When growth gets a seat on the executive committee

For years the request that came to my function was a campaign. A unit head wanted footfall for a new cath lab. The CEO wanted the flagship visible before a competitor opened across the road. A specialty wanted a launch. We delivered the campaign, reported the enquiries, and were thanked or blamed depending on the month.

Then one budget cycle the request changed shape. The CFO did not ask what I planned to run. He asked what number I would sign for — revenue, by unit, by quarter — and what I needed to hit it. The seat on the executive committee came with that question, and I spent the first two quarters learning that the seat was not a promotion. It was a transfer of liability.

Most growth leaders want the seat. Fewer have thought about what it obliges them to do, and what it does to relationships that used to be easy. This is what changed for me.

From a campaign to a number

A campaign is an output. You can deliver it regardless of what happens next. A number is an outcome, and in a hospital the outcome is a product of things you do not control: bed capacity, the surgeon who resigned in March, the TPA that delayed empanelment by a quarter, the discharge process that keeps average length of stay two days too long and blocks the beds your demand was meant to fill.

The first obligation, therefore, is to decide which number you are signing for and to be precise about it. Enquiries are not a number the committee cares about. Revenue is, but revenue in a hospital is occupancy multiplied by realisation multiplied by mix, and growth cannot own all three. What I ended up owning was the top of that equation — new-patient revenue by unit and specialty, against a plan built with the unit heads — and a stated dependency on capacity that the committee agreed to in writing. If the unit could not admit the patients, the miss was recorded as capacity, not demand. That distinction sounds bureaucratic. It is what makes the number defensible when it is missed, and it will be missed.

There is a second precision to insist on. The number must be the same number in the CRM, the unit’s dashboard and the finance pack. In most groups it is not, and the first quarter in the seat is spent discovering that three functions have been reporting three different versions of how many new patients came in. Until there is one number, there is no forecast, only an argument.

Capital discipline, including against your own asks

Before the seat, I argued for the digital budget. In the seat, I saw the capital queue: the linear accelerator, the ICU expansion, the new unit in a Tier 2 city, the ERP replacement, the working capital tied up in government-scheme receivables. My CRM upgrade was in that queue. So was a contact-centre platform I had championed for two years.

What the seat obliges you to do is rank your own asks against the others honestly, in the committee’s units. I have argued in that room for an ICU expansion over my own platform because the ICU was turning away cases with better margin than any campaign could produce. The team did not thank me. But the credibility that buys — the CFO knowing you will argue against your own function when the numbers say so — is the only currency that gets your next case through without a fight.

The corollary is that you stop presenting cases you would not fund if the money were yours. The seat removes the luxury of asking for everything and letting finance say no.

There is a subtler discipline. Demand and digital spend is opex, and it looks cheap next to a capital item. It is tempting to use that. But opex recurs. A contact-centre expansion approved this year is in the base next year and every year after, and the committee that approved it as a small number will meet it again as a large one. Present the run-rate, not the first year, and say when it stops growing.

The trade-offs that are not yours alone

Growth’s interest and the group’s interest diverge more often than growth leaders admit. A discounted health-check camp fills the OPD and produces enquiries; it also fills the OPD with low-realisation volume that displaces the referred surgical consult the unit actually needed. A specialty launch draws demand to a unit whose OT schedule is already full, so the patients you brought wait, and leave. A regional-language campaign in a district town brings patients whose payer mix the unit is not set up to collect from, and the receivable days that follow appear in the CFO’s pack with nobody’s name on them.

In the seat you see the second half of each of those sentences. The obligation is to bring the whole trade-off to the table rather than the half that flatters your function. The committee will find the second half anyway, and it will remember who left it out.

Saying no to your own function

This is the part nobody prepares you for. Your team built plans on the assumption that you would fight for them. Now some of those plans lose in a room they are not in, and the person who let them lose is you.

