Peter Gicharu
Back to blog
•
3 min read
What I've Learned Leading a Small but Effective Engineering Team in Healthtech

I have been leading TIBU Health’s engineering team for nearly four years. We are small-under 10 engineers-but we have built and scaled a platform serving 60,000+ patients. Here is what I have learned about making small teams punch above their weight.

Hire for Breadth First, Depth Second

In a small team, narrow specialists are a bottleneck waiting to happen. Every engineer on our team needs to be reasonably comfortable across the stack:

  • Backend: APIs, databases, business logic.
  • Frontend: Web or mobile UI.
  • DevOps: Deployment, monitoring, infrastructure.

We hire T-shaped engineers: broad generalists with one deep specialty. This reduces bottlenecks when someone is away and makes code reviews more meaningful.

Define Clear Ownership without Silos

Silos kill small teams. We assign a Primary owner (responsible for design and maintenance) and a Secondary owner (familiar enough to cover and review PRs). Critical systems always have at least two people who deeply understand them.

Bias toward Action over Process

Over-process kills momentum. We optimize for speed:

  • 1-week cycles: No multi-week sprints; daily standups only.
  • Ship fast, iterate faster: An MVP in production beats perfect code in staging.
  • Minimal meetings: Weekly planning (1hr), daily sync (15min), monthly retro (1hr).

Cultivate both Pioneers and Gardeners

Sustainable velocity requires a mix:

  • Pioneers: Prototype new features and prove concepts.
  • Gardeners: Optimise performance, fix bugs, and improve reliability.

Invest in Foundational Tools Early

We automated early to save time:

  • CI/CD pipelines: Every merge to main deploys to staging automatically.
  • Monitoring: New Relic and Sentry catch errors before users do.
  • Automated Migrations: No manual SQL changes.

Protect Focus Time Ruthlessly

Context switching is productivity poison. We enforce:

  • No meetings Tue/Thu mornings: Core coding time with Slack on DND.
  • Async-first communication: Default to Slack threads, not calls.
  • On-call rotation: One engineer handles production issues; everyone else focuses on building.

Build Trust through Transparency

Trust lets small teams move faster without layers of approval. We share everything:

  • Weekly updates: What we shipped and the challenges faced.
  • Blameless postmortems: Focused on system improvements.
  • Salary transparency: Everyone knows the compensation formula.

Know when to Say No

We ruthlessly prioritize based on three questions:

  1. Will this directly improve patient care or clinic operations?
  2. Can we ship a simple version in 1-2 weeks?
  3. Is this a “must have”?

If it’s a “nice to have,” it stays on the backlog. We are not trying to be a 50-person team; we are trying to be the most effective 8-person team possible.