Ed Muzio 0:05
Good afternoon, everybody. I think at a real high level, there are two useful things we can do in this dialogue. One of them is talk about the possible organizational improvements that can happen. I think that's probably pertinent to the innovators and maybe some of the investors. And I think the other one is, there's sort of a, how does good external engagement look compared to not so good and external engagement of like what's possible? So I feel like then that have useful to some of the providers in the audience as well. So I feel like we could probably talk on both of those channels. Yeah, I
Todd Powell 0:35
think so. And hi, everyone. That sounds good. I think, obviously, this isn't deeply rehearsed. But I think the the full scope of these topics are near and dear to our hearts. And we're excited to share some stories with you and do as we go, should we kind of entertain questions as they come to? Or do you want to kind of keep it?
Ed Muzio 0:57
We can keep it old conversation, I think, yeah, we'll try and leave maybe 10 ish minutes every we've never had a meeting that went more than 28 minutes. So I feel like we're probably no, I think that's probably true. We're both talkers. So I for time, we do a lot. So maybe I'm thinking we start with what your need was, when we met, it's a good place to start. Sure, I
Todd Powell 1:13
can do that again. So I'm Todd. I'm the president, CEO of RefleXion, medical. And the company has been around since 2009. But in many ways, it was kind of two guys, the classic two guys in a laptop story for the first five years, raised his first institutional capital in 2014, with sofinnova, and Venrock, as well as Pfizer, and then has had rounds kind of ever since then raised a little over $650 million. And we just set a little bit of context, right for the kind of the history of the company started treating our first patients with our novel form of therapy, which very quickly, this isn't about RefleXion, per se. So I'll keep this very quick, but which is a form of radiation therapy that uses injectable radiopharmaceuticals pet tracers. And as you probably appreciate how pet tracers work, they target and collect, in our case, cancer. And then we've built a machine that is uniquely and for the first time sensitive to those signals, and can fire right back at the origin of those signals, which is, again, the cancer itself. In fact, that's where the name RefleXion comes from. We started those actual therapeutic treatments last year in August, and now done that throughout our installed base. And we're seeing really fun and compelling clinical results already, with 50 publications, abstracts already accepted this year. So it's super exciting time for the companies, we kind of roll through science into kind of early commercial and clinical rollout, right, that's kind of the face of the company. Like Like, I think a lot of the companies you're you are all familiar with. And getting back to your question. And when did we start engaging in talking? It was probably 2018, maybe, right? Right, right around, then I joined the company in 2017, as a CEO to sort of transition the company from a team of physicists into a company, right, so to take a technology and sort of start to turn it into something that can be produced at scale. And, and to kind of do that I've been in med tech for about 30 years, and spent about a third of that as a software engineering then kind of moved into different kinds of management, stuff like that. But it was clear, when I joined the company, there were about 50 of us, and we were well capitalized and have continued to be well capitalized, we were growing fast, it's at we're a big expensive med tech, we have a, you know, 50,000 square foot factory that can make 125 of these big and heavy and expensive machines per year that machines kind of look like something you would shoot into space, you know. So it's kind of the typical big capital kind of story. And so, we're growing fast, hiring a lot of people, all different types of people, not just the physicists and engineers. And it was very clear to us during that phase of growth, or that was kind of the first knee of inflection in our growth, right. As we sort of transition to this phase, it was clear that if we did not embrace, proactively, deliberately a management methodology, and by that I don't mean a program or project management methodology, I mean, a decision making methodology, a strategy and management of the tactics to support a strategy and an early warning system related to all that so you can make course corrections quickly, because it was we all know, you have to it was clear that through that rapid growth of personnel that if we didn't proactively design a system, build a system and implement it, that system was going to grow organically, with or without us. And it would be a hodgepodge of half a dozen methodologies through well intentioned people that would join the company and it would just be sort of chaotic. And that was the situation we were in and I'll tell you a little bit more about how we came to know you and what that change, but that was the landscape at the time that you and I started talking.
Ed Muzio 4:55
Yeah, that was the starting point. And so for me, kind of my background and context I was an engineer I started my career as a mechanical engineer. But I started my career at Intel back when there was no such thing as Intel computer engineers, so they just hired any engineer that could fog a mirror. And then they showed us when we got there, how to do it. So I was that for 10 years. And while I was there, I got kind of entrenched in their methodology that was back when they were among a small number of companies that were running a 10 year product roadmap with 18 month product releases, each of which was to release into a market that did not exist yet and wasn't clear that ever exist. So they just be super agile and adaptable, even though they were this giant company. And so I sort of grew up in that. Then I left I went into consulting and ended up forming a relationship with someone who became a mentor of mine, I started working on culture stuff, he had been working on kind of the sociological elements of what goes on high performing management, going back to like old school behavioral research from the 60s of guys with clipboards following managers around and saying, Is there something management? Does that makes things better? Or does it not matter? And there's some answers to that. And so that all came together for me. And so I've been, I've been doing this embodiment of this kind of work for around 10 years now, which is to answer the question of how do we need to run so that when we get bigger, we get faster? If I, some of you have met with me this week, if I've said this already to you, but if I take your computer, and I put a new processor in it, and I give it back to you, and I say to you, you it's now run by a larger, more complex system. So it'll be slower get used to it, you would fire me as your IT person, right. But that is a lot of what comes out of the org development and HR space around, what you should do is if you're a leader, you better start slowing down a little and kind of thread this needle between you gotta go slow to be accountable, but you got to go fast to stay alive. And it's kind of unfair, because it tips that about 25 to 50 people, and you better still be faster to that small. So, um, so that's my background. So I came into it, and here they are looking for a methodology. And I've been working on this, like, what happens when, you know, what do we have to do to make the company run?
Todd Powell 6:53
That's right. And when I first started to get to know it, and I think we were introduced by a really sharp project manager that works for us. And he was at Kla, 10 core, right, we had worked together, obviously, a very big, sophisticated company that, that is very robust in its project management. And, and I think you worked with that individual to stand up some of this technology there. And, you know, as when I came to RefleXion, at that time, I had been part of small startups that grew into kind of big companies, and I've been, you know, run large teams all around the world. You know, and over those years, probably, like, a lot of you, I had the experience of kind of coming into a company, and then being responsible for a change management journey, where you might have had a company that had grown through maybe a dozen, maybe 20, acquisitions all around the world, you know, so you not only have geography and language to contend with, you have wildly different, you know, cultures and wildly different philosophies about what management even means, what decision making even means, what consensus means or doesn't mean, and how much is that important and, and, you know, happy to come in, and I was responsible for a change management journey, and one of those and was not a lot of fun. It was really brutal. And I wanted to get as far ahead of that pain with this company as I could. And it was like it, you know, so I'm kind of going into a bunch of physicists and engineers, super smart people, that RefleXion, best team I've ever had the honor of working with. And I'm saying, Look, we're going to implement a management methodology. And they're like, why, why would you do that? But you know, you couldn't pry it out of the company. Now, if you had to pry it out of the company, you couldn't, because people realize the efficiency of it the inherent effectiveness of having a common lexicon a common set of dashboards that everybody understands, we can, you know, and I'm probably jumping ahead, right, but you can, that's what we do. That's how all of our conversations tend to go. But, you know, we can move people between teams completely different a marketing person can jump over into a science deep team and advanced development team can pull back and deal with a support team that's dealing with the current release in the field. And they all have a common lexicon, they all have a common method for establishing and tracking progress towards goals and and a common tool set for escalating things when early warning signs go off. And they're gonna go off because there's a methodology to ensure they go off. You know, we all have this kind of common toolkit about how to stand up task forces and working groups and they live and then they're reported upon and then they die and we move on. And it's, it's turned out to be really slick. It's really stuck. Well, it's stuck Absolutely. To the point where in fact, we don't, it's got a book. Maybe you've seen it, and an ad talks about his company, and he's good at all this stuff, as I'm sure you're gonna pick up on, but we took it and made it our own. So we, we don't call it iterate now, which is the title of your book. And and in fact, when people say it, I kind of, you know, kind of smack them on it a little bit because we now call it the RefleXion management methodology, right? Because it's, we've taken the basic tenants of it, rolled it into our own framework. And that's just what we onboard people with now, when they when they start, they, you know, they get that as part of the onboarding process, we train that we do on site trainings, you've trained us so that we train ourselves on that now shifted from sort of a foreground role for a couple of years to a back away, and back away. Yeah, and that is your goal. And as your goal from the beginning,
