Firstly, Open Source is not a factor here. The number of customers who care about our code is zero. Not even rounding to zero, just zero. Paying someone to look at, understand, Make, test, change etc dwarfs what they pay us. They are in the "health" business not the software business.
Our business model -does- matter though. We often get evaluated "as a supplier". The obvious things like how long we've been around, staffing levels, track record etc. Also non-obvious things like profitability, income model, some even ask to see the books (we draw th line before that.)
It turns out they're not buying software. They're buying a relationship. They want to know we'll be around in 5 years, 10 years, 15 years. That's -much- more important than the cost.
(As an aside, having the primary message on your front page literally soliciting donations is a bad look. Funding via donations overall is not a good look.)
Lastly the software is not used by the guy who makes the purchasing decision. The buyer doesn't care about the UI or workflow (much). As long as the price is "ok" (and he has a large budget to spend) that doesn't matter either. He cares about the warm and fuzzies the salesman gives him. He cares about the success of the project overall. He cares about his job rolling out this big project. Decisions like this are career making, or career breaking.
Oh, and the desire to -change- systems is zero. Sure there's lots of whining, that's easy to ignore. Changing is high risk (and will bring in the same amount of whining).