The CFO: a true strategic and operational co-pilot for startup founders

In September 2023, Quest for Health launched a CFO Club, a dedicated space for Administrative and Financial Directors working in the field of health tech innovation. The goal? To foster peer-to-peer exchange and the sharing of best practices on key topics such as finance, taxation, and human resources. Today, around a dozen members meet monthly on the Nextmed campus and stay connected via a dedicated Discord channel.

At the heart of this initiative are Carole Lascombes, Controller at Sartorius, and Thierry Mignot, part-time CFO for companies including Spartha Medical, Keymaging, BrightSens Diagnostics, Urania TX, Unpointneuf, and Superbranche. They co-lead the Club and share in this article their missions supporting entrepreneurs, along with advice on structuring and professionalizing financial management from the very beginning of a business venture.

Financial management is a strategic challenge in the growth journey of a startup. In the early stages, founder-CEOs often focus on developing and validating their technology, sometimes putting financial structuring on the back burner. Yet, a solid financial organization from the outset is a key factor for success.

Accountants typically handle day-to-day bookkeeping and ensure compliance with tax and social obligations. While they may offer some advisory services, they do not manage the overall financial growth strategy of a startup. This is where the Administrative and Financial Director (DAF, also referred to as RAF or CFO) comes in.

The CFO brings both strategic and operational financial vision. Their role is to anticipate needs, optimize resource management, and support executives in decision-making, especially in preparation for and securing fundraising.

Why structure the finance function early on?

From day one, finance should be seen as a growth driver rather than a bureaucratic burden. This is particularly true for health startups, whose specific challenges (long development cycles, unique business models, significant and recurring funding needs, capital-intensive production) make structuring essential.

A structured finance function enables:

• Clear financial visibility: Rigorous monitoring of expenditures, particularly in R&D, and early-stage budget planning.
• Access to non-dilutive funding: Obtaining support such as the French Research Tax Credit (CIR) and other innovation grants (e.g., Region Grand Est, Bpifrance, EU) requires meticulous financial management, program coordination, and regulatory expertise.
• Preparation for fundraising: Investors expect accurate accounts and a structured finance organization capable of producing clear indicators.

Overall, a strong finance function boosts startup credibility and builds trust with stakeholders and investors, which is essential to securing future funding.

The vital role of the CFO: More than a financial manager

The CFO’s role goes well beyond basic accounting. As the guarantor of a solid financial strategy, they contribute in several key areas:

• First budget creation: A collaborative exercise across teams to align on strategy and ensure effective monitoring. The CFO facilitates this process by promoting team engagement.
• Structuring financial management: Implementing cash flow monitoring, reporting processes, and financing need forecasts.
• Optimizing the relationship with the accountant: Ensuring fluid communication and enhancing the quality of financial data.
• Cash flow planning: Preventing liquidity issues that could threaten the business.
• Supporting decision-making: Using relevant financial indicators to help steer company strategy.

Management accounting: A tool for clarity and alignment

Beyond financial expertise, the CFO plays a central role in communicating and explaining the business model. In this way, the CFO becomes a “translator” of company performance.

Management accounting becomes a strategic tool for internal and external alignment. With detailed reporting tools and simplified financial data presentation, the CFO offers clear insights into R&D project costs—essential for summary reports required by non-dilutive funders.

This system also helps analyze profitability, costs, and margins once the project is monetized. These insights benefit not only the management team but also internal teams, who gain a better understanding of business performance and can align more effectively with objectives. Additionally, this transparent approach strengthens investor confidence.

It is essential, for example, to communicate cash burn forecasts, recruitment plans, and future margin potential—even during development phases.

In addition to financial oversight, the CFO plays a critical role in administrative and HR matters: managing contracts, tracking social obligations, structuring internal processes, and setting up HR information systems for project time tracking. This helps build a solid organization aligned with the founder’s vision—crucial to startup growth.

Preparing and succeeding in fundraising with a CFO

Raising funds is more than just convincing investors—it requires financial rigor and anticipation. The CFO is key throughout this process.

Before the raise:

• Build a solid business plan with credible financial projections: It’s important to submit realistic forecasts, even if they’re less flashy. These numbers often serve as a reference for future discussions.Overly optimistic projections can harm credibility and long-term support. The CFO ensures consistency in your financial messaging.
• Prepare for due diligence: Make sure all financial data is accurate, reliable, and documented (data room).
• Anticipate investor expectations for reporting and financial KPIs.

After the raise:

• Manage cash flow and ensure optimal use of raised funds.
• Structure financial tracking and implement management tools (dashboards, forecasts).
• Maintain regular reporting to keep investors informed.

A CFO is a true credibility asset for a fundraising startup. They reassure investors of financial control and, post-raise, act alongside the CEO to provide effective oversight and transparent reporting.

Integrating a CFO: When and how?

At launch, a founder’s priority is the vision, product, market, and team. The CFO allows them to focus on the “business” by handling finance, HR, and accounting.

The CFO should be integrated at the right time and in a format suited to the company’s needs and resources. When financial management becomes too complex or time-consuming, or when institutional investors are considered, it becomes essential to bring in a professional.

• Determine the right timing: A CFO becomes indispensable when finance exceeds the founder’s expertise or fundraising looms.
• Choose the right format: An outsourced or part-time CFO can be an agile first step before full-time internalization.
• Specific skills: The CFO should understand startup needs (non-dilutive funding, tax credits, pre-financing tools, fundraising) and industry challenges (e.g., medtech/biotech, product development cycles, regulatory environment).

Having a CFO provides critical support and ensures business continuity—even in tough times.

Two real-life examples

Fizimed, a medtech startup founded in 2017: Fizimed brought in a CFO early on, even before official incorporation. The CFO provided initial feedback on the business plan and gradually built a structured financial system. As the company entered commercialization, finance management evolved into more strategic roles like controlling and analytics. This allowed Fizimed to focus on its market and development, while maintaining a clear financial path to profitability.

Superbranche, a biotech startup launched in 2019: In 2020, Superbranche engaged an outsourced CFO to secure innovation-related tax issues and professionalize accounting review processes. This intensified with an upcoming fundraising to support R&D and industrialization. The CFO also handled HR, supported leadership, and advised on complex topics, boosting team cohesion and freeing up time for fundraising preparation. The team’s awareness of the CFO’s internal role eased the transition to an in-house CFO post-raise, further strengthening company structure.

Key Takeaway

The growing importance of the finance function is a powerful lever for startup development. Bringing in a CFO early—who can structure finance, HR, and admin—boosts credibility, efficiency, and peace of mind, allowing founders to focus on scaling their innovations. The earlier the CFO joins, the better the company is positioned to secure funding, manage growth, and drive success.