Ed Muzio 10:31
I'm supposed to get out. And that's engineers work themselves out of jobs and consultants work themselves into jobs. And I'm an engineer first. And that's, I think one of the unique things is that, I guess, yeah, I think that's
Todd Powell 10:40
true. And that resonated with me, too, with my background, being in physics and engineering. And I immediately got the way Ed taught. And we're a super sciency engineer, kind of driven, like at our core, right? These are really smart people. And I knew that if I came at them with sort of the, I hope I'm not going to offend anybody. When I say McKinsey or anything, I'm so sorry. But you know, like, I've been in those big companies, too. And I've rolled out those multimillion dollar change management journeys driven by that kind of thing. And so I get that, totally. But I knew that if I came with anything that even smelled like that, it just wasn't going to fly. Right. But you came in and said, This is the beginning. And pretty quick. If this goes, well, you're not going to see me anymore. And it was like, I thought that was pretty cool. And I think and I think it's proven to earn the trust of the organization to kind of take those first leaps. And then it's the progress that kind of pays for the next leaps, right? People just kind of get it. Like I said, we I don't think we could pull it out of there. Now if we try to without that we would right
Ed Muzio 11:45
now. And I think that's I mean, maybe this is both of those conversations, what's possible in this kind of work and what's possible in general, but, you know, I think they're the the HR slash HR thought leader universe has a machine where publishers go to conferences and listen for buzzwords, not knowing what they mean. And then get people to write books about those buzzwords and then push it back out there. And so it's an echo chamber in a lot of ways. I don't mean to say there are not good HR and OD thought leaders out there. I mean, to say there are many more of them than there are good ones. And so so that has led to a sort of an overall ethos of like, posters. So I'm supposed to leave my poster on Todd's wall with my footnote of Ed museo iterate with little r. And that is actually antithetical to real system change. Because the system I have taken to doing my personal career development by hanging out with people that understand how brains work, because organizational systems are a lot more like the complex neurological network of the brain than they are like the org chart we're using in HR, right. So if we're gonna make a system change, we have to get past the equivalent of the immune system. And one really good way to activate the immune system is to put a sign on it that says, this didn't come from here, right? This is from outside, and then I come in, you pay me and I leave and my poster stays. But that's all that stays. Right. So we were really intentional and and always are very intentional to not just yours, this is yours. Take it your language and
Todd Powell 13:01
do it. Yeah. And it's and it's been fun. You know, I think Ed obviously has a style that I think resonates with me, I mean, it's a nerd. And I mean that in the most complimentary way. And our company is, you know, a bunch of nerds, right and myself included, and we get it, we kind of spoke a common language. And it was just a no nonsense approach to make people more efficient, so that they can focus their time and energy on the stuff they love to do. Where the management sort of is automatic. And I've been really just on obviously, I was pleased, right, you know, I mean, I wouldn't be here supporting a in talk, having a conversation with you about this unless I was and and you know, and it's funny, because I, when we first started talking about this panel, and we talked to Scott about doing this and things like that. It was a little like, I think we both sort of asked ourselves the question, Well, is there an audience here that will be interested in this? Or, you know, we were like, until five minutes ago, we're like, is anybody even going to write you know, as like, is anybody going to come? But what we told ourselves, and hopefully, it's true, I'm not trying to speak for anybody, maybe there, maybe there was just no other place to sit down or something, but but the, the, I, you should care about it. I just don't know how to say it. Right. But you should care about this stuff, whether you're running a company, I know you care about it, you know, but as an investor, you should care about it too, right? Because obviously, the one thing we all learn in working with investors is that you invest in people, right? You invest in teams. And and this methodology is like the grease between the gears of a team right and it pulls teams together. It makes them more efficient. It reduces the grind of those gears and you know, as an investor, you should want that and, but don't raise your price. I think as an investor, we want it to remain cost of Active too. And you aren't cost effective, especially when you compare it to some of those other things out there, where you leave the poster behind. Right? Well, yeah,
Ed Muzio 15:07
you know, one of the things that that I think is, is probably worth mentioning here, just sort of what I'm actually putting in place, because it's really fairly simple. And this is, you know, this is where the engineer goes in me goes, you know, I say I can do this and a quarter. And other bigger name firm will say, it'll take two years and $10 million. And I go, I don't understand what you're doing for those two years, because we're just making a system change. All we're really doing and a fundamental level is usually 25 to 50 people, and I work with that size up to multinationals. You tip from, we all get into a room and look where we're going to do it, too. We now have layers and Todd's my boss's boss. So I'm, I'm going to make a status update to my boss, that looks good for Todd because either my boss is a little worried, or I'm a little worried or something. And so all of a sudden, Todd finds himself sitting in a staff meeting with a series of nine minute status updates. And so it becomes his job to look down at these updates and go, I think that was telling the truth. And now it's my job to put them together. Where what we what we really want is not something theatrical, like that. And so the change we make is to go know what's gonna happen in that meeting is they're all gonna come in, and they're gonna go, Look, we're going here together as a group. And right now my piece says, we're gonna end up here, and that's a difference. So I want to put this on the table right now, I think we should do this, this and this, to bring those two things together. And so that takes about three minutes instead of nine, and so on to make a decision about that we implement it. And so that decision breaks something else, or something else breaks on its own. And next week, we make a new decision. So we're putting more decisions in more frequent cycles. And you can speak to how that looked in your staff at that general thing we're trying to do.
Todd Powell 16:34
Yeah, no, and thanks for that reminder, because it's funny, because we've been doing this now for a few years. Right. Right. Right. Yeah. And it's interesting that you reminded me of, of feeling that my team and I had when we started rolling this out, and it was immediate. And like a lot of startups, we all know, it's hard, right? It's incredibly hard. It's super stressful. And there's always something right, and what teams tend to do, and my experience of every startup I've been a part of, and I'm sure this is common among you, as well, it's easy to fall into a trap of a lot of storytelling, right? Because it's like, Hey, look at this incredible thing that I overcame over the last month, and you spend a lot of time, storytelling. And and and those stories are important because they bring a team together. And it's part of the fabric of self support that we I think we all appreciate is necessary in a startup trying to do something new and important and difficult. But if you don't tilt the equation, so that it's maybe 10%, storytelling 90% forward looking, you're you're not seeing around corners, you need to see, and then you know, you're you're going to react to things that you should be avoiding, to some degree, right, you'll never avoid everything, but you get the you get the idea. And I think we had started falling into that trap. And and we immediately noticed through the discipline of a relatively simple and straightforward methodology that we flipped that and the storytelling went down. In fact, it went so far down, I'll tell you what we did about in a minute. It went so far down that we spent all of our time forward looking, but we immediately were talking about the right things that were potentially months into the future. And we're doing that in a very consistent manner across a team, all staring at a single single kind of guiding point on the horizon in terms of goals, right. And, you know, I don't just mean one goal, like, you know, address late stage cancer that we're working on, but the detailed goals for that year, enable the to enable that, right. And, in fact, we got so good at not storytelling, that we had to add a section to our formal agenda called Cafe time. And it's a little just to do a little bit. So at the end of every agenda, there's a cafe slot, and it's just sort of like, Hey, you're hanging out with colleagues at a coffee shop, having an espresso or whatever, and it's an opportunity to share stories, right, that's, you know, in fact, you shouldn't be bringing up something that you should be bringing up in the bulk of the, of the weekly meeting. And, and it's turned out to be great. So people kind of separate that, and they kind of know. So it's not like we carved that out so much that people felt like they didn't have the opportunity for that storytime, but there's this the storytelling, the socialization of those events happen in a dedicated slot, which is proportionally appropriate, versus the bulk of the management methodology. You
Ed Muzio 19:24
remember, Todd, I don't remember this or not. But like when we when I when I come in first, I observed some meetings. And then we do a big touchpoint. It's like a, it's like an on site off site. Except when you get back instead of being three days behind. You're three weeks ahead, because we actually do the work of the company for a few days with three layers. So Todd has people there people, but I watched a couple of meetings, your staff meeting, and it was all intelligent, good stuff around stuff that was coming up in the next I'd say four to six weeks, maybe eight to 10 weeks. And then we did that process and the first staff meeting after one of your people came in and went in 18 months we're gonna do the installs and if we don't solve this now it's not gonna work and you and I looked each other went, there it is. That's
Todd Powell 19:59
right there. Yeah. And it was just really cool. Right? Yeah. And ever since then I
Ed Muzio 20:03
think it was it was there. I think
Todd Powell 20:05
so too, that that sort of solidified it. Right. And we got it. Yeah.
