There is a point in a career when experience alone is no longer enough, when the constraint is no longer knowledge, but environment.
After more than three decades in medical devices, working across engineering, commercial leadership, and executive roles, I had developed a clear understanding of how companies are built. I had also seen, repeatedly, how long it takes, how much it costs, and how often progress is slowed by factors that have little to do with the quality of the underlying innovation. Strong ideas fail or stall not because they lack merit, but because they are developed in fragmented systems—where clinical insight, technical development, and commercial strategy are separated by time, distance, and misalignment.
The question, then, was not how to build. It was where to build.
That question ultimately led me to Houston and to the Medical Device Labs at TMC. The decision to move was not incidental. My wife and I sold the Chicago suburban home we had lived in for more than two decades and relocated, recognizing that to fully benefit from a community like this, proximity is not optional; it is foundational.
What I have experienced since then has reshaped my understanding of time and capital efficiency.
In traditional operating models, efficiency is often framed as a function of execution: tighter processes, better planning, and incremental improvements over time. While those elements matter, they do not address a more fundamental issue—structural delay. Time is lost not simply because teams move slowly, but because the system in which they operate requires information to travel, decisions to be deferred, and access to be constructed rather than assumed.
The environment at TMCi changes that dynamic. Efficiency here is not about speed for its own sake; it is about eliminating the conditions that make things slow. When clinicians, engineers, operators, investors, and decision-makers are in close proximity, the distance between question and answer collapses. Conversations that would typically unfold over months happen in days, sometimes hours. Insights that would require formal studies or external consultants emerge through direct engagement with those closest to the problem.
This dynamic became clear almost immediately upon arriving.
In my first month at TMCi, I met the founders of a company called Roam Technologies. Roam Technologies is developing a continuous oxygen solution, and like many early-stage companies entering the U.S. market, they were navigating not just the technology, but the complexity of commercialization.
In a more traditional setting, that process would likely begin with months of research: understanding how oxygen delivery is reimbursed, identifying distribution pathways, evaluating whether the economics support a viable business, and determining how the product fits within existing care models. These are not trivial questions, and they are often addressed sequentially, at significant cost.
Here, they were addressed immediately.
Within a short period of time, we were able to map out how oxygen products reach patients’ homes through durable medical equipment (DME) providers, how reimbursement is structured through HCPCS codes, and, critically, what level of profitability remains after those constraints. That clarity led to a more grounded discussion: not just whether the product works, but whether it can sustain a business.
Once we had confidence that the solution had a viable path to commercialization, the focus shifted toward accelerating product development itself.
Through the Medical Device Labs @ TMC, Roam gained direct access to onsite engineering support, allowing the company to move quickly from strategic validation into technical iteration. Working alongside the engineering team, they were able to explore strategic decisions in real time, whether to adjust the product to meet higher oxygen flow rates or to commercialize within current specifications and use early revenue to support future iterations.
In many environments, that process alone can take months of coordination across external firms and vendors. Here, technical iteration and commercial strategy were advancing simultaneously, allowing decisions to be made earlier, with greater confidence and significantly less friction.
At the same time, Roam Technologies was connected to a network of expert vendors curated by TMCi, spanning areas such as intellectual property, reimbursement, and regulatory strategy. These are not just service providers, but partners experienced in working with early-stage MedTech companies, with business models aligned to support growth rather than slow it down. Combined with access to clinical environments across hospitals within the Texas Medical Center for immediate, real-world validation, this created a pathway where product and business decisions could advance in parallel—significantly reducing both time and cost.
“What stood out wasn’t just speed, it was the clarity of decision-making. Being embedded in the Texas Medical Center ecosystem meant we were in the room with the right clinicians, operators and commercial experts from day one. In a matter of days, we validated how our product fits within U.S. care pathways and what needed to change to accelerate adoption. The relationships we’ve built are now the backbone of how we’re scaling the business.” – Shan-Shan Wang, CEO, Roam Technologies
This experience reflects a broader pattern I have observed in my role as an Entrepreneur-in-Residence. When I joined, I had a specific hypothesis: that many early-stage companies do not fail because of insufficient innovation, but because of insufficient translation.
The gap between a promising product and a viable, investable company is rarely technical. It is commercial.
Understanding how a product generates revenue, who pays for it, how adoption decisions are made, and how long it takes to move from initial use to scale are not secondary considerations; they are central to both time and capital efficiency. In many settings, these questions are addressed late in the process, after significant resources have already been committed. Here, they surfaced early.
The most meaningful measure of time efficiency is not how quickly something is done, but what no longer needs to be done at all. Extended cycles of exploratory consulting, misaligned product features that require rework, and delayed access to clinical feedback are not inevitable steps; they are artifacts of disconnected systems. When those systems are integrated, these steps are either shortened or eliminated.
Capital efficiency follows naturally. When decisions are made earlier and with greater accuracy, resources are deployed more effectively. There is also an important signaling effect: operating within TMC provides a level of credibility that reduces perceived risk for investors, grant organizations, and strategic partners. This can accelerate access to both dilutive and non-dilutive funding, further compressing the path to commercialization.
However, this environment also demands a different level of rigor from founders and operators.
The concept of boldness, often associated with risk-taking, takes on a more precise meaning in this context.
Boldness is not simply the willingness to act; it is the willingness to confront the commercial reality of a product with clarity and discipline.
“Early-stage innovation doesn’t fail because there aren’t enough ideas—it fails because teams spend too much time on the wrong ones. Our focus is helping founders get to the truth as quickly as possible. Strip it down to what matters most: does this work, does it create value, and who will pay for it. When you answer those questions early, everything else becomes clearer—and significantly more efficient.” — Tom Luby, Chief Innovation Officer, TMC
In practice, this means asking—and answering—a set of fundamental questions:
Where, specifically, will revenue come from?
Who is the economic buyer, and what incentives drive their decision-making?
What existing reimbursement pathways can support initial adoption, and what must be proven to expand beyond them?
What is the lowest unit of demand, and how long does it take to generate it?
What are the key performance indicators that determine success for each stakeholder involved—clinicians, administrators, payers—and how does the product align with them?
What is the realistic timeline from initial use to scalable adoption, and what milestones must be achieved along the way?
These questions are not always comfortable, but they are essential. Addressing them early can prevent months or years of misdirected effort and significant capital expenditure.
In this sense, the phrase Audentes Fortuna Juvat—fortune favors the bold—captures something important, but incomplete. Fortune does not favor boldness alone; it favors informed boldness, grounded in a clear understanding of how value is created and realized.
On my second day at TMCi, I was introduced to an opportunity that developed into the foundation of a new company I have spun out within months. While that outcome may seem exceptional, it reflects a broader truth about the environment. When the right elements—clinical insight, technical capability, commercial expertise, and strategic access—are aligned within a single system, progress becomes less about overcoming barriers and more about moving through a well-defined pathway.
Timelines do not simply move faster; they compress. Capital is not merely conserved; it is deployed with greater precision. And opportunities that might otherwise remain theoretical become tangible, actionable, investable and, ultimately, scalable.
In early-stage healthcare innovation, this alignment is not a luxury. It is the difference between ideas that remain promising and those that become real.
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