Columbia Business School

The Secret to Managing a Flat Organization

Presented by Columbia Business School

managing a flat organization. This is a view from above a work desk. You can see 4 people each working on different projects

One of the difficult challenges of running a place like Memorial Sloan Kettering is that we are an incredibly flat organization.


I have a complicated job as the president and CEO, because every day at Memorial Sloan Kettering 1,200 people come to Memorial Sloan Kettering knowing they’re in charge. They’re in charge of the patient care unit that’s seeing patients with lung cancer. They’re in charge of the research unit trying to figure out what this new molecular testing is all about. And they’re sure they’re in charge of Memorial Sloan Kettering.

The amazing thing about Memorial Sloan Kettering is that 900 of them leave every day knowing that they were in charge all day long — and that’s what makes us a successful organization


However, 300 of them discover that there’s an impediment to delivering the best possible care to their patients or discovering the most fundamental processes of cancer. And that ultimately rolls up to my office to say “Why didn’t you provide those resources to do that?”

We’re an incredibly flat organization, and so, by the end of the week, enough people have discovered that they aren’t in charge that they agree by Friday afternoon that I’m the president and CEO and I should fix the place.

The great news is that it’s 300 different people every day, and every month there are people who go through the entire month knowing they were in charge and that makes us successful.

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