What you bring
A candid picture of the company’s operations: what’s breaking, which decisions keep landing on your desk, and what you’d do with the 40% of your time operations takes now.
Services
Not every company needs me for six months.
Some founders need a written assessment they’ll act on themselves, and some need the full build. Others want someone senior on call for the quarter ahead. The diagnostic conversation sorts out which, and nothing gets scoped before it.
Where every engagement starts
Thirty minutes. No charge. A specific recommendation, even if it’s not me.
Bring the current state of your company: what works, what doesn’t, and what keeps you up at night. The conversation tells us what the right engagement looks like.
Sometimes that’s the Operational Assessment. Sometimes it’s the full Operational Spine™, or Advisory Services. Sometimes it’s narrower: one deliverable, a board prep session, a compliance question. And sometimes the honest answer is that this isn’t the right fit, in which case I’ll tell you.
What you get
A clear read on what’s causing the most drag, and a specific recommendation for the right engagement, or a straight explanation of why this isn’t the right fit.
The commitment
One conversation. If there’s a fit, I’ll tell you how I would approach it and what it costs. If there isn’t, you won’t hear a follow-up pitch.
Where founders usually are when they call
“I need to know how bad it is.”
You feel the gaps but can’t name them yet, and you won’t commit six months to a problem you haven’t defined. Start with the Operational Assessment.
“I already know what’s broken.”
You’ve done the diagnosis yourself. What you need now is someone in the room, building. That’s the Operational Spine™.
“It mostly works. I want someone to call.”
The infrastructure is in place and the team runs it. You want senior judgment before the board meeting instead of after. That’s Advisory Services.
Can’t tell which one you are? The thirty minutes will sort it out.
The Operational Assessment
A fixed-fee look at where your operational risk sits, before you decide whether the full engagement is worth it.
It’s built for founders who want more than a thirty-minute recommendation and aren’t ready to commit to six months. You get a written, prioritized gap map across four categories: people and structure, process and cadence, compliance and risk, and financial infrastructure. They’re the same four the Spine’s Diagnose phase covers.
Most of the five weeks happen inside the company. I read the documents, sit in your team meetings, and listen to customer calls. That time is Phase 1 of the Spine, and it’s why the gap map is worth acting on.
You own the result and can act on it with or without me. If you continue into the Spine, this work becomes Phases 1 and 2 at no extra cost. Same work, billed once.
Investment
$8,000 to $12,000, fixed fee
Scoped after the diagnostic, based on how complex the company is. Five weeks. If you continue into the Spine, it counts as Phases 1 and 2.
What it covers
Structured discovery and time embedded with the team, then an assessment across the four categories.
What you get
A written gap map: what’s broken, what each gap puts at risk, and which one reaches you first. It stands on its own whether or not you continue.
Timeline
Five weeks, fixed. A written report plus a live briefing with you and your leadership.
The Operational Spine™
A six-month embedded fractional COO engagement in five phases, from learning your company to handing off infrastructure that runs without you in the room.
I build the infrastructure with your team (org design, accountability frameworks, compliance posture, financial reporting, and operating cadence) and stay until it holds. There’s no deck at the end and no list of recommendations left for you to implement alone.
The phases run in the same order every time, because each one builds on the one before it. What gets built inside them depends on what the gap map finds.
Six months is a real commitment, and you shouldn’t have to make it after one thirty-minute call. The Operational Assessment exists for that: five weeks, a fixed fee, and you decide afterward. If you continue, it counts as Phases 1 and 2.
Investment
A fraction of a full-time COO’s salary
A monthly retainer over about six months, scoped to company stage, team size, and the gaps involved. You’ll hear a range on the diagnostic call and an exact number in the written proposal. A full-time COO also expects equity; a fractional COO doesn’t.
The five phases
The Operational Assessment covers these two
Discover
About 3 weeks
I learn the company and earn the team’s trust at the same time: an independent read of your documents, structured sessions with you, and time in team meetings and customer calls. It needs your active participation throughout.
