Before you hire: find the bottleneck
By Jamie Rixon · Published 30 September 2026 · Updated 1 October 2026
A practical guide to deciding whether your next growth problem needs clearer ownership, a better process or another person.
When a growing business feels stretched, another hire can seem like the obvious answer. Sometimes it is. But before writing a job description, I would ask: which part of the work is actually getting stuck?
Key takeaways
Find where work waits before deciding which role to hire.
Separate missing ownership or authority from a genuine shortage of time or skills.
Define what a new hire would own, then review delivery and quality alongside cost.
What the research says
In its 2025 report Unleashing SME Potential to Scale Up, the OECD found that service sector businesses which subsequently scaled were already more productive than other SMEs before that growth. The comparison used 2017 productivity measures and growth during 2017 to 2020 across 11 countries with available data. Read the OECD analysis and Figure 1.10.
This is an association, not evidence that a particular workflow change or a fractional executive causes growth. It is also not a study specifically of private clinics. My takeaway is narrower: it is worth examining how the business works, not only how many people it employs.
Four questions before adding headcount
1. Where does work wait? Follow one real piece of work from first request to completion. Identify waiting, repeated checks, missing information and avoidable handovers.
2. What still needs the founder? Separate decisions that genuinely require the founder from tasks that return to them because ownership, authority or the next step is unclear.
3. Is this a capacity gap or a coordination gap? A sustained workload beyond the team’s available time is different from work piling up around one approval. Those problems may need different responses.
4. What would a successful hire change? Define the work the new person would own, the support they would need and the measures you would review. Consider the full cost, not just salary.
A worked example: one delay, two different causes
Illustrative example, not a client case study. A small service business is taking too long to onboard new clients. The founder is considering hiring a coordinator.
If the problem is coordination: each handover arrives with missing information, nobody owns the next step and routine questions wait for the founder. A starting point could be one intake checklist, a named owner and agreed decision boundaries. Check that the owner has time and authority to do the work before adding responsibility.
If the problem is capacity: handovers are complete and ownership is clear, but demand consistently exceeds the team’s available time. Document the workload and skills needed, then consider reprioritising work, adjusting commitments or hiring for that specific gap. A better checklist will not create extra hours.
In either case, compare onboarding time, rework, backlog and overtime with the starting point. The purpose is to test the diagnosis, not assume that avoiding a hire is always the leaner choice.
Start with a small, visible improvement
I would agree one operational priority, one accountable owner and a short review period. Track a few relevant measures, such as turnaround time, rework, backlog and time spent on founder escalations, alongside service quality.
In a healthcare business, efficiency must sit alongside patient safety and appropriate clinical oversight. This is a business operations framework, not clinical advice.
The aim is not to avoid hiring. It is to make the next hire count.
Explore fractional operations support or tell me where your business is getting stuck.
Research references
OECD (2025). Unleashing SME Potential to Scale Up, Figure 1.10. The comparison describes productivity before subsequent growth; it does not establish the effect of a particular operational intervention.