MedTech’s Blueprint for Failure

This Commentary:
  • Unpacks the hidden costs of dismissing emerging trends as “irrelevant”
  • Explores why short-term thinking persists in traditional MedTech leadership
  • Challenges the industry’s reliance on outdated playbooks and familiar metrics
  • Highlights strategic blind spots - from AI and value-based care to patient-centricity and global markets
  • Offers a lens on what it takes to stay relevant in a shifting healthcare landscape

MedTech’s Blueprint for Failure

Let us begin with respect. The seasoned MedTech executive is not a figure of the past, but the architect of the present - responsible for building some of the most durable, trusted, and clinically impactful companies in healthcare. These leaders have guided global organisations through shifting regulations, economic cycles, and evolving standards of care. They have delivered not just products, but platforms of safety, precision, and reliability that clinicians and patients around the world depend on. Their legacy is real, earned, and deeply embedded in the modern healthcare system.

MedTech leaders have operated in environments defined by complexity - balancing regulatory scrutiny with engineering excellence, margin pressure with operational discipline, and clinical outcomes with commercial scale. They have not just adapted to change; they have often outlasted it. And while others have chased the latest buzzword or market trend, these executives have anchored their strategies in consistency, trust, and results.

Yet in many boardrooms today - especially those contending with near-term headwinds - pressing concerns like debt, tariffs, remediation, stagnant growth, and quarterly targets increasingly overshadow the pursuit of long-term strategy. Anything not tied directly to fixing, shipping, or selling is often sidelined. Innovation becomes a luxury. Structural change is postponed. And conversations about AI, value-based healthcare, emerging markets, or digital-transformation are acknowledged but often not given the time they merit.

This mindset is not irrational - it is forged under pressure and reinforced by financial reality. But the cost of sidelining strategic evolution is often subtle and slow building, only revealing its consequences over time. Early symptoms - like subtle shifts in talent retention, slight erosion of market positioning, or narrowing strategic options - are easy to dismiss under the pressure of day-to-day demands. Yet, by the time the damage becomes visible on a balance sheet, the organisation is often already in decline, with fewer, harder, and more expensive paths to recovery.

It is within this diagnostic blind spot - where early warnings go unnoticed or unheeded - that we locate the central tension facing today’s legacy institutions: the trade-off between operational resilience and strategic relevance. It is in the spirit of this tension that we offer the following reflection. Not a barrage of new imperatives, but an inventory of what over decades has too often been dismissed as “irrelevant” or “peripheral” by established leadership. Not to mock, but to reflect. Not a rejection of their discipline, but a gentle inquiry: what truths might be slipping through the cracks beneath the weight of short-term certainty?
 
In this Commentary

This Commentary explores the growing disconnect between the operational priorities of legacy MedTech companies and the strategic shifts reshaping the industry. It highlights the mindsets, market signals, and structural forces often dismissed as ‘irrelevant’ or ‘peripheral’ - AI, digital therapeutics, emerging markets, patient agency - and contends that what has long been sidelined may, in fact, shape the essence of today's competitiveness - and define that of tomorrow. It is both a reflection on the past and a challenge to reimagine relevance before the market makes the decision for us. The Commentary is essential reading for MedTech executives because it surfaces the uncomfortable truths behind strategic stagnation, offering a candid lens on how legacy thinking - while once effective - may now be undermining future viability.
 
AI & Machine Learning: “Hype for Those Without Real Products”

AI and machine learning have become the preferred language of tech evangelists, analysts, and keynote speakers - often cited with urgency, as if predictive algorithms alone can remake healthcare. But for many in traditional MedTech, these developments remain abstract. After all, who needs real-time clinical insight when a mature salesforce, a trusted product line, and a robust procurement process continue to deliver quarter after quarter? Why invest in data infrastructure when the commercial team already “knows the customer”?

AI, legacy executives argue, may be making waves in radiology, accelerating image analysis, reducing diagnostic errors, and even optimising surgical workflows - but where is the SKU? Where is the billing code? And until machine learning finds its way into a procurement algorithm or a reimbursement pathway, it can be safely filed under “interesting, but not actionable.”

What is often overlooked is that while AI might not yet sit neatly on the income statement, it is rapidly embedding itself in the competitive context - influencing everything from operational efficiency to clinical decision-making.

But for now, the advantage of declaring it irrelevant is that it requires no investment, no transformation, and no urgency. It remains a future problem - and for many executives, that is precisely the point.
 
