Intro
Dissent in your team is an act of faith.
A little bit of dissent in your team is a good thing.
It’s not how it makes you feel at the moment but how it makes you feel and move to execute the mission in the long run.
Successful leaders use dissent as a constructive force, even in the face of changing markets, competition and customers.
Even in the face of AI.
Let’s get it on.
The Boss is Stuck
It’s happened to all of us.
The leader of your team does not decide. Your co-founder does not decide. Your VP Engineering does not decide.
Not deciding happens for a number of reasons:
Decision paralysis, often out of fear of another person, a competitor or a regulator.
Sustaining Hierarchy. In large organizations, decisions can be bumped upstairs to someone else higher up in the hierarchy. The boss doesn’t understand the problem and is inclined to do nothing and ignore signals from soldiers lower down in the organization. Doing nothing (“keeping your nose clean”) is a way of sustaining the hierarchy.
This is a common issue for non-technical managers. Their problem is not a lack of decisiveness, but a lack of understanding. I’ve seen this too often in security and privacy questions. A non-technical manager may be happy to accept that a cloud provider’s declaration of privacy compliance is sufficient to meet FDA Cyber guidance. (It’s not).Non-standard ways of decision making. In global organizations, different business units may have different ways of taking decisions. One of them might be “do nothing” first. Running turf wars and not solving root problems might be another.
Disaggregation. When a decision-maker needs other people to make a decision, the process breaks down into smaller pieces. The smaller pieces have less information and less inclination to make a decision that makes them look bad.
The usual approach to the Boss is Stuck anti-design pattern uses the traditional tools of organizational politics:
Keep a low profile and hope you don’t get hit with flying missiles.
Have meetings. As many as possible with as many people as possible.
Dilute decisions. Make a decision that only addresses part of the problem, then tell people you solved the problem.
The usual approach makes problems worse.
Solution
The solution to Boss Is Stuck is based on the idea that you cannot put a feature into your product that you don’t have in your team.
Your product is a reflection of your team. Clarity and simplicity of a product is a reflection of a team that possesses clarity of purpose and simplicity of decision making.
Since Team is Product, the most important feature for you and your team is being purposeful about everything.
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Is dissent the antithesis of being purposeful?
Actually not - you can (and should) be purposeful about encouraging others to dissent with the party line and accepted ways of doing things.
Dissent derives from diversity of ideas, which is crucial to the success of the team and your product.
You want to be purposeful about channeling dissent into constructing value. You do this in several ways:
Achieve buy-in for a new / different idea.
Use constructive confrontation to achieve buy-in. “Constructive confrontation” requires addressing problems directly, objectively, and in a positive manner. Have your data and your opinion, be prepared to get in a conference room with the other person and argue your opinion, assertively and backed by data.
Do internal marketing. Get people interested and curious about your new/different idea so that you can achieve buy-in.
Pre-staff. After internal marketing and buy-in, meetings will be short and to-the-point since you already have buy-in before the staff decision making meeting.
Constructive confrontation results in 1 of 4 possibilities:
Agree and commit - This is the best. Everyone is on the same page and works towards the goal.
Agree and not commit - This is bad. It can torpedo a project.
Disagree and commit - This is great, because it acknowledges the reality of diversity in the team.
Disagree and not commit - Less good, but at least, the problems are out in the open.
Conclusion
When you understand that your team is your product, you can leverage dissent.
AI can’t give you constructive confrontation, only your culture can.
This week on Life Sciences Today
This week on Life Sciences Today, I hosted Pamela Tenaerts, Chief Medical Officer at Medable. Pamela has a unique perspective as a former practicing physician who transitioned to clinical trials and became a leader in public policy. She ran the Clinical Trials Transformation Initiative (CTTI) for 10 years, worked at Duke University’s DCRI in Belgium and US and operated a clinical trial center at the hospital for 12 years.
Decentralized clinical trials (DCT) pioneer Medable was founded in 2015 and raised a total of $521M. Michelle Longmire, co-founder and CEO of Medable is an example of a leader that faced market dissent and the crash of a hype cycle — and kept moving.
Medable recently released their DCT technology for long-term patient follow-up in a SaaS model for pharmaceutical and biotech companies.
The FDA mandates 15-year follow-up for gene therapy trials. Current statistics show poor retention with 20% of CAR-T patients stop participating completely, and 80% stop after 5 years. The reason for this is that traditional follow-up is crazy. Patients often travel from far (even internationally) for treatment, and then have to deal with parking and logistics issues at hospitals, blood work and imaging requirements.
Watch the episode - Long term patient follow-up with Medable
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My 18 week program
How do you facilitate constructive confrontation between technology, clinical and regulatory teams when safety signals emerge?
What does “disagree and commit” look like when your Head of Manufacturing thinks your dosing schedule is unscalable but your Chief Medical Officer believes it’s clinically optimal?
How do you prevent the “dilute decisions” trap when FDA meetings require unified company positions despite internal disagreements?
What’s dissent worth in your company — an extra IND, a faster pivotal trial, a stronger FDA briefing?
I work with a handful of execs each quarter where dissent and delay are existential. If that’s you, let’s talk.
If dissent is costing you time, money, and regulatory momentum, book a call here. Let’s see if you’re ready to invest the next 18 weeks and turn it into your competitive edge.
About Medable
Medable’s mission is to get effective therapies to patients faster by providing an end-to-end, global cloud platform with a flexible suite of tools that allows sponsors, patients, providers and contract research organizations (CROs) to work together as a team in clinical trials.
Visit Medable here to learn more.