You just finished a pitch that felt like a win. The clinical team loved the demo, the department head was already talking about a pilot and you left feeling confident that there is momentum to move forward. Then, weeks later, someone you’ve never spoken to, someone who wasn’t even in the room, puts the deal on hold.
It’s a frustrating experience, and one most founders are familiar with. Most founders assume the hardest part of selling into healthcare is building something worth buying. But sometimes the hardest part is understanding who you actually have to convince.
The founders who succeed at selling into healthcare aren’t the ones with the best solution or slickest deck. They’re the ones who understand the stakeholder dynamics in healthcare buying decisions and how best to navigate them. If you related to the opening paragraph, it’s likely because you didn’t engage all of the right people.
The good news: once you understand the primary stakeholders and their roles, your path through a complex sales process gets a lot clearer.
It’s a fallacy to assume there’s a single person you need to convince to close. Many founders end up chasing their tail to find this person.
As margins have continued to tighten across healthcare, expense management and vendor evaluation have grown increasingly complex. Health systems have dedicated committees and cross-functional teams whose sole job is to vet solutions before they ever reach a budget line.
There is no one decision-maker in a large hospital or health system. Instead, there is a decision-making system with five distinct roles, played by different people, and any one of them are capable of moving the deal forward or killing it completely.
Here are the five roles and how to tell who’s playing them:
1. The User
The user is the person who lives with the problem you’re trying to solve. They feel the pain in their daily workflow. They’ll be the first person to use what you’ve built, and the first to abandon it if it doesn’t fit. Their adoption is critical, but it isn’t enough to fully move the needle.
The user rarely holds the final say or the budget to move a deal forward. They can be an advocate, but they often cannot sign off. A mistake many founders make is treating the User’s excitement as a signal that the deal is real. When in reality, it just indicates that the problem is real.
The tell: Users say, “I would use this tomorrow.” Then, when you ask what their boss thinks, or how to get approval, they go silent. They don’t know because, in their day-to-day, they don’t need to know. That’s a cue to keep searching for additional roles.
2. The Buyer
The buyer controls and/or approves the money. They rarely use the product or solution. Often, they don’t fully understand how it works, and don’t really need to. Their role is to understand the economics.
The Buyer doesn’t care about features. They are evaluating if the money spend is financially responsible and aligned with organizational priorities.
The mistake founders make is pitching to the Buyer the same way they pitched to the User. They walk in, show off features and discuss workflow efficiencies. But the Buyer needs to hear the story in their language, not yours. Explaining economic impact is key. Think: margins, payback period, lifecycle cost, ROI modeling.
It’s worth noting that, in healthcare, economic impact doesn’t always show up as a direct, line-item cost reduction. Some solutions improve cost structure indirectly by improving clinical outcomes, accelerating turnaround times or minimizing risks, all of which affect broader cost structure and, in many cases, revenue. Before you enter the room, you need to know exactly where and how your solution creates an economic advantage. Buyers will understand the math if you can build it clearly.
The tell: The Buyers are usually the most easily identifiable. They’ll open with economic questions like, “What does this replace?” or “What’s the financial impact in year one?” Don’t answer with vague claims like improved throughput or enhanced workflow. Answer with defensible, grounded numbers to capture their attention.
It bears repeating: the Buyer doesn’t care about features. When you’re pitching with a Buyer in the room, you must address the economic impact.
3. The Blocker
The Blocker is a person or people who can stop a deal. They are often a person founders fear, but it’s more important to understand them.
Blockers are charged with mitigating risk for the organization. They shouldn’t be viewed as an enemy; they’re doing what their role requires. In healthcare, the Blocker is often a compliance officer, IT security lead, procurement director, or even a value analysis committee; people whose entire profession is to ask hard questions about implementation, security, infrastructure requirements and downsides. They exist because healthcare organizations are high-risk environments where decisions directly impact patient safety, data privacy and financial stability.
