Scenario Thinking for Hospital System Foundation Leaders

Navigating Change as You “Rehearse the Future”

A common pitfall of leadership is sometimes being unable to see the forest for the trees. There are so many moving parts to the operating environment of any successful hospital system foundation that it’s easy to get lost in minutiae and not be able to identify the right questions to be asking of the strategic challenge ahead. If you have been asking yourself, “What decisions should I be making now amidst all these sweeping changes in order to position us for optimal operating success in the future?” then you’ll undoubtedly be hoping to see with new eyes how the central question could be answered.

My newest paper presents a scenario development tool that, while no panacea, helps you get to shared clarity and ownership of the work ahead. Additionally, it helps you marry your collective attention to your stated intention. Four operating scenarios are developed as an illustration of how to apply this thinking to your foundation.  Completing the scenario development exercise with your leadership team can provide you great insights and enable you to gauge the strategic thinking skills and adaptability of your team. Having done so in a proactive way, the operating transformations become more direct and the rationale for doing so becomes abundantly clear. In that way, you’ll avoid the drag of the skeptics and give the early adopters a clearer path on which to lead.

Free download of 7 page paper in PDF format

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A Spectrum of Health System Foundation Postures in a Population Health Context

As we navigate the current environment of Population Health we have to reexamine the posture of philanthropy (and the professionals charged with its effectiveness). Here is a one pager that we’ve developed to frame internal discussions about some available options to consider. We’re working with hospital health systems on reimagining their possibilities. Hope this adds value to your current thinking and planning.

Health System Foundation in the Vanguard

Like every other community hospital/system in the U.S., HealthEast Care System is grappling with the mindset (and operational) shift triggered by the Affordable Care Act. Payment mechanisms are leading hospitals to engage with their communities in different ways. Their foundations are similarly facing sweeping changes. Working with a current client, HealthEast Foundation (St. Paul, MN), I am witnessing a courageous group of leaders trying to personally navigate these changes to gain clarity AND trying to inspire others to adopt a whole new perspective: that is, acting WITH a community and not ON a community.

Kathryn Correia, the system CEO, challenged the entire system to lean into a newly adopted vision of “optimal health and well-being for our patients, our communities, and ourselves.” Foundation Executive Director, John Swanholm, was the first to grab hold of this challenge, using the Foundation’s planning process as a vehicle for rethinking the role of the health system foundation and its value to donors and to community. John’s team spearheaded a comprehensive approach to arrive at a clear systems view of health and well-being in the East Metro service area. He guided the team through several exercises over six months:

  1. Charted the behavior over time (last 30 years) of key indicators of community well-being and philanthropy
  2. Used a vision deployment matrix to clarify the scope of changes embedded in the adopted vision
  3. Articulated a clear and compelling “theory of change” for the health system/foundation vision
  4. Used a scenario thinking process with system and community leaders to reimagine the future, resulting in 4 viable scenarios of the East Metro in 2030
  5. Charted the imagined behavior over time of key indicators per each of the 4 scenarios
  6. Inventoried and mapped the existing East Metro well-being community assets, using social network analysis 7. Developed a 36-month Foundation plan around 3 core strategies, while redeploying his professional staff and reconceptualizing the role and focus of his board.

No small undertaking, to be sure! The early challenges were largely around people at every level being locked in to outdated mental models of how a hospital and its foundation worked. Based on the Foundation’s leadership, which by the way was hand-in-hand with the system CEO, we are now seeing an organization considering what is right being and wise action. Prior behavior was rewarded (implicitly and explicitly) by being the best responder to the presented situation (medical issue/illness) and building brand around awareness of that posture. Foundations were uber-promoters of that position. While laudable on the surface, this position left the health system disconnected from the community. Despite its huge set of assets and resources, the overall health and well-being of the community was not impacted. In reality, small groups of citizens, individual churches, and small agencies were trying their hand at solving some small (and often big) social problem. Now at HealthEast, the health care system AND its foundation (which they now refer to as HE/F, reflecting the growing integration of what was previously separate entities), have a powerful role of convener and catalyst. Correia and Swanholm recognize that they must view their work through a long lens and they will succeed only if they foster sufficient trust equity that others believe the health system is not acting out of a marketing agenda but out of a true, authentic desire to be part of a bigger solution–not dictating the solution or imposing the “program” on the community. This is a much harder path to take, requires a long term perspective, and great leadership grit–all of which HE/F possesses.

Kudos to John Swanholm for employing social network analysis to better understand how to enter the community well-being dialogue in a targeted and value-added way. Social network analysis is the social science methodology of applying statistical analysis to the distances between members of a network or a set of networks. This science has been in use since the early 1950’s, particularly in the fields of disease management, crime prevention, and counter-terrorism.

We apply the statistical practice of social network analysis to help nonprofit organizations understand and leverage the inherent strengths in their relationships networks. This approach uses nodes to represent individuals and organizations, the lines between the nodes represent their connections to each other. It also measures the connectedness between nodes within the network as a whole, using a set of algorithms that identify opinion leaders and connected clusters. By visually representing this analysis, we can better understand the connectedness between nodes in a network and understand which individuals or organizations within a network have the greatest influence within that network.

The objective of using social network analysis for HealthEast Foundation is to better understand the various formal and informal networks that support health and well-being in St. Paul. By understanding how these networks function—and the key players within these networks—the Foundation (and, by extension, HealthEast Care System) are now better equipped to connect externally and accomplish its objectives within the community. HE/F now has a tool that can be used to support strategy development and relationship building and will enable HealthEast/Foundation leaders to effectively engage the community in the most efficient manner.

The whole conversation about health care, well-being, and philanthropy is changing at HealthEast. That’s pretty cool.

Planning Means Asking the Right Questions

Planning is a mindset and a discipline. There are many effective approaches and techniques to frame your planning dialogue. More important than the technique employed is your  willingness to ask and answer really hard questions. Following are a few questions that can be applied to individual programs, entire departments, and entire organizations.

  • What do we have to do to create opportunity for everybody to participate in this community in a whole/healthy way?
  • How do we live our vision so that it is a reflection of our attention and our intention and not just beautiful narrative?
  • What should we be doing for the next 20-30 years?
  • What is the question that we’ve never asked ourselves and how do we address it in a way that provokes the very future we say we aspire to bring about?
  • How will we go about raising assets in a model that reflects the intention of mission, vision, and signature programs?
  • How do we orchestrate a new conversation with our community and go about a new approach to resource development that models this vision?

These questions are not intended to be comprehensive yet they will evoke great discussion and–hopefully–some new perspectives on old issues.

Have at it!