QBRs and EBRs: the strategic rhythm

A QBR (Quarterly Business Review) is a structured recurring vendor–customer meeting to review the relationship; an EBR (Executive Business Review) is the senior version — once or twice a year, executives from both sides in the room.

The failure mode, and the fix

The universal failure mode: the QBR becomes a status meeting — tickets closed, usage stats, everyone politely bored, senior people delegating attendance downwards until it dies.

The fix is value realisation — measuring and communicating the business outcomes the customer is actually getting, in their numbers, against the business case they bought on.

A strong agenda

1. Outcomes against goals (the heart of it): the metrics they care about. For a virtual-ward platform: beds freed, readmissions, length-of-stay, staff time — their outcomes, not your feature usage.
2. What we learned / what's not working: honest, including your own misses. Credibility compounds.
3. Their roadmap: what's changing in their organisation next — where expansion signals surface unprompted.
4. Your roadmap: relevant product direction (with product, not instead of them).
5. Agreed actions: dated, owned, reviewed next time.

Field note

Everyone in this industry can recite the status-meeting failure mode, and most QBR decks are still forty slides of ticket counts — because usage stats export in minutes while outcome data has to be negotiated out of the customer's own teams. A useful internal test before any QBR: if the customer had to pay to attend, would they? If the honest answer is no, postpone the meeting and spend the time getting the outcome data instead.

Two rules

• No surprises in the room — pre-wire contentious topics with your champion (pre-wiring = testing content with key people in advance so the meeting confirms rather than debates).
• The QBR is renewal insurance: a year of documented value reviews makes the renewal a formality and arms you against any procurement price attack.

Voice from the field

"You can focus on adoption, retention, expansion, or advocacy; or you can focus on the customers' Desired Outcome and get all of those things."
— Lincoln Murphy, Desired Outcome is a Transformative Concept (2016)

7. Stakeholders over time

New-business sales manages stakeholders for months; account management manages them for years, through the natural turbulence of organisational life.

Executive sponsorship

An executive sponsor is a senior leader in your company assigned to a key account, matched to a senior leader in the customer's. Sponsor relationships survive working-level turnover, unlock escalations, and usefully flatter the account. Part of the KAM's job is to broker and script them: arrange the meetings, brief your executive, make it easy.

Champion succession

Assume every champion will eventually move on, and plan before it happens. The discipline is multi-threading: several relationships at several levels, so no account is one resignation away from risk.

When a champion leaves:

1. Meet the successor fast with a crisp "here's what this programme does for you" briefing — they inherit your product as their asset, not their predecessor's pet project.
2. Keep the departing champion warm — a door into wherever they land, and one of the cheapest pipeline sources in B2B.
3. Re-verify the stakeholder map — one departure usually reshuffles several seats.

Re-orgs

Reorganisations redraw budgets and reporting lines under your feet — endemic in the NHS. The play:

• re-map quickly;
• re-anchor your business case to the new structure's objectives (the old case may belong to a unit that no longer exists);
• treat the re-org as a trigger — new leaders need early wins, and an incumbent who can deliver one is well placed.

The hostile new stakeholder

Sooner or later a new arrival wants to make their mark by reviewing (or ripping out) inherited suppliers — sometimes because they used your competitor last job. Don't fight, don't go around them (that almost always backfires). The sequence:

1. Direct meeting early.
2. Treat them as a brand-new prospect who owes you nothing — full discovery of their priorities.
3. Re-present the value evidence in those terms.
4. Give them a way to put their stamp on the programme (a change or expansion they can claim as a win).
5. Keep the rest of the account multi-threaded so the decision is never one person's alone.

8. Customer health, and the AM among the other teams

The health score

A customer health score is a composite indicator — often traffic-lighted red/amber/green — that predicts retention risk. Typical inputs:

• usage (breadth, depth, trend);
• support-ticket volume, severity and age;
• engagement (meetings kept, QBR attendance and seniority);
• relationship coverage (multi- or single-threaded);
• sentiment (survey scores such as NPS — Net Promoter Score, the "would you recommend us 0–10" measure);
• business-context flags (re-org, M&A, budget freeze).

