Pilots Are Not Progress: The Healthcare SaaS Scaling Myth
The Healthcare SaaS scaling myth
Pilot programs have become almost institutionalized in the healthcare innovation ecosystem. They are pitched as low risk tests, a way in the door, a stepping stone between concept and enterprise. But if you are a healthcare SaaS founder, you need to hear this blunt truth:
Pilots are not just unhelpful. In many cases they are actively harmful to your product’s ability to scale, to your team’s focus, to your credibility with buyers, and ultimately to your unit economics.
In this article, we unpack why pilots are dirty, why they trap companies, degrade roadmaps, and create false expectations, and how founders should rethink GTM and enterprise adoption altogether.
The Illusion of Safety: Why Pilots Became the Default
In theory, a pilot program sounds incredibly reasonable. Try a solution on a small scale, test whether it works, then expand if there is real value. In healthcare, the reality is very different.
Healthcare systems love the idea of pilots because they feel controlled and contained. However, many CIOs and C-suite executives now view the word “pilot” itself as problematic. A kind of dirty word that signals low stakes experimentation with little path to real commitment. They reduce perceived risk for organizations that are structurally cautious, sparing the CIO from costly errors. But that very lack of risk often eliminates real accountability, incentive to scale, and organizational commitment.
Industry reporting and recent analyses show that healthcare organizations consistently struggle to move beyond pilots. This is not because the technology fails, but because pilots are treated as the destination rather than the starting point. The CIO.com piece on the AI readiness gap (January 2026) makes this painfully clear. If you haven’t read it, I suggest you check it out.
Across digital health and artificial intelligence initiatives, the numbers are sobering. Recent reports, including MIT's NANDA/Project findings (2025) and multiple industry analyses, indicate that 80-95% of healthcare AI pilots never make it to full deployment—often closer to 95% for GenAI/enterprise tools when measuring measurable ROI or production-scale value. The pattern is familiar:
Launch a pilot
Collect limited data
Celebrate early signals
Allow the initiative to stall quietly
Dirty Truth #1: Pilots Are Not Go-To-Market Strategy
Here is the uncomfortable reality founders need to internalize:
A pilot is not a sale.
A pilot is not revenue.
A pilot is barely even a meaningful reference.
Healthcare buyers often treat pilots as experiments with an easy exit. They do not require procurement urgency. They do not force budget allocation. They do not activate scaling playbooks.
When pilots fail to scale, the same explanations surface again and again:
User adoption was low.
The return on investment was unclear.
The workflow impact was too disruptive.
These explanations sound reasonable, but they are symptoms, not root causes.
The real issue is simpler and harsher. No one inside the health system cared deeply enough to make it succeed.
Successful adoption requires someone to fight for it. Someone who pushes through friction, redesigns workflows, advocates for training, and keeps leadership attention focused. When that person does not exist, pilots die quietly. Often without producing insights worth learning from.
If no one would be upset if your product disappeared tomorrow, that pilot was never real. It was a checkbox. That is why pilots are dirty. They create motion without commitment.
Dirty Truth #2: Pilots Corrupt Your Metrics
From the founder perspective, pilots do more than delay revenue. They actively distort how you understand your business.
Pilots create false positives. A small group of motivated users can appear enthusiastic in isolation, but that does not predict organization wide adoption.
Pilots generate misleading return on investment signals. During pilots, vendors over support implementations (rightfully so). Workflows are customized. Teams receive special attention. Performance looks strong under these artificial conditions, but it rarely holds at scale.
Pilots skew the product roadmap. Health systems request changes that benefit their specific pilot environment, not your broader market. Founders end up building bespoke features that do not generalize.
Pilots create budget paralysis. Because pilots are low commitment, they often delay real purchasing decisions. Procurement cycles stall. Funding remains uncertain. Discounted or no cost arrangements drag on.
The result is a perverse incentive structure. Teams optimize for pilot success rather than scalable product market fit. Investors and operators see this pattern repeatedly. Companies end up strong at pilots and weak at growth.
Dirty Truth #3: Pilots Hide Readiness Gaps
Healthcare systems are complex. Data is fragmented. Workflows are brittle. Priorities compete constantly. Pilots do not solve these problems. They conceal them.
Data often lives in disconnected systems that require months of integration work. Clinicians usually distrust new tools that are not embedded naturally into daily practice. Governance and incentives are rarely aligned for scale.
Pilots mask the exact barriers that will later determine whether your company lives or dies at scale.
Playing Devil’s Advocate: Why Pilots Still Attract Founders
Despite all of this, pilots remain attractive and even helpful, especially early on.
They reduce perceived risk for buyers.
They provide initial exposure inside real clinical environments.
They generate early usage data and testimonials.
When founders need traction, pilots can feel like the only available door. Offering “free” services for months & months on end.
The problem is not that pilots offer no value. The problem is that their value is superficial unless they convert into something larger.
A funded enterprise contract.
A scalable deployment plan.
A long term procurement commitment.
Clear performance metrics tied to system priorities.
What happens instead is a vicious cycle. One pilot leads to another. Founders accumulate decks and datasets, but not durable revenue. It feels like progress, but it is not.
This is the pilot treadmill. Motion without escape velocity.