Ed Muzio 20:09
So it's it's a, it's, it seems sort of strange. And part of the reason I'm so appreciative of Todd for doing this is normally my clients come in through referrals, because I say, I'll come in and fix this in three months. And you know, big name firm says two years and $20 million, and I seem like a crazy person, except then I come in to fix three months. So Todd calls his friend, like over there, that's how it usually works. So and it's only because it's not, as he said, it's not that complicated. The trick is to shift the behavior as collective habits. And I think that's a good thing to talk about is how the habits of your people changed. Yeah. And from that view, it
Todd Powell 20:42
is that collective habit is totally right. I mean, now, it's, you know, there's part of this process is kind of a formal process for creating, updating and deploying goals across the entire company, which, you know, it's more than an all hands to say, this is what we're doing, right? I mean, it's sort of the, it's through the methodology that these things are memorialized, and artifacts are created that can be tracked in every single team meeting. And like, if, if I am behind on something like that, because I'm out raising capital, or any other things that we do, I mean, I have people nagging me for the, for the artifacts of this methodology, like right away. And it's, that tells you something too, right? I mean, people won't let this stuff go. They are counting on it that, you know, when we establish Task Force and working groups, we all know what a task force and a working group is. But there's a specific methodology for that, and our behavior, and people just expect it and we report on it. And they people know what that means. They understand the difference. There's a decision making timeline that, you know, there's all kinds of just sort of very pragmatic things that we understand, because
Ed Muzio 21:54
actually, I think that so that the task force and working group, you guys have that language, now we do. But that's actually turns out to be a really important thing, right? So so if you're doing this, right, we're in Todd staff. And there's a decision to make, and we have to get you, you got to figure this out. And so if this is working in town, staff, Todd goes, you you take two weeks, go come back in the recommendation, we're putting on the agenda in two weeks. And that's called the task force, which is your only job as recommendation come back. And it's boring, and you do it all the time. And now Todd goes, we know what that is. But in the absence of that language, and structure, one of those people has to figure out on their own there's an issue, figure out who else to talk to get them to come to a meeting. And so we are tasking people with inventing management and leadership on top of their job of doing it, and it's hard enough to do it right. So once you get that in place, it's boring. We stand up, we tear it down, and then it goes on. That's
Todd Powell 22:43
right. And I think it's important to remind ourselves, and we sort of struggled with this, too, it's like, no, well, no, like, you know, among our physics team, we like to look at challenges and solve challenges in this way. And in our market organization, we want to do it that way. And our service team does it this way. And that was just terribly inefficient, right. And getting to a point where we were we formalized, even if it was kind of a light touch formality. But to have that a lexicon, an approach, and sort of a template to use cross functionally, has allowed the service person to be on the physics team and drafted in and the physical physics person to go draft into a service team, and just not be caught off guard, like, Wait, what are we doing? You know, it's just like, people get it. And they can flow it, we found our ability to have teams be more fungible. In a cross functional setting, because of this, it's enabled project management to have a better footing in this process, because they can reach across as well. Yeah, I just haven't seen a downside. And I'm really glad we did it. It's been a super productive journey. And and it's now part of the fabric of what we do.
Ed Muzio 23:54
Yeah, yeah. And I think that the higher level, I think the other conversation we're having about what's what is, what's what can be good about an external engagement is even in a whole different space, I think, you know, part of what we're trying to do with what I'm doing is to say it is very light, right? So in my multinational clients, there could be templates that are pages long. The template toss talking about his four letters, literally, make sure you cover these four things and do it in less than three minutes. So we didn't on a single page. Yeah, on a single page, right. And so so we didn't say like, your marketing department likes asana and the other people like, that's fine, Keep it keep it you're doing for sure. Which in bigger companies, they they kind of get heavy with it. But being able to stay late is important. I think. I
Todd Powell 24:30
think it's definitely important to be able to stay late. I agree. So
Ed Muzio 24:33
I think we're close to the q&a part is I guess I want to ask you before we do that, from the lens of kind of behaviors, and you're kind of in a sense, your remote from a lot of what goes on the next level down, but do you see what do you see as systematic behaviors now that are almost like unquestioned, but you can look back to before we did it and say those weren't like that. I
Todd Powell 24:58
feel like we're We're much better at looking around corners. Like I feel like because of this methodology, and there's just the mindset of, of spending, you know, kind of 90% of our team engagement. Looking for ways we won't achieve a goal, whether it's a high goal, a low goal that feeds into a high goal, we understand the linkage between goals, every team has to quantify their goals. There's terminology for it, I won't get into, that's part of the methodology but, and then associate them to the higher level goals. So every single thing that every single thing in the company that everybody works on, no matter what function can be directly tied back to one or more corporate goals that are maintained. And if and if there's any reason to believe we aren't going to achieve one of the things down here it because of the methodology will ripple all the way up. And people like to do that, you know, that we sort of measure whether or not we're being honest with ourselves based on the number of these sort of one page things that are these early warning signs, how often they come up, and they, they come up a lot, it's, I think the early warning system is in place, right? It doesn't keep things from going wrong. But I feel like we're reacting to what's wrong faster, then I have seen in other companies that did not have a consistent methodology across all functions, right.
Ed Muzio 26:23
And I think that one thing I want to say about that the methodology pieces, and this is pretty important, I think, I don't know if I should name the one of the other bodies of work around goal setting, but But I will say it's really good. There's a body of work called OKRs. Maybe you've read the book, it's really very good. It comes from the same initial research and information that they generate content comes from. And that book is literally like my chapter three, I think. So it is very consistent with what I'm doing the benefit of that book, as it gets much deeper into how to do that part of it. Well, the downside of that book is there is a way to read it that makes it sound like as long as you get the goals, right, everything else falls into place. And that's not actually true. And I've seen time and again, this is especially true in the larger organizations, or people that have come out a large organization that you were doing this, but some of these guys in your seat will do this, where it's like, we came from one of the fewer high functioning large organizations. And now I'm going to do it here. And what's most visible is linked goals like OKRs. And the second thing that's most visible is regular meetings. And so I've seen multiple times executive, I don't understand I put linked goals and regular meetings in place. And it got more bureaucratic. Those two things by themselves, add bureaucracy, and they add, I think about a 15 to 18% tax on the organization. If you just do that, if you do the thing, Todd's talking about just the early warning system and the decision making and the cycling of raising issues, so that you're taking bite by bite out of the work, that's iterate, right, that's, that's the piece that makes it work, right.
Todd Powell 27:41
And I just think there's, there's just certain cultural things like the thing that I liked about this, and again, kind of refreshing my memory of some of the decision process that I went through when we took this on, as, at the end of the day, this is a change management journey, right. And we've all done change management projects. And, and there are great ways to do those and terrible ways to do those. And we've probably all lived through those examples. The thing that I really liked about this approach, and I found it common among every good change management journey I've been a part of is that it was relatively simple, right? It was straightforward, it was not tool based, like where you get a tool, and it's a software thing, and you have to do it every time I have a thought or a decision, I'd have to document in a tool that's awkward and hard to use. And then everybody's got to learn the tool. It just wasn't. These are like one page Word document artifacts, right, that are just simple. Because it was more it was like a, it was a change management process that started with a cultural impact, supported by simple kind of process improvements and methodologies and kind of a lexicon of vocabulary. Versus like, Oh, here's the ED software tool, and y'all gotta use that we need an annual subscription, you know, and all it was none of that. And so I, I felt like because it led with culture. It has been supportive of our culture and amplifying of our culture. And what I tell every employee that has ever worked at RefleXion, I and I literally mean it and you could ask anybody that's there. I want this to be the best job they've ever had, no matter what happens, I want it to be the best job they've ever had for the outcome of our patients for the outcome of our clinical partners and for the outcome of their career and the advancement of their own career. And, you know, that's super important to me, it's super important to my team. And part of that I think the biggest part of that is that trance they and they would tell you, I think if you ask them that they believe that RefleXion is among the most transparent companies they've ever worked for. And that's my goal, because I was part of great magical startups that were everybody knew everything. And we were all in it together. And it was the kind of classic Silicon Valley thing. And I've been parts of big bureaucratic organizations too, and I knew I just hated that and did not want to I want to do everything I could to go in the opposite direction to that. And so we hit this hard from that cultural perspective through the lens of transparency. And, and I think because this is a simple and easy to implement tool based on common sense, that appeals to people in that manner, it's amplified our transparency. And I think that's probably why people like it, right? They kind of know what we're doing. They know why we're doing it. They know what the risks are, they know how we're managing the risks, because there's a common set of things that we all share and publish lies. And you know, what I mean, it's just part of what we do. And I think that's, you know, at the end of the day, I mean, what more could I want from how a management team reacts, interact with each
Ed Muzio 30:40
other. And as hard as it sounds on the front end to say, we're gonna build a culture where people bring issues early and never go on wondering if there's really no, everything's fine in my area, look over there, you know, on the flip side of it, that creates the transparency that love and retention they love, because it's like, Oh, when I have a problem, there's a whole bunch of peers waiting for me to bring it to them to help me as early as I can. And they say thank you, and I bring it because they want to solve it sooner. And that's a that's a big flip of what's normally there. I don't think by the way on the on this, those of you are service providers, what makes a good engagement? When the guy who hires you says I'd like this to be one of your best effort, engagements to which Todd said to me when you hired me, that's a good sign. That's good manners. Yeah, no, and I, you know, I also I, I am lucky in that usually, my CEO clients self select out if they're trying to run dictatorships, or if they're overly obsessed with their own power, you know, because they hear me talking and go, I don't want to do that. But, you know, Todd was definitely all the way the other direction of like, someone who's saying, like, I see the importance of this, and I want to make sure we do this right. And it's worth a little bit investment wants to get it right, versus trying to hack our way through it and get it wrong a few times. And I think that's a good, a good, yeah.
