Dr Jing Ouyang, founder at Patchwork Health


June 28, 2023

The emotional cost of scaling a startup

While the mental health challenges at startups are well-known, the emotional cost of scaling a team is less understood

Jing Ouyang

4 min read

While the mental health challenges of working within a startup are well documented, the emotional cost of how relationships change across your team as you scale can come as a surprise. 

Since we raised a Series B in August last year, at Patchwork Health — the healthcare workforce platform I cofounded — we’ve seen our wider team structure evolve, and significant people changes have taken place along the way. I’ve also had to adapt to stark changes in my role as cofounder and COO. 

Here’s how I’ve learned to tackle each hurdle, and my advice for other founders on how to do the same when scaling.


Embracing the evolution of your team

Your inaugural startup team is usually small, tight-knit and bonded over a shared mission. Your colleagues might quickly become some of your closest friends, or be like-minded innovators who share a common goal. Either way, you’ll end up with an inimitable camaraderie fuelled by the drive to get your startup off the ground. During this time, you’re working as equals, closely collaborating and mucking in to get the job done. 

When you begin to scale, preserving this same structure is impossible. You need to introduce more clear-cut hierarchies to help you manage a growing team. 

Each team member will need to take on specific roles and responsibilities, and for some, this will mean reporting directly to those they’ve previously worked alongside in a flatter structure. Despite technically reporting to either myself or my cofounder Anas, our early team felt much more like colleagues than employees. But as we began to grow, these relationships had to become more formal. We had to adapt to working and managing the team in a much more structured way, with a closer focus on performance management, appraisals and KPIs — which hadn’t previously been necessary. 

This shift can be difficult to manage, and some people will be more resistant to the change than others. But embracing the evolution is essential to expand your team in line with your company’s growing needs.

Accepting people you love will leave

Growth inevitably means change and as your team evolves, not everyone will stay. As we’ve grown from a team of three in 2016 to more than 100 today, there have been difficult goodbyes with colleagues I’ve struggled to see go. There can be a whole manner of reasons behind this, from shifting personal priorities to the desire to explore new career opportunities. Whatever the reason, it will sting, especially when some people will have been there since day one. 

Over time, I’ve learned to embrace such people changes as a natural part of the process

For me, one of the most difficult goodbyes was to one of our first ever hires. Having been with the team since our launch, as the company scaled they sadly made the decision to leave. It felt like the closing of a chapter. They were such a significant part of the team, and while on a personal level their departure was difficult, I also worried how it might affect the rest of the team. We made this transition as easy as possible by being fully transparent, explaining the reasons behind their departure and marking the significance of such an integral team member moving to pastures new. 

Over time, I’ve learned to embrace such people changes as a natural part of the process. It can be hard to heal, but by acknowledging the bigger picture I’ve been able to rationalise any feelings of hurt or rejection and maintain valuable friendships with those who have left.

Adapting to your own evolving role

Perhaps the most difficult emotional hurdle when you’re scaling your company is how you feel in relation to shifting dynamics and structures. I’ve had to acknowledge and accept the trade-offs that have come with scaling. While welcoming a more formal team structure has brought us more stability — and fewer emotional highs and lows than in the early stages — I’ve felt sad that we’ll never experience the same rollercoaster unique to those initial steps on the startup journey. 

I’ve had to accept this and have grown to understand that, while my title may not have changed, my role as founder has altered to reflect the company’s own evolution. The demands and challenges that land on my plate have shifted in line with the changing priorities for the wider business. This has meant less time spent directly with customers and a greater focus on handling relationships with wider stakeholders, such as board members and potential investors. While these new challenges are exciting, the change can still sometimes feel a little scary.

Reaching out to others who’ve charted a similar path is an invaluable source of support. Speaking to my cofounder Anas and other founders in our network has reminded me that I’m not alone in feeling a sense of loss as certain aspects of the business — and my role — evolve. Sharing this has helped me to accept the inevitability of the changes that accompany each stage of company growth. Being prepared for this, and embracing it, is essential to help maintain the confidence and momentum needed to keep driving your company forward.


Jing Ouyang

Jing Ouyang is cofounder and COO of British healthtech Patchwork Health.