Fractional COO Retainer
Your Practice Needs Someone Running the Operational Side of the House. It Does Not Need a Full-Time Hire to Get It.
Most independent practices do not have a dedicated operational leader. The physician fills that role by default, which is an expensive use of clinical time and not sustainable. This engagement provides the weekly cadence, the KPI accountability, and the hands-on execution support that keeps a practice running well without adding full-time overhead.
What This Role Actually Requires
I have led the operational side of multi-site physician practices. That means running the weekly leadership cadence, owning the KPI scorecard, managing vendor relationships, working through access and revenue cycle problems, and keeping 90-day priorities from drifting into the background.
The work is not glamorous. It is showing up every week with the numbers, asking the uncomfortable questions, and making sure the things that were supposed to happen actually happened. Most practices do not have anyone doing that job consistently. That is why the same problems keep coming back.
This engagement is a retained relationship. It is not a project with a defined end date. It is an ongoing operational partnership built around a weekly cadence, clear accountability, and the kind of institutional knowledge that only comes from being inside the practice week after week.
Signs This Is the Right Engagement
These are the patterns I see most often in practices that are ready for this kind of support.
Priorities keep shifting
The leadership team is busy, but the same problems keep coming back. Nothing sticks because there is no operating cadence holding the work accountable week to week.
Cash feels unpredictable
Volume looks stable but cash flow is inconsistent. A/R aging is drifting, denial patterns are not being addressed, and nobody has time to dig into why.
Access and intake are straining the team
Phone queues, scheduling friction, and authorization backlogs are creating noise that pulls clinical staff away from patient care and erodes the patient experience.
Vendor initiatives are stalled
Projects that were supposed to improve operations are sitting half-implemented. The business rules were never finalized, the follow-through was never assigned, and the vendor is waiting.
The physician-owner is running operations by default
The practice does not have a dedicated operational leader, so the physician is filling that role. That is an expensive use of clinical time and it is not sustainable.
What the Work Looks Like Week to Week
Five activities that form the operating system of the engagement. Each one is designed to create accountability, surface problems early, and keep execution moving.
Weekly Operating Cadence
A structured weekly leadership huddle with a standing agenda, decision log, and clear ownership of every open item. This is the mechanism that makes everything else work.
KPI Scorecard and Decision Support
A 10 to 15 KPI scorecard that tracks what matters and turns the numbers into decisions. Not a dashboard that gets ignored. A working tool that drives the weekly conversation.
90-Day Execution Cycles
A rolling priority backlog with owners, dates, and progress tracking. Every 90 days we reset, review what moved, and set the next cycle. Priorities do not drift when they are written down and reviewed weekly.
Operational Problem Solving
Direct involvement in removing bottlenecks across access, intake, authorizations, and revenue cycle. Not advising from the outside. Working through the problems with your team.
Vendor and Initiative Coordination
Keeping vendor projects moving, finalizing business rules, holding internal owners accountable, and making sure implementations actually deliver what was promised.
What You Get
Five concrete deliverables that are produced and maintained throughout the engagement.
Weekly KPI scorecard
10 to 15 KPIs covering access, revenue cycle, staffing, and financial performance
Weekly leadership huddle
Standing agenda, decision log, and open item tracking from every session
Priority backlog
Rolling 90-day list with owners, dates, and progress status updated weekly
Standard work documentation
Written workflows for selected processes so the gains do not depend on any one person
Monthly owner operating review
A structured review of the prior month and the next 30-day priorities for the physician-owner
Engagement Levels
Three structures depending on where your practice is and what it needs right now.
Advisory Light
Monthly operating review and KPI conversation. Right for practices that have operational leadership in place and want a structured external perspective on the numbers and priorities.
Fractional COO
Weekly cadence plus direct execution support. This is the most common engagement. It covers the full operating system: scorecard, huddle, priority backlog, and hands-on problem solving.
Embedded Fractional COO
Weekly cadence plus deeper leadership integration and change management. Right for practices going through significant operational transformation, expansion, or leadership transition.
What This Is Not
This is not a substitute for clinical leadership. The operational side of the house and the clinical side require different expertise, and this engagement does not cross that line. The goal is to free your physicians to focus on what they trained to do, not to add another layer of oversight to clinical decisions.
This is also not a one-time project. The value of a retained operational partner comes from continuity: knowing the history, understanding the team dynamics, and being present when the problems surface rather than arriving after the fact. Practices that want a single deliverable are better served by the Operational Baseline engagement.