From digital head to growth leader: what I had to unlearn

For most of my career I was rewarded for a particular kind of competence. I could take a budget, a brief and a deadline and produce a campaign that moved a number. I could build a team that shipped. I could stand in front of a management committee with a dashboard and make digital look like the most alive part of the organisation. In retail, in telecom, in media and then in hospitals, this was the job, and I was good at it.

Then the job changed. Not the title at first — the questions. The CFO stopped asking what the campaign had delivered and started asking what the group’s demand would look like in three years and what it would cost to get there. The chief executive stopped asking about the app and started asking which formats the group should be in. The medical director stopped asking me to promote a department and started asking me whether the department should exist. I answered every one of these questions the way a digital head answers, and I was wrong every time, in ways it took me a couple of years to see.

This is what I had to unlearn. Some of it I am still unlearning.

Campaign thinking

A digital head thinks in campaigns. There is a launch, a burst of activity, a result, a report, and then the next one. It is a rhythm that suits marketing and suits the people who fund it, because every quarter produces a story.

The rhythm is wrong for growth. A hospital group’s demand is not a series of bursts. It is a base that is either compounding or eroding, slowly, driven by things campaigns do not touch — whether a Tier 2 unit’s contact centre answers the phone in the local language, whether the search listings for fifty doctors are accurate, whether a patient who came in for a consult was ever followed up. The campaign moves the number for six weeks. The base moves it for six years.

The habit I had to break was reaching for a campaign when a number dropped. The habit I had to build was asking what in the base had shifted. It is a slower, less visible way to work, and for the first year I felt as if I had stopped doing anything. Then the base started moving, and it did not stop when the quarter ended.

Channel ownership

I owned channels. Search, social, the website, the app, the chatbot, the contact centre, the CRM. Each had a budget and a team and a set of numbers, and my worth to the organisation was measured by how those numbers moved. When the group centralised, I fought to own more channels, and I won most of the fights.

What I did not see was that owning the channels had made me the wrong person to judge them. Every rupee moved from one channel to another was a rupee moved between my own teams. Every channel that underperformed was a team I had built. I was defending a portfolio, and the portfolio’s shape was an accident of what I had been allowed to build, not a decision about where the group’s demand should come from.

The growth seat does not own channels. It owns demand, and it should be indifferent to where demand comes from. The moment I understood that, I started cutting channels I had personally built. That was the hardest thing I have done in the role and the most useful. A chatbot I had championed. A social programme I had hired a team for. Both good work. Neither producing patients at a cost the margin could carry. I had known this for a year and had found reasons.

Vanity metrics

I will be specific about which ones, because I reported all of them with a straight face.

Traffic. Followers. Reach. App downloads. Chatbot containment. Search rankings. Cost per lead. Every one of these is a real number that measures a real thing. None of them is a patient in a hospital. I reported them because they went up, and a number that goes up is a number an executive committee likes, and an executive that brings numbers the committee likes gets funded.

The unlearning came in a single P&L review. I had presented a strong quarter — lead volume up, cost per lead down, app engagement up. The CFO asked how many of the leads had become kept appointments, and what those appointments had been worth. I had a number for the first. I did not have a number for the second. He said, not unkindly, that until I did, he had no way of telling whether digital was an investment or a cost.

I now regard every metric that stops short of a kept appointment and its revenue as an internal number. Useful for running the function. Not for describing it. The difference between a digital head and a growth leader is which numbers you are willing to be judged on. The second set is much harder to move and much easier to lose your budget over. That is what makes it the right set.

The instinct to build

An engineer by training with a digital remit is dangerous in a hospital group, because the group will let you build almost anything if you frame it as innovation. I built. A patient app, a consumer platform, a chatbot, dashboards, integrations. Some of it was necessary. A fair share of it was because building is what I knew how to do and what got noticed.

The growth seat asks a question I had never asked: what is the cheapest way to prove this demand exists before we spend capital on it? A new format — home care, a digital clinic, a day-care centre — does not need a platform to prove demand. It needs a landing page, a contact centre script and ninety days of data. A new service line does not need an app. It needs to show up in search for the conditions it treats and convert the enquiries that follow. The platform comes after, if the demand is there, and half the time it is not.

I now hold my own function to a rule I would have found insulting five years ago. Nothing gets built until the demand has been shown with something that already exists. It has killed several projects I would have loved to run. It has also meant that the things we do build get funded without a fight, because the case was made before the capital was asked for.

Capital discipline

This is the habit I had furthest to travel on, because nothing in a digital career teaches it. Digital spends operating budget. Growth spends capital, or argues for it, and the two are governed by entirely different logic.

Operating budget is a cost. You are asked to spend it well. Capital is a bet. You are asked to defend the return, the payback, the alternative uses, and the downside. When I first presented a new format to the executive committee, I presented it the way I would have presented a campaign — the plan, the timeline, the launch. The committee asked what the capital could earn if it went into a new floor at an existing unit instead. I had not considered the question. It had not occurred to me that my proposal was competing with a cath lab.

Every capital case I have built since has started from that comparison. What else could this money do, and why is this better? It is a question that a digital head never has to answer and a growth leader cannot avoid. It has made me argue for less, more carefully, and win more often.

Saying no to my own function

The teams I built expect me to fight for them. That was the deal, for years. I got the budget, they did the work, and when the group came for the budget I stood in the way.

The growth seat breaks the deal. If I am responsible for the group’s demand and its cost, then I am responsible for judging my own function by the same standard I judge everything else, and sometimes my function loses. The social team that produced beautiful work and no patients. The app feature that the product team loved and nobody used. The agency relationship that had become comfortable. In each case the person cutting it was the person who had built it, and the team knew it.

What I learnt is that the teams respected it more than the fighting, once they understood what it meant. A leader who defends everything defends nothing in particular. A leader who cuts his own work when the numbers say so can be believed when he says something is worth keeping. It took a year for that to land. It cost me two good people who preferred the old deal. I would make the same call.

Arguing from the P&L

The last habit, and the one that changed the seat more than any other. A digital head argues from possibility: what we could do, what the technology enables, what the competitor is doing. A growth leader argues from the P&L: what this does to revenue, to margin, to capacity, and when.

I resisted this because it felt like a smaller way to think. It is not. It is a more honest one. The P&L is where the group’s choices actually live. A proposal that cannot be expressed as a line on it is not a proposal, it is an enthusiasm. When I learnt to say that a new vertical would take three years to reach contribution, that it would need the contact centre to add two languages, and that the alternative was a unit expansion with a faster payback but a worse mix — the executive committee started treating me as one of them rather than as the digital person who wanted money.

The medical director, notably, started listening too. Clinicians distrust marketing. They understand a P&L argument, because their own departments live and die on one.

If you are making this move next year

1. Pick the one metric you will be judged on and make it a kept appointment and its revenue. Report nothing to the executive committee that stops short of it.
2. Find one channel you built that is not earning its place. Cut it yourself, before someone else does, and say why.
3. Before proposing anything that needs capital, write the case for what else the money could do. If your proposal does not beat it, do not present it.
4. Sit in the P&L review for two quarters without presenting. Learn what the CFO and the unit heads argue about. Then argue in their terms.
5. Stop building for a year. Prove every demand with what already exists. See what survives.
6. Tell your teams the deal has changed. Do it once, clearly, and then behave as if you meant it.

I was a good digital head. The habits that made me one were most of what I had to give up. Nobody warns you that the promotion is a subtraction.

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