A consultant who spent his early career in public health tends to look at a struggling company the way an epidemiologist looks at a neighborhood full of asthma cases. She does not start by handing out inhalers. She asks what is in the air, what is in the housing stock, what changed in the local environment. Nicholas Mukhtar carried that instinct out of Detroit and into corporate consulting, and it shapes how he diagnoses organizations today.

His central claim is blunt: “The system is the outcome.” A broken company and a broken public health system fail for similar reasons. Upstream decisions, or the absence of them, create downstream dysfunction that compounds over time.

Watch how most companies respond to trouble and the pattern becomes obvious. A department runs over budget, so leadership cuts headcount. Revenue dips, so marketing gets restructured. Someone in the C-suite leaves and the reporting chain gets reshuffled overnight. None of those moves touch the cause. Mukhtar compares it to treating an acute case rather than addressing the exposure that produced it. They’re reflexes, not fixes.

The questions he wants leaders to ask sit further upstream. Was decision-making authority ever documented? Were communication expectations codified before the team scaled, or left to improvisation? Was financial reporting frequent enough to catch a problem before it became a crisis? A 2025 paper in Frontiers in Health Services described systems thinking as a methodology that “enables policymakers to comprehend the interconnections within public health systems and anticipate the potential consequences of policy implementation”. Mukhtar learned the same lesson on the ground, where a plan and its execution rarely match.

His training gave the instinct a formal structure. He earned dual master’s degrees in public policy and public health from Johns Hopkins University by 2017, and he did it as a Bloomberg Fellow while still running Healthy Detroit, the nonprofit he founded. Fellows stay embedded in their organizations during training, so he studied the work while doing it.

What he took away was a habit of tracing a problem to its origin before proposing a fix. At Healthy Detroit, that meant a standardized model for each site, so a struggling location could be tied to a specific breakdown in staffing or scheduling rather than a flawed concept. In a company, it means resisting the urge to react to the visible symptom.

When someone calls to say their business is struggling, Mukhtar does not open by asking what went wrong. He asks how the company was built. What was designed deliberately. What was improvised. What was never discussed at all. That last question, he says, is usually where the real work begins.

The design of a system cannot be separated from the outcomes it produces. Leaders who internalize that stop firefighting symptoms and start rebuilding the conditions underneath them.