Todd Powell 31:42
And especially, like, I don't want to take any, any excess credit for that, right. I mean, I think it's because it's just immediately identifiable to the people that are going through the change, you know, basic tenant of change management, right? Celebrate wins early, right and get every you know, so that you can kind of go, wow, this is worth doing some change management journeys, you got to wait a long time before you see some wins, right. So you're kind of hoping that you have enough momentum to sort of push through the first kind of break the first wall of ice, but we started seeing wins right away, cultural wins, transparency wins. And and I think that has created a momentum that the company has continued to build around. And it
Ed Muzio 32:22
hasn't, it was its fundraising, we got we got into COVID, a little bit. And so I ended up staying around a little differently with RefleXion than I would otherwise. Which was really cool for me, I got to see, like, I got to really see in real life, something happened the executive team, and then the next level down copied it, not because anyone told them to just because it made sense. And next level down, like it was like, Oh, they're they're all doing it. Like I got to see the theory of like cultural replication go down, which by the way, if you are an innovator, and you're running a team of any size, run your team as clean as you can, because they are all bad photocopies on the way down, right, don't get worse. So do your best to have to be cleaned. Because they will they will do it. Well, if you do it well. But if you do it, if you do it, but not clearly, it just gets it just gets fuzzier. So
Todd Powell 32:59
that's all I got. I don't know if you have anything else. But I mean, I know we're getting close on time. But um, this is probably a different kind of panel, then you've come to at LSI. It's a different kind of panel that I've been on at LSI. But he brought, but you know, I hope you found it interesting. And so I for one want to thank you for your time. Yeah,
Ed Muzio 33:22
I thank you also for your time. And thank you, Todd for for doing this. This has been a fun experience this way too. We have a few minutes left. If anyone wants to ask questions we can I think do it right. And then wait. Yeah, yeah. We'll go across those. Yeah, there are Oh, good. There you go. Can you hear me?
Audience Question 33:38
Is there a meta process? Which is to say like, every amount of time or every incident or whatever, we pause and we think, is this decision framework working? Do we need to change anything about it? Or? Right? Is there any of that built into the
Todd Powell 33:52
framework? I mean, not all answer my interpretation of that you will. Yes, is the short answer. And it's continuous. The book is called iterate, and it's based on and the methodology that we have adopted is based on continuous iterations with then current information. So whenever new information comes up, whether it's a lack of progress to challenge something that needs to be fixed, or corrected or influenced, otherwise, you won't achieve that goal. That's when it comes up. So it's sort of not like, Okay, see you next quarter or even see you next month. It's whenever it needs to come up. Exactly, you interpret I think that's right. I
Ed Muzio 34:30
think, you know, the thing I would say, from my perspective, is I always say I only know two things, what has to happen and how to get it to happen. So if you read the book and do it, that's all you need. Except you're right. The one thing I didn't put in the book that I will put the next edition is there should be a debrief process every so often to just check out what's going and so if
Todd Powell 34:46
that's what you're referring to sort of the broader process, health check on the process. We do that too. And so there is an opportunity and you know, fortunately my team has no trouble raising objections. And so they're We that that comes up a lot, too.
Audience Question 35:02
And can I ask a quick follow up? Is there some memorialization of the decisions and some annotation of how you arrived at that decision? And is that somewhere? So it's institutionalized? Somehow
Ed Muzio 35:13
decisions within the meetings? Or the decisions or decisions that would change?
Audience Question 35:17
You know, something about? Yeah, yes. Yeah, we do that, too. That's part of it. And there's, there's the one pagers or do you have like a separate log,
Todd Powell 35:24
we have an ongoing set of very quick minutes, especially around decisions, task force working group input output. So that all that's memorialized. So if we go back six months later, we've all been there, right? And you're like, why did we pick that? Again, you can go back and there's
Ed Muzio 35:36
some very block and tackle stuff built in here as well, some high level stuff, I want to answer a question you didn't ask. That's very related. Because I think it's super cool. One thing these guys did, which now I recommend is the best method, if the company is into it is when we got done you, you created a little brochure, and it said who we are matters, and it was mission vision values. And then the next page, it said, how we work matters. And it was RefleXion management methodology. So that's also memorialized, and they did it in a way of like, when someone comes in, like, here's the culture, and it's very clear, very clear, very short, so that they so that everyone coming in the door understands why and what why. Yeah, thank you over there. I think
Todd Powell 36:06
I was just curious how you're triaging these early warnings as they come in. Every team does this, but I'll speak to my team. So so we have our weekly stand ups every Tuesday. We deliberately do them on Tuesdays so that the team is in the office on Monday might pick up something that wouldn't otherwise pick up. And then by Friday evening, they have to have submitted everything that they would like to raise in the Tuesday meeting, including any issues that all look at and I decide one of the one of the parts of the methodology is, what are what are my deliberate active decisions versus you know, what, sometimes the team is trying to influence me to make a decision? And it needs to be clear that I'm the decider. I'm on the hook for that. Right. And, and so that's one, it's kind of an administrative example. But I decide what's going to be on the agenda or not, because I might delay something because I want some additional information to come in or anything like that. Yeah, so there is a triaging opportunity. So, but it works out pretty quickly, it's been rare that I say we're going to delay that one a week, or a few days based on some new information that they may not be aware of, or something like that. That's those are the exceptions. But we do have that opportunity to
Ed Muzio 37:23
one of the things that I've seen that relates to that is, and I don't know how much this was the case with you guys a little bit. I think sometimes it's more pronounced. Sometimes there's this effect of like, oh, it's staff, what are we gonna talk about? And when we get it up and running the right way, it's like, staff populates itself, because your people put it a bunch of issues, you're picking the highest priority one. And oh, by the way, three weeks ago, you had an issue, you put it on the agenda for today to come back with recommendations fast.
Todd Powell 37:43
Right? And so we're just like going around the table just like digging, digging, digging, digging, you know, I mean, it's really efficient. I mean, we, we still meet often, but but we get through a lot fast and efficiently.
Ed Muzio 37:56
I had another client that they they did the process. At the end, the leader pointed at somebody and said, You've been here the longest, what do you see as the difference? And this was a virtual one, it was worldwide group. And we do it virtually. And, and she goes, I just watched a recording of one of our staff meeting six months ago, and she goes, we weren't doing very much. And then like, in real time, she goes, Wait, Ed, you knew? And I was like, Well, I mean, you know, you're getting more done now. And that's, you know, there was there's potential there. Right. But it is it really is a it's hard to describe the level of like, how much more happens per cycle? Yeah, but
Todd Powell 38:24
it's, it's real. Yeah.
Audience Question 38:28
Thanks so much. Um, one of the things I'm struggling to understand is how do you get people out of that star startup, you know, firefighting phase, if you like, you're always looking at the thing that's right in front of you that needs to get done, and really get them to think about, well, what matters in 18 months that I have to address today.
Ed Muzio 38:46
I don't think you push them to 18 months, so much as you give them away to raise the issues, that's part of it, that accelerator is is like, you have to get those cleared, you can't say don't worry about this, look out there, you have to go we're gonna start to clear issues faster. And then they move out themselves, I think,
Todd Powell 39:00
yeah, I think I think there's a there's a push and pull. And they both happen, right? The pool is that look, we're going to shift from storytelling 80% of the time, to storytelling 10% of the time, and everything else is got to be forward looking, which by definition means we have to have goals, which by definition means we have to talk about the tactics to support those goals. Right. And so then there's a strategy session to produce the goals in the first place. And so, you know, you sort of inherently the poll is that the team are forced to think about the future more now the future might be a week, a month a day, six months, whatever, right? So it kind of depends on the function and where the company is obviously. But but the push is that at least in my case, like the reason I was talking about wanting to do this was because I saw that if we didn't there was gonna be a problem right? And we already started to feel pockets of it and the way you know how it goes right? Teams express their present frustration not to say like, Hey, we don't have you know, company Why goals are they don't say that they say, We don't feel aligned cross functionally, it's that kind of thing, right. And so sufficient pain gathers in the organization to the point where it is motivated for change. And that's the that's the pain you tap into, so that they're pushing. And then the poll is the goal setting and the tactics, I think it's both and and so if you if you can emphasize that pain, and you have the companies trust, and I'm sure you do, you know, you have the opportunity to kind of try something right. And as long as you get the early wins, quick buy in, it starts to build a virtuous bit of momentum behind it. Does that make sense? Yeah, so
Ed Muzio 40:37
we're hitting the time wall here, Todd, thank you so much for this. I'm gonna sign a purchase at my table over by registration. I also hit 10 books under the table. So if you don't have one yet, I might have one for you. But Todd, thank you so much. This has been fun and glad to thanks again. Thank you
I'm an engineer-turned-management-consultant, and for 20 years I've been providing analytical solutions to the challenges of running organizations of all sizes. If my information and links here seem like they'd be useful to you, let's connect.
I'm an engineer-turned-management-consultant, and for 20 years I've been providing analytical solutions to the challenges of running organizations of all sizes. If my information and links here seem like they'd be useful to you, let's connect.
Todd has over 25 years of experience in medical-technology & innovation leadership with multi-national, teams of all sizes from startups to over 1200 employees. IPO experience along with numerous mergers, acquisitions, technology and commercial partnerships.
He has a particular ability to formulate and nurture a vision and the strategy to commercially realize it through thoughtfully developed, cross-functional teams at the highest organizational levels.
