Post-Close Operating System Build

Founder-led reactive management → institutional operating discipline in 12 months

~16 sites · ~100 providers · ~$50M revenue at acquisition

THE SITUATION

Sixty days post-close. The board asks for the first KPI report. There isn’t one. The CFO is pulling numbers out of three spreadsheets the founders maintain by hand, and nobody can answer how the business actually performed last month.

That was the picture when the PE sponsor stepped in. Strong clinical reputation. Loyal patients. Committed providers. And a business that ran on the founders’ presence: decisions in hallways, performance in the CEO’s head, board updates filtered through whatever the founders chose to share. The platform needed an operating system that could survive the founders stepping back without destroying what made the business work.

WHAT I BUILT

• Organizational assessment presented to board to inform restructuring

• KPI dashboards across clinical, operational, and financial dimensions

• Monthly operating reviews, quarterly board reviews, annual planning cycles

• Clear ownership: every initiative had an owner, a timeline, and a metric

These three dimensions are interdependent. Assessment without performance infrastructure produces a one-time snapshot. Performance infrastructure without a planning cadence produces dashboards nobody acts on. A planning cadence without organizational clarity produces plans that stall on execution. The operating system needs all three running together.

THE RESULT

• 10% SG&A reduction through organizational redesign

• 20% increase in employee engagement scores through the professionalization

• Planning cadence institutionalized

• Board and leadership gained operational visibility for the first time

THE TRAJECTORY

Over the four-year hold that followed, the platform scaled from roughly 16 to 36 sites, ~100 to 400+ providers, and ~$50M to $100M+ in revenue, completed around 20 add-on transactions, and stood up a clinically integrated network covering tens of thousands of lives. Every subsequent build ran on this foundation.

CFO owns monthly reviews. COO owns quarterly reviews. Department heads own functional KPIs. The cadence is embedded in how leadership runs the business. This operating system became the foundation for every subsequent build during the hold period.

Where is the platform stuck?

Sixty days post-close and the board’s asking for KPIs you don’t have yet? Let’s talk.

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