No Operating Manual

No Operating Manual | Episode featuring Carol Robinson, Founder & CEO of Midato HealthWhat happens when a healthcare policy veteran interviews thousands of stakeholders and keeps hearing the same problem? She builds a company to solve it.Carol Robinson spent years in Oregon state government shaping health IT infrastructure before launching Cedar Bridge Group, a consulting firm that brought her face-to-face with one of healthcare's most persistent — and overlooked — problems: patient consent. Specifically, the near-impossible challenge of getting sensitive behavioral health and mental health data to flow safely between providers who need it most.In this episode, Carol shares the origin story of Midato Health and its flagship product, ShareApprove, a consent management platform designed to put patients back in the driver's seat of their own health data. We dig into what it actually takes to build a compliant, scalable software product in healthcare, why data privacy is getting more complicated (not less), and why Carol believes patients deserve to be more than "the football" in the healthcare team sport.In this episode:How Carol went from state government to startup founderThe real barriers blocking integrated behavioral and primary careHow ShareApprove works, and why scalability was everythingNavigating data privacy in a landscape of rising bad actorsThe financial reality of building healthcare-grade software from scratch

What happens to working healthcare parents — and their careers — before, during, and after parental leave? It's a question Michelle Yu couldn't stop asking, even after more than a decade at the top of healthcare consulting.In this episode of No Operating Manual, host Erin O'Brien sits down with Michelle Yu, co-founder and CEO of Josie, a company that partners with organizations to support working parents through parental leave coaching and return-to-work transitions. Named after Michelle's daughter, Josie was born out of Michelle's own raw and honest reckoning with what it meant to return to the road — pumping breast milk in airport bathrooms, feeling resentful, watching talented colleagues quietly exit careers they'd spent years building.Michelle and Erin discuss the real cost of treating parental leave as a logistical formality rather than a strategic imperative. They explore why the healthcare industry, which sets the clinical standards for parental leave, so often fails its own employees, and what the difference looks like between a lactation room stocked with snacks and a hospital OB-GYN pumping in a bathroom between patients.They also get into the founder journey itself: the pivot from polished consultant to vulnerable storyteller, the slow build of confidence that no pitch deck can fast-track, and why Michelle believes the best founders are the ones building something they can't imagine not doing.In this episode:The parental leave data that should alarm every HR leaderHow Josie's B2B model evolved through listening to customersWhy clinical settings lag behind corporate in supporting new parentsThe guilt, the joy, and the identity shift of returning to workWhat it means to lead with lived experience as your credibilitySources:https://pubmed.ncbi.nlm.nih.gov/37096124/https://www.aamc.org/news/why-women-leave-medicinehttps://pmc.ncbi.nlm.nih.gov/articles/PMC6889631/https://www.forbes.com/sites/michelletravis/2025/11/12/which-large-us-companies-scored-best-on-paid-parental-leave-in-2025/

Derek Baird has been watching the specialty care referral system fail patients for over two decades. As an EMR product manager at 23, he first learned how referrals actually worked. Not much has changed since. Today, as co-founder and CEO of Switchboard Health, he's doing something about it.In this episode, Derek walks Erin through the real cost of a broken referral process. It's not just the frustration of patients who can't find an in-network specialist or wait months for an appointment, but the downstream clinical and financial consequences when people give up entirely. We're talking tens of thousands of dollars in avoidable costs, and health trajectories that get knocked permanently off course.Switchboard's approach works directly inside the EMR, identifying the right specialist at the right moment — factoring in location, insurance, wait times, and clinical fit — so that patients leave the exam room with a plan. Derek also reflects on what's changed in healthcare technology since Switchboard launched in 2022, why the pace of change is forcing even young companies to rebuild from scratch, and what he's learned transitioning from advisor and investor to first-time founder. Including what that actually looks like on a Tuesday night in a Starbucks parking lot.

