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HealthPadTalks: End of the Pitch

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This episode of HealthPadTalks explores the collapse of traditional sales in MedTech. The days of slick pitches and product-pushing are fading fast. With AI, value-based care, and digitally savvy patients reshaping the landscape, the old playbook no longer works. We dig into why some cling to it, how others are thriving without it, and what it takes to lead in this new, ecosystem-driven era.

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Margaret Thatcher’s MedTech Masterclass

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Glass Cliff Dynamics: Why women are appointed to lead struggling MedTech firms - and how to turn crisis into opportunity
Thatcher as Playbook: Strategic lessons from Margaret Thatcher on power, presence, and perception under pressure
Persona as Leverage: How executive presence can reshape authority in male-dominated environments
Team Overhaul: Building leadership teams aligned to transformation - not just survival
Legacy Leadership: Moving beyond fixes to create lasting, institutional change in MedTech

Margaret Thatcher’s MedTech Masterclass

It has been several decades since Margaret Thatcher became the UK’s first female Prime Minister - a milestone often cited as a pivotal moment of progress for women in leadership. And indeed, women now lead Fortune 500 companies, run central banks, and shape global policy. Yet beneath this surface of advancement lies a persistent truth: in many industries, including MedTech, the path to senior executive leadership for women remains fraught, uneven, and frequently obstructed. In some sectors, real power is still only offered to women once the ship is sinking.

In the US MedTech sector, women occupy just ~4% of CEO roles - the lowest representation across healthcare subsectors. This disparity is striking given that women make up nearly half of entry-level positions in the industry. While ~34% of executive roles are held by women, their presence sharply declines at the highest leadership tier, highlighting a persistent gap in advancement. This disparity is not due to a lack of capable female leaders. Studies have shown that companies with strong female leadership - defined as having at least three women on the board or a female CEO - deliver higher returns on equity, outperforming male-led firms by ~36%. Yet, many women in MedTech report systemic barriers to advancement. A survey found that ~74% of women believe they do not have the same potential for advancement as their male peers, and ~65% feel they are not paid equally.

With >6,500 MedTech companies in the US, the underrepresentation of women at the top is not just a gender equity issue - it is a missed opportunity for innovation and performance. While there has been a modest increase in female CEO appointments across industries - from 6.1% in 2019 to 8.5% in 2023 - the MedTech sector lags. To progress, the industry must address these disparities, recognising that diverse leadership is not only fair but also beneficial for business outcomes.

Enter the glass cliff - a term coined to describe the precarious positions women are often handed: high-risk leadership roles at failing companies, where the likelihood of success is slim and the scrutiny intense. This dynamic is playing out with unsettling clarity. Female leaders are parachuted into what a 2024 McKinsey report on the MedTech industry called the “have-not” companies - organisations constrained by stagnant pipelines, outdated strategies, regulatory chokeholds, and dwindling investor confidence. These are not the innovation-rich flagships of the sector, but the distressed assets - burdened with legacy thinking and in need of reinvention.

In this crucible, Thatcher’s example is more than just relevant - it is instructive.

When Margaret Thatcher took office in 1979, she did not step into a well-laid path - she confronted a nation in economic turmoil, institutional inertia, and a political elite that viewed her with undisguised scepticism. Her rise was not facilitated - it was hard-fought. She methodically recalibrated her presence, including her voice, strategy, and leadership style, to cut through the noise and assert control. This kind of reinvention was not cosmetic - it was tactical. (It is worth noting that voice coaching and wardrobe advice is not uncommon among high stakes leaders; Sir Keir Starmer, the current UK Prime Minister, is also reported to have worked with a voice coach and had wardrobe advice). In positions where authority must be projected as well as earned, such preparation is pragmatic - not performative.

Thatcher’s example offers relevant lessons for anyone - regardless of gender - taking on entrenched systems under pressure. But for women in MedTech leading turnarounds in cultures that have not historically recognised them as default leaders, her case carries resonance. This is not about political alignment; it is about leadership under fire, and the ability to shift perception without compromising clarity or force.

