Insights by Rachel Feinman, SVP of Innovation and Managing Director of TGH Ventures, Tampa General Hospital on The Big Unlock podcast
“At TGH, we don’t do pilots.” That line, which was delivered with equal parts conviction and practicality, sets the tone for this episode of The Big Unlock. Rachel Feinman’s point isn’t that Tampa General Hospital flips a switch and rolls everything out systemwide overnight. It’s that they refuse to live in what she calls “endless pilots,” where momentum dies slowly and “testing” becomes a polite way to avoid committing.
Rachel brings a distinctive lens to this conversation because her path into healthcare innovation didn’t start in the usual place. She began as an M&A and business lawyer and found herself frustrated by how quickly strategic conversations ended right when the most interesting operational problem-solving began. She wanted to be in the room where strategy, execution, and value creation were actually happening, not just documenting it after the fact. That mindset, combined with deep involvement in the startup ecosystem, eventually led her to help create what is now TGH Ventures, Tampa General’s innovation, investment, and commercialization arm, translating a CEO’s vision into a structured operating model.
In other words, Rachel isn’t describing innovation as a slogan. She’s describing it as an execution system, one built to move quickly, measure clearly, and scale outcomes, not just ideas.
Escaping “pilot purgatory” starts with a mandate, not a mood
The phrase “pilot purgatory” shows up early in the conversation, and Rachel doesn’t dance around it. She describes a very specific reason Tampa General took a hard stance: pilots often become “a slow no,” or a symptom of misalignment and inability to prove results.
The mandate at Tampa General came from CEO John Couris after frustration with the way pilots can drag on without delivering meaningful operational change. Rachel is careful to clarify that this isn’t about recklessness. It’s about discipline. The organization still starts in a focused place, with a defined problem and an approach designed to prove impact quickly. But the intent is different.
They start with a thesis.
They identify the right partner and solution.
They begin in a setting where results can be measured quickly.
And if the solution performs by driving the outcomes they expect, they scale fast.
For Rachel, this is the key; the “pilot” is not the goal. It is the smallest version of a scaling strategy. If it works, they don’t leave it in limbo. If it doesn’t, they stop and move on.
This stance is important because it reframes the most common failure mode in healthcare innovation: treating experimentation as a destination instead of a step in an outcomes-driven path.
Rachel’s insistence on a thesis-first approach also solves another chronic problem: innovation that chases “the next shiny object” instead of measurable needs. A thesis forces specificity. What outcome are we driving? Where will we start? How will we measure? What would success look like, and how quickly should we see signals?
This is how organizations avoid building impressive “proofs of concept” that never integrate into real operations.
Moving fast without compromising safety: “go slow to go fast”
One of the most valuable parts of the episode is how Rachel resolves a tension every health system leader recognizes.
On one side: “fail fast,” experiment, iterate.
On the other hand, healthcare’s tolerance for risk, especially in clinical settings, is low, and for good reason.
Rachel doesn’t pretend those forces magically align. She explains that the reason healthcare hasn’t moved as quickly historically is that when you’re talking about patient care and safety, failures can have serious consequences. “Fails around safety are not okay,” she says, and that becomes the grounding principle.
So how does a system move faster without compromising safety?
Her answer is to separate domains and apply the right speed to the right work.
She describes an enormous opportunity to innovate in the administrative, operational, and logistics layers of healthcare, well before you get into direct clinical decision-making. She even frames health systems as “one giant logistics company,” coordinating people, schedules, resources, and information across complicated care protocols. In those areas, moving fast is not only possible, but it’s also necessary. Scheduling efficiency, care coordination, and non-clinical process redesign can produce a meaningful impact quickly and safely.
When the innovation touches clinical care, the approach changes.
That’s where her “go slow to go fast” philosophy comes in.
The idea is to go slow at the beginning to set the right guardrails. Put the right governance in place. Get the right people around the table early, such as clinical leaders, safety stakeholders, compliance, and operations, so you don’t spend months later stuck in “what if” loops. It is imperative to do the careful work upfront, deliberately, while accelerating as quickly as possible, in a meaningful way, to the end goal.
Once governance, safety, and guardrails are clear, you can move faster with confidence. You’re not skipping safety, you’re engineering for it, out of the starting gate. This mindset is a direct antidote to a common problem: innovation teams doing great work, only to hit a late-stage wall of approvals and concerns. Rachel is essentially describing a system that front-loads alignment, so execution doesn’t stall later.
