The healthcare industry is one of the most challenging spaces for innovation. While startups bring agility, fresh ideas, and a willingness to take risks, corporations provide structure, resources, and the ability to scale. But how do you balance these seemingly opposing forces? In this episode of The Strategy Gap, we sat down with Dave McMullin, Chief Business Officer at Anumana and Chief Strategy Officer at nference, to explore how startups can maintain their innovative edge while scaling—and what they can learn from larger organizations.
Aligning Strategy with Execution: A Non-Negotiable for Growth
One of the biggest challenges startups face is balancing long-term vision with short-term execution. Investors want to see a compelling vision for the future, but they also need tangible milestones that show progress.
“Generally, when you go to investors, they want to see that you have a vision, and they want to see the evidence to believe in that vision, and that can be like five years plus,” Dave explained. “But they also want to know that if they’re investing in you, you’re going to translate that into some de-risking milestones or value generation milestones directly bringing in cash in the next year or two.”
This balancing act means startups can’t afford to separate strategic planning from daily operations. Unlike large corporations, where strategy meetings and budgeting processes happen in distinct silos, startups must integrate these discussions into their everyday decision-making.
“We don’t really have just separate strategy sessions and budgeting sessions,” Dave noted. “It’s all part of the same thing, and we’re constantly adjusting as we go.”
For startups, this means staying nimble—aligning key stakeholders frequently, adjusting strategy in real-time, and ensuring that long-term goals don’t get lost in the chaos of daily operations.
The Discipline of Communication: Keeping Everyone Aligned
One of the most overlooked yet critical components of successful strategy execution is consistent communication. As companies grow, it becomes harder to ensure that everyone—from executives to frontline employees—remains aligned on key strategic priorities.
Dave shared a practical method he used at Anumana to stay disciplined:
“I committed myself to hold a town hall for all the employees the week after every board meeting. In that town hall, I would always update anything on the strategy front, what we’re doing, the progress to date, and the operational priorities from here to the end of the year.”
By scheduling these meetings in advance and setting clear expectations, Dave ensured accountability—not just for the leadership team, but for himself as well.
“That put a stake in the ground where I was holding myself accountable by doing that touchpoint in front of other people and ensuring that the tyranny of the urgent wasn’t overwhelming my day-to-day, eroding my success.”
This structured communication strategy is something both startups and corporations can learn from. Whether through town halls, regular check-ins, or structured updates, organizations need to create a rhythm of communication to keep strategy from becoming just another forgotten PowerPoint deck.
Scaling Without Killing Innovation: The Startup’s Greatest Challenge
A common challenge for high-growth startups is scaling while maintaining an innovative culture. In the early days, startups thrive on speed, adaptability, and creativity. But as they grow, processes, hierarchies, and compliance requirements inevitably enter the picture.
“To scale the organization, you have to start to standardize,” Dave explained. “You have to create swim lanes, you have to create repeatable processes, and you have to put these guardrails in place. That allows you to become bigger and stronger.”
However, standardization can be a double-edged sword. While it brings stability, it can also slow down the very innovation that made the startup successful in the first place. So how do you scale without killing creativity?
At Anumana, Dave and his team built a dual-track system that allowed innovation and structure to coexist:
“We’ve built that up in parallel and kept the core R&D work as a standalone organization. It’s small, and it’s got those innovative people in it. They know that once the innovation gets to a point, it has to go through a design control process, which is much more controlled.”
This approach ensures that the creative “engine” of discovery remains intact while also allowing the company to develop scalable, compliant solutions.
“That little engine of discovery is still down there and able to operate—it’s got some messiness to it. Its purpose is to come up with ideas, patent them, and then hand them off to different teams that are scaling.”
This model—separating early-stage innovation from later-stage scaling—offers a powerful blueprint for startups navigating growth. By allowing the messy, experimental side of the business to thrive separately while establishing more structured processes for execution, companies can continue to innovate without losing their ability to scale effectively.
Closing the Gap: Lessons from Both Worlds
The tension between startups and corporations isn’t a bad thing—it’s a learning opportunity. Startups bring speed, creativity, and agility, while corporations offer structure, resources, and risk management.
By taking lessons from both worlds, startups can:
✔️ Align long-term strategy with short-term execution to attract investors and stay focused
✔️ Establish disciplined communication rhythms to keep teams aligned
✔️ Develop dual-track innovation models to scale while preserving creativity
As Dave’s experience shows, bridging the gap between startups and corporate structure isn’t just possible—it’s essential for long-term success.
Want to hear more? Listen to the full episode of The Strategy Gap with Dave McMullin now!
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A podcast about the space between savvy strategy and practical execution, including everything that can go wrong on the way.
