Beyond Pilot Fatigue: The Rise of 'Promise Fatigue' in Health Tech

Written by Clayton Russell, Vice President of Operational Strategy, Dental Care Alliance

Pilot fatigue is real in the DSO world, and it’s becoming a bigger issue than ever before. It’s oftentimes overlooked as just the nature of how business gets done, both by the vendor-partner and internally at the DSO as well.

But a much bigger problem has entered the arena, and it’s causing an even larger chasm between DSO Leadership, Field Operations, and the Vendor-Partners involved……I couldn’t find documentation of this having been classified in the past, so I coined the term “Promise Fatigue” (shoutout to Matt McGaw for the conversation that sparked the term, and ultimately this article).

For years, vendors, especially Tech/AI vendors, have overpromised and underdelivered……DSOs have taken notice……their budgets did too.

To be clear, I’m not here to knock Tech or AI vendors or stymy innovation. I love what’s happening in our industry, and the ‘promise’ that it brings from a business value standpoint. Most importantly, the potential value that can be brought to those who work day-in and day-out in dental offices across the country offering the highest levels of service to those they serve….the patient. The purpose here is shed light on a growing issue in the space, and continue to build a bridge so we can best work together pioneering a future that benefits all involved.

First, let’s define what promise fatigue looks like:

Slides that claim 30 to 50 percent lifts with no denominator or data source
Demos that live in a sandbox that doesn’t touch production reality
“We have an API/partnership” that really means “we’ll have one soon”
Pilots that end right before the hard part: change management, integration, and scale

So let’s talk about how to do it right. If you’re looking to bring new tech to a DSO and want to form a true partnership, start with Clarity, Transparency, and Truthfulness.

Here’s a playbook that wins:

CLARITY

Define the exact problem, who feels it, and the current baseline. “Average days to schedule hygiene recall is 27. Target is 18. We attack the delta.” Get to know the business you’re selling into well enough to be able to clearly outline all 3 of these.

Pick two production use cases that matter now. Get out in front of inevitable questions by naming what you are not doing yet, don’t hide behind hoping they don’t ask. Again, all of this comes to first understanding your customer’s business thoroughly.

Show the workflow inside real PMS, imaging, or payments, not just your UI. How will this integrate? Have you thought of all facets of the business that will be impacted? Have you included all relevant departments in the discussion?

TRANSPARENCY

Pilot like it’s production. State start date, go-live criteria, exit criteria, and who owns each task (work closely with the groups Project Management Office if they have one). Have a well-thought out plan built specifically for the customer you’re working with, not a template you’ve used on the last 4.

Publish the metric formula…aka write the KPI exactly the way you calculate it so any DSO analyst can reproduce it without your tool. Numerator, denominator, source system, refresh cadence.

Total cost of ownership in plain sight. Setup, training, integrations, overages, data egress, and price at scale. Displaying the FULL cost-of-ownership can be intimidating, but failing here puts the entire partnership in jeopardy moving forward.

TRUTHFULNESS

Say what the model can and cannot do today. Hallucination guardrails, confidence thresholds, and human-in-the-loop specifics. The TRUTH shall set you free!

Security and compliance aren’t bullets. It’s not enough to say “we’re secure.” Prove it with specifics any DSO security lead can verify. SOC 2 type, BAA posture, PHI boundaries, audit artifacts, etc.

References that answer hard questions. Offer two blind references and one who paused or churned, and explain why.

Action Plan: Design a Pilot That Wins

So what do all these bullet points look like in practice? How do you move from scanning a LinkedIn article to actionable execution? Once you’ve earned the DSO’s trust, design a pilot that’s set up for success. Skip the platitudes and possibilities. Instead, anchor your pilot to mutually agreed goals, clearly defined KPI’s and time-bound milestones.

“I have never cared what something costs; I care what it’s worth.” (Ari Emanuel)

To get you moving, use the first meeting checklist below. You’ll be surprised, many teams skip these essentials. Show how you create value in the real world….the pilot will follow.

Outline for your first meeting one-pager:

Problem we solve and the baseline we measured
Two workflows we improve with a 90-second loom
Data we need, how we secure it, how we return it
Metric formula, target, and reporting cadence
Pilot plan with owners and exit criteria
Price to pilot, price to scale, term flexibility
Three references and the best reason to tell us no

Pilot design that earns trust:

Success metric: “Net show rate for new patient calls” or “Attachment rate on treatment plans,” not vanity clicks
Timeline: week 1 data access, week 2 workflow config, week 3 soft launch, week 4 measurement review
Change enablement: who trains whom, how content is delivered, how proficiency is measured
Risk share: ramp pricing or performance credits tied to the metric you published

Pricing that signals confidence:

Land small with a path to standardize across regions when metrics hold
Simple tiers tied to usage or outcomes, not guesswork
No gotchas in month 13, no surprises on data export
Confidence that you can deliver wins the day here – price yourself accordingly to lay a foundation of long-term trust and partnership

To wrap up with an overview:

Tell the truth about today. Prove it in production. Share the risk. Make the numbers easy to verify.

Keep doing that over and over again that and you will beat louder promises with quieter proof.

If you’re an AI or software vendor selling to DSOs and can fill in the one-pager above, you will earn a second meeting. If you’re a DSO leader tired of promise fatigue, share this with your partners and ask for it up front.

My hope is that this article marks the beginning of the end for the phrases “coming soon”, “it’s in our development pipeline” and “that’s likely coming next quarter” while driving true partnership to propel our great industry forward.

Clayton currently sits as Vice President of Operational Strategy for Dental Care Alliance where he leads the Project Management Office and oversees the evaluation, implementation and execution of key strategic imperatives and initiatives to maximize impact throughout the organization. He also sits on Group Dentistry Now’s Editorial Board. Clayton welcomes feedback via LinkedIn through direct message or comment.

Read Clayton’s other article: Vendor-Partner: The Strategic Advantage of Partnership Over Transaction