Turnaround and interim leadership

If your board is weighing a turnaround, you've already heard plenty of confidence. I lead with a diagnosis instead.

For twenty-five years I led behavioral-health and community-health systems through the kind of trouble that gets a board's attention — insolvency, compliance failure, a system the legislature had already called failing. I don't run those as a permanent CEO anymore. I take them on as a fractional or interim leader: I come in, read the system, and either lead the turnaround or tell you plainly that the one you're imagining can't be built on the structure you have.

The engagement is built to the situation. The method isn't.

No two of these are alike, so I don't sell a package. What an engagement looks like — a fractional seat, a full interim stint, or a board-level diagnosis and hand-back — depends on what your system actually needs, and we'd size that together.

What doesn't change is how I read the problem. I run a system through four co-equal lenses — financial health, compliance, quality of care, and stakeholder trust — and I treat them as faces of the same cube: move one and the others shift, so there is no fix in a single quadrant that doesn't cost something in another. The work is finding the moves that hold across all four. I wrote the long version of how this works, across three systems, in Rubik's Cubes and Community Health.

And before I commit to anything, I read one thing first: whether the system can actually unify around a single plan — whether the board has the authority to own that plan and be held to it over time. That ninety-day read tells me whether what you have is a turnaround or a holding action. It's the first thing I diagnose, because it's the thing everything else depends on.

I'll tell you the truth, including the expensive one.

Sometimes the most useful thing I can say to a board is that the turnaround you're picturing can't be built on the governance you have — and that you'll spend two years and a great deal of money proving it if no one says so now. I would rather tell you that in the first ninety days. A board that wants to hear it's all fixable has plenty of people to call. I'm not one of them.

If you're the executive who just walked into it

Not every call comes from a board. Sometimes it's a new CEO who has just inherited the mess and needs someone who has sat in that chair. I've sat in it. If that's you, the method is the same — I'll think it through with you rather than render a verdict on you.

Start with your own situation

Before we ever get on a call, you can put your situation through the way I actually think. The tool below runs the same diagnostic I'd run with you — bring a real problem, and see what it surfaces. If it's useful, we'll pick the conversation up from there.