Beginnings are exciting and it's always entertaining to dream of the future. But the stuff in between the two can be challenging. Yet most of life, at work and elsewhere, is lived in the middle part between the very start and the ultimate success (or failure). The decisions that truly define great leadership happen in the day-to-day of mid-stage growth. Resources are not as limited, but opportunity cost is great. A leader can do some things directly, but not all, and choosing the wrong path may have substantial long-term consequences.

As CEO of GoHealth Urgent Care, YPO member Todd Latz has guided his company from 5 acquired sites to over 75 newly built sites, from 50 to over 800 team members and from a single market to coast-to-coast operations in just 3 years. One could say that GoHealth Urgent Care has reached that preferred future, knowing that the business has won design, retail innovation, customer service and online access awards, and has achieved Net Promoter Scores that exceed the best-performing companies across any industry. But Latz has plenty of experience leading through that "middle terrain."

Latz believes that strategic decisions at the "awkward adolescent stage," past the start-up period but before long-term stability and success, are by far the most difficult. They are less binary, there are much more options and the right path forward is decidedly less clear. This includes how to balance growth with optimization and efficiency; if, when and where you should add more infrastructure; and whether to turn down new opportunities. He has identified 7 tactics that he has employed to guide his company to where it is today.

  1. Communicate closely with your front line.

"I am stunned by how many of our team members have never worked for a company before where they personally met the CEO," Latz says. "Yes, the larger you get, the more difficult it is to stay in contact with everyone, especially in a multi-site business. But that helps you stay present." Frontline employees live the business every day. That makes them critical to your success. It also makes them a source of valuable information. "We utilize a simple technique we refer to as EODs: end of day emails. These quickly summarize what happened at each site each day. They are an invaluable way for me to feel what our front-line team members feel and to have a direct line of sight into the business." Keeping in touch with operations will ensure you are making the right infrastructure, growth and strategic decisions.

  1. Go big, but act small.

According to Latz, "Adding bureaucratic layers does not make those tough, mid-range decisions any easier. We are focused on staying nimble, entrepreneurial and lean, no matter how much we grow." As growth happens, obviously there can be a need for more infrastructure, centralization, and efficiency. But people who come on board early don't join small companies for, and are not motivated by, excess process and bureaucracy. Don't sacrifice the uniqueness that made you successful in the first place.

  1. Embrace productive friction.

Many choose to avoid conflict and fear its impact on the workplace. Latz believes that a little disagreement can be good. "It's rarely as uncomfortable as you think it will be, and often shines a bright light on the answer to that tough strategic decision." People who are curious, engaged, and committed to the business will frequently disagree on strategy and solutions. Properly channeled, this diversity of thought and perspective can be an invaluable tool. As a leader, your job is to foster trust so that your team can push one another without the intrusion of ulterior motives, ego or competing agendas.

  1. Keep customers close to your heart.

"Healthcare has not historically been known for customer service," Latz admits. "Delivering the best possible experience gives us an amazing opportunity to differentiate ourselves and create value for our partners. As we grow, our customers are still central to our strategic decision-making. When in doubt, we try to think about things from their unique perspective." Consider how your business can be even more valuable to customers going forward. As you hire, seek to attract more people who can meet the customers' needs, thus deepening buyers' loyalty.

  1. Learn to make it look easy, even when it is not.

"When you look at a duck, it glides effortlessly across the surface of the water. But if you see it from below, you learn that it's actually paddling like crazy." Growing a company involves a lot of paddling like crazy while looking serene. Two steps forward can lead to one step back (or sideways). Or there may be no obvious right path when you come to forks in the road. Latz believes that expecting the unexpected will help you stay nimble and ready to pivot quickly in the face of external forces. "It's easy to see forward progress in the early stages and to clearly envision dreams of the future. The middle stage is where it gets hard, especially when progress doesn't happen the way you like."

Accept that adolescent stages are hard and awkward. You may actually learn more from a step backwards or sideways than you ever took away from a solid foot forward. As you learn, remember it doesn't do you any good to show your team or partners that you are not certain about the path forward, struggling with a tough decision or at a loss on how to strategically execute. You can paddle like mad below the surface to gain more information, vet your alternatives and make an informed call and still face the day with a calm, confident smile.

  1. Embrace the tough decisions.

Latz knows that "hard choices don't get any easier when you wait. Short-term decisions can be easier since by nature they must be addressed now. But some decisions must be made with one eye on the longer term. I believe in very direct communication (with our team, our partners, and other stakeholders) and taking issues head-on." You might know that those future-oriented decisions should be considered now, but it can still be tempting to procrastinate, especially when you are already busy or the topic is unpleasant. But hoping an issue will resolve itself is not a strategy. Making tough decisions when they present themselves sets the right tone, better prepares you for the next set of issues and continues your momentum.

  1. Learn to influence instead of command.

"You probably got to where you are by doing a lot of this work yourself or through your sheer force of will - but that doesn't scale very easily. As your business grows, you can no longer single-handedly muscle through tough decisions," he cautions. Develop others' ability to lead, then give them enough freedom to learn and execute. You can and should exert influence over their decisions, but be careful not to make the decisions for them. "You are not as close to the action as you once were," he says, "and you will stunt their growth, as well as your own if you try and do it all yourself."

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