Stay Adaptable and Scalable at Every Size — Growing from Five Employees to Hundreds | LSI USA '25

Ed Muzio  0:05  
Well, hi everybody. Glad you're here. This has been a new topic, a new ish topic, I think, in this way, for LSI and where this came from, I'll tell you more about me. We get to intros, but just to kind of tee up what we're doing here, I was here last year. I did a panel with a CEO of RefleXion Medical, Todd Powell, and we talked about a culture change that I had done with him and his organization. And it was kind of like a LSI saying, Well, you know, will anyone come to this if they have other places to sit in the hall, you know? And they did. And so the feedback was positive enough that we decided this year to expand it to sort of this broader question of, hey, as you're growing in size, what can you look at and as your team gets bigger, and so I will tee it up in terms of group sizes, which Jeff and I were talking on the phone previously. And I picked the numbers based on what I know about how group work works. And he went those the same numbers I see based on how startups works. I think we got some pretty good so we're gonna start off small and kind of step up and just talk about each of our experiences in terms of what that looks like. I think I'm going to ask you to hold questions till the end, because I normally in a panel, I go whatever we talk about is fine, but we're trying to actually make an arc here from small to big. So we'll try and make that arc, and then leave some time at the end for discussion, and that'll be some questions we can do here in the room, and then we'll be here after as well. So that's kind of the the plan. And so with that, I think I'll move into intros, and I'll just let each of us kind of talk through kind of what our background is and how we care to be here. So Susan, you'll start, yeah,

Susan Insley  1:28  
sure. My name is Susan Insley, and I currently am not in your industry at all. I work for a company called nexnav. We IPO ed as a de SPAC. Recently, last couple of years, and we're about 100 people, and throughout my career, I've worked at different size companies, usually starting at the small but then getting to the really big and and I've, I'm here because of my HR experience, but I also kind of grew up in finance and internal audit, so I've, kind of, I've seen a lot. So 

Ed Muzio  2:01  
all right, Jeff

Jeff Pompeo  2:04  
Hi everybody. Appreciate you coming. My name is Jeff Pompeo. I'm the president, CEO and co founder of a company in Charlottesville, Virginia, called Caretaker Medical. We make a wireless wearable patient monitor that measures continuous beat by beat, blood pressure, cardiac output, stroke volume, advanced hemodynamics and fluid response as a noninvasive alternative to invasive. A lines and Pa catheters in high risk patients across the full continuum of care. Data goes to the cloud and so forth and so on. We're commercial phase. 18 months ago, got our FDA clearance last year did sort of our soft launch, and this is the year we're hitting the gas pedal and really going direct sales to hospitals. I guess my timing could have been better with hospitals budgets being tight and slashed in the environment we're in. But you know, it's all about reducing costs and improving patient outcomes, and maybe most importantly, improving productivity for clinicians inside the hospital. So, background, yeah, so, so I started in giant organizations. I'm an ex GE guy, so I was GE with GE for many years, running large businesses, and that was back in the Jack Welch era, where, you know, if those of you remember him, he was just maniacal about people. The you know, the company was the people, the products were second, and managing those people and driving them, and driving the culture and stack ranking them, and, you know, constantly turning your bottom 10% you know, those were core tenets. And to make a long story really short, so I left ge 21 years ago to do my first startup. This is my fifth startup. We've been lucky enough to monetize and exit the other four, two in medical devices, two in technologies. And I think you know, when Ed we're talking the interesting thing was that transition from running these giant, well oiled everything is a template organization to making it up in my basement with two other people was a incredible transition. And my wife says it's a disease that I have now this entrepreneurship thing, I can never go. It's funny, our last company that we exited, I had to, I called it the indentured servitude year. You know, when you get acquired, you have to work for a year for the I couldn't stand it. I mean, it was just nothing against the company, just the big corporate bureaucracy, I learned, is just not in my DNA. So it's the quick, nimble, make mistakes, fast, back the truck up and try again. That I really

