5 questions with Nicholas Mukhtar about strategy, governance, and what’s wrong with managers
Few consultants come to business consulting through public life. Nicholas Mukhtar did it. After founding Healthy Detroit in 2013, growing it to an annual budget of $15 million, and being recognized by the American Public Health Association as the National Public Health Organization of the Year in 2017, he changed his focus – first advising government offices and congressional leaders through Healthy Communities, LLC, then he founded Tera Strategies, where he now advises his management at Tera Strategies. CEOs, family offices, medical directors, and wealth management practices across the country.
This career path, from public health planner to senior business consultant, has given Nicholas Mukhtar an interdisciplinary lens that reveals patterns that other consultants often miss. He sat down and answered five questions about the state of business leadership, what management structures need, and where most managers get lost before they realize that.
Q1: You transitioned from leading a large non-profit organization to consulting private sector executives. What does one country teach you about another?
Mukhtar says the machines of both worlds are more similar than most people expect. Running Healthy Detroit showed him that whether the organization is a city park health program or a family-run company, the core issues are almost always structural, and the transition from grassroots to institutional is a global challenge. “I look at companies in two different buckets,” he said. “One of these big established companies that act like these big city governments or these bureaucratic machines that sometimes can’t get out of their way. And then there’s this other bucket, the startup machine.”
He draws a straight line between what he saw building a public-private partnership model in Detroit — where government officials often stifled innovation — and what he encounters inside big companies today. His approach reflects that framework: different organizations require very different interventions, and managing in the same way is one of the most costly mistakes a leader can make. Observations are weighted against current data. NACD’s 2025 survey of directors found that the majority of board members marked improvements in governance and risk management as a priority, indicating that even at the governance level, organizations face a gap between stated direction and the ability to deliver.
Q2: You work a lot with family offices on governance and succession. What’s the biggest mistake you’ve seen them make?
Mukhtar’s answer is consistent with almost every family office engagement he does: not getting children involved early. The consequences, when they do occur, are often dire. “You never know what life has in store for you,” he said. “You will see situations where someone will pass away or there will be an accident or something, and these children don’t really know what their parents built, how they build, how things are set up, what they should do.”
The scale of the problem is huge. According to a 2025 report from RBC Wealth Management and Campden Wealth, nearly half of all family offices expect change within the next decade, yet only 69% now have a formal succession plan in place, up from just 53% last year. A study published by Simple, a family office consulting firm, found that without a defined decision-making framework, families are dangerously dependent on one or two people, and when those people are suddenly unavailable, the organization has no fallback structure. Clients Mukhtar describes doing well start their children with small investment accounts as young as ten or eleven. “Just teaching them the importance of having time in the market, saving money, building buckets,” he said. “Put 30% here, put 30% here, put 30% here.” According to his experience, the families who are struggling are the ones who are consumed by construction to the extent that they no longer see who they are building for.
Q3: When a new client comes to you, what’s the most common root problem – and what question do you want them to ask themselves before picking up the phone?
Mukhtar says the answer is almost the same, regardless of industry, company size, or property ownership. “I kid you not,” he said, “that seems to be 90 percent of the problems across the country. People just need to speak up.” He does not place this as a matter of individuality or ability to work with others. He attributes the failure of communication to the structural environment – the constant stimulation of modern professional life, where managers are pulled by so many competing demands that the act of sitting down and asking the right question becomes really difficult to prioritize.
The organizational costs of that failure are well documented. Research from the Top Workplaces 2025 survey found that the biggest gap organizations face is failing to keep employees informed during times of change. When that gap persists, the trust involved in working together begins to break down. Mukhtar sees it playing out on an individual level: people who are more likely to leave a job without saying what they really need from their employer. “Did you as an employee sit down with the business owner and explain why you want something different and what you really want?” he said. “It could be that easy.” His medicine is not detailed. “People just get pulled in so many different ways,” she said, “and a lot of it you just need to simplify things and talk about why this isn’t working.”
Q4: Most managers say they believe in clear strategies. Why do so few actually do it?
Mukhtar traces the gap between belief and execution to one recurring failure: treating every organization as if the same solution works. He retreats from universal laws, and his thinking is based on observation rather than theory. “If I talk to 10 CEOs, they all have a very different style, a different way of looking at things,” he said. “There is no single solution to any problem. And I think you have to approach it that way.”
That view weighs against current data. McKinsey’s 2024-2025 survey of more than 400 CEOs worldwide found that only 21% reported that their organization’s strategy passed the firm’s Ten Strong Tests, a 40% drop from results taken a decade and a half earlier. A different analysis found that 68% of middle managers in a McKinsey study admitted that they properly organize negative information before forwarding it, which means that managers often finalize plans based on a picture that no longer shows the conditions on the ground. In mature organizations that operate as large bureaucratic institutions, Mukhtar says the answer often involves thinking outside the box: someone with no institutional attachment can ask questions insiders have stopped asking. For small companies still getting their structure, the task is different. “There are growing pains for many of these start-up companies trying to transition into full-fledged companies,” he said. “Every organization, every person is different and you have to treat it as such.”
Q5: What do you want to work on in the next few years, and where do you think the biggest opportunities are in your field?
Mukhtar is specific about his ambitions, and they are closer to results than growth metrics. He describes looking for work where results are visible and measurable, rather than projects measured on timelines that are too long to produce real accountability. “I like to take on projects where I can see results,” he said. “I’m a results-oriented person. I don’t like to work on things that you won’t see results for a hundred years.”
That orientation points him to health care reform as a priority, especially Medicaid, where he spent several years earlier in his career and believes that big, measurable change is still possible. “There are a lot of opportunities to use Medicaid to really help people and get them to a place where they are healthy and contributing members of the community,” she said. “I don’t think that’s how our Medicaid system is being used today.” More broadly, Nicholas Mukhtar says he wants to grow Tera Strategies to the point where he can be selective about his involvement, choosing clients and projects based on merit and impact rather than volume. He doesn’t explain the scale because of it. He describes the ability to pursue the kind of work that produces the results he saw happen in Detroit – a park where kids played basketball on an abandoned court, a block that looked different because someone chose to intervene. He said: “Seeing those results and seeing kids use something that you had a hand in building,” he said, “that’s what I love. That’s what I love to do. That’s what drives me.”
Read More: Nicholas Mukhtar shares new insights into decision making in complex organizations
