Scaling an Organization: Lessons from My Journey with Suburban Diagnostics

“Good business leaders create a vision, articulate the vision, passionately own the vision, and relentlessly drive it to completion.” - Jack Welch

When I started Suburban Diagnostics, the path to scaling wasn’t fully clear. We worked out of our first lab for 10 years before taking the step to open another centre. I received a practical MBA during those 10 years because we learnt on the job and did everything ourselves. From marketing to operations to finance to customer management to testing to generating reports, the onus of each step lay on our shoulders.?

However, over the years, as we expanded from a single diagnostic centre to multiple locations, I learned some critical lessons that I believe every entrepreneur should consider.?

In my fourth newsletter, I spoke about how entrepreneurs can build their organization from scratch. But today, I would like to share my reflections on scaling an organization and the steps I think are important for every founder to keep in mind.?

Scaling isn’t just about opening more branches; it’s also about maintaining the integrity of your organization while adapting to new challenges and opportunities.?

1. Building a Good Team: The Backbone of Growth

The most important element of scaling is the people you surround yourself with.?

From day one, I focused on building a team that shared my vision, not just of growth, but of delivering high-quality diagnostics that patients could trust.?

I hired my first Pathologist after a few years of running solo when I realized I could not do everything myself. Staying behind the microscope was my comfort zone; but it dawned on me that if we had to grow, I had to move to the other side of the microscope and place more people behind the microscope. This allowed me to ”build more microscopes” for the organization.?

While the non-medical part of the business was handled by my wife, the testing side lay in my hand. We knew we had to build a good team to make our venture successful. Over time, we professionalized all non-medical functions in parallel to building the medical functions.?

A strong team is a mix of attitude, skill and alignment with your core values. I have always believed - “hire for attitude and train for skill” and this has worked for me.?

In the early stages, this meant handpicking individuals who brought diverse expertise but worked well together.?

Getting the right talent takes time; take time to build the team, just as you build the processes, to support the growth (for which the capital is raised in most cases). The right team and right processes will fuel the right kind of growth.?

The right team is not just operationally efficient but also aligned culturally, driving the organization forward even when challenges arise. Covid was a prime example of how the team came together to manage the biggest challenge we ever faced.?

2. Financial Governance: Staying True to the Numbers

As we expanded, one of the biggest challenges was financial governance. Growth is exciting, but it needs to be sustainable.?

One of the patients who consulted with me about his reports asked me ‘I would like to see your report’. He didn’t mean my medical report but my organization report - MIS (Management Information System).?

He made me realize that running a business is great but knowing our numbers and having data is how we will track our performance.

We had to ensure that our finances were managed with discipline. This meant setting clear financial goals, maintaining robust controls, and continuously monitoring our cash flow and margins.?

We adopted a governance framework that allowed us to reinvest intelligently without compromising our stability. It is crucial to remember that growth without financial prudence can become a liability.

We knew exactly where our money was being spent.?

It is crucial for every entrepreneur to track their finances, understand their P&L and balance sheets, and how to spend their money prudently.?

3. Strong Communication: Keeping Everyone Aligned

Scaling introduces complexity, and with complexity comes the risk of miscommunication. We found that clear, frequent, and open communication at all levels was key to keeping everyone aligned.?

Communication within our organization improved when we introduced SOPs (Standard Operating Procedures) for every function. It took care of every element required to scale an organization - who, what, when, where, and how.?

As a leader, I made it a point to ensure transparency—whether it was about new opportunities, challenges, or the direction of the company.?

From senior management to our front-line staff, communication bridged gaps, fostered trust, and helped prevent misunderstandings as we scaled.

4. Agility and Ability to Pivot: The Competitive Edge

In today’s fast-changing business environment, agility is a non-negotiable trait.?

At Suburban Diagnostics, we encountered unexpected market shifts, competitive pressures, and regulatory changes.?

We were one of the few labs in India to get an accreditation from NABL (National Accreditation Board for Testing and Calibration Laboratories). Our agility was to understand that the power of a certification and accreditation will help build credibility among our customers and hospitals. It also allowed us to define all processes which helped us as we scaled.?

Today there are nearly 3L labs in the country but hardly 2000 have an NABL accreditation. While it wasn’t mandatory (nor is it today), it was one thing I thoroughly believed in - Quality is non-negotiable.

An international visitor representing a large multinational lab equipment manufacturer complimented us by saying ‘this could be like any top rated lab in the west’ - a moment of pride for the entire team.?

We had to pivot several times, whether it was incorporating newer technologies, introducing modernized equipment, shifting focus to specialized diagnostics, or exploring new partnerships.

The ability to adapt, pivot, and be agile allowed us to stay competitive and even turn potential setbacks into growth opportunities. Investing in molecular diagnostics, even when our workload was insufficient, during the H1N1 epidemic, allowed us to become the first lab (with 3 others) to be approved for Covid testing in India in March 2020.?

5. Leveraging Technology: The Game Changer for Scaling

Twenty years ago, the idea of speaking over a screen or having a virtual chat with someone across the globe seemed unthinkable. Today, technology has revolutionized the way we communicate and work—whether it's AI-powered notetakers, video calls that bridge geographical distances or data-driven insights at our fingertips.?

I have always been an advocate of technology. While we started by recording data manually, we eventually moved to paperless and completely digital registration, adopting barcoding of samples and online reporting along the way.?

