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

Acting from a Place of Conscientious Compassion

Like many, I subscribe to numerous blogs and other daily feeds. Most don’t connect with me; some do; a few connect at the deepest level. This one did. In it, a Buddhist perspective from the Venerable Bhikkhu Bodhi addresses climate change, social justice, and saving the world. His perspective is interesting and important on many levels. What animates me this morning is wondering to what extent social sector organizational leaders are actually having these kinds of conversations inside and outside their organizations.

Bodhi says we “can be most effective by networking with others who regard human dignity and the integrity of the natural world as more precious than monetary wealth. By joining together, a collective voice might emerge that could well set in motion the forces needed to articulate and embody a new paradigm rooted in the intrinsic dignity of the person and the interdependence of all life on Earth. Such collaboration could serve to promote the alternative values that offer sane alternatives to our free-market imperatives of corporatism, exploitation, extraction, consumerism, and toxic economic growth.”

Bodhi discusses two primary moral principles involved in this effort to work toward a new level of collective action. “One is love, which arises from empathy, the ability to feel the happiness and suffering of others as one’s own. When love is directed toward those afflicted with suffering, it manifests as compassion, the sharing of their suffering, coupled with a determination to remove their suffering,” he says. “The other principle that goes along with love is justice….In my understanding, justice arises when we recognize that all people possess intrinsic value, that all are endowed with inherent dignity, and therefore should be helped to realize this dignity.”

How much of this line of thinking is working its way explicitly or implicitly into personal decision making and organizational life that is mission-oriented? Do we have blinders on, permitting us to see only (or primarily) our own objectives and priorities? When we approach donors to invite them to share our concerns and aspirations are we working to connect at the most basic definition of justice? David Cooperrider and Diana Whitney remind us that “human systems grow in the direction of their deepest and most frequent inquiries.”[1] So….what is at the heart of YOUR deepest and most frequent inquiry?

[1] David Cooperrider and Diana Whitney, Appreciative Inquiry: A Positive Revolution in Change, 2005.

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.

Awake in the World

I found the following in my morning stream and thought it applicable to how I’m readying my mind for Conversation. I find myself thinking at times that I am fully “awake” in the world. If truth be told, however, I’m more often “focused” rather than truly “awake.” I may salve my conscience by rationalizing that my work and my attitude of engagement is enough to be fully “awake.” Messages like this help me remember that the “awakening” doesn’t end with me. Messages like this make me ask myself whether I’m truly “awake” to what is trying to emerge and unfold in society around me….and if I’m truly “awake” to that realization, how will I be in this world? What will I do? What generosity is required of me?

Hope it resonates with you.

“The path of personal transformation and the path of social transformation are not really separate from each other. We must reclaim the concept of awakening from an exclusively individualistic therapeutic model and focus on how individual liberation also requires social transformation. Engagement in the world is how our personal awakening blossoms.” – David Loy, “Awakening in the Age of Climate Change”

The Leadership Model of Philanthropy

Earlier this month the Lumina Foundation’s CEO, Jamie Merisotis, posted an insightful blog entry to the SSIR blog, entitled The Leadership Model of Philanthropy. In it he lifts up the characteristics of focus, flexibility, and fortitude, which, he suggests, must be present for grant-making foundations to truly have systemic impact.


For the moment, let’s not get too lathered up about another “model.” Personally, I’m a bit reticent to toss around the “model” label. Solid contributions along a similar line as Jamie’s have referred to catalytic philanthropy, high impact philanthropy, etc. Despite my caution about falling prey to “model-itis,” his points are right on.

I think there are many parallels in grant-seeking organizations who endeavor to “act bigger and adapt better” (language from the Monitor Institute a few years back). For more organizational CEOs and philanthropy executives to embrace this type of thinking, they’ll need to hone their study of whole systems. I hear a growing desire to “take things to scale” but I don’t always see a corresponding understanding of the systems in which the organization exists. Trying to discern the path to scale without an understanding of systems thinking is hollow and the results will undoubtedly fall short.

