Naji Gehchan: Welcome to SpreadLove in Organizations, the healthcare leadership podcast where we explore leadership with purpose.
I’m Naji Gehchan, your host, joined today by Nelson Repenning, Faculty Director of the MIT Leadership Center and the School of Management Distinguished Professor of System Dynamics and Organization Studies at the MIT Sloan School of Management.
Nelson’s early work focused on understanding the inability of organizations to leverage well-established tools and practices. He has worked extensively with organizations trying to develop new capabilities in both manufacturing and new product development. Nelson has also studied the failure to use safety practices that often lead to industrial accidents and has helped investigate several major incidents. This line of research has been recognized with several awards, including best paper recognition from both California Management Review and the Journal of Product Innovation Management.
Building on his earlier work, Nelson now focuses on developing the theory and practice of dynamic work design, a new approach to designing work that is both effective and engaging. I personally have extensively learned from and benefited from this work, including dynamic management systems, a method for ensuring that day-to-day work is tightly linked to the strategic objectives of the firm.
Nelson, I am really so excited to see you here and have you with me today, especially with the launch of your new book, There’s Got to Be a Better Way.
Nelson Repenning:
It’s a pleasure to be here. I know you and I have been trying to get together for quite a while, but thank you for having me.
Naji Gehchan:
So Nelson, before we dig into the book and your research, can you tell us a little bit more about your personal journey and ultimately how you became such a central voice in shaping organizational work?
Nelson Repenning:
Well, that’s a very kind construal. So I came to MIT on my 23rd birthday not really knowing what I wanted to do other than I thought I wanted to be an academic when I grew up. I’ve never left, as it turns out, so it was a good decision. I thought I was going to be here four or five years — that was 35 years ago.
What really defined my trajectory is that when I first got here, most people in my department were developing tools. I thought I was pretty good at math, but I realized quickly there was a whole level I wasn’t even aware of. Many of my fellow PhD students were far more sophisticated than I was, and I worried I wasn’t going to be able to compete.
Around that time, John Sterman — my thesis advisor and later my colleague — and I came across what I still think is a heretical question: do people actually use these tools we spend so much time developing? As I dug into it, I realized this wasn’t just about system dynamics — it applied to management tools broadly, whether from books, HBR articles, or elsewhere.
The answer turned out to be: at best, maybe — and often not at all. That question has driven my work ever since. I’ve focused on tools that actually have good evidence that they work, because it makes for better research design. That question opened a million doors into broader organizational phenomena.
Like most good things in life, it was mostly luck — I stumbled onto a topic that grabbed me personally. Every day I see new variants of the same phenomenon. It’s been the gift that keeps on giving.
Naji Gehchan:
Thank you for sharing that. Let’s go deeper into the work. Your research has always been about helping people do meaningful work in better ways. What is the core human problem you’re trying to solve with dynamic work design, and what ultimately inspired you to write this book?
Nelson Repenning:
I’d describe my career in two phases: a diagnostic phase and a solution phase. The diagnostic phase showed that people struggle to use new tools because they’re trapped in daily firefighting — a very familiar setting for managers.
We open the book with a quote from a former student:
“I know my organization is in trouble. When I show up Monday morning, I make a list of important things to do. I work my ass off all week. On Friday afternoon, I check my list — and I’ve got nothing done.”
Many people resonate with that. You walk in with great intentions, then a customer is mad, equipment breaks, something doesn’t arrive — and suddenly your whole week is gone. You never get to strategy, new tools, or future thinking.
The diagnosis boils down to what I call the capability trap. Fixing short-term problems gives fast, clear feedback — our brains love that. Preventing problems or building capability gives slow, ambiguous feedback — and so we avoid it. That asymmetry drives firefighting.
Early in my career, I’d present this and people would say, “That’s exactly my organization.” Then they’d ask, “What do we do about it?” And I didn’t have a good answer.
This book is the answer. Most organizational processes assume we can predict the future — budgeting is a great example. We create budgets assuming forecasts are accurate, then the world changes and we spend the year working around the budget. All of this happens with good intentions, but the workarounds create complex, brittle systems.
So the book offers design principles for operating in a dynamic, unpredictable world. When organizations apply them, the gains can be shockingly large. You get both productivity and more engaging work.
Naji Gehchan:
I’m smiling because it feels like daily life — especially in healthcare. Many of my listeners work in pharma, hospitals, and health systems. Firefighting is the norm, and we often feel healthcare is “different.” Does dynamic work design apply there?
