Healthcare Operations Leader
Introduction
Forward-thinking investors, boards and founders are turning to the interim COO to drive rapid execution, de-risk transitions, and build sustainable value.
I know why from the operating seat. As a former COO of an investor-backed professional services firm, I have seen how fast an operating landscape can shift. Post-funding expansion, disruptive technology integration, and leadership transition all raise the demand for high-caliber operational leadership.
Debbie Schapira is a healthcare operations leader with two decades of experience in PE and VC-backed healthcare delivery, behavioral health, and digital health businesses. She now serves as a recurring interim COO across investor-backed healthcare businesses. I sat down with her to explore why this model is gaining ground.
Why do strong operators choose the interim path?
The strongest interim operators choose the model on purpose. They want variety, impact, and the energy of a new problem, and a single permanent role limits all three.
Debbie describes it this way:
Economics also played a role. Debbie saw a clear market opportunity among early-stage companies that needed deep industry expertise but had not yet reached the size or stage to justify a senior, full-time operating leader. She found a market that valued deep experience at a price point that matched where those companies were.
When should a VC or PE-backed company bring in an interim COO?
The right diagnostic asks what an unfilled gap costs the organization.
Four circumstances consistently signal genuine need.
The mandate differs by stage and investor profile. In early-stage companies, the work almost always centers on growth. The interim builds the operational infrastructure that supports what the growth engine has already started. The inflection points are predictable. Investors start asking for more operating scale. Tooling built for a $5M company breaks at $20M. The organization grows faster than its internal processes can support.
In PE-backed companies, the orientation shifts to fixing and optimizing against a value creation plan underwritten before the interim arrived. The interim COO complements the sponsor’s operating partners. The operating partner brings deal specific, portfolio-wide perspective, and the interim COO embeds with the team to drive day-to-day execution and change management.
What does an interim COO do, and what does the company have at the end?
An interim COO delivers a strategy and runs the business at the same time, with direct reports, KPIs, and a seat on the leadership team. There is no 90-day onboarding. The opening days and weeks go to active listening, building trust quickly, and establishing clarity with the CEO and board about the work and how they will measure progress.
Change management often creates durable value, and scoping can overlook it.
The interim stabilizes a team navigating uncertainty and retains leaders who might otherwise leave.
A strong interim COO works in two operating modes, depending on what the company needs. The first unlocks growth. The interim builds the infrastructure, workflows, and tooling that support rapid expansion. The second is stabilization.
The interim steps into high-friction environments to address systemic failures, evaluate cost structures, and maintain business continuity while the organization resets. Both modes require the same diagnostic instinct, and companies often need both.
What a company has at the end goes beyond the deliverable it hired for. It has a leadership team that has been through a transition and stayed, documented processes that have been handed off, and a permanent hire who can be productive in weeks rather than months.
The best interim COOs contribute directly to that hire, from participating in the search to facilitating onboarding. They know the quality of the exit matters as much as the quality of the work that precedes it.
What does an interim COO cost compared to a permanent hire?
On a dollars-per-day basis, an interim executive looks more expensive. Fully loaded, the math almost always reverses.
A permanent COO’s cost includes cash compensation, equity dilution over a four-year vest, severance exposure, and full benefits. An interim engagement is typically limited to cash and carries no equity, severance, or tail.
The gap itself also carries hidden costs. Deals are not renegotiated, talent leaves because the organization feels unstable, and progress toward goals stalls.
What do boards and founders get wrong?
The warning signs of a less successful engagement usually appear before it begins.
Unclear goals cause the most failures. An interim without specific, measurable objectives delivers activity without accountability, and the company risks blaming the model for a problem it set-up before day one.
Exclusion from core leadership functions comes second. An interim absent from leadership meetings and board interactions cannot do the change management work that justifies the engagement.
Third, some companies use interim leadership to avoid a hard decision about the permanent team. No amount of operational skill resolves a governance problem the company has not solved.
CEOs and boards can assess readiness with four questions.
- Is there a mission-critical gap?
Will delaying action by three to six months during a permanent search hurt key EBITDA or growth targets? - Are the goals concrete?
