.

The patient population on the receiving end was exactly the one in greatest need of such technology. Severe hearing loss. Polytrauma. Parkinson’s disease. Three conditions that strip communication in different ways, sometimes even compounding in the same patient. On paper, it was a slam dunk.

But that’s not the point, is it?

We ran a pilot. My clinicians did not want to add captioning-glasses assessments or device fittings into their clinical workflows. The whole thing floundered. It failed miserably.

I’ve seen countless glossy pitches that appear polished and designed to land. That’s not enough. I can buy the tech. I can take an interest. I can feel intrigued and even optimistic. But that’s to say absolutely nothing about integration of that product into clinical workflows or adoption of that product by the gatekeepers that matter: clinical providers.

There is a story to be told that med-tech vendors desperately need to hear: most health systems can buy any individual piece of tech, but very few are wired to actually absorb it.

The moat is coherence, not strategy

Cleveland Clinic is the best-documented case of what absorption actually looks like when a health system gets it right. Disease-based Integrated Practice Units (IPUs) in lieu of specialty silos. A salaried-physician model instead of RVU-driven incentives. An Epic-based clinical backbone with MyPractice, integrated cost data, and Explorys analytics under the hood. These components get named in every Harvard Business School case study and every strategy panel. That’s not the interesting part.

This architecture was designed to work as a stack. IPUs only generate efficiency because shared accountability is reinforced by salaried compensation. Bundled payments only price correctly because cost data are integrated. The culture only holds because the structure is deliberately devised to support it. This is what business-strategy scholar Jay Barney called a socially complex, hard-to-imitate capability: not the components, but the way they fit. That is the moat.

Same components. No coherence.

Then there’s the illusion of scale. A massive, multi-site health network or legacy system that appears unified from the outside: shared branding, massive bed count, centralized procurement. It purchased the same enterprise EHR (Epic, Cerner) as the most coherent systems, so vendors assume plug-and-play interoperability and readiness. But this is a technological false positive.

The reality is messy. The software was purchased centrally, but the clinical workflows were never standardized across the enterprise. Every regional site or department runs its own highly customized version of the exact same EHR module, creating invisible data and operational silos. And the physician compensation model remains strictly RVU-driven or silo-budgeted, punishing the protected time, multidisciplinary collaboration, and cross-departmental handoffs required to make any new predictive tool, clinical decision support tool, or care pathway function.

Now imagine a sophisticated vendor drops a clinical decision support tool into this environment, predicated on the idea that a shared EHR equals shared operational capacity. Same components. No coherence.

A vendor pitching into this system sees the logo, the bed count, the prestige, and assumes absorption capacity that simply isn’t there. The pilot stalls, not because the product failed, but because the stack couldn’t hold it.

The gap nobody is standing in

Here’s what most vendors miss. Good products keep dying in the gap between R&D, clinical operations, and commercial strategy. R&D builds without enough clinical context. Clinical teams cannot always translate adoption failure back into product requirements. And commercial teams pitch without understanding either side well enough to see the mismatch before it costs them the pilot.

This is not a two-sided problem. It is three-sided. The product does not exist without the scientists and engineers who build it. It does not get adopted without the clinical reality it has to survive. And it does not scale without the commercial logic that gets it through the door. Most organizations have people who are fluent in one of these. Sometimes two. Yet almost nobody sits in the center of all three. What happens when no one can read all three at once? If cross-domain decisions lack a multilingual owner, who prevents the hardest calls from simply defaulting to whichever silo speaks the loudest? The machine gets evaluated by its parts, and the whole picture, the thing that actually determines whether a product lives or dies, goes unseen.

What this means for vendors

If you are selling into integrated health systems, stop pitching the institute. Pitch the stack. The prestige of the logo tells you nothing about whether the system can absorb what you’re selling. What tells you is whether their structure, incentives, and workflows are actually wired to hold it.

The systems that can absorb your product are the ones whose structure, incentives, and workflows are already coherent. The ones that cannot will pilot you indefinitely. Buyers should be qualified on coherence, not prestige.

Photo: alphaspirit, Getty Images

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.