Few consultants come to business consulting through public health. Nicolas 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 shifted his focus, first to advising government offices and congressional leaders across Healthy Communities, LLCthen establishing Tera Strategies, his Fort Lauderdale-based management consulting firm, where he now advises CEOs, family offices, chief medical officers and wealth management firms nationwide.
This career arc, from community health organizer to senior business consultant, has yielded Nicolas Mukhtar a cross-sector perspective that highlights patterns that other advisors tend to overlook. He sat down to answer five questions about the state of business leadership, what governance structures are actually required, and where most leaders go astray before they realize it.
Q1: You went from leading a large nonprofit to advising private sector executives. What does one world teach you about another?Mukhtar says the mechanics of the two worlds are more similar than most people think. Running Healthy Detroit showed him that whether it’s a city park health initiative or a family business, the root problems are almost always structural, and that transitioning from a scrappy startup to a functioning institution is a universal challenge. “I look at companies in two different categories,” he said. “One is these large, established companies that operate a bit like these big city governments or these bureaucratic machines that sometimes can’t get out of their own way. And then this other bucket is the startup machine.”
He draws a direct line between what he observed while building a public-private partnership model in Detroit – where government bureaucracy systematically blocked innovation – and what he encounters today within big business. His advice approach reflects this framework: different organizations require fundamentally different interventions, and treating them the same way is one of the most costly mistakes a leader can make. The observation weighs heavily compared to current data. A 2025 NACD survey of directors found that a majority of board members reported improving planning oversight and risk management as top priorities, signaling that even at the governance level, organizations are struggling with the gap between stated direction and ability to execute.
Q2: You work a lot with family offices on governance and succession. What is the biggest mistake you see them making?Mukhtar’s answer is consistent in almost every family office engagement he undertakes: don’t involve the children early enough. The consequences, when they manifest themselves, tend to be serious. “You don’t know what life will throw at you,” he says. “You’ll see situations where someone dies or there’s an accident or something, and these kids really have no idea what their parents built, how they built it, how things are organized, what to do.”
The scale of the problem is considerable. According to a RBC Wealth Management and Campden Wealth 2025 Reportalmost half of all family offices expect a generational transition over the next decade, but only 69% of them now have a formal succession plan, compared to just 53% the year before. A study published by Simple, a family office consulting firm, found that without a defined decision-making framework, families become dangerously dependent on one or two people, and when those people suddenly become unavailable, the organization has no structure to fall back on. Mukhtar clients say they have successfully started their children with small investment accounts at the age of ten or eleven. “Just teach them the importance of spending time in the market, saving money and creating buckets,” he said. “Put 30% here, put 30% here, put 30% here. » In his experience, the families that struggle are those who become so absorbed in building that they lose sight of who they are building for.
Q3: When a new client comes to you, what is the root problem you most often encounter – and what question do you wish they would have asked before picking up the phone?Mukhtar says the answer is almost always the same, regardless of industry, company size or ownership structure. “I’m not kidding,” he said, “this seems to be 90 percent of the problems across the board. It’s just that people need to talk.” He doesn’t see this as a matter of individual personality or interpersonal skills. He links the failure of communication to a structural condition: the chronic overstimulation of modern work life, where leaders face so many competing demands that sitting down and asking a direct question has become genuinely difficult to prioritize.
The organizational cost of this failure is well documented. Research from the Top Workplaces 2025 survey found that the most significant gap organizations face is the failure to keep employees informed during periods of change. When this gap persists, the trust that holds performance cultures together begins to erode. Mukhtar sees this also playing out on an individual level: people on the verge of leaving their job without ever expressing what they really need from their employer. “As an employee, have you met with the owner of the business and explained why you want something different and what you’re really looking for? he said. “It can be as simple as that.” Its prescription is not elaborated. “People are just pulled in so many different directions,” he said, “and a lot of it is just simplifying things and having a conversation about why it’s not working.”
Q4: Most leaders say they believe in a clear strategy. Why do so few people actually perform it?Mukhtar attributes the gap between belief and execution to a single recurring failure: treating every organization as if the same solution applies. He is opposed to universal prescriptions and his reasoning 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 one-size-fits-all solution to a problem. And I think you really need to approach it as such.”
This view weighs on current data. A 2024-2025 McKinsey survey of more than 400 senior executives worldwide found that only 21% said their organization’s strategy passed at least four of ten rigorous business assessment tests, a drop of 40% from results a decade and a half earlier. A separate analysis found that 68% of middle managers surveyed in a McKinsey study admitted that they actively suppress negative information before passing it up the chain, meaning that leaders often finalize plans based on a picture that no longer reflects conditions on the ground. For mature organizations operating as large bureaucratic institutions, Mukhtar says the answer often involves outside thinking: someone without institutional ties and able to ask the questions that insiders have stopped asking. For young companies that are still finding their structure, the work is different. “There’s a lot of growing pains in a lot of these companies that are startups trying to transition to fully operational businesses,” he said. “Each entity, each person is unique and must be treated as such.”
Q5: What do you want to work on over the next few years and what do you see as the biggest opportunities in your field?Mukhtar is direct about his ambitions, and these are closer to results than growth indicators. He describes wanting work whose results are visible and concrete, rather than projects measured over time frames that are too long to produce real accountability. “I like to take on projects where I can really see the results,” he said. “I’m a results-oriented person. I don’t like working on things that you won’t see results for a hundred years.”
This focus points him toward health care reform as a priority, particularly Medicaid, where he worked several years earlier in his career and believes substantial, measurable change remains 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 to society,” he said. “I don’t think that’s how our Medicaid system is used today.” More broadly, Nicholas Mukhtar says he wants develop Tera strategies to the point where it can be truly selective about its engagements, choosing clients and projects based on suitability and impact rather than volume. It does not describe the scale for its own sake. He describes the ability to continue the kind of work that produces the results he saw unfold in Detroit: a park where children played basketball on a field that was once an abandoned lot, a city block that looked different because someone chose to intervene. “Seeing these results and seeing kids actually use something that you had a hand in building,” he said, “that’s my passion. That’s what I love doing. That’s what motivates me.”
Learn more: Nicholas Mukhtar shares new analysis on decision-making in complex organizations
