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The Growth Signal Audit · From Design to Dollar Figure

A structured diagnostic for healthcare organizations where patients and clients are leaving between first contact and committed care.

A structured diagnostic for design organizations that can't yet translate their work into the revenue outcomes executives act on.

Your design team is doing real work that the executive team isn't reading as strategic value.

The mandate is there. The people are in place. The architecture connecting design decisions to business outcomes is missing. That gap is costing your organization revenue, patient retention,client acquisition, conversion, and the seat design deserves at the table.

Book a 30-Min Call See what the Audit covers
200+ Healthcare Practices Researched Organizations Researched
20 Years Product and Systems Design Experience
6 Proprietary AI Agents Built
1 U.S. Utility Patent at T-Mobile
The Moment Design Is In

Design is being asked to prove it drives growth.

Most teams struggle with that question. Not because the work isn't good because the connection between design decisions and business outcomes hasn't been integrated or supported at the executive level. Design keeps getting relegated to UI production, which is now being cannibalized by AI.

The design organizations in healthcare that want to survive and thrive need to pivot to design as strategy and risk mitigation, and that means confronting the disruption AI is introducing to the equation.

The design organizations that want to survive and thrive need to pivot to design as strategy and business growth driver, and that means confronting both the AI disruption and the internal credibility gap head-on.

"The system that connects design work to growth outcomes is MIA due to ownership fragmentation."

Deliverables are not outcomes
Teams ship features while acquisition, conversion, and retention stay broken. The work is real. The revenue connection was never built.
AI mandates with no integration system
Executives want AI-integrated workflows yesterday. Design organizations are scrambling to figure out where and how AI and design actually connect, or what that even means at the systems level.
Strategic role, tactical measurement
Design leaders are being asked to think at the business layer but measured on output speed. The gap between the business mandate and the structure is widening at record speed.
Revenue quietly leaves before anyone notices
In healthcare, patients and clients engage and don't convert because the qualification layer is manual or missing. The drop-off is visible in hindsight. The system to prevent it hasn't been built.
Revenue quietly leaves before anyone notices
Qualified leads engage with your clients and don't convert because the qualification layer is manual or missing. The drop-off is visible in hindsight. The system to prevent it hasn't been built, and design is perfectly positioned to build it.
The Growth Signal Audit

Clarity before
commitment.

This is a structured diagnostic engagement. I map exactly where your organization's design-to-growth architecture is broken and quantify what it costs you annually to leave it that way.

The Audit is not a generic consulting pitch. It's a standalone deliverable with a specific output: a clear picture of the design-to-business gap, what it's costing the business, and the strategic roadmap that defines what to address first. The implementation is not included, that belongs to your team, or to a separate engagement if needed.

The methodology behind the Audit is the same thinking that translated design decisions into eight-figure outcomes at T-Mobile.

In January 2026, I began researching patient acquisition in healthcare. Since then, I've researched 200+ healthcare organizations. I know what broken looks like, what it costs, and what fixes it. This Audit tells you what's broken, what it's costing you, and the steps to take to fix it.

01
Structured Intake Review
Your team submits existing documentation, patient journey maps, acquisition data, technology stack, and the AI tools currently deployed. They are reviewed through a revenue architecture and growth system lens. No PHI is collected. No generic questionnaires. All findings are covered under a mutual NDA executed at engagement start.
Your team submits existing documentation, customer journey maps, acquisition and conversion data, technology stack, and the AI tools currently deployed. They are reviewed through a revenue architecture and growth system lens. No generic questionnaires. All findings are covered under a mutual NDA executed at engagement start.
02
Design Team Survey
Every member of your design team completes a structured anonymous survey before interviews begin. It covers their perception of design's strategic role in the organization, the gap between their mandate and their actual access to business decisions, where they see patientclient acquisition and conversion breaking down, and how AI currently fits, or doesn't, into their workflow. The survey ensures the people doing the work have a direct voice in the diagnosis, not just leadership's account of what's happening.
03
Cross-Functional Interviews
Three to five structured 45-minute sessions with designated stakeholders: design or patient experience leadership, frontline patient coordination staff, marketing leadership, operations or revenue cycle leadership, and one C-suite sponsor.
Three to five structured 45-minute sessions with designated stakeholders: design or product leadership, marketing and sales leadership, revenue operations, and one C-suite sponsor. Structured to surface the gap between what design is building and what the business is trying to grow.
04
Acquisition Architecture Review
I map your client acquisition journey against the survey findings, interview data, and available revenue data, across your acquisition and conversion process, post-appointment conversion gaps, any AI performance and/or integration gaps, and the design team's positioning against the growth mandate.
I map your client acquisition journey against the survey findings, interview data, and available revenue data, across your acquisition and conversion process, post-qualification drop-off, AI integration gaps, and the design team's structural access to the growth mandate.
05
Diagnostic Report
A 15–20 page written report: key findings drawn from the survey, interviews, and architecture review, quantified revenue recovery opportunity, prioritized gap analysis, and a 90-day growth architecture roadmap. The roadmap defines what to address first and in what sequence. The implementation is yours to execute, whether through your internal team or a separate engagement.
06
Executive Readout
A 90-minute working session with your design leadership and one C-suite sponsor. We walk through every finding and the architecture roadmap together. This is where the work becomes organizational momentum.
⌀
Timeline
60 days from engagement start to executive readout, contingent on interviews scheduled within the first 30 days. Client-caused delays extend the timeline accordingly.
What You Receive

