Is Leadership Broken or Just Misaligned?
It’s easy to assume leadership is broken in early-stage startups. Founders feel stuck in the weeds. Teams don’t trust “management.” Progress stalls, not because of market forces, but because of internal drag.
But leadership isn’t broken. It’s misaligned.
Built for a stage that no longer reflects the complexity, or ambition, of the business.
Most startups were shaped by a familiar model:
The founder leads by doing
Decisions are centralized
Roles evolve organically
Communication happens informally
That model works. Until it doesn’t.
As the company grows, so does its complexity: more products, more functions, more stakeholders. What once felt efficient becomes the bottleneck.
It’s not dysfunction. It’s a system doing exactly what it was designed to do, in a context that’s outgrown it.
In Practice: A 360° View of Veterinary Leadership
Each edition, we bring you insights from industry leaders shaping the future of veterinary innovation and just as importantly, from the people living it every day: veterinarians, practice managers, and veterinary technicians.
This week, we’re featuring Suzanne Thomas, BA, BS, LVT, CVT, NASM-CPT, Senior Manager of Operations for a leading veterinary corporate group and Founder & CEO of Leading Veterinary Teams LLC.
Suzanne brings a rare 360° lens to the leadership conversation. She’s been the technician, the trainer, the operations lead, and now a strategic partner for hospitals and startups alike.
She leads with honesty, energy, and a deep respect for the people doing the real work, because she’s done it herself.
Her message to founders is direct: If your solution doesn’t reflect how leadership actually works inside a clinic, it won’t land.
“I have the rare advantage of having been the veterinary technician, led the operations, built the training, and now helping shape strategy from the outside in. That perspective lets me see clearly where so many veterinary startups go wrong.
Not long ago, I worked with a company struggling to understand why their onboarding feature wasn’t getting traction. It was sleek. Automated. Technically brilliant. But no one was using it. So I asked: “Has anyone on your team actually trained a new tech while managing a 10-hour surgery schedule and fielding callbacks from upset clients?” Crickets.
And that’s the real issue: Companies are hiring incredibly smart people. Marketers, product managers, operations leads, all with the right credentials and impressive experience, but those same people stay behind desks. They don’t go to the clinics. They don’t talk to the people doing the job. And they definitely don’t watch what it looks like to lead a team through change when you’re already short-staffed and emotionally maxed out. So of course things fall apart.
The disconnect between headquarters (or the decision makers) and the front line? It’s not just a communication issue. It’s a leadership breakdown. Because the truth is: If your solution doesn’t make life easier for the person actually executing it, you don’t have a product — you have a PowerPoint.
So I walked the team through what onboarding actually looks like in practice: Interrupted trainings. Constant pivots. Emotional labor. And the “mentor” often juggling anesthesia, callbacks, and skipped lunches. We didn’t change the feature. We changed the lens.
The messaging shifted from “improve efficiency” to: “Ease the burden of onboarding for your most overextended team members.” We added real support, not just workflows. And just like that, the clinics started using it. Not because it got flashier. But because it finally spoke their language. That’s the gap I see missed all too often in vet med.
It’s not about building the perfect product or system. It’s about making sure your product or system fits the imperfect systems it’s walking into. Have you ever heard the saying: you can’t fit a square peg into a round hole? That’s exactly what this is. What would help set everyone out on the right foot? Well, it all boils down to communication. As leaders, we’re expected to speak both languages: the frontline teams and the HQ teams.
But here’s the thing: It’s time HQ starts speaking the language of the front line, too. When a new product or service comes to you proclaiming to be the next big fix to your clinics problems - ask the right questions. And you know how you know the right questions to ask? By either partnering with the clinic or being in the clinic to know first hand! That’s how alignment is built. That’s how adoption happens. That’s how trust grows. It’s not about simplifying the product. It’s about removing complexity for the people doing the work.”
Common Leadership Misalignments in Startups (and What You Can Learn from the Clinic Floor)
Leadership inside veterinary and healthcare startups doesn’t usually fail because of lack of vision or drive. It fails because functions don’t align. Strategy and execution fall out of sync. And teams start solving different problems at the same time.
