By Erika Rosenthal, Novastrat Growth | Reading time: 17 minutes

Why brilliant science often loses commercial momentum, and how healthcare leaders can restore clarity without sacrificing clinical credibility

Some of the most difficult medical devices to commercialize are also some of the most impressive.

They are created by scientists, engineers, physicians and clinical experts who have spent years solving difficult problems. Their organizations understand the technology at an extraordinary level of depth. They know the mechanism of action and understand the engineering. They can explain the clinical literature, product specifications, patient populations, contraindications, workflows and competitive differences.

Then, something happens as the company grows. The organization learns more. The message gets longer.

Clinical Affairs adds another study. Engineering adds another capability. Regulatory refines the claims. Product Management adds new specifications. Marketing creates collateral for additional audiences. Sales develops competitive responses based on what it hears in the field. Almost every addition is legitimate. 

Collectively, however, the company can begin to lose something important: the story. Complexity increases. Meaning decreases. I have seen this happen in medical-device companies with genuinely differentiated technology and credible clinical evidence. The organization becomes increasingly sophisticated in explaining how the device works while becoming less effective at explaining why it matters.

That creates a commercial problem; not because hospitals don't value evidence, because they absolutely do. Evidence is fundamental to medical-device evaluation. Hospital purchasing and value-analysis processes explicitly consider clinical evidence alongside quality, outcomes, cost, reimbursement and other factors. (AHRMM)

The problem is that evidence alone cannot do all the work required to move a complex organization toward adoption. Someone still has to understand it. Someone has to determine its relevance. Someone has to translate the clinical findings into implications for patients, clinicians, operations, and economics. 

Eventually, multiple people with different responsibilities must become sufficiently confident in the decision to move forward. That takes time. It consumes resources. When a medical-device company makes that process unnecessarily difficult, it creates what I call Decision Friction. Decision friction gets in the way of converting a prospect to a customer. Many times, marketing, and even sales, will try and pack as much information as possible into a sales deck. In meetings where multiple stakeholders are making decisions, the process can break down. Even getting to the meeting with stakeholders can break down if the emphasis is on the entire story instead of just trying to get to the next step. It creates information overload and complexity. 

Complexity itself is not the enemy. Medicine is complex. Science is complex. Hospital operations are complex. The clinical evidence supporting an innovative technology may necessarily be complex. Oversimplifying that evidence can be irresponsible and, in a regulated industry, potentially dangerous.

The problem is unnecessary complexity.

There is a cognitive cost associated with asking someone to determine what matters from a large amount of information. Consider the different people who may become involved in evaluating a new medical technology:

These aren't less sophisticated questions than the science. They are different questions. They don't necessarily arise in a predictable sequence.https://www.gartner.com/en/sales/insights/b2b-buying-journey?utm_source=chatgpt.com

Research into complex B2B buying supports this broader reality. Gartner describes today's B2B buying process as non-linear, with buying teams repeatedly revisiting activities such as problem identification, solution exploration, requirements building, supplier selection, validation and consensus creation rather than progressing through a neat sequence of stages. (Gartner)

Hospital technology purchasing adds another layer because the stakes can include patient outcomes, safety, cost and operational performance. Research on hospital medical-device purchasing describes processes involving clinicians, finance and administrative leaders, with evaluation criteria explicitly encompassing clinical and financial considerations. (PubMed)

Yet many medical-device sales organizations still equip their teams as though the buying journey were linear.

Real hospital decisions rarely behave in that linear manner.

Medical-device companies spend considerable time positioning themselves against competitors.

Sometimes the most formidable competitor isn't another manufacturer.

It is: Do Nothing. 

A new technology can therefore be clinically compelling and still encounter organizational resistance, and not necessarily because anyone opposes the technology. The existing system already works well enough to avoid the work associated with changing it. This distinction matters enormously for medical-device leadership.

If your organization believes its commercial responsibility is simply to demonstrate product superiority, you may continue producing more evidence, more slides, and more feature comparisons; however, if you recognize that the hospital is being asked to undertake a decision process, the leadership question changes:

How can we make a rigorous decision easier to make without making the decision less rigorous? 

That is a very different commercial mandate.

There is a dangerous version of "simplification" in medical-device marketing that reduces clinically sophisticated products to superficial taglines. That is not what I am advocating.

Hospitals need compelling evidence that is greater than the status quo.

The point isn't that clinical evidence matters less. The point is that clinical evidence deserves an architecture that helps the appropriate stakeholders understand why it matters.

Think about the resources required to interpret sophisticated clinical evidence correctly. The clinician reading the study may understand its methodology and endpoints immediately. Other stakeholders may not. They shouldn't need to become clinical researchers to understand the implications of the research for their responsibilities. The manufacturer's job is not to dilute the evidence. It is to make its relevance accessible. This leads to a principle I believe applies well beyond medical-device commercialization:

Leadership reduces complexity without reducing truth

The objective isn't to remove complexity from the science. It is to remove unnecessary complexity from the process of understanding it.