As mentioned in the previous point, to build world-class labs, we needed world-class diagnostic equipment and that was made possible by purchasing from several global equipment manufacturers such as Roche, Siemens, Sysmex, etc.?

For entrepreneurs, leveraging technology isn’t just an option; it’s essential to stay competitive. Instead of merely increasing manpower to solve problems, I believe in throwing technology at those challenges.?

By integrating tech solutions into our operations, we’ve been able to streamline processes, enhance customer experiences, and scale efficiently. This allowed us to improve access for our customers, improve efficiency for our teammates with increasing workloads, while continually improving the accuracy of our output.?

Technology not only solves problems but also empowers us to innovate and adapt in real-time. In today’s market, entrepreneurs must harness the power of technology to amplify their stake and drive sustainable growth.

6. The Power of a Peer Group: Learning and Evolving Together

Scaling an organization can sometimes feel like navigating uncharted waters.?

Having a peer group—fellow entrepreneurs and industry leaders—was invaluable.?

The ‘ASCENT’ peer group provided a space to discuss challenges, brainstorm solutions, and, most importantly, learn from one another’s experiences. It has been 10 years since I have been part of the peer group and even till date each of us serve as a sounding board, listening ear, and a perception builder among us.?

It’s an underrated but powerful tool for personal and organizational growth. Every leader should leverage the value of community and peer learning.?

7. Building an Advisory Team: External Wisdom

As we grew, I realized the importance of surrounding myself with mentors and advisors.?

An advisory team brings in a wealth of experience from diverse sectors and helps you see things from a different perspective. They add value to our experience and complement our weaknesses, ensuring we do not lose focus on key objectives.?

Their guidance was instrumental in helping us navigate complex decisions, from expansion strategies to risk management to people practices to governance and compliances; there are many areas to take benefit from.?

Run the organization with the same level of diligence and transparency as a well run business, preferably a public company. Bring smart individuals on board who could be independent directors or advisors to the board and can complement the missing competencies at the top level - legal, HR, marketing, finance, etc.

Having experienced external voices also provides the objectivity needed to make well-informed decisions.

8. Exploring All Options of Raising Capital

Having had my experience of raising capital, I wanted to share a snippet of my learnings, which hopefully can benefit the startup ecosystem.?

Scaling requires capital, and at Suburban Diagnostics, we explored multiple avenues for this.?

In the initial stages, we bootstrapped the business, reinvesting our profits to fuel expansion. Initially it was loans from family, who believed in our vision, and later turned to banks for more structured financing.?

I believe every entrepreneur must take into consideration the pros and cons of raising capital. Just because we have access to funding doesn’t mean we need it.?

We did not rely on any equity funding till we reached a certain profitable stage.?

Every stage of raising capital came with its own set of challenges and learning, but each option helped us sustain our growth without compromising on our goals.

Here are a few things you must keep in mind before raising capital -?

i. ?Evaluate all forms of capital before raising equity - Debt and structured finance options must be considered before opting for private equity right away. Not many founders understand that PE is the most expensive form of raising capital.

ii. Dilute as little as late as possible - If other options of capital raise have been eliminated and equity is the only option, raise as little as possible and dilute as little as necessary. Retaining a larger amount of equity gives you more leverage and options.?

Over multiple rounds of capital raises, I gave up nearly 40% equity to a sole investor. When it came time to offer them an exit, prospective financial or strategic investors demanded over 50% ownership and control of operations. This left me with no choice but to accept a full sale, as I wasn't willing to operate in a minority, non-controlling position.?

iii. Use the capital wisely - It is important for businesses that have been run frugally, and attract investors, to not get carried away with the sudden and fresh influx of capital.?

iv. Profit & Loss - Never lose sight of profitability. Investors often push for early growth at the cost of profits, but in the end, all companies are valued on profitability (EBITDA, PAT) and free cash flow. Balance growth with maintaining a healthy bottom line, even when top-line focus dominates.?

v. Annual Operating Plan (AOP) - A well-prepared monthly MIS sets the tone for performance transparency. As has been said, “what gets measured gets done!” This dovetails into building an annual operating plan (AOP) that gives the guidelines for what needs to get done in the year ahead - targets, bottom line improvements, improving efficiency & productivity, building accountability within the team.?

vi. Building value or valuation - Some companies focus on driving valuation to monetize, while others build value in their product or service, with valuation as a by-product. Ensure alignment with your investor's approach to avoid surprises, enabling smoother exit opportunities and avoiding decisions that contradict the founder’s vision.?

vii. Exit for investors - Most investors aim to exit within 5 to 10 years, either through an IPO, a fund buying shares, or a strategic investor acquiring the company. Recently, secondary market exits have emerged, where shares are sold without new capital infusion, often at a discount. Founders must understand exit options before bringing in investors.

Building a Scalable Playbook

Finally, one of the most important lessons I learned was the value of having a scalable model—a playbook.?

A well-defined operational framework allowed us to replicate the same success formula across multiple locations. By standardizing our processes, setting clear KPIs, and training our team thoroughly, we ensured that every new branch of Suburban Diagnostics adhered to the same high standards that defined us from the beginning.

Scaling an organization is not just about growth in numbers, but in maintaining the quality and integrity of your service. For me, it’s been about blending vision with discipline, agility with structure, and innovation with consistency. With the right team, strong financial governance, and a replicable model, scaling becomes less daunting and more rewarding.