A David and Goliath Story: Succeeding as a New Entrant in the Established U.S. Advanced Wound Care Market


An interview with Terry Bromley, Senior VP and GM, Crawford Healthcare U.S.

When UK-based Crawford Healthcare made the decision in 2013 to enter the highly competitive U.S. advanced wound care market, it faced the daunting task of developing and executing a winning strategy. Although highly fragmented, the U.S. market is dominated by a small handful of players, including Smith & Nephew, Acelity, Molnlycke, and ConvaTec. Together, these four companies compose over 70% of the ~$2.5 billion U.S. advanced wound care technology market.These well-established companies, with their solid platform of product awareness and network of relationships, presented much the same to Crawford as Goliath did to David, when he turned to face off with his giant competitor.

When I spoke with Terry Bromley, Senior VP and GM, about how he spearheaded the U.S. launch of Crawford, he did not choose to face this challenge without significant forethought around the plan of execution. One of his first considerations was how to address the dynamics of the U.S. wound care arena, which could be classified as simultaneously encouraging and challenging. The introduction of the Affordable Care Act (ACA) has prompted significant changes that align and incent hospitals to offer and increase quality of care, while reducing cost. These changes have paved the way for the introduction of new and improved technologies that demonstrate proven clinical benefits, with additional opportunities to be incorporated into facility protocols for the prevention and management of wounds. However, the introduction of the Affordable Care Act has applied downward pressure on costs that have eroded manufacturer margins, making it a challenge for smaller players like Crawford to compete due in large part to a lack of economies of scale in production, distribution, and sales. Although these are barriers to entry, Terry did not view them as insurmountable, instead focusing on the opportunities that he could exploit.


Overall, the U.S advanced wound care market is compelling, with strong clinician and patient awareness of wound technologies that serves to generate demand and volume growth. In addition, the regulatory pathway for the introduction of a new medical device is relatively straightforward, provided there is a predicate product available that has already been cleared by the FDA. However, lower barriers to entry alone could not lead Crawford to success. Simply stepping into the fight does not guarantee victory, especially when facing such fierce and entrenched competition. The Crawford team possessed the key attributes necessary to succeed as an underdog: the right “tools” supported by a courageous vision; a targeted market-focused strategy; and expert skill in the delivery of their strategy. Together, these elements can, and do, produce winning results, and during our conversation, Terry shared the thinking that went into the successful development and execution of Crawford’s U.S. launch plan.


Just as when David spotted the rock he would use in battle, Terry felt confident he had the right portfolio of products needed to battle his marketplace “Goliaths.” The UK-based Crawford team had thoughtfully developed and acquired a portfolio of advanced wound care technologies that Terry knew would be well-received by the U.S. wound care market, if he could support them with compelling, benefits-based messages and effectively deliver them to the highest-interest audiences.

From his years of experience in the U.S. medical device field, he was convinced that these dressings possessed both the clinical and value propositions that would be compelling to U.S. wound care clinicians, as well as resonate with healthcare administrators and payers aligned with pay-for-performance and quality-of-care based payment models. He says that having a solid belief in the products of your company makes the opportunity to sell them a personally fulfilling undertaking in the quest to improve patient quality of life.

Building on this confidence in the product portfolio, Terry envisioned the establishment of Crawford U.S. as a top-selling advanced wound care dressings provider that is used in the hospital setting, following patients across various venues of care. However, with limited resources, and the incumbent “Goliaths” to contend with….how would he build toward this vision?


Terry discussed the investment he and his team made upfront to similarly address the “how” and “where” for their launch. They invested time to segment the market and analyze the attractiveness and Crawford’s ability to win in each segment. This helped them pinpoint their initial and secondary targets, as well as quantify various selling and distribution models in order to budget for and allocate resources.

When David selected the rock to use against Goliath, he knew that he had selected the right “tool” to deliver on his goal (the “what” he would use to try to win). However, he also had to think through the “how” and “where” aspects in order to implement his strategy to ultimately defeat Goliath.


Just prior to Terry’s joining the company, Crawford had licensed a silver-based wound dressing already being sold in the U.S. market, and additionally acquired its associated field sales force. “This was our initial platform to build upon as we launched the UK product portfolio into the U.S. market,” Terry says. “Although the licensed silver technology provided us with a great starting place, it did not come with widespread product awareness, existing contracts, or strong distribution channels. Therefore, we knew we had to identify a segment of the market where decision-making is more heavily dependent upon clinicians, and where this technology would be recognized for its high potential to deliver desired clinical outcomes.”


“We considered a variety of initial segments for our U.S. launch, such as post-surgical wounds. Physicians treating these are faced with helping to limit the number of hospital acquired infections (HAIs), a metric rising in importance across acute care facilities due to underperformance resulting in significant reimbursement hold-backs.” Ultimately, they targeted the burn market for several reasons. This is a well-established and easily-identifiable community of clinicians, with patients who have a high level of immediate need. Product decisions are normally controlled by clinical decision makers, who can appreciate the differentiation that their product offers. And finally, the sales team they had acquired through the license was seasoned in the field of burn care and had deeply established burn care clinician relationships.

Advanced burns provided the perfect gateway for Crawford’s market entry and ability to add significant value alongside its silver technology product and greater wound care product portfolio.