There comes a point in the growth of many medical-device companies when leadership needs to stop adding to the message and step back from it. The question becomes less:

And more:

Start higher.

Only then should the organization descend into the supporting evidence.

That is where I use a structure I call the Clinical Messaging Pyramid.

The exact message will vary by device and market. The hierarchy matters more.

Features should support the story. They should not become the story.

One of the easiest mistakes to make when simplifying medical-device messaging is reducing "Reasons to Believe" to a collection of broad marketing claims, often with quantitative proof points.

Those are assertions. They aren't reasons to believe. Whenever the evidence allows it, quantitative proof is stronger:

The specific measures will depend entirely on the technology and the quality of available evidence. In addition, a medical device company willing to partner with the hospital and help them to quantify these changes is worth a great deal to an already stretched-thin hospital staff.

The discipline should remain the same:

Those aren't competing objectives. They're complementary.

The Clinical Messaging Pyramid provides a common story. It does not mean every stakeholder receives the same conversation. This is where sophisticated medical-device selling differs from simply creating better collateral. Imagine a device that generates data supporting a time-sensitive clinical decision.

• The physician may ask: Does the information improve the quality or speed of my clinical decision?
• The technologist operating the device may ask: How difficult is it to use accurately?
• Nursing may ask: What does this add to the workflow?
• Biomed may ask: How often does it need to be calibrated, and who can service it?
• Supply Chain may ask: What are the disposable requirements and recurring costs?
• Finance may ask: What is the total economic impact?
• Hospital leadership may ask:  Does this materially improve the standard of care or advance one of our strategic priorities?

Same device. Same evidence base. Same value proposition. Different decision requirements. That distinction is essential.

A medical device sales force is one of the company's most expensive commercial investments. When field talent has to rebuild the story, locate evidence, or educate each stakeholder from scratch, commercial capacity is lost. Arming the sales force with a coherent story and the right supporting resources can improve selling efficiency and may help reduce customer acquisition cycle time, customer acquisition cost (CAC), and time to adoption and utilization.

Medical-device companies often devote extraordinary attention to clinical differentiation and comparatively little attention to what happens after the purchase order is signed. Hospitals cannot afford that luxury. They have to live with the device. Operational Confidence, therefore, deserves a deliberate place in the commercial story. Rather than overwhelm the customer with operational detail, the commercial team should be able to answer the questions that matter most:

These details aren't beneath the strategic story. They demonstrate that the manufacturer understands the customer's reality. It is the difference between a transactional sale and behaving like a long-term partner.

AHRMM's current product-value-analysis curriculum similarly describes hospital purchasing as encompassing patient needs, standardization, clinical evidence, outcomes, quality, cost and reimbursement rather than price or clinical performance alone. (AHRMM)

The evidence runs through all three. Clinical evidence isn't replaced by this model. It is contextualized within the broader decision.

There is another cost that rarely appears in a medical-device business case. The cost of understanding. There is a cost, every time:

I call this Cognitive Cost: the mental effort required for a stakeholder to identify, understand, and apply the information necessary to evaluate a decision. Not all cognitive costs can or should be eliminated. The goal is to remove what is unnecessary. Unnecessary cognitive cost contributes to something more commercially consequential.

Decision Friction.

I define Decision Friction as: 

The cumulative resistance that prevents stakeholders from confidently moving a decision forward.

Messaging complexity can create decision friction. Messaging complexity that isn’t aligned to hospital key objectives can cause decision friction; however, it is only one source.

Or it may simply be inertia: "This looks interesting, but replacing what we're doing today isn't a priority." This is why I would resist a simplistic formula claiming:

More complexity = longer sales cycle.

Reality is more nuanced. A sophisticated technology can move quickly when the problem is urgent, the value is clear, the evidence is compelling and the organization has confidence in implementation.

A relatively simple technology can stall indefinitely when nobody believes change is worth the effort.

The more useful relationship is:

This is not intended as a mathematical equation. It is a diagnostic relationship. And that distinction matters.

This brings us to a leadership problem. Many medical-device sales guides remain linear.

Process discipline has value. Regulatory requirements matter. Consistency matters. A rigid script can underestimate both the complexity of the customer's decision and the intelligence of the salesperson.

Complex B2B buying does not occur in a predictable linear sequence. Gartner's research specifically describes buying teams moving back and forth among buying tasks, and recommends helping buyers complete the tasks necessary to reach a confident decision rather than treating the journey as a simple progression through seller-defined stages. (Gartner)

That is remarkably relevant to medical-device commercialization.

An experienced salesperson sitting across from a hospital stakeholder needs something more useful than: "You are now in Stage 4."

