100+ Workshops.
Four Sectors.

Canada's MRI system was already at capacity before Leqembi arrived. Wait times for non-urgent MRI ranged from months to over a year in most provinces, driven by a combination of workforce shortages, outdated equipment, scheduling inefficiencies, and a funding model that had not kept pace with clinical demand. Leqembi would require multiple MRIs per patient per year — a volume the existing system had no plan to absorb. Eisai could not build MRI capacity, hire radiologists, or change provincial funding policy. Like Biogen before it, the company needed a coalition of system actors to solve a problem none of them could solve alone. And unlike a drug approval, there was no regulatory deadline forcing anyone to move.

What must we all do, now and over the next 6 months, to ensure that MRI access does not become the barrier that prevents eligible early Alzheimer's patients from accessing Leqembi?

The binding constraint was not a shortage of solutions — radiologists, neurologists, health administrators, and policy experts each had ideas. The problem was that they were scattered across institutions and provinces, had never been asked to solve the problem together, and had no shared diagnosis of where the system was actually breaking down. MMG convened 28 participants over three days via Zoom and MURAL: Eisai internal staff, neurologists, radiologists, MRI technologists, patient advocates, health system administrators, and policy experts. Six topics — Burning Platform, Workforce, Prioritization and Guidelines, Funding, Technology and Process Improvement, and Policy and Advocacy — ensured that the recommendations would address the full pipeline of MRI access barriers simultaneously rather than in isolation.

Eisai Canada left the workshop with three things it could not have produced through internal planning alone: A system-wide diagnosis of MRI access failure — a candid, granular account of where the pipeline actually breaks down, built by the clinicians and administrators managing it daily: workforce bottlenecks, scheduling practices that deprioritize outpatient neurology, equipment utilization gaps, and the absence of any national guideline for Alzheimer's-related MRI monitoring. 19 prioritized recommendations — spanning immediate clinical guideline development to define and standardize Alzheimer's MRI protocols; workforce strategies to expand MRI technologist capacity; funding advocacy to provincial governments and hospital systems; and technology and process improvements to increase throughput without adding machines or staff. A cross-sector coalition with a shared mandate — 28 participants from neurology, radiology, patient advocacy, and health administration who had built the strategy together and left with shared ownership of its execution, giving Eisai a network of credible, committed partners to carry the recommendations into health systems and policy channels where a pharma company cannot go alone.

The Canadian healthcare system was completely unprepared: no standardized diagnostic pathway, no sufficient imaging capacity, deep stigma around dementia that suppressed early help-seeking, and COVID-19 actively causing care deferral across the board. Biogen could not mandate any of this to change. It is a pharma company — it cannot force provinces to fund PET scans, compel physicians to adopt new protocols, or direct patient advocacy groups to shift their priorities. And yet all of those actors would need to move, together, in the same direction. They had never been in the same room.

What must we all do, now and over the next 6 months, to ensure early and appropriate use of the new disease-modifying therapies for early Alzheimer's, assuming no new system resources?

The binding constraint was not a lack of will — it was that the neurologists, patient advocates, homecare providers, and health system leaders who each held one piece of the solution had never been asked to solve the problem as a team. MMG convened 27 participants over three days via Zoom and MURAL: 9 internal Biogen participants and 18 external stakeholders including neurologists, Alzheimer Society representatives, a homecare provider, a healthcare consultant, a former Ontario Health CEO, and one patient. Six topics — Awareness, Activation and Screening; Referral and Diagnosis; Treatment; Patient Experience; Burning Platform; and COVID and Other Scenarios — were designed to surface the full system's barriers simultaneously, so that the recommendations would fit together as a coherent strategy rather than a series of unconnected asks.

