Organizational change is rarely easy—especially in high-growth medtech companies where rapid scaling can lead to misalignment, inefficiency, and decision-making bottlenecks. Without a clear framework, leadership culture change can feel like an uphill battle.

At LSI USA ‘24, Todd Powell, President and CEO of RefleXion Medical, and Ed Muzio, President and CEO of Group Harmonics, took the stage to discuss a real-time case study of culture transformation at RefleXion Medical. Their conversation highlighted the importance of a structured problem-solving methodology—one that ensures alignment, accelerates decision-making, and creates a system that gets faster as a company grows.

The Challenge: Scaling Without Chaos

RefleXion Medical, a company pioneering a novel radiation therapy for cancer treatment, has grown significantly since its early days as a two-person startup. With over $650 million raised and a transition into commercial treatments, Powell recognized the need for structured decision-making before organizational complexity took hold.

“It was clear that if we did not embrace a proactive, deliberate management methodology, one would form organically—but it would be a chaotic mix of well-intentioned but inconsistent approaches,” said Powell.

His concern was common in fast-scaling companies: as teams grow, decision-making slows down instead of accelerating. “If we didn’t implement a strategy early on, we would get bogged down in inefficiency,” he added.

Enter Ed Muzio, a management methodology expert known for helping organizations scale faster by making decisions smarter.

Leadership Culture Change: Building a System That Moves Faster

Muzio’s approach focuses on creating decision-making systems that keep organizations agile—even as they scale.

“I’ve spent my career studying how to make companies move faster, not slower, as they grow,” Muzio explained. “Most organizations hit a point—somewhere between 25 and 50 employees—where decision-making shifts from fast and flexible to bureaucratic and fragmented. That’s when leadership culture change is needed.”

For RefleXion, this meant implementing a structured framework that:

• Established a common lexicon for decision-making
• Created a clear system for tracking progress toward goals
• Provided an early-warning system to surface and address challenges before they became major issues
• Made cross-functional collaboration seamless

The Turning Point: From Storytelling to Problem-Solving

One of the biggest shifts in RefleXion’s leadership culture was changing how meetings were run.

“Startups tend to spend a lot of time storytelling—explaining the incredible hurdles they’ve overcome,” said Powell. “But if you spend 80% of your time looking backward, you aren’t seeing around the corners for what’s ahead.”

With Muzio’s framework, RefleXion flipped that dynamic:

• 90% forward-looking discussions
• Proactive problem-solving instead of reactive firefighting
• A structured methodology for surfacing and addressing risks early

“The difference was immediate,” Powell shared. “We weren’t reacting to fires—we were seeing around corners and addressing issues months before they became urgent.”

How the System Works in Real Time

The RefleXion management methodology—built on Muzio’s Iterate framework—creates predictability and transparency in decision-making.

Here’s how it works in practice:

1. Issues surface early through structured team check-ins.
2. Each team updates leadership on their trajectory, highlighting any challenges that could impact company-wide goals.
3. Decisions are made in real time, eliminating bureaucratic bottlenecks.
4. Task forces and working groups are formed with clear mandates—not just endless discussions.

“We have a standardized process for escalating problems and making decisions,” Powell explained. “If a challenge comes up, there’s a formal way to address it rather than letting it simmer for months.”

The result? A faster, more transparent, and more efficient organization.

From External Consultant to Embedded Leadership Change

Unlike many corporate change programs that fizzle out after a consultant leaves, RefleXion made the methodology its own.

“We don’t call it ‘Iterate’ anymore,” Powell said. “It’s The RefleXion Management Methodology now. It’s how we run our company.”

This ownership is key to long-term leadership culture change. Instead of relying on external consultants indefinitely, RefleXion trained its own team to sustain and evolve the system.

“Ed worked himself out of a job, which is exactly what you want in a good change management consultant,” Powell joked.

The Impact: A More Transparent, Aligned Organization

Since implementing the system, RefleXion has seen measurable improvements in alignment, efficiency, and decision-making:

• Cross-functional collaboration is seamless—team members can move between departments without missing a beat.
• Early warning signals surface issues proactively, reducing last-minute crises.
• Meetings are focused on action rather than passive status updates.
• The entire company understands how their work connects to broader corporate goals.

“We’ve removed the guesswork from decision-making,” Powell said. “Everyone knows the playbook. They know how to escalate problems, how to track progress, and how to drive real results.”

Final Thoughts

As RefleXion continues scaling, Powell sees leadership culture change as a competitive advantage.

“This isn’t just about managing a company—it’s about creating a system where we get faster and better as we grow,” he said.

Muzio agreed, adding, “Companies don’t slow down because they get big. They slow down because they don’t put the right systems in place early enough.”

For medtech investors, founders, and executives, this case study is a powerful example of how structured leadership culture change can transform an organization—without slowing it down.

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