For many threatened with long-term or acute organ failure, organ transplant may be the only option. The greatest risk to these patients, aside from the inevitable risk that comes with surgery, is tissue rejection. Their immune systems, paradoxically, set about to destroy the one thing that will save them. Physicians have learned to mitigate this risk by focusing on four major factors: 

1. Start with a relatively healthy patient. To maximize the chance of recovery, specialists try as hard as they can to limit transplant procedures to patients who are in relatively good health otherwise.
2. Pick the right donor. The number of gene variants in the organ, called alleles, is directly correlated with the likelihood of tissue rejection. This helps explain why the first successful organ transplant was completed between twins Richard and Ronald Herrick in 1954. Doctors try to match donors and recipients carefully and can run tests to gauge the likelihood of acute rejection.
3. Immunosuppression therapy. Within limits, doctors can treat the recipient’s immune system so that it doesn’t attack the transplanted tissue with all guns blazing. I say “within limits” because if the conditions for acute rejection are there, even immunosuppression won’t help.
4. Ongoing monitoring and intervention. It is critical to closely monitor patients after surgery and adjust treatment accordingly to promote tissue acceptance. Intervention can include blood transfusions, anti-bodies and new approaches to immunosuppression therapy.

I’ve gone into far more detail than you probably wanted because I find that these four steps are remarkably similar to the strategies the best company founders use as they integrate new professionals. Done right, “transplanting” the best talent from the outside can preserve and improve the company’s founding culture, while adding crucial new skills and capabilities. It is essential, however, to recognize that new professionals will naturally be met with resistance—especially in the strongest cultures. For founders, success requires prepping the patient in advance and taking full control of the integration process:

1. Start with a healthy patient. The founder is ultimately responsible for making sure the organization is a healthy recipient for transplanted talent. This means explaining to the company that there are talent gaps to be filled and that new people will enhance the culture, not diminish it. Founders also have to make clear that they, themselves, will do all they can to support integration, emphasizing that they expect the same from the rest of the company. A “healthy patient” knows survival depends on transplants and is united from top to bottom around the goal of making new leaders at home. As one professional CEO in China noted after joining a new company, “I was amazed at how welcoming the founder’s team was. They agreed I should be there and wanted me to succeed.”
2. Pick the right donor. Founders need to work equally hard to hire the right people. They have to know the “unit of experience” they require (using "the talent table"); they need to look for the right cultural fit (usually “black sheep from blue chips"); and they need to seek out energy givers and systems builders, not just administrators. (For more on identifying “A”-player characteristics, see this useful blog post.) Finding the right candidates requires a detailed recruitment process with lots of input. But founders need to own the final decision themselves, because a commitment to hire is a commitment to do what it takes to make the new leaders successful. One founder put it this way: “I have to own the final decision, because I have to be the first and last person committed to making these candidates successful.”
3. Immunosuppression therapy: For all the right reasons—but to disastrous effect—the original team may set about to destroy the invader in their midst, just as the immune system sets out to destroy the organ that is there to save it. Founders need to anticipate this and take personal accountability for integrating new leaders, helping them learn the company’s culture. They also need to make it the job of the original founding team to support the new leaders, which will sometimes feel about as comfortable as a blood transfusion. “It is easy to pull the rug out from under our CEO,” one founder noted. “I just have to agree with my original team about how many mistakes he makes. What is a lot harder is to support the CEO in every interaction, rallying all the original employees to welcome the change and recognize that the ‘mistakes’ are new ways of working.”
4. Ongoing monitoring and intervention. The rejection of an organ can be acute or can be chronic; the acceptance or rejection of a new professional can happen at once or can happen over time. Too many executives bleed out slowly, suffering the proverbial death by a thousand cuts. The founder must continue to intervene, support and adjust until the transplant “takes.” Sometimes the intervention is focused on the original team, sometimes on the new leader. The adjustment is a matter of fit, and a perfect fit requires adjustments all around.

We know that as companies grow, founders inevitably face the challenge of bringing in new professionals while preserving the company’s original culture.

We also know this process must become a repeatable skill because, unlike the medical analogy, it will be repeated hundreds of times. What’s crucial is teaching the original team that new skills and capabilities—even new leadership styles—will increase the company’s chances of success by helping the culture grow and adapt. In the end, being the best home for the best talent—new and old—is a competitive weapon.

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About the Founder's Mentality

The three elements of the Founder's Mentality help companies sustain performance while avoiding the inevitable crises of growth.