Biogen Canada left the workshop with three things a pharma company cannot buy or commission: A candid system diagnosis — a shared, ground-level account of where the Alzheimer's diagnostic and care pathway actually breaks down, surfaced by the clinicians, advocates, and administrators living those breakdowns rather than inferred from secondary research. A cross-sector action plan — an integrated set of commitments spanning awareness and stigma reduction; referral and diagnostic pathway improvement; treatment readiness; and patient and caregiver experience, built by the people who would have to execute each part. A coalition ready to act — 18 external stakeholders who had stress-tested the strategy together and left with shared ownership of its implementation, giving Biogen a network of committed partners rather than a roster of separately-briefed contacts.

That strategic plan was written in 2016. Five years later, nothing had changed. NESDIS was still an organization of scientists and engineers each working in their own silo, polishing their own hardware, with little incentive to think about the impact of their work on end users or colleagues. Decisions got pushed up to Volz because no one wanted to be held accountable. New priorities were added constantly while nothing was ever stopped. Consultants — including McKinsey — had been brought in, big decisions had been made, and then nothing changed. With the Biden administration proposing a record $6.9 billion NOAA budget and the IPCC issuing alarm-bell climate reports, the window for transformation had never been larger. The internal frustration had never been higher. As one participant put it: she didn't want this to be just one more event where people pour out their hearts, get their hopes up, but then nothing comes of it.

Starting now and over the next 6 months, what must NESDIS start, stop, and continue doing to ensure our long-term capacity to adapt and respond to local, national, and global challenges with our unique whole earth system view, capabilities, and partnerships?

The barrier was not a shortage of ideas — NESDIS had already produced four different sets of governance guidelines since 2018. The barrier was that the people who needed to change their behavior had never been in the same structured conversation with a mandate to produce a strategy they themselves owned. MMG convened a deliberately non-senior participant group: stars and change agents from across NESDIS and NOAA, chosen because they wanted to be part of the solution — not the senior leaders who had repeatedly failed to follow through. Dr. Volz participated as the sole Critic, a role designed to give him visibility into the recommendations without dominating the process. The workshop was structured across six topics — Value Proposition, Innovation, Prioritization, Whole System View, Workforce Transformation, and Partnerships — so that the 18 recommendations would form a coherent transformation system, not a list of unrelated fixes. Those recommendations were designed as direct input to NESDIS's Fall Strategy Meeting, a 5-day gathering of 50 senior leaders, giving them organizational weight that a standalone workshop rarely achieves.

Volz and his leadership team left the workshop with three things that years of consulting engagements had failed to produce: An honest internal diagnosis — a candid account of why NESDIS kept failing to change, surfaced by the people living the dysfunction: deference to leadership, the inability to stop anything, a speak-up culture that didn't exist, and a workforce that had learned that innovation was punished rather than rewarded. An 18-recommendation transformation strategy — organized into three clusters: clarify what NESDIS uniquely does and should prioritize; build a culture of innovation, flexibility, and accountability; and develop a workforce and partner network capable of executing the vision. Each recommendation came from inside the organization, not imposed by consultants. A follow-on mandate — the recommendations were adopted as the framework for the Fall Strategy Meeting, with Volz and his team committed to presenting them to 50 senior leaders and beginning implementation immediately, giving the work institutional momentum that previous efforts had lacked.

NESDIS wasn't ready to just do it. Fire detection products from GOES-R and JPSS had been developed through entirely separate acquisition programs, using different algorithms developed by different science leads, with requirements written a decade before satellite launch and no mechanism to update them based on user feedback. The result was product inconsistency, duplication, and — in some cases — algorithms that generated so many false positives that frontline fire managers had stopped using them. The broader cultural problem compounded everything: NESDIS scientists worked in silos, no one was willing to stop the line when they saw a defect, and the organization had a long track record of agreeing on priorities in meetings and then ignoring them. $120 million in new federal money was now sitting on the table, with the 2022 fire season approaching, and no integrated system — or accountable team — to spend it well.

Starting now and over the next 6 months, how can NESDIS create an agile, effective, and integrated fire product suite in coordination with partner agencies, and remove any barriers that are making that hard to do now?

