Navigating organisational growth: The role of the Operating Model
Every growing team and every fast scaling company eventually hit the same wall.
Revenue is growing and the market demands your product. Outwardly, it's a success story.
Internally? It feels different: Chaotic, everything takes too long, teams duplicate work, founders and leadership teams are trapped in operational weeds instead of looking at the horizon.
When companies or teams hit this wall, leadership almost always blames the product, the commercial team, or someone else.
They are fixing the wrong thing (and it's usually neither the product nor your people). The actual problem is your operating model.
Business Model vs. Operating Model
Let's clear something up straight away: Your business model and your operating model are completely different things.
Your business model is your promise. It’s what you sell and to whom.
Your operating model is the factory floor. It’s how you actually deliver that promise, the actual mechanics of your company.
Most executives think their operating model is just the org chart. But an org chart tells you who reports to whom. It tells you nothing about how work actually gets done.
A real operating model maps the core of the business. It defines how teams collaborate, who holds the real decision-making authority (and who just gets to give an opinion), your cultural habits, and the technical infrastructure enabling it all.
The operating model provides guardrails. What it doesn't do is dictate strategy or micromanage daily tasks. It just builds the tracks so the train can run fast without derailing.
What a typical Operating Model looks like (and what it isn't)
Now we learned, that an Operating Model is more than just an org chart, but what is it? A robust operating model comprises the following main pillars:
People and organisation: How teams are grouped (functional, product-led, or matrixed), defined capabilities required, reporting lines.
Process: Outlines the core workflows and end-to-end processes to execute efficiently
Governance: How decisions are made, risk management, and steering mechanisms to keep the organisation aligned.
Technology: Details the digital foundation, applications and IT infrastructure required to enable and support people, governance, and processes
An operating model creates a predictable, repeatable system for value creation.
What it doesn’t do: It does not dictate strategy, nor does it micromanage daily tasks. It provides the guardrails for autonomy.
The "rule of 3 and 10"
So, why does your operating model break? Because of a concept called the "Rule of 3 and 10". Every time headcount roughly triples: 3, 10, 30, 100, 300. The old ways of working shatter. You cannot run a company or team of 50 the way you ran a company or team of 5.
Running an early-stage spin out is different to running a commercial-stage company or a large team. The operating model must radically shift at specific funding and headcount milestones.
At 5 people: Your operating model is a group chat. Decisions take seconds. Everyone knows everything.
At 50 people: That intimacy is dead. Silos emerge. You suddenly have teams (clinical, engineering, sales, etc.). If you don't formalise how they talk to each other, they'll build entirely different realities. You need managers, and the span of control has to formalise (usually around 1 manager to 7 reports).
At 500 people: You are now fighting human nature. You’re dealing with Dunbar’s Number (the cognitive limit of ~150 people with whom one can maintain stable social relationships). You need real governance, capital allocation committees, and hard KPIs. Without a rigorous operating model at this stage, operational drag can consume up to 30% of your workforce's time.
According to McKinsey & Company data, organisations that proactively redesign their operating models to match their growth stages have a 70% greater chance of achieving top-quartile financial performance.
A typical medtech example: R&D vs. Commercial
If there is one universal symptom of a broken operating model, it’s the friction between the Regulatory/R&D teams and the commercial teams.
Your early operating model was built to do one thing: get regulatory clearance. But as you scale, you are trying to deploy a commercial sales force. If R&D and Regulatory are still acting as a siloed ultimate authority, your go-to-market strategy will stall.
If your Chief Medical Officer and your Chief Revenue Officer aren't structurally forced to align on what constitutes a "successful deployment," your commercial reps will inevitably sell promises your regulatory team won't legally let you deliver. A strong operating model forces these factions into the same room and gives them shared commercial KPIs.
What needs to be true before you fix it
You can't just sketch a new matrix structure on a whiteboard. To be honest, of course you can, but expect your time-to-activation to drop significantly. A few things have to reflect reality first.
A clear strategic north star: You cannot design the how if the what is ambiguous. A model optimised for speed looks entirely different from one optimised for compliance. Are you optimising for rapid geographical expansion across Europe, or deep, clinical utilisation and adoption in a handful of key UK Trusts? You can't build the how if the what changes every board meeting.
Leadership alignment: The C-suite has to stop protecting their fiefdoms. If leaders won't agree to optimise the whole organisation, even if it means giving up some of their own headcount, the model is dead on arrival.
Data infrastructure: You need evidence-based metrics to track the model's efficacy.
How to redesign your operating model (a short explainer)
Upgrading how your company or team operates isn't a weekend exercise. This process requires stepping entirely out of the day-to-day operations to look at the machinery of your business objectively. It is a complex transition, but the alternative is watching your growth stagnate under the weight of your own success.
Here's a short explainer:
Map the commercial reality: Start with the patient or clinical user experience and map backward. What actually has to happen to delivery value? Find the bottleneck first.
Identify core capabilities: What 3-4 things must your company or team do better than anyone else in the market? Disproportionately allocate your best talent and budget at that specific capability.
Build around the work, not the egos: Resist the urge to build departments to accommodate loud personalities. Design the ideal structure for the work that needs doing, then map your people to the roles.
Write down who decides: Establish actual governance. Decide exactly who owns the launch or an implementation go-live, who controls the feature roadmap, and who has the final say on pricing discounts.
It’s difficult, unglamorous work. But the alternative is watching your runway disappear while you struggle to install a product the market actually wants.
Scaling your impact across healthcare systems takes more than just hiring more reps or engineers. If internal friction is starting to cost you enterprise contracts, it’s probably time to look under the hood. Let's talk about diagnosing your operating model.
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