Despite strides in equality, many legacy MedTech firms continue to reflect outdated assumptions about who leads and how. Women stepping into executive roles are often asked - explicitly or implicitly - to prove not just their competence but their legitimacy. In that context, Thatcher’s example becomes instructive. Her approach - combining strategic clarity, resilience, and the symbolic dimensions of leadership - offers a framework for navigating, and reshaping, deeply embedded systems.

In this Commentary

This Commentary explores what Margaret Thatcher’s leadership under pressure can teach today’s women navigating high-risk turnaround roles in MedTech. With only ~4% of CEOs in the sector being women, the Commentary offers strategic insights on power, perception, and performance. For female MedTech executives, it is a call to lead not just boldly - but irreversibly.

Persona as Power: Reconstructing the Leader Without Losing the Self

Leadership has always been as much about perception as performance - a reality that applies to men and women alike, though the stakes are often different. For women operating in spaces where their authority is still questioned, this dynamic can be pronounced. Margaret Thatcher grasped this with acuity. Confronted by a political establishment that saw her as an outsider, she did not shrink or conform - she recalibrated how she was seen. She worked with a vocal coach not to suppress her femininity, but to amplify her authority in environments acoustically and culturally attuned to male voices. She curated her wardrobe not to placate expectations, but to signal strength, discipline, and strategic intent. Crucially, this was not about becoming someone she was not - it was about ensuring the version of herself that stepped forward to lead was impossible to dismiss.

Male leaders, too, engage in this kind of intentional self-styling. We have mentioned Keir Starmer, but also Barack Obama was keenly aware of how he was perceived as a Black man in the highest office of a historically White political structure. He modulated his tone and body language in public settings - consciously projecting calm, reason, and poise - to defuse racialised assumptions. His carefully curated image was not artifice, but strategy: a way to lead more effectively in a world where perception can shape credibility as much as substance.

In today’s MedTech industry, female executives still encounter subtle, yet deeply embedded scepticism - often unspoken, but always consequential. They step into boardrooms where credibility must be established before strategy can be heard. They lead investor calls where conviction is conveyed through tone, tempo, and command. They face regulatory panels where calm authority can be the difference between trust and delay. In these moments, executive presence is not vanity - it is leverage.

Code is the Cure

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The role of seasoned board members becomes pivotal during periods of executive transition. Just as figures like Thatcher, Obama, or Starmer stepped into leadership with formidable capabilities yet needed to calibrate their approaches to the rhythms of their political landscapes, so too must even the most accomplished executives adapt to the contours of MedTech leadership. In such moments, a board’s role extends beyond governance into the realm of stewardship. This includes offering perspective, context, and yes, sometimes personal insight - shared not from a place of authority, but of collegial investment in the leader’s success.

Guidance in these instances is not about critique, but about enabling alignment - between the executive’s strengths and the unspoken expectations, cultural codes, and strategic nuances of the organisation. To suggest that such insight must be withheld based on the gender of either the giver or the receiver is to risk reducing leadership development to a transactional affair, stripped of the relational wisdom that often makes the critical difference. The more constructive question, then, is not Should a male board member advise a female executive? but rather, How can we, as experienced peers, offer the kind of support that allows leadership to flourish - for the benefit of the company and all its stakeholders?

This is not a call for women to change who they are. It is a call to weaponize clarity, precision, and poise - to own the space with authenticity and intent. Persona, in this context, is not about artifice. It is about alignment: aligning your presence with your purpose, your communication with your conviction. As Reshma Kewalramani has shown at Vertex Pharmaceuticals, leadership does not demand loudness - it demands gravitas. Her calm, science-led authority reshaped expectations of what a biotech CEO looks and sounds like.

Like Thatcher, today’s female leaders in MedTech are rewriting the script - on their terms. And in environments where institutional power may still lag talent, symbolic authority matters. It fills the vacuum while systems catch up. It tells the room: I belong here - and I’m in charge.

