Judged only on the work.
The work was the only thing vouching for me, and it was enough. Across more than two years as a fractional executive, two healthcare organizations hired me by the engagement, with no title doing the persuading and no org chart to stand on, and judged every structural change on whether the reasoning held. One judged it worth building a permanent executive role around: the AVP, Technical Success seat at Mosaic.
The day nobody was where they were supposed to be.
My first day was not in an office. It was on site at a live deployment, standing at the elbow of radiologists while the team worked through worklist and workflow problems in real time. That was the point. You cannot diagnose an operation from a conference room.
At 5:30 that evening, an urgent email went out from another leader. They needed 60 people to support a go-live the following week. They had 13. My leader got on a call and said we were staying on it until we found all 60.
That was hour nine of the engagement, and it told me more than any document could have. Over the rest of that first week I sat with operations leaders who described the same thing from the other side: work that never became a ticket simply never got resolved, nothing carried from one week to the next, and nobody trusted that their radiologists would be supported. The frustration was not with any individual. It was with the absence of a system.
Everybody chasing the same ball
This was a startup mindset in an organization that had outgrown it. My shorthand for it is fourth graders playing soccer: everybody runs to wherever the ball is. The talent was not the problem. These were highly skilled people with deep experience, all working the same visible problems and all ignoring the same invisible ones.
What it needed was a triangle offense. A rhythm to the chaos, the right skills applied at the right pressure points. Knock down two or three of the big, hairy, time-consuming things and you do not improve capacity by a few points, you change the game.
The call that showed me the real fracture
A practice director called me. One of my people had picked up an escalation and had been working the machine for three or four hours with no progress, keeping a radiologist tied up the whole time. That was the surface complaint. The real finding was underneath it: the person on that call was a workstation specialist, someone who knows hardware and basic software. He was being asked to troubleshoot workflow, which was nowhere near his skill set.
That was the moment the structure gave itself away. We had people being put into situations they were simply not skilled to handle, and we had given them no pathway to find the skill set that actually could solve it. The title told you nothing about what a person could do, and nobody could fix that on their own.
So we split the tracks. RAD Support Specialists and Field Service Technicians became distinct roles with distinct skills, distinct training, and distinct escalation paths. Not a reorganization for its own sake. A way to make sure the person who picks up the phone is the person who can actually finish the call.
If they're sending it to you, it's your fault
The tier structure had the same disease. Tier one was pushing everything upward, so my senior specialists were spending 40% or more of their time on low-complexity work. They came to me frustrated, saying the tier one team needed to get it together.
They did not love that. So I explained it. You are the expert. You are the one who knows what is supposed to happen. Why are you not building the knowledge articles and training that team, so that when these issues come through they know how to handle them? You are sitting back saying they do not know, and you are the one holding the knowledge.
We ran sessions with screen recordings and used AI to build out a detailed knowledge base quickly. One of them came back to me later and told me the truth about it.
My team went and trained tier one directly. Tier one was relieved, because nobody enjoys escalating work they do not understand. It built real bonds between two groups that had been quietly blaming each other. Resource time came back, expertise spread, resolution cycle times dropped, and end-user satisfaction moved with them.
Paying for behavior, not for results
The compensation model was market-driven and value-driven, benchmarked against comparable roles and built to scale with issue resolution. But the design principle underneath it matters more than the number.
Pay for the behavior you want, not the result. Results-based structures are too easy to break, because two metrics end up in tension and people optimize against each other. Tie compensation to behavior, especially where skills have to be coordinated across a network of resources and departments, and the behavior turns cooperative. People start working toward shared team results because that is what actually pays.
Four days, ten hours, and a benefit that was also a strategy
The schedule was three things at once. The research supports four-by-ten shifts producing higher engagement. Compressed shifts let me layer the high skill set against the real volume peaks instead of spreading it evenly across a flat week. And it landed with the team as a benefit rather than a change imposed on them.
That is the same move as the compensation design. Build the structure so the behavior you need is the one people actually want.
Technology does not get results. Processes do not get results. Financial metrics do not get results. Mission statements do not get results. People get results.
People perform best doing what they enjoy and what they are good at. When that balance tips, when more of the day is work they dislike or are not suited for, you get stress, tension, and the attrition of exactly the talent you cannot afford to lose. So my job is to understand the mission, understand the team's strengths, and get each person doing what they enjoy and do well 80% of the time.
The rule only works with the ask attached: you need to be talking to me about that. It puts the read on them, not on my guess about them.
The offer I was not looking for
The plan was the next engagement. An offer was not part of it. Then my leader came to me with something I did not expect.
The honesty in it was the part that landed. He told me I would be a little out of step for a while, because I represented the expansive thinking and the collaboration mindset the organization was evolving toward as it moved an AI radiology platform into the commercial market. A pilot hire, brought in to shape what the position itself should become.
A chance to shape what an organization would look like, feel like, and how it would operate in its next form. That engagement is the one that became the AVP, Technical Success role at Mosaic. Game on.
Every call they missed was a patient who waited.
This was a retail radiology business: a platform that runs and staffs imaging locations where people can pay out of pocket for their own exams, and that also sells excess radiologist capacity to other organizations who need it. Two customers, consumers and commercial partners, one contact center serving both.
Which makes the contact center the business, not a support function attached to it. A call that goes unanswered is not a service metric. It is a delay of care and a direct revenue loss in the same moment. That framing changed what the engagement was actually about.
Matching the call to the person who can take it
First move was skills-based routing. Difficult interactions to skilled representatives, fast and simple ones to newer staff who had just been trained. The same principle as the specialist split at the other engagement: stop pretending a title tells you what a person can handle.
Staffing is a design problem, not a headcount problem
Then the staffing plan, built on time-of-day intervals and real utilization rather than a flat schedule. But staffing alone would have left most of the capacity on the table, so the work went into the telephony itself: call flow, queuing, structure, and handle times.
The part people miss is that the software is a staffing decision. If an agent struggles to enter data in one part of the screen, that friction extends every call, and every extended call is capacity you no longer have. So we value-mapped the whole interaction for efficiency, then layered in start times and break times to hold optimum coverage around the clock.
The offshore question, answered with engineering
The cost-benefit analysis on offshore support came with the rest of it: transition plan, training plan, onboarding and ramp-up. The result was an onshore and offshore model in a tightly optimized staffing environment.
The objections were real and they were not the ones you would expect. Training and ongoing management were the loudest, along with time-of-day coordination for an East Coast organization. Protected health information sounded like the blocker, but it was solvable with technology: scrubbing, filtering, and anonymization removed PHI from the equation, and an edge-server VPN structure held privacy and security while the staffing and rate optimization went through. The PHI issue became moot.
The genuine hesitation in the C-suite was not privacy or cost. It was optics. What would customers think about offshore. So we had that conversation directly, about what to expect and what it would actually look like, rather than around it.
The decisive argument was not the savings. It was that coverage went from roughly nine to five in each time zone to nearly 24 hours across the board, including late night. For a business where an unanswered call is a patient who waits, the expansion was not a cost story. It was more care delivered, and more revenue captured, in hours the operation had simply been closed.
Nobody had to listen to me. That was the point.
Inside a company, a title does some of the persuading for you. As an outside contractor, none of it carries. Every structural change in these two engagements happened because the reasoning held up in front of people who could have simply said no, and in one case because the organization decided the reasoning was worth building a role around.
That is the whole argument for hiring the person rather than the resume.