By Michael Zagami, health tech product leader
“The greatest trick the devil ever pulled was convincing the world he didn’t exist.”
— Verbal Kint, The Usual Suspects
Everyone knows technical debt. It’s the annoying pest that comes with moving fast, making tradeoffs, and being agile. It doesn’t challenge leadership judgment. Engineering can own it, and roadmaps can hide it. With enough capital and time, it can be reversed completely. It’s a feature of growth, not a bug.
“Organizational debt” is different.
It is the devil nobody thinks they have. Worse, it’s the one many companies actively welcome. It arrives disguised as good judgment, customer obsession, and strategic flexibility. It passes every sniff test. It gets applauded in exec meetings. It is the wolf in sheep’s clothing quietly wandering through Sales, Ops, Product, Finance, and Compliance. It’s everywhere.
Organizational debt accumulates when decisions that were perfectly reasonable – and often celebrated – in one environment continue to be funded in another. A customer exception that was never sunset. A contract that nudged the product slightly off-axis. A partner deal that felt strategic. Of course, we support that client. Of course, we take that revenue. Of course, we explore that opportunity.
Individually, these aren’t bad decisions. But collectively, they quietly redefine what the organization must sustain.
There is no metric that cleanly accounts for this debt, so it is hidden from quarterly business reviews and executive sessions. It can also hide behind virtue, making the leaders reluctant to speak up to question it.
And yet we feel it.
Every capability, workflow, exception, and promise requires something: capital, attention, risk tolerance, organizational energy, etc. This dedication of resources may seem fine, even normal, in the early days. But over time, things begin to feel different, a bit more stressful. Defining the cause of increasing tension may be elusive, but the tension is there. And, at scale, everything competes for resources, so it gets worse.
Unlike nature, with its natural selection, organizations are not adept at letting non-essential traits die. Instead, they keep feeding them, indefinitely. This is the insidious part. It’s accumulation without selection. Eventually, success becomes less about execution and more about whether the company can survive the complexity it has created.
Which brings us to the Product leader.
While most companies spend a lot of time articulating their vision, it’s rare to see a company commit to what it won’t do…or won’t do any longer.
And yet, for the confident Product leader, this becomes an opportunity to raise awareness about this growing burden. To see not only what’s being built, but what’s being sustained. To call out not only what works, but what must be continuously fed.
More than just identifying these dynamics, a Product leader must frame a plan to fix this. That means making invisible costs visible. It may mean forcing explicit expirations: sunset clauses, reevaluation points, kill criteria, etc. These decisions must not be delayed.
And though they are perhaps the least glamorous decisions to make, they are foundational requirements for scale.
The Product leader needs to reframe the conversation, moving away from consensus and alignment and toward fitness. Does this decision make the organization stronger in the environment it is moving into, or does it simply preserve momentum from the last one?
Product leaders don’t just warn; they propose subtraction. Those who know me best will recognize this quote, “a decision to do something is a decision to not do something else.” Just as capital is not infinite, neither are time, attention, and motivation, and they can all be squandered by organizational debt.
So, what gets defunded? What gets retired? What clarity emerges on the other side of these critical decisions?
I’ve seen this done well. A while ago, I watched a Series A company walk away from a partnership with a billion-dollar organization. The deal would have exposed the product to millions of consumers almost overnight. On paper, it was a dream. After months of diligence, the smaller company said no. Not because the opportunity wasn’t real, but because the organizational debt would have been too much to bear. Whole departments would have had to contort around a scale the company wasn’t built to absorb.
I like to think this team chose survival over immediate growth. After about six years, that company is now in Series C. Not explosive growth, but perhaps a more scalable path forward.
Organizational debt doesn’t announce itself. It passes every review. It feels responsible. It sounds strategic. And it will quietly eat the company alive if no one is willing to say, “We don’t need to feed this anymore.”
Product leaders – you can root out this devil. Don’t wait for another leader to take this on. Just don’t expect your pursuit to be greeted with open arms. Scaling hurts. But remember that it’s temporary pain that fades as old systems, processes, and features (limbs) die off so that the best version of your organization can thrive.
About the Author
Michael Zagami is a health tech product leader with 18 years of experience at the intersection of member engagement, population health, and care delivery. He has held VP and CPO-level roles at companies including Eliza Corporation, HMS Holdings, and NuvoAir, where he served as CPO and founding member of the US clinical service. Michael is known for his ability to connect clinical insight with commercial strategy — translating the real frustrations patients face navigating the healthcare system into products that actually change behavior and improve outcomes. He believes the industry is at an inflection point where AI, transparency mandates, and shifting consumer expectations are finally making true personalization in patient engagement possible.