A better understanding of whole systems thinking will likely result in a bone deep commitment to true collaboration and it will force one to look at the future with a long lens. Further, I believe it changes the conversation with donors–maybe not all donors but certainly those big thinkers who are not so interested anymore in simply supporting one organization because they’re trying to bring about some type of lasting change in people, in society. They’re looking for something bigger than any single organization. That’s systemic change and THAT’s where the power of philanthropy is at its most robust possibilities. Linked to systems thinking, philanthropy can really be catalytic.

That’s not a conversation every executive or philanthropy executive can have comfortably today–nor is it one every donor will welcome. But if you’re not preparing yourself and your colleagues to think this way, you’ll miss growing opportunities to have a truly big and lasting impact.

GHC Client, Providence Health & Service, Receives $25m Phil Knight Gift

Congratulations to the medical team leaders, foundation staff, and senior administrators of Providence Health & Services in Portland Oregon. They announced August 12th, the largest living individual gift ever received in the 5 state health system. This gift will support the heart program, primarily at Providence St. Vincent Hospital in Portland. I’m thrilled for the patients and staff of these fine hospitals and super proud of the great relationship work of the docs and foundation team over a span of many years. Kudos all. More details here.

This is the leadership opening

Making my space, finding my space, going into my space….an inner knowing—both individually and organizationally. This seemed to be a common theme among participants during reflection on our 2014 consideration of right being and wise action in community at GHC Conversation 2014. Following this discussion, Ken Hubbell offered an interpretation of the ingenuity gap[1], wherein we default to thinking that there must be some really smart people sitting in an office with “the answers to the problems we’re facing.” We act as if there’s a tacit assumption that some smart people keep within certain bounds along some logic all the systems we’ve built in our society. When certain things “go wrong” they know why this has happened. Unconsciously, this is our mental model!!

He continued to point out that large current, complex issues complicate this (e.g., the question of whether large scale health care reform will make us healthier). Tacitly, we seem to be waiting for somebody somewhere to do something about the things we see and help us understand what to do about it. Our mental model is “someone has it all figured out.”

This is the leadership opening. When we finally realize that nobody’s got it completely figured out and we are going to have to figure out these wicked problems together. It’s almost akin to a perfect storm for adaptive leadership. Rather than tacitly assuming that these problems will require all kinds of brainy people working in all kinds of different ways in order to break through default thinking and assumptions (i.e., “we’ll get to it later when we have more data;” or “We’ll elect a new President who will appoint a Secretary of Complexity who will solve it.”). In actuality, we all have to get in and work together in new ways to solve the wicked problems that we will always face until something emerges that feels right. Waiting around for an expert is not very wise. What complements this awareness is asking oneself: How do I fine tune myself to the moment? What must be my position, ideas, capacity, power, access, and view in order to get in and stay in this adaptive leadership moment?

This is where Conversation 2015 begins. If we are to move beyond our assumptions we must work toward individual clarity AND authentic concerted action. At present, 14 colleagues have registered for Conversation 2015Wise Action in Community: Generosity, Leadership, and Concerted Action. Six seats remain until we hit capacity. Will you join us March 26 – 28, 2015 on Hilton Head Island, S.C. Learn more and registerhere for Conversation 2015.


[1] Thomas Homer-Dixon, 2002, The Ingenuity Gap: Facing the Economic, Environmental, and Other Challenges of an Increasingly Complex and Unpredictable Future.

Is My Board Ready for Campaign?

In helping a healthcare foundation evaluate the degree of readiness their board of trustees currently exhibits for the coming campaign, I expressed some thoughts that may have application elsewhere.

Right outta the shoot I got asked who we are and what we believe. My response: we help organizations and leaders adapt and change. We believe that philanthropy is a lever for change and an expression of collective will and impact.

