When an organisation begins to grow, commercialise, enter a new market or strengthen its leadership team, several appointments can appear necessary at the same time. The organisation may need stronger governance, an executive leader, commercial capability, operational discipline and specialist expertise. The difficulty is rarely identifying roles that would add value. The difficulty is determining which appointment should come first.
This is often treated as an organisational design question. What should the leadership team look like? Which functions should report to the CEO? Which titles are used by comparable companies? Those questions have a place, but they can encourage an organisation to design the full structure before understanding the immediate constraint.
Organisations do not usually need every part of the future team at once. They need the capability that will most improve their ability to make the next important decision, reach the next milestone or remove the issue holding everything else back.
That creates a more useful way to think about sequencing. Rather than asking which role is most senior or most commonly appointed by similar companies, consider which appointment will unlock the next stage and which appointments will remain constrained until that capability exists.
A growing life sciences company may believe a senior commercial appointment should come first because commercialisation is approaching. That may be correct if the organisation has a credible product pathway, understands the target market and needs someone to establish the commercial model and build the team.
The answer may be different if the regulatory pathway remains uncertain, the market access case requires more work or the product proposition is still changing. In that setting, the commercial leader may spend much of the first year waiting for other decisions, revisiting assumptions or trying to create certainty in areas outside their remit. Commercial capability is still needed, but it may not be the capability that should be built first.
An experienced regulatory, medical or market access leader may do more to advance the organisation at that point because their work clarifies the conditions under which commercial activity can succeed. The commercial appointment can then follow with a clearer mandate, better information and a more realistic view of the market.
This is not an argument for always appointing technical or specialist capability before commercial leadership. It is an argument for understanding dependency. If one appointment cannot make meaningful progress without the work of another function, the dependency should influence the sequence.
The same framework applies to governance and executive leadership. A Board preparing to appoint a CEO may discover that it does not yet agree on the organisation’s strategic direction, the authority the incoming leader will carry or the balance between the founder, Board and executive team. Beginning the CEO search at that point may produce candidates, but it will not resolve the disagreement behind the brief.
Strengthening the Board or clarifying the mandate may need to come first. This could involve appointing an experienced Chair, adding relevant Non-Executive Director capability or working through the strategic and governance questions before the CEO search begins. The purpose is not to delay the executive appointment. It is to create the conditions in which that appointment can succeed.
In other organisations, the leadership strategy is clear but execution has become the constraint. The CEO and Board know where the organisation is heading, but responsibilities are spread across people who no longer have the capacity to carry them. Decisions are made, yet implementation is inconsistent. New initiatives begin, but existing leaders are unable to maintain momentum across all of them.
Another strategy role is unlikely to solve that problem. Operational leadership, programme capability or stronger functional ownership may be more valuable. The appointment may sit below the executive team, but its impact on the organisation could be greater than another C-suite hire.
This is why hierarchy is not always a reliable measure of priority. A business-critical specialist can occasionally unlock more progress than a senior executive. A regulatory expert may remove uncertainty around a submission. A quality leader may create the systems required for scale. A clinical operations leader may establish the discipline needed to move a programme forward. A market access specialist may test whether the commercial assumptions supporting the strategy are realistic.
The importance of the appointment is determined by the work it enables, not simply where the role sits in the organisational chart. This reflects Hunton Executive’s organisation-wide approach to Board, executive, functional, management and specialist appointments. [Hunton_Exe…ofile 2026 | Word]
A practical way to test the sequence is to imagine that each proposed appointment has been made successfully. If the commercial leader joined next month, what would they still be waiting for? If the CEO were appointed, which decisions would remain unresolved by the Board? If the regulatory leader joined, which milestone could move sooner? If an operations executive joined, what responsibility would transfer from the existing leadership team and what would that allow others to concentrate on?
These questions move the discussion away from whether a role would be useful. Most proposed appointments will be useful. The real test is whether the organisation is ready to use the capability and whether its introduction changes what becomes possible next.
The answers can be considered through three connected factors. The first is constraint: what is presently slowing the organisation or creating the greatest risk? The second is dependency: which future decisions or appointments rely on this capability being in place? The third is readiness: does the organisation have enough clarity, authority and supporting capability for the person to succeed once appointed?
An appointment can score highly on importance but poorly on readiness. That is often a sign that another decision should come first. The organisation may ultimately need the role, but it may need to clarify the strategy, strengthen governance, complete a critical piece of specialist work or establish reporting lines before approaching the market.
It is also useful to consider what will happen around the person after they join. A Country Head appointed to establish a local operation will eventually need commercial, medical, regulatory, market access and operational capability. The question is not only whether the Country Head should be appointed first. It is whether part of their mandate is to shape the team, whether essential capability needs to arrive alongside them and whether any function must be established before they can operate effectively.
The same applies to a new CEO. The appointment may resolve an immediate leadership need, but it can also expose gaps around the leader. A CEO may require a different executive structure, stronger financial capability or specialist support that did not exist under the previous model. Thinking one appointment ahead helps the organisation understand whether the first hire is genuinely unlocking the future team or simply creating another dependency.
Comparisons with similar organisations can inform this work, but they should not determine it. Two healthcare or life sciences companies may have similar funding, revenue and headcount and still need very different leadership structures. One may be preparing for a regulatory milestone, another may be integrating an acquisition and another may be entering the United States. Their organisational charts may eventually look similar, but the sequence required to reach them will not.
The better decision is therefore not necessarily to appoint the most senior person, the most visible role or the capability that appears most often in comparable organisations. It is to appoint the person whose work changes the conditions around the organisation and creates a better foundation for the decisions that follow.
Begin with the constraint
You may know that several appointments will be required but be less certain about their order, structure or timing. Hunton Executive can help you understand which capability matters now, what should follow and whether permanent, interim or fractional support is the right place to begin.
About Hunton Executive
Executive search, strategic headhunting, and specialist recruitment for healthcare and life sciences organisations. From Board appointments and executive leadership to the specialist capability around them. Permanent, interim and fractional.