Reshaping the Inner Circle: Strategic Authority Over Sentiment

One of Margaret Thatcher’s earliest and most consequential acts as Prime Minister was the strategic reshaping of her cabinet - not to assert control, but to ensure alignment with her mandate for reform. She removed ministers whose support was performative, who spoke the language of change while resisting its substance and brought in those who shared her economic vision and had the discipline and capacity to deliver it. Thatcher grasped a distinction often lost in traditional legacy MedTech leadership: political endorsement is not synonymous with meaningful execution. Her approach was rooted not in consensus for its own sake, but in clarity of purpose and the resolve to surround herself with those prepared to act competently.

MedTech turnaround CEOs - especially women navigating precarious “glass cliff” scenarios - face a similar dilemma. They inherit leadership teams entrenched in legacy thinking and cautious by design: teams that preserve outdated playbooks even as the market evolves around them. In such cases, restructuring the executive core is not about disruption for disruption’s sake - it is a necessary condition for renewal.

Yet the challenge runs deeper. Senior executives often rise through their political fluency - their skill in mirroring dominant leadership styles, projecting alignment, and surviving shifting agendas. Such individuals are not saboteurs; they are products of systems that prize optics over innovation. New leaders, whether in government or business, often find themselves flanked by long-serving figures who have mastered the appearance of loyalty while sidestepping meaningful change. When bold strategies are introduced - digital transformation, market expansion, cultural reinvention - these incumbents may nod in agreement, offering gestures of support without true follow-through.

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Next Gen MedTech: Why Gen Z Is the Future

The real threat is not open resistance. It is performative compliance that preserves the status quo. Thatcher understood this well. She did not take alignment at face value - she demanded evidence in action. So must any leader intent on transformation.

In MedTech, where stakes are high and timelines tight, there is no room for ambiguity. Leaders must distinguish between those committed to transformation and those protecting their proximity to power. As Deborah DiSanzo demonstrated at Philips Healthcare, reshaping an organisation’s trajectory means reshaping its mindset. She did not simply rearrange the org chart - she infused it with people who understood where the industry was going and had the courage and ability to get there.

The lesson is clear: transformation starts with trust - but not blind trust. Keep the builders, elevate the challengers, and scrutinise the chameleons. Align on purpose, not posture. Like Thatcher, today’s leaders must be prepared to make difficult, sometimes unpopular decisions - not to consolidate power, but to unlock it. This is not about replicating Thatcher’s persona - it is about emulating her strategic clarity. Leadership is not inherited. It is built - intentionally, relentlessly, and often in the face of disguised resistance.

Strategic Shock: Breaking Inertia with Bold Execution

Margaret Thatcher inherited a nation in economic freefall. Inflation was rampant, productivity had collapsed under the weight of union dominance, and Britain’s global competitiveness had all but evaporated. With little fiscal room to manoeuvre, and no popular mandate for change, she could have been forgiven for managing the decline. Instead, she engineered a strategic shock: sweeping deregulation, privatisation, tax reform, and an aggressive dismantling of entrenched power structures. She did not wait for headroom - she created it.

MedTech turnaround CEOs today face similar constraints. Many are handed the reigns of companies suffocating under debt, facing FDA warning letters or consent decrees, watching valuations slide, and trapped in low-growth or mature markets with stagnant pipelines. Internal energy is consumed by compliance, remediation, and investor appeasement. It is easy to become fixated on fixing. But as Thatcher showed, transformation demands the ability to walk and chew gum at the same time. You must repair the engine while plotting a new route.

Thatcher’s genius was to recognise that fixing the past and building the future are not sequential tasks - they are concurrent imperatives. MedTech leaders must do the same. This means delivering credible operational triage and bold bets on the future, simultaneously.

Consider Medtronic’s strategic pivot toward AI-driven surgical robotics and remote patient monitoring - a deliberate evolution beyond its traditional, device-centric foundation. Or take Anne Wojcicki’s 23andMe, which initially disrupted the genomics landscape by circumventing conventional reimbursement channels through a direct-to-consumer model, reshaping public engagement with personal health data. While 23andMe’s trajectory ultimately faltered, its bold reimagining of market entry points underscored a broader truth: these were not incremental innovations but fundamental shifts in business architecture.