Through his experience and industry relationships, Todd has a deep understanding of the complexities and nuance of the oncology market including the rapidly changing clinical, financial and operational challenges within healthcare networks.
Todd has over 25 years of experience in medical-technology & innovation leadership with multi-national, teams of all sizes from startups to over 1200 employees. IPO experience along with numerous mergers, acquisitions, technology and commercial partnerships.
He has a particular ability to formulate and nurture a vision and the strategy to commercially realize it through thoughtfully developed, cross-functional teams at the highest organizational levels.
Through his experience and industry relationships, Todd has a deep understanding of the complexities and nuance of the oncology market including the rapidly changing clinical, financial and operational challenges within healthcare networks.
Ed Muzio 0:05
Good afternoon, everybody. I think at a real high level, there are two useful things we can do in this dialogue. One of them is talk about the possible organizational improvements that can happen. I think that's probably pertinent to the innovators and maybe some of the investors. And I think the other one is, there's sort of a, how does good external engagement look compared to not so good and external engagement of like what's possible? So I feel like then that have useful to some of the providers in the audience as well. So I feel like we could probably talk on both of those channels. Yeah, I
Todd Powell 0:35
think so. And hi, everyone. That sounds good. I think, obviously, this isn't deeply rehearsed. But I think the the full scope of these topics are near and dear to our hearts. And we're excited to share some stories with you and do as we go, should we kind of entertain questions as they come to? Or do you want to kind of keep it?
Ed Muzio 0:57
We can keep it old conversation, I think, yeah, we'll try and leave maybe 10 ish minutes every we've never had a meeting that went more than 28 minutes. So I feel like we're probably no, I think that's probably true. We're both talkers. So I for time, we do a lot. So maybe I'm thinking we start with what your need was, when we met, it's a good place to start. Sure, I
Todd Powell 1:13
can do that again. So I'm Todd. I'm the president, CEO of RefleXion, medical. And the company has been around since 2009. But in many ways, it was kind of two guys, the classic two guys in a laptop story for the first five years, raised his first institutional capital in 2014, with sofinnova, and Venrock, as well as Pfizer, and then has had rounds kind of ever since then raised a little over $650 million. And we just set a little bit of context, right for the kind of the history of the company started treating our first patients with our novel form of therapy, which very quickly, this isn't about RefleXion, per se. So I'll keep this very quick, but which is a form of radiation therapy that uses injectable radiopharmaceuticals pet tracers. And as you probably appreciate how pet tracers work, they target and collect, in our case, cancer. And then we've built a machine that is uniquely and for the first time sensitive to those signals, and can fire right back at the origin of those signals, which is, again, the cancer itself. In fact, that's where the name RefleXion comes from. We started those actual therapeutic treatments last year in August, and now done that throughout our installed base. And we're seeing really fun and compelling clinical results already, with 50 publications, abstracts already accepted this year. So it's super exciting time for the companies, we kind of roll through science into kind of early commercial and clinical rollout, right, that's kind of the face of the company. Like Like, I think a lot of the companies you're you are all familiar with. And getting back to your question. And when did we start engaging in talking? It was probably 2018, maybe, right? Right, right around, then I joined the company in 2017, as a CEO to sort of transition the company from a team of physicists into a company, right, so to take a technology and sort of start to turn it into something that can be produced at scale. And, and to kind of do that I've been in med tech for about 30 years, and spent about a third of that as a software engineering then kind of moved into different kinds of management, stuff like that. But it was clear, when I joined the company, there were about 50 of us, and we were well capitalized and have continued to be well capitalized, we were growing fast, it's at we're a big expensive med tech, we have a, you know, 50,000 square foot factory that can make 125 of these big and heavy and expensive machines per year that machines kind of look like something you would shoot into space, you know. So it's kind of the typical big capital kind of story. And so, we're growing fast, hiring a lot of people, all different types of people, not just the physicists and engineers. And it was very clear to us during that phase of growth, or that was kind of the first knee of inflection in our growth, right. As we sort of transition to this phase, it was clear that if we did not embrace, proactively, deliberately a management methodology, and by that I don't mean a program or project management methodology, I mean, a decision making methodology, a strategy and management of the tactics to support a strategy and an early warning system related to all that so you can make course corrections quickly, because it was we all know, you have to it was clear that through that rapid growth of personnel that if we didn't proactively design a system, build a system and implement it, that system was going to grow organically, with or without us. And it would be a hodgepodge of half a dozen methodologies through well intentioned people that would join the company and it would just be sort of chaotic. And that was the situation we were in and I'll tell you a little bit more about how we came to know you and what that change, but that was the landscape at the time that you and I started talking.
Ed Muzio 4:55
Yeah, that was the starting point. And so for me, kind of my background and context I was an engineer I started my career as a mechanical engineer. But I started my career at Intel back when there was no such thing as Intel computer engineers, so they just hired any engineer that could fog a mirror. And then they showed us when we got there, how to do it. So I was that for 10 years. And while I was there, I got kind of entrenched in their methodology that was back when they were among a small number of companies that were running a 10 year product roadmap with 18 month product releases, each of which was to release into a market that did not exist yet and wasn't clear that ever exist. So they just be super agile and adaptable, even though they were this giant company. And so I sort of grew up in that. Then I left I went into consulting and ended up forming a relationship with someone who became a mentor of mine, I started working on culture stuff, he had been working on kind of the sociological elements of what goes on high performing management, going back to like old school behavioral research from the 60s of guys with clipboards following managers around and saying, Is there something management? Does that makes things better? Or does it not matter? And there's some answers to that. And so that all came together for me. And so I've been, I've been doing this embodiment of this kind of work for around 10 years now, which is to answer the question of how do we need to run so that when we get bigger, we get faster? If I, some of you have met with me this week, if I've said this already to you, but if I take your computer, and I put a new processor in it, and I give it back to you, and I say to you, you it's now run by a larger, more complex system. So it'll be slower get used to it, you would fire me as your IT person, right. But that is a lot of what comes out of the org development and HR space around, what you should do is if you're a leader, you better start slowing down a little and kind of thread this needle between you gotta go slow to be accountable, but you got to go fast to stay alive. And it's kind of unfair, because it tips that about 25 to 50 people, and you better still be faster to that small. So, um, so that's my background. So I came into it, and here they are looking for a methodology. And I've been working on this, like, what happens when, you know, what do we have to do to make the company run?
