In medicine, frailty is theoretically defined as a clinically recognisable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. 

In the absence of a gold standard, frailty has been operationally defined as meeting three out of five phenotypic criteria indicating compromised energetics: low grip strength, low energy, slowed waking speed, low physical activity, and/or unintentional weight loss . A pre-frail stage, in which one or two criteria are present, identifies a subset at high risk of progressing to frailty. Various adaptations of Fried’s clinical phenotype have emerged in the literature, which were often motivated by available measures in specific studies rather than meaningful conceptual differences.

Patients who are frail before surgery are more likely to have serious complications and mortality afterward and increased costs of care, suggesting that frailty should be factored into risk calculations before surgery.

Consequently, surgeons develop clinical judgement when doing patient selection for surgery. Whether to operate is as important, if not more, than how to operate.

In several ways, organisations and companies are like patients. When they are sick, some interventions , like change management, digitisation, leadership development and innovation initiatives are high risk if the company is frail.

Corporate frailty, is as yet undefined, but might include:

1. Unexplained revenue or market share loss.
2. Exhaustion manifested by employee burnout or innovation fatigue.
3. Low physical activity with resulting under-productivity, waste, or complacency.
4. Slowness in seeing potential threats or opportunities or inability to respond to environmental and business model threats.
5. Weakness in the C suite, lack of market power or other parts of their competitive strategy They just can't get a grip.
6. Sarcopenia i.e lack of muscle strength.
7. Small energy reserves.
8. Inability to withstand stressors, no matter how minor.
9. Failure to scale.
10. Multiple system failure.

Like frail patients, operating on a sick business when it is frail is associated with complications and higher rates of mortality and patient selection is key to favorable outcomes. Pre-habilitation is a necessary requirement before taking them to the OR. Structure eats culture for lunch.

Arlen Meyers, MD, MBAs is the President and CEO of the Society of Physician Entrepreneurs on Twitter@ArlenMD.