Turnaround leaders must embrace this duality. Slash underperforming product lines. Redirect R&D toward high-conviction, future-facing bets. Exit legacy business models that burn cash but preserve ego. Kill innovation theatre - invest in innovation that scales. You cannot nibble at the margins when the platform is burning. Thatcher did not wait for consensus. She moved fast, with clarity, precision, and a willingness to absorb criticism in service of results. For MedTech leaders, particularly women who may face greater scrutiny in high-stakes roles, the lesson is clear: do not just fix the mess - build the next.

Mastering Adversarial Arenas: Turning Scrutiny into Strategic Advantage

Few leaders have faced a more combative arena than Margaret Thatcher at Prime Minister’s Questions. Week after week, she stood at the Parliamentary despatch box amid volleys of jeers, interruptions, and barbed attacks - not only from the opposition, but at times from restless corners of her own party. Yet she never wavered. Armed with meticulous preparation and delivered with a steely cadence, her words cut through the noise with surgical precision. What others approached as a political ambush, she transformed into theatre - unyielding, disciplined, and commanding. In an age of shifting positions and political hedging, she made her stance unmistakably clear: “You turn if you want to. The lady’s not for turning.” Clarity over charm. Authority over appeasement. Resolve over rhetoric.

Today’s MedTech CEOs face their own version of this arena - not across dispatch boxes, but in regulatory meetings, investor calls, public earnings reports, and hostile shareholder engagements. Whether it is defending a remediation plan to the FDA, navigating a recall, or confronting activist investors demanding a board overhaul, the battlefield is real - and public.

A common misstep among leaders is viewing moments of scrutiny as reputational liabilities rather than pivotal opportunities to lead. Margaret Thatcher never sought popularity - she pursued respect. MedTech executives under pressure must adopt a similar stance. Confrontation, when handled with clarity and conviction, becomes a foundation for credibility. Whether facing a Form FDA 483, a Warning Letter, or heightened investor scrutiny, the goal is not damage-control - it is narrative control. Step forward, acknowledge the issue before others do, present a clear path forward, and project steady, competent leadership. That is how trust is earned in turbulent times.

Thatcher mastered the adversarial arena because she understood that public scrutiny is a test of leadership, not likability. She stayed on message, controlled the tempo, and turned conflict into theatre - with her as the director. For MedTech leaders facing their own high-stakes interrogations, the lesson is timeless: respect is not given in these moments - it is taken.

Global Influence: From Margins to Powerbroker

When Margaret Thatcher stepped onto the world stage, Britain was widely seen as a faded empire - its economy faltering, its global influence waning. And yet, she refused to play small. Through a partnership with US President Ronald Reagan, she positioned herself - and the UK - as a force in shaping the late 20th century global order. Together, they pushed for market liberalisation, confronted Soviet expansionism, and reasserted the primacy of democratic capitalism. Her international credibility did not stem from Britain’s material might, but from her strategic boldness, ideological clarity, and the force of her convictions.

Today’s MedTech leaders, especially those leading smaller or turnaround companies, face a similar crossroads. On paper, they may lack scale. But they hold the levers of global relevance - if they choose to pull them.

In a sector long dominated by wealthy US and European markets, the boundaries of influence are shifting. Nearly 85% of the world’s population lives outside these mature economies and represents ~40% of global GDP. That figure is not just a statistic - it is a call to action. The future of MedTech will be shaped by those who recognise that healthcare equity and commercial expansion are no longer separate goals. They are intertwined - and urgent.

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India’s Healthcare Revolution: High Volume, Low Cost, No Excuses

Namal Nawana’s leadership at Smith & Nephew illustrates what this looks like in practice. When he took the helm in 2019, the company had a strong legacy but limited global velocity. Nawana pushed aggressively into emerging markets, prioritised strategic acquisitions that aligned with growth geographies, and restructured operations to reflect a global - not Western - future. Under his leadership, Smith & Nephew began to look less like a traditional British MedTech and more like a borderless platform for surgical innovation.

