I activate mission-critical initiatives in healthcare and life sciences when there's no playbook. I build the structure, get it running, and leave. These are the notes from the room: pressure, failed structures, and what actually moves organizations forward.
July 2026Tools I Use
Alignment Has a Shelf Life
Fast growing commercial pharma organizations tend to look remarkably similar beneath the org chart. Brilliant people, deep in their specialties, moving quickly because the goal is clear, and the patients waiting are real. That speed is necessary. It also means plans are sometimes more directional than definitive, decisions ripple beyond the people in the room, and dependencies slip until they become urgent. That's where I tend to add the most value: connecting the work downstream, making the tradeoffs visible, and helping teams stay aligned as priorities shift. Alignment isn't a one time thing, it has a shelf life, and it's best kept fresh.
Takeaway
The tracker, scorecard, or plan is rarely the important artifact. Any decent methodology calls these out, I've worked in most of them. The value is in making dependencies visible, tying decisions back to their purpose, and showing where yesterday's alignment needs revisiting. As an outside advisor, I get to ask the questions busy teams often don't have the space to ask: does this still line up with that other decision, or are we drifting? What about the person still delivering against the old decision, do they know it changed? What tradeoff actually brought us here? Do we address the consequence now, or plan for it later?
June 2026Tools I Use
AI Helps Me Do the Work. It Is Not the Work.
AI. AI. AI. AI. Sometimes it feels as though every business conversation starts and ends with the same two letters. I use AI every day. It makes my practice faster, lighter, and more capable. It can analyze information, challenge my thinking, improve a draft, test a model, and absorb hours of mechanical work. But AI is not what a client hires me for. Clients hire me to understand the situation, connect what different stakeholders are seeing, recognize the decisions that matter, and help people move through them. AI helps me do that work. It is not the work itself.
Takeaway
Early in my career, I learned the mechanics of consulting by doing them. I reran the numbers, fixed the fonts, aligned the text boxes, revised the proposal, and listened as senior partners debated a single word. AI can now do a meaningful share of those mechanics. That is real progress, and organizations should pursue it. Most of my daily AI use is deliberately ordinary. It helps draft standard invoice language, organize internal notes that contain no confidential client information, structure CRM tasks within approved systems, prepare outreach, refine public writing, build checklists, and test different ways to express an idea. It handles first passes and administrative friction. I review the work, make the decisions, and own the final output. What AI cannot reproduce is the experience happening around the task: why a word mattered, which executive should open the meeting, who should answer the difficult question, what we knew about the client's stakeholders, history, and values that changed how the recommendation should be presented. An AI model can process the record of experience. It cannot have the experience, read the room, or accept responsibility for the decision.
May 2026Provider Review
Lead With Your Values When Choosing Partners
A thought stayed with me recently: we rarely abandon our values deliberately. We simply lose sight of them. Haste is especially good at making that happen. A deadline is approaching, the team is stretched, and a provider arrives with a polished roadmap for moving forward. Their perspective may be thoughtful and their offering may be excellent. But under pressure, their definition of what matters can quietly become yours. I help teams pause long enough to make their own values visible, collectively, before asking providers how they would deliver against them. It does not slow the decision. It makes the decision belong to the team again.
Takeaway
Haste rarely presents itself as compromise. It feels like momentum. Take the meeting. Use the provider's framework. Start the demonstration. Borrow the evaluation criteria. A provider recently offered to write a client's capital request. Helpful on the surface, but it would have let the proposed solution begin writing its own business case. Each shortcut feels reasonable. Together, they can leave a team comparing solutions before agreeing on what it is trying to protect. Values, in this context, are not words on a wall. They are the choices a team wants its decision to honor when attractive options pull in different directions. Speed or control? Consistency or local flexibility? Immediate relief or a capability that will last? Provider perspectives are useful. Peer experience is useful. Understanding why a company invests in certain parts of its roadmap is useful. The problem begins when those inputs stop informing your values and start replacing them. A good competitive process makes the team's values explicit, reconciles the differences among stakeholders, and turns what matters into criteria providers can respond to. The result is more than a defensible selection. It is a decision that still feels right after the sales cycle ends.
April 2026Lessons
Got It. Helpful. Good Communication.
A CEO I respect once replied to one of my emails with three short sentences: "Got it. Helpful. Good communication." It remains some of my favorite feedback. The email was brief, but it was not incomplete. The request came first. Three summary points gave him everything he needed to know. The supporting detail was there if he wanted it. Good communication is not about saying less. It is about making the reader work less.
