You might be thinking: "I need a chief operating officer (COO). Or, if I can't afford one, a few good people to piece it together."
Short answer That instinct makes sense, and a COO or a stronger team may be the right move. Any new hire still needs structure to work with. Before you hire, make sure you can say where revenue is slipping, which workflows are documented, and which decisions truly need the owner, so your next hire has something to run.
Here's how it usually looks. Billing is a struggle, staff keep turning over, and every decision still lands on the owner's desk. There's a sense that something is wrong, with no clear picture of what. Hiring feels like the fastest way out. A new executive or a few new hires then walk into that same fog, and on their own they often struggle to clear it.
More people isn't the same as the right expertise
Revenue cycle is its own discipline. So are healthcare finance, operations, compliance, and technology. An office manager, a billing coordinator, and a part-time bookkeeper can each be capable and still not add up to someone who can see how it all connects and build a system to fix it. Without that, the main thing that grows is payroll.
A COO is still one person. Being fluent in every one of those areas at once, inside an organization they don't know yet, is a big ask, and it usually shows.
Ask yourselfIf you hired a COO tomorrow, what would you hand them on day one: documented workflows and clean numbers, or a list of problems to find?
It's an infrastructure gap, not a staffing gap
Many owners have run the practice on their own judgment for years, and it worked, because they're good at it. The strain shows when the practice outgrows what one person can hold. Sometimes that's growth. Sometimes the practice is small and stuck: staff is thin, turnover is high, and the owner makes every call, not by choice, but because nothing else is set up to make the answer clear.
Adding people in the hope that the problem spreads out rarely works. What's missing is structure, and neither headcount nor a single executive supplies that on their own.
The question isn't who to hire. It's whether the practice is ready for anyone you hire to succeed.
What has to exist first
A practice that's ready for operational leadership, whether a COO or a capable team, can answer a few basic questions clearly:
- Revenue. Where is revenue slipping, and why?
- Workflows. Which workflows are documented, and which exist only in someone's head?
- Decisions. Which decisions truly need the owner, and which land there because nothing else catches them?
Without those answers, a new hire can spend months finding them out before anything improves. That's a long, costly runway.
Ask yourselfOf the decisions that reached you last week, how many truly needed you?
How we approach it
We bring expertise matched to where your practice is under pressure, whether that's revenue cycle, operations, finance, or technology, from people who have done this work inside practices. In the Assessment, the first 30 days of a 90-day plan, we examine what's happening and diagnose where the problems are concentrated. Then we work with your team to build the structure that lets the practice run without the owner at the center of everything: documented workflows, clear financials, and defined roles with real decision authority.
We build systems your team can run. They stay with the practice, and we stay involved for as long as it helps, so whoever you hire next, whether a COO, an operations lead, or a stronger team, walks into something they can work with.
We're not the alternative to hiring the right people. We help make the people you hire effective once they arrive.
If you're already having this conversation
A COO or a stronger team may be exactly right for your practice. Before you commit to either, take a clear look at what you have and what it would take for the next hire to succeed.
See what this looks like in your numbers.
Start with a free first look at your numbers in a discovery call.