Value-Based Care: “A Fine Theory for Panels and Podcasts”

Value-based care has become something of a permanent fixture at healthcare conferences - a well-rehearsed talking point, often nestled between ESG updates and digital transformation slides. It is the kind of topic that earns nods on stage and silence in the boardroom. Yes, payers talk about outcomes, total cost of care, and shifting financial risk upstream. But for many traditional MedTech executives, these are macro-level abstractions - ambient noise in a world still largely driven by volume, device utilisation, and unit sales.

The logic is simple: procedures are still reimbursed, hospitals still procure on precedent, and the salesforce still delivers - why rethink the fundamentals? Why disrupt a business model built on predictability just because someone rebranded cost containment as “value”?

Beneath the surface, the shift toward value-based care is gathering momentum. Contracts are increasingly tied to performance metrics, and payers are testing shared savings models. Providers are beginning to reassess the true, end-to-end cost of patient care. Yet fully embracing these changes means confronting uncomfortable realities - exposure, accountability, disruption. And so, value-based care remains more aspiration than action: cited with reverence but kept at arm’s length.

A compelling vision of tomorrow - just not one that needs to interfere with this quarter’s pricing strategy.
 
Consumerisation & Patient-Centricity: “Charming, But Not for Us”

The notion of consumer empowerment in healthcare has always held a certain charm - well-suited, perhaps, to wellness apps. Talk of patient autonomy, real-time health tracking, and personalised care journeys tends to generate polite applause, especially at innovation forums and digital health expos. But in the commercial reality of MedTech, where relationships are measured in surgeon loyalty and purchasing decisions rest with procurement committees, this wave of patient-centric rhetoric can feel somewhat . . . ornamental.

After all, patients are not the buyers. They are not typically involved in procurement decisions or responsible for evaluating tenders. The idea that individuals managing chronic conditions might influence device design, data visibility, or treatment planning introduces an unfamiliar variable into a system optimised for clinical workflows and sales cycles.

And yet, slowly, persistently, the paradigm is shifting. Patients are choosing care pathways. They are tracking their own health data. They are becoming participants, not passengers. Platforms that once served physicians now speak directly to the patient.

But for many MedTech incumbents, this shift remains peripheral - acknowledged just enough to be applauded, but not yet enough to require change.

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Digital Therapeutics & SaMD: “Not Quite Real Enough”

In the traditional MedTech imagination, a real medical device has weight - preferably metallic. It should arrive with a sterilisation certificate, a SKU in the ERP, and a Class II or III designation that took years to earn. It lives in an operating room or a cath lab. You can hold it, implant it, clean it, and ideally bill for it with a code that is older than the average digital health start-up.

So, when software - intangible, updateable, and fast to iterate - began showing up with clinical claims, it was met with a familiar scepticism. These so-called Digital Therapeutics and Software as a Medical Device (SaMD) offerings seemed free of traditional manufacturing constraints, and even worse, largely indifferent to legacy distribution channels. They do not require hospital contracts, nor do they fit neatly into capital budgeting cycles. And they speak in a language unfamiliar to many: customer engagement, data loops, and behavioural algorithms.

Still, some executives politely applaud their promise while waiting for them to fade under regulatory scrutiny or investor fatigue. But the landscape is shifting. These “not quite real” solutions are now earning FDA clearances, showing outcomes, integrating into clinical workflows - and being prescribed.

Ignoring them has become less a strategy and more a luxury of a shrinking window.

Emerging Markets: “Strategically Ignored for Your Convenience”

Asia, Africa, India, Latin America - regions rich in population, clinical need, and rapidly evolving health infrastructure. Fascinating from a distance, and always good for a growth slide in an investor deck. But in the daily rhythm of many MedTech boardrooms, these geographies tend to fall neatly into the “too hard” bucket. Regulatory systems are diverse, reimbursement pathways inconsistent, and distribution? A logistical adventure.

Far easier, and more comfortable, to focus on the tried-and-tested: the mature markets of North America and Western Europe - which account for ~68% of the global MedTech market. Further, here, the rules are known, the players familiar, and margins - while tightening - remain respectable. Besides, there is always another round of hospital consolidation to “unlock efficiencies” and delay the need to confront more complex growth decisions.

And yet, while traditional players revisit the same contracts in the same regions, something different is happening elsewhere. In these so-called ‘secondary markets’ (~83% of the world’s population lies outside North America and Europe), healthcare systems are leapfrogging legacy infrastructure, adopting digital-first models, and demanding innovation designed for scale and affordability - not just high-margin precision.