Health scores are early-warning radar, not truth: an account can be green on every dashboard and still churn for political reasons, which is why the AM's qualitative read is itself an input. Use the score to allocate attention — reds get save plays, greens get expansion conversations.

The cast around the AM

Interviews will ask how you work cross-functionally:

• Customer Success (CS / CSM): in many software companies, a distinct role focused on adoption and outcomes, while the AM owns the commercial relationship (renewal, expansion, negotiation). Healthy division: CS drives value, AM monetises it; the failure mode is a turf war over who "owns" the customer. If asked, say you'd agree the split explicitly per account and share one account plan.
• Support: fixes problems. The AM watches escalations and owns the customer's experience of big issues without becoming a ticket-chaser — an AM turned first-line support has lost the strategic role.
• Product: the AM is a conduit — structured customer feedback in, roadmap news out (carefully: never promise unshipped features; the graveyard of trust is full of AMs who sold the roadmap).
• Delivery / implementation (in services businesses): the people who do the work. If you've worked in delivery, project management or agency-side client handling, this interface is home ground — sitting between clients and delivery teams on scope, change requests, timelines and budgets is directly transferable evidence that you can hold a commercial line while keeping client and delivery aligned.

Field note

The CS/AM split is tidy on slides and messy in practice: whoever is paid on the expansion tends to own it, whatever the org chart says, and customers are quietly bemused to find they have three "owners" from one vendor. The turf war rarely gets settled by argument — it dissolves when both roles work from one account plan and one agreed definition of who does what at renewal. If you interview somewhere with both roles, asking how they have drawn that line is a genuinely good question that signals experience.

9. Key-account selling into very large organisations (the NHS case)

The defining UK health-tech scenario — the shape of KAM roles selling into NHS trusts: a book of a few NHS trusts — each huge (thousands of staff, hundreds of millions in budget), long procurement cycles, safety-critical context, many stakeholders (clinical, operational, financial, technical, procurement), most of whom can say no and few of whom can say yes.

What changes at this scale

• Account-based everything. The account isn't a customer, it's a market. Research it like one — board papers, strategy, published performance data, people — and measure progress in relationships and proof points as much as pipeline. A trust's whitespace grid might have directorates and clinical pathways as rows.
• Patience with a plan. Cycles run months to years; the compounding assets are trust, evidence and relationships. The KAM who lands one pathway, documents outcomes rigorously and expands methodically beats the vendor pitching cold. Patience is not passivity: every quarter still has concrete moves.
• Arm the champion. Most of the selling happens in rooms you're not in. Make the internal case easy: the business case in their template, the evaluation data, answers to the objections coming from finance, information governance and clinical safety.
• Be easy to buy from. In heavily-governed environments, the vendor with paperwork ready — information-governance and data-protection answers, security documentation, framework listings (the NHS buys heavily through pre-approved procurement frameworks), references, standard contracts — removes friction that kills deals as surely as price. An underrated strategy and a lovely interview phrase.
• Public-sector texture: budget cycles matter (money can appear late in the financial year and must be spent or vanish); decisions above trust level increasingly involve ICBs (Integrated Care Boards, the NHS bodies planning and funding care regionally); evidence expectations sit closer to clinical research than SaaS marketing.

Without NHS sales experience

Coming to a role like this without NHS sales experience? Don't pretend otherwise in the interview — it never survives contact with a panel that lives this daily.

The credible position is to assemble what you do have — any multi-stakeholder or complex-organisation experience (enterprise clients, public sector, big institutions), any client or account ownership from adjacent work, any clinical, scientific or healthcare fluency from study or a past life — and then show you understand the shape of NHS key-account work using the concepts above.

Hiring managers for these roles expect to teach the NHS specifics; what they're screening for is whether you think in accounts, evidence and years rather than transactions.