Part 3: Operational Friction in Scaling Series A and PE-Backed Healthcare Innovation
In Parts 1 and 2, we looked at the friction and acceleration factors behind adoption of healthcare innovation. Many organisations manage to achieve a level of adoption, and it’s tempting to treat that as a predictor of scale — but that is rarely the case. The friction and acceleration factors for scale deserve equal consideration, at both the pre-letter of intent stage and the 100-day review. An operator’s lens, rather than detailed analysis of historical data, is key to understanding them. In Parts 3 and 4, we look at the friction and acceleration factors for scale, to help inform thinking and challenge assumptions for PE firms.
Why Success During Implementation Does Not Guarantee Success at Scale
One of the most striking observations from healthcare delivery is that successful implementation and successful scale-up are not the same thing: many programmes clear early adoption barriers only to meet a new set of challenges as growth accelerates.
The observations below focus on what happened after implementation began to succeed — the factors that most often determined whether innovations translated into sustained operational impact across larger populations, services and organisations.
Scale Friction Point 1: Delivery Capability and Capacity Throttled Strategy
Many organisations had clear ambitions, compelling strategies and strong executive support — what they lacked was sufficient operational capacity to execute at the required pace.
Growth plans often assumed a level of implementation capability that operational teams didn’t have. Existing service pressures, workforce constraints and competing priorities limited how much change the organisation could absorb — sometimes down to something as narrow as a local IT service-level agreement with an outsourced provider.
Counterintuitive observation: growth was rarely constrained by opportunity. It was constrained by execution capacity and capability.
Scale Friction Point 2: Roll-Out Metrics Concealed Adoption Problems
As programmes expanded, reporting often focused on implementation milestones — systems deployed, sites onboarded, services launched. These indicators frequently masked significant variation in utilisation: deployment was visible and measurable, whereas adoption required a deeper look at how services were actually operating, and how far the innovation had diffused through clinical and operational culture.
Counterintuitive observation: what management reported as implemented was not an indication of scale performance.
Scale Friction Point 3: Scaling Exposed Assumptions Hidden by Pilots
Pilot environments commonly benefited from dedicated support, focused leadership attention and concentrated resources — conditions that were difficult to replicate across larger populations and more complex operational environments. As initiatives scaled, assumptions that had looked valid during initial implementation ran into operational realities that had previously stayed hidden. Dedicated leadership was one example: it rarely scaled across an entire organisation or pathway.
Counterintuitive observation: pilots frequently validated the innovation while inadvertently concealing the implementation challenge.
Scale Friction Point 4: Technology Improved Capability Without Changing Performance
Many programmes successfully introduced new functionality and capability, but improved capability didn’t automatically translate into improved operational outcomes. Performance only improved once organisations changed workflows, governance processes, escalation mechanisms and day-to-day working practices — capability frequently arrived well before measurable improvement. Pulling an innovation into daily practice was often the deciding factor, yet frontline staff — who usually determined whether scaling happened — were often poorly informed and rarely empowered to drive it.
Counterintuitive observation: new functionality often appeared without a corresponding change in operational performance.
Scale Friction Point 5: Projects Produced Benefits That Operations Could Not Sustain
Several programmes generated strong early results, supported by dedicated project teams, additional resources and concentrated leadership attention. But maintaining that performance proved harder once initiatives moved into routine operations. Benefits weakened when ownership stayed within programme structures rather than transferring to established operational management. Without that enthusiasm, many downstream users experienced the innovation as a series of routine transactions, not the strategic breakthrough promised at the point of contract signature.
Counterintuitive observation: many successful initiatives became unsuccessful business-as-usual services.
In our final instalment, Part 4, we look at the acceleration factors that help healthcare innovation move from implementation to scale — the counterintuitive dynamics that are only visible through an operator’s lens, and worth close consideration at both pre-letter of intent and the 100-day review.
It’s tempting to assume that a great innovation, backed by the right team, funding, regulatory approval and strong clinical evidence, will scale across health systems almost by default. When it doesn’t, the instinct is to revisit the numbers to see which assumption was wrong. Our experience suggests something different: the original assumptions were rarely wrong so much as incomplete. Looking at the acceleration factors for scale through an experience-led lens can reveal a different strategy altogether.