The Costs You Can't Ignore When accidental managers and seasoned leaders share the same stage

Every six months, it feels like I work at a completely new company. The team is bigger, the challenges are different, and my role changes entirely. For half the year I can be deep in technical decisions, and the next half I'm raising capital with my co-founder. Then before I know it, I'm building out a technical leadership team and trying to manage at scale. I have never done any of these jobs before, yet I need to be effective from day one. That constant reinvention is part of the thrill of being a founder, but it comes with a hidden cost.

Over the years, I have built up what I think of as 'leadership debt'. It's the organisational equivalent of technical debt. Sometimes I've been faced with the decision of whether to promote people before they were ready because we needed someone in the seat immediately, not in six months. Sometimes I have avoided hard calls because I did not have the confidence to make them. None of this was done carelessly and without thinking about the people in question first. It was done in service of keeping the company moving. But just like technical debt, leadership debt compounds over time.

The doer era: building at full tilt
At the beginning of getting a start-up off the ground, you hire the best individual contributors you can possibly find. These are the kind of people who can deliver at a pace that makes the impossible look easy. They are builders, problem-solvers, fixers. They have an almost uncanny ability to figure things out. Together, you move mountains.

At this stage, no one is thinking about leadership frameworks or management training. The team is small, everyone is hands-on, and alignment happens naturally because you are all in the same room, chasing the same urgent goals.

The accidental manager era: promoting without preparation
Then the company grows. You need team leads, managers, department heads. Naturally, you look to your early doers. They know the product inside out, they have delivered again and again. They've built trust across the whole company.

But doing and leading are different skills. Coaching, delegating, managing performance do not appear overnight just because someone gets a title. Some accidental managers adapt brilliantly. Others feel overwhelmed or frustrated. Many never wanted to lead in the first place. They just wanted to keep building.

The seasoned leader era: professionalising leadership
Eventually, continuing on a high-growth trajectory requires you to bring in seasoned leaders who have been through scale before. They bring processes, structure, and foresight. They know how to plan two steps ahead and how to manage complexity at size.

Suddenly, you have two leadership cultures side by side. The accidental managers are holders of deep institutional knowledge, culture carriers, and the people who have been there since the earliest fires. The seasoned leaders are trained in the playbooks of scale, with the muscle memory of leading larger teams.

If you are not careful, these groups can misread each other's value. Accidental managers might feel pushed aside. Seasoned leaders might underestimate the ingenuity and context the early team brings. The friction can slow execution, erode trust, and contribute to you losing great people.

Servicing leadership debt: bridging worlds with empathy and time
Servicing leadership debt is not about replacing one kind of leader with another. It is about helping people adapt to change, rebuilding trust when needed, and making space for different leadership styles to coexist and evolve.

New leaders often join with valuable experience from more structured environments. They bring clarity, process, and a sense of scale. But when those approaches are introduced without understanding the company's history or the context that shaped it, they can land badly. The most successful new leaders are the ones who take time to listen, observe, and learn from those who have been in the trenches.

Simultaneously, some of our earliest leaders are discovering that the methods that worked brilliantly at 50 people strain under the weight of more complexity. Reinvention doesn't mean starting from scratch; it means learning what good looks like at this stage and drawing on the experiences of leaders who have seen excellence elsewhere.

At Semble, the responsibility to bridge these two worlds feels even sharper. Every decision we make - even about who steps into a leadership role - ultimately ripples out to a patient. It's a reminder that our work is never just about organisational structure. It's about building a company where the right leaders help us serve patients better, every single day.

That's why a strong mission and shared cultural drivers anchor everything we do. "Impact" is not just a buzzword – it gives clear leadership direction, empowering those closest to our product to make the next right decision and focus on outcomes. To reinforce this, we have structured, personalised onboarding checklists that send new leaders on listening tours to understand how we operate, our culture, and how deeply we care about our users.

We also operate with empathy at our core. We strengthen this for our users through concrete actions: customer visits in our onboarding programme "First Shot" that every new starter attends, company-wide workshops featuring the very healthcare organisations that rely on us every day, and role playing how to set up a clinic as further opportunities for our leaders to step into our users' shoes.

This is how we repay leadership debt. It takes time and deliberate effort. But if we do it well, we get the best of both worlds - the deep context and ingenuity of our early builders, and the clarity and maturity of those who have helped other companies scale. That is how we grow without losing ourselves - and grow in a way that keeps the heart of the company intact.