Writing ยท June 2023

Healthcare Roadmaps: The Trilemma and the 70/20/10 Rule

Clinical excellence, patient experience, operational efficiency: you can't lead on all three. A framework for choosing where to win.

Healthcare products live inside a trilemma: clinical excellence, patient experience, and operational efficiency. Almost no organization has the resources to lead on all three, and trying usually produces mediocrity across the board. The answer is to pick where you'll win and allocate deliberately: 70 percent of resources to your primary differentiation area, 20 to your secondary, 10 to your tertiary.

That framework comes from building digital health products across multiple organizations. Here's how to apply it.

The healthcare product trilemma

  • Clinical excellence: medical quality, efficacy, and health outcomes
  • Patient experience: intuitive, engaging, emotionally supportive interactions
  • Operational efficiency: sustainable, scalable, compliant systems

The central question isn't "how do we do all three well?" It's "where will our limited resources create the most value?"

The 70/20/10 model

The 10 percent allocation isn't neglect, it's a floor: minimum viable standards you maintain regardless of focus. Even an experience-led product needs baseline clinical safety and operational compliance. The model just forces you to be honest about where you'll actually stand out.

Choosing your primary focus

Market context

If competitors lead with clinical excellence but ship poor user experiences, differentiate on UX. In a market full of slick but clinically questionable apps, double down on evidence.

Organizational strengths

An organization with deep clinical expertise should lean into medical innovation. One with design talent should lead with experience.

User needs

Some patient populations prioritize outcomes above all. Others value convenience or affordability more. Research yours before deciding.

Three archetypes

1. The clinical innovator (70% clinical excellence)

Leads with breakthrough medical approaches or superior outcomes. Invests in research, clinical validation, and medical expertise. Think advanced diagnostics or AI-powered clinical decision support.

2. The experience leader (70% patient experience)

Differentiates through usability, engagement, and emotional connection. Invests in design and user research. Think consumer health apps and accessible telehealth platforms.

3. The operational optimizer (70% operational efficiency)

Stands out on scalability, cost, or integration. Invests in infrastructure and automation. Think administrative platforms and interoperability solutions.

Building the roadmap

1. Set minimum viable standards

Define the baseline for each pillar that must hold regardless of strategy.

2. Sequence by strategic focus

Early initiatives establish differentiation in your primary area. Later phases strengthen the secondary and tertiary.

3. Weight your metrics

Track KPIs across all three pillars, weighted to your strategic focus, so you hold direction without going blind on the other two.

4. Plan for evolution

Once your primary differentiation is established, shift allocation. An experience leader that's won on UX might then invest in clinical validation or scale.

Case study: a patient-centric digital therapeutic

At a previous digital health company, we built a chronic pain program allocated 70 percent to patient experience (personalization, engagement, intuitive interfaces), because research showed poor adherence was why existing treatments failed. Clinical got 20 percent: evidence-based, best practices, but no novel protocols. Operations got 10: basic scalability, accepting higher costs from our high-touch approach.

The result dramatically improved adherence over traditional approaches, which drove better outcomes despite less advanced clinical protocols. That's the trilemma resolved by choice rather than by accident.

The takeaway

Strategic focus drives differentiation. Make the deliberate choice about where you'll truly excel, and keep the discipline to hold that focus when the temptation to spread resources evenly shows up. It always shows up.