Takeaway
A line commonly attributed to Mark Twain says, "I would have written a shorter letter, but I did not have the time." It appears the thought actually belongs to Blaise Pascal, which I appreciate even more. I learned the basics of programming in the language named after him. Long before I understood how much structure matters in communication, Pascal was teaching me structure in another form. That part of the lesson simply took longer to compile. The point is that brevity takes time. Most of us share too much because we are afraid of leaving something out. That transfers the work to the reader, who now has to search through our thinking to find the point. Brevity and completeness are not opposites. Good formatting lets you provide both. Put the takeaway first, organize the evidence beneath it, and let the reader decide how deeply to go.
March 2026Field Notes
Two AI Portfolios, Indistinguishable
I have reviewed the AI pilot portfolios of two of the largest pharmaceutical companies in the world. Hundreds of pilots at each, spanning medical coding, drug discovery, patient services, compliance, and nearly every other part of the enterprise. Remove the company names and you could not tell the portfolios apart. The same use cases. The same provider names. Sometimes four or five AI partners contracted within a single business function, with similar pilots duplicated across business units of the same company. Most were created under a principle of autonomy over alignment. That is often the right way to spark experimentation. It is the wrong way to run year three of it.
Takeaway
Your list of AI pilots is not your differentiation. Your industry peers are holding nearly the same list. Differentiation begins with what happens next. Which pilots do you scale? Which do you stop? Where should capabilities be consolidated? Which provider dependencies have become material? Do the contracts and governance reflect the maturity and consequences of the deployment? That is the discipline organizations tend to fund too late: a portfolio view, honest stop and scale decisions, contract and dependency terms someone has actually stress tested, and governance that matches what the technology has become.
February 2026Where I Missed
Work Before Enough Structure Wastes Time, Including Mine
I tell every client the same thing: build enough operating structure before you start doing the work. Then I spent months building my own firm's marketing and pipeline almost entirely out of my head. No CRM, no defined stages, and no shared view of what actually needed to happen next. It took someone helping me build that structure to point out the obvious. I was doing exactly what I advise clients not to do.
Takeaway
Expertise does not exempt you from your own advice. It simply makes it easier to convince yourself that you are the exception. I am not. Nobody is. The discipline I bring to a client's business has to exist in my own. That means creating enough structure to know where my time is going, which opportunities deserve more attention, and when being helpful has started to become unpaid delivery. Without that structure, ambition can look a lot like progress while producing very little of it.
December 2025Lessons
The Activation Gap: Why Your Strategy Deck Is Collecting Dust
I keep coming back to Patrick Lencioni's Working Genius framework, which organizes six types of work across three phases: ideation, activation, and implementation. Organizations are stacked for the first and the third. Strategy firms and senior leaders live in ideation. Delivery teams, whether internal or outsourced, grind through implementation once it is clear what to do. Activation is the messy middle where structure gets designed, stakeholders get aligned, and momentum gets created. It is the phase in shortest supply, and it is where funded initiatives quietly stall.
Takeaway
The activation gap is usually not a skills problem or a people problem. It is a structural problem. Someone needs to sit between the executive who said "go" and the team that heard "go... where?" That someone builds the execution architecture, aligns the stakeholders, and creates enough clarity that the team can sustain momentum without them. Then that someone leaves.
November 2025Lessons
There Is No Budget for Help Until Waiting Costs More
A VP once told me, in our first real conversation, "Everyone is busy, but nothing is moving." That usually does not signal a lack of effort. It signals that capable people are working from different definitions of what matters most. Activity is everywhere. Progress is harder to find. Bringing in outside help can feel like adding another problem. Someone has to find the budget, explain the context, and get a new person into the work. That is a fair concern. But when an important strategy carries millions in investment, opportunity, or risk, the cost of getting it moving is often a rounding error. The expensive choice is another quarter of committed people burning in different directions.
Takeaway
I am rarely a line item in the original budget. The need for my work becomes visible when a leader replaces the progress story with a clear view of what is actually stuck. When I hear, "Everyone is busy, but nothing is moving," I ask each person what they believe the priority is. Four or five conversations usually produce four or five different answers. This takes less than half a day to compile. That mismatch is not a failure of the team. It is evidence that the decisions, tradeoffs, and ownership have not been made clear enough for the work to move. The budget does not appear because outside help suddenly became inexpensive. It appears because the cost of waiting became impossible to ignore.
September 2025Provider Review
The Consulting Partner Who Actually Shrank Their Own Scope
I've worked alongside dozens of consulting firms. Exactly once, I saw a partner proactively tell a client: "You don't need us for this next phase. Your team can handle it. Here's how." She lost about $400K in extension revenue. The client has hired her firm for three subsequent engagements, each one bigger.
Takeaway
Trust is the most undervalued asset in professional services. Most firms optimize for utilization. The ones that optimize for trust build something that compounds. I try to operate this way every single time: stay until the work sustains itself, then leave. If the work is good, the phone rings again.