Todd Powell 6:53
That's right. And when I first started to get to know it, and I think we were introduced by a really sharp project manager that works for us. And he was at Kla, 10 core, right, we had worked together, obviously, a very big, sophisticated company that, that is very robust in its project management. And, and I think you worked with that individual to stand up some of this technology there. And, you know, as when I came to RefleXion, at that time, I had been part of small startups that grew into kind of big companies, and I've been, you know, run large teams all around the world. You know, and over those years, probably, like, a lot of you, I had the experience of kind of coming into a company, and then being responsible for a change management journey, where you might have had a company that had grown through maybe a dozen, maybe 20, acquisitions all around the world, you know, so you not only have geography and language to contend with, you have wildly different, you know, cultures and wildly different philosophies about what management even means, what decision making even means, what consensus means or doesn't mean, and how much is that important and, and, you know, happy to come in, and I was responsible for a change management journey, and one of those and was not a lot of fun. It was really brutal. And I wanted to get as far ahead of that pain with this company as I could. And it was like it, you know, so I'm kind of going into a bunch of physicists and engineers, super smart people, that RefleXion, best team I've ever had the honor of working with. And I'm saying, Look, we're going to implement a management methodology. And they're like, why, why would you do that? But you know, you couldn't pry it out of the company. Now, if you had to pry it out of the company, you couldn't, because people realize the efficiency of it the inherent effectiveness of having a common lexicon a common set of dashboards that everybody understands, we can, you know, and I'm probably jumping ahead, right, but you can, that's what we do. That's how all of our conversations tend to go. But, you know, we can move people between teams completely different a marketing person can jump over into a science deep team and advanced development team can pull back and deal with a support team that's dealing with the current release in the field. And they all have a common lexicon, they all have a common method for establishing and tracking progress towards goals and and a common tool set for escalating things when early warning signs go off. And they're gonna go off because there's a methodology to ensure they go off. You know, we all have this kind of common toolkit about how to stand up task forces and working groups and they live and then they're reported upon and then they die and we move on. And it's, it's turned out to be really slick. It's really stuck. Well, it's stuck Absolutely. To the point where in fact, we don't, it's got a book. Maybe you've seen it, and an ad talks about his company, and he's good at all this stuff, as I'm sure you're gonna pick up on, but we took it and made it our own. So we, we don't call it iterate now, which is the title of your book. And and in fact, when people say it, I kind of, you know, kind of smack them on it a little bit because we now call it the RefleXion management methodology, right? Because it's, we've taken the basic tenants of it, rolled it into our own framework. And that's just what we onboard people with now, when they when they start, they, you know, they get that as part of the onboarding process, we train that we do on site trainings, you've trained us so that we train ourselves on that now shifted from sort of a foreground role for a couple of years to a back away, and back away. Yeah, and that is your goal. And as your goal from the beginning,
Ed Muzio 10:31
I'm supposed to get out. And that's engineers work themselves out of jobs and consultants work themselves into jobs. And I'm an engineer first. And that's, I think one of the unique things is that, I guess, yeah, I think that's
Todd Powell 10:40
true. And that resonated with me, too, with my background, being in physics and engineering. And I immediately got the way Ed taught. And we're a super sciency engineer, kind of driven, like at our core, right? These are really smart people. And I knew that if I came at them with sort of the, I hope I'm not going to offend anybody. When I say McKinsey or anything, I'm so sorry. But you know, like, I've been in those big companies, too. And I've rolled out those multimillion dollar change management journeys driven by that kind of thing. And so I get that, totally. But I knew that if I came with anything that even smelled like that, it just wasn't going to fly. Right. But you came in and said, This is the beginning. And pretty quick. If this goes, well, you're not going to see me anymore. And it was like, I thought that was pretty cool. And I think and I think it's proven to earn the trust of the organization to kind of take those first leaps. And then it's the progress that kind of pays for the next leaps, right? People just kind of get it. Like I said, we I don't think we could pull it out of there. Now if we try to without that we would right
Ed Muzio 11:45
now. And I think that's I mean, maybe this is both of those conversations, what's possible in this kind of work and what's possible in general, but, you know, I think they're the the HR slash HR thought leader universe has a machine where publishers go to conferences and listen for buzzwords, not knowing what they mean. And then get people to write books about those buzzwords and then push it back out there. And so it's an echo chamber in a lot of ways. I don't mean to say there are not good HR and OD thought leaders out there. I mean, to say there are many more of them than there are good ones. And so so that has led to a sort of an overall ethos of like, posters. So I'm supposed to leave my poster on Todd's wall with my footnote of Ed museo iterate with little r. And that is actually antithetical to real system change. Because the system I have taken to doing my personal career development by hanging out with people that understand how brains work, because organizational systems are a lot more like the complex neurological network of the brain than they are like the org chart we're using in HR, right. So if we're gonna make a system change, we have to get past the equivalent of the immune system. And one really good way to activate the immune system is to put a sign on it that says, this didn't come from here, right? This is from outside, and then I come in, you pay me and I leave and my poster stays. But that's all that stays. Right. So we were really intentional and and always are very intentional to not just yours, this is yours. Take it your language and
Todd Powell 13:01
do it. Yeah. And it's and it's been fun. You know, I think Ed obviously has a style that I think resonates with me, I mean, it's a nerd. And I mean that in the most complimentary way. And our company is, you know, a bunch of nerds, right and myself included, and we get it, we kind of spoke a common language. And it was just a no nonsense approach to make people more efficient, so that they can focus their time and energy on the stuff they love to do. Where the management sort of is automatic. And I've been really just on obviously, I was pleased, right, you know, I mean, I wouldn't be here supporting a in talk, having a conversation with you about this unless I was and and you know, and it's funny, because I, when we first started talking about this panel, and we talked to Scott about doing this and things like that. It was a little like, I think we both sort of asked ourselves the question, Well, is there an audience here that will be interested in this? Or, you know, we were like, until five minutes ago, we're like, is anybody even going to write you know, as like, is anybody going to come? But what we told ourselves, and hopefully, it's true, I'm not trying to speak for anybody, maybe there, maybe there was just no other place to sit down or something, but but the, the, I, you should care about it. I just don't know how to say it. Right. But you should care about this stuff, whether you're running a company, I know you care about it, you know, but as an investor, you should care about it too, right? Because obviously, the one thing we all learn in working with investors is that you invest in people, right? You invest in teams. And and this methodology is like the grease between the gears of a team right and it pulls teams together. It makes them more efficient. It reduces the grind of those gears and you know, as an investor, you should want that and, but don't raise your price. I think as an investor, we want it to remain cost of Active too. And you aren't cost effective, especially when you compare it to some of those other things out there, where you leave the poster behind. Right? Well, yeah,
Ed Muzio 15:07
you know, one of the things that that I think is, is probably worth mentioning here, just sort of what I'm actually putting in place, because it's really fairly simple. And this is, you know, this is where the engineer goes in me goes, you know, I say I can do this and a quarter. And other bigger name firm will say, it'll take two years and $10 million. And I go, I don't understand what you're doing for those two years, because we're just making a system change. All we're really doing and a fundamental level is usually 25 to 50 people, and I work with that size up to multinationals. You tip from, we all get into a room and look where we're going to do it, too. We now have layers and Todd's my boss's boss. So I'm, I'm going to make a status update to my boss, that looks good for Todd because either my boss is a little worried, or I'm a little worried or something. And so all of a sudden, Todd finds himself sitting in a staff meeting with a series of nine minute status updates. And so it becomes his job to look down at these updates and go, I think that was telling the truth. And now it's my job to put them together. Where what we what we really want is not something theatrical, like that. And so the change we make is to go know what's gonna happen in that meeting is they're all gonna come in, and they're gonna go, Look, we're going here together as a group. And right now my piece says, we're gonna end up here, and that's a difference. So I want to put this on the table right now, I think we should do this, this and this, to bring those two things together. And so that takes about three minutes instead of nine, and so on to make a decision about that we implement it. And so that decision breaks something else, or something else breaks on its own. And next week, we make a new decision. So we're putting more decisions in more frequent cycles. And you can speak to how that looked in your staff at that general thing we're trying to do.
Todd Powell 16:34
Yeah, no, and thanks for that reminder, because it's funny, because we've been doing this now for a few years. Right. Right. Right. Yeah. And it's interesting that you reminded me of, of feeling that my team and I had when we started rolling this out, and it was immediate. And like a lot of startups, we all know, it's hard, right? It's incredibly hard. It's super stressful. And there's always something right, and what teams tend to do, and my experience of every startup I've been a part of, and I'm sure this is common among you, as well, it's easy to fall into a trap of a lot of storytelling, right? Because it's like, Hey, look at this incredible thing that I overcame over the last month, and you spend a lot of time, storytelling. And and and those stories are important because they bring a team together. And it's part of the fabric of self support that we I think we all appreciate is necessary in a startup trying to do something new and important and difficult. But if you don't tilt the equation, so that it's maybe 10%, storytelling 90% forward looking, you're you're not seeing around corners, you need to see, and then you know, you're you're going to react to things that you should be avoiding, to some degree, right, you'll never avoid everything, but you get the you get the idea. And I think we had started falling into that trap. And and we immediately noticed through the discipline of a relatively simple and straightforward methodology that we flipped that and the storytelling went down. In fact, it went so far down, I'll tell you what we did about in a minute. It went so far down that we spent all of our time forward looking, but we immediately were talking about the right things that were potentially months into the future. And we're doing that in a very consistent manner across a team, all staring at a single single kind of guiding point on the horizon in terms of goals, right. And, you know, I don't just mean one goal, like, you know, address late stage cancer that we're working on, but the detailed goals for that year, enable the to enable that, right. And, in fact, we got so good at not storytelling, that we had to add a section to our formal agenda called Cafe time. And it's a little just to do a little bit. So at the end of every agenda, there's a cafe slot, and it's just sort of like, Hey, you're hanging out with colleagues at a coffee shop, having an espresso or whatever, and it's an opportunity to share stories, right, that's, you know, in fact, you shouldn't be bringing up something that you should be bringing up in the bulk of the, of the weekly meeting. And, and it's turned out to be great. So people kind of separate that, and they kind of know. So it's not like we carved that out so much that people felt like they didn't have the opportunity for that storytime, but there's this the storytelling, the socialization of those events happen in a dedicated slot, which is proportionally appropriate, versus the bulk of the management methodology. You
Ed Muzio 19:24
remember, Todd, I don't remember this or not. But like when we when I when I come in first, I observed some meetings. And then we do a big touchpoint. It's like a, it's like an on site off site. Except when you get back instead of being three days behind. You're three weeks ahead, because we actually do the work of the company for a few days with three layers. So Todd has people there people, but I watched a couple of meetings, your staff meeting, and it was all intelligent, good stuff around stuff that was coming up in the next I'd say four to six weeks, maybe eight to 10 weeks. And then we did that process and the first staff meeting after one of your people came in and went in 18 months we're gonna do the installs and if we don't solve this now it's not gonna work and you and I looked each other went, there it is. That's
Todd Powell 19:59
right there. Yeah. And it was just really cool. Right? Yeah. And ever since then I
Ed Muzio 20:03
think it was it was there. I think
Todd Powell 20:05
so too, that that sort of solidified it. Right. And we got it. Yeah.