Thatcher understood that influence was not granted - it was constructed. MedTech leaders should adopt a similar posture. This means engaging not just in markets, but in movements: shaping global regulatory convergence, advocating for access in underserved health systems, forming public-private partnerships that move the needle on affordability and delivery. It means going beyond the balance sheet to build reputational capital that opens doors in India, Brazil, the Middle East, Southeast Asia, and Africa - not just Wall Street or Brussels.

Female CEOs, particularly those thrust into turnaround roles, may be underestimated by legacy investors or competitors. But that is itself an opportunity. Thatcher never waited for permission to lead beyond her domestic base - she imposed her vision globally. Likewise, today’s MedTech leaders must play bigger than their current footprint. They have the chance to define the next frontier of the industry - not as responders, but as architects. To lead globally is not a vanity project. It is a strategic imperative. As Thatcher showed, conviction can become currency. And in today’s MedTech, those who combine growth with equity will not only transform markets - but they will also reshape what leadership in healthcare looks like.

Legacy and Longevity: Institutionalising Change

Margaret Thatcher did not just fix Britain’s problems - she rewired its operating system. Her reforms changed how the UK economy functioned, how labour interacted with government, and how Britain positioned itself on the global stage. Even her fiercest critics must contend with this: decades after she first took office, the structures she reshaped - privatised industries, deregulated markets, and a leaner, more global-facing state - still frame key debates today. That is the essence of real leadership: not personal dominance, but institutional endurance.

In MedTech, the bar should be just as high. The most consequential leaders - especially those stepping into fragile or failing organisations - must look beyond short-term wins and quarterly optics. Transformation is not cosmetic. It is structural. It lives in rewired innovation cycles, redefined performance cultures, and redesigned talent pipelines. It is felt long after the leader has left the stage.

This is critical for women leading in turnaround environments. Too often, the narrative focuses on resilience, personal grit, or “heroic” efforts under pressure. But leadership that lasts is not about heroics - it is about systems. It is about codifying a culture that prizes agility over hierarchy, rewards insight over incumbency, and builds institutional memory that does not vanish with the next succession.

Consider how some of today’s most forward-looking MedTech firms are evolving: embedding AI not just as a tool but as a mindset, decentralising R&D to tap global insight, building leadership pipelines that reflect the diversity of their patient populations. These are not symbolic changes. They are foundational.

Thatcher’s legacy did not begin with her voice, or even her cabinet - it began with the clarity of her intent. But it endured because she built structures that shifted national direction. Her influence outlasted her office, crossed oceans through her alignment with Reagan, and still echoes in policy and political strategy around the world. That kind of legacy is not about longevity - it is about impact.

For MedTech leaders, especially women rewriting the rules in male-dominated institutions, the question is not just whether they can fix what is broken. It is whether they can build something that holds, scales, and endures. Thatcher did not aim to be remembered. She aimed to be irreversible. That is the kind of leadership the future of MedTech demands.

Takeaways

Margaret Thatcher did not wait to be accepted. She did not ask for a seat at the table - she bulldozed the table, rewrote the rules, and built a new game. Not because she led as a woman, but because she led with vision, force, and unapologetic intent. And that is what the next generation of MedTech’s transformational leaders - many of them women - must do. The terrain is different now, but the resistance is familiar: bureaucratic drag, underpowered teams, legacy systems, and subtle doubt in every room. The instinct might be to fix quietly, to lead cautiously, to soften the edges. Don’t!

This moment does not call for caretakers. It calls for catalysts.

The future of MedTech belongs to those who can stabilise the system and simultaneously reinvent it. Who can navigate warning letters, sinking valuations, and global complexity - and still bet boldly on what is next. This is not about proving yourself. It is about building something that outlasts you. Thatcher’s real legacy was not her resilience. It was her irreversibility. The mandate for today’s MedTech leaders? Be clear. Be disciplined. Be bold. And when you lead -make it permanent.

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