You are Renata Sokol, six weeks into running Clinical Operations at Meridian Cardiac Systems in Plymouth, Minnesota. A new contract requires your unit to triple its volume. In four weeks you must take a plan to the executive committee, and the first thing to settle is what the survey you have just received says about your own culture.
The situation
It is Wednesday 4 February 2026. Meridian makes and services implantable cardiac-monitoring devices: 1,150 employees, US$310 million in revenue, a 19% EBITDA margin. Your 140 analysts, field engineers and support specialists serve cardiologists and hospital technicians. They have posted customer satisfaction above 98% for eleven years running, something no other unit in the company has managed. You helped build that way of working yourself: veterans who teach the newcomers, deadlines agreed directly with each hospital, complex cases handled as craft.
A contract with a hospital network changes everything. Devices under support will grow from 40,000 to 120,000 in eighteen months, and monthly cases from about 3,300 to about 10,000; the first 25,000 devices go live within 120 days. The contract demands a clinical response within 24 hours: each miss costs US$25,000, capped at US$1.5 million a year, and complaint handling is federally regulated. Closing the gap by hiring alone would mean about 120 more people (86% of headcount) against a transition budget of US$2.0 million.
The ninety-person survey paints a unit built around relationships and improvisation, and thin on results-tracking and standard process. Two senior field engineers hold 30% of the best hospital relationships, and nobody has yet asked them to change anything. On the committee's scorecard the unit starts at 22 for culture fit, 18 for throughput readiness, 40 for trust and 15 for leadership range, out of 100.