Ed Muzio 20:09
So it's it's a, it's, it seems sort of strange. And part of the reason I'm so appreciative of Todd for doing this is normally my clients come in through referrals, because I say, I'll come in and fix this in three months. And you know, big name firm says two years and $20 million, and I seem like a crazy person, except then I come in to fix three months. So Todd calls his friend, like over there, that's how it usually works. So and it's only because it's not, as he said, it's not that complicated. The trick is to shift the behavior as collective habits. And I think that's a good thing to talk about is how the habits of your people changed. Yeah. And from that view, it
Todd Powell 20:42
is that collective habit is totally right. I mean, now, it's, you know, there's part of this process is kind of a formal process for creating, updating and deploying goals across the entire company, which, you know, it's more than an all hands to say, this is what we're doing, right? I mean, it's sort of the, it's through the methodology that these things are memorialized, and artifacts are created that can be tracked in every single team meeting. And like, if, if I am behind on something like that, because I'm out raising capital, or any other things that we do, I mean, I have people nagging me for the, for the artifacts of this methodology, like right away. And it's, that tells you something too, right? I mean, people won't let this stuff go. They are counting on it that, you know, when we establish Task Force and working groups, we all know what a task force and a working group is. But there's a specific methodology for that, and our behavior, and people just expect it and we report on it. And they people know what that means. They understand the difference. There's a decision making timeline that, you know, there's all kinds of just sort of very pragmatic things that we understand, because
Ed Muzio 21:54
actually, I think that so that the task force and working group, you guys have that language, now we do. But that's actually turns out to be a really important thing, right? So so if you're doing this, right, we're in Todd staff. And there's a decision to make, and we have to get you, you got to figure this out. And so if this is working in town, staff, Todd goes, you you take two weeks, go come back in the recommendation, we're putting on the agenda in two weeks. And that's called the task force, which is your only job as recommendation come back. And it's boring, and you do it all the time. And now Todd goes, we know what that is. But in the absence of that language, and structure, one of those people has to figure out on their own there's an issue, figure out who else to talk to get them to come to a meeting. And so we are tasking people with inventing management and leadership on top of their job of doing it, and it's hard enough to do it right. So once you get that in place, it's boring. We stand up, we tear it down, and then it goes on. That's
Todd Powell 22:43
right. And I think it's important to remind ourselves, and we sort of struggled with this, too, it's like, no, well, no, like, you know, among our physics team, we like to look at challenges and solve challenges in this way. And in our market organization, we want to do it that way. And our service team does it this way. And that was just terribly inefficient, right. And getting to a point where we were we formalized, even if it was kind of a light touch formality. But to have that a lexicon, an approach, and sort of a template to use cross functionally, has allowed the service person to be on the physics team and drafted in and the physical physics person to go draft into a service team, and just not be caught off guard, like, Wait, what are we doing? You know, it's just like, people get it. And they can flow it, we found our ability to have teams be more fungible. In a cross functional setting, because of this, it's enabled project management to have a better footing in this process, because they can reach across as well. Yeah, I just haven't seen a downside. And I'm really glad we did it. It's been a super productive journey. And and it's now part of the fabric of what we do.
Ed Muzio 23:54
Yeah, yeah. And I think that the higher level, I think the other conversation we're having about what's what is, what's what can be good about an external engagement is even in a whole different space, I think, you know, part of what we're trying to do with what I'm doing is to say it is very light, right? So in my multinational clients, there could be templates that are pages long. The template toss talking about his four letters, literally, make sure you cover these four things and do it in less than three minutes. So we didn't on a single page. Yeah, on a single page, right. And so so we didn't say like, your marketing department likes asana and the other people like, that's fine, Keep it keep it you're doing for sure. Which in bigger companies, they they kind of get heavy with it. But being able to stay late is important. I think. I
Todd Powell 24:30
think it's definitely important to be able to stay late. I agree. So
Ed Muzio 24:33
I think we're close to the q&a part is I guess I want to ask you before we do that, from the lens of kind of behaviors, and you're kind of in a sense, your remote from a lot of what goes on the next level down, but do you see what do you see as systematic behaviors now that are almost like unquestioned, but you can look back to before we did it and say those weren't like that. I
Todd Powell 24:58
feel like we're We're much better at looking around corners. Like I feel like because of this methodology, and there's just the mindset of, of spending, you know, kind of 90% of our team engagement. Looking for ways we won't achieve a goal, whether it's a high goal, a low goal that feeds into a high goal, we understand the linkage between goals, every team has to quantify their goals. There's terminology for it, I won't get into, that's part of the methodology but, and then associate them to the higher level goals. So every single thing that every single thing in the company that everybody works on, no matter what function can be directly tied back to one or more corporate goals that are maintained. And if and if there's any reason to believe we aren't going to achieve one of the things down here it because of the methodology will ripple all the way up. And people like to do that, you know, that we sort of measure whether or not we're being honest with ourselves based on the number of these sort of one page things that are these early warning signs, how often they come up, and they, they come up a lot, it's, I think the early warning system is in place, right? It doesn't keep things from going wrong. But I feel like we're reacting to what's wrong faster, then I have seen in other companies that did not have a consistent methodology across all functions, right.
Ed Muzio 26:23
And I think that one thing I want to say about that the methodology pieces, and this is pretty important, I think, I don't know if I should name the one of the other bodies of work around goal setting, but But I will say it's really good. There's a body of work called OKRs. Maybe you've read the book, it's really very good. It comes from the same initial research and information that they generate content comes from. And that book is literally like my chapter three, I think. So it is very consistent with what I'm doing the benefit of that book, as it gets much deeper into how to do that part of it. Well, the downside of that book is there is a way to read it that makes it sound like as long as you get the goals, right, everything else falls into place. And that's not actually true. And I've seen time and again, this is especially true in the larger organizations, or people that have come out a large organization that you were doing this, but some of these guys in your seat will do this, where it's like, we came from one of the fewer high functioning large organizations. And now I'm going to do it here. And what's most visible is linked goals like OKRs. And the second thing that's most visible is regular meetings. And so I've seen multiple times executive, I don't understand I put linked goals and regular meetings in place. And it got more bureaucratic. Those two things by themselves, add bureaucracy, and they add, I think about a 15 to 18% tax on the organization. If you just do that, if you do the thing, Todd's talking about just the early warning system and the decision making and the cycling of raising issues, so that you're taking bite by bite out of the work, that's iterate, right, that's, that's the piece that makes it work, right.
Todd Powell 27:41
And I just think there's, there's just certain cultural things like the thing that I liked about this, and again, kind of refreshing my memory of some of the decision process that I went through when we took this on, as, at the end of the day, this is a change management journey, right. And we've all done change management projects. And, and there are great ways to do those and terrible ways to do those. And we've probably all lived through those examples. The thing that I really liked about this approach, and I found it common among every good change management journey I've been a part of is that it was relatively simple, right? It was straightforward, it was not tool based, like where you get a tool, and it's a software thing, and you have to do it every time I have a thought or a decision, I'd have to document in a tool that's awkward and hard to use. And then everybody's got to learn the tool. It just wasn't. These are like one page Word document artifacts, right, that are just simple. Because it was more it was like a, it was a change management process that started with a cultural impact, supported by simple kind of process improvements and methodologies and kind of a lexicon of vocabulary. Versus like, Oh, here's the ED software tool, and y'all gotta use that we need an annual subscription, you know, and all it was none of that. And so I, I felt like because it led with culture. It has been supportive of our culture and amplifying of our culture. And what I tell every employee that has ever worked at RefleXion, I and I literally mean it and you could ask anybody that's there. I want this to be the best job they've ever had, no matter what happens, I want it to be the best job they've ever had for the outcome of our patients for the outcome of our clinical partners and for the outcome of their career and the advancement of their own career. And, you know, that's super important to me, it's super important to my team. And part of that I think the biggest part of that is that trance they and they would tell you, I think if you ask them that they believe that RefleXion is among the most transparent companies they've ever worked for. And that's my goal, because I was part of great magical startups that were everybody knew everything. And we were all in it together. And it was the kind of classic Silicon Valley thing. And I've been parts of big bureaucratic organizations too, and I knew I just hated that and did not want to I want to do everything I could to go in the opposite direction to that. And so we hit this hard from that cultural perspective through the lens of transparency. And, and I think because this is a simple and easy to implement tool based on common sense, that appeals to people in that manner, it's amplified our transparency. And I think that's probably why people like it, right? They kind of know what we're doing. They know why we're doing it. They know what the risks are, they know how we're managing the risks, because there's a common set of things that we all share and publish lies. And you know, what I mean, it's just part of what we do. And I think that's, you know, at the end of the day, I mean, what more could I want from how a management team reacts, interact with each
Ed Muzio 30:40
other. And as hard as it sounds on the front end to say, we're gonna build a culture where people bring issues early and never go on wondering if there's really no, everything's fine in my area, look over there, you know, on the flip side of it, that creates the transparency that love and retention they love, because it's like, Oh, when I have a problem, there's a whole bunch of peers waiting for me to bring it to them to help me as early as I can. And they say thank you, and I bring it because they want to solve it sooner. And that's a that's a big flip of what's normally there. I don't think by the way on the on this, those of you are service providers, what makes a good engagement? When the guy who hires you says I'd like this to be one of your best effort, engagements to which Todd said to me when you hired me, that's a good sign. That's good manners. Yeah, no, and I, you know, I also I, I am lucky in that usually, my CEO clients self select out if they're trying to run dictatorships, or if they're overly obsessed with their own power, you know, because they hear me talking and go, I don't want to do that. But, you know, Todd was definitely all the way the other direction of like, someone who's saying, like, I see the importance of this, and I want to make sure we do this right. And it's worth a little bit investment wants to get it right, versus trying to hack our way through it and get it wrong a few times. And I think that's a good, a good, yeah.
