Why The Best Hire You Ever Make Might Think Like An Owner
There is a particular kind of employee that changes the trajectory of a small business the moment they walk through the door. They are not simply doing a job. They are looking at the business the way an owner looks at it, spotting the gaps, taking initiative on problems nobody asked them to solve, and treating the practice's success as something personal rather than something they clock in and out of. In business circles this person is increasingly being described as an intrapreneur, someone who brings the mindset and drive of an entrepreneur to a business that already belongs to someone else. It is a concept that has been getting a lot of attention lately, including from high profile founders talking about how they build their teams, and it is worth taking seriously if you run a practice.
Most practice owners hire for competence. They want someone who can do the clinical work, manage the front desk, or keep the books in order, and that is a reasonable starting point. But competence alone does not grow a practice. Competence keeps a practice exactly where it is. What actually moves a business forward is someone who notices that a particular patient pathway is clunky and fixes it without being told, or who sees an opportunity to bring in a new revenue stream and brings you a plan rather than a complaint. That is a different quality altogether, and it is rarer than most owners assume.
The instinct in healthcare is often to hire people who will simply follow the system that already exists. There is a logic to that. Clinical environments need consistency, and a practice cannot run on improvisation alone. But there is a meaningful difference between someone who follows a system well and someone who follows a system well while also actively looking for ways to make it better. The first type of employee is valuable. The second type of employee can genuinely change what your practice is capable of, because they are effectively doing part of your job for you, and doing it because they want to rather than because it is written into their contract.
Finding this kind of person requires a different kind of hiring conversation. Instead of asking only about qualifications and experience, it is worth asking what they noticed the last time they walked into a business as a customer or a patient themselves. It is worth asking what they would change about how a typical clinic operates if it were entirely up to them. The answers tell you something that a CV never will, which is whether this person naturally thinks in terms of ownership or naturally thinks in terms of tasks.
It is also worth saying plainly that this kind of hire needs to be met halfway. An intrapreneurial employee who brings you ideas and initiative and is met with indifference, or worse, territorial defensiveness, will not stay that way for long. They will either leave for a business that actually wants their input, or they will quietly downgrade themselves into someone who just does the job, which is a loss for everyone. If you want people who think like owners, you have to be willing to actually listen when they do.
The practices that grow fastest and hold onto their best people tend to be the ones where this dynamic is deliberately built rather than left to chance. That means being clear from the interview stage about the kind of contribution you are hoping for, giving genuine ownership over specific areas rather than just tasks, and recognising initiative when you see it instead of only rewarding output. Good medicine deserves a good business behind it, and a good business is very often built by people who care about it almost as much as you do.