My turn to ask the group some questions before we dug in deeper. First, other than the millions of dollars sought, what do you want more of for the foundation? Second, what will that (answer to question 1) produce with and for the community? Third, what’s in the way of you fully achieving those ideals (their answer to #2)? That got our conversation about readiness started!

I believe that boards can be the growth engines of foundations during times of change and transformation. Campaigns are “moments in time” where organizations invite the community of stakeholders to share and shape a vision of great possibilities. The campaign is a sustained alignment of the organization’s intention and its attention. Fundraising is a disciplined process of invitation with resolve. The champions of that invitation process are board members. Each board prepare for campaigns rich with history and past achievement AND with potentially disabling blind spots and vulnerabilities.

The question becomes: do you have the courage to address these issues—not in a “fix it” manner, but born of an authentic desire to prepare a board for its highest and best purpose? If we want more major gifts focus, participation, and productivity from our boards, we have to see their work in full context—not just in “collection” mode. The Advisory Board Company’s research (2007) points to 14 best practices*, all of which are grounded in common sense but too often ignored during “the chase.” We reap what we sow with our boards. If we sense that “they’re” not ready for campaign it foolishly suggests a we/they environment that becomes insidious and it’s still up to professional staff to have the hard conversations and provide the support and direction in order to get high-value results.

*If you’re interested in having your board members do some self-assessment against the Advisory Board’s best practices, contact me and I can provide you a set of survey questions adapted from their research findings. Could be a good way to get a new conversation started with your board.

Personal Mastery

So the place to start this journey of understanding is with our own personal commitment to right being, or self-leadership, or mastering oneself. If there are seven areas of mastering leadership from the inside-out, first among them is Personal Mastery1 (aka, right being).

Kevin Cashman’s Eight Points for Personal Mastery

  1. Take total responsibility.
    1. The foundation of genuine leadership is built with self-leadership, self-responsibility, and self-trust
  2. Bring beliefs to conscious awareness
    1. Remind yourself of the Personal Mastery mantra: “As you believe, so shall you lead.”
  3. Develop awareness of character and coping
    1. Instead of overinvesting in Coping (reacting to circumstances to elicit an immediate result), commit your energies to leading with Character (the essence of who you are).
  4. Practice Personal Mastery with others
    1. Practicing Personal Mastery requires risk and vulnerability. It means placing ourselves in situations where we may not be accepted or validated by others for who we are or what we think or believe. If we do not take this risk, we too often will be led by the expectations of others. As a result, we might unknowingly compromise our integrity.
  5. Listen to feedback
    1. Rather than spending our energy defending a rigid state of self-awareness, we can think of Personal Mastery as a continuous, lifelong, learning process
    2. Personal Mastery involves the delicate paradox of being open to learning from others without allowing ourselves to be unduly created by them.
  6. Consider finding a coach
    1. …studies have shown that companies now use coaching 75 percent of the time to optimize performance vs. “fixing” problems. Having a coach as your partner during your growth process might be the most “right” thing you ever do
  7. Avoid confusing self-delusion with self-awareness
    1. Self-assessment can be the least accurate leadership assessment. To remedy this, use grounded, validated assessments with a solid research history to ensure that your growing self-awareness is real.
  8. Be agile
    1. Understand and appreciate your strengths, but also be flexible and adaptable.

1 See Kevin Cashman, Leadership From the Inside Out (2008), Berrett-Koehler Publishers: San Francisco,  pp. 55-58.

Whether Conscious of It or Not, What Does My Organization Need Most of Me?

Leadership is the hard seat to occupy in an organization. Like any living organism or system, organizations are self-organizing and self-perpetuating. The leaders’ role is less to steer or control but more to navigate and inspire, determining what conversations to be part of and how to engage in those conversations in ways that afford the opportunity to model the mindsets you want others to adopt. Mostly it’s about positioning oneself to be able to spot moments of authenticity and personal courage, as I believe that most people perform their work with the desire to do well and do the right thing. However, these golden moments of right being often go unnoticed. Those moments are not diminished by lack of fanfare