Two deliverables.
One clear path forward.

The Audit produces two concrete outputs your organization can act on not observations alone, not a list of generic recommendations. A written diagnostic and a working session designed to turn findings into organizational momentum.

Deliverable 01
Diagnostic Report
15–20 pages · Delivered in writing · Yours to keep
  • Key findings across every assessed area of your patientclient acquisition and conversion architecture, grounded in the design team survey, cross-functional interviews, and architecture review
  • Quantified revenue recovery opportunity: what the gaps are costing you annually, in specific dollar terms
  • Prioritized gap analysis identifying the highest-impact structural disconnects in your organization
  • 90-day growth architecture roadmap: strategic priorities in sequence, what to address first and why. The how is for your team or a separate engagement.
Deliverable 02
Executive Readout
90 minutes · Remote · Design leadership + C-suite sponsor
  • Live walkthrough of every finding in the Diagnostic Report with your leadership team present
  • Architecture roadmap discussion: sequencing, ownership, plus what needs to move first and why
  • One C-suite sponsor is required to ensure the findings carry organizational weight beyond the design team
  • A working session that turns a diagnosis into a decision
What the Audit Produces

Four possible outcomes.
All of them useful.

The Audit doesn't produce a recommendation to act. It produces a finding grounded in what the data shows. That finding takes one of four forms, and every one of them gives the organization something concrete to act on.

01
Outcome
The opportunity is real. The conditions exist. Pursue it.
The gaps are quantified, the cost to close them is justified by the return, and the team has or can develop the capability to execute the 90-day roadmap.
The finding: here is the opportunity, here is what it costs to test, here is what you will learn in 90 days.
02
Outcome
The opportunity is real. The conditions don't exist yet.
The gap is worth closing but the prerequisite conditions — whether budget, team capacity, executive alignment, or technical infrastructure — aren't in place yet.
The finding: here is the opportunity, here is what is blocking it, here is the order of operations to get to a position where the 90-day test makes sense.
03
Outcome
The opportunity exists but the cost-to-fix outweighs the cost-to-wait.
The math doesn't support the investment right now given current constraints.
The finding: here is the opportunity, here is why the timing is wrong, here is what would need to be true for the calculus to change.
04
Outcome
The perceived problem isn't where the actual gap is.
The Head of Design and their team have been focused on one set of gaps but the audit reveals the real cost is coming from somewhere else entirely.
The finding redirects attention and investment toward the higher-leverage problem.
Why Not a Consultant

This is an audit.
Not an open-ended consulting engagement.

Healthcare organizations have hired consultants. They've sat through the discovery sessions, received the slide decks, and watched the recommendations get shelved. The Audit is structurally different, not because the work is better, but because the scope, the starting point, and the output are designed to avoid the failure modes that make consulting expensive and inconclusive.

Design organizations have hired consultants. They've sat through the discovery sessions, received the slide decks, and watched the recommendations get shelved. The Audit is structurally different, not because the work is better, but because the scope, the starting point, and the output are designed to avoid the failure modes that make consulting expensive and inconclusive.