Ed Muzio  4:44  
love I've got that resonates for me. So sorry my my background is big Corp to small as well. So I started day to 10 years in tech. I worked for Intel. Intel's having a hard time right now. I worked for Intel nerd really well. And I I got into, I was engineer, and I got into kind of how system. Work and how authority works and how decisions get made. And then 10 years after I started, I exited. I've been doing this for 20 years, and this is really working with companies. And now I work from Fortune 500 all the way down to start up with 50 people, 20 people, and it's the same work. What I'm doing is I'm saying we have 70 years of research and experience that says that if you work the way most companies work, you get what most companies get, which starts with meetings, where you get together and everyone talks for nine minutes each about how it's going, and the answer is mostly well. And then they run around do a bunch of work, so they can say mostly well next week. And so you get late, if any warning that things are off track, and the top performing companies don't do that, they get together and they go, we're going this way, and in the future. And right now, it looks like we're headed here. So let's do this today to put that back together. And then we do that, and it breaks something. And so we go do something to fix that. And so I call it iterate. My book out there is iterate. And you just the company claws its way through. And so I always say, What I know is two things, what has to happen. I wrote that in the book, and how to get it to happen. And I do that by coming in and working for about a quarter with leadership to just run the company that way. Because if you just ask people to do it, and you go, all you go, all you got to do is stick your neck out and say, something's wrong. Who wants to go first? Right? And the answer is, maybe they do. So we do it all at once around the company. We speed up right away. And so that's kind of my background here. But I was resonating with what you said, because I work fortune 500 and I work startup, and I can work a fortune 500 and they will say to me, we cannot believe the progress you made in a quarter and how much faster we are. And I smile and go, I'm glad you were happy. And I go home and go, because when I work in a 50 person or 100 person or a 300 person company, like, we change what the company is like, and it's different. Forever. I'm gone and it's different. So it's really, I think I'm unemployable now, like, even, but it's really kind of fun to watch the same thing. You're the small company now, like, you see it, like it's there. So, so anyway, let's, let's start small. We're gonna, we're gonna move, like, from five to really big, and we're gonna start with five to 15. So, you know, five is, everyone fits around a table. This was my bias. And picking these numbers, right? They're just representative, but everyone fit around a table. And then we get to 15, which is, like, we still fit around a table, but it's a big table, and it's a little harder to have a conversation like we used to have. And also there's probably, you know, at five, the mission was probably like, make a thing, and at 15, now there's probably something else, commercial, financial, there's more stuff coming in. So it's also more complex, right? So why don't you start us off? Jeff, what? What do you see at five and 15 that has to happen, you know? How do you set up for the next

Jeff Pompeo  7:20  
phase? Yeah, and there, it's interesting, you know, back to that, when I left GE to go to this first startup, I was sort of the number two guy in the startup, and there were six of us, and I kept trying to institutionalize and templatize and and formalize everything. And, you know, I'll go back to his name was also Ed, just sort of my mentor at that time that taught me how to be an entrepreneur. Was, you break all that, right? This is about to your point, iteration. It's try, try, try, faster, faster, faster. So, so for us as that company, we grew that company from the six of us that started it to about 120 people in about two years. And that was, that was the classic late 90s, you know, you could get funding on a PowerPoint. You know, you get $20 million on the PowerPoint from Sand Hill Road and run with it. And so it was about spend as fast as you can, so that you can, you know, quickly raise another round with an up round. But the cultural we hired, we hired so fast. And so that culture, we spent creating the company for those first five or six, or the six of us together, we all knew everything about everything. There was unequivocal trust. I mean, you know, we vacation together. I mean, it was like a family, right? We our kids knew each other. We had dinners together. And as we started adding people, there was a there was a time where we were hiring three or four people a day, especially out in this in the sales team that was and we had to learn how to delegate. We had to learn how to empower and trust, but have a feedback mechanism, mechanism where you could quickly, quickly ascertain where that trust wasn't working or that trust was being taken advantage of, so that you could clip it, and that got me back to my Jack Welch training is you can't be afraid to terminate someone fast and early when it's clearly not working since fast, which

Ed Muzio  9:11  
is not that hard to do at 15, but it's not that easy. Oh,

Jeff Pompeo  9:15  
yeah, one of those other core tenants was you're going to spend 80% of your time trying to turn a C player into a B player, when you should be spending 80% of your time on your a player, finding an a plan. And that's what we kept trying to judge, so that that that scale was fast and rapid, and it broke all our processes. I mean, we we had to go from running a company with spreadsheets to buying a system and implementing a system. And I remember when we when we got to about 20 people, that's when we hired our first HR person, right? Which was a godsend, because we, you know, we were all trying to do HR on the side, if you will, right, while doing our real jobs, and it wasn't or that that's fine at five, seven, maybe even 10, that's

