Product-Market Fit and the Go/No-Go Decision
When to Continue, When to Kill, When to Pivot
The learning framework
The device every physician loved
A team builds a device that solves a real clinical problem. Physicians who try it are enthusiastic. Every conversation at every conference produces the same reaction: this is genuinely better, I would use this. The company treats that as demand and raises against it. Two years later they have almost no installed base. The physicians were sincere. They were also not the buyer. The device shifts cost onto a department budget while the benefit accrues to a service line that does not control that budget, and there is no payment pathway that moves money from where the value lands to where the cost sits. The purchasing committee is not unconvinced by the clinical case. It is answering a different question, and nobody on the founding team had ever asked it. The evidence was available in year one. It arrived as enthusiasm from users and silence from buyers, and silence is easy to read as a sales problem rather than a structural one.
Why the decision to continue is rarely made
Continuing is the default. Stopping requires an affirmative act, a conversation nobody wants, and an admission in front of people whose support you needed to get here. So the question is never formally asked, and the venture proceeds by momentum rather than by decision. Three forces hold the default in place. Sunk cost, which grows precisely as the case for continuing weakens. Founder attachment, which is difficult to separate from conviction and which the entire culture of entrepreneurship rewards. And institutional pressure, which runs in one direction: a university has announced the spinout, a department is proud of it, an investor needs a markup, and none of those parties is positioned to say stop. Underneath all three sits a technical failure. Thresholds were never set in advance, so every result is interpretable. Slow enrollment becomes a site problem. Flat adoption becomes a messaging problem. A threshold defined after the data arrives is not a threshold.
A decision made on evidence rather than momentum
Healthcare innovators who complete this evolution set thresholds before the data exists, and write down what would have to be true to stop. They can name, separately, who the user is, who the buyer is, who the payer is, who the approver is, and who the beneficiary is, and they know which of those five is not yet convinced. They treat continue, pivot, license, pause, and terminate as five available answers rather than as one answer and four failures. And they can distinguish their own attachment from the evidence, which is not the same as being unattached.
By the end of this evolution, you will be able to:
Separate the user, the buyer, the payer, the approver, and the beneficiary
Five different parties evaluate your technology against five different problems, and in healthcare they are almost never the same person. Learn to identify each for your specific venture and to recognize which one has not actually said yes.
Set evidence thresholds before the evidence arrives
Define in advance what result would justify continuing, what would trigger a pivot, and what would mean stopping. Understand why a threshold defined after the data is not a threshold, and how to write one that survives contact with a disappointing quarter.
Assess the clinical problem and its alternatives honestly
Weigh how important the problem actually is to the people who have it, how much better your solution is than what they do now, and whether the difference is large enough to justify the cost of changing behavior.
Read adoption barriers and workflow impact
Understand why a technically superior product fails when it requires a workflow change nobody is incentivized to make. Learn to assess where your product sits in an existing clinical process and what it asks people to stop doing.
Treat reimbursement and regulatory burden as viability inputs
Recognize that the cost of the evidence you still owe, and the existence of a payment pathway, are inputs to whether the venture is viable at all rather than problems to solve later.
Map capital requirements to the next value-inflection point
Identify the next event that would materially change what the company is worth, cost it honestly, and compare that cost to what the inflection would actually be worth. Understand why a milestone that consumes more capital than it creates is a reason to stop.
Recognize sunk cost, attachment, and institutional pressure
Learn to see the three forces that keep ventures alive past the rational stop point, including in yourself. Understand why the pressure is asymmetric and why nobody around the table is positioned to say stop.
Choose among continue, pivot, license, pause, and terminate
Treat all five as live options with different structural consequences. Understand what each does to your capital, your obligations, your institution, and your own position, so that stopping is a decision with a shape rather than an absence.
Why this matters
Recommended for
Healthcare innovators navigating:
Faculty who understand the process move through it faster.
Academic medical centers, research universities, and health systems sponsor cohorts so that inventors arrive at the office of technology transfer prepared: complete disclosures, clean assignment records, and realistic expectations about pathway and timeline. Cohort training is available for faculty, residents, and research staff, with CME.
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Your path to becoming a Certified Professional Entrepreneur
Reserve your seat
Your deposit reserves a place in the cohort. Twenty seats. No application, no admissions committee, no waiting on a decision.
Begin the evolutions
Structured online learning you work through on your own schedule. Lectures run under fifteen minutes. Each evolution carries reading, supporting material, working tools, and case studies drawn from real transactions.
Join the live sessions
Live discussion sessions on Zoom, facilitated by Chris and Christos. Not recorded. This is where the material meets your actual situation, and where the cohort becomes a network.
Continue your structural training
Answers that help you decide with confidence
Continuing is a decision. It is just rarely made on purpose.