Your systems are running. Someone's handling tickets, managing backups, dealing with vendors. But you're still not sure if your technology actually supports your mission or just exists. The question isn't whether you need IT support. You already have that. The question is whether you need technology leadership, and if so, what kind. The Three Options for Strategic Technology Leadership Full-Time CTO A full-time chief technology officer makes sense when your organization has reached a specific threshold of complexity and investment. Consider this option when: You manage multiple facilities with complex integration requirements You're pursuing major strategic initiatives where technology is central to execution Technology decisions need to be made in real-time during executive meetings Your board expects technology leadership represented at the C-suite level The volume and complexity of technology work justify dedicated executive attention The investment is substantial: full compensation, benefits, and the organizational integration that makes the role effective. You're paying for someone who can make real-time decisions and be present across all strategic initiatives. When the complexity and strategic importance justify the investment, dedicated technology leadership changes how effectively your organization can grow and adapt. Fractional CTO Fractional technology leadership addresses a specific gap: you need strategic guidance, but you don't have enough work to justify a full-time executive hire. This approach makes sense when: Your IT staff executes well but lacks experience in strategic planning You need vendor-neutral perspective on major decisions like EHR selection or infrastructure investments You're uncertain whether your technology spending is efficient or simply habitual You need someone who can translate effectively between leadership and technical staff Your technology challenges are primarily strategic rather than operational Fractional engagement means you're paying for judgment and experience, not hours. Your existing IT staff continues to manage day-to-day operations. The fractional CTO helps you determine what's worth doing and why. This model works best when your primary questions are "what should we prioritize?" and "is this investment justified?" rather than "who's going to implement this?" Traditional Vendors Most community health centers work with some combination of managed service providers, value-added resellers, and implementation consultants. These relationships handle important functions: MSPs manage infrastructure and provide ongoing support VARs recommend and implement specific technology solutions Implementation consultants manage complex projects like EHR migrations Many of these vendors provide honest, consultative guidance and genuinely prioritize client success. The limitation isn't integrity. It's incentive structure. MSPs generate revenue through recurring service contracts. VARs earn commissions on software sales. Implementation consultants bill by the hour for project work. Even the best vendors are optimizing within the scope of services they provide. They're less likely to recommend reducing complexity, cutting services, or questioning whether you need what they're currently managing. Vendors excel at execution. When you know what needs to be done, they're essential for getting it implemented. They're less equipped to provide the unbiased perspective that helps you determine what's worth doing in the first place. Understanding the Distinctions Full-time CTOs are invested in your organization's long-term success and accountable to your leadership team. Fractional CTOs provide strategic judgment without the conflicts inherent in vendor relationships. Traditional vendors deliver execution capability but operate with structural incentives that may not align with your best interests. Most organizations need all three at different times: Internal IT staff or an MSP to maintain operational stability Vendors to implement specific solutions when justified Strategic guidance to determine what's actually worth doing The common mistake is expecting your MSP to function as your strategist, or assuming your technical staff member can also serve as your CTO. These require different skills, different perspectives, and deliver different value. Determining What You Need Consider these questions: Are technology decisions driven by vendor recommendations or by your strategic priorities? Does your leadership team have clear visibility into what your technology can and cannot support? When discussing major technology investments, do you have access to evaluation expertise that isn't connected to a sales process? Is your technology approach primarily reactive or genuinely proactive? If you're confident in your answers, your current structure is likely appropriate. If these questions create uncertainty, or if technology decisions feel more like guesswork than informed choice, you may lack the strategic leadership your organization needs. Next Steps The 7-Metric Assessment provides a structured way to evaluate where you currently stand. It won't prescribe whether you need a full-time CTO or fractional support, but it will reveal whether your current approach is delivering the results your organization requires. That clarity matters before making decisions that affect both your budget and your team's capacity to serve your community effectively. The free assessment is available at assessment.metric7.net or reach out if you'd like to discuss your specific situation.

You took the 7-Metric Assessment. You got your scorecard. You saw which areas are strong and which need work. Now what? Most people stop here. They look at the results, feel validated or concerned, and then nothing changes. That's not because the insights weren't useful. It's because insight without action is just expensive self-awareness. If you're going to improve your technology operations, you need a plan that's realistic about time, focus, and what improvement actually looks like. Pick One Metric, Not Three Low scores in multiple areas don't mean you tackle everything at once. Trying to improve alignment, efficiency, and security simultaneously is how you burn out your team and accomplish nothing meaningful. Instead, identify which single metric, if improved, reduces friction across the board. Improving alignment often improves efficiency as a side effect. When leadership agrees on what technology should enable, teams stop building contradictory solutions. Look at your lowest scores and ask: which one, if addressed, makes the others easier to solve? That's your focus for the next six months. What Improvement Actually Looks Like Better scores don't happen because you decided to care more. They happen because specific patterns change in ways people notice. Better alignment means leadership stops contradicting each other in meetings about technology priorities. Better reliability means you stop getting urgent calls about systems being down. Better efficiency means staff spend less time on workarounds and manual processes. Whatever metric you choose to improve, you'll know it's working when the complaints stop, the workarounds disappear, and technology starts feeling invisible instead of constantly demanding attention. These outcomes take time. Which brings us to the hard part. Wait Six Months Before Retaking It Thirty days is too soon. Ninety days is the absolute minimum. Real change takes 4-6 months before teams stop noticing the old pain points and start taking the new normal for granted. That's when perception actually shifts enough to register on a subjective assessment. If you retake the assessment too soon, you're just retaking the same test with the same biases and calling it progress. Give yourself six months. Focus on one metric. Make changes. Let them settle. Then reassess. Have Someone Else Take the Assessment Too Before you retake the assessment yourself, have a colleague take it. Ideally someone who works in operations or sees the daily reality of how technology performs. If you score alignment at 70% and your operations director scores it at 40%, that gap is the real problem. You're not seeing what they're experiencing. If you score reliability at 50% and your clinic manager scores it at 20%, you're underestimating how often systems fail in ways that disrupt patient care. Those gaps matter more than the absolute scores. They tell you where communication has broken down and where your perception doesn't match reality. What If You Can't Fix It Internally? Some people take the assessment, look at the results, and realize they don't have the capacity or expertise to address what's broken. That's honest, not failure. You have three options: accept the current state while you handle more urgent priorities, invest in building internal capability over time, or bring in outside help. All three are legitimate responses depending on your situation. The key is being honest with yourself about which path you're actually on. If internal fixes aren't happening because you're stretched too thin or lack specific expertise, acknowledging that earlier rather than later saves everyone frustration. The Real Goal The 7-Metric Assessment isn't a test you pass or fail. It's a tool for organizing what you already know and tracking whether your efforts are working. Take it. Pick one metric to improve. Make specific changes. Wait six months. Have a colleague take it too. Then retake it yourself and see if perception shifted. If scores improved, you know your changes had impact. If they didn't, you learned something about what doesn't work. Either way, you're making decisions based on patterns instead of guessing. If you haven't taken the assessment yet, it's at assessment.metric7.net. If you have, and you're not sure what to tackle first, that's a conversation worth having.

Community health centers operate under pressure that most organizations never experience. Demand for services increases year after year. Budgets stay flat or shrink. Regulatory requirements multiply. Staffing shortages force teams to do more with less. And through it all, the mission remains: provide care to the people who need it most. This creates a peculiar kind of trap for leadership. You know you need to step back and think strategically. You know that addressing root causes would eliminate recurring problems. You know that reactive firefighting is expensive and exhausting. But when do you actually have time for that work? Your morning starts with a system outage that affects patient check-ins. By lunch, you're covering for a staffing gap in the clinic. By end of day, you're prepping documentation for a compliance review. Tomorrow brings a different set of fires, but the pattern repeats. Strategic thinking requires space, and space is the one resource you absolutely don't have. The Real Cost of Constant Firefighting Here's what happens when organizations stay locked in firefighting mode: problems don't get solved; they get managed. The same issues surface again and again, just with different details. Your team develops workarounds that become permanent fixtures. Technology that should make work easier instead creates friction. And the gap between where you are and where you need to be keeps widening. This isn't a failure of leadership. It's a structural problem. Mission-driven organizations are asked to do impossible things with limited resources, and the daily demands are real and urgent. You can't ignore the fires. People depend on you. But you also can't keep fighting the same fires forever. What Breaking the Pattern Looks Like I've seen this play out in organizations over the years. A leadership team that's been firefighting for months finally pauses long enough to map out where the friction actually lives. They discover that three separate "technology problems" all trace back to poor data quality in one system. Or that staff frustration with "unreliable systems" is actually about one vendor who consistently misses deadlines. Once you see the pattern, the path forward gets clearer. Not easy, but clearer. You know what to prioritize. You know where effort will actually pay off. You stop wasting energy on symptoms and start addressing causes. The challenge is creating enough clarity to see those patterns when you're in the middle of the chaos. You don't need perfect information. You need a way to organize what you already know. That's exactly why the 7-Metric Assessment exists. It's not a comprehensive technology audit. It's a structured way to see where the real friction lives. A few minutes to answer 21 questions, and you get back a scorecard that shows you which recurring fires share the same root cause. Making the Time I won't pretend this is easy. The fires are real. The demands on your time are legitimate. But staying locked in firefighting mode has a cost too: exhaustion, burnout, recurring problems that never get solved, and technology that creates more work instead of less. You don't need a weekend retreat to think strategically. You need clarity on where to focus. And clarity doesn't require unlimited time. It just requires asking better questions. The assessment is available here. It only takes a few minutes, and it might surface something worth your attention. Because the only way out of the firefighting trap is seeing the pattern clearly enough to break it.