Meridian Health · Series B, ~180 people · A role designed against the nine functions
The company has grown from 40 to 180 people in eighteen months, and the founder is now the single point of integration across functions that no longer talk to each other directly. Product, commercial, and clinical operations each make sound decisions in isolation that collide at the executive level — and the founder is spending most of their week reconciling those collisions rather than leading.
This role exists to hold the integration the organization outgrew. It does not run a function, and it does not manage the executive's calendar.
The integration layer between the executive and the senior leadership team. Two things move off the founder's plate: the synthesis of cross-functional information into a single view the executive can act on, and the management of strategic priorities once they have been set.
Where a decision touches a co-founder relationship or a board matter, the Chief of Staff frames the decision and recommends — the executive decides.
The Chief of Staff is the person who tells the executive what others will not. That challenge happens in private. Outside that relationship, the Chief of Staff and the executive are aligned.
By the end of week one, the executive should notice the absence of three standing demands on their time.
The executive team meeting runs without the founder needing to prepare it, and the leadership team brings aligned recommendations rather than competing positions.
Cross-functional collisions are caught and resolved before they reach the executive.
The organization has an operating rhythm that doesn't depend on the founder's personal intervention — and the executive is leading the next stage of growth rather than holding the current one in place.
Reports directly to the Chief Executive. Full access to financial reporting, the board pack, function-level metrics, and the executive's inbox where delegated. Attends board meetings as an observer. There is no information the executive sees that the Chief of Staff cannot, except co-founder and personnel matters the executive designates as direct. The executive thinks aloud with the Chief of Staff before a decision is formed — the first place an idea is tested, not the last.
The integration work held manually should be substantially built into how the organization operates — a planning rhythm, a decision-routing structure, a leadership team that integrates horizontally. At that point the role grows into a broader remit, or the person moves into a function-leadership role they have earned. The role is not designed to make itself permanent by making the organization dependent on it.
Compensation: named range, stated directly. The role's seniority and authority are reflected in the compensation — not described as "competitive."
The authority is designed in from day one — not left to "develop over time as trust builds." This exemplar is built against the nine functions.
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