The irony is that the future footprint of global MedTech is already being laid - just not necessarily in the markets where comfort still masquerades as strategy.
 
Sustainability & ESG: “A Future Agenda Item”

Environmental sustainability, climate resilience, ethical supply chains - all important considerations. And there is no shortage of working groups, position papers, and corporate statements affirming their significance. But in the real world of commercial MedTech, where quarterly earnings drive strategy and procurement continues to prioritise cost over carbon, ESG often remains a well-meaning footnote rather than a board-level priority.

The logic is straightforward: carbon disclosures do not drive revenue, Scope 3 emissions do not appear on the P&L, and regulatory mandates - at least for now - are more suggestion than obligation. Besides, the packaging is recyclable, and there is an ESG tab on the investor relations site. Is not that enough?
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Yet the calculus is changing. Investors are starting to assign risk premiums based on climate exposure. Hospital systems, under pressure from their own sustainability commitments, are factoring environmental impact into procurement decisions. And younger talent - the people legacy MedTech firms need to attract - are making employment choices based on whether purpose lives beyond the PowerPoint.

Still, for those intent on prioritising Q2 over 2030, sustainability can remain someone else’s problem - for now. Just do not be surprised when it shows up disguised as a lost bid or a brand erosion no spreadsheet saw coming.
Interoperability: “The Inconvenient Virtue”
 
Open data, shared platforms wikis, plug-and-play integration - admirable concepts! They appear regularly in white papers and keynote speeches, often accompanied by words like ecosystem, collaboration, and patient-centricity. But in the practical world of traditional MedTech, interoperability can feel more like a Trojan horse than a noble pursuit.

After all, the value of an installed base has long rested not just in clinical outcomes, but in strategic insulation. When systems speak only to themselves, switching costs rise, vendor loyalty deepens, and the customer journey - while perhaps less elegant - becomes predictable. One vendor, one platform, one point of contact. Efficiency through exclusivity.

The idea of opening those walls - of making data portable, devices interoperable, workflows vendor-agnostic - threatens to loosen what has kept margins healthy and customers captive. Why enable cross-vendor visibility when we have spent a decade engineering lock-in?

And yet, interoperability is no longer a future aspiration; it is becoming a market expectation. Health systems want seamless integration. Clinicians want consolidated insights. Regulators and payers are asking new questions about data silos. What was once a competitive moat may soon look more like a barrier to relevance.

For now, though, resisting interoperability remains a strategy - just one increasingly out of sync with the systems it is meant to serve.
 
Radical Collaboration: “Strategy by Committee”
 
The language of modern innovation is increasingly becoming crowded with phrases like: co-creation, open innovation, multi-stakeholder ecosystems. These concepts, while fashionable in accelerator pitches and design-thinking workshops, can sound close to relinquishing control - a notion that sits uneasily with traditional MedTech leadership, where strategy has historically resided in the safe hands of the C-suite, and product development follows a controlled, internal cadence.

The idea that a device roadmap might be shaped by input from patients, start-ups, or digital health partners is, for some, a step too far. Where does it end? With transparency? With shared credit? With a developer in a hoodie contributing to a Class III product?
And yet a different model is taking hold. The complexity of modern care, the speed of technological change, and the convergence of digital and clinical domains are rendering vertical silos inefficient at best, and irrelevant at worst. The most adaptive players are not simply tolerating collaboration - they are institutionalising it. They are building shared platforms, pursuing joint ventures, and embedding end-users into the development process.
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Still, for those wary of strategy by committee, the default remains simple: keep innovation proprietary, partnerships transactional, and the decision-making neatly behind closed doors. Just do not confuse control with competitiveness.
 
Healthcare Equity: “A Noble Distraction from the Real Business”

Healthcare equity - an issue widely acknowledged as morally urgent, globally significant, and commercially. . . inconvenient. No one disputes that access to care remains uneven, outcomes vary across geographies and demographics, and millions remain excluded from the full benefits of modern medicine. These are important concerns - and the subject of many keynote speeches and Corporate Social Responsibility reports.

But when it comes to actual commercial strategy, equity has long been treated as something of a philanthropic side project. After all, real markets are “addressable” - preferably with clear reimbursement codes, centralised procurement structures, and margins that respect investor expectations. Equity, by contrast, lives in the realm of public health policy, not product portfolio planning.

And yet, while the underserved continue to be framed as someone else's mandate, the business case for inclusion is gaining weight. Regulators are scrutinising clinical trial diversity. Health systems are tying equity metrics to partnership decisions. Investors are asking tougher questions. And new entrants - often digital-first and community-based - are reaching populations once deemed commercially irrelevant.

