Doors to manual: A flying lesson for digital health companies

I’ve had meetings in some interesting places recently. From The King’s Fund and The Royal Society of Medicine – think oak panelled meeting rooms and display cases containing exquisite, ancient medical texts – to a night club in South London that I wrote about before.

More typically my meetings are in a coffee shops, as it was for a meeting that didn’t happen last week. I was due to meet the CEO of a digital health company to discuss how I could help them improve their commercial performance – they have a great product but are struggling to achieve revenues – but the meeting was postponed at short notice. The CEO was very apologetic but also very excited as he was jumping on a plane to get to a meeting with an NHS contact that he’d managed to arrange at short notice. I wished him well but also gave him a warning which I’ll share with you too.

Imagine you’re on that flight, working hard as the safety briefing starts: “blah, blah, oxygen mask, life jacket, emergency exit…” Soon enough it’s over and you focus on your work – until the pilot distracts you with some frankly unnecessary information about the cruising altitude, the great view from the cockpit window that you can’t see and the weather at the destination. Why? Surely the pilot should just fly the plane as safely and smoothly as possible? Anything else is unnecessary.

You may have worked out where this analogy is heading – the CEO was off to discuss a possible pilot with an NHS contact. I warned him to be very careful before saying yes.

It’s easy to get excited about doing a pilot in the NHS. After all, “it’s a £100billion pound market and a pilot would prove the value we deliver.” But they rarely deliver commercial benefit.

When I took over BT’s telehealth and telecare business my sales team told me about all the exciting pilots they were planning. I reviewed them all and then removed every single one from the opportunity list. Before you commit your scarce resources to delivering a pilot you should qualify it very carefully too. Here are three key questions to ask:

  1. Show me the money!

Yes, it’s Cuba Gooding Jr’s famous line to Tom Cruise in the film Jerry Maguire. The NHS often wants free pilots. Perhaps they think that all businesses have plenty of money. You know that’s not true so push for payment. If your product works then payment is justified, even if it’s only modest initially due to public procurement rules. Certainly before you commit any of your scarce resources to delivering a free pilot be sure (i) that you know exactly how much it’s going to cost and that you can afford it and (ii) that you consider the opportunity cost – what else could you do instead and would that be better for your business?

  1. Show me the money!

Yes, the same point, but now about next year’s money. If “we don’t have the money in this year’s budget” is used to justify a free pilot you’re probably better off pushing for a sale next year. If you are going to pilot be clear about success criteria and next steps: “if we achieve x, y and z then an order next year is guaranteed.” However, it’s not easy for the NHS to make and honour such promises so again, be really careful.

  1. Where is the value?

If it’s not money, what value are you getting from the pilot? This to me is the only justification for most pilots. You might build credibility or evidence of your product’s benefit for future sales, or learn how to deploy at scale. But can you agree these pilot objectives with your ‘customer’? Remember, they’re not paying so to them it will seem far less important than it does to you (for my potential client the short notice at which the meeting was arranged was a warning flag in this area). As other priorities emerge you may find your pilot stalled and your valued contact too busy with what they see as ‘real work’ to return your calls. They might be busy checking the weather in Newcastle when you want them to fly the plane.

So, if you are considering a pilot, qualify very carefully. If you think you need some help doing that get in touch. You need any pilots to help your company fly, lead you to a profitable landing and ultimately a successful exit. Pick the wrong pilot and you’ll be wishing that you’d paid more attention to the safety briefing as you rapidly burn through your cash and see the emergency exit looming large.

Good luck.


Rob Brougham


© Rob Brougham. Rob is a digital veteran, having spent the bulk of his career in the telecoms industry. He set up his first company, a conference call firm, in 2003 and successfully sold it in 2006. He first developed a passion for digital health when he led BT’s telehealth business, providing clinically led remote support services to patients with chronic long term conditions such as COPD and diabetes. He now runs his own consultancy, TCLT Solutions Ltd, supporting digital health and other technology enabled firms create and deploy effective commercial strategies and is co-founder of a start-up that is at about to launch its MVP, You can contact Rob at

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