Founder's Lens
First 90 Days in a
Distress Hospital.
What Can You Actually Do
-By Vivek Shukla
Founder & Managing Partner
Surge Growth Partners
"Nobody hands you a burning building and says take your time.
When a board or investor brings you into a distressed healthcare asset, the clock is already running. Cash is draining. Staff are watching for signals. Physicians are hedging their referrals. Insurers are paying slower than usual. The word has already travelled.
The first 90 days are about stopping the bleeding, reading the real situation, and building just enough momentum that the Organization believes recovery is possible.
Here is exactly how you could approach it."
DAY 1- 30: Diagnosis without Anaesthesia
The instinct of most incoming leaders is to listen, observe, and avoid early judgements. You could do the opposite.
1. Where is the cash actually going?
2. Who are the three people without whom this place stops functioning tomorrow?
3. What does the medical staff actually believe about this Organization?
Not the P&L. The cash.
You want the bank statements, the payables ageing, the receivables ageing, and the insurance claim rejection log.
In most distressed hospitals, the P&L has been managed for presentation. The cash tells the truth.
Within the first week you will know whether this Organization has a revenue problem, a cost problem, or both — and in GCC hospitals, it is almost always a revenue cycle problem dressed up as a cost problem.
Every hospital has them. They are rarely in the senior leadership team. They are the revenue cycle manager who knows every insurance code by memory.
The head nurse who holds the ward together in nights. The doctor whose referral relationships bring 30% of surgical volume. You find them in the first two weeks and you protect them.
Not what they say in town halls.
What they say to each other. You must do one-on-one sessions with every department head and senior consultant in the first three weeks. No agenda.
No HR present. Ask two questions: What would you fix first if you ran this place? And: What would make you leave?
The answers to those two questions tell you more than any management report.
4. Where is the Board's real appetite?
Boards that bring in a turnaround specialist do not always want a turnaround.
Some want validation for an exit they have already decided on. Some want optics for a lender.
Some are genuinely committed to recovery but have no real understanding of what it costs in terms of capital, in difficult decisions, in time. You should know which board you are working with before committing to a recovery plan.
DAY 31 - 60: Stabilise, Signal, and Cut Clean
By day 31 you now have a view. Now act on it. Stop the cash drain - specifically.
Not through a blanket cost freeze, which destroys morale and kills operational capability simultaneously. Specifically, identify the top five cost lines that are either inflated, discretionary, or contractually renegotiable. In most GCC hospitals that list includes: agency staffing, medical consumables procurement, underperforming ancillary services running at a loss, and facility management contracts that have never been benchmarked. Those five lines alone, addressed properly, move EBITDA in 60 days.
Accelerate receivables without alienating insurers.
Make one visible decision that signals things have changed.
Protect the patient experience. Non-negotiably.
The fastest cash in any distressed hospital is sitting in unpaid claims. In UAE and Saudi markets, the average claim rejection rate in a distressed facility can be up to 20%. That is recoverable revenue. Put a dedicated team on the top 90 days of outstanding claims in the first fortnight. Not to fight every rejection, but to identify the coding and documentation patterns that are generating them and fix them upstream. That change begins paying back within 45 days.
Organizations in distress need a signal that the new reality is real. That signal cannot be a memo. It has to be a decision — one that is visible, significant, and that could only be made by someone with real authority and real conviction. It might be a structural change. A contract that gets terminated. A standard that gets enforced after years of tolerance. The content matters less than the clarity. People need to see that this time is different.
In a turnaround, there is always pressure to cut corners on the patient-facing environment. Staffing ratios, cleanliness, waiting times, discharge processes. Hold the line on these absolutely. Patient experience is not a luxury in a distressed asset. It is the only thing generating new revenue while everything else is being rebuilt. One viral complaint in a GCC market, where WhatsApp groups move faster than any press, can undo three months of referral rebuilding in a week.
DAY 61 - 90: Build the Foundation for What Comes Next
The first 60 days buy credibility. Days 61–90 are about converting that credibility into a plan the Organization can execute without me in the room.
Install the right operating rhythm.
Rebuild the referral pipeline deliberately.
Give the Board a real picture.
Most distressed hospitals lack a functioning management system that turns information into decisions on a predictable cadence. Always put in place a weekly operating review, not a status update, a decision meeting with clear ownership, clear metrics, and zero tolerance for reports that describe problems without proposing solutions.
By day 60 you have a clear picture of which physician relationships have gone dormant and which have gone cold. Focus exclusively on the dormant ones. Brief the clinical leadership, address whatever drove the disengagement; whether it was process, communication, or clinical credibility. Ask for one chance to demonstrate the change. Most physicians will give that chance once, if approached by someone they believe is serious.
Not a turnaround narrative. A real picture with a 12-month EBITDA bridge, a clear set of milestones that will indicate whether recovery is on track, and an honest assessment of the risks that could still derail it. Boards that are kept in managed optimism make worse decisions. Boards that have full picture make better ones.
They also hold management more accountable to the commitments that have been made.
By day 90 the Organization should be stabilized, the leadership should be aligned, and the path forward, whether turnaround, strategic pivot, or managed exit, should be clear.
The first 90 days will not complete a turnaround.
But they will determine whether one is possible.
That is the job.
I have led turnarounds and performance transformations across healthcare providers in the GCC and globally for 27 years. If your organization is in a difficult period and you need an honest view, not a consulting proposal, I am available for a direct conversation.