Diagnose
About 2 weeks
A structured look at people and structure, process and cadence, compliance and risk, and financial infrastructure. The output is a ranked gap map: what each gap puts at risk, and which one reaches you first.
Build
13 to 15 weeks
The longest phase. It opens by turning the gap map into a sequenced build plan with owners and dependencies. Then we build in that order, testing each deliverable with the team and revising it before moving on.
Pressure Test
3 to 4 weeks
Training, stress-testing, and closing the last gaps. Your team runs the infrastructure under real conditions with support close by. Nothing gets handed off until it passes here.
Sustain
2 to 3 weeks
Formal handoff to permanent owners, plus a briefing for you on what was built and what to watch as the company grows. Most clients continue with Advisory Services afterward. Entirely optional.
How you’ll know Build is working
Signs you’ll see during the Build phase, roughly in the order they show up:
- Every gap on the build plan has an owner and a date next to it.
- The weekly operating meeting runs from an agenda and a scorecard instead of from your memory.
- A process runs without its owner in the room. Someone else runs it alone, from what was written down, and it works.
- Decisions you used to make get made below you: a hire, a vendor, a customer escalation.
- Your calendar changes. Fewer operational meetings, more time on the science, the product, and your customers.
What gets built
Operational infrastructure
- Org design and team structure
- OKRs and accountability frameworks
- Cross-functional operating cadence
- Hiring and onboarding infrastructure
- Vendor and partner management systems
Compliance and risk architecture
- Regulated data and PII governance
- SOC 2 and PCI compliance posture
- FDA regulatory strategy framing
- Data governance and access controls
- Multi-state licensing infrastructure
Financial and investor readiness
- Investor-ready financial modeling
- Board deck preparation and cadence
- KPI dashboards and reporting infrastructure
- Diligence preparation and data room
- P&L management and cost structure
Advisory Services
You don’t need to finish the Spine first. If the diagnostic shows you need senior operational counsel on a specific challenge instead of a full build, Advisory Services is where we start.
It’s also how most Spine clients continue once the embedded phase ends. The infrastructure is in place and the team runs it, but growth keeps raising new questions. A senior outside view catches a problem early instead of in a board meeting.
Think of it as a backstop. It starts with a standing check-in, monthly or quarterly. What we add on top depends on what the company is facing: board prep, diligence, or more time in the room.
Investment
Scoped to the engagement
Lighter than the Spine retainer. Scope and pricing follow the diagnostic. No minimum commitment.
Standing check-ins
A monthly or quarterly review of operational health that surfaces issues early and keeps the infrastructure built during the Spine scaling with the company.
On-call operational support
Help with specific questions as they come up: a compliance question from a health system customer, a board meeting that needs prep, or a hiring decision with operational consequences.
Board and investor diligence support
Preparation for board meetings and investor diligence, so the operational story is as credible as the product story.
Ongoing fractional involvement
For companies that need more than check-ins: fewer hours, still in the room and still building, as the company grows toward its next hire or its next raise.
Three questions founders ask first
What does a fractional COO actually do?
A fractional COO is an experienced operator who builds the infrastructure a company needs to run without its founder in every decision. Part-time or defined-term, not a full-time hire.
When should a healthtech startup hire a fractional COO?
The fit is clearest for founders who have started hiring, are watching execution gaps threaten customer relationships or a raise, and need infrastructure built.
What’s the difference between a fractional COO and a consultant?
A consultant tells you what to build. A fractional COO builds it, embedded in the company, accountable for whether it works.
Who this isn’t for
Engine No. 9 is built for healthtech founders at Seed through Series B who need operational infrastructure built from scratch, or senior operational counsel from someone who already knows the domain. If you need a commercial leader to build a sales motion, a CFO to run a financing process, or a management consultant to diagnose a strategy problem, I’m the wrong hire, and I’ll say so.
Start with the diagnostic.
Every engagement starts with the same conversation, whether it becomes the Operational Assessment, the Spine, Advisory Services, or something narrower. Bring the current state of your company, and we’ll work out the right next step together. If this isn’t the right fit, I’ll tell you that too.
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