These same patterns play out inside your customers’ world, too, on the clinic floor.
If you want traction with practice teams, understanding how leadership misalignment shows up in their daily reality helps you design better messaging, better onboarding, and a more relevant GTM strategy.
Here are the most common leadership breakdowns we see in both startup teams and the practices they're trying to serve:
1. Siloed Departments In startups: product, marketing, and customer success don’t align on what “success” actually looks like.
In clinics: operations, medical, and client service don’t collaborate.
Why it matters: If your internal teams can’t agree on what value looks like, your message won’t land with a team that already struggles to find alignment themselves.
2. Undefined Roles In startups: you’ve got overlapping job functions, unclear accountability, and critical tasks that fall through the cracks.
In clinics: nobody knows who’s responsible for follow-up, callbacks, or onboarding a new system.
Why it matters: Clear role definition is table stakes, inside your company and in how your product fits into theirs.
3. Resistance to Change In startups: reluctance to update messaging, shift ICP, or adapt based on feedback slows growth.
In clinics: change fatigue and “we’ve always done it this way” block adoption.
Why it matters: The teams you’re selling into are navigating the same resistance. If your leadership team can’t adapt, your customer won’t either.
4. Inadequate Training In startups: lack of enablement means great products stall post-sale.
In clinics: rushed onboarding kills momentum.
Why it matters: Don’t just market ease-of-use, build training that earns belief. Inside your team and outside it.
5. Poor Communication In startups: marketing says one thing, product delivers another, and support gets caught in the middle.
In clinics: the front desk, techs, and DVMs all operate with different information.
Why it matters: Your customers live this every day. If your post-sale messaging isn’t tight, they’ll assume your product adds to the noise.
6. Lack of Strategic Planning In startups: teams focus on activity over strategy, burning resources without clarity.
In clinics: practices drift without direction.
Why it matters: Clarity scales. Internally and externally. If you don’t have it, your customers won’t feel it either.
7. Overburdened Leadership In startups: one person wears five hats. In clinics: same.
Why it matters: You’re building solutions for overextended buyers. Lead like you understand that.
8. No Feedback Loops In startups: no system for learning from the floor, until it becomes a churn problem.
In clinics: no clear way for team members to surface concerns.
Why it matters: Listening isn’t a feature. It’s a growth strategy.
9. Rigid Structures In startups: early team structures don’t evolve, even when the business does.
In clinics: outdated org charts stall innovation.
Why it matters: Your team’s flexibility signals your product’s adaptability. Both matter.
10. Neglecting the End User In startups: fundraising, features, and sales outrank usability or clinical realities.
In clinics: internal ops override the client experience.
Why it matters: When your customers feel seen in your product, they trust it. When they don’t, they ghost you.
These leadership breakdowns, silos, unclear roles, poor communication, aren’t isolated to your org chart.
They echo through your product. Your messaging. Your customer experience.
When your internal alignment is shaky, the practices you serve can feel it. And if you're trying to support teams under pressure while leading from a place of chaos?
That disconnect becomes the reason they don’t move forward.
Your customers aren’t just evaluating your product.
They’re reading between the lines, watching how your team communicates, how your message holds up under pressure, and whether your leadership mirrors the clarity they’re craving in their own world.
Misalignment isn’t a dealbreaker. But if you don’t fix it internally, don’t expect anyone to believe you can help fix it externally.
Lead with clarity. Operate with alignment. Build trust that scales.
So where do you start?
If misalignment is the drag, these are the levers that move you forward. The strategies below aren’t silver bullets, but they are high impact shifts we help founders make every day to rebuild clarity, momentum, and trust from the inside out.
1. Build Cross-Functional Alignment Create regular rhythms that connect product, ops, sales, and marketing. Shared planning sessions and outcome-based KPIs reduce silos and get every function focused on traction, not just tasks.
Why it matters: You’re asking practice teams to align their staff around your solution. Model that alignment inside your company first.