Nelson Repenning:
This question always comes up. Everyone thinks their industry is unique — and it is, to a degree. But the common denominator is people. The work only applies to organizations with humans in them — wonderfully flawed humans with good intentions.
We deliberately use principles instead of best practices. Best practices rarely transfer cleanly. Even companies across the street from each other in the same industry can’t copy-paste success.
If you understand the principles, you can adapt practices to your own culture. That’s the goal.
There’s a famous NEJM article titled “Keep the Toyota Crap Out of My Hospital.” I get the argument — patients aren’t cars. But with adaptation, lessons from manufacturing can absolutely improve hospitals. We’ve seen big wins in patient flow, ICU stays, and drug development — but never by copying blindly.
Naji Gehchan:
Yes, and I can attest that it works across industries. You outline five principles in the book. Can you walk us through them, and highlight one especially relevant for healthcare leaders?
Nelson Repenning:
The first principle is solve the right problem. Be an intuitive scientist — clarify the real problem before jumping to solutions.
Second is structure for discovery — design work so people learn the right lessons. Poor incentives and fragmented roles often teach the wrong lessons.
Third is connect the human chain — ensure problems reach the best person to solve them quickly.
Fourth is regulate for flow — manage how much work is in the system.
Fifth is visual management.
If I had to pick one, it’s regulate for flow. Most organizations take on far too much work. When leaders rank-order priorities and enforce focus — real flow emerges.
Instead of killing pet projects, we rank them. Most never rise in priority — and eventually disappear naturally.
Balancing workload unlocks massive gains across patients, drugs, invoices — everything.
Naji Gehchan:
Another thing I took from your classes is that small, well-designed changes can transform systems far more than top-down initiatives. Can you share a story that crystallizes this?
Nelson Repenning:
Large organizations often use what I call the “T-shirt and coffee mug” change model — slogans, consultants, binders. I’ve never seen it produce meaningful change. It breeds cynicism.
The alternative is dynamic work design: pick one critical process, identify one real problem, go see the work, fix it fast, then expand outward.
Senior leaders are often shocked when they actually watch work happen. They find low-hanging fruit immediately. Small experiments limit risk, accelerate learning, and — most importantly — model the right behavior.
When leaders get their hands dirty, it sends a powerful signal. And once results appear, momentum builds quickly.
Naji Gehchan:
If a leader listening today wants to start Monday morning, what should they do?
Nelson Repenning:
Ask: what is the biggest collective pain in our ass? Not external shocks — internal, recurring problems. Projects always late. Enrollment always slow. Systems never work the first time.
Go see the work. Talk to the people doing it. Pick one problem and solve it hands-on.
You’ll know you’re succeeding when your team tells you, “We’ve got this — you can leave.”
Naji Gehchan:
I can attest to that — from drug development to decision-making structures, small changes had outsized impact on getting therapies to patients.
Nelson Repenning:
And as an MIT professor, I’m obligated to mention AI. We’ve seen cases where AI inserted surgically — after understanding the work — cut processes from 60 days to four hours. AI should solve real problems, not be applied everywhere blindly.
Naji Gehchan:
I love that perspective. Now, quick reactions. Leadership.
Nelson Repenning:
Leadership development needs a revolution. We shouldn’t copy hot leaders — we should develop who we are meant to be. Effective leadership development requires a mirror, not a model.
Naji Gehchan:
A3?
Nelson Repenning:
A powerful structured problem-solving tool — but more importantly, A3 thinking changes how you approach complexity.
Naji Gehchan:
Biking?
Nelson Repenning:
I’m an avid cyclist — it keeps me grounded.
Naji Gehchan:
Spread love in organizations?
Nelson Repenning:
We spend most of our lives at work. Loving your work, colleagues, and community makes everything better. I’m all for it.
Naji Gehchan:
Any final word for leaders?
Nelson Repenning:
Don’t be the “what part of 17% don’t you understand?” manager. Targets without support kill learning. If someone brings you a problem, they’ve done you a favor. Leadership is about developing people, not deflecting responsibility.
Naji Gehchan:
Thank you so much, Nelson. It’s always a pleasure.
Nelson Repenning:
My pleasure. Thanks for having me.
Naji Gehchan: Thanks for listening to the show! For more episodes, make sure to subscribe to Spreadloveio.com or wherever you listen to your podcasts. Let’s inspire change together and make a positive impact in healthcare, one story at a time.
Follow us on LinkedIn and connect with us on spreadloveio.com. We’re eager to hear your thoughts and feedback. Most importantly, spread love in your organizations and spread the word around you to inspire others and amplify this movement, our world so desperately needs