The innovation engine: partnerships, ventures, and proof of value
Rachel’s role spans innovation, ventures, and digital solutions, and she explains how TGH Ventures operates with a dual focus that many systems struggle to balance.
Yes, there is an investment strategy. Financial diligence matters. The organization wants confidence in the likelihood of a solid financial return on venture investments.
But her emphasis is clear: strategy comes first.
TGH Ventures evaluates whether a company advances Tampa General’s system strategy, not in generic terms like “improving patient experience,” but in ways tied to the organizational action plan and specific tactical priorities. That matters because it forces venture activity to support real operating goals rather than becoming a separate “innovation island.”
She offers a concrete example: Reimagine Care.
What makes this part of the conversation resonate is that it’s not delivered as a pitch. It’s delivered through lived experience. Rachel shares that her father was diagnosed with esophageal cancer and was treated at TGH. Navigating oncology symptoms and treatment side effects is complex. It can create a high burden on patients, families, and care teams. The number of messages to providers grows. Nurse lines have hours. Families worry about when they’ll get answers and what to do if they don’t.
In that context, Reimagine Care’s model, AI coupled with 24/7 clinical support, is framed as a practical solution: help patients manage symptoms, reduce avoidable emergency room visits, improve satisfaction, and reduce provider burnout. Rachel cites outcomes seen at other institutions: up to a 70% reduction in avoidable ED visits for oncology patients.
Whether or not every organization achieves that exact number, the point is larger: Tampa General isn’t investing for novelty. It’s investing in solutions that can produce measurable operational outcomes and relieve real clinical pressure.
This is also where her “beyond the walls” theme becomes clearer. She repeatedly highlights the fragmented nature of care, with patients often moving between settings, specialists, and touchpoints that don’t always connect. Innovation that matters, in her framing, is innovation that stitches that fabric together, so nothing falls through the cracks.
That “connective tissue” focus is not theoretical. It is the difference between a healthcare experience that feels like a series of disconnected transactions and one that feels coordinated and safe.
Scaling impact requires a thesis, governance, and the courage to commit
Rachel Feinman’s message is straightforward: healthcare doesn’t need more experimentation for experimentation’s sake. It needs a repeatable operating model that moves promising work into real impact.
At Tampa General, that begins with a refusal to linger in “pilot purgatory.” It’s not a rejection of starting small, it’s a rejection of staying small without decision. The approach is to start with a thesis, pick partners intentionally, measure results quickly, and scale fast when outcomes are proven.
She also offers a mature answer to a question that often paralyzes organizations. How do you move fast in a zero-risk environment? Her answer is to apply the right speed to the right domain. In other words, move fast in operational and administrative workflows where there is a massive opportunity, and “go slow to go fast” in clinical innovation by putting governance and guardrails in place early.
Finally, she points toward the real frontier: connecting fragmented care journeys and extending care beyond hospital walls, so patients experience a seamless system rather than disconnected silos.
The through-line is execution. Not ideas. Not pilots. Execution.
The Takeaway
Rachel Feinman’s view of healthcare innovation is refreshingly practical. In her world, the industry doesn’t need more pilots that drift without commitment; it needs an outcomes-driven model that starts with a clear thesis, measures value quickly, and scales what works with urgency. Her message is also nuanced: healthcare can and should move fast in logistics, access, and operational workflows, while using a “go slow to go fast” governance approach for clinical innovation where safety must be engineered upfront. In her framework, AI is a powerful accelerant, but only when paired with intentional partnerships, disciplined measurement, and a system-level focus on stitching together fragmented care journeys so patients experience continuity, not silos. The organizations that lead won’t be the ones running the most experiments. They’ll be the ones that can standardize, support, and spread proven solutions because their innovation strategy is built for scale impact, not just scale ideas.
Sitting at the intersection of strategy, deal-making, and real operational accountability inside a large academic health system, Rachel Feinman’s unique insights are especially valuable:
- “Pilot purgatory” is avoidable when leadership mandates impact: start with a thesis, prove results, and scale quickly instead of drifting in endless tests.
- Healthcare can “fail fast” in operational and administrative workflows, where logistics and coordination offer massive upside without compromising clinical safety.
- For clinical innovation, the right approach is “go slow to go fast”: set governance and guardrails early so execution can accelerate later.
- A health system venture arm creates the most value when investments are tied directly to the system’s strategic action plan and not generic innovation goals.
- AI becomes meaningful when it compresses cycle time, turning insights into near real-time outputs that move stakeholders from discussion to action.
- The next frontier is connecting fragmented care journeys and extending care beyond hospital walls, so patients experience seamless coordination rather than specialist silos.
