• Healthcare is full of promising innovations, yet many fail to become routine practice. The gap often lies not in the technology itself, but in the operational complexity of integrating new solutions into real-world clinical environments.
• To unpack why innovations stall between pilot and scale, three leaders who work inside major health systems every day – Brian S. Englander, Shiva Chandrasekaran, and Patrick Mahanger – shared candid insights on workflow realities, internal decision-making, and institutional risk.
• The discussion took place as 10 medtech startups began the 10th cohort of the Science Center’s Capital Readiness Program (CRP), giving founders an inside look at the operational hurdles they will need to navigate to move innovations into standard care.
Earlier this month, we convened three experts who operate inside institutional complexity daily – a population health physician strategist building agentic AI clinical services, a Penn Medicine radiologist and newly appointed interim CMO, and a former Wall Street operator running psychiatry operations at Penn - sat down to discuss what it takes to translate innovations into routine care.
In the audience were 10 promising medtech startups kicking off the 10th Capital Readiness Program (CRP) cohort, several investors, and numerous visiting experts and healthcare stakeholders.
Here are some of the operational truths that emerged.
Idealistic vs. Operational Realities
Too often founders hyperfocus on fixing a problem but ignore context. When a startup comes up with an idea for improving depression screening, for example, the physician who champions depression screenings is thrilled. The other five clinicians in the practice, however, see the new tool as an added burden to their already overloaded workflow.
Brian S. Englander, Chair of Radiology at Pennsylvania Hospital at Penn Medicine, pointed out that innovations that go the distance often demonstrate that they can scale beyond a narrow context. “Are we really impacting patients in a way that is concrete and sustainable and can grow, and really be embraced beyond just a specific population?”
That transition – from controlled success to real-world adoption – is where many innovations falter.
“What works in an idealized setting doesn't necessarily work in the real world,” advised Shiva Chandrasekaran, MD, FACP, Chief Medical Officer of Regional Operations at Lumeris. Startups need to focus on the real-world workflow: the interaction between patient, clinician, their caregiver, and the technology that already exists, and make their innovation work in that context.
“Joining and navigating a very highly-matrixed organization is something you need to know how to do. To be able to make innovation successful, especially from my vantage point, you need to be able to tell me a few things: how is this going to make the pain points that we experience in the department? Are you going to fix the pain points? You also need to know how to get traction in an organization. Who makes the decisions?” added Englander.
Knowing who makes the decisions is important, because decision-making doesn’t always follow the flow-chart of titles you’d necessarily expect – especially in complex institutions where roles and responsibilities often overlap.
Patrick Mahanger, Chief Operating Officer of the Department of Psychiatry at Penn Medicine, brought up the real-world example of “Mary in the file room” and how it’s impacted his approach to organizational buy-in. “When I joined Penn, one of the senior leaders said to me, Patrick, one of the things you'll need to know is: just when you think you have everyone's buy-in, you forgot to ask Mary in the file room because she's been here 30+ years – and she's the decision maker. So unless you ask Mary, you won't get it,” he said.
Just when you think you have the buy-in, you might realize you forgot to ask the one person who has the power to say “no” in the organization – and that’s a problem.
Moving Innovation Forward: the Role of the Skeptic
Moderator Tiffany Wilson, President and CEO of the Science Center, had a pointed question for the group: exactly how many cold emails from startups does the group receive each day? The answers ranged from dozens, to over a hundred: the competition for a slice of attention is fierce, and physicians are already pressed for time.
Chandrasekaran said that physicians know what it’s like to be a founder with an innovative idea for the space, because they’ve often been there themselves: they have a new process they are convinced will make the experience better, and they have to be able to sell it to both the clinician ready to champion their cause and the skeptical, concerned, over-worked clinician.
“I've sat on the side where I'm buying and being sold and demoed tools and technology,” he recalled. “And now I'm on the other side trying to figure out how can we develop the tool in a way that it's really going to resonate with health systems, with patients, with clinicians, but also is going to financially make sense for the organizations that are trying to navigate this really complicated world.”
The skeptical clinician is not a barrier to innovation – rather, startups will need to keep their time constraints and healthy skepticism top of mind as they ideate. “If you have someone who just buys into the concept as a theory, you're not going to be challenged as a company to really grow and figure out if it's a great product,” said Englander. The skeptic’s questions need to be answered, not ignored: ultimately, that helps push the product forward toward a more successful solution.
“They’re not skeptical because they're against all new technology or they don't believe AI is going to help patients: they're skeptical because they've been burned before,” added Chandrasekaran.