Ed Muzio  9:59  
recover. Yeah, but then, yeah, yeah, no, that's great, I think. And I'm, by the way, as a side note here, I'm panelist and moderators. We decided we'd rotate who talks when, so I'm going to jump in here if we go along. But I, for me, somebody asked me today for a podcast interview, like, what can you do when you're five? Because, of course, I have this whole book that's really about levels, and my first answer is, right at five. At three, it doesn't work, but right at five, start making decisions together in a way that is the way we know works to make decisions, and that is, we know who the decider is, and the decider listens to everything everybody knows, and then the decider says, here's what I'm deciding, and here's why. And then everybody does that thing. And I say that, it sounds very obvious, but it's very easy to tip into something like voting. It won't be called voting at five. You won't say, let's take a poll. But people say things like, let's see how everybody is leaning. And anything that looks like voting, this is not a political comment. This is a group work and business comment, anything that looks like voting in small group work produces irrational results. And the reason is, if we three work for the same boss, and the boss says, twice in a row, let's see how you're leaning. We have a future together, and we have a history together, and we like each other, or we don't. And so we are going to start trading votes. And so that person immediately is removed from information, because now I don't come in and go, here's what I know. And Jeff says, Here he knows. Susan says, Here's what I know. We say, we all agree, Boss, do this because I've horse traded for something else later. And so start small. Do that. As you move 15, you can start to say, Okay, now let's bring in a future look. Let's make sure we're continuing to look down the road, because at five, you will automatically look forward. At 15, you will start doing the status update dance. Here's what's going on today, so make sure you're not doing that. Do the what's coming in six months, what's coming a year? What can we do today about the future? Because you can just say this, if you're in the company, we cannot do anything today about what's done, right? So let's make a decision. Let's start now making decisions for the future. And if we have a one hour meeting and we're 23 minutes in and we haven't made a decision yet, let's fix that meeting. So we stopped doing that. If you catch that at 15, yeah, it'll save you a lot. Yeah. I

Susan Insley  11:57  
want to go back to something Jeff said about hiring. I think one of the things that's really important at this phase is really understanding who's on the team and what they can do, so making sure you understand who are your utility players and who are your experts. And then that's going to also come into play when you're talking about making decisions, like, who do you know that you need to ask more questions to so that you're getting the best information out on the table, and you can be the decider, or whoever is the decider, but you've got to think about that team as a portfolio of assets. And as you start to grow, you need to know where your gaps are and where you're going and what you're going to need in order to get there, so that having that inventory at the ready is it's going to be super important. 

Ed Muzio  12:41  
And I think you start that early and start to build it started early. 

Susan Insley  12:44  
So then as you're hiring, either going to 15 or 15 and beyond, you're you're filling in your portfolio,

Ed Muzio  12:51  
right, right, right, yeah, I feel like both of us have had individual version of this conversation where it's like, don't get the big bureaucratic template yet, yeah, but think ahead, just a little just just a little bit of prep for that, which it's understandably hard to do,

Susan Insley  13:06  
yeah, yeah. And this is the time too, to really solidify that trust. So both of you talked about trust, so I agree it's not voting, but making sure that everybody has the opportunity to put information out on the table, and you're listening. As a really key part of building.

Ed Muzio  13:23  
Don't skip the listening. Yeah. 

Susan Insley  13:25  
Don't just go straight to, like, ask questions, be curious, listen to the answers, and then decide, yeah for sure. 