Kristin Kelly has built healthcare companies, worked inside government, and now helps other founders do the same. In this episode, the Founder and CEO of Voyageur Health Advisory joins Erin O'Brien to share what it really takes to grow in a system that doesn't bend easily — from her time standing up Minnesota's ACA marketplace and scaling Bright Health, to the hard truths she now brings to the startups she advises. They get into what founders consistently misread about government, payment models, and go-to-market timing — and why enduring healthcare companies are built on alignment, not just ambition.

In the ever-evolving landscape of healthcare, finding the right care at the right time has become a pressing challenge. In a recent episode of No Operating Manual, Erin O'Brien speaks with Adeel Malik, co-founder and CEO of ClearStep, who has been dedicated to simplifying healthcare navigation since 2018. This blog post delves into the key insights shared by Adeel, highlighting the evolution of ClearStep and the lessons learned during the pandemic. The Genesis of ClearStepClearStep was founded in 2018 with a vision to make healthcare easier for patients. According to Adeel, the core mission has remained consistent: helping patients access optimal care seamlessly. He emphasized that although the landscape has evolved, the fundamental issue of navigating healthcare systems has persisted. Adeel noted, "Everyone has known for longer than 2018 that it is too hard to navigate to the truly optimal side of care." Rapid Response During COVID-19The COVID-19 pandemic served as a catalyst for ClearStep's growth. Adeel highlighted how the company quickly adapted its existing technology to develop a COVID triage tool within days. This rapid deployment showcased the potential for innovation in healthcare when urgency drives decision-making. However, Adeel cautioned that this swift progress was not sustainable in the long term, as the healthcare industry reverted to its slower procurement processes post-pandemic. Lessons Learned and Market DynamicsAdeel discussed the challenges faced in 2022 as healthcare systems began to recover from the pandemic. The funding that had previously supported innovation dried up, leaving many organizations hesitant to invest in new solutions. He observed that understanding the acute problems faced by healthcare systems is crucial for success. Adeel stated, "It is all about solving an acute problem that the customer organization is really feeling now." User Testing and Decision-MakingOne of the most significant insights from ClearStep's research involved user testing. Adeel shared findings indicating that over half of the time, patients' initial decisions regarding their care were incorrect. For instance, patients often underestimated the urgency of their conditions, leading them to choose less appropriate care options. This revelation underscored the importance of ClearStep's role in guiding patients to the right level of care. Financial Implications of Proper Care NavigationAdeel elaborated on the financial impact of directing patients to appropriate care settings. Through detailed modeling, ClearStep demonstrated that rerouting low-acuity patients from emergency rooms to primary care not only saves costs but also enhances revenue opportunities for healthcare systems. He explained, "The value of redirecting care more appropriately is really significant." This insight highlights how optimizing care pathways can benefit both patients and providers. ClearStep's journey offers valuable lessons in navigating the complexities of healthcare. As Adeel Malik articulated, understanding the nuanced needs of patients and healthcare systems is essential for creating effective solutions. The insights gained from the pandemic and ongoing user testing underscore the importance of guiding patients to the right care at the right time, ultimately benefiting the entire healthcare ecosystem.

She waited 13 months for cancer treatment while uninsured. Now she's rebuilding the system that failed her. What does it take to fix a healthcare system from the inside? For Torrie Fields, founder and CEO of TFA Analytics, the answer started with her own harrowing experience as a patient, diagnosed with cancer, uninsured, and forced to wait over a year for care.In this episode, Torrie shares how that experience, along with decades of work in healthcare analytics and policy, shaped her mission to reduce the total cost of care for patients with serious illnesses. From founding her first nonprofit at 15, to launching a venture-backed startup days before COVID, to building TFA Analytics on grants and customer revenue, her journey is a masterclass in purpose-driven entrepreneurship.We dig into why scheduling is one of the most underestimated forces in patient outcomes, what a truly team-based care model looks like, and why data balanced with compassion is the most powerful tool we have for transforming healthcare.