They need to understand: Where is the friction?

People do not always vocalize what matters most to them. Great salespeople know this intuitively.

And then they access the evidence, story, customer example, operational resource, or economic tool that helps the customer address the issue at hand. Leadership should make that easier.

This is where I believe medical-device commercial leadership needs to evolve.

Instead of giving salespeople a rigid path, give them an architecture they can navigate.

• The salesperson doesn't move clockwise around the diagram. They navigate it.
• A concern emerges about training? Access the user-adoption tools.
• A CFO enters the conversation? Move to economic evidence.
• Biomed asks about calibration? Use the operational materials.
• A physician questions applicability? Return to clinical evidence.
• A committee isn't convinced change is necessary? Reestablish the patient, clinical or operational problem and the cost of maintaining the status quo.

The architecture doesn't prescribe the conversation. It equips the salesperson to navigate it. That respects the intelligence of experienced commercial professionals while giving less-experienced representatives a structure within which to develop judgment. In addition, it allows the company to maintain one coherent story without demanding one identical conversation.

A company can have excellent positioning and still make selling unnecessarily difficult. The value proposition may live in a marketing presentation. The clinical evidence may sit in a document library. The economic model may exist, but the sales team may not know when to use it. Implementation resources may not appear until after the customer has already worried about implementation.

This is where Applied Marketing matters. Applied Marketing is the translation of strategy into practical resources that help people act.

In medical-device commercialization, that means giving the sales team a coherent core story and access to the evidence or resource that fits the decision in front of them. A clinical concern may call for the right evidence summary. A workflow concern may call for a peer-user example. A Biomed concern may call for maintenance and calibration information. A status-quo concern may require the team to reestablish why change matters at all. The goal is not to create a tool for every conceivable objection. That simply creates another form of complexity. The goal is to make the right support easy to find and use when it matters.

Rather than asking whether the company has "good messaging," leadership can ask where customer decisions repeatedly encounter resistance. A useful diagnostic should examine four broad areas:

I would resist creating a sophisticated scoring formula before we know what deserves to be measured. First identify the observable friction. Then determine which measures reliably predict stalled or advancing decisions.

First prove the model. Then instrument it.

There is a simple way to begin without a formal diagnostic. Pull the last three meaningful hospital opportunities that stalled. Not necessarily the three you lost. The three where movement stopped. For each one, ask:

Then ask the most important question:

Perhaps the customer had to calculate the economic impact. Perhaps the physician champion had to explain the technology internally. Perhaps nursing had to determine the workflow implications. Perhaps Biomed had to hunt for maintenance requirements. Perhaps nobody helped leadership understand why maintaining the status quo carried a cost of its own. If the same friction appears across multiple stalled opportunities, you may not have a salesperson problem. You may have an architecture problem.

It would be easy to classify all of this as a messaging problem. I don't think that's accurate. Marketing may build the architecture. Sales may use it. Clinical Affairs may substantiate it. Product may inform it. Medical Affairs may protect its scientific integrity. Leadership has to decide that making the customer work unnecessarily hard is unacceptable. That is a leadership choice.

Medical-device companies should continue producing rigorous evidence. Scientists should continue advancing the science. Engineers should continue improving the technology. Clinical teams should continue challenging claims and generating evidence. Simplification should never become an excuse for superficiality. Leadership has a different responsibility: organize the complexity.

Give people a coherent story. Make the evidence accessible without diminishing it. Help each stakeholder understand what the technology means for their role. Give salespeople the tools to navigate a non-linear decision rather than forcing them through a linear script. Reduce unnecessary friction between a clinically meaningful innovation and the patients who may ultimately benefit from it. This is where medical-device messaging becomes something larger than marketing. It becomes decision architecture.

A sophisticated medical-device company should be able to answer several questions clearly:

And when the decision stalls, can the commercial team identify where the friction is occurring? If not, adding another sales deck probably isn't the answer.

The medical-device industry has no shortage of brilliant technology. Nor should anyone argue that sophisticated science needs to become simplistic. The commercial challenge is different. 

Hospitals are being asked to evaluate increasingly sophisticated technologies in environments where clinical, economic and operational pressures compete for finite attention and resources. The evaluation itself requires work. Medical-device leadership can either add to that burden or help reduce it. The companies that do this well won't necessarily communicate less.

Because ultimately: Great leaders don't simplify because their organizations are simple. They simplify because the decisions their organizations face are complex.

 "If you can't explain it simply, you don't understand it well enough." — Often attributed to Albert Einstein (attribution is uncertain)

Medical devices are an unusually powerful proving ground for this principle because the decisions are high-stakes, multidisciplinary, evidence-driven and operationally complex. If leaders can reduce Decision Friction here without compromising scientific rigor, the principle has implications far beyond medical-device commercialization.