Justin Fulcher on Managing Relationships with Institutional Clients
Winning a contract with a government agency or large healthcare institution differs from closing a commercial deal. The sales cycle is longer, the decision process involves more people, and the threshold for trust is higher. But the harder discipline, and the one fewer founders think about, is what comes after the contract is signed.
Justin Fulcher is a technology founder who has spent two decades building companies, serving his country in the public sector, and working inside the institutional systems and regulated environments that shape both. He built RingMD from a telehealth startup into a platform serving government agencies and hospital systems across more than 50 countries. He then spent six months in Washington in public service, first at the Department of Veterans Affairs and then as a Senior Advisor at the Pentagon.
His experience on both sides of the vendor-institution relationship shaped his opinions on what institutional relationship management requires.
Why Institutional Relationships Differ from Commercial Ones
Institutional clients operate under conditions that shape how they engage with vendors since they’re often accountable to elected or government-appointed stakeholders. Their procurement processes and their approach to managing vendor relationships reflect that accountability in a way that’s not common in the private sector.
For a technology founder entering these sectors, the adjustment goes beyond learning a new sales process. The institution isn’t just buying a product. It’s initiating a relationship that carries organizational risk. In high-stakes environments, where the consequences of a failed deployment extend beyond a commercial loss, that caution is institutional drag by design rather than bureaucratic inefficiency.
Justin Fulcher has spent close to two decades navigating these complexities across healthcare and government sectors, building companies whose survival depended on sustaining institutional trust. His focus has been on the real-world constraints that institutional partnerships involve, and on building the relational infrastructure that those partnerships require.
Credibility Doesn’t Transfer Between Institutions or Sectors
Procurement cultures differ between institutional agencies, as does risk tolerance. Institutions tend to carry memories of past vendor failures that shape how they assess new entrants, regardless of what those vendors delivered elsewhere. A strong track record with one government partner is useful context, but it doesn’t substitute for the trust-building process each new institution requires.
Fulcher encountered this while scaling RingMD across government and institutional health partners in multiple jurisdictions. The platform’s early government partnerships in Asia and its later work with U.S. federal agencies involved different procurement environments, different compliance requirements, different stakeholder structures, and different definitions of success. What carried over was the underlying capability of the product.
“Every institution has its own culture, its own risk tolerance, and its own definition of what a trustworthy partner looks like,” Fulcher has said. “You don’t often get to import credibility from somewhere else. You earn it where you are.”
Institutional Decisions Involve Many Distributed Stakeholders
In commercial sales, it’s often possible to identify a primary decision-maker and build the relationship around them. Institutional procurement tends not to work that way. Government agencies and large healthcare organizations make vendor decisions through processes involving procurement officers, legal and compliance teams, operational leads, clinical staff in healthcare contexts, and senior leadership. Each group evaluates the vendor against different criteria, and a deal backed by one group can still stall when another raises concerns.
A practical approach to this challenge is to map the stakeholder landscape early and maintain contact across it. That doesn’t mean lobbying every person in the building. It means understanding who has authority over the decision, what each group’s concerns are likely to be, and making sure the relationship isn’t dependent on a single point of contact.
“You don’t win an institutional deal by convincing one person,” Fulcher has said. “You win it by making sure no one with a stake in it was left out of the conversation.”
How Institutional Trust Builds Across Regulated Environments
Institutional trust accumulates through consistent delivery over time. It’s damaged quickly by a single failure to deliver on a stated commitment, whether a missed compliance requirement, a deployment that runs late, or a capability described in broader terms than the product could support.
Justin Fulcher’s operating principles address this risk directly: execution over narrative, accountability over optics, durability over speed. Those aren’t abstract ideals in an institutional context. They describe the behaviors institutional clients watch for, because those clients have seen enough vendors overpromise that they’ve built evaluation processes designed to detect it.
Building institutional relationships requires sustained execution across the full life of a partnership, not just during the sales process. Accountability isn’t something institutions grant to vendors. It’s something vendors demonstrate through consistent delivery, and that takes time. The relationship doesn’t peak at contract signing. That’s the point at which the institution starts forming its actual opinion of the vendor.
What Managing Institutional Relationships Looks Like in Practice
Managing institutional relationships is unglamorous work. It involves consistent communication with multiple contacts across the institution. It involves surfacing problems early rather than managing them when they become harder to explain. And it involves setting and meeting conservative expectations, rather than hoping work catches up to overly optimistic goals.
In regulated environments, deployments involve clinical workflows, compliance requirements, and integration across core systems. The implementation phase tends to surface friction that no procurement process fully anticipates. How a vendor handles it frequently determines whether the relationship continues beyond the initial contract.
Founders who treat implementation as purely a delivery exercise, rather than a test of the relationship, can damage the client’s confidence during that phase. A vendor that communicates clearly and works through problems as it solves them tends to come out with a stronger relationship than it had going in.
Relationships built during the sales process matter here, too. A vendor connected across multiple stakeholders has more channels for managing a potentially difficult implementation.
“The implementation phase is where a lot of institutional relationships are won or lost,” Fulcher has said. “Getting the contract means you’ve cleared the bar to be there. What you do during deployment is what tells the institution whether they want to keep working with you and what the future holds.”
What Fulcher Observed as a Public Sector Advisor in Washington
Fulcher’s time in public service gave him a view of institutional relationships that most technology founders never get. As a founding member of the Department of Government Efficiency, and later as a Senior Advisor at the Pentagon under Secretary of War Pete Hegseth, Fulcher was inside the institutions technology that vendors were serving. What he observed there confirmed what he’d learned building companies in the private sector.
He repeatedly saw vendors arriving at institutions in Washington with a strong grasp of their own product but a limited understanding of the institution’s operating environment.
In contrast, successful vendors understood and acknowledged the institution’s constraints and goals as part of the sales process, often asking more questions than they answered in early meetings. These vendors also grasped that in an institution where many stakeholders have authority over a decision, the relationship had to be built broadly, not just with the person who invited them in.
That focus on institution-wide relationships is one of the disciplines that applies whether the client is a defense department agency, a hospital system, or a public health organization building critical infrastructure for a patient population.
“The vendors who made real progress were the ones who’d done the work to understand the institution before they tried to sell to it,” Fulcher has said. “They understood that the relationship was with an organization, not a single buyer.”
What Productive Institutional Relationships Require
Justin Fulcher’s perspective on institutional relationship management is shaped by an uncommon combination of experience: building companies in regulated environments that had to earn institutional trust repeatedly; working across different markets and compliance frameworks; and then spending time inside government, working with institutions served by private sector technology companies.
The founders who do well in these sectors tend to bring the same discipline to relationship-building that they bring to product development: consistent execution, clear accountability, and a focus on what the institution actually needs rather than what’s easiest to sell. The work compounds slowly. But in institutional environments, it’s the work that lasts.
