For startup companies, outstanding execution is non-negotiable. While investment is again increasing, time to market and financial stability remain critical aspects for any executive team. In my experience, startups fail just as often from poor execution or executives who are not aligned or understanding of the inherent business risks as they do from a concept or therapeutic that didn’t work.
IPM’s research has shown that alignment among executives is critical to achieving efficient execution. Biotech startups may think they are immune to misalignment since they are smaller and have fewer communication combinations.
But many, if not most, of the emerging biotech companies we work with still have misalignment in their company goals and the inherent risks, either among the executive team themselves, among the project execution team functional members, or between the project team and the executive team—any of which can hinder execution and cause critical delays.
Tales from the Front
A biotech company that we supported recently was in later-stage development and facing the pressures of regulatory deadlines and product launch preparation. These pressures revealed misalignment in several areas. One was strategic versus operational, where frequent changes from the clinical team (e.g., protocol adjustments, accelerated timelines) clashed with CMC’s capacity. Another was that a minimal project execution framework left the teams without shared tools to gauge and track progress or gaps, or decision-making processes. And a third was limited executive involvement to change a culture of hesitancy in cross-functional sharing of timelines, which undermined planning. Remedying these misalignments and issues created an environment where the team was able to execute much more effectively and efficiently.
Another emerging biotech we were brought into was in a key transition phase and had experienced significant leadership challenges when abrupt changes and removal of dissenting voices revealed poor alignment on strategic priorities and intolerance for healthy debate. Departures of key roles and the overlapping responsibilities of drug development blurred accountability, and decisions were poorly communicated. Additionally, some leadership-driven changes clashed with execution realities, generating wasted effort. Helping the company create clear governance structures, aligning strategic goals with operational capacity, and fostering transparency resulted in greatly improved execution.
A third biotech startup we supported was progressing their drug candidate through Phase 2 clinical trials and was at a critical juncture trying to balance key strategic partnerships and financial viability. Beyond project risk, the executive team wasn’t aware of the company’s overall financial, functional, and business risk that could derail their ambitions. Establishing a shared understanding of key organizational risks and contingencies enabled faster, more consistent decision-making and greater organizational transparency. That alignment cascaded throughout the company, creating a more unified workforce and improving the execution of development efforts.
Three Key Questions
A simple but powerful first step executives can take to drive successful execution is to align on a few critical questions. Ask yourselves and your teams the following:
- Question 1: What are the two most important, measurable milestones we must achieve in the next six months and 12 months?
- Question 2: What are the two greatest risks to the success of our business, and are we fully aligned as an executive team on those risks and how to address them?
- Question 3: What are the two most significant project risks that could prevent us from achieving our six- and 12-month milestones?
The quality of the answers will quickly reveal whether your organization has the clarity, alignment, and risk awareness necessary to execute successfully. Once you understand the gaps, you can address them. Achieving alignment will be critical to optimal execution—it will focus your resources to the most important few things.
Try asking the questions above and see what you learn. And if you have time, please let me know the results at [email protected].
For more insights about how leadership teams can get and stay aligned, including results from exclusive IPM research, download You’re Not as Aligned as You Think You Are.
August 6, 2026
