ROAD MAP

Grow Your Culture as You Scale

5 things to keep in mind as your company grows

By Shane Reeves

Every leadership team preparing for significant growth worries about the same thing: How do we scale without losing what makes us special? I’ve heard that question in boardrooms and I’ve asked it in my own conference room.

I’ve built two healthcare organizations from a single location, sold the first after more than two decades, and grown the second into a multi-state infusion network that has earned a place on the Inc. 5000 for seven consecutive years. That experience has changed the way I think about culture and scale.

Culture does not survive growth simply because leaders work hard to protect it. It survives when they are intentional about building the systems, expectations and leadership practices that allow it to scale. Here are five keys to keep in mind.

1. Build a culture that reproduces itself.

Early on, employees learn culture through proximity. They watch the founder, see how decisions are made and absorb what the organization values. But across more than 30 locations, thousands of those moments happen without a senior leader in the room. McKinsey's research on hypergrowth companies reaches a similar conclusion: Companies that scale successfully are deliberate about preserving the cultural attributes that create competitive advantage.

A culture that depends on the founder’s presence is still a personality. A culture that guides decisions when the founder is nowhere in sight has become a system. Making that transition is the real work of scaling.

2. Design the experience, then build the model around it.

Much of healthcare was built around institutional workflows, reimbursement requirements and operational constraints, with patients as an afterthought. Reversing that equation is one of the highest-leverage decisions a healthcare operator can make. The Agency for Healthcare Resarch and Quality defines patient experience in practical terms: whether patients can get timely appointments and communicate clearly with clinicians and staff. Those should not be viewed as soft measures—they should be treated as operating requirements.

Start by defining what you want a patient to experience from the first phone call through the final follow-up. Then build the staffing, processes, technology and accountability needed to deliver that experience consistently.

Growth replicates an experience, not a floor plan. Before opening the next location, your team should be able to clearly articulate what patients should experience, how leaders are expected to behave and how problems get resolved. The goal is to standardize enough that the organization’s values survive changes in geography, scale and personnel without making every location feel identical.

The market increasingly rewards that discipline. In Deloitte's 2025 U.S. healthcare executive outlook, 55% of health system executives said they need to improve consumer engagement, trust and experience to attract consumers and drive organic growth. Patient experience is not separate from the business model. It is part of the business model.

3. Reward the behavior you want repeated.

Growth creates specialization, and specialization creates silos. But patients experience one organization, and no patient ever agreed to navigate our organizational chart. We reward people for solving the patient’s problem, not protecting a job description.

Values also need behavioral definitions if they are going to scale. “We put patients first” means very little at 10:30 a.m. on a Tuesday when something goes wrong. Define what that value requires someone to do in that moment, then hire, evaluate and promote accordingly. People watch those decisions closely. They reveal what the organization truly values.

The business case is measurable. Gallup’s Q12 meta-analysis of more than 180,000 teams found top-quartile engagement units outperformed bottom-quartile units by 23% in profitability and 10% in customer loyalty. The number that gets my attention is patient safety incidents, where the median difference reaches 58%. That is a workforce measure showing up in a clinical outcome.

4. Your employee experience becomes your patient experience.

Asking exhausted, unsupported people to deliver an extraordinary patient experience is a contradiction. The National Academy of Medicine ties clinician well-being inextricably to the quality of care. A great place to work and a great place to receive care must be the same project. One produces the other.

5. Simplify the mission as you get bigger.

Complex organizations write complex rules. Culture works the other direction. The more locations and management layers you add, the simpler the decision framework your team needs. Ours is one question: What's best for the patient? That leaves diagnosis and treatment where they belong, with clinicians. As a cultural compass, it aligns 30 locations faster than any policy manual.

McKinsey's Organizational Health Index puts a number on that alignment: Organizations in the top quartile of health deliver roughly three times the total shareholder returns of those in the bottom quartile.

The Real Milestone

The goal was never to build 30-plus independent locations that happened to share a name. It was to build one culture that could show up consistently in 30 or more different places. When hiring, onboarding, training, recognition and promotion all reinforce the same philosophy, culture begins to replicate itself, and the founder no longer has to be in the room.

The proof is in the patient response. More than 3,000 five-star reviews across our centers tell me that the culture traveled. Each one reflects an experience someone else delivered in a moment I never saw. That is the asset I would want any acquirer or successor to inherit, and it is the one you have to build deliberately from the beginning.

As founder and chief executive officer of TwelveStone Health Partners, Shane Reeves has built a best-in-class specialty infusion center organization that covers six states and 30 sites. In 1995, he and Rick Sain bought Reeves-Powell Drug Store. They built it into a multi-million-dollar healthcare company serving the state of Tennessee with specialty pharmacy, infusion, respiratory, enteral, durable home medical equipment and MEDIpack, its prescription medication management and chronic care support program.

In 2015, they sold the retail and specialty pharmacy to Entrust in 2015, forming TwelveStone Health Partners in early 2016. Reeves is a state senator for Tennessee's District 14, a position he won in a special election in 2018. He has a Bachelor of Science from Middle Tennessee State University and graduated from the pharmacy school at the University of Tennessee Memphis. Visit 12stonehealth.com.