2. Clarify Roles and Ownership As your team grows, ambiguity kills execution. Define who owns what, clearly. Document responsibilities, decision rights, and reporting lines.
Why it matters: Clarity scales. Vague titles and fuzzy ownership slow delivery and create risk in high-stakes moments.
3. Make Change Easier to Adopt Whether you’re onboarding a new hire or implementing a new GTM strategy, treat change as a process. Build in context, training, and feedback loops so your team doesn’t just understand the change, they own it.
Why it matters: Your customers live in environments resistant to change. Learn how to lead through it—so you can sell through it, too.
4. Prioritize Communication as a System Don’t rely on Slack messages and ad hoc meetings. Set up structured communication: weekly check-ins, written updates, shared dashboards. When expectations are clear and progress is visible, teams move faster.
Why it matters: If your internal messaging is scattered, your external messaging will be too.
5. Right-Size Leadership Capacity Many founders try to hold everything, strategy, execution, delivery, growth. That works until it doesn’t. Audit what’s on your plate. Use fractional leaders to fill expertise gaps before you burn out or bottleneck the business.
Why it matters: Practices want to partner with companies that show up with clarity and consistency. Exhausted, overextended leadership erodes both.
6. Keep the Client Journey Visible Your internal alignment should center on what the customer experiences, from first touch to full adoption. Regularly audit that journey with input from product, CX, and sales. Fix friction. Simplify steps. Reinforce wins.
Why it matters: Veterinary and healthcare practices are managing complexity all day. If your solution adds more, they’ll bounce.
Real alignment isn’t cosmetic—it’s operational. These six shifts don’t just fix internal friction. They reshape how your company shows up to the teams you serve.
Because the practices you're selling into? They’re facing the same pressures. And when your structure mirrors the clarity they need, trust follows.
Startups and the practices they serve aren’t as different as they seem. Both operate under pressure. Both juggle competing priorities. And both need leadership systems that scale clarity, not just effort.
At Thavma Consulting, we help innovation-driven teams align from the inside out, so what you’re building lands with the people you built it for.
Leadership isn’t just a title. It’s a structure that either amplifies your impact, or slows everything down.
The Shift: From Hero Leadership to System Leadership
The companies thriving today aren’t just well-funded. They’re structurally sound.
They’ve made the shift, from hero leadership to system leadership:
Where leadership is shared, not hoarded
Where communication has shape, not just intention
Where the business runs on rhythm, not firefighting
System leadership isn’t about stepping back.
It’s about designing environments where everyone can lead from their seat, with clarity, incentives, and space to own outcomes.
Where Leadership Actually Lives
Modern leadership isn’t about having all the answers. It’s about designing a system where the right people can lead from the right seat—with clarity, trust, and traction.
What does that look like?
A product lead who co-owns customer success, not just the roadmap
An ops lead who builds systems that prevent fires, not just puts them out
A fractional CMO or COO who bridges vision and execution, while mentoring internal talent
A founder who finally becomes the strategic steward, not the default firefighter
This isn’t about abandoning what worked in the early days. It’s about expanding what leadership can be—as your company grows in complexity and ambition.
Because leadership alignment isn’t a one-time fix. It’s a daily discipline that shapes how teams function, grow, and lead together.
It’s the difference between:
Departments that operate in silos vs. those that move in sync
Founders stretched thin vs. leaders empowered to lead
Reactive decisions vs. deliberate, cross-functional momentum
At Thavma Consulting, we bring a systems-thinking lens to leadership. We help you connect roles, rhythms, and strategic direction across the business—so what you’re building actually lands with the people you built it for.
We’ve sat in the rooms where decisions stall, departments disconnect, and growth outpaces clarity. And we work alongside your team where leadership actually lives: in the day-to-day.
So whether you're navigating growing pains, rebuilding your leadership structure, or wondering why forward motion feels so heavy, know this:
Misalignment isn't failure. It's a signal. A sign that you're ready to lead differently.
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Let’s connect on LinkedIn: Fotine A Sotiropoulos
