Big Hairy Challenges
Solving the problems that stall progress because they are messy, cross-cutting, and hard to own.
These are the challenges that tend to linger because no single leader, function, or discipline can solve them alone. They span strategy, operations, experience, facilities, politics, culture, and economics all at once. I help organizations cut through that complexity, define the real problem, surface the constraints that actually matter, and move toward solutions that are practical, implementation-minded, and durable.
Selected examples of work where complexity, competing interests, and real-world constraints had to be turned into a path forward.
Designing Emergency Care for Extreme Volume, High Acuity, and Cultural Complexity
Public Hospital + Academic Medical Center, Qatar
Challenge:
Planning a new trauma and emergency model required more than forecasting volume: it meant preparing for more than 500,000 annual visits, roughly one patient arrival per minute, and a care model shaped by gender, nationality, acuity, length of stay, and culturally specific expectations for how different patient groups should enter, move through, and experience care.
Result:
Produced a new trauma and emergency care model that defined how more than 500,000 annual visits could be managed through a multi-level ED with culturally responsive arrival sequences, standardized intake, high-acuity adjacencies, and a clearer logic for patient flow and staff operations.
Untangling an Academic Health System’s Acute Care Gridlock
Academic Health System, Midwest U.S.
Challenge:
A multi-campus academic health system needed to rethink its acute care footprint as extreme occupancy, uneven campus roles, and the limits of optimization alone exposed the need for a broader strategy of redistribution, expansion, modernization, and replacement.
Result:
Produced a phased enterprise strategy for acute care that repositioned the flagship hospital, expanded selected community campuses, advanced replacement and modernization decisions, and established a more durable footprint for future growth and disruption response.
Redesigning a Statewide Behavioral Health System Under Pressure
State of Texas, Southwestern U.S.
Challenge:
A statewide psychiatric hospital system under growing strain needed to redefine its role as forensic demand crowded out civil capacity, infrastructure aged, workforce shortages deepened, and community-based care remained underbuilt across much of the state.
Result:
Developed a statewide behavioral health plan that moved beyond “more beds” alone, redefining the relationship between state hospitals, community capacity, forensic demand, and rural access while establishing a clearer path for system redesign, an approach later reflected in hundreds of millions of dollars in state appropriations and the launch of multiple new and replacement psychiatric hospital projects across Texas.
Aligning Three Cancer Ambitions into One Coherent Model
Community Health System, Mid-Atlantic U.S.
Challenge:
What began as a cancer planning effort became far more than visioning as a regional health system worked to define a model that could satisfy the expectations of a local provider, a regional partner, and a top-ranked oncology program, all without losing a distinct identity of its own.
Result:
Produced a cancer-center strategy that turned competing visions into one coherent and implementable model, aligning brand, care journey, operations, and space while creating a clearer path for how patients should enter, navigate, and experience care within a constrained existing footprint.