Operational Scalability: Lee Wilford Of Puzzle Healthcare On How To Set Up Systems, Procedures, And People To Prepare A Business To Scale
Do Not Ask Your Team To Do Anything You Haven’t Done: You should know your business inside and out. Otherwise, you’re unable to build processes that truly succeed.
In today’s fast-paced business environment, scalability is not just a buzzword; it’s a necessity. Entrepreneurs often get trapped in the daily grind of running their businesses, neglecting to put in place the systems, procedures, and people needed for sustainable growth. Without this foundation, companies hit bottlenecks, suffer inefficiencies, and face the risk of stalling or failing. This series aims to delve deep into the intricacies of operational scalability. How do you set up a framework that can adapt to growing customer demands? What are the crucial procedures that can streamline business operations? How do you build a team that can take on increasing responsibilities while maintaining a high standard of performance?
In this interview series, we are talking to CEOs, Founders, Operations Managers Consultants, Academics, Tech leaders & HR professionals, who share lessons from their experience about “How To Set Up Systems, Procedures, And People To Prepare A Business To Scale”. As part of this series, we had the pleasure of interviewing Lee Wilford.
Lee Wilford, a healthcare executive with deep operational and strategic expertise across the post-acute continuum, serves as the Chief Operating Officer of Puzzle Healthcare. In this role, he focuses on developing scalable, technology-driven systems designed to improve care transitions and patient outcomes within the post-acute landscape. Under his leadership, Puzzle Healthcare has evolved from an early-stage startup into a multi-state organization with a rapidly growing national presence, supported by strong operational frameworks and data-driven growth strategies. Prior to this role, Lee supported and led initiatives across post-acute therapy programs, advancing innovative models of rehabilitative care for patients recovering from complex medical conditions.
Thank you so much for your time! I know that you are a very busy person. Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I started my career as a treating occupational therapist. While this job was inspiring, one of the most frustrating patterns I saw was the “revolving door” of care. Patients would go from the hospital, to the nursing home, back home, often discharged too early, only to end up back in the hospital again. It was disheartening to watch, and it became clear that the issue wasn’t just clinical, it was structural. After experiencing this, I realized that I wanted to be part of something bigger, something that could break that cycle. That desire ultimately led to my role at Puzzle Healthcare where our focus is on aligning providers and facilities so that patients don’t slip through the cracks. Today, we operate across multiple states with a team of more than 150 providers, all working toward the same goal: solving a persistent issue in post-acute care and improving patient outcomes at scale.
It has been said that our mistakes can be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
The funniest mistake I made early on was trying to launch a program in a new facility on a Monday. Anyone who works in post-acute care knows Mondays are pure chaos, from trying to manage new admits from the weekend, to doctors rounding, and leadership trying to catch their breath. I thought I was making a big splash, but instead I just added to the noise. I quickly learned that the real way to win people over was to show up on a Tuesday, particularly with donuts and coffee. It turns out caffeine and pastries are sometimes the best relationship-building tools in healthcare.
What do you think makes your company stand out? Can you share a story?
What makes Puzzle Healthcare stand out is our ability to help patients seamlessly navigate the care continuum. We’re not only embedded within our post-acute partners’ buildings, but we also leverage strategic health system and community partnerships to ensure smooth transitions of care. By doing so, we reduce fragmentation, prevent unnecessary readmissions, and make the patient’s experience more consistent from hospital, to nursing facility, and eventually to home. That focus on integration and partnership is what sets us apart.
You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
1. Persistence: Healthcare is full of roadblocks such as credentialing delays, staffing challenges and payor shifts but I quickly realized that you can’t let those stop you. I’ve learned that persistence, simply showing up every day and pushing forward, is often the difference between progress and standing still.
2. Willingness to Learn: I don’t pretend to have all the answers. Some of the best ideas at Puzzle have come from listening, whether it’s from a provider in the field or a partner at a facility. Being open to learning has shaped how I lead and how our company continues to grow.
3. Adaptability: Nothing ever goes exactly as planned, especially when scaling across different states with different regulations and realities. Being able to adjust quickly and not get stuck in “how it’s always been done” has been essential.
Leadership often entails making difficult decisions or hard choices between two apparently good paths. Can you share a story with us about a hard decision or choice you had to make as a leader? I’m curious to understand how these challenges have shaped your leadership.
One of the hardest calls I made was deciding to exit certain facilities even though we’d invested heavily in those relationships. The metrics were clear, our model wasn’t a fit, but the human side of ending the partnership was painful. That decision reinforced for me that leaders have to balance loyalty with sustainability.
Thank you for all that. Let’s now turn to the main focus of our discussion about Operational Scalability. In order to make sure that we are all on the same page, let’s begin with a simple definition. What does Operational Scalability mean to you?