He continued “With our initial point of entry selected for our platform product, we then focused on developing and executing the rollout strategy to bring in and succeed with the larger Crawford product portfolio. We did this by adopting an approach that is marketing-led and sales-driven. Our goal was to enable the sales team to expand into new areas and venues where the products could be successful by providing high customer value.” Positioning this growth strategy within the context of the market drivers, which include the ACA’s mission to drive better care by implementing quality indicators to measure clinician performance, meant they had to focus on the clinician need to perform against these quality indicators. The Crawford portfolio includes a range of products that decrease wound occurrence as well as help promote wound healing. So their strategy included the development of messages that clearly articulated and quantified these product benefits. They supported their claims with researched-backed data. This approach continues to guide their focus on additional venues where they can be successful by reliably supporting standards of care. “It has also helped drive our resource allocation decisions, such as the choice not to directly focus on the long-term care (LTC) market. There are about 14,000 LTC facilities across the U.S., and we would not be able to provide this level of customer experience if we were stretched that far. However, beyond burn care centers and wound clinics, which we can attend to as we grow our direct sales force, we needed to decide how to access the 5,000+ U.S. hospitals.” The analyses they performed in building out their 5-year strategic plan determined that acquiring this broad base of customers was going to be critical to success.

“To attempt this on a direct basis is nearly impossible, and also unaligned with hospital goals such as decreasing multiple invoices from multiple vendors. In these larger-volume institutions, key players are group-purchasing organization (GPOs), most of which designate a prime vendor distributor. Therefore, we have built a strategy that incorporates elements of organic growth in the post-acute environment, and strategic partnerships in the acute environment.”


“With this relevant positioning of both prevention and treatment, our sales organization has been able to explain how our products can positively impact quality indicators, such as the prevention of hospital-acquired pressure ulcers, or a decrease in the number of HAIs. Once the decision has been made to utilize Crawford products, our team can then work with the clinicians and administrators to incorporate our products into a facility’s protocol of care.”

Having a solid plan, great products, and a delivery system in place will only lead to success—especially if facing fierce competition—when driven by deep sales and marketing expertise. Although he was the underdog, David was able to swing and release his rock with such force and pinpoint accuracy that he prevailed. Similarly, the Crawford team possesses the intelligence, skill and enthusiasm to successfully execute the U.S. strategy.

“We set out to hire on experience and a will to win.” Terry says. “We wanted people who could deliver on the plan. We wanted Crawford sales and marketing personnel to have the maturity to anticipate the challenges within their personal domains as well as within the greater healthcare marketplace, with its rapidly-evolving changes in metrics, payment models, and product-approval processes. Many startups bring in academia-based people. However, we built an organization with experienced professionals who understand the business drivers and are able to drive action plans in ways that greatly facilitate our sales processes.

“Anyone on our team—in marketing, sales, R&D—can lead and effectively interact with customers. We all possess a depth of understanding in our target therapeutic areas that is rare in our industry. Further, our insights deepen with our commitment to having two-way conversations where we truly listen to and learn from our customers, gaining insight to strengthen our offerings. Having a team where everyone has these skills has really set us apart from the competition, and is the key reason we have developed strong, trust-based, customer relationships.” In addition to really having that outward, customer-focused view, as well as a seamless, mutually-reinforcing sales and marketing team, Terry reports that they have an insatiable drive. “Enthusiasm is not only a pre-qualified characteristic of our hires, but also something that is further cultivated internally with mentoring, support, and recognition. I recently rode with a rep in Chicago who entered his territory 18 months ago with no pre-existing Crawford product sales or brand awareness. Now he is well on his way to being totally self-sustaining. When I asked him what he believed were the key drivers of his success, he attributed it to the confluence of comprehensive product training and marketing support; our high-quality, data-supported portfolio of products; a smart and focused selling strategy; and a passionate attitude that permeated the entire organization. In short, he felt prepared and supported by Crawford to successfully take on his Goliath.”


With their skilled team, streamlined distribution, and deeply established customer relationships, they have been able to double the business of Crawford U.S. for three consecutive years. They have built a profitable business and captured market share. “With our product messages that offer solutions to address specific clinical needs, we have recently been awarded a multi-year contract position with one of the largest GPOs in the US. This position now allows us access to over 3,500 hospitals and 130,000 associated member facilities where the Crawford team can spread a winning customer experience.

“It has not been easy to succeed in this competitive industry, but it has been an exciting and enjoyable ride, and one that we plan to take to the next level by incorporating our learnings and building on all of the great relationships we have established.”

For Terry and the Crawford U.S. team, these wins have not derived from matching the size of Goliath. Instead as David, they are succeeding by leveraging their agility, skills, and ability to execute with courage and enthusiasm, in this highly dynamic and continually evolving U.S. advanced wound care marketplace.

1 Analysis of the Advanced US Wound Care Technologies Market; Emerging Technologies Expand Wound Applications. Frost & Sullivan, June 2015 (note: base year of figures is 2014).

Terry Bromley

Sr. Vice President and General Manager Crawford Healthcare Terry is an entrepreneurial executive skilled in setting strategies, leading teams, and commercializing technologies. He has broad experience in general management, marketing, strategic planning, and sales management, and is adept at optimizing resources in both large corporate and start-up environments.


Crawford Healthcare is a supplier of advanced wound care products covering a broad range of skin conditions. It is a rapidly growing international company dedicated to developing innovative treatments and effective dermatological, wound care and diagnostic products for the care and repair of skin. Its international head office is in Knutsford, Cheshire, UK, where it is the country’s fastest-growing skin care company. From early 2013, Crawford Healthcare Inc. began operations out of the US, through its office in Doylestown, PA.


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