> What does it mean in this context to be more intelligent and shrewd than the existing owners?

Streamlining everything. Sometimes this is done in a bad faith way, but it’s often not difficult to do it in a good faith way.

Some simple examples:

- right-sizing staff (can be reducing, increasing, or changing roles)

- improving marketing (e.g., simple things like customer reactivation, packaging the product/service better, or just plain, ol’ getting the word out better via stuff like before/after pics or success stories)

- improving operations (e.g., better organization, better processes, better communication, better training, better logistics, etc.)

> Delivering better profit margins?

Improved profit margins are a byproduct of the things listed above.

I mean, losing money is not sustainable. If a doctor or physician group isn't business savvy and can't earn a profit they will eventually go under. That's not good for the patient.