Still, for the legacy executive, healthcare equity remains safest when framed as a noble aspiration rather than a strategic necessity. Just do not be surprised when future growth starts showing up in places once written off as too complex to matter.
 
Legacy Playbooks: Elegantly Outdated

Amid all the noise - the shifting markets, the digital incursions, the reshaping of care pathways - the traditional MedTech executive remains a model of composure. A lighthouse of predictability in a fog of disruption. Grounded in operational excellence, fluent in regulatory nuance, and rewarded for consistency not reinvention, this leader follows a playbook that has served the industry - and shareholders - well.

After all, why chase the abstraction of platform thinking or dabble in the uncertainty of agile R&D when a single, well-validated hardware SKU can still deliver millions in revenue? Why invest in data infrastructure or user experience design when your procurement contracts are locked in for another cycle?

And building for 2030 is a noble concept - but the board evaluates performance every 90 days. The calendar alone tends to keep ambition in check.

Yet outside this disciplined architecture, the ground is shifting. Software-first models are changing timelines. Ecosystem thinking is redefining value. And growth is increasingly flowing to those who can move fast and adapt wide.

Still, the legacy playbook remains intact - not because it is future-proof, but because, for now, it has not yet fully failed. Which is the most seductive form of risk.
 
The Strategic Cost of Disdain

The irony is that the forces most easily dismissed as peripheral or irrelevant - too new, too soft, too speculative - are the ones now redrawing the competitive boundaries of MedTech. What does not map neatly to this quarter’s operating plan is what will determine the next decade’s relevance. But when you have mastered a playbook that has delivered decades of steady growth, it becomes easy to mistake familiarity for wisdom - and to confuse irrelevance with inconvenience.

And yet, the early signals of disruption are no longer subtle. Valuations are migrating toward companies that are not just selling products but enabling platforms - software-first, data-rich, and service-wrapped. Top-tier talent is bypassing incumbents in favour of purpose-driven, tech-enabled ventures that move faster, speak differently, and build with a fundamentally broader view of healthcare. Payers are evolving from passive reimbursors to active shapers of innovation, increasingly willing to back outcomes over devices. Regulators, once a shield for incumbents, are becoming more agile, more digital, more impatient. And patients - long treated as endpoints - are asserting themselves as active participants and economic agents in care.

What is often framed as a distraction is a different order of relevance - one that does not fit the existing metrics but will soon define them. Ignore it, and the cost is not just missed opportunity. It is strategic erosion, playing out slowly, then all at once.
 
Takeaways

For decades, legacy MedTech companies have been navigating a subtle but persistent decline - an erosion that has unfolded so gradually it was easy to dismiss, much like the onset of a chronic illness. What once appeared as stability was, in fact, stagnation. The industry’s longstanding dependence on mature product lines, familiar markets, and traditional operating models has led to a slow accrual of vulnerabilities: stagnant growth, eroding valuations, mounting debt, regulatory setbacks, and an aging leadership culture out of sync with a tech-driven future. Meanwhile, the pipeline of young, purpose-driven, digital-native talent continues to shrink. These are not isolated issues to be patched - they are symptoms of deeper structural malaise. Simply treating the pain points without addressing root causes is no longer viable. The era of incrementalism is over. The next chapter of MedTech will not be written by those who measure relevance through the rearview mirror, nor by those who treat the overlooked as optional. Legacy players may have little room left to manoeuvre - but manoeuvre they must.

In a sector now being redefined by data, decentralisation, patient agency, and new value models, the most dangerous words a leadership team can utter are “irrelevant” or “peripheral” - especially when aimed at the forces transforming the foundation beneath them. What if the so-called detours - software-first care, AI-driven pathways, health equity, emerging markets, radical alliances - are not distractions, but the main road? What if growth no longer comes from building higher walls around legacy, but from widening the gates to welcome new models, new mindsets, and new partners?

This is not a call to abandon strategic discipline or chase the latest trend. It is a call to confront blind spots. To recognise that irrelevance is rarely a cliff - it is a slope, made slippery by inertia and unchallenged assumptions. The future will demand more of MedTech. The only question is whether its incumbents will demand more of themselves - before the market decides for them.

A forthcoming Commentary will outline a strategic roadmap for legacy MedTech leaders navigating mounting headwinds, offering practical steps to overcome structural constraints and reignite value creation, growth, and competitive relevance.

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