Hurdles to Rollout: Trust Needs to be Built
Although emailing may sometimes feel like the easiest solution, the panelists agreed that relationships are often what move the needle towards having an initial dialogue – and that founders would be wise to network and find an avenue for referral to get their foot in the year.
“Relationships make a difference. And when there's no relationship, I think there's a trust and skepticism issue,” warned Chandrasekaran.
Once the gauntlet has been surmounted and startups have successfully found an audience for their innovation, the next step is selling physicians on the idea. It’s during this stage that the first bricks of trust are built in the relationship between the innovator and the institution – and building up this trust, brick by brick, is key to advancing change through the complicated matrix.
According to Chandrasekaran, building trust begins with simple dialogue – discussing, rather than monologuing, and acknowledging the blind spots as they’re discovered. “Be humble and ask. Like: hey, we believe this, but we want to hear what you have to say.’ And course correct – ‘Wow, because of this conversation, I came in with this conversation thinking this was the problem, but you helped me adjust a little bit.’ And each time you do that, I think you'll generate more trust,” he explained.
They cautioned startups to move beyond the flashy pitch decks and catchy jargon in their pitches and try to focus on how their innovation will enable the physician’s workload, or share relevant case stories that generate genuine excitement. “Avoid ‘AI -enabled’, ‘holistic patient care’. There are just all these buzzwords that have become almost meaningless now,” added Chandrasekaran.
And an important part of establishing trust is also making sure the claims are backed up by the hard data institutions will require to move forward.
“So if you come to me with an idea and you tell me, look, my idea is evidence-based, I'm going to say: okay, is it really evidence-based? Because my philosophy is trust but verify,” explained Mahanger, noting that establishing whether the research, peer journal publications, and clinical perspective behind it is key.
Once an idea is accepted, the next step – which can become a killzone for startups that haven’t done their due diligence – is governance and regulatory.
Unignorable: Governance and Regulatory
Many founders live by the adage “move fast and break things.” Startups operating on a lean budget and a limited runway may be tempted to cut corners and squeeze under the limbo stick of regulatory compliance. In the medtech world, though, companies need to move forward with a recognition of the risk factors at play – both for them and for the healthcare entities they engage with. Breaking things in the regulatory environment can have profound consequences for product viability.
Englander said that startups looking to collaborate with larger health organizations need to understand how much oversight there is – and why. Any misstep for them can have a huge, reverberating impact. He noted that Penn has been burned in the past: “We have worked with companies that have a great product and think they can skirt around the process. And maybe if we were also a startup, that would be true. But the expectation from Penn, at least, is that these are our rules, and it's very hard to deviate.”
Understanding the true risks and legal issues involved with moving forward in the medtech space can also help startups better gauge how much runway they need – because the regulatory hurdles of operating in a healthcare space can take many months to clear.
“The understanding of how long something can take to get done is really important,” explained Mahanger, noting that it can take weeks or even months to get legal, managed care, and billing involved. He recalled having to explain to an international company that no CPT codes existed for their service. Because these codes determine billing, establishing them can significantly delay a product’s path to patients.
“We have to dot all the I’s and cross the T's to make sure from a risk perspective, we're not bringing in a product that's going to be adverse to our patients,” he explained, and told founders to assume delays will happen: “A lot of things go on to delay the implementation of an idea once you generate it.”
Not surprisingly, the topic of AI was ever-present. Though the technology is increasingly popular with medtech startups, healthcare systems must have a healthy skepticism where patient information – and patient care – is potentially involved, and that’s a concern startups will need to meet with privacy and guardrail reassurance.
“I think there's a huge opportunity with technology and with AI. What concerns me is the risk,” warned Mahanger. “I need to be sure that a patient isn't engaged with a bot that's telling them, ‘you need to go to X,’ and they end up in an adverse situation. And we've seen a lot of things like that happen. Young kids especially are very vulnerable. So the guardrails have to be there. You need to be able to say, ‘Here's what I'm going to do for you, but here's how I'm going to control what the patient can actually do or not do with the technology.’”
Building Trust, Navigating Complexity, Driving Change
Healthcare does not lack innovation. Instead, workflow integration, operational governance, and trust can get in the way of ideas becoming solutions. And rather than seeing these complexities as roadblocks, founders should instead see them as an integral part of the innovation pathway.
“Every day I worry about my patients and how do I get the best care to my patients. And that's my number one priority,” said Mahanger. “So if you can come to me and tell me this is how I'm going to help you get your patients to do better with their treatment, with their medication, I'm all ears.”
Ultimately, meaningful innovation requires understanding the people and processes it touches. As Englander put it:
“Be persistent with patience and curiosity. In healthcare, curiosity is the key and wondering what we could do better.”