Nima Roohi, CEO of Blooming Health, joins us to share how a career in data science and a personal caregiving experience led him to tackle one of healthcare's most overlooked problems: the gap between medical care and social services.Nima breaks down the three core failures in social care — fragmentation, missing data, and an inability to scale — and explains why simply hiring more social workers isn't the answer. Instead, Blooming Health uses AI and automation to digitize social care delivery, partnering with community-based organizations to extend their reach and impact.We also dig into his unconventional go-to-market strategy: building from the ground up by empowering community organizations first, then using that proven network to attract healthcare plans and larger systems.If you work in healthcare, social services, or tech for good, this episode is packed with hard-won lessons on building at the intersection of all three.

In this conversation, Duffy Fallon, founder and CEO of Nosis Health, shares his personal journey through recovery and how it inspired him to create an integrated health system focused on substance use care. He discusses the importance of addressing both physical and mental health in recovery, the role of technology in enhancing care, and the challenges of scaling a healthcare business while maintaining personalized care. Duffy emphasizes the need for a holistic approach to recovery that includes lifestyle changes and advanced diagnostics, and he reflects on the lessons learned in building a company in the healthcare space.

In this conversation, Kobby Amoah, CEO and co-founder of River Health, discusses his unique journey from finance and international development to healthcare. He emphasizes the importance of understanding the specific needs of hourly workers, who often face significant barriers in accessing affordable healthcare. River Health aims to provide innovative solutions tailored to this demographic, focusing on essential healthcare services at a low cost. Kobby also highlights the significance of building trust with members through transparency and consistent service delivery. He shares valuable lessons for aspiring healthcare founders, including the importance of understanding your audience and being open to experimentation.

In this conversation, Erin O'Brien speaks with Maura McGinn, founder and CEO of Impetus Talent, about her experiences in recruitment and leadership within healthcare startups. They discuss the challenges of finding the right talent, the evolution of company culture, and the changing landscape of startup funding. Maura shares insights from her time at Bright Health, emphasizing the importance of clarity in leadership roles and the need for collaboration among team members. The conversation also touches on the current state of healthcare startups and the strategic considerations founders should keep in mind as they grow their businesses.

In this conversation, Georgina Dukes-Harris, founder of Swishvo, shares her personal journey that led to the creation of her company, which aims to connect women experiencing pregnancy, trauma, addiction, and grief with community-based providers. She discusses the challenges of navigating the healthcare system, the importance of holistic and community-based care, and the need for reimbursement for these services. Georgina emphasizes the significance of measuring outcomes in non-linear care and the value of culturally competent care. She also offers advice for founders working on care models that don't fit traditional healthcare systems.

Atiya Hasan talks about how her path through medicine, law, and business shaped how she leads Samar Health. She explains why she’s built a company that puts people first in a space increasingly driven by automation, how she balances clinical instincts with business decisions, and where AI helps versus where it falls short. Throughout the conversation, Atiya comes back to trust, empathy, and relationships, and why those things still matter if healthcare is going to work at all.

Emily Olson talks about how she went from bedside nursing to working inside early-stage healthcare startups, and what surprised her most along the way. She shares what it’s actually like to move from large health systems into environments where there’s no playbook, how she’s built care models for people with complex needs, and where technology genuinely helps (and where it doesn’t). Emily also offers practical advice for nurses thinking about a startup role, including what to know going in and how to decide if that kind of uncertainty is right for you.

Dr. Najib Jai talks about how wanting to be a doctor as a child, largely shaped by his mom’s generosity, eventually led him somewhere a little different. He shares how stepping outside of clinical practice helped him understand how healthcare actually works, what it was like to build and sell a health tech company, and why value-based care is still so hard to get right. Along the way, Najib reflects on entrepreneurship, why grit matters, and why enjoying the work is just as important as winning, especially when most startups don’t go the way you expect.