What NESDIS needed was not more planning — it had plenty of that. It needed 26 of its best fire-domain minds, including external partners, in the same structured problem-solving environment with a shared mandate to produce a strategy they all owned. MMG convened 26 participants over three days via Zoom and MURAL: scientists, engineers, program managers, and policy staff from across NESDIS, two National Weather Service physical scientists, an NOAA research director, an EPA director, an IT specialist from NOAA's Office of the Chief Information Officer, and a senior lead from The Aerospace Corporation. Six topics — Impact Mindset, Whole Customer View, Transformation, How We Work, Communication, and Governance — were designed so that the fire challenge would be solved from every angle simultaneously, producing an integrated playbook rather than a set of siloed fixes.

NESDIS leadership left the workshop with three things the $120 million in new federal funding had not automatically provided: A unified fire system playbook — an integrated set of governance, accountability, and coordination commitments, anchored by the empowerment of Mike Pavolonis as Fire Program Manager with a dedicated tiger team, clarified roles and responsibilities across the NOAA enterprise, and a plan to integrate the fire information system into the NESDIS cloud and project portfolio management framework beyond FY22. A community of practice and co-development model — a structure for bringing fire-domain power users, including NWS field forecasters, EPA partners, and commercial operators, into the product development cycle as pathfinders and co-developers rather than passive recipients, closing the feedback loop that had allowed ineffective algorithms to persist for years. A test-and-learn execution strategy — a build-test-learn approach to the 2022 fire season, including a DevOps campaign to rapidly deploy improved capabilities, a user tracing plan to measure real-world impact, and a proving ground model for fire and smoke innovation that could serve as a blueprint for other thematic areas across NESDIS. 100% of participants supported moving forward with the recommendations.

In practice, the two offices gave users conflicting platform advice, took too long to align, defaulted to familiar contractors over better alternatives, and resisted emerging tools like AI and machine learning. Scientists with a PhD-honed DIY mentality simply stopped asking and built their own solutions. As one staff member put it: "It sometimes feels like we're bobbing along in our own individual life rafts, when we should be sailing together in the same boat." OST and OCIO directors Evan Howell and Nancy Majower had been trying to close this gap for years without success. A $3.3 billion Inflation Reduction Act investment had now raised expectations and shortened the clock.

How do two government offices that have been siloed for years — with different cultures, different incentives, and a long history of failed attempts at integration — finally change in a way that sticks?

The binding constraint was not a lack of ideas — it was that the people who needed to change their behavior had never been in the same room, working the same problem, at the same time. MMG convened 31 participants: 12 from OST, 6 from OCIO, 6 scientists from the regional fisheries science centers whose frustration was driving the urgency, and 7 NOAA Fisheries partners including representatives from NESDIS and OAR. Structuring the challenge across six interconnected topics ensured that the recommendations would form a coherent transformation system, not a list of unrelated fixes.

OST and OCIO leadership left the workshop with three things that years of internal effort had failed to produce: Clarity on why previous attempts had stalled — a shared, candid diagnosis of the cultural, structural, and workforce barriers preventing OST and OCIO from functioning as a unified operation, surfaced by the people living the problem rather than commissioned from an outside consultant. A confident action plan — an integrated set of commitments spanning change management strategies to overcome skepticism and embed new behaviors; a shared vision and North Star; leadership accountability structures and a guiding coalition; a redesigned operating model to close the gap between user inquiry and solution delivery; user-centric service principles; and a workforce and partnership strategy to build the skills and contractor relationships the vision requires. A coalition ready to act — 31 participants from OST, OCIO, the regional science centers, and partner offices who had stress-tested the strategy together and left with shared ownership of its execution. The planning team committed to a follow-on session to assign owners, timelines, and roadblock analysis to each commitment.

COVID-19 had destabilized HIRO's member organizations at exactly the moment when demand for brain injury services was rising. Staff across the sector were burned out. Service delivery had shifted to virtual models that many organizations had neither the technology nor the training to execute well. HIRO itself faced a version of the same pressure: it had been managing crisis for 18 months and had drifted from its strategic priorities without a clear plan to return to them. The sector lacked a shared playbook for operating in the post-COVID environment — for retaining exhausted staff, for advocating effectively to a government consumed by pandemic recovery, and for building the organizational resilience that would allow member organizations to thrive rather than just survive. HIRO's leadership knew what the problems were. What they didn't have was a strategy their members had built together and therefore owned.