The Growth Signal Audit
Traditional Consulting
Scope
Fixed. One deliverable. One timeline. No scope creep.
Open-ended. Expands with every new finding. Rarely ends when you planned.
Starting Point
Robust intake process to define the top problem and gaps related to patient acquisition, plus design's role in solving the problem. Robust intake process to define the top problem and gaps related to client acquisition and design's structural role in solving it. No frameworks applied before the evidence is in.
General frameworks applied to your organization. The learning curve is billed to you.
Output
A 15–20 page written diagnostic sourced from the design team survey, cross-functional interviews, and architecture review, with quantified revenue opportunity and a 90-day action roadmap. Yours to keep and execute.
A presentation deck. Often too high-level to act on without the consultant still in the room.
Timeline
60 days, contingent on interviews scheduled within the first 30 days.
3 to 6 months minimum. Often longer once stakeholder alignment phases begin.
Independence
No skin in the political game. The findings reflect what the data shows, not what leadership wants to hear.
Often embedded long enough to become politically captured. Findings drift toward consensus.
Evidence
Every gap is expressed as a revenue figure derived from your data and validated against industry research.
Recommendations often based on limited intake and pattern-matching to other clients.
Next Step
The Audit stands alone. Organizations with internal design teams implement the roadmap themselves. Practices without a design or tech team can explore a separate implementation engagement, only if the working relationship warrants it.
Discovery is typically phase one of a larger engagement sold before the findings are known.
What the Audit Surfaces

Four things most organizations
don't know they're missing.

The Audit doesn't produce observations. It produces a diagnosis specific, quantified, and sequenced so your team knows exactly what to do with it on day one. These are the four areas every engagement covers.

01
Acquisition Architecture
Where qualified clients are leaving before they ever reach you
Most healthcare organizations optimize the top of the funnel while the qualification layer stays manual and broken. We map the full patient decision journey and find where right-fit patients drop out before booking.
Most organizations optimize the top of the funnel while the qualification layer stays manual and broken. We map the full client decision journey and find where right-fit prospects drop out before engaging.
02
Conversion & Recovery
The revenue sitting in consulted-but-didn't-book clients
In healthcare organizations, post-appointment drop-off represents significant recoverable annual revenue. We identify the gap, estimate the cost, and design the recovery architecture.
Post-qualification drop-off represents significant recoverable revenue in most design-led organizations. We identify where engaged prospects stop converting, estimate what it costs annually, and design the recovery architecture.
03
AI Integration Gaps
Where AI could work at the client acquisition system layer, and where it currently isn't
Not a tool audit. A systems-level diagnostic of where AI integration would produce measurable business outcomes in patient communication, operational efficiency, and design team capacity.
Not a tool audit. A systems-level diagnostic of where AI integration would produce measurable business outcomes in client communication, lead qualification, and design team capacity.
04
Design Team Positioning
Assess whether design has the structural access to drive the outcomes being asked of it
The mandate to prove business value requires structural access to business data, decision-making processes, and leadership alignment. We survey and assess the gap between the ask and the current system architecture the design team is working in.
For Design Leaders

Why a Head of Design brings in someone
who's been inside it.

You already know what good design looks like. You likely already know something in the system is broken. What you don't have is a diagnosis from someone who spent 20 years watching this gap operate across verticals and is now outside it.

That's the specific position this engagement requires. Not just a third party. Someone who knows the organizational dynamics from the inside, knows why the gap persists, and can speak to leadership in the language it takes to move the needle.

"I've sat in the rooms where design gets relegated to output instead of strategy. Twenty years of that gives me the credibility to name what's broken and the distance to say what leadership needs to hear."

What This Engagement Actually Is

Shanelle isn't coming in to run the acquisition program. She's coming in as a researcher and systems thinker who has worked inside these environments, who understands the internal politics the Head of Design is navigating, and who can produce an externally credible diagnosis that gives the design team the evidence and the roadmap they need to build political capital, strengthen working relationships, and win the argument they've been right about all along.

The audit is the unlock. The team is the execution.

"The Growth Signal Audit diagnoses where a company's client acquisition system is leaking revenue and filtering poorly qualified leads, quantifies what those gaps are costing the business, and delivers a 90-day test-and-learn roadmap the internal design team can execute against to start closing those gaps."

