You Can't Automate People

Everybody loves the roll-up story from the deck: raise the fund, buy the clinics, march toward scale. Almost nobody talks to the person who has to actually merge the people — the handbooks, the benefits, the job titles, the twelve different definitions of “full-time.”

Katy Zorich is that person. She is VP of People Operations at Zarminali Pediatrics, a venture-backed pediatric platform that has raised over $100 million and completed roughly a dozen acquisitions in about two years. She and two teammates, plus a Chief People Officer and two recruiters, support more than 800 employees spread from rural Tennessee to downtown Las Vegas.

Her path there is not the usual one. She left a neuroscience PhD program after realizing she did not want to spend a career writing grants, took a job at a University of Pittsburgh research center sitting across the table from people going through cognitive testing, and learned to build a room where someone will tell you the truth. That turns out to be the whole job.

“I learned very quickly how to create safe spaces so that people could show up as their full selves — and that is a skill set that has carried through every single job experience I’ve had since then.”

Twelve acquisitions, twelve open enrollments

Most HR leaders run open enrollment once a year. Katy has effectively run it once per deal. The thing that makes that survivable is not stamina, it is sequencing.

Every acquisition starts with a transition of services agreement — a TSA — that deliberately staggers what changes and when. New employees are not handed a new handbook, a new benefits plan, a new payroll system, and a new EHR on the same Monday. Full integration runs anywhere from a couple of months to closer to a year depending on the group.

The other lever is diligence. Her broker team runs a benefits analysis before the deal closes, comparing the group’s existing plan against what Zarminali offers, so the very first conversation with employees uses actual dollars rather than reassurance.

“Whether that’s for the best, or there’s a little bit of change management we have to do right out of that first conversation, we are at least going into it prepared with actual dollars.”

The first thing to standardize is a definition, not a system

Asked what she would put at the top of the standardization list, Katy did not name a platform. She named a phrase: full-time equivalency.

Every group they acquired had been thinking about it slightly differently. Some counted patient-facing hours; others counted patient-facing hours plus admin time. Some clinicians worked four ten-hour shifts but were clocked for eight and a half or nine. Is that a 36-hour week or a 40-hour week? Had someone been working 30 hours and calling it full-time?

None of that is academic. Benefit eligibility, paid leave eligibility, PTO accrual rates, and holiday pay all hang off that one definition — which is why the questions show up downstream as “why wasn’t I paid for this holiday?” weeks after close.

“We need to level set on full-time equivalency — really start at the basics — in order to adequately support and iron out a lot of those wrinkles.”

Moving a practice onto athenaOne without breaking it

Systems come later, and the EHR is the loudest change of all. Katy is blunt about the amount of unglamorous work that sits underneath a migration to athenaOne: mapping the data over, confirming the configuration is right, and understanding how the clinic actually operates before go-live.

The bar she sets is not “launch on schedule.” It is: do not break the thing you came to improve.

“It takes a lot of legwork just to map over to Athena and make sure things are set up correctly — that we’re not breaking things when we’re introducing a process that’s supposed to improve things at the clinic.”

Rural Tennessee is not downtown Vegas

A national platform still runs local clinics, and Katy’s answer to holding both is a principle rather than a policy: aim to do no harm through the transition. Your role is not changing overnight. Your compensation is not changing overnight. Each acquisition gets its own compensation analysis, and to date they have not used the transition as a moment to reset pay.

What employees get instead is legibility — what is happening, when, why, and what they need to do about it. That is a lower-drama promise than “day-one alignment,” and it is the one that keeps a practice’s staff intact through the handoff.

Why this matters if you are automating anything

There is a line in the middle of the conversation that is really about software, even though nobody was talking about software.

The easier a process is to automate, the more standard it already was. When a group arrives with one intake workflow, one definition of a full-time clinician, and one way of handling after-hours calls, automation is a build. When it arrives with twelve variants, automation is twelve builds — and every one of them is a place for something to drift.

That is the case for doing the boring work Katy describes: the standardization that looks like HR hygiene is what makes the rest of the roll-up automatable at all. The machinery gets templatized so a team of three can carry 800 people. The part in the middle — the conversation where someone finds out what is happening to their job — is the part you do not hand off.

You can’t automate people. You can stop making them absorb twelve versions of everything.