Has the company identified two or three immediate, measurable metrics for the interim leader to own? - Is the organization open to outside influence?
Is leadership prepared to give an interim real access to board discussions,
team meetings, and operational levers? - Is the transition plan clear?
Does everyone understand that the interim lays the foundation for permanent leadership and will not fill the seat indefinitely?
Clear answers to these questions create stability for the organization during the engagement.
Where does an interim COO create the most value in regulated industries?
Operating leadership in highly regulated sectors demands domain specificity from day one. Generic management playbooks fall short where compliance shapes every operating decision. Getting it wrong costs dollars, regulatory exposure, workforce trust, and reputational damage that takes years to rebuild.
The interim must embed regulatory requirements in daily operations and avoid treating them as a parallel workstream. In industries like healthcare, financial services, and energy, managing teams across jurisdictions requires mastery of federal and state rules that vary by geography, role, and business model. Revenue cycle management, contract compliance, and SLA obligations demand senior operational oversight, because penalties compound quickly and surface slowly.
Workforce dynamics add another layer. In mission-driven organizations such as healthcare, education, and nonprofit-adjacent businesses, employees have invested personally in their credentials and their work. They assess operational leadership quickly and accurately. An interim COO who cannot connect with the culture loses the workforce’s trust when the organization can least afford it.
The operators who create the most value in these environments have navigated regulatory and workforce complexity before. Generalists who learn the industry during the engagement do not.
How is AI changing the interim COO role?
AI proficiency is table stakes. Every company is now integrating AI, and the harder question is whether it is working. The interim leader must understand where AI creates operational leverage, where it creates risk, and how to guide a team through adoption that disrupts how people work.
Many organizations have moved past pilots and now face the more difficult work: redesigning roles and workflows, proving returns against the value creation plan, governing AI in regulated environments, and keeping the trust of a workforce whose jobs are changing. An interim COO brings pattern recognition from multiple companies in that same transition and can distinguish real gains from expensive activity.
The volatility AI has introduced into organizational design is one of the strongest arguments for access to interim operators who have seen it before.
How does the interim COO path evolve?
The interim COO career compounds in a way permanent roles do not. Multiple engagements per year bring multiple new business models, leadership cultures, and operating challenges. Each builds pattern recognition that makes the next engagement faster and more effective.
The path extends naturally into Chief Transformation Officer, Chief Strategy Officer, President, and in the right circumstances, interim CEO.
Title selection matters strategically. The right title signals authority to external partners and keeps space open for high-potential internal leaders. The operators who navigate this well use title as a tool for setting up the engagement, and the organization, for success. They do not read it as a measure of their seniority.
What should a senior operator know before choosing this path?
The interim model does not suit every strong operator. The self-assessment comes down to four things.
First, appetite for the work itself. Short timelines, new companies, new teams, and new problems every few months define the structure of the model. Operators who find satisfaction in building something over time and watching it compound will find the model unsatisfying, however capable they are.
Second, operators need to be good at change management and enjoy spending a lot of time on it. They also need to enjoy moving fast with a sense of urgency and balancing short-term fixes with longer-term scalable solutions.
Third, comfort with business development. The pipeline does not manage itself. Maintaining visibility, investing in placement firm relationships, and staying present in a professional network all happen in parallel with intense, short-term execution. The operators who build durable practices treat business development as a core function.
TrueBridge exists to reduce that friction. We connect experienced interim operators with the boards and investors already looking for them, so their energy goes toward the work rather than the search.
Lastly, differentiation. As the fractional and interim market grows, being a generalist is necessary but not sufficient.
Sustaining an interim practice takes ongoing work in both directions: keeping your sector expertise sharp enough to stand out, while staying broad enough to win engagements across companies and evolve as the market shifts.
What do the operators built for this model have in common?
I asked Debbie to finish one sentence. The operators who are built for this model all have ___ in common.
Having sat in an operating seat myself, I recognize that quality. It is the ability to hold a clear view of what matters when everything around you is moving, and to execute against that view without the stability a permanent role provides. The companies that get this right see the model as a competitive advantage.