A Founder’s Guide to Breaking Down Barriers and Breakout Growth
By Tim Streit, Co-Founder and General Partner, Grand Ventures
A year ago, one of our earliest portfolio companies was at an inflection point, with a clear opportunity to strengthen its operating foundation for the next phase of growth. The company was facing a mix of operational and organizational challenges that were limiting efficiency and making it harder to scale.
What followed over the next twelve months was one of the clearest examples I’ve seen of how companies break through operational ceilings, not through magic, but by identifying the right constraints and removing them in the right order.
I’m writing this for founders because what gets labeled a “turnaround” is often something much simpler: a business finally gaining clarity on what is broken, what matters most, and what has to change first.
What Was Broken
When Aqil stepped in on February 11, 2025, he didn’t inherit a single catastrophic issue. He inherited multiple interconnected operational challenges, which are almost always harder to solve.
The business needed sharper visibility into spending, performance, and operational drivers. But more importantly, there was limited visibility into why. The data infrastructure was so fragmented that a quick audit led to a simple conclusion: there was no real data warehouse.
The company’s core productivity metric looked acceptable on the surface, but it understated the true cost of labor by excluding the time and expense tied up in training.
That training system itself was inefficient: six weeks to onboard, followed by high attrition within the first 90 days. The business was effectively retraining a significant portion of its workforce regularly.
Employee sentiment reflected the need for stronger structure, support, and clearer operational alignment.
At the same time, spending decisions weren’t aligned with outcomes. The company was paying for consultants with unclear impact, running initiatives without defined ROI, and was close to committing to a six figure chatbot contract for a program without active customers.
Operational leadership gaps compounded the issue. Training sat within HR without alignment to day-to-day execution, and there was no middle management layer to effectively support and manage over 150 care coordinators.
Clarity – What Was Fixed
The first step was clarity.
Aqil started by following the money: contracts, vendor spend, invoicing, and cash flow. That visibility became the foundation for every decision that followed. From there, the work was sequenced in a disciplined way. First, unnecessary spending was cut. Projects without near-term ROI were paused or eliminated, underperforming consultants were removed, and the chatbot project was canceled.
Rebuilding measurement systems.
Before trying to optimize operations, the team had to be able to see them clearly. Structured data layers, a centralized warehouse, and more reliable reporting created real visibility into performance.
Strengthening leadership and accountability.
A new Head of Operations was brought in, and accountability was clarified across the organization. The structure needed to manage scale was put in place.
Optimizing the enrollment funnel.
Enrollment costs were reduced by over 50% by internalizing the function from third parties, which directly improved unit economics.
Redesigning training.
Training was moved into Operations and aligned with the actual role. New hires were exposed to real workflows early, improving retention and reducing early attrition.
Improving the workforce structure.
The company introduced four-day, ten-hour work schedules aligned better with workforce expectations and contributed to improved retention.
By year-end, the results were clear and, more importantly, they reflected real improvement in the company’s underlying economics, not just temporary cost cutting:
- 31% revenue growth (following a prior-year contraction)
- Gross margins expanded by 146%
- Operating cash flow brought to sustainable and scalable long-term values
- By year-end, the company had materially improved efficiency, strengthened unit economics, and built real momentum going into 2026.
- The icing on top: finished 2025 by landing one of our biggest customers ever, with a full pipeline of large health systems that need our solution.
Lessons for Founders
- Clarity precedes action.Understanding where resources are going is the first step to improving performance.
- Metrics must reflect reality.Incomplete metrics can create false confidence. Accurate measurement drives better decisions.
- Focus requires constraint.
Eliminating non-essential initiatives allows teams to execute effectively. - Sequence matters.
Operational improvements should precede automation or technology investments. - Structure enables scale.
Clear accountability and management layers are necessary for sustained performance.
What Most People Miss
One of the biggest mistakes founders and boards make is expecting financial results to show up immediately after operational fixes are put in place.
In reality, many of the right changes were implemented early, while the numbers continued to reflect old inefficiencies. Financial performance lagged operational progress. That is what makes sustained execution so important during a transformation.
Another leading indicator was employee sentiment. Morale improved before the financials did, which is a useful reminder that internal alignment is often an early signal that the business is moving in the right direction.
A Reflection
When we first invested in TimeDoc in 2017, the thesis was simple: proactive care improves outcomes.
That hasn’t changed.
What changed was the company’s ability to execute against that vision at scale.
This wasn’t driven by a single breakthrough. It was the result of consistent operational discipline across data, processes, and leadership.
For founders, that is often what breaking through looks like. The ceiling is rarely the market alone. More often, it is a set of internal constraints that have not yet been clearly identified and removed in the right order.
