I am not ashamed to say I have been binging The Pitt lately. I may be slightly ashamed of having dreams that I am Dr. Robby for early-stage startup triaging. Either way, here we are.
Welcome to triage. Scrub in and join me for the ride.
PATIENT ONE: “My Team won’t take any ownership”
Patient enters ER at 8:12 am.
Founder visibily agitated.
Primary complaint: “I just need my team to take more ownership.” The patient’s crew nods their heads politely while biting their lip. One department head stares at the floor. Another has 15 outstanding Slack messages from the patient.
Initial vital signs look normal. Upon further examination, we discover the team has been attempting to make decisions for months. Recently, the crew stopped adhering to the decision-making treatment plan as they were not seeing progress in the patient.
Dr. Katie steps in with questioning:
Who is actually allowed to make a decision?
What happens if they make the wrong one?
When was the last time someone made a call without you?
What decisions still NEED to go through you?
What decisions just do?
Founder pauses.
BINGO! We found the blockage. Very common condition called founder bottlenecking.
Treatment is straightforward. Doctor prescribes:
Define ownership
Define decision rights
Clarify what needs founder input and what does NOT.
Harder part of treatment…the founder needs to let someone make a decision that isn’t identical to the one that they would have chosen. Patient is frustrated, but agrees to try treatment.
Prognosis is excellent!
PATIENT TWO: Active Revenue Leak
Patient arrived at 12:01 am.
Complaint that “Sales are slower than we expected.”
Founder requests new pipeline strategy immediately. Sales team would also like more leads. Everyone is chatting about outbound.
We begin the routine labs.
Before ordering any new campaigns or strategic moves, Dr. Katie asks a highly annoying question. (Yes, this made the chart.)
Are we collecting all of the money we have earned?
Met with silence. We inspect invoicing, renewals, contract dates, failed payments, billing systems, and arrangements.
Surfaced many items that rely on one person knowing to execute something based on memory or a calendar event.
Found it…Revenue already sold, but wandering around the hospital unattended. (I once found over $30k in unbilled revenue a startup didn’t realize existed.)
Treatment as follows:
No new funnel needed.
Find the leak.
Assign ownership.
Create a super boring and repeatable process.
Automate where it makes sense.
Put an actual human in charge of noticing when something goes wrong.
Patient is discharged with improved cash flow and mild embarrassment. Should clear within one to two weeks.
PATIENT THREE: Customer Success Trauma
Patient arrives via ambulance.
Chief complaint: “Customer success just keeps dropping balls.”
CS has been informed they need to be more proactive. Morale is low. Sales appears to be doing mysteriously well.
Dr. Katie unleashes the boring questions.
Walk me through the last deal you closed.
What did sales promise?
What info did CS receive?
When did they receive it?
Where does it live?
What does “onboarded” mean here?
How do we know the customer is healthy?
Who owns the renewal?
One member of the crew slowly backs toward the exit.
Diagnosis made. Customer was sold one thing, but the handoff to CS never existed. Or was frankly a Slack message and broken link to a gdoc. Onboarding seems to vary across all clients. Success milestones do not exist. CS did not create this wound.
Treatment as follows:
Trace the entire customer journey.
Identify all handoffs.
Define what information travels with the customer.
Assign owners.
Decide what “good” (or even better “great”) looks like for your team.
Then we make sure the systems support the process instead of forcing the team to be amateur detectives whenever a customer asks a question.
Patient will recover. Sales has been asked to stay for observation. (Click here for more information on this treatment.)
PATIENT FOUR: Accute Mettingitis.
Patient arrives out of breath at 10:10 am after 3 scheduled meetings.
Primary symptom:
“We have a communication problem.”
Current treatment plan includes:
Monday leadership meeting.
Tuesday department meeting.
Wednesday project meeting.
Thursday cross-functional sync.
Friday “quick check-in.”
Three standups.
Two recurring “touch bases.”
One mysterious calendar event called ALIGNMENT.
Exhaustion is evident.
Before administering further meeting treatment, we again unleash the boring questions to the patient and their entourage.
What have the last few weeks looked like?
Show me your calendar.
What changed recently?
Where do decisions get made?
Where do updates get shared?
What happens after meetings?
This is the ops triage I really love. Talking to the founder. Get their side of the story. Then we step away, and I meet with the people around the founder. Connecting the dots between what I hear from leadership and what I hear from those in the day-to-day is the fix.
Patient diagnosed with Severe Communication Without Architecture.
Treatment:
No added recurring meetings.
Establish a regular operating rhythm. (I shared my preferred one here.)
Meetings should be where decisions get made. Not where everyone reads updates off an agenda live.
Several meetings are removed. Patient immediately relaxes.
PATIENT FIVE: The Startup Hypochondriac
3:30 pm Friday afternoon. Patient bursts through the ER doors shouting. “We are a DISASTER!” Full trauma team is called upon.
Founder reports:
Everything is broken. Nobody knows what they are doing. This company cannot scale. Ops are a mess. Series A is doomed before it starts.
We begin examination…
Revenue is growing. Customers really like the product. Team is capable. There are some documented processes. Founder has delegated many decisions. Meetings are a bit messy. Handoffs aren’t totally clear, and there are four tools doing jobs Claude could handle.
Dr. Katie looks up from chart. Ma’am I am happy to say you have a startup.
This is one of my favorite diagnoses. Growing companies are messy! We aren’t going to get away from that fact. Sometimes a founder spent so long in the weeds with every imperfection they forget that normal chaos and growth is painful.
No emergency transplants needed.
Treatment:
A few conversations with the right people.
Maybe a revised written process or two.
Probably fewer Slack channels.
Hydrate & rest.
Call me if the founder starts approving every invoice again.
QUICK NOTE FROM TRIAGE
Funny thing about startup ops. My clients almost never arrive saying “Hello, I believe we have an unclear ownership model creating downstream customer lifecycle issues.”
They arrive complaining of all the things above. This is why my first move is ALWAYS talk to the people. Do the actual digging to find the real diagnosis. Not the thing one person is screaming about.
Sometimes the company needs surgery. Other times it needs a few lil stitches. And sometimes at the end of the day, I tell the founder to stop googling symptoms.
The waiting room remains full.
The operator washes her hands.
If your startup would like to be seen by the Dr. Robby of operations, my waiting room is open.
See you in triage.
KB
Patient Five is the one I recognise. I spent a long stretch sure the company was falling apart and what I had was a company.
The founder cannot do the comparison. You have a sample of one, seen from the inside. So every mess reads as evidence. Ma'am I am happy to say you have a startup is not reassurance, it is information they have no way of getting for themselves.
Example 2 jumped out to me because I see often founders screaming "more leads" when the real diagnosis is a revenue leak or broken handoff.
If you don't know where the revenue is leaking more leads into a broken system is more lost revenue. The key is it understand your current system and make sure it is leak proof (or mostly leak proof) before you pour more leads into it.
Thanks for sharing these are great examples.