Todd Powell 31:42
And especially, like, I don't want to take any, any excess credit for that, right. I mean, I think it's because it's just immediately identifiable to the people that are going through the change, you know, basic tenant of change management, right? Celebrate wins early, right and get every you know, so that you can kind of go, wow, this is worth doing some change management journeys, you got to wait a long time before you see some wins, right. So you're kind of hoping that you have enough momentum to sort of push through the first kind of break the first wall of ice, but we started seeing wins right away, cultural wins, transparency wins. And and I think that has created a momentum that the company has continued to build around. And it
Ed Muzio 32:22
hasn't, it was its fundraising, we got we got into COVID, a little bit. And so I ended up staying around a little differently with RefleXion than I would otherwise. Which was really cool for me, I got to see, like, I got to really see in real life, something happened the executive team, and then the next level down copied it, not because anyone told them to just because it made sense. And next level down, like it was like, Oh, they're they're all doing it. Like I got to see the theory of like cultural replication go down, which by the way, if you are an innovator, and you're running a team of any size, run your team as clean as you can, because they are all bad photocopies on the way down, right, don't get worse. So do your best to have to be cleaned. Because they will they will do it. Well, if you do it well. But if you do it, if you do it, but not clearly, it just gets it just gets fuzzier. So
Todd Powell 32:59
that's all I got. I don't know if you have anything else. But I mean, I know we're getting close on time. But um, this is probably a different kind of panel, then you've come to at LSI. It's a different kind of panel that I've been on at LSI. But he brought, but you know, I hope you found it interesting. And so I for one want to thank you for your time. Yeah,
Ed Muzio 33:22
I thank you also for your time. And thank you, Todd for for doing this. This has been a fun experience this way too. We have a few minutes left. If anyone wants to ask questions we can I think do it right. And then wait. Yeah, yeah. We'll go across those. Yeah, there are Oh, good. There you go. Can you hear me?
Audience Question 33:38
Is there a meta process? Which is to say like, every amount of time or every incident or whatever, we pause and we think, is this decision framework working? Do we need to change anything about it? Or? Right? Is there any of that built into the
Todd Powell 33:52
framework? I mean, not all answer my interpretation of that you will. Yes, is the short answer. And it's continuous. The book is called iterate, and it's based on and the methodology that we have adopted is based on continuous iterations with then current information. So whenever new information comes up, whether it's a lack of progress to challenge something that needs to be fixed, or corrected or influenced, otherwise, you won't achieve that goal. That's when it comes up. So it's sort of not like, Okay, see you next quarter or even see you next month. It's whenever it needs to come up. Exactly, you interpret I think that's right. I
Ed Muzio 34:30
think, you know, the thing I would say, from my perspective, is I always say I only know two things, what has to happen and how to get it to happen. So if you read the book and do it, that's all you need. Except you're right. The one thing I didn't put in the book that I will put the next edition is there should be a debrief process every so often to just check out what's going and so if
Todd Powell 34:46
that's what you're referring to sort of the broader process, health check on the process. We do that too. And so there is an opportunity and you know, fortunately my team has no trouble raising objections. And so they're We that that comes up a lot, too.
Audience Question 35:02
And can I ask a quick follow up? Is there some memorialization of the decisions and some annotation of how you arrived at that decision? And is that somewhere? So it's institutionalized? Somehow
Ed Muzio 35:13
decisions within the meetings? Or the decisions or decisions that would change?
Audience Question 35:17
You know, something about? Yeah, yes. Yeah, we do that, too. That's part of it. And there's, there's the one pagers or do you have like a separate log,
Todd Powell 35:24
we have an ongoing set of very quick minutes, especially around decisions, task force working group input output. So that all that's memorialized. So if we go back six months later, we've all been there, right? And you're like, why did we pick that? Again, you can go back and there's
Ed Muzio 35:36
some very block and tackle stuff built in here as well, some high level stuff, I want to answer a question you didn't ask. That's very related. Because I think it's super cool. One thing these guys did, which now I recommend is the best method, if the company is into it is when we got done you, you created a little brochure, and it said who we are matters, and it was mission vision values. And then the next page, it said, how we work matters. And it was RefleXion management methodology. So that's also memorialized, and they did it in a way of like, when someone comes in, like, here's the culture, and it's very clear, very clear, very short, so that they so that everyone coming in the door understands why and what why. Yeah, thank you over there. I think
Todd Powell 36:06
I was just curious how you're triaging these early warnings as they come in. Every team does this, but I'll speak to my team. So so we have our weekly stand ups every Tuesday. We deliberately do them on Tuesdays so that the team is in the office on Monday might pick up something that wouldn't otherwise pick up. And then by Friday evening, they have to have submitted everything that they would like to raise in the Tuesday meeting, including any issues that all look at and I decide one of the one of the parts of the methodology is, what are what are my deliberate active decisions versus you know, what, sometimes the team is trying to influence me to make a decision? And it needs to be clear that I'm the decider. I'm on the hook for that. Right. And, and so that's one, it's kind of an administrative example. But I decide what's going to be on the agenda or not, because I might delay something because I want some additional information to come in or anything like that. Yeah, so there is a triaging opportunity. So, but it works out pretty quickly, it's been rare that I say we're going to delay that one a week, or a few days based on some new information that they may not be aware of, or something like that. That's those are the exceptions. But we do have that opportunity to
Ed Muzio 37:23
one of the things that I've seen that relates to that is, and I don't know how much this was the case with you guys a little bit. I think sometimes it's more pronounced. Sometimes there's this effect of like, oh, it's staff, what are we gonna talk about? And when we get it up and running the right way, it's like, staff populates itself, because your people put it a bunch of issues, you're picking the highest priority one. And oh, by the way, three weeks ago, you had an issue, you put it on the agenda for today to come back with recommendations fast.
Todd Powell 37:43
Right? And so we're just like going around the table just like digging, digging, digging, digging, you know, I mean, it's really efficient. I mean, we, we still meet often, but but we get through a lot fast and efficiently.
Ed Muzio 37:56
I had another client that they they did the process. At the end, the leader pointed at somebody and said, You've been here the longest, what do you see as the difference? And this was a virtual one, it was worldwide group. And we do it virtually. And, and she goes, I just watched a recording of one of our staff meeting six months ago, and she goes, we weren't doing very much. And then like, in real time, she goes, Wait, Ed, you knew? And I was like, Well, I mean, you know, you're getting more done now. And that's, you know, there was there's potential there. Right. But it is it really is a it's hard to describe the level of like, how much more happens per cycle? Yeah, but
Todd Powell 38:24
it's, it's real. Yeah.
Audience Question 38:28
Thanks so much. Um, one of the things I'm struggling to understand is how do you get people out of that star startup, you know, firefighting phase, if you like, you're always looking at the thing that's right in front of you that needs to get done, and really get them to think about, well, what matters in 18 months that I have to address today.
Ed Muzio 38:46
I don't think you push them to 18 months, so much as you give them away to raise the issues, that's part of it, that accelerator is is like, you have to get those cleared, you can't say don't worry about this, look out there, you have to go we're gonna start to clear issues faster. And then they move out themselves, I think,
Todd Powell 39:00
yeah, I think I think there's a there's a push and pull. And they both happen, right? The pool is that look, we're going to shift from storytelling 80% of the time, to storytelling 10% of the time, and everything else is got to be forward looking, which by definition means we have to have goals, which by definition means we have to talk about the tactics to support those goals. Right. And so then there's a strategy session to produce the goals in the first place. And so, you know, you sort of inherently the poll is that the team are forced to think about the future more now the future might be a week, a month a day, six months, whatever, right? So it kind of depends on the function and where the company is obviously. But but the push is that at least in my case, like the reason I was talking about wanting to do this was because I saw that if we didn't there was gonna be a problem right? And we already started to feel pockets of it and the way you know how it goes right? Teams express their present frustration not to say like, Hey, we don't have you know, company Why goals are they don't say that they say, We don't feel aligned cross functionally, it's that kind of thing, right. And so sufficient pain gathers in the organization to the point where it is motivated for change. And that's the that's the pain you tap into, so that they're pushing. And then the poll is the goal setting and the tactics, I think it's both and and so if you if you can emphasize that pain, and you have the companies trust, and I'm sure you do, you know, you have the opportunity to kind of try something right. And as long as you get the early wins, quick buy in, it starts to build a virtuous bit of momentum behind it. Does that make sense? Yeah, so
Ed Muzio 40:37
we're hitting the time wall here, Todd, thank you so much for this. I'm gonna sign a purchase at my table over by registration. I also hit 10 books under the table. So if you don't have one yet, I might have one for you. But Todd, thank you so much. This has been fun and glad to thanks again. Thank you
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