How do you keep key people committed through a change that takes years?

Cody Simmons kept his core team through eight years without a sale. His method works for any owner changing how a business runs: say how hard it will be on day one.

Tell them how long and how hard it will be before they sign on. Cody Simmons, co-founder and CEO of DermaSensor, spent eight years in research and development before the company could legally sell a single device. The people he hired knew it could be a long slog that might never pay off, and they came anyway because the mission was worth it. Three of them have now worked together for more than nine years.

DermaSensor makes a handheld device that family doctors use on a mole or spot they're already worried about, to help decide whether the patient should go see a dermatologist. Cody did his graduate work in bioengineering, spent four years at Genentech, mostly in oncology, and got involved more than ten years ago, when his co-founder Dr. Maurice Ferre was looking for someone to turn a research project into a company. The technology came out of Boston University as a desktop machine Cody described as bigger than a printer. It's now about the size of a phone.

I had Cody on the show because the owners I work with keep asking me a smaller version of his question. They're about to change how their business runs, often by handing work to AI agents, and they want to know how to keep their best people on board while the payoff is still months away. Most of them feel impatient after eight months. Cody held a team together for eight years with no revenue.

Why does a big change take longer than the plan says?

Because the plan only counts the steps you can already see. Cody's company was doing three hard things at once, and he put it plainly.

Healthcare is hard, hardware is hard and dealing with the FDA or any major regulator, right? People commonly say each of those and we did all three.

Cody Simmons

The original plan was three or four years. A year or so to shrink the machine, a couple of years of studies, a few months with the FDA. Here's what it actually took, by Cody's account:

Every stage ran long. I think every business owner reading this has a version of that table, even without a regulator in it. When you move work from people to agents, I'd plan for the testing and the fixing to run long too. The difference is whether your people saw it coming.

What should you tell your team before a long change starts?

The purpose, and the hard part, out loud. Cody grew up with two parents who were educators, and he said the lesson at home was that your work should line up with your moral compass. He looked for people who felt the same, and he didn't dress the timeline up for them.

This could end up being a long slog. May never even happen, right?

Cody Simmons

He pointed out that plenty of researchers in drug and device companies go their whole careers without working on a product that reaches patients. Nobody on his team could say they weren't warned.

When I played it back to him on the show, I said setting expectations with his people was the number one thing I heard. The purpose got people in the door. The honest expectations kept them there. His COO, Ryan Freiden, joined eight months after Cody, once Cody had talked to the engineers and realized this was not going to be a one-year project. A few months later came the person who is now their VP of clinical affairs. Those three have been working side by side for over nine years. Cody also said they've added only one new board director in that time.

How do you get people behind something that can't pay off yet?

Cody said the need did most of the work. When he shows people the device, they often ask why it didn't exist already. His answer:

Yep, yeah, it's a great idea. It's very hard to do, right? Like, flying cars is a great idea, too. Good luck building them, right?

Cody Simmons

Selling the vision was the easy part. The harder sell, seven or eight years ago, was convincing investors this particular technology would lead. Papers were coming out saying you could take a smartphone photo of a mole, run an algorithm on it and match a dermatologist. Investors asked why they should pay to miniaturize a big machine, with all the manufacturing and supply chain headaches that brings, when an app might do the job.

Cody's answer was that a photo only shows the surface the doctor is already looking at, and photos have to deal with lighting, distance, hair and skin tone. DermaSensor reads what happens to light inside the lesion. The FDA's decision summary describes it this way: the device records light scattered back from the lesion across a range of wavelengths, and an algorithm built with machine learning analyzes that pattern for signs of melanoma, basal cell carcinoma or squamous cell carcinoma.

Your team will ask you a version of the investors' question. Why do this the slow, hard way when there's a shortcut? Have your reason ready before they ask, the way Cody had his.

How do you earn trust from people who know the work better than you?

Cody's phrase was confident but humble. He wasn't a dermatologist, and he said he learned a lot of what he knows by osmosis from experts in the field. So he listened, took in opinions that sometimes disagreed, and then stood behind one plan and explained why. He was also a young, first-time founder, which he said makes the balance harder, because people are quick to decide you're full of hot air.

That's the spot a lot of owners are in when they start changing how the work gets done. Your office manager knows the phones and the schedule better than you do. Listen first, then pick the plan and say why.

With the FDA, trust came from not cutting corners on clinical data. He described several pre-submission meetings before the studies started, months of back-and-forth questions during review, and six clinical studies submitted in total. He mentioned, almost in passing, that he got shingles during it.

Cody said the review came months after doctors started talking about pulse oximeters being less accurate on darker skin, and that the FDA told them directly it did not want to authorize something that later turned out not to work for certain groups. The FDA's own record shows how that landed. The agency authorized the device and required the company to run post-market testing in patients representative of the US population, with extra weight on the darker Fitzpatrick skin types IV, V and VI, where skin cancer is less common and the premarket data was thinner. Cody's point was that plenty of companies get asked for that kind of study and never run it, and eight years of meetings is how the FDA came to believe his team would.

I saw a small version of it myself. Cody showed up a minute or two late to our recording, and he said so before I did. He told me he isn't always on time, but he always owns it when he isn't. Eight years of that is what trust looks like from the outside.

What should an owner do to keep people committed through a long change?

Whatever you're rebuilding, the timeline is probably longer than the one in your head. Cody's team made it because nobody was promised a quick win. Before you start moving work to agents or changing who does what, tell your key people how long it could take, what could go wrong, and why it's worth doing anyway. The ones who still say yes are the ones you want in year two, and in year eight.

If your team is already quietly working around the tools you've bought, start with why that happens before you ask them for another year of patience.

This post shares Cody's experience from our conversation and isn't medical advice. The DermaSensor device is a prescription tool for physicians who are not dermatologists, used on lesions already judged suspicious, and the FDA says it should not be used as a screening tool or as the sole basis for a skin cancer diagnosis. Questions about a mole or spot belong with a qualified clinician.

Cut from Building the First FDA-Cleared Skin Cancer Scanner for Family Doctors.