Betsy Nesbitt

Strategic Advisor · Fractional COO · Speaker · Writer

Aligned teams built on trust go further, faster

I build trust, focus, and follow-through so organizations perform better.

"Betsy earned trust everywhere."

- John Nicol, Ph.D., former colleague and VP Engineering, digital health startup

I work with leaders of mission-driven and investor-backed organizations at turning points: rapid growth, realignment, restructuring. Together, we look at how your operating model is working and where trust and engagement stand. Then we lead change, adjusting your structure and systems and how you communicate with and empower your people. You get faster results, more engaged teams, and simple, research-backed tools for your leaders to keep using after our work together ends.

Problems I solve

  • Why do people disengage even when they believe in the mission? Rebuild trust and close cultural divides that stall progress.

    • Result: Diagnosed the root causes of medical staff disengagement at an independent community hospital and delivered a stabilization plan to align the operating model and repair trust between leaders and staff. Now advising the CEO through a reorganization.

    • Writing: Can You Get Me the Shampoo - how trust is built in healthcare, Duck Cookies - how understanding human needs restores engagement and trust

  • Why do the same problems keep circling? Redesign and align your systems, so your people are empowered effectively.

    • Result: Redesigned annual planning for a 6-hospital regional health system and academic medical center. Cut system goals from 18 to 12 and drove 100% on-time monthly check-ins from key result owners.

    • Writing: Internal Alignment - how to diagnose and correct alignment, from strategy to structure, process, and skills

  • Why do change initiatives stall even when the case for change is clear? Lead change through how you communicate, connect, recognize, influence, and empower.

    • Result: Improved operating margin 4% through pricing strategy and an operational turnaround at a VC-backed services company.

    • Writing: We Should Talk - how to use trust to lead through change

  • How does knowing what you and your organization need help you lead effectively even when things are uncertain?‍ ‍Improve awareness and range to lead more effectively.

    • Result: Sourced a proprietary acquisition for a PE-backed autism therapy platform and guided the sellers, clinically trained owners new to M&A, through their first deal, adding $1.1M EBITDA and new market territory. Four 100-mile trail ultramarathon finishes.

    • Writing: Swim Home - how to practice trusting yourself, Know Where You Stand - how to make faster, better-informed decisions by reading three landscapes: the business terrain, your team, yourself

How I work

  • Workshops and keynotes: Stories and practical tools to build alignment, engagement, and trust. For leadership retreats, team offsites, and conferences.

  • Strategic advising: A candid thinking partner to help you make data-grounded decisions and choose the right next step.

  • Diagnostic Projects: Understand the state of trust, the cultural and operational drivers, and create a plan to improve performance.

  • Fractional leadership: Interim COO or Chief of Staff.

What I contribute

Operating experience.  Twenty years across regional health systems, PE-backed behavioral health, VC-funded startups, management consulting, investment finance, and global public health. I've been a COO, Chief of Staff, finance director, and consultant. That range helps me see patterns others miss and sense the whole picture.

An athlete's awareness. A lifetime outdoors and dozens of ultramarathon finishes, including four 100-mile trail races, taught me to read the terrain and myself at the same time, and calibrate my effort to achieve my goals. I do the same with clients. I read what your people feel and need and what the business needs, then build a plan to move forward.

See a case study on the approach page.

Thought Leadership

I write about trust and leadership to understand why we think, feel, and act the way we do. Writing is how I learn and how I teach. Essays pair stories with research and practical tools. Business, nature, and endurance sports are my sandboxes.

Forthcoming book “Swim Home: A Memoir and Playbook for Trusting Yourself and Others Through Change” coming out in 2027.