About
Most operators who come into healthtech are capable, and they spend their first three months learning the domain. I started in the domain, then spent more than twenty years learning to build the business infrastructure that lets a company scale and raise.
I started Engine No. 9 as a consulting practice in 2003. Founders needed senior operational help from someone who understood both the science and the business, and I built a practice to provide it.
What surprised me was what clients needed once I was inside. Engagement after engagement, founders asked for advice and then needed someone to build the systems, processes, and accountability structures that let a company scale without breaking. A deck of recommendations never did that for anyone.
That pattern moved Engine No. 9 from consulting to the fractional COO model. I didn’t decide it at a whiteboard. Clients kept telling me what they needed until I listened.
Today every engagement runs through the Operational Spine™: five phases over about six months, from learning the company to handing off infrastructure that holds. It’s the same work I’ve done since 2003, and the model finally describes it accurately.
When a healthtech company starts hiring and operational gaps begin to threaten a customer or the next raise, I help the founder move from running everything personally to a company that runs on its own infrastructure. I start by learning the company from inside, then map and rank the gaps, then build in order with the team and test it before I step back.
For most companies between Seed and Series B, a full-time COO solves the wrong problem at the wrong time.
The role doesn’t have a shape yet
At this stage, the COO job isn’t defined well enough to attract the right full-time hire. You end up with someone too junior to build what you need, or someone senior enough to be frustrated by the ambiguity, who leaves in eighteen months.
Full-time pay is difficult to justify yet
A full-time COO at market rate is a big line item against a finite runway, and the equity expectation comes on top of the cash. A fractional COO gives you senior judgment at the stage that needs it most, without the burn or the dilution.
Most COOs need 90 days before they build anything
A generalist COO spends the first quarter learning the clinical, technical, and regulatory context of healthtech. I did that work years ago, so my ramp is under 30 days. The only thing left to learn is your company.
My résumé is on LinkedIn. This is what each part of it means for an engagement we’d run together.
Your clinical team never has to translate for me
I trained as a bioengineer before anything else (MSE and BSE, University of Pennsylvania). I follow the clinical conversation as it happens and turn it into operational and product decisions without losing anything in translation.
The budget conversation and the board deck, handled by one person
Financial modeling, P&L ownership, investor materials, and board reporting. An MBA in Finance from Wharton gave a bioengineer the financial vocabulary of the C-suite, so nothing gets lost between the clinical team and the cap table.
Your enterprise sales cycle won’t stall while someone learns the buyer
As Principal of ZEFER’s Health and Life Sciences practice, I led engagements for Johnson & Johnson and Siemens Healthcare, including a large-scale digital health and enterprise IT implementation at J&J. I know what a health system or medtech buyer looks for before your team finds out the hard way.
Compliance that won’t block your Series A or B
I built SOC 2 and PCI compliance postures from nothing at two organizations, and managed PII and regulated data governance at enterprise scale at Verizon. All of it under real regulatory and customer scrutiny.
I’ve sat in the chair you’re hiring for
I’ve run operations and carried a P&L as both a COO and a CEO. Payroll, customer escalations, and the board conversation all landed on my desk. A framework reads differently once you’ve used it under pressure.
Your engineering lead won’t have to simplify it for me
I started programming at thirteen and have worked in half a dozen languages since, from assembly to C to PHP. When your engineering lead says a change will take two weeks, I know what makes it two weeks, and what happens to that estimate when a customer asks for something.
Neither fits neatly on a résumé.
Science and finance, tested in court
At Greenleaf Medical Systems in 1993, I was asked to evaluate virtual reality technology against the performance terms of an exclusive contract the company held for medical use. The job needed a technical assessment of whether the technology had performed and a financial model of the damages if it hadn’t. I built both, then defended both in court.
It’s an odd line on a COO résumé. It’s also the clearest example I have of what I bring to an engagement: I evaluate the science, model the business consequences, and hold both up under adversarial pressure in the same room.
Healthcare policy at the highest level
In 1996, I testified before the Senate Finance Committee on Social Security, and in 1998 before a congressional commission on Medicare. I wasn’t there as a lobbyist or a political operative. I had built a working command of healthcare financing and population health economics, and I was asked to bring it to the people writing the policy.
Most fractional COOs in healthtech have never defended a position on healthcare financing in front of a Senate committee. It’s why I hold my own across the table from a health system executive, a CMS official, or a value-based care investor.
If you’re a healthtech founder between Seed and Series B, and this sounds like the operator you’ve been looking for, let’s speak. Thirty minutes, no charge. I’ll ask about your company, where the operational gaps create the most drag, and whether this engagement fits where you are right now. If the right answer isn’t me, I’ll tell you that too.
Book a Call