Applying dynamic work design to healthcare

In this episode of Spread Love in Organizations, host Naji Gehchan welcomes Nelson Repenning, Faculty Director of the MIT Leadership Center and Distinguished Professor at MIT Sloan, to explore why so many organizations struggle to turn proven management ideas into real, sustained impact. Drawing on decades of research in system dynamics and organizational design, Nelson unpacks the hidden forces that keep teams trapped in constant firefighting despite the best intentions, smart people, and well-documented best practices.

At the heart of the conversation is Nelson’s work on dynamic work design, the foundation of his new book There’s Got to Be a Better Way. He explains the “capability trap” that pulls leaders toward short-term fixes and away from long-term learning, and introduces five practical principles that help organizations escape this cycle: solving the right problem, structuring work for discovery, connecting the human chain, regulating flow, and using visual management. Through real-world examples, from manufacturing to healthcare and drug development, Nelson shows how small, well-designed changes can unlock surprisingly large gains in performance, engagement, and impact.

The discussion also dives into leadership, healthcare complexity, and the thoughtful use of AI, emphasizing that effective change doesn’t come from top-down initiatives or copying “best practices,” but from leaders who are willing to go see the work, listen deeply, and develop people. Nelson closes with a powerful reminder: great leadership is not about issuing targets or demanding solutions, but about creating the conditions where people can surface problems, learn together, and do meaningful work. A compelling episode for anyone seeking to build more humane, resilient, and effective organizations.

"Most organizations don’t have a strategy problem, they have a flow problem. We take on far too much work, and everything grinds to a halt."

MEET OUR GUEST 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 P. Repenning is the 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.

His 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 the 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 the 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— and Dynamic Management Systems, a method for ensuring that day-to-day work is tightly linked to the strategic objectives of the firm. His book (co-authored with Don Kieffer) There Has Got to Be a Better Way describing Dynamic Work Design will be published by Public Affairs in 2025. He is also a partner at ShiftGear Work Design and serves as its chief social scientist.

In 2003, Nelson received the International System Dynamics Society’s Jay Wright Forrester Award, which recognizes the best work in the field in the previous five years. In 2011 he received the Jamieson Prize for Excellence in Teaching. He was recently recognized by Poets and Quants as one of the country's top instructors in executive education.

Nelson is also an avid bike racer and regularly competes in Masters cycling events. He holds a BA in economics from Colorado College and a PhD in operations management and system dynamics from MIT.