The evidence ladder — and why pilots stall

Healthtech deals climb an evidence ladder. Each rung answers a costlier question:

1. Case studies — "someone like us has used it and liked it." Cheap, weak; enough for a first meeting, not a committee.
2. Pilots / evaluations — a pilot is a limited live deployment in the buyer's own setting; a proof of concept (POC) is its smaller sibling, testing feasibility. This is where "does it work here?" gets answered.
3. Health-economic analyses — modelling of costs and consequences: staff time released, admissions avoided, cost per outcome (health economists use measures such as the QALY, quality-adjusted life year, to standardise benefit). This convinces finance and commissioners.
4. Peer-reviewed studies — published clinical evaluation, ideally in the buyer's own population. This convinces sceptical clinicians and satisfies NICE-style evidence frameworks.

A vendor's maturity is visible in how far up the ladder it can point. You inherit whatever evidence the company has — but you judge whether a given deal needs another rung climbed or just the existing evidence well told.

Pilotitis is the industry's name for the failure mode: endless pilots that never convert to paid, scaled contracts. Trusts like pilots (low cost, low risk, good publicity); vendors accept them hoping momentum does the rest. It usually doesn't.

Pilots stall when never wired to a purchase decision — no agreed success criteria, no named budget for scaled deployment, no committed go/no-go process.

Voice from the field

"I think organisations often use pilots as a way of getting things for free, because they don't have any money. That's kind of unhelpful because if you want to scale something, you have to fund it."
— Tom Whicher, co-founder of DrDoctor, Rory's Always On newsletter (2024)

What makes a pilot convert — the discipline seasoned vendors apply, learnable before your first deal:

• Success criteria agreed in writing before the pilot starts, tied to metrics the buyer's committees care about — not vendor vanity metrics.
• A named executive sponsor and a pre-agreed decision meeting: "in month four, this group reviews results against these criteria and decides on the business case."
• The commercial path defined up front: what full deployment costs, which budget it comes from, which procurement route it uses. A pilot whose scale-up has no identified route is a science fair, not a sale.
• Deployment reality tested honestly — integration, IG, training — so the pilot de-risks the real project rather than running as a sandboxed demo.

If you're asked one hard operational question in a healthtech sales interview, it will be a version of "how do you avoid pilotitis?" — this list is the answer.

6. Selling to pharma and biotech

Now switch buyers entirely. Selling any of these means selling into the pharmaceutical R&D machine:

• LIMS (laboratory information management systems)
• ELN (electronic lab notebooks)
• eClinical software (systems supporting clinical trials — data capture, trial management, randomisation/supply)
• scientific informatics
• CDMO/CRO services (contract development & manufacturing organisations make drugs for other companies; contract research organisations run research and trials for them)

The R&D organisation

The R&D organisation you are mapping:

• research/discovery (lab scientists generating candidates)
• development (turning candidates into manufacturable, testable products — including CMC, chemistry-manufacturing-controls)
• clinical operations (running trials)
• quality assurance
• regulatory affairs
• IT/informatics

Users sit in research or clinical ops; money and signatures sit with directors and VPs; quality and IT hold vetoes.

GxP and validation as a sales factor

"GxP" is the umbrella for "good practice" regulations — GLP (laboratory), GCP (clinical), GMP (manufacturing).

Where a computer system supports GxP-regulated work, it must undergo CSV — computer system validation: documented evidence that the system does what it's specified to do, with audit trails, access controls and electronic-signature compliance (the famous US rule is 21 CFR Part 11; the EU equivalent is Annex 11; the standard methodology is GAMP).

Seller's implication: validation is cost and time the customer spends on top of your licence fee, so vendors compete on reducing that burden — validation documentation packs, qualified cloud environments. "How do you support our validation?" is the pharma equivalent of the NHS's IG grilling; the vocabulary is table stakes.

Two audiences, two currencies

With scientist users you earn scientific credibility — speaking assay, sample, batch and protocol well enough that they trust the product was built by people who understand their work (this is where a science degree at any level does real work: not peer-of-a-PhD status, but fluent translation).

With executives you build the business case — the structured argument that benefits justify cost: cycle time, data-integrity risk, audit readiness, capacity.

Presales and sales roles here bridge the two; cycles are long, multi-stakeholder and committee-governed — enterprise selling as you know it, with new nouns.

Field note

Deals here can clear the science and still die in quality or IT review — the scientists love the demo, then the quality team's vendor audit surfaces a thin validation pack, or IT vetoes the hosting model. Seasoned sellers qualify the veto-holders as hard as the users: ask in the first meetings who audits vendors, what the validation expectations are, and which IT and security standards apply. The answers change the deal plan more than anything the end users say.

How CDMO/CRO business development differs from software sales

You sell capacity, expertise and trust, not a product. Deals are programmes — "develop and manufacture our molecule" — often worth millions over years, won through formal RFPs followed by bid defence meetings where your scientific team presents and the client's scientists interrogate.

The BD person orchestrates: qualifying which opportunities fit the organisation's real capabilities and capacity, building relationships years ahead of need, running the proposal machine — in a business where a client's molecule dying in trials can vaporise revenue through no fault of yours.

Closer to professional-services selling than SaaS: fewer, bigger, slower, deeply technical deals, with scientists as both audience and delivery team. If any part of your background involved scoping custom work, coordinating specialist colleagues, or managing a delivery relationship — an agency, a consultancy, a research group, even organising a complex event — that is the right shape of experience to point at, whatever the industry was.