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A. I was, and a lot of that goes back to my upbringing. My mother started and runs a preschool, and she is also very involved in running our family farm outside of Boston. My father’s a surgeon and also started an oncology research foundation. I always grew up with the sense that it was O.K. to try new things and be out on your own.

The first real business I started was when I was 11 and bought about 60 chickens and sold organic eggs with one of my cousins. From there, I was always trying to think of things I could do that would be new and interesting. I liked the risk and the personal accountability of trying to build something.

Q. And what about your first business after college?

A. I started one with a couple of guys I had known from school. We were part of the last batch of companies that got funded before the market turned in 2000. It ended up being an interesting experience of trying to build a business in a bad market. We raised about $3.5 million. The company was a downloadable application to deliver high-quality photos — back then, that was hard to do because of bandwidth constraints. It was an interesting concept, but probably the biggest lesson from that experience was that market timing is everything. The market was too small, and we just didn’t have a way to really make enough money to make it a big business.

Q. Other lessons from that experience?

A. We didn’t have a strong sense of our senior management and how our goals were defined. And you could kind of feel that permeate the company. A lot of it was just very tactical thinking, just getting done what was in front of us. We didn’t set the context very well. Now I try to create a much broader sense of what we’re doing and why people should be doing it, and giving them more of a hand to shape how they’re going to do it.

It’s interesting. There’s such a premium, particularly in Silicon Valley, placed on youth, but there are certain things you can’t learn without years of experience. Or there’s a certain credibility you gain with people because they know you’ve been through a lot of situations.

Q. What were some other lessons?

A. I ended up joining a company in the mobile space called m-Qube, and it was the opposite experience of my first company. There was this inflection point, and we had this incredible hypergrowth. The business went from roughly $5 million in revenue to north of $80 million in a year.

Q. It can be tough to maintain a culture when you’re growing that fast.

A. There was a strong core culture at the top with the senior management team, and they were very accessible to everyone. One of the things I took away from that experience is that you can’t have senior managers who are off in their own little area. You need a team that’s very approachable, so people can see them and absorb the culture.

Q. And now with your current company, you had the chance to hit the reset button on culture. What’s been your approach?

A. A big thing I talk about at SessionM is that I don’t let the company off the hook when it comes to creating culture. Because at a small company — we have 55 people now — it’s not about a C.E.O. telling you what the culture is. It has to be about the company creating the culture and living the culture and embodying it. So I actually say at all company meetings, “Look, this is a rare opportunity in your career to create a company culture and be a core part of it, because I’m not going to sit up here and just tell you what it is.” So I’ve really tasked our company to help create the culture very overtly.

Q. So what are some examples of what you’ve done?

A. We have something I call our “SessionM PACT,” which is less about our values and more about the way we want people to work. When you join this company, you agree to this PACT, which stands for purpose, accountability, commitment and teamwork. There’s not a meeting that goes by when I don’t mention the PACT. And we have a quarterly award that we give to an employee who truly embodies that way of working.

Q. How do you hire?

A. The most important thing for me is seeing how someone connects with people. Part of that is how they connect with me as an interviewer, but more deeply it’s about whether I can get evidence of connections with people in other parts of their life. So I’ll ask people about their families. I’ll ask about their friends, past colleagues. How do they interact? Do they have strong relationships? Are they someone who can be flexible with different types of people? I typically get a sense very early on if someone’s going to be a fit. First impression for me is very important — that gut feel you have about their excitement and also their style and approach.

Q. Anything you have an unusually low tolerance for in terms of behavior?

A. The “I need” syndrome, where people say: “I need this. I need that.” And part of me thinks: “But then what? What’s your solution? What are you going to do about it?” Because it’s easy to say, “I need 10 more employees.” I think there can be this syndrome of people feeling like they should get a star for saying, “I figured out what I need.” But they’re not helping push the conversation through to what’s going to solve the problem.

Q. What’s your advice to graduating seniors who are about to start their careers?

A. I would say that it’s O.K. to not know exactly what it is you’re going to do next. Don’t get paralyzed thinking that you have to find the perfect job. Part of it is just take action, do something, get in the mix, and you’re going to learn so much more than just theorizing or speculating from the sidelines.

Also, stop worrying about your résumé, and trying to make your résumé something for somebody else. Your résumé is a story of your professional life, and you should be doing it for yourself, not for someone else.

This interview has been edited and condensed.

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My mother is Dutch, so I didn’t grow up around her family, but my grandfather would often mail me games and puzzles, starting my lifelong love of solving problems. I would figure them out and mail the answers back to him in the Netherlands. He turned 100 last year, and we attended his birthday celebration there.

I started swimming competitively at a young age but still found time, during vacations in high school, to scoop ice cream at a local ice cream parlor, deliver magazines and give swimming lessons.

I attended Princeton and was a member of its swim team. One time, while our team was competing in the N.C.A.A. championships, I substituted as anchor of a relay race for an injured teammate and was almost caught by our opponents. We won, but that close call showed me how discipline and hard work could put you in a position to be lucky.

After graduating with an economics degree in 1992, I spent a year skiing in Colorado. I moved to Crested Butte and got a job in accounting. I spent my paycheck on rent and a ski pass and applied to law schools. The next year, I enrolled at Harvard Law School, where I met my future wife, Jeannie. After I graduated in 1996, I returned to Dallas to be a clerk for a Federal District Court judge. I had always assumed that, like my father, I would practice law, but Jeannie helped me realize that I do best around people, building teams and relationships, rather than being immersed in legal research.

I joined McKinsey & Company in 1997, working on a study of the petroleum industry, first in Dallas and then Houston. In 1999, I transferred with McKinsey to Amsterdam, where Jeannie and I lived for two years. When we returned to the United States in 2001, we moved to Washington, where we have since expanded our family to include three children.

At the Washington office of McKinsey, I continued to work with a range of clients in consumer products and other industries. I loved the problem-solving. But management consultants figure out the solutions and generally leave the implementation to others. I wanted to help drive the solutions through to completion.

In 2003, I joined the Advisory Board Company, working first as its executive director of strategic planning and new product development. I moved up to the company’s business intelligence unit, becoming executive vice president for general management.

Our principal clients are hospitals and health care systems, where we provide strategic guidance and analytic software and help them improve the quality of services they deliver at a lower cost. I was named chief executive in September 2008, just as the financial recession began. Despite that, we have grown steadily and now serve some 3,000 health care institutions. It has been very satisfying to work with health care leaders like the Cleveland Clinic and the Mayo Clinic and to work with other institutions to reduce hospital readmissions at a time when this issue is receiving national attention. We have also been branching out to work with higher-education institutions. We now have about 2,300 employees.

We are also committed to our communities. Staff members last year worked close to 20,000 free hours on community service projects. I serve on the board for Miriam’s Kitchen, a nonprofit organization in Washington that is dedicated to ending chronic homelessness.