What Shanelle is not doing

  • Building the qualification system
  • Redesigning the acquisition experience
  • Running the 90-day experiment
  • Managing the team's execution

What Shanelle is doing

  • Arriving as a researcher and systems thinker with cross-industry experience in the environments these Heads of Design are navigating
  • Conducting a structured diagnostic against the acquisition system
  • Translating the findings into revenue terms the executive team will engage with
  • Handing the team a roadmap scoped small enough to test, learn from, and iterate on without requiring organizational transformation upfront
01
A third-party perspective rooted in the same discipline
It's hard to diagnose your own system from inside it. I know because I too have lived it when working in enterprise design orgs. This audit brings a human-centered approach to your organization's growth architecture without the blind spots that come from proximity or politics.
02
Findings that carry weight because they aren't internal
This audit gives you something internal advocacy never can. Evidence that doesn't require political capital to land, presented in a format that moves from "we think design matters" to "here's what it's costing us."
03
Designed at the systems level, not the feature level
Most audits map individual touchpoints. This one maps the architecture connecting your design work to business outcomes, patient acquisition, conversion, AI integration, and strategic positioning. The diagnosis shows where the system is broken, not just where the experience needs polish. That's the conversation that earns design a seat at the table.
Most audits map individual touchpoints. This one maps the architecture connecting your design work to business outcomes, client acquisition, conversion, AI integration, and the internal credibility gap. The diagnosis shows where the system is broken, not just where the experience needs polish. That's the conversation that earns design a seat at the table.
04
A quantified diagnosis, not an educated guess
Design leaders frequently know something is wrong but can't put a number on it. This audit closes that gap. Specific revenue opportunity, prioritized by impact, documented in a format your CFO can read. Evidence replaces intuition, and that's the shift that moves the organization from debating whether design matters to deciding what to do about it.
Shanelle Roberts, researcher and systems designer
Why This Works

Twenty years inside the problem.
Now outside it.

I spent 20 years in design and tech watching the same gap show up across every vertical I worked in. Design teams doing real work with no architecture connecting it to business outcomes. I lived it from the inside long enough to understand exactly how it happens and why it's so hard to fix from within. Now that I'm outside of it, I can see the system clearly, diagnose it without political constraint, and advocate for the change that organizations can't drive for themselves. The credentials below are the foundation the Audit methodology is built on.

Track Record · Acquisition Architecture
MVP device activation experience for iPad at T-Mobile
Designed the end-to-end activation experience that made the iPad sellable across two distinct customer segments. The work required mapping a new device category to an existing infrastructure that wasn't built for it, then designing the experience that removed the friction blocking purchase.
Generated millions of dollars in annual revenue across two customer segments.
Track Record · Conversion and Cost Recovery
First iOS app for Scam Shield at T-Mobile
Designed the first self-service iOS application for Scam Shield, giving customers the ability to manage a paid product independently. The experience shifted customer behavior from high-cost support calls to in-app self-service, recovering cost at scale without reducing the customer relationship.
Saved $5M+ annually in calls to care.
Track Record · Fraud Prevention and Revenue Protection
First secure digital payment experience at Wilmington Trust
Led the team that built the first digital experience allowing Wilmington Trust to schedule, send, and receive wire and ACH payments in a secure application. Fraud had cost the bank over $60M across three years prior. By securing the payment experience behind authenticated login and building security checkpoints into the payment request flow, the team eliminated fraudster access and significantly reduced incorrect payment entries.
Addressed $60M+ in fraud losses accumulated over three years.
200+ Healthcare Practices Researched
Not surveyed. Research into patient acquisition architecture, conversion patterns, post-appointment drop-off, and digital growth infrastructure across 200+ healthcare organizations in the US. I know what the pattern looks like across healthcare, not just inside one organization.
200+ Organizations Researched
Not surveyed. Research into client acquisition architecture, conversion patterns, post-qualification drop-off, and the gap between design work and business outcomes across 200+ organizations. The pattern is consistent across industries: design teams doing strong work with no revenue bridge to show for it.
20 Years of Product and Systems Design
Two decades of designing products, experiences, and enterprise systems grounded in user research, operational architecture, and business outcomes, across enterprise telecom and institutional fintech, healthcare-adjacent verticals. The work includes a U.S. Utility Patent from T-Mobile.
20 Years Inside. Now Outside.
In 2025, I designed a field research study to observe the full post-appointment experience across multiple healthcare organizations as a prospective client. What I found was consistent: a significant gap between the initial engagement and any structured follow-through. The pattern held across 200+ organizations. But the underlying problem, design with no architecture connecting it to business outcomes, isn't new. I watched it operate for 20 years across enterprise telecom, institutional fintech, and healthcare before I stepped outside of it and built the diagnostic to address it.
I watched this gap operate from the inside for 20 years, at T-Mobile, at Wilmington Trust, across enterprise design organizations at scale. Design teams doing work that mattered with no revenue bridge to show for it. I know what it looks like, why it persists, and what makes it so difficult to fix from within. Being outside of it now is the only position from which you can actually diagnose it clearly: without political capture, without proximity bias, without the organizational gravity that keeps the gap in place.
AI in the Strategy Layer
From December 2025 to May 2026, I used AI to research, synthesize, and stress-test a full diagnostic framework for healthcare client acquisition gaps, producing hundreds of pages of structured analysis, service architecture, and go-to-market strategy with AI as a strategic thinking partner. This is what AI integration at the systems level can look like.
IP Not Opinion
The Audit delivers a proprietary diagnostic framework that are grounded in human-centered design principles and methods, research, and systems thinking.
Fixed Scope. Real Clarity.
This isn't discovery for a larger engagement. The Audit is the engagement. Fixed scope, fixed timeline, specific output. Organizations with design and marketing teams take the findings and roadmap and implement internally. Practices without a dedicated design or tech team can explore a separate implementation engagement if the working relationship makes sense.
Right Fit

