When a fractional COO or CMO makes sense, and when it does not
A fractional or interim leader owns a defined result a few days a week instead of full time. In health organizations the need usually looks like one of these:
- Revenue is fine, costs are not. The clinic is busy, but operating cost has outrun revenue and nobody can say which service line pays for which. That is operations work, the kind I led as COO of Laser Treat Group.
- The service is good, growth is not. Not enough patients come, or they do not come back. That is a growth problem with a trust problem inside it.
- Between leaders, or ahead of one. An interim COO for a clinic that cannot leave operations without an owner while it hires, or a digital health startup that needs senior judgment before it can carry a full-time executive.
It does not make sense when you need someone in the building every day, or when nobody inside will own the work afterwards. As I argue in Half a COO, fractional fails when it is treated as a full-time hire with fewer hours; the role has to be designed for the handover. The free fractional vs full-time cost calculator compares the two, with US and Bangladesh examples.
What I do in the first 90 days
The order matters: make the operation visible, fix what the numbers show, then grow on top of it. Growth poured into a leaking operation costs more than it earns.
Operations: the fractional COO side
- Cost visibility and one set of systems. Cost made visible by service line, department and category, with ERP, patient records, BI, HR and customer-experience systems in one place. At Laser Treat the ERP and BI build did that, and the savings came from what it revealed.
- Patient flow and staffing. Scheduling, staffing models and service delivery around the doctors, from booking to follow-up.
- Retention. Which patients do not come back, and why. Retention is the real growth engine.
Growth: the fractional CMO side
- Corporate-first channels. Employers and partner organizations treated as managed accounts, the way Praava Health's corporate client base grew from 342 to about 1,400.
- Trust before reach. Distribution through things people already use, like the doctor hotline printed on a Lifebuoy soap bar that took about 3,000 calls a day.
- Pricing clarity. Packages and self-pay prices patients can understand, and referrals that do not depend on kickbacks.
By day 90 you have a cost view by service line, a dashboard the team uses, a growth plan with named owners, and a written handover plan.
What I run, and what stays with your clinicians
Operations and growth are my work: customer service, clinic operations, workflows, staffing models, procurement, systems, finance, cost structure, marketing and sales. Medical services and clinical decisions stay with your doctors and clinicians. At Laser Treat my remit was customer service, clinical operations, business functions and finance; medical care sat with the doctors. The same rule applies here.
Proof, not promises
Five engagements from health care. Each one opens the full case study.
Growth is the core of my record, and most of it came before health: seventeen years across eight industries.
Need an operator, not a full-time hire?
If you need an operator for part of the week rather than a full-time executive, start with a thirty-minute call.
How it works across Michigan and Bangladesh
I am based in Redford, Michigan, and built most of my operating record in Dhaka. Dhaka is 10 or 11 hours ahead of Michigan depending on the season, so Michigan mornings meet Dhaka evenings, and the reverse.
Most of the work runs remotely: a fixed weekly review, shared dashboards and written decisions. On-site days in metro Detroit and Ann Arbor, or visits to Dhaka, can be part of an engagement where the work needs them; we agree that at the start. For a Michigan clinic or a Dhaka diagnostic group, the questions are the same: where the cost sits, where patients drop off, and who owns the number.
Work with me: start with a thirty-minute call
Bring the number that is not moving: an operating cost that has outrun revenue, patients who do not come back, a channel that has stalled. I will tell you what I would look at first, and whether I am the right person to look at it. Scope and terms are agreed on the call.
Questions people ask before we talk
What does a fractional COO do for a clinic or health group?
Runs the operations side: customer service, scheduling, patient flow, staffing models, systems, procurement, finance and cost structure. The first step is making cost visible by service line, department and category.
Do you make clinical decisions?
No. Medical services and clinical decisions stay with your doctors and clinicians, as they did at Laser Treat Group, where medical care sat with the doctors.
Do we need a fractional COO or a fractional CMO?
If operating cost has outrun revenue, start with operations. If the service is good but not enough patients arrive or return, start with growth. Many health organizations need both, which is why I do both.
Do you work with health organizations in both Michigan and Bangladesh?
Yes. I am based in Redford, Michigan, and built most of my operating record in Dhaka. The work runs mostly remotely, with on-site days in metro Detroit and Ann Arbor or visits to Dhaka where the work needs them, agreed at the start.
Do you lead digital transformation for clinics and health groups?
Yes, as an operator rather than a software vendor. At Laser Treat Group, a multi-entity clinical group in Bangladesh, I put one ERP, digital patient records, BI dashboards, HR and customer-experience systems in place. Cost became visible by service line, and the result was about $0.5M a year in operating-cost reduction and +13% patient retention. The technology serves a business number; clinical decisions stay with your clinicians.
How are scope and terms agreed?
On a free thirty-minute call. Scope, days per week and terms depend on the problem, so they are agreed there rather than listed here.
Md Shafaat Ali Choyon (also written Shafaat Choyon) is a growth and operations leader based in Redford, Michigan, with seventeen years across eight industries. MBA in operations management, MCIM, MPH in Health Education and Promotion, and CHES®. Founder of HSREP, a health-system resilience platform. The same body of work, presented for other needs: growth marketing, Michigan, growth marketing, Bangladesh, fractional CMO, Michigan, brand and communications, health communication, digital health, population health. Bangladesh readers: বাংলায় পড়ুন.