The Intelligent Surgery Blog

Incorporating Quality by Design as a MedTech Startup

Written by Monica Williams | February 2025

As a medtech startup, you have an idea that could perhaps change lives. But how do you ensure your innovation works and is safe, effective, and scalable?

This is where Quality by Design (QbD) comes in. It's a mindset that can guide your journey from prototype to final product. Let's walk through how we incorporated QbD at Enhatch and some lessons we learned along the way.

What is Quality by Design?

Quality by Design is a systematic approach to product development in which quality considerations are proactively incorporated throughout the product's lifecycle.

  • Instead of fixing issues in an end product, you design quality into your product from day one.
  • It's about understanding customer needs, identifying risks early, and ensuring your processes consistently deliver products that meet regulatory requirements and patient expectations.

For medtech status, this means embedding quality into every decision, from initial sketches to clinical validation and beyond.

1. Start With the End in Mind

One of the first lessons we learned at Enhatch was to define our goals clearly.

  • What problem are you solving?
    For us, it was creating AI-powered solutions to improve preoperative planning. This helps define why the device is used and characterizes the use case in order to address the needs and risks that arise from user-device interactions.
  • Who is your end user?
    Surgeons, hospitals, medical device companies, and patients were at the heart of our decisions.
  • What are the regulatory requirements?
    Understanding FDA and ISO standards and guidance documents in detail helped us plan early and avoid surprises.

Document these answers. They will act as your compass throughout development.

2. Map Your Design Inputs and Outputs

In medtech, it's about translating an idea into a product that works in real life.

This starts with defining design inputs (design requirements, what the product must do). Design inputs are the starting point for product design.

Design inputs should be linked to design outputs (how the product will achieve this). Design outputs involve everything that goes into making the medical device.

For example:

  • Input: The software must generate accurate 3D models of patient anatomy.
  • Output: The AI algorithms were trained on diverse datasets to achieve high accuracy when compared to ground truth.

At Enhatch, each input-output pair was tracked and tested. This traceability ensured we stayed aligned with our goals.

3. Test Early and Test Often

Testing isn't just for the final product. We tested at every stage.

  • In early-stage concept and planning, we focused on feasibility setting the stage for accuracy improvements and robust integration.
  • Throughout development, we ran usability and voice-of-customer sessions with surgeons and medical device companies.
  • Before launch, we conducted rigorous verification and validation on various patient conditions and challenging case scenarios within the system's intended use.
  • Performance monitoring tools and cybersecurity surveillance ensure continual quality and compliance maintenance.

This consideration of quality throughout each phase allowed us to catch issues early and drive toward a reliable product with consistent outputs. Testing revealed any gaps and gave us time to pivot.

4. Embrace risk management

Risk management isn't just a checkbox for compliance. It's a way to protect your innovation.

We created a detailed risk management plan early. Every risk—technical, clinical, or operational—was identified, assessed, and mitigated.

One lesson we learned? Risks evolve.

In such a fast-paced development field, we were noticing increased cybersecurity concerns arising and flushed out a comprehensive security approach to address these risks and maintain operational effectiveness with controls and mitigations Staying proactive kept us ahead.

5. Collaborate Across Teams

An advantage of being a medtech startup is transparency, open communication, the ability to wear many hats, and, thus, the shared ownership of embedded quality.

QbD isn't just for your quality team; it's everyone's responsibility.

At Enhatch, we have focused on creating a quality-first culture right from the outset.

We held regular cross-functional meetings. R&D, quality, clinicians, data scientists, and marketing contributed to shaping the product. This collaboration helped us see blind spots and align on the bigger picture.

Tip: Encourage open communication. Some of our best ideas came from unexpected sources.

6. Don't Fear Documentation

Documentation can feel like a chore, especially when you're moving fast, but it's non-negotiable in medtech.

From our design history file to our risk management reports, documentation created a solid foundation. It also made audits and regulatory submissions smoother.

The key? Make it a habit.

We right-sized a regulatory-compliant QMS for the applicable procedures and policies to adopt and enforce. Additionally, we used tools to automate where possible, reducing the burden on our team.

7. Stay Flexible and Open to Feedback

The medtech journey rarely goes as planned. Regulations change, market needs shift, and your product will evolve.

For us, early feedback from customers highlighted features we hadn't considered. Instead of adhering rigidly to our original plan, we adapted. This agility allowed us to create a product that truly met user needs.

8. Plan for AI Workflow Risk Management

As a startup with an AI-powered product, we faced unique challenges. Ensuring the algorithms were transparent, explainable, and reliable required extra attention.

We incorporated QbD into our AI workflows by:

  • Implementing robust data governance practices.
  • Testing performance under varied conditions.
  • Keeping humans in the loop for critical decisions.

This approach not only built trust with users but also aligned with regulatory expectations.

9. Engage Early With Regulators

Regulators aren't your adversaries; they're your allies.

Our perspective of the FDA changed drastically after the opportunity for three Submission Issue Request (SIR) Q-Submissions. The FDA is very amenable to collaboration and discussion about your device and the sooner you initiate the better off you are.

Engage with the FDA early, seeking feedback during pre-submission meetings. This helped us align our QbD practices with regulatory expectations.

Tip: Don't wait until the review period clock is ticking to start these conversations. Early engagement saves time and reduces risk.

10. Celebrate the Wins (Big and Small)

Building a medtech product is hard work. QbD doesn't happen overnight. Celebrate milestones along the way.

For us, every completed prototype, successful test, or positive user review was a reason to cheer. These moments kept us motivated through the tough times.

Incorporating Quality by Design isn't just about compliance; it's about building a product you're proud of. It ensures your innovation delivers on its promise and improves lives.

As you embark on your medtech journey, remember to stay patient, stay focused, and keep learning. And if you're using AI, embrace the unique challenges and opportunities it brings.