This engagement is selective.

I work with 2 organizations each month to ensure the quality. The Audit works best when the conditions are right, and I'll tell you honestly in the 30-minute call if they aren't. If timing doesn't align, I maintain a short waitlist.

I work with 2 organizations each quarter to ensure the quality. The Audit works best when the conditions are right, and I'll tell you honestly in the 30-minute call if they aren't. If timing doesn't align, I maintain a short waitlist.

Not the right fit if:
  1. Your organization wants another vendor or tool to solve your growth problems, not a strategic partner.
  2. You're looking for validation of a decision already made.
  3. You're not yet ready to connect design to a business outcome you can measure.
  4. Your organization is focused on replacing humans with AI rather than using AI to make the humans in the room significantly better at their work.
Audit Prerequisites

The Audit requires existing infrastructure to diagnose against.

Specifically, two things need to exist before the engagement begins. Without them, there is no acquisition system to audit — only inputs waiting to be organized into one. That's a different engagement with a different timeline and a different cost structure.

1
A mapped customer or client journey for the acquisition process, at least at a working level. Not necessarily perfect or recent. But something documented that reflects how the organization currently understands the path from first contact to closed client.
2
At least one documented persona the Head of Design can share. Not necessarily sophisticated segmentation. But at least one documented characterization of who the organization is trying to acquire.

The Head of Design who has a mapped journey and at least one persona is operating at a fundamentally different level of organizational maturity. They've already done the foundational work. That's the buyer this audit is built for. If either prerequisite is missing, the honest answer is: what you need comes before what this audit does.

  • You lead design at a healthcare organization and you're being asked to prove design's value to business leadership, without a clear framework for how to do that.
    You lead design at a company with 200–5,000 employees and $25M+ ARR and you're being asked to prove design's value to business leadership, without a clear framework for how to do that.
  • Your organization has an AI mandate and hasn't figured out the right framework for where design actually connects to it at the systems level, not as a productivity tool, as a strategy.
  • You know patients or customers are leaving between first contact and committed care, and no one has diagnosed why at the system level.
    You know qualified leads or clients are dropping off somewhere in the funnel, and no one has diagnosed why at the system level.
  • You want clarity before commitment, a specific diagnosis of what's broken and what it costs, before any implementation decision is made.
  • You have C-suite access, or can create it. The Audit requires one executive sponsor in the readout for the findings to have organizational traction.
Stay in Touch

Not ready yet? Stay close.

I share research findings, pattern observations from the field, and thinking on patient acquisition, design strategy, and AI in healthcare. No pitch cadence. Just work worth reading.

I share research findings, pattern observations from the field, and thinking on design strategy, client acquisition architecture, and AI integration. No pitch cadence. Just work worth reading.

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The Conversation

It's not just about what I can do.
It's about what you're trying to solve.

The 30-minute call is a diagnostic conversation, not a pitch. We talk about what your organization is navigating, whether this engagement is the right fit, and what you'd walk away with. If it's not the right fit, I'll tell you that too.

Engagements begin at $35,000, scoped to organization size. The 30-minute call determines fit before any commitment is made.

Book a 30-Min Call No obligation · No sales deck · Just the right conversation