I have cut my own function’s budget in a review to protect a unit’s nurse hiring, because the unit could not take the volume the budget was meant to generate. I have deferred a platform my team had spent a year specifying. What I learnt is that the team can accept the decision if they understand the trade-off, and cannot accept it if they hear it as a rumour. Tell them the same day. Tell them the reason in the committee’s terms, not softened. Then tell them what you argued for and won, because there will be something.

The growth leader who keeps every rupee of their own budget while the group is short of nurses is not on the executive committee. They are a lobbyist with a seat.

When you can see the unit P&L

The relationship that changes most is with unit heads. Before the seat, you were a service provider: they asked, you delivered, they judged. After, you are in the review where their P&L is read line by line, and they know you are there.

Some unit heads become allies immediately, because you can now see what they have been saying for years — that their demand problem is really a capacity problem, or a doctor problem, or a payer-mix problem — and you can say it in the room with data they could not assemble. Others become guarded, because the person who used to take their brief now sees their occupancy, their revenue per occupied bed, their doctor costs, their discounts. Their brief was always shaped by what they wanted the centre to see.

Three rules kept this workable for me. First, never use a unit’s P&L as a weapon in committee. If the number is bad, they hear it from you first, privately, with your view on why. Second, bring them something. A unit head who gets, from you, a clean view of demand by specialty against their own capacity has a reason to want you in the room. Third, never take a unit’s demand plan to committee without the unit head’s name next to yours. A growth number without the unit’s ownership is a number growth will be blamed for alone.

The unit heads who never adjusted were the ones who had been managing the centre’s perception rather than the unit. The seat makes that visible, which is not comfortable for anyone, and is one reason the CEO wanted growth in the room in the first place.

What you owe the committee

Forecast accuracy above forecast ambition. A growth leader who forecasts high and misses has taught the committee to discount everything they say. One who forecasts accurately and explains variance has taught them to plan around it. Bad news early, always, in the same format as good news. And one version of the number: if the sources disagree, resolving that is your problem, not an interesting observation to share.

There are quieter obligations. Decisions the committee makes are decisions you represent afterwards, including the ones you argued against. What is said in the room stays there, and the temptation to tell your team which unit head blocked what is strong and must be resisted. The CEO’s agenda in a given quarter — a launch, an acquisition, a cost programme — is the agenda, and your function’s priorities bend to it rather than competing with it.

And there is the obligation to prepare. An executive committee runs on papers, and a paper from growth that arrives the night before, with a number that has not been reconciled with finance, wastes the time of eight people who each run something larger than your function. The paper goes to the CFO’s team a week early. The number they see in the room is the number they have already checked.

What the seat does not give you

It does not give you authority over clinicians. The medical director’s “no” on a service promotion, a doctor’s capacity or a package inclusion is still a “no”, and the seat does not change that. It does not give you the doctors’ loyalty; they still see the growth function as the people who put their faces on hoardings. It does not give you the unit heads’ P&L; you see it, you do not own it. And it does not give you the right to run the units’ operations, however clearly you can now see what is wrong with them.

The growth leaders I have watched lose the seat lost it by mistaking visibility for authority — by telling a unit head how to run discharge, or a medical director whom to recruit, because they could now see the numbers. Seeing is an obligation to inform. It is not a licence to direct.

If you have just been given the seat

• In the first month, agree in writing which number you own, what it depends on, and how a capacity miss is recorded differently from a demand miss.
• Read twelve months of every unit’s management pack before your first review. Do not walk in learning the P&L in front of the people who own it.
• Visit every unit head before the first committee meeting where their numbers are discussed. Tell them what you will say.
• Rank your own capital asks against the group’s queue before finance does. Withdraw the ones that lose.
• Reconcile the demand number across CRM, unit dashboards and the finance pack. Until there is one number, there is no forecast.
• Tell your team what the seat means for them — that some of their plans will lose, that they will hear it from you, and what you will fight for.

The seat is where you find out whether you wanted to grow the group or grow the function. Only one of those keeps the seat.

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