Operational leadership
Fractional COO for Medical Practices
Executive-level operations leadership without the full-time cost. HMCG steps in as your part-time Chief Operating Officer to streamline workflows, close gaps and build the systems your practice needs to grow, while you get back to leading and practicing medicine.
At a glance
When operations run on whoever has time
Many early-stage and growing practices don't have a full-time COO. Operations end up split between a physician owner, an overextended practice manager and whoever is closest to the problem that day.
The result is familiar: workflows that work around each other, staff who aren't sure who owns what, and growth that adds complexity faster than it adds revenue. Patients feel it too, in longer waits, missed calls and inconsistent follow-up.
A fractional COO brings the strategic oversight and operational discipline of an executive, for the hours and season your practice actually needs.
Is a fractional COO right for you?
- You're adding providers, services or locations
- A physician owner is still running day-to-day operations
- Your practice manager needs a senior leader to work alongside
- You've lost an operations leader and need continuity
- You need an executive's view but not an executive's salary
What we do
What a fractional COO does for your practice
Gap and inefficiency analysis
A thorough review of your current operations to surface what is holding growth back.
Process optimization
Find and remove inefficiencies across administrative and clinical workflows, from scheduling to checkout.
Team structure and communication
Clear roles, reporting lines and handoffs so every team member knows what they own.
New systems implementation
The operational infrastructure you need to scale, introduced without adding complexity.
Regulatory compliance support
Operations that meet quality, safety and compliance standards without disrupting care delivery.
Patient experience built in
Every workflow change is measured against the Nine Pillars, so efficiency never comes at the patient's expense.
Engagement options
Defined hours, so you know exactly what you're getting
Every engagement is built on a set number of hours, and every hour is measured against the Nine Pillars, so operational gains never come at the patient's expense.
Strategic direction and a second set of eyes
About 10 hours per month
A monthly operations review, KPI tracking, support for your practice manager and a senior leader on call for the big decisions.
Best for: Practices with a functioning manager and team that need direction and accountability.
Starting at $2,000 per month
Hands-on operations leadership
About 8–10 hours per week
Weekly presence with your leadership team. We lead improvement projects, redesign workflows, implement new systems and hold the team accountable until changes stick.
Best for: Growing practices adding providers, services or locations.
Starting at $6,500 per month
Full coverage through a leadership gap
Near full-time, for a set period
Day-to-day operations leadership while you recruit or restructure, with a clean handoff to your next leader.
Best for: Practices that have lost an operations leader or are mid-transition.
Custom quote
Advisory and Embedded engagements have a three-month minimum, because operational changes need time to take hold. Additional hours are billed at the hourly rate, or you can move up a tier.
Need one defined fix? Project-based engagements are available for scoped work like opening a location or redesigning front office workflows.
Discuss a project →How it works
- 1
Discovery call
We talk through your practice, your growth plans and where operations feel stuck.
- 2
Operational assessment
A review of workflows, roles, systems and metrics to find the highest-impact gaps.
- 3
90-day priorities
A focused plan your team agrees on, with owners and measures for each priority.
- 4
Lead and hand off
We lead the work alongside your team and build the habits that keep it running after we step back.
Why HMCG
An operator who has sat in your chair
Melissa Gilkes-Smith, DHA(c), brings more than 15 years of hands-on healthcare operations experience across multiple levels of leadership and diverse care settings. She has built the workflows, managed the teams and owned the outcomes you're responsible for.
What sets HMCG apart is the lens: every operational decision is tied back to the patient experience through the Nine Pillars framework, because the most efficient workflow is useless if it costs you patients.
Meet Melissa →Fractional COO FAQs
What is a fractional COO?
A fractional COO is an experienced operations executive who works with your practice part-time, on a retainer or project basis, providing the same strategic leadership as a full-time Chief Operating Officer for a fraction of the commitment.
How is a fractional COO different from a consultant?
A consultant typically recommends. A fractional COO leads: setting priorities, working with your staff week to week and staying accountable for results.
Will a fractional COO replace my practice manager?
No. A fractional COO works above and alongside your practice manager, handling strategy and systems so your manager can focus on running the day and growing as a leader.
How many hours does a fractional COO work?
It depends on the engagement: about 10 hours a month for Advisory, about 8–10 hours a week for Embedded, and near full-time for Interim coverage. Hours can scale up during a launch or transition and down once systems are stable.
Do you work with practices outside the DC area?
Yes. HMCG works on-site across Northern Virginia, Washington, DC and Maryland, and virtually with practices across the United States.
Get executive operations leadership, on your terms
Tell us where operations feel stuck. We'll tell you honestly whether a fractional COO is the right fit.
Schedule a Discovery Call