A fractional COO is an experienced Chief Operating Officer who works with your company on a part-time or contract basis rather than as a full-time employee. You get senior-level operational leadership — the strategy, systems-building, and team alignment that a COO provides — without the full-time salary, benefits, and overhead. Fractional COOs typically work with multiple clients simultaneously, bringing cross-industry perspective alongside deep operational expertise.

A fractional COO handles the operational side of your business so you can focus on growth and vision. This includes building and optimizing processes, creating accountability systems and dashboards, aligning your leadership team around shared priorities, managing cross-functional projects, and identifying the bottlenecks that are quietly costing you margin. Day-to-day, a fractional COO might attend your leadership meetings, redesign a fulfillment workflow, restructure a department, or build the KPI framework your team needs to scale. The scope depends on your stage and your goals — but the through-line is always the same: making growth sustainable.

The core difference is commitment and cost. A full-time COO is an employee — typically commanding $200,000–$400,000 or more in annual compensation, plus benefits, equity, and onboarding time. A fractional COO delivers comparable strategic and operational impact at a fraction of that cost, engaging for a set number of hours or days per month. For companies in the $5M–$50M range that need senior operational leadership but are not ready to justify a C-suite salary, a fractional model is often the smarter path. You get the expertise when you need it, without the fixed overhead and without the risk of the wrong full-time hire.

Fractional COO engagements typically range from $8,000 to $25,000 per month depending on the scope of work, hours committed, and complexity of the business. At MM Strategic Solutions Group, engagements start with a focused 30-Day Assessment to diagnose your biggest operational gaps and build a prioritized roadmap. From there, you can move into a 90- Day Sprint for targeted problem-solving, an Operator Lite retainer for ongoing support, or a fully Embedded Operational Leader arrangement for comprehensive COO-level partnership. Every engagement is scoped to fit where you are and what you actually need.

The right time to bring in a fractional COO is when growth is outpacing your systems. Common signs include: your leadership team is misaligned or overloaded, margins are eroding as you scale, the same operational problems keep recurring, you are spending too much time in the weeds, or you're preparing for a significant expansion. Be it new locations, new markets, a major hire, or a funding round. If you are a founder who is still running operations because no one else can, and that's limiting your ability to lead the business forward, a fractional COO can be the change that unsticks everything.

Healthcare and healthtech organizations face a distinct set of operational challenges: regulatory compliance, multi-site coordination, workforce management in a tight labor market, billing and margin pressure, and the complexity of scaling clinical programs without sacrificing quality. A fractional COO with deep healthcare experience understands these constraints — and knows how to build systems that work within them. At MM Strategic Solutions Group, healthcare is a primary focus. Mariann Morell has helped healthcare organizations grow from 4 to 18 locations, scale budgets from $15M to over $65M, and achieve consistent federal audit compliance throughout — experience that transfers directly to the challenges your organization is navigating.

Yes — and this is exactly where a fractional COO tends to add the most value in healthcare. Multi-site expansion is operationally complex: you need standardized workflows, consistent quality across locations, leadership structures that don't rely on the founder to function, and financial controls that scale. Without the right systems in place, growth can actually hurt margins instead of improving them. With the right operational infrastructure built before and during expansion, each new site becomes easier to launch and faster to reach profitability. If you're planning to open additional locations, bring on new programs, or bring on a significant volume of new patients or clients, a fractional COO can help you build the foundation that makes that growth sustainable.

It depends on what you're trying to accomplish. A 30-Day Assessment is a focused diagnostic — a clear starting point with a deliverable roadmap. A 90-Day Sprint is designed to solve a specific operational problem from end to end. Ongoing retainer arrangements — like the Embedded Operational Leader or Operator Lite models — typically run for six months to a year or more, with the scope adjusting as the business evolves. Many clients begin with a sprint or assessment and then continue with ongoing support once they see the impact. There's no minimum commitment beyond the initial engagement, and the work is always scoped around your goals.

Fractional COO engagements tend to deliver the highest impact for companies in the $5M– $50M revenue range with 20 to 100 employees, particularly those growing 20% or more yearover-year. At this stage, the founder is typically still deeply involved in operations, the team is growing faster than its processes, and the business is too complex to run informally — but not yet large enough to justify a full C-suite. This is the inflection point where operational infrastructure makes or breaks long-term growth. Smaller businesses can benefit too, particularly those approaching a major milestone like their first leadership hire, a new market entry, or a capital raise.

Look for someone who has operated inside companies like yours, not just consulted from the outside. The best fractional COOs have held senior operational roles, built systems from scratch, managed teams through growth, and have the scars to prove it. Beyond experience, look for a genuine operator mindset: someone who will show up to your leadership meetings, dig into your data, and own outcomes. Not just deliver a framework and leave. Industry fit matters too, particularly in healthcare or other regulated environments where context isn't optional. Finally, look for clear communication and chemistry. You'll be making decisions together. The relationship needs to work.