The device works. The evidence is solid. What gets it to patients is understanding every human in the system — and building the conditions for each of them to move.
Reference sites and usage sites are not the same conversation.
I have been inside multiple product launches — direct sales, distributor models. When a launch stalls, it is almost never because the reference site work went wrong. It is because the reference site playbook was applied to usage sites — and those are a completely different engagement.
Workhorse hospitals want one thing: does this work in my system, on my terms, without breaking what I have already built? Getting them to genuinely adopt takes patience and operational depth that most commercial plans never budget for.
When you do that work properly, the model becomes repeatable. What you learned transfers to the next hospital. That is when you stop winning individual sites and start building a market position.
Reference site
Clinical credibility and endorsement
Values innovation and research. Tolerant of longer timelines. Success here gets you on the shortlist.
→ Gets you in the room. Essential but not sufficient.
Usage site
Scale, workflow and economic fit
Values simplicity, workflow fit and a clear economic case. Low tolerance for disruption. Success here builds the business.
→ Gets you the numbers. Requires a completely different approach.
The Lumenara position
Most companies apply the same approach to both. We build a distinct strategy for each — because success at one does not transfer to the other.
“Every stakeholder faces a different barrier. Real success happens when all are removed.”
Surgeon · Procurement · Nurse · Sales rep
What success looks like
When adoption is architected correctly
Three outcomes that happen when the full system is mapped before the investment is committed.
01
The board meeting changes
Instead of explaining why utilisation is below target, you are presenting a clear adoption pipeline — which sites, which stage, what is next.
02
The workhorse hospital becomes an asset
When you understand how it actually operates, the high-volume site becomes your strongest commercial proof point — not for clinical credibility, for scale.
03
Adoption compounds
Once you have the repeatable model, each new site moves faster than the last. That is the difference between a collection of wins and a market position.
“The reference site gets you on the shortlist. The usage site gets you a business. They require completely different thinking.”
Arun Kumar · Founder, Lumenara
“Rigorous architecture. Built for the human system, not the pathway document.”
Rigorous · Integrated · Human-centred
How we build it
Four stages to the repeatable model
We start by establishing what kind of site you are working with — and what that site actually needs.
1
Map the full human system
Surgeon, procurement, nursing, theatre, department leadership — each stakeholder, their specific barrier, what it takes to move them. Not the pathway document. The human system.
2
Distinguish reference from usage
Reference sites need clinical relationship management. Usage sites need operational depth, workflow fit and an economic case for the right audience. Different sites. Different plans. Always.
3
Design the adoption architecture
Workflow integration, training architecture, economic justification by audience, correct sequencing of engagement. The system sell most companies never fully build before launch.
4
Build the repeatable model
Stay embedded until you understand how the site actually operates. That understanding transfers. The second usage site moves faster than the first. That is when adoption becomes a market position.
Who we work with
Three moments where this makes the difference
We work across device types and commercial stages. The work matters most at three specific points.
Before launch — build it right
CE mark or UKCA cleared. About to commit the investment. Get the reference and usage site strategies right before the pressure starts — not after six months of stalled utilisation.
Pre-launchCE / UKCA clearedUK or EU entry
Post-launch — find what is blocking flow
Reference sites positive. Usage site adoption not following. The forecast gap is widening and the board wants answers. We find what is blocking the system and build the path through it.
Post-launchUsage site stallBoard pressure
Scaling — make the model travel
Adoption working in one system. Now it needs to move to new hospitals, regions or European markets. What worked in one context must be rebuilt for the next — not assumed to transfer.
Proven adoptionScaling phaseEMEA expansion
Two streams. One conversation.
Clinical intelligence
Active surgical practice — insight from inside the system your device is entering. When we map a surgical workflow we draw on what actually happens in the theatre. Not the protocol. The reality.
Commercial intelligence
Direct experience across multiple launches — direct sales, distributor models, reference sites and usage sites, board pressure. What the stocking order and the six-month review feel like from inside them.
“Both streams. In the same room. Building the same repeatable model.”
What we do
Four ways we engage
Each built around the same question: what does this device, in this system, at this stage, need next?
Clinical Adoption Strategy
The complete system sell — every stakeholder mapped, every barrier identified, conditions built for each to move.
Full stakeholder landscape mapping
Reference and usage site strategy — distinct for each
Workflow integration, training architecture, adoption monitoring
Early Market Architecture
Phase 1 commercial sequencing before the investment is committed — so what follows the launch actually compounds.
Market access pathway design and Phase 1 sequencing
Investor-ready commercial narrative
NHS, AHSN engagement and health economic evidence strategy
Commercial & Clinical Advisory
Ongoing partnership — senior commercial experience and active surgical practice on the same problem, for as long as both are needed.
Commercial strategy with clinical reality-testing
KOL development and centre of excellence
European market entry — EU MDR and UKCA navigation
Adoption Recovery
Usage site adoption stalled after a strong reference site launch — a clear diagnostic and a rebuilt pathway to scale.
Root cause diagnostic — reference vs usage site distinction
Stakeholder barrier reassessment and economic case rebuild
Re-sequenced adoption programme for usage sites
Common questions
What people ask at the start
Honest answers to the questions we hear before almost every engagement.
A reference site is a prestigious centre — typically an academic hospital — that provides clinical credibility. A usage site is a high-volume workhorse hospital where the device must function as part of routine practice at scale. Reference sites value innovation. Usage sites value workflow fit, training simplicity and a clear economic case. Confusing the two is one of the most common reasons MedTech launches stall after strong initial reference site performance.
Because they require completely different things. A reference site adopts because of clinical interest. A usage site adopts because the device fits the workflow, the training burden is manageable, and the economic case is compelling for that audience. Companies that apply the reference site approach to usage sites consistently find the model does not transfer.
Three things happen. The board conversation shifts from explaining underperformance to presenting a clear adoption pipeline. The workhorse hospital becomes a commercial proof point — evidence the model works at scale. And adoption compounds — each new site moves faster than the last because the understanding of how that type of hospital operates transfers.
Because every human in every system has a different barrier. The surgeon faces workflow disruption. Procurement faces budget pressure and unclear value. The nursing team faces training burden. The sales representative faces skepticism. Real adoption happens when all barriers are removed — not just the most visible one.
Typically 18–36 months from first usage site engagement. This reflects the patience required to understand how a workhorse hospital actually operates — its procurement cycle, theatre scheduling, training capacity and economic decision-making. Companies that try to accelerate by applying a reference site playbook consistently find the model does not transfer.
Yes. We work across UK and European markets. Through our EMEA partner network we support commercialisation across Germany, France, the Netherlands, Ireland and other EU markets. We also work with US and global device companies navigating EU MDR compliance and UK market entry for the first time.
Start the conversation
If you want the numbers to follow the investment — let’s talk.
Not a discovery call that ends in a proposal. A real conversation about where you are, what kind of sites you are working with, and whether we are the right fit.
Tell us the situation. We will tell you what we see — including if what you need is not us.
