What it takes to survive the MedTech valley of death

Six lessons on building a successful MedTech start-up, shared by our CEO Bjorn Sprengers at EWMA 2026 and drawn from the journey we’re still on at Plasmacure.

 

Every technology company has to cross the gap between an early-stage prototype and a commercially viable product. For MedTech, that gap – the so-called valley of death – is unusually deep and unusually long.

New technology means asking clinicians to change how they work, and that change only happens if reimbursement is in place. But reimbursement codes often don’t exist yet, there are rarely predicate devices to lean on, and frequently no single stakeholder owns the problem you’re trying to solve. Each of those is a hurdle on its own. Together they explain why so many promising MedTech companies stall in exactly this phase.

This week at EWMA 2026, our CEO Bjorn Sprengers was asked to share what it takes to build a MedTech company that survives this part of the journey. He skipped the theoretical frameworks and shared something more useful: field notes from a company still in the middle of it.

Plasmacure has been bringing cold plasma technology to complex wound care since 2014. Our device PLASOMA achieved 62% wound closure in cases that have failed other therapies but the path here has not been a straight line, and we are still very much navigating the valley.

These are the six lessons Bjorn shared.

 

Lesson 1: Product-market fit now means three things, not one

A decade ago, demonstrating better patient outcomes might have been enough to build a MedTech business. Today, with healthcare systems under severe cost pressure, it isn’t.

New solutions only survive if they combine three things at once:

• Better patient outcomes
• Lower treatment costs
• Lower treatment friction for clinicians and patients

Miss any one and adoption will stall, no matter how compelling the clinical data looks on paper. The economic case has to be as well-built as the clinical case, and the workflow has to be something a busy clinician can actually absorb.

For PLASOMA, this meant designing a device clinicians can integrate into existing workflows, supported by a health-economic case that holds up to payer scrutiny.

 

Lesson 2: Focus on winning, not on being everywhere

Most start-ups and scale-ups fail from lack of focus or from focusing on the wrong thing.

The discipline is to win in your home market plus one carefully chosen second market. Together, those two markets should give you a credible path to a €5-10M business which is roughly the threshold at which exit investors begin to take serious interest.

But geography is only half of it. The other half is what you build.

The temptation is to build a product. The harder, more valuable work is to build an adoption system: the combination of clinical evidence, KOL relationships, local usage data, unit economics, and payer engagement that turns a product into something a healthcare system can actually absorb. Done well in two markets, an adoption system becomes a template you can credibly export to the next ten.

 

Lesson 3: Raise money when you can, not when you should

The single most expensive mistake a MedTech founder can make is waiting until cash runs low to raise. By the time you need to raise, your leverage is gone and the terms reflect it.

The discipline runs in two directions:

Earn money wherever you can. Grants, subsidies, paid clinical collaborations, early commercial revenue. Every euro earned is a euro you don’t have to dilute for.

Bring high-quality investors on board when you meet them. Even if the timing isn’t textbook. Patient, knowledgeable investors are one of the most underrated assets a MedTech company can have. They are also one of the hardest to acquire under pressure.

 

Lesson 4: Build your follower base

Leaders have followers. That sounds obvious until you realise how few founders actively work at it.

Investors, clinicians, employees, partners – people want to work with leaders, and leadership is built one relationship at a time. The test of whether you’ve genuinely built a following isn’t who shows up to your meetings but who advocates for you when you’re not in the room.

For a MedTech company, that advocacy from a respected clinician, an early investor, or a former colleague who recommends a future hire is often what moves things forward.

 

Lesson 5: System-thinking and system-doing

Start-ups are organized around achieving product-market fit. Scale-ups have to demonstrate something harder: that product-market fit can be turned into a path to profitability.

That requires synchronising milestones, resources, and decisions across every function at once – clinical, regulatory, product, engineering, commercial, and finance.

When one discipline lags, the whole system slows. And in MedTech, misalignment between teams burns cash fast. A commercial team that sets a price before the clinical evidence is strong enough to defend it will spend the next year arguing with payers.

System-doing, the operational practice of keeping all functions moving in step, is what separates companies that scale from those that stall just past the valley.

This is where leadership experience, the quiet competence of people who have done this before, paired with a team that mixes deep functional experts with versatile generalists matters most.

 

Lesson 6: Culture is the multiplier

Culture is the multiplier on every other lesson on this list. The right team executes all five of the above lessons better. The wrong team makes each of them harder.

What has worked at Plasmacure is hiring for values and growth mindset, and then paying close attention to the quality of conversations between team members. Because what we’ve come to believe is that companies are largely the sum of the conversations happening inside them. When those conversations are honest, useful, and in good spirit, the business tends to find its way. When they aren’t, no strategy survives long.

 

Where Plasmacure is now

We are still in the valley, but we are crossing it.

PLASOMA is on the path to reimbursement in the Netherlands, and the clinical evidence base keeps growing. We’re seeing genuine pull from the wound care community across Europe, North America and Asia, backed by investors, and validated by credible competitors who are helping establish the category. And we have a team with the kind of experience you can only earn by going through it.

If you are working on a MedTech company yourself, or considering investing in or partnering with one, we hope these lessons are useful.

And if you would like to talk about cold plasma, complex wounds, or what we are seeing in the field, we would love to hear from you.