Healthcare leaders need to stop chasing Silicon Valley unicorns


By Ashwini Zenooz and John Brownstein

As we head into the back half of 2023, the healthcare industry faces a swirl of mixed signals. On one hand, we’re seeing widespread contraction as health systems face mounting financial pressures, the “unicorn” boom of 2021 becomes a distant memory, and many health tech startups face a do-or-die moment. On the other hand, revolutionary new developments such as generative AI are radically expanding the potential for innovation, demanding action and investment. 

How can healthcare leaders navigate this “flashing yellow” moment and chart a smart and sustainable path to innovation?

From our vantage points working at different ends of the healthcare ecosystem, we see this unforeseen moment as a welcome opportunity—a wake-up call to stop chasing unicorns and instead reground our strategies in key principles of intentional innovation.

Balance pragmatism with disruption

Healthcare is still a morass of inefficiencies, gaps that need closing, and care that needs coordinating. In these lean times, many health systems have less of an appetite for Silicon Valley disruption. Instead, they’re looking to extract new value from legacy EHRs and other tech investments.

Amid a labor shortage, for example, Commure partnered with a large health system to help them address the need for more nimble shift scheduling. Rather than rip-and-replace their existing platform, we built a lightweight tech layer on top of it to automate scheduling through machine learning. Faced with similar labor and financial pressures, the Boston Children’s Hospital nevertheless recently hired its first ChatGPT prompt engineer to test and explore use cases for generative AI.

As has been reported elsewhere in the industry, we’re starting not with moonshots but with low-hanging fruit: upskilling our workforce and alleviating administrative burden for clinicians. Even in a time of belt-tightening, health systems can’t afford to fall behind or miss out on opportunities to innovate—but they can be pragmatic about the disruptions they pursue.

For sustainable value, partner—don’t promise

The core problem is the very fact that promises, rather than partnership, are driving too many decisions and too much technology development in healthcare.


It’s time for the tech tail to stop wagging the hospital dog. Startups that formerly embraced a grow-fast-at-all-costs approach need to refocus on creating measurable, long-term value for their health system partners. Health systems, in turn, need to evolve from being passive buyers of—or guinea pigs for—tech to being active and invested development partners.

For example, the team at Commure worked in lockstep with Thomas Jefferson University Hospitals several years ago to begin designing a staff safety solution that would address an urgent rise in workplace violence impacting health systems across the country. By co-developing with TJUH before bringing it to scale, the solution was directly informed and improved by iterative testing with and feedback from providers, nurses, staff, and security personnel—the very people who were going to use it every day. 

Put innovation in the service of long-term goals

For innovation to be long-lasting and sustainable, it must be downstream of and in service to institutional goals and priorities, especially in a market that is forcing tough choices for many health systems. Rather than push or chase the next shiny thing, any solution or tech partnership a health system seeks out should be evaluated for its potential to advance strategic priorities—whether that’s expanding virtual or at-home care, addressing health equity concerns, or another area of focus.

Boston Children’s, for example, recently identified families’ barriers to nutritious food access as a top community- and institution-wide priority. This led us to actively develop and pursue solutions which led to a partnership with Instacart Health to leverage their products as part of a new food-as-medicine program. By allowing the solution to emerge organically from a rigorous needs assessment, it’s more likely to target the problem and deliver value.

While common wisdom regards constraint as the enemy of innovation, studies have consistently shown the opposite to be true. In one in-depth analysis of 145 empirical studies summarized in Harvard Business Review, researchers found that a healthy dose of constraint and limitations tends to foster innovation and lead to solutions that are more realistic and sustainable. The field of medicine, with our sacred oath to “do no harm” while pioneering new cures and breakthroughs, is certainly no stranger to the merits of constraint. Embracing constraint and leaning into more practical innovation isn’t just a good approach to weathering tough times; it’s fundamental to driving value and lasting change under any market conditions.

Ashwini Zenooz is the CEO of Commure. John Brownstein is the chief innovation officer of the Boston Children’s Hospital.

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