To me, operational scalability is the ability to grow without losing consistency. It means building systems, processes, and teams that can handle double the volume tomorrow without breaking down and ideally, while getting more efficient as we grow. In healthcare, that also means there can never be a reduction in the consistency or quality of care. No matter how large we get, the patient always has to come first.
Which types of business can most benefit from investing in Operational Scalability?
In any business, human-capital intensive or not, operational scalability is paramount. If you are unable to sustainably grow your business, you will never make the impact you’d like to have. Although it matters in every industry, it is especially critical in those that are heavy on the human capital side because changing dynamics can directly influence outcomes. Without the right infrastructure in place, teams can struggle to succeed, and the ripple effect of that failure is felt across the entire organization.
Why is it so important for a business to invest time, energy, and resources into Operational Scalability?
Growth without scalability is like building a house on sand. You can’t sustain it. Investing early in scalable systems saves you from constant firefighting and lets leaders focus on strategy instead of daily chaos.
In contrast, what happens to a business that does not invest time, energy, and resources into Operational Scalability?
Without proper investment in scalability, you burn out your best employees. Quality drops and in healthcare, patients often feel it first. Growth eventually slows or reverses because the very thing that made you successful, being your people and services, can’t keep up with demand.
Can you please share a story from your experience about how a business grew dramatically when they worked on their Operational Scalability?
One of the biggest game-changers for scalability at Puzzle has been the use of AI models. They’ve allowed us to take a lot of the repetitive, time-consuming work off our team’s plate and do it faster and more accurately. We’ve been able to automate so many parts of our business that tie directly into compliance, operations, and even clinical workflows. The result is that our staff can focus on what really matters instead of getting bogged down in manual tasks. The best part is how this shows up for our partners. Through automated reporting they can clearly and easily see the impact we’re having on key outcomes like length of stay, readmission rates, and functional improvements. Having that data front and center has not only strengthened our partnerships but has also been a major driver of our growth as more organizations see the tangible value Puzzle brings.
Here is the primary question of our discussion. Based on your experience and success, what are the “Five Most Important Things A Business Leader Should Do To Set Up Systems, Procedures, And People To Prepare A Business To Scale”? If you can, please share a story or an example for each.
1. Build Clear Systems Early: Even if it feels too soon, document workflows so they can be replicated.
2. Invest in People: Technology won’t fix culture. Hire leaders who can own and scale functions.
3. Measure What Matters: Focus on a few core metrics that drive decisions — not vanity metrics.
4. Automate Repetitive Tasks: Anything you do more than twice should be automated to improve workflows.
5. Do Not Ask Your Team To Do Anything You Haven’t Done: You should know your business inside and out. Otherwise, you’re unable to build processes that truly succeed.
What are some common misconceptions businesses have about scaling? Can you please explain?
A common misconception is that scaling means “grow at all costs.” In reality, true scaling is sustainable and is about building efficiency so growth doesn’t collapse under its own weight. Another misconception is that scaling only comes down to adding more technology. While tools are important, if you don’t have the right people, culture, and processes in place, the tech won’t save you. And finally, some leaders think scaling means removing themselves from the details. In my view, you have to understand your business deeply to build systems that actually work. Scaling isn’t about distancing yourself — it’s about creating a foundation so the whole team can perform at a higher level.
How do you keep your team motivated during periods of rapid growth or change?
When employees feel like they are contributing to a part of something greater, they are no longer just employees — they are part of a team. We want people to join Puzzle and add to a culture of self-motivation, with leaders in place to help guide and support. Motivation also comes from balance: making sure work and quality of life complement one another. In my experience, when people feel genuinely valued by their company and the work they do, they maintain a level of intrinsic motivation that’s nearly impossible to manufacture.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My mentor and our CEO, Ahzam Afzal, PharmD, once told me: “To be a true leader and operator, you must understand every facet of the business. You cannot influence people whose jobs you don’t understand, and you cannot build a company without knowing what is required.” That advice has stuck with me. It applies directly to scaling companies, but also to life in general — real leadership starts from a place of understanding.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
If I could start a movement, it would be to reimagine how healthcare empowers patients through data transparency. Too often, patients and families are left in the dark about their own care plans, outcomes, and options. Imagine if every patient had real-time access to a simple, understandable dashboard that tracked their progress, risks, and goals the same way you can track your steps or sleep on a wearable. I believe giving patients and families ownership of their data could transform how people engage with their health, improve accountability across providers, and ultimately shift the system from reactive to proactive.
How can our readers further follow your work online?
The best place to follow my work is on LinkedIn: https://www.linkedin.com/in/leewilford/
Thank you so much for sharing these important insights. We wish you continued success and good health!
Thank you!
Operational Scalability: Lee Wilford Of Puzzle Healthcare On How To Set Up Systems, Procedures, And… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.