What a Trip to the Doctor can Teach you about Scaling Up

Exploring aspects of conversation, both personal and professional

How the medical industry has had to scale up to the application of technology

Recently I’ve been attending a number and variety of medical appointments with my partner. What’s really struck me is how the medical industry has had to adapt to the application of technology in the profession.

The specialist used to be the quintessential small business person, with one doctor and a receptionist or perhaps a number of doctors sharing a receptionist. Nowadays, technology is playing a major part in the assessment and treatment of some patients. This requires expertise which the specialists need to either outsource or employ in their team. I’m sure at one point they tried to operate the technology themselves but soon realised that in the long run it would be financially better and achieve better outcomes if they employed someone with the right technical expertise to undertake the task.

This is really no different from what we advocate when scaling up your business.

One of the key things to get right - The Functional Accountability Chart

One of the key things to get right is the specific accountabilities of each of your leadership team for your company’s functions and business units. When you’re scaling up it’s just not feasible to do everything yourself and because you may not have a leader for each business function you are going to need to agree with your team who’s doing what.

Amongst our suite of simple, practical, and actionable tools we have a one page tool designed to help you get this level of clarity...

The Functional Accountability Chart, (FACe) that you can download here, assists you identify the right people in the right seats at the top of the organisation clear in what they are accountable for and how success will be measured. Remember that an organisation is simply an amplification of what’s happening at the senior level of the company. If a function is not working within the business, then your problem more than likely lies with the functional leader.

In the FACe tool there is a list of the common set of functions that must exist in ALL companies. Even a start-up, or indeed a Doctor’s surgery, will have all these functions it’s just that one person is doing everything! The key is to work out which functions on the chart to delegate and to whom.

Completing the Function Accountability Chart
Step 1

Get each member of your leadership team to fill in the first blank column on the sheet with who they believe is accountable for each function or business unit. Then compare these lists amongst the leadership team to see if there is agreement. It’s quite likely there isn’t, even when it comes to who is head of the company!

Step 2

Once the team has agreed on the people accountable for each function you should consider the 4 questions that are summarized at the bottom of the form:

1. Do you have more than one person accountable for a function?

The rule is that only one person should be accountable, otherwise there will be confusion. Having more than one name in a box is a red flag.

2. Does someone’s name show up in more boxes than everyone else’s?

In growth companies it is by no means unusual that a leader may wear multiple hats, but if one executive’s name is showing up three or four times compared to everyone else’s one or two this is another red flag. They will either burn out or one of their functions won’t be supported sufficiently.

3. Are there boxes with no names in them?

This can happen when there’s a function that you feel that ‘all of us’ are accountable for. The reality is, no one will be accountable, and that box should be left blank. The rule of accountability means that one person should ultimately take ownership. Rather than having to hire someone you may choose to rotate this responsibility through the team and switch accountability for this function every 6 months.

4. Are you enthusiastic about the person you have in each box?

Maybe a leader isn’t getting the job done or they are in the wrong seat. Perhaps they have too many seats, or there could be a performance issue. Sometimes a really talented person just doesn’t fit the culture, which can happen when a “big company” executive joins a growing business.

Answering these four questions can be a touchy subject as it may involve executives who have become dear friends after surviving through the start-up phase. But it is vital to face these decisions if the organisation is to grow. Some of the leaders from the start-up phase may in fact be relieved as they are not passionate about the scaling up phase. You just won’t know until you have these crucial and sometimes tough conversations.

Step 3

The second column on the page is to complete KPI’s for each function. It’s critical that these KPI’s align with the business model of the company. Don’t make the mistake of just using the KPI’s for the person that has accountability for that function. The KPI’s are intended to be leading indicators measuring the daily and weekly activities for the function and should be driving superior results. For help in selecting KPI’s that are appropriate for your industry visit Once one or two KPI’s are determined for each function then consider if the person in the job function has the skills and aptitude to deliver on them. A misalignment may identify a potential problem.

Step 4

The next step is a great exercise for the CFO or the person in charge of accounting to lead. Basically, you go through the financial statement and decide who is accountable for each line item (don’t confuse this with authority). Then make a decision on the most important line item for each of the functions and put this into the Results/Outcome column. As in Step 2, once you have identified accountability for each line item ask the 4 questions to ensure the workload is equally distributed across the leadership team.

Once you’ve completed the Function Accountability Chart

Once you’ve completed this form it should help you diagnose where you have people and performance gaps on the leadership team. One word of warning though, often the strength of the business’s leader becomes the weakness of the organisation. Sounds odd I know, but it’s because leaders have a tendency to hold on too tight to the function that is in their area of expertise. They either strangle the efforts of others or they bring in someone too junior to oversee the function versus bringing in the star they really need to drive the function. Leaders should make a counterintuitive decision to bring in people who exceed their own capabilities in their area of strength to prevent the company from stalling.

So what might you do now?

If you haven't already done so, download a copy of your Function Accountability Chart (FACe) and complete the exercise with your leadership team to ensure you have the "right people doing the right things right".



If you are interested in further exploring how to leverage simple, actionable, and practical tools to help you have the "right people doing the right things right" why not come along to the Scaling Up Business Growth Workshop we are running in conjunction with our partner SWAAB on Tuesday 4th, December.

More informationGet tickets


Alternatively, if you would just like to learn a little more about Scaling Up - grab yourself a copy of the "Quick Start Guide".



Scaling Up: How a Few Companies Make it...and Why the Rest Don't

Verne Harnish






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