David Pomfret reflects on how MedTech startups can balance speed, ownership, focus, learning, and the structure needed to scale.
Over the course of my career working for/with MedTech companies, I’ve had the opportunity to contribute to organizations at many different stages of growth. Some are well-established companies with mature processes. Others are early-stage startups building something entirely new.
Working with startups has been one of the most energizing parts of that experience.
They move fast, think creatively, and approach problems with a level of urgency that can be contagious. But working closely with startups has also shown me that speed alone isn’t what determines success.
The real differentiator is how well speed, focus, and learning are balanced.
The power of speed and ownership
One of the most noticeable things about startups is how quickly things move. Decisions are made faster, ideas are tested earlier, and teams are often willing to challenge conventional approaches.
That speed is often driven by a strong sense of ownership. In early-stage companies, people naturally wear multiple hats. Titles matter less than outcomes, and everyone contributes where they can add value.
That environment can be incredibly productive. It encourages initiative, creativity, and problem-solving. You’re rarely waiting for someone else to act — the team simply moves forward.
Another advantage is proximity to the customer or end user. In many startups, the feedback loop between development, leadership, and the market is short. Insights from clinicians, investigators, or patients often make their way directly to the people building the solution.
When that happens, innovation becomes more focused and practical.
When agility becomes complexity
However, some of the same traits that make startups effective early on can create challenges as the company grows.
In the beginning, flexibility is an advantage. But as teams expand, undefined roles can start to create duplication or confusion. When everyone is responsible for everything, it can become unclear who ultimately owns a decision.
That’s when structure begins to matter.
Clear ownership doesn’t remove agility — it supports it. Teams move faster when people know who is accountable for what and when decisions can be made without unnecessary escalation.
Another pattern I’ve seen is founder dependency. In the earliest stages, it’s natural for many decisions to flow through the founder or founding team. But as organizations scale, progress depends on distributing decision-making across the team.
Trusting leaders and subject matter experts to make decisions is often what allows a startup to truly scale.
Scaling what worked — and what doesn’t
Something that works well for five or ten people rarely works the same way when a company reaches thirty or fifty.
Early on, communication tends to be informal. Information spreads quickly because everyone is close to the work. But as teams grow, those informal systems start to break down. Onboarding becomes inconsistent, priorities become less clear, and coordination becomes more difficult.
This is often where startups experience what has been called “scaling chaos.”
The companies that navigate this transition well are the ones that introduce just enough structure to support growth without losing the energy that made them successful in the first place.
Speed × focus × learning
Working with startups has reinforced an important idea for me: speed is only valuable when it’s aligned with direction and learning.
Many startups don’t fail because they move too fast. They struggle because they move quickly in the wrong direction, pursue too many ideas at once, or scale before operational foundations are in place.
Startup leaders focus on three things:
- Moving quickly, but toward clear priorities
- Executing ideas with discipline
- Continuously validating assumptions through real feedback
In practice, that means short learning cycles, honest conversations about what’s working and what isn’t, and a willingness to adapt.
Why I enjoy working with startups
Despite the challenges, working for and with startups remains one of the most rewarding parts of my career.
There’s something uniquely motivating about being close to innovation in its earliest stages — when ideas are still evolving and teams are figuring things out in real time.
When speed, focus, and learning are balanced well, startups can achieve remarkable things.