What must HIRO and its member organizations start, stop, and continue doing to stabilize, renew, and strengthen the brain injury rehabilitation sector in Ontario as it emerges from the COVID-19 pandemic?

What the sector needed was not a report commissioned from outside — it needed the people running its member organizations to get into a structured problem-solving environment and build a strategy they would actually implement. MMG convened HIRO leadership alongside representatives from member organizations across Ontario, structuring the challenge across topics designed to address the sector's most urgent renewal priorities: workforce and burnout, service delivery and virtual care, advocacy and government relations, and organizational sustainability. The result was a strategy built from the inside out, by the people who would have to execute it.

HIRO left the workshop with three things 18 months of crisis management had not produced: A shared post-COVID diagnosis — a candid, sector-wide account of where member organizations were actually struggling, including the burnout and retention crisis, the uneven adoption of virtual care, the erosion of strategic focus under sustained operational pressure, and the advocacy gaps that had left the sector underrepresented in pandemic recovery conversations. A prioritized renewal strategy — an integrated set of commitments spanning workforce stabilization and staff wellbeing; virtual care standards and capacity building; a sharpened government advocacy agenda; and organizational sustainability measures, built by member organization leaders rather than imposed on them. Renewed collective ownership — a participant group from across the Ontario brain injury sector who had stress-tested the strategy together, resolved the tensions between competing priorities, and left with a shared sense of direction and accountability that a consultant's report could not have generated.

The pieces weren't adding up. The company's business units — Cymax, Freight Club, Channel Gate, and a nascent marketplace operation — operated as separate silos with different cultures, different incentives, and no shared identity. Vendors and partners couldn't articulate what Cymax Group actually was or did. Internally, 80% of revenue came from 20% of customers, but 80% of the work went to the bottom 20%. The organization didn't manage out underperformers, didn't have a disciplined hiring or development process, and hadn't invested in the marketing, people, or infrastructure the $500M goal required. Leadership, by their own admission, was too deep in the weeds to think strategically, and the organization lacked the EMT-level talent — in People and Culture, Sales, Partnerships, and Marketing — to execute at the scale they were targeting. The question wasn't whether the opportunity was real. The question was whether the organization was capable of taking it.

What must Cymax Group start, stop, and continue doing — in terms of its identity, strategy, people, and growth priorities — to reach $500 million in revenue and build a company worth acquiring or taking public?

The leadership team needed to get out of their day-to-day roles long enough to make the hard strategic choices they had been deferring: what the company actually was, which growth bets were worth pursuing, what kind of people and culture it would take to execute, and how to build the organizational infrastructure that would hold up at scale. MMG structured the challenge across four interconnected topics — Who We Are, Purpose, Hyper-Growth Opportunities, and People and Leadership and Culture — ensuring that the identity and values decisions would inform the growth decisions, and that both would be grounded in the people and leadership capacity required to execute. Owners were assigned to each major initiative during the workshop itself, making accountability a feature of the output rather than an afterthought.

The Cymax leadership team left the workshop with three things their day-to-day operations had never forced them to produce: A shared identity and purpose — a resolved definition of what Cymax Group is (an eCommerce enablement company that makes it easy to win online), which business units fit under that identity, and how to communicate it consistently to vendors, carriers, employees, and potential acquirers or investors. A prioritized growth agenda with owners — a set of concrete hyper-growth bets — including a B2B commercial marketplace, private label, direct sourcing, Freight Club expansion, and data monetization — each with a named owner from the leadership team and a clear connection to the $500M goal and exit value strategy. A people and culture blueprint — a prioritized EMT hiring plan (People and Culture first, then Sales, Partnerships, and Marketing), a professional development framework, a clearer definition of what a great Cymax employee looks like, and a commitment to the disciplined performance management the organization had previously avoided.