Ed Muzio  13:29  
And there is a thing there that I think actually has a good launch into our next size, which is okay, so now we're going from 15 to 25 right? So now, and you kind of noticed into this a little bit, Jeff in your conversation already, but, like, conversation already. But like, you know, from my perspective, 15 we could get around a table. 25 I mean, I guess we could find a table, but I can't hear that person anymore. So we're not only at a place where we can't do group work, we're also at a place now where, like, we can't even really have a conversation. All we can do is someone can give a presentation, and people can go like this, right, which is not actually decision making. So, you know, same questions, you know, what do we do? And I think that the thing that I would add to kind of key into what you guys just said is, I'll go first on this one, is I talked about already look forward. Now you've basically started to say, hey, we have 25 people. So you guys go work and come back and so, so now we get into look up, which is when I send someone off to do something, whether it's them by themselves, or them with a group they're running. I need to make them understand, yeah, you have a goal, but we're not holding you accountable to your goal. We're holding you accountable to owning a piece of the higher level goal, right? So you can't succeed at your piece. This is not that hard to do at 25 this is exceedingly difficult to do at 100 because everyone goes, here's my status, boss, and it looks, looking good, right? So, but, but if you can get to this place you go, no, no, you we may change your goal at a time. We're all doing this together. We succeed or fail together. If you can start to plug that in at that 2025, space that, I think is that is the piece that helps you together with that is we want bad news. I have stickers on my table and say, We love reality. At 25 you have to start to say, Bring me bad news. Bad news is good news because that's the place where it also tips into, Oh, my boss's boss wants to hear that it's going well, so let's make it look like it's going well, like no, my boss's boss wants to hear what's broken. We solve the biggest problem every week. And so you have to learn my favorite thing to tell leaders as I go practice, saying this the way you see me arranging my face, is worry about what's coming up, but not about you personally. Thank you for bringing the problem. Please continue to bring problems, because otherwise they go, Oh, he's mad. I'll never bring another problem, right? So that's the, that's the that's my thing for for 2550 to 25 to start. Susan, how about you?

Susan Insley  15:41  
Yeah, I think just building on that, not not taking any of that, this is the time where you're really starting to establish culture in your company, so you have trust with the small group around the table. And now you're going to expand the table, so you're, you're not necessarily going to be connecting with everyone in the same way you were connecting with that smaller group a year previously, or what have you. So your trust is going to come into play. You're going to start needing to put a little bit of structure in place so that communication and information still flows freely, that there's a place to bring the bad news, whether it's in you know a regular rhythm of one on ones, or just knowing people knowing that you have an open door so they can get to you with that bad news. Or daily stand up like this is the time to start creating a little bit more clarity about how information is going to move. Yeah, yeah,

Jeff Pompeo  16:36  
yeah. Right now we're, we're approaching the 20 person. So we're living this now, and you know, we've got a plaque in our conference room that says we attack ideas, not each other. I love that. And every Monday morning we have a stand up. And you know, the tenant of that whole stand up is, what are you afraid of? What are you worried about? You know, we were looking for the bad news, because as you grow to your point, that the bad news starts to get masked. Because now it's not a dozen people all you know with the same shared vision. Now it's you know, 2030, people that now career aspirations come in, and promotions come in, and layers and and all that that starts to mask the truth that as a CEO in particular, you got to know now, because as a small, perpetually underfunded company. You've got to see these problems coming. You know when they're small, because when they get big, it can be too late. The last point I made you mentioned utility players. I think that's another big inflection point when you're in that kind of 510, maybe 15, utility players are awesome, right? I want all Derek jeters, because they can play any position on the field any but then you get to 2025, now you got to start special you can't if you had all utility players. Now you have to start using process instead of people to solve these scale problems. And you can't just keep plugging in more shortstops. You've got to have a first baseman. That's great. And yeah. Then then you pepper in sort of the different profiles of the employees, right? How? You know, it never stops to I keep getting surprised over and over, which means I'm an idiot about this. But the way engineers, software, hardware engineers and scientists think is polar opposite to the way commercial and sales people think, you know, you know, engineers and tech, foot people, Aaron, something. It's the thrill of the chase, right? It's you do some, you do some vision casting of the CEO as the CEO. They're all in, and you're chasing that vision. And that's the goal, the satisfaction. I don't want to say sales people are coin operated machines, but to some degree, there's a little bit of that, right? And it's vision casting is not enough. There needs to be justification and answers and compensation programs that you know are more financially motivated in the short term, as opposed to just accomplishing the vision. So being aware of that as you grow and scale, especially in Medtech, because we all start basically with technical people first, then you grow to the commercial people, and you got to understand they're wired differently. They need to be managed differently. They're motivated differently. Not every employee is the same.