A mistake founders can make is avoiding the Blocker or trying to find a route around them. That always backfires. A Blocker finding out about a deal late in the process can trigger additional scrutiny, not necessarily because they oppose the solution, but because they were not given the opportunity to evaluate risk and opportunity early on. Those are elements of their job.
The tell: Blockers, like Buyers, don’t care about features. Blockers will ask about implementation. They want to know the nitty-gritty details about what happens down the road in 3 months, 6 months and beyond. The questions may seem in the weeds, but they are questions that earn their approval.
Blockers are powerful allies. The more you learn from them, the better prepared you’ll be in the future. The best advice is to find and engage your Blockers early. In doing so, you’ll have a better chance of successfully converting them to another vital role: the Influencer.
4. The Influencer
The Influencer is the person who has the ability to shape decisions without using or holding the budget. They are an active voice in the organization, someone who sits on committees, advises leadership and has built credibility on different levels. While they’re vocal, they aren’t necessarily loud, and they can be easy to miss.
In healthcare, Influencers are everywhere. They can be a respected physician, a consultant, a service line director or a board member. Founders can miss them because they don’t always introduce themselves, but their name comes up in conversations.
The tell: Someone says something like “We’ll want to loop Sally in on this,” or “before we do that, I want to run it past Dr. Morales.” The names will come up often in casual conversation. This signals that the person has influence that doesn’t need to be announced.
Listen closely for the names that come up unprompted. These are likely your Influencers.
5. The Champion
The Champion is the person who believes in what you’re building enough to put their own political capital on the line. They are an advocate when you’re not in the room and will help push back on internal objections. Their buy-in is critical to gain traction with the other stakeholders.
True Champions can easily be misidentified. A Champion isn’t a friendly contact who likes you or a senior person who praises your demo. A Champion is someone willing to take a risk for you, and that risk shows up in observable ways.
The tell: A real Champion will name the internal blockers before you ask. They’ll give you advice on unknown politics in the organization. They’ll say things like “value analysis will push back on the integration piece.”
The Champion won’t just tell you when things are going well; they’ll help you navigate the rough terrain.
You’ll notice that none of these roles are actual titles like CEO, CFO or COO, because the five decision-making roles span a range of titles. A CEO might be a Champion for one solution and a Blocker for another. One person can play two roles, or a title that sounds important may not play any role.
So how do you make sense of the organization you’re pitching into, and how do you get ahead with each of these decision-making roles?
Before your next pitch, take five minutes to write each of the five roles: User, Champion, Blocker, Influencer and Buyer. Try to fill in a real name next to each.
Some of those names will come easily, and others won’t. Not every role will be visible from the outside; some will only reveal themselves once you’ve had a chance to have real conversations inside the organization. The goal is to know what you’re missing and to go in with intentional questions designed to fill those gaps.
Once you have the names, even partial ones, take it a step further. Design a unique value proposition for each role, so that you know how to speak to them in a way that captures their attention. For each role, ask yourself two things: what does this person care about, and what question would get them to tell me something I don’t already know?
A user wants their workflow to be easier. A buyer wants a number they can defend. A blocker wants to know you’ve thought through risks that they’re accountable for.
Each of those is a different conversation. Appealing to their unique needs while also being curious about their perspective will open the door to more fruitful conversations that better position you for success in the future.
Selling into healthcare is uniquely complex. The decision-making systems are layered and scattered. The more clearly you can map the people and dynamics inside an organization, and the more intentionally you engage with them, the easier it is to build the momentum you need to close.
Understanding the people involved in decision-making is only the first step. Understanding why they’ll say yes or no is yet another layer of complexity in the sales process, and one just as worthy of your attention as you build your go-to-market approach.
At CQuence, we work with early-stage and scaling healthcare business to help you anticipate the unknowns before it costs you a deal. Drawing on decades of operational experience in healthcare, our team helps founders think through the chaos clearly and avoid predictable mistakes.
If you’re working through a complex sales process or preparing for your first hospital pilot and you’d benefit from a strategic partner, we’d be glad to talk.
Learn more about our approach to strategic guidance at www.cquencehealth.com/strategic-guidance.