At some point in the journey, most CEOs encounter a difficult realization.
Growth begins to slow. Decisions start to pile up. The team hesitates, waiting for direction.
And eventually, a harder truth surfaces. The constraint is no longer the market or the product.
It is the CEO.
Carla Larin did not shy away from that reality. “I’ve felt that way in the past, that I’m the bottleneck to our company’s growth.”
That moment is not a failure. It is a turning point. What a CEO does next determines whether the company breaks through or stalls.
The Shift From Thinking to Execution
Carla’s early career was shaped in environments that reward structured thinking.
At Goldman Sachs and in consulting, she developed strong skills in analyzing problems, building frameworks, and communicating clearly. Those are valuable skills, but they do not fully prepare you for what comes next.
Running a company demands something different.
“I spent a lot of time early in my career in Excel spreadsheets and PowerPoint… but not actually following through and completing the task to completion.”
That shift from thinking to execution is one of the first real tests of leadership.
You can define the work. You can explain the strategy. But until you deliver results, none of it matters.
Scaling a company forces that transition quickly. There is no room for theory without action.
Hiring Changes Everything
Once execution becomes the focus, another truth becomes impossible to ignore.
You cannot do it alone.
Carla described it clearly: “The power of hiring amazing people is the biggest unlock.”
This is where many CEOs underestimate the impact of a single decision. In an early-stage company, one hire can dramatically accelerate progress or quietly stall it.
A strong sales leader can create momentum across the entire organization. A weak one can drain time, energy, and confidence.
Hiring is not a background task. It is one of the highest leverage activities a CEO has.
And it does not stop once the role is filled.
From Hiring to Amplifying
Building a leadership team is only the first step.
The next challenge is getting the most out of that team, and this is where many CEOs need to evolve their approach.
Carla focuses on two key levers.
The first is alignment. People who have a direct impact on enterprise value should participate in creating it. That clarity reinforces what matters and ensures that effort is directed toward the right outcomes.
The second is feedback. At MaxRTE, performance conversations are not limited to an annual review. They happen quarterly and, just as importantly, they go both ways.
“I want feedback as much as they want feedback.”
That mindset shifts the culture. It signals that growth is expected from everyone, including the CEO.
When leaders model that behavior, the organization becomes more adaptive, more honest, and ultimately more effective.
Scaling Yourself Alongside the Company
As the company grows, the CEO must grow with it.
There is no way around this.
For Carla, one of the most challenging areas was building a sales function from the ground up. It was a critical investment, but it was not an area where she had prior experience.
So she leaned into learning: “I talked to people who were a lot smarter than me, learned from others, and iterated.”
That process required humility and persistence. It also required the discipline to test ideas, accept failures, and refine the approach over time.
At the same time, she had to resist distractions.
Healthcare offers endless adjacent opportunities. Different verticals, different customer types, different use cases. Each one can appear compelling.
But chasing too many paths at once slows everything down. Focus, more than anything else, enables scale.
Choosing Where to Focus
One of the more difficult decisions Carla faced was determining where to concentrate her go-to-market efforts.
SMB offered speed. Enterprise offered depth.
Each path required different capabilities, different messaging, and different expectations.
Many CEOs try to keep both options open. They experiment lightly, hoping the right answer will emerge without committing too early.
Carla took a more deliberate approach.
She gathered data. She spoke with customers. She analyzed where churn was happening and where satisfaction was strongest.
Over time, the pattern became clear: “We found that our superpower was on the enterprise side.”
That decision simplified the organization. Sales motions became clearer. Product development became more focused. Customer relationships became stronger.
While enterprise deals require patience, they create a more durable foundation for growth.
When the CEO Becomes the Constraint
Even with the right strategy and a strong team, one challenge continues to surface.
The CEO becomes the bottleneck.
It rarely happens all at once. Decisions slowly move upward. Approvals take longer. The team begins to defer instead of acting.
Before long, everything depends on one person.
Carla has seen this firsthand: “The two sides of the coin are empowering others to make decisions and making sure you have the right leaders in place.”
Those two elements must exist together.
Empowerment without capability creates risk. Capability without empowerment creates frustration. Scaling requires both.
Letting Go Without Losing Direction
This is one of the hardest transitions for any CEO.
You know how to do the work. You have been deeply involved in every decision. Letting go can feel uncomfortable.
But holding on creates a ceiling.
The goal is not to step away. It is to lead differently:
- Set clear direction.
- Define expectations.
- Provide context.
Then allow your team to execute.
If you have hired well, they will rise to the challenge. If they do not, that points to a different issue that needs attention.
Either way, the solution is not to pull everything back to the CEO level.
Taking a Disciplined Approach to AI
When the conversation turned to AI, Carla’s perspective was grounded and practical.
Internally, the approach is straightforward. Use the tools. Improve productivity. Enable teams to move faster and operate more efficiently.
Externally, the approach requires more discipline.
There is significant pressure in the market to build AI-driven features. Customers expect it. Budgets are increasingly allocated toward it. Competitors are talking about it.
That creates a natural temptation to follow. Carla resists that impulse: “Build for real pain points.”
Not for trends. Not for positioning. Not for appearances.
MaxRTE has a distinct advantage through its access to proprietary healthcare data built over decades. That data is not easily replicated, and it allows the company to deliver precise, reliable outcomes.
In healthcare, precision is not optional. It is essential.
Focused Innovation Wins
Rather than applying AI broadly, Carla’s team focuses on specific, validated use cases.
They identified a real problem within prior authorizations. They confirmed it with customers. Then they built a solution designed to address that exact need.
This level of focus matters.
AI is not a strategy by itself. It becomes valuable only when it is applied to a meaningful problem.
Companies that stay disciplined in how they deploy it will outperform those that chase every new capability.
What CEOs Should Take Away
Carla’s experience highlights a few important truths:
- At some point, you will become the bottleneck. Recognizing it is the first step toward solving it.
- Hiring remains one of the most powerful levers you have. One great hire can change the trajectory of your company.
- Empowering your team is not optional. It is required if you want to scale.
- And when it comes to new technologies like AI, focus on solving real problems. Ignore the noise.
The role of the CEO evolves continuously.
In the beginning, you do everything. Then you build a team. Eventually, you step back so that team can perform at a higher level.
That final transition is often the most difficult. It is also where real growth begins.
I am Glenn Gow. I coach CEOs. If you feel like the bottleneck, take that seriously. It is not a weakness. It is a signal that you are ready to lead at the next level. Listen to the full episode here.