Susan Insley  19:13  
Yeah, just to add on to that, and I'm sorry to interrupt you, Ed, but like, I think that's a super important point. You're still at a size where you can make sure you have those individual connections and understand everyone's motivations and making sure you have the incentives and systems in place to keep those people motivated as they become further away from you in the daily activities. Right? If you're

Ed Muzio  19:37  
Right, you're at a size there where it's it takes a little more effort, but you still do it. Can still do it, 

Susan Insley  19:40  
Yeah, 

Ed Muzio  19:41  
Yeah. And that's, that's a good tee up for, okay, now we're gonna go from 25 to and I wrote in my notes 50 to 100 or more, which are really, really different and also kind of the same. It's kind of like if I give a keynote, and, you know, if I have 12 people or 20 people, I can tell, but if I have 300 or 500 people, like it's just me and bright lights and two rows, and it doesn't, it's. Like you lose that visibility, right? I think that's what happens. You know, now you've got now your meetings are happening in parallel, your mission and your issues are split into different pieces. So if you're the leader, you've got things happening that you don't need to know about. To your point, we start with highly technical people that are generalists and good at everything. And about 25 they can still run around and be in everything. They look pretty haggard, their hair doesn't look great, but they're in everything, right? And I've done many clients where I can point to the guy, it's usually the engineering manager, and go, that's the one. He's in all of it. But 75 people, that person cannot that's not sustainable anymore. You can't pack them all in room and have them go around and get updates. And so you've got to really, you've got to really start to figure out, what do you do about some two, you know, two levels away from me, and like, all of a sudden the important work is happening two levels away from me. So what does that mean? So who started Susan?

Susan Insley  20:46  
I'll take that one first. I think this is, I'm the culture person. So this is a really great time to start getting very clear on what your values are as an organization. So you don't want a lot of structure, but you do want to know from everyone in the organization, like, what are those kind of key tenants that everybody can operate off of and not have to be managed day to day? And so they know, like, our values are accountability or transparency, communication, whatever those are, and those are the things that they're going to use every day to guide their work, whether you're right next to them or not. So this is one of the things that I just did, coming into next nav, you know, 100 people was really helped them. I, you know, craft their identity, if you will, as a culture. So, you know, having all the employees kind of give us what are the top five things that you think that represent how we get work done. And then we did it kind of a tops down, bottoms up, kind of exercise, and realized that, hey, like, of all the words that were submitted, it was very clear that these five words here are the ones that everybody's using to get their work done, to make decisions, to guide their behaviors. And it was very easy for us to say, This is who we are and this is how we operate.

Jeff Pompeo  22:08  
Yeah, yeah. At that level, I think you know when you're small kind of sub, that when you start trying to stack Rike employees and all that, it's, it's, it's pretty obvious in a small organization, and who's great and who's not so great. Everyone knows that. You don't have to formal. You get to scale, 50 100 people. It becomes more ambiguous. You know, who's great? 

Ed Muzio  22:31  
What do you mean by great? 

Jeff Pompeo  22:33  
Yeah, what does great even mean?

Susan Insley  22:34  
 you don't see their work. So how do you know they're great? 

Jeff Pompeo  22:37  
Yeah. And, you know, we all try all the standard techniques, right? The skip level meetings, but, but to your point, Ed, skip level meetings, you don't always get authenticity in those conversations, right? It's career management kind of conversation, so you have to dig deep. And for me, it's, it's asking, you know, very specific questions, you know, let, let's go out into the factory floor. Tell me about this machine. Why this? Why that? To try to dig into to get past sort of the superficial fluff of, you know, all the boss is here. Let's put on a show, right? You know, you're not there for a show. You're there to understand the problems, right? It's all about solving these problems quickly, yeah, and then you're trying to maintain that culture. It's all about communication, right? If you don't. So, you know, I think now that we have zoom and all these tools that we didn't have a decade ago. It's much easier to have these all employee meetings and quick 30 minute bursts so you get face time with everybody. Everyone feels like a cohesive group, even as 100 it's really tough to do without putting a whole bunch of layers in between, which, yeah, is no good for anybody,

Susan Insley  23:39  
and the complexity of in person versus remote as well. So we have so many people on the workforce today who prefer to be remote. So we were talking about that last night. Jeff, maybe you want to talk a little bit more about that, because I think it was really important. 