When pilots do work and scale (as some ambient AI scribe deployments have across specialties), it's usually because key elements were in place upfront: paid contracts from day one, strong clinical champions with skin in the game, outcome based criteria, and modular design that anticipates cross department friction.
The Root Cause: Pilots Remove Accountability
Pilots rarely fail because the product is fundamentally broken.
They fail because pilots are the wrong mechanism for driving organizational commitment.
At the center of most pilot failures is a simple question:
Who inside the health system is accountable for making this succeed? The CIO, CMO, CNO?
If the answer is unclear, the outcome usually is not. Regardless, you should be able to answer when qualifying.
Pilots allow organizations to explore innovation without consequence. They preserve optionality. That may be fine for research, but it is toxic for businesses trying to scale.
A Better Path: Treat Scale as the Default
Healthcare SaaS founders need a different posture.
Sell outcomes, not experiments. Health systems buy solutions to prioritized problems such as revenue cycle pressure, clinician burnout, length of stay, or risk adjustment accuracy.
Create proof with an endpoint. Evidence programs should end in contracts, not extensions.
Design for multi-site deployment from the beginning. Products that only work in one department are easy to pilot and hard to scale. For example: Just because an ambient scribe pilot worked well in the oncology department does not mean the same solution will work seamlessly in radiology or other specialties—differences in documentation density, terminology, workflow pace, and edit intensity can create unexpected friction, even if the core tech performs similarly.
Make integration part of the value proposition. If integration is painful, adoption will stall regardless of pilot results.
Real adoption does not come from pilots. It comes from alignment, commitment, and outcomes.
Solutions: How to Escape the Pilot Trap for Good
If your startup is stuck cycling through pilots, the problem is not healthcare conservatism, slow buyers, or insufficient evidence. It is almost always a GTM design failure.
Pilots persist when founders optimize for permission instead of commitment. Escaping the pilot treadmill requires changing how you sell, how you scope value, and how you define success.
Replace Pilots With Commercially Bounded Proofs
The fastest way out of pilot purgatory is to stop offering open-ended trials.
Instead of pilots, structure commercially bounded proof programs:
A paid contract, even if modest
A fixed scope and timeline (e.g. 30-60 days)
Explicit success criteria tied to business outcomes
A pre-agreed expansion path if those outcomes are met
It is arguably better to dig deep for a contract “win” than get stuck running a 2-3 month pilot program without the guarantee of actually earning your paycheck.
Payment changes behavior.
Contracts force prioritization.
Timelines force decisions.
2. Pre-Sell the Scale Path Before Anything Goes Live
Scale should never be a post pilot conversation.
Before implementation begins, you should secure alignment on:
What “success” actually triggers (deployment size, users, sites)
What organizational changes are required to get there
What approvals or dependencies exist
What budget must be unlocked
3. Design for Operational Friction, Not Demo Conditions
Pilots succeed in artificially optimized environments. Scale fails in reality.
Founders should intentionally test their product under conditions that resemble real deployment:
Limited vendor involvement
Standardized workflows
Real training constraints
Real integration timelines
Real clinician resistance
If your product only works with white glove support and constant intervention, the pilot is giving you false confidence.
Designing for friction early is uncomfortable. It is also the only way to build something that survives enterprise rollout.
4. Standardize Value and Ruthlessly Resist Customization
Pilots are fertile ground for roadmap corruption.
Every pilot introduces “small” requests that feel reasonable in isolation and destructive at scale. One integration tweak. One workflow exception. One reporting change “just for this department.” Over time, these concessions accumulate into a fragmented product that is harder to deploy, harder to support, and harder to explain to the market.
Founders must actively defend product coherence.
That requires:
A narrow, opinionated value proposition
Clear boundaries around what the product explicitly does not do
Willingness to walk away from deals that demand bespoke behavior
Playing Devil’s Advocate
Resisting customization early is not about limiting ambition. It is about creating future leverage.
By standardizing the core product first, founders create clarity around what actually works across environments. That clarity becomes the raw material for future expansion.
When a single workflow proves durable across multiple customers, it reveals:
Which features are foundational versus situational
Which integrations are broadly valuable versus customer specific
Which adjacent use cases are worth building into products rather than one off fixes
This is how product expansion happens.
Instead of accumulating custom features in response to pilot requests, companies can later:
Launch new modules that address validated secondary workflows
Package integrations as scalable offerings rather than bespoke projects
Enter adjacent departments or specialties with confidence, not guesswork
Price and sell expansion as productized value, not professional services
Customization done too early locks you into someone else’s roadmap. Standardization earns you the right to design your own.
Conclusion: Stop Treating Pilots as Progress
Pilots are not inherently evil. But in healthcare SaaS, they are often distractions masquerading as strategy.
They delay commitment.
They distort incentives.
They hide adoption risks.
They waste founder time and energy.
And most importantly, you aren’t making any money.
If your go to market motion relies on pilots, you are optimizing for buyer hesitation rather than buyer commitment.
Healthcare is complex. Adoption is hard. But building for real workflows, real budgets, and real outcomes is the only path to scale.
Founders who move beyond pilots do not just build better companies. They build companies that last.
Author Notes
If you’ve made it this far, thanks for reading! If you are building and want to design a go to market strategy that avoids the pilot trap, we are always open to thoughtful conversations.
- Hunter Wolma, Co-Founder