August 2025Provider Review
$2M Strategy, Zero Activation
I joined a client just after a Big 4 firm completed a six month strategy engagement. Beautiful deck. More than 200 pages. Comprehensive analysis. The client's team was staring at it as though it had been written for someone else. The strategy described the destination. Nobody knew what to do on Monday morning.
Takeaway
This was not bad strategy. It was strategy that stopped before ownership, sequencing, and decisions had been made executable. That distinction matters. The engagement had been designed to deliver a strategy. The client believed it had also purchased movement. In three weeks, I translated more than 200 pages into a four page execution roadmap with named owners, weekly milestones, and clear escalation triggers. The team started moving in the first week. A strategy does not become valuable when it is approved. It becomes valuable when people know what they own next.
June 2025Tools I Use
Why I Read the Actual Contract, Not the Summary Someone Handed Me
A client asked me to weigh in on a vendor relationship everyone assumed was locked in for years. I pulled the master agreement instead of trusting the recap sitting in someone's inbox, and found a short notice convenience exit clause nobody on the team knew existed. That single clause changed the entire negotiating posture, from we're stuck, let's make the best of it, to we have leverage, let's use it.
Takeaway
Contracts get treated as legal's job, read once at signing and then filed away. I treat them as a live strategic asset. Every renewal, every vendor tension, every "can we get out of this" conversation starts with me reading the actual document again, not the institutional memory of what it says. Institutional memory needs reminders.
May 2025Field Notes
If We Can Track Pizza, We Can Track Cancer Cures
A child with pediatric leukemia is waiting for a CAR-T therapy manufactured from their own blood. It expires in 48 hours. One logistics failure and there is no second chance. Meanwhile, I can track my Domino's pizza from oven to doorstep. That contrast wasn't absurd. It was a problem I knew how to solve.
Takeaway
Nobody needed a new technology. They needed someone to thread together hundreds of data points across lab systems, cold chain logistics, hospital intake, and parent-facing visibility into one coherent patient journey. Offerings developed for the platform support CAR-T programs across four manufacturers and thousands of patients.
March 2025Culture Watch
The Three Words That Tell Me a Client Engagement Is Going to Be Rough
"Make it happen." When a senior leader says this to their team about a complex initiative without defining what "it" is, how it gets done, or what good looks like, they're not delegating. They're abdicating. And they're about to burn out the people underneath them.
Takeaway
I've learned to spot this in the first week of any engagement. It usually comes with two other symptoms: no one can articulate the actual goal in the same way, and the team has stopped asking clarifying questions because they've been punished for it. If I see all three, the first conversation is with the leader, not the team. The team isn't the problem.
February 2025Tools I Use
Why I Use a Stakeholder Alignment Map Before I Do Anything Else
Before I write a project charter, before I schedule a kickoff, before I touch a timeline, I map the stakeholders. Not just who they are, but what they care about, what they're afraid of, who they trust, and where they disagree. This takes about 3-5 conversations and a half day of synthesis. It saves weeks of rework downstream.
Takeaway
Most consultants start with the work. I start with the people. Because the work is never what's stuck. What's stuck is the misalignment between the people who need to agree on what the work even is.
December 2024Culture Watch
The Client Who Treated Their Contractors Like Family
At one engagement, the VP invited the entire extended team, including contractors and consultants, to the holiday gathering. Not the corporate one. The real one. It was a small thing that signaled something enormous: we're all on the same team here, and we treat our people well.
Takeaway
In 25+ years, I can count the number of times this has happened on one hand. The teams that treat external partners as full members of the crew consistently outperform. Not because the contractors work harder out of gratitude (though that happens), but because information flows freely when there's no caste system. The best intelligence about what's really going on often lives with the people who are closest to the work but furthest from the org chart.
October 2024Where I Missed
I Sold the Vision Before the Product Was Ready
Early in my career at BigConsulting, I was part of an MVNO platform pursuit where we sold capabilities that were still vaporware. We believed hard work and ambition would close the gap. It didn't. The firm took a bath on it.
Takeaway
Ambition and hard work do not circumvent reality. I vowed never to overstate capabilities again, and that conviction shaped every deal I scoped and priced from that point forward. If I tell you I can do something, it's because I've done it or something genuinely close to it. If I haven't, I'll say so.
August 2024Where I Missed
I Stayed Too Long on a Project That Had Already Succeeded
The initiative was running. The team had it. But the client kept extending and I kept saying yes, partly because the revenue was good, partly because I liked the people. By month four of the extension, I was adding marginal value and I knew it. The team was starting to defer to me on things they should have owned.
Takeaway
My whole model is "work yourself out of a job." When I violate it, the client suffers, even if they don't realize it yet. Dependency is comfortable but corrosive. Now I have a hard rule: at the end of every month, I ask myself whether the team would be meaningfully worse off without me. If the answer is no, it's time to have the conversation.