Jeff Pompeo  23:53  
Yeah. I mean, if there's one good thing that came out of COVID, I would say it was this forcing function of embracing remote work, yeah. And it works, as long as the culture embraces, if there's this undertone of, we've got the, you know, we've got the in office people and the out off office people, I think that tips over pretty quickly. I don't think it works. 

Ed Muzio  24:15  
The other thing that I've seen is it drives a level of discipline. So I'm like, as you hear me talk, I'm very much about, how do we get together make decisions? And one of the things I saw when companies jump into Zoom is it's like you can fix a lot of badness in your meetings, in the hallway when you leave, so you can have a performative status, non decision oriented meeting. And everybody's walking out, they do the real work on Zoom. They all hit the red button and no work happens, right? They do the performance, and they go back to, like, being alone. So it does drive a level, I think, of discipline, both in how you approach it, like you're saying, and also, then, what do you do with the time you have together? Because it's necessarily limited,

Jeff Pompeo  24:45  
yeah, and we use Slack. I mean, there's a lot of tools like that, but that has helped, I think, with those hallway water stations. Yeah, you know, you're just always now, our software guys in particular say that's a very disruptive tool. I'm trying so. So we have sort of 'no Slack' period from twelve to two 

Ed Muzio  25:04  
Don't walk into my office. Yeah, yeah, exactly No. And I think, I mean, I think you are talking about the same stuff I always think about, which is, you know, from my perspective, like I have mostly leaders who are really good leaders who mean, well, like the nature of what I do is, let's be collaborative. So the ones that want to be dictators and really mean people, they walk away from me, which is lovely side effect of my career. But having said that, I work with these people that are really good leaders, and I don't think they always realize they're scary. They're not scary personality wise. They're not scary as people. But when you're my boss's boss or my boss's boss's boss, like, there's reptile brain stuff going on there. And so if you go, Great, let's have a skip level. What's going on. Like, you didn't say only bring me good news, but they heard it. And so I think, to your point, like, Go show me what's going on. I also think there's a very heavy modeling function. So I always tell my senior team, like, what's a bigger company? Like, I want you to run your meeting like, the way I'm talking about, like, forward looking. I want you to solve issues. I want you to reinforce the importance of bringing bad news. I also want you to get in the habit of when issues on the table and you can't solve it today and it doesn't need solution today. Have a mechanism where you go, you, you, you, you have two weeks go off, come back with recommendations I'm putting on the agenda now for two weeks, we'll ratify it. So there's a mechanism, because the better you model that in the senior team, the more it's going to copy down every every team on the way down is a bad photocopy. And so if you do those things loosely on the senior team, you're into a mess down there. Review it really well on the senior team, you'll get enough of it at the lower levels so that you have it happen. Because you can't go down there and tell them to do it without seeming like now you're that mean boss again. And I think if you, if you do that and get in the habit of showing them, hey, look, we listen, we act, we adjust, right? No news is, you know, no news is bad news, but bad news is good news, and no decision is final, but every decision is always implemented. I think that modeling at the top will flow down and make your culture too. 

Susan Insley  26:47  
Yeah, the modeling thing is really key, good and bad. So everyone needs to be very conscientious. If somebody does come and give you bad news, make sure it's not the person that you're getting ready to fire, because as soon as you terminate that person, everyone's going to know I brought them bad news, and they were the first out the door. So really, if you are going to be thinking about letting people go or making changes, I would be very conscientious about how you're communicating with that person what they're bringing to you. How do you make sure that it isn't tied to something that they've put on the table? 

Jeff Pompeo  27:25  
Yeah, and I think establishing that accountability structure as you scale and grow is critically important. And to your point, it's modeled at the leadership right? If you don't follow up on things, people get that and then they they won't follow. So yeah, we have a formal problem. We call it the FUP file, F-U-P, follow up. So there is a physical FUP file with all, I want to be very clear and enunciate that it's the FUP file. And that's become a cultural thing is, you know, where's the FUP on that? It's, you know, there's some

Ed Muzio  27:57  
very block and tackle stuff. I get into a senior people, and I never lead with this, because they'll think he's a meetings guy. And I meetings guy, and I'm not, but it's like agenda horizon, which is when you send the task force off to go come back with a recommendation, you put it on the agenda in two weeks now, that way it doesn't get forgotten about. You know, FUP, right? Like, what's so and so said they do this. And then people ask me, Well, how often should we review it? And I go, I don't know, review it some. And if people aren't doing stuff, review it more, they have a second year of time less. But like, have it, you know, and, oh, by the way, also, like, have a plan for the meeting. We're going to talk about this issue and this issue so that you're not walking in going, you know, what are we doing today? Because I've seen a lot of meetings where it's like, what are we going to talk about in staff today? You know, you better find something. It's like, No, you should have a queue of issues to do.

