A Chief Operating Officer (COO) helps oversee the day-to-day business of an organization.

In a healthcare practice, that can mean managing the administrative and leadership teams, keeping an eye on financial performance, improving how work gets done, and making sure the business is moving in the direction the owner wants it to go.

It's a role that often develops out of necessity.

When a practice is small, the owner can usually manage most of these responsibilities themselves. As the practice grows, there are more employees to support, more decisions to make, and more moving parts to keep track of.

At some point, running the business can become a full-time job of its own.

A COO helps carry that responsibility.

And because not every practice needs or can afford a full-time executive, fractional COO support allows you to bring in experienced leadership for an agreed-upon amount of time without making a full-time hire.

There's no particular number of clinicians or revenue milestone that tells you it's time to bring in a COO.

I would pay more attention to how the business is functioning.

Are you still the person everyone comes to for decisions? Are you spending more time managing administrative problems than working on the things you care about? Do you have capable employees who need more direction or support than you have time to give?

Maybe the practice is growing, but you're not entirely sure whether it's becoming more profitable. Or you've hired managers, but you're still carrying much of the responsibility for their departments.

Those are the kinds of situations where additional operational leadership can be helpful.

It doesn't necessarily mean you need a full-time COO. It may mean you need someone experienced to help you understand what's happening and determine what kind of support would make a difference.

The biggest difference is how involved I am in running your business.

As a consultant, I'm typically brought in to help with a particular problem, project, or decision. We agree on what needs to be accomplished, and I work with you to develop and implement a solution. Once the work is complete, the engagement comes to an end.

As a fractional COO, I take on a more active, ongoing leadership role within your practice. I work alongside you and your team to oversee operations, manage priorities, support employees, and help make sure important work actually gets done.

I'm not simply offering recommendations from the outside. I'm involved in the day-to-day decisions and responsibilities we've agreed I'll help manage.

Neither arrangement is necessarily better than the other. It depends on what your practice needs.

Sometimes you need someone to help solve a problem. Other times, you need someone to help carry the responsibility of running the business.

Fees depend on the kind of support you're looking for and how involved I'll be in your business.

For ongoing fractional COO leadership, I work on a monthly retainer based on the responsibilities and time commitment we agree upon.

For a 90-day engagement, we'll establish a fixed scope and fee before beginning.

Smaller projects and advisory work may be priced separately, depending on what's involved.

I want you to have a clear understanding of the investment before making a commitment. All fees, responsibilities, and terms will be outlined in a written proposal.

Not necessarily. It depends on what you're looking for.

Some practice owners need help with a specific project or challenge, while others are looking for someone to take on a more consistent leadership role.

For practices that need broader operational support, I also offer a 90-day engagement. This gives us time to understand how your business operates, identify priorities, and begin making improvements without committing to a long-term arrangement.

At the end of those 90 days, we can talk about what's been accomplished, what still needs attention, and whether continuing our work together makes sense.

I prefer to build working relationships that are useful to both of us. Sometimes that means working together for a few months. Other times, it develops into a longer partnership.

We'll agree on the scope, timeline, fees, and commitment before getting started.

No. Some owners come with a specific project in mind. Others know things aren't working as well as they'd like but aren't sure where to begin. We can use our first conversation to talk through what's happening and determine a reasonable next step.

That depends on the engagement. I may work directly with managers, attend leadership meetings, review operational information, or help implement changes with the employees responsible for the work. We'll establish those expectations together.

We'll start with an introductory conversation about your practice, the challenges you're navigating, and what you're looking for in an operational partner.

I'll share how I work, ask questions to better understand your business, and offer my perspective on where I think I can be most useful.

If there's a good fit, I'll put together a proposal outlining the scope of work, responsibilities, timeline, and fees.

The right working relationship matters. I'm selective about the engagements I take on, and I want to be confident that my experience is well suited to what your practice needs.