FRACTIONAL LEADERSHIP
Fix Clinical Operations & Projects That Limit Growth and Valuation
Brian is the operator brought in when a project is in trouble or growth has stalled. He diagnoses the structural constraints holding back scale and enterprise value, then installs the operating discipline to fix them.
EXECUTIVE SUMMARY
Brian is the operator brought in when a project is in trouble or growth has stalled. He diagnoses the structural constraints holding back scale and enterprise value, then installs the operating discipline to fix them. He works in complex environments: post-acquisition integrations that never took hold, fractured infrastructure, stalled change programs, and executive teams pulling in different directions. The breakdown patterns are consistent. Misaligned priorities, weak communication, cultural resistance, fragmented systems, manual workarounds, and missing execution governance. Brian rebuilds these from the inside, restoring clarity at the executive level and standing up the operating infrastructure that protects margin and strengthens valuation at exit. He also guides leadership through the operational shift to AI, integrating it into how the business actually runs so the gains hold after the engagement ends. Works with: Mid-market organizations between $1M and $50M in revenue with 10 to 200 people on the team. Founder-led, PE-backed, or VC-backed. Single-site or multi-site. Running on multiple systems that don't talk to each other. These companies are deep in operational complexity: dense workflows, layered automations, regulated procedures, and processes that grew organically as the business scaled. Most have hit the point where the systems and the org chart can't keep up with the growth. Brian specializes in the industries where this complexity runs highest: healthcare, manufacturing, and retail or franchise operations. The common thread is a project, integration, or change initiative that's stalled out, gone over budget, or quietly stopped delivering. That's when the call comes in.
WHY CLIENTS WORK WITH BRIAN
Founder of MTI Global Group, specializing in transforming multi-site clinical operations and improving performance across complex healthcare organizations.
What shaped how Brian thinks Three high-growth startups built from the ground up. Twice through the same transition: 20 people to 150, the messy middle where legacy systems fail under new volume and institutional knowledge starts to silo. That repetition taught him the lesson that anchors his work today. Today's fire is the visible problem. The system producing those sparks is the actual problem. Most operators only fix the first one. Two convictions came out of those years. First, founder-led chaos is the primary bottleneck to scale. The instincts that got the company to $20M can actively block the path to $50M, and nobody on the inside wants to name it. Brian does. Second, the single constraint in a workflow, once removed, improves the entire throughput. Brian's diagnostic time goes to finding that one constraint. Everything else gets fixed in its wake. And one operating principle, learned the hard way: simplify and standardize processes before layering automation on top. Otherwise automation just speeds up what's already broken. The right sequence protects margin and prevents the team from burning out as the business grows.
WHO THEY WORK WITH
Mid-market organizations between $1M and $50M in revenue with 10 to 200 people on the team. Founder-led, PE-backed, or VC-backed. Single-site or multi-site. Running on multiple systems that don't talk to each other. These companies are deep in operational complexity: dense workflows, layered automations, regulated procedures, and processes that grew organically as the business scaled. Most have hit the point where the systems and the org chart can't keep up with the growth. Brian specializes in the industries where this complexity runs highest: healthcare, manufacturing, and retail or franchise operations. The common thread is a project, integration, or change initiative that's stalled out, gone over budget, or quietly stopped delivering. That's when the call comes in.
Business stage
- Early-stage
- Growth-stage
- Scaling
- Mature
Business type
- Founder-led
- PE-backed
- Franchise
- Healthcare
COMMON BUSINESS SITUATIONS
What this often looks like inside a business.
- Inefficient processes
- Lack of systems and structure
- Bottlenecks in execution
- Scaling breakdowns
- Poor cross-functional alignment
- No operational visibility
- Role confusion
- Process documentation gaps
- Operational AI implementation sprawl
- Revenue stalled
- Scaling challenges
- Leadership misalignment
- Operational inefficiencies
- Exit preparation
- Other
HOW THEY HELP
A practical path from complexity to action.
- Brian's four-stage approach The work moves through four stages. The shape is the same on every engagement. The depth and pace vary based on what the diagnostic finds. Stage 1. Diagnose and architect Brian runs a structured operational diagnostic to find the root cause of the trouble, set the financial and performance baseline, and name the priorities that will actually move the business. The output is an Evaluation and Action Plan plus a 90-day roadmap to stabilize the operating model. Stage 2. Stabilize and execute Stop the bleeding and install operating discipline. Brian makes the structural corrections, stands up KPI governance so the leadership team can see performance in real time, and tightens the systems carrying the volatility. The focus is disciplined execution and measurable progress, week over week. Stage 3. Transfer and strengthen Ownership of the new operating model moves to the client's leadership team. KPIs and standards become a leadership discipline, not a consultant deliverable. Founder or executive bottlenecks come out. The team learns to run the cadence themselves. Stage 4. Govern and scale Executive governance is in place, strategy gets refined on a regular cadence, and the KPIs are being hit consistently. With the operating infrastructure holding, the business is positioned for durable growth without Brian in the room.
- Framework: The MTI Operating System The MTI Operating System is the framework Brian uses on every engagement. It's built for complex, high-growth environments where the operating model has fallen behind the business. The arc moves organizations through four phases: from operational strain to structured stability to durable growth. Brian starts by diagnosing the root cause and setting a clear path forward. He stabilizes the core systems and installs execution discipline. As the operating model strengthens, ownership transfers to the leadership team and internal capability gets built up. The final phase puts governance in place so the discipline holds long after the engagement ends. The four phases 1. Diagnose and architect. A structured operational diagnostic identifies the root causes, establishes financial and performance baselines, and names the priorities that will actually move the business. The output is an Evaluation and Action Plan plus a 90-day roadmap to stabilize the operating model. 2. Stabilize and execute. Brian makes the structural corrections, stands up KPI governance, and refines the systems carrying the most variability. The focus is disciplined execution and measurable progress, week over week. 3. Transfer and strengthen. Ownership of KPIs and operational standards moves to the leadership team. Dependency on the founder or key individuals comes down. The team learns to manage performance on its own. 4. Govern and scale. Executive governance is in place, strategy gets refined on a regular cadence, and the KPIs are being hit consistently. With governance and operating infrastructure holding, the business is positioned for durable growth.
- The MTI Operating System The MTI Operating System is the framework Brian uses on every engagement. It's built for complex, high-growth environments where the operating model has fallen behind the business. The arc moves organizations through four phases: from operational strain to structured stability to durable growth. Brian starts by diagnosing the root cause and setting a clear path forward. He stabilizes the core systems and installs execution discipline. As the operating model strengthens, ownership transfers to the leadership team and internal capability gets built up. The final phase puts governance in place so the discipline holds long after the engagement ends. The four phases 1. Diagnose and architect. A structured operational diagnostic identifies the root causes, establishes financial and performance baselines, and names the priorities that will actually move the business. The output is an Evaluation and Action Plan plus a 90-day roadmap to stabilize the operating model. 2. Stabilize and execute. Brian makes the structural corrections, stands up KPI governance, and refines the systems carrying the most variability. The focus is disciplined execution and measurable progress, week over week. 3. Transfer and strengthen. Ownership of KPIs and operational standards moves to the leadership team. Dependency on the founder or key individuals comes down. The team learns to manage performance on its own. 4. Govern and scale. Executive governance is in place, strategy gets refined on a regular cadence, and the KPIs are being hit consistently. With governance and operating infrastructure holding, the business is positioned for durable growth.
- What Brian looks for first Two signals tell him whether a rescue can succeed. The first is real executive support. The kind where someone at the top owns the outcome and is willing to back hard calls when the change starts to bite. Without that, the rescue doesn't hold. The second is honesty in the room. Teams that can name their broken processes, failed initiatives, and bad assumptions out loud are teams that can be fixed. Teams that protect the story can't. When both are in place, the first 30 days move fast. Brian triages the active revenue leaks, separates what's truly broken from what's just dated, and runs a gap analysis against where the business needs to be in 90, 120, and 180 days. By the end of the first month, the leadership team has a sequenced plan and the first wins are already moving.
RELEVANT OUTCOMES
What working with Brian can lead to.
What shaped how Brian thinks Three high-growth startups built from the ground up. Twice through the same transition: 20 people to 150, the messy middle where legacy systems fail under new volume and institutional knowledge starts to silo.
That repetition taught him the lesson that anchors his work today. Today's fire is the visible problem.
The system producing those sparks is the actual problem. Most operators only fix the first one.
Two convictions came out of those years. First, founder-led chaos is the primary bottleneck to scale.
The instincts that got the company to $20M can actively block the path to $50M, and nobody on the inside wants to name it. Brian does.
Second, the single constraint in a workflow, once removed, improves the entire throughput. Brian's diagnostic time goes to finding that one constraint.
Everything else gets fixed in its wake. And one operating principle, learned the hard way: simplify and standardize processes before layering automation on top.
Otherwise automation just speeds up what's already broken. The right sequence protects margin and prevents the team from burning out as the business grows.
WORKING WITH BRIAN
Get a clear view of your opportunities and the steps to accelerate your growth.