Susan Insley  28:37  
I just, I have this vision of people walking around the hall, going, what the FUP 

Ed Muzio  28:41  
what the FUP? What's on the FUP? Slack me the FUP. So we're good. I wanted to give us about 10 ish minutes for Q A, which we actually have. So any like, final thoughts before we jump into open Q A, and if you have a question, please kind of head for the microphone so they can get it on the recording, or, I guess we can. They'll bring it to you or something. But yeah, what any final thoughts? 

Susan Insley  28:59  
Well, I think we've got a question. I heard you're on the story. 

Audience Question  29:00  
So my question is about the application of this in the med tech context. So I've worked in 200,000 person companies. I currently lead a five person company, so have seen lots of different models, but one of the things in how fundraising trends have changed is there's more and more of us here at this conference who are getting into later stages of quality controls, right? You're at a QMS level where you have to have SOPs and you have to have control processes. Meanwhile, your team is still in that five to 10 category. And so can you just speak a little bit to how you think about the culture that's being less structured and less formalized, while at the same time having product activity and operational activity that does have to be more structured and formalized. How do you balance those two in smaller teams?

Jeff Pompeo  29:53  
I can take that. That's a phenomenal question, right? How do you maintain this fail fast? Entrepreneur, nobody. Bureaucracy in an environment, in a regulated FDA, regulated environment where you have to have a QMS platform. You know, I've done a number of these startups, so I make a different mistake in every one. Two startups ago, the mistake we didn't take QMS seriously. I mean, we had a three ring binder with paper SOPs that we downloaded from the Internet, and no one ever opened the book. That was a huge mistake, because when it came time for our audit, you know, guess what happened? So, so now we know we take QMS seriously. It's a semi automated process. We still take shortcuts, but we take them purposely, knowing we've got to go back and clean it up and we treat them as experiments. So the shortcut around this SOP or we're not putting, you know, this is going to happen outside the QMS system as an experiment on bench top or whatever. Then we'll go back and sort of do it again, Fast Track under the QMS rules and get it documented. 

Audience Question  30:58  
So I'm actually asking question the other way around. So as the company gets more and more controlled, how do you still keep a lot of the benefits of only a five to 10 person team having that much more informal communication and kind of without the QMS B and B production level, product considering 

Ed Muzio  31:21  
I can maybe talk to that a little bit and tell me if I'm getting it or not, but what I've seen in my clients, and this is from med tech and elsewhere as well, is V and V and product development life cycle and QMS stuff. All of that often gets confused with how we run the company. That's not how we run the company, that's an output that we carry. And so I had one client in Medtech who we did this intervention. Thing that I do, we put the iterate methodology in place, and on the QMS side, they're very clear to delineate, like, how we run meetings is not QMS. QMS is we decide in these meetings how to implement this thing. And so we've activated the, for want of a better term, the group intelligence, the organization, to keep clawing forward. And one of the outputs we carry is to have compliance, and is to have, you know, whatever we need in those ways. And we pay attention to the right thing. So we notice is our PLC, you know, serving us anymore, not because, you know, just like your filing system when you were 20s to now, it's like, it was great till I got my second job. And it's like, oh, that's not working, right? I need three folders now. Now now I need 100 levels, right? So, but as long as we task the human intelligence with keeping that up, instead of getting confused and saying, Oh, we use that as a way to regulate everything we do, that's what I've seen to work. Is that closer to what you're asking?

Audience Question  32:35  
Yeah, I just, I've seen this kind of tension. So thank you,

Audience Question 2  32:39  
Susan, you use the word, but I think in a different context, transparency, yes, and I've been part of four startups now, and one of which was bought in the middle of.com into his massive company in all the earlier ones, and I was a co founder in one of them, transparency was we shared Everything with everybody about the state of the company, the P and L on a quarterly basis. You know, things that are going well, things are going bad, and that's different than just being open communication, right, about getting your work done. So what's, what's your all thoughts on that? Because when we hit the big.com company, they're like, you can't tell all the employees that we're you know that that's inappropriate, that you're talking about that in meetings, and people started quitting because they just it's too ambiguous where we work, and we don't know what's going on.

Susan Insley  33:31  
Interesting, I think. You know, as a public company there, obviously there are things that you can't share and until you're in certain windows and, and in some cases, are things that just stay at the top and and can't go down. But I think it's really about what you think people need to know in order to really be invested in their work, right? So what? What helps them stay attached to the company? What builds trust with you and the other leaders. So are you sharing you ask them to share bad news. Are they? Are you sharing bad news with them too? So are you providing that level of vulnerability to create the trust that keeps the information flowing? So that's really the objective, if you will, of transparency. It doesn't necessarily mean everybody needs to know all the worst news that's going on, but enough to know that you you care about their level of commitment to the company so much so that you're going to bring them in. It's building inclusive culture, right?

Ed Muzio  34:38  
There's an active decision there about what can we not share? What must we share? And what's in the gray area? And I think that you know better, decision making at the top helps with that. I've seen a version of that too, where the you know, I do my thing, and at some point, and this has happened with most startup CEOs, they look at me and they go, I'm gonna know a lot more about kind of what's happening and what's in trouble now. And I go, Yeah. And they go, should I tell the board? Yeah? And I go, I don't know. I mean, yes sometimes. And so they all come to their own kind of peaceful place of like, what's an on stage conversation and what's a backstage conversation? Because these are forecasts, right? So, you know, like, what makes you more predictable to the board? And it's a version the same question, which is, what do I have to tell them? What should I never tell them? And then what's gray area and what's the benefit? So it's a conscious decision, I think, more than one answer, yeah, 

Jeff Pompeo  35:24  
Yeah, one cautionary tale. I mean, it's a bit situational to know who you're speaking to. I mean, yeah, if you're too transparent, you just terrify people, especially, especially as a negative EBITDA company, you know, that's trying to, you know, you're going to run out of money at some time. That terrifies people, right? Is it 12 months? Is it 12 months? Is it 18 months? Oh my gosh. Do I need to look?

Ed Muzio  35:44  
 There's no right answer. 

Susan Insley  35:45  
You don't need to keep reminding them. You need them to be focused on doing their work, right?

Jeff Pompeo  35:48  
Yeah, yeah. So there is some limit to, you know, just know your audience, I guess is the message, yeah.

Audience Question 3  35:55  
So we are currently living in the remote world where we see very good things happening, also, like sometimes a few positions works out very well with remote and few not, in my opinion, like to hear your thoughts, you thought of it. How is the future going to look like, especially having the culture of remote scaling up, having the remote positions, especially in the Medtech if you can.

Ed Muzio  36:22  
90 seconds future remote go.

Jeff Pompeo  36:24  
You have to embrace it. It's here to stay, and you're not going to get the best, best and brightest people if you mandate in the office. Generally, there are certainly exceptions. So you have to embrace it,

Susan Insley  36:35  
and you have to be intentional to make it successful in your company. And you can't just let it happen. As we have already mentioned. You've got to have communication mechanisms. You've got to have that trust in there so everybody's showing up at meetings. You've got to have a way to have Hallway Conversations, if you will, outside of meetings. So it does take a little bit of effort in it, but Jeff's right, it's not going away. So embrace it. 

Ed Muzio  37:00  
Last thing I can add to that is I have various clients at different with different approaches, and if you have some people remote and some people in a room, invest in the software that puts cameras in the room so when they can see who's talking. So it's not like a little square with nine little heads, because that makes it a lot better. It's almost like the same experience. We are out of time. Thank you for being here. We'll hang a bit for discussion afterwards, I'll head down to my table where I have books come and get one. They're heavy, and I don't wanna take them home. But 

Susan Insley  37:00  
and free 

Ed Muzio  37:00  
and free, thank you. Heavy and free, that's the sales pitch. But thanks for being here, thanks for attending, and please stick around and chat with us after.

Susan Insley  37:33  
Thanks everybody.

Ed Muzio  37:35  
Thank you.