No Operating Manual

Erin O'Brien
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  • ENTREPRENEURSHIP

No Operating Manual is a podcast about building healthcare companies when there’s no clear path and no one tells you what comes next. Each episode features candid conversations with founders and operators working at the earliest stages, where decisions are made with incomplete information and roles are undefined. The focus is on the real work: what you learn, what you have to unlearn, and what it actually takes to make healthcare companies function in the real world.

  1. The Consent Conundrum: How Carol Robinson Is Giving Patients Control of Their Health Data

    APR 28

    The Consent Conundrum: How Carol Robinson Is Giving Patients Control of Their Health Data

    No Operating Manual | Episode featuring Carol Robinson, Founder & CEO of Midato Health What 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

    29 min
  2. The Parental Leave Problem Healthcare Can't Ignore | Michelle Yu of Josie

    APR 20

    The Parental Leave Problem Healthcare Can't Ignore | Michelle Yu of Josie

    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 credibility Sources: https://pubmed.ncbi.nlm.nih.gov/37096124/ https://www.aamc.org/news/why-women-leave-medicine https://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/

    32 min
  3. Lost in Referral: How AI Is Fixing Specialty Care Referrals with Derek Baird

    APR 14

    Lost in Referral: How AI Is Fixing Specialty Care Referrals with Derek Baird

    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.

    30 min
  4. The System Is the Starting Point: Kristin Kelly on Building Healthcare Companies That Last

    APR 7

    The System Is the Starting Point: Kristin Kelly on Building Healthcare Companies That Last

    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.

    15 min
  5. The AI Front Door: Adeel Malik on How Healthcare Systems Are Streamlining Patient Navigation

    MAR 29

    The AI Front Door: Adeel Malik on How Healthcare Systems Are Streamlining Patient Navigation

    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 ClearStep ClearStep 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-19 The 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 Dynamics Adeel 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-Making One 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 Navigation Adeel 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.

    29 min
  6. Torrie Fields on Data, Access, and the True Cost of Care

    MAR 22

    Torrie Fields on Data, Access, and the True Cost of Care

    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.

    25 min
  7. Building Bridges in Social Care with Nima Roohi

    MAR 16

    Building Bridges in Social Care with Nima Roohi

    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.

    38 min
  8. Duffy Fallon on Why Physical Health Holds the Key to Lasting Recovery

    MAR 10

    Duffy Fallon on Why Physical Health Holds the Key to Lasting Recovery

    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.

    21 min
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About

No Operating Manual is a podcast about building healthcare companies when there’s no clear path and no one tells you what comes next. Each episode features candid conversations with founders and operators working at the earliest stages, where decisions are made with incomplete information and roles are undefined. The focus is on the real work: what you learn, what you have to unlearn, and what it actually takes to make healthcare companies function in the real world.

Information

  • Creator
    Erin O'Brien
  • Years Active
    2K
  • Episodes
    14
  • Rating
    Clean
  • Copyright
    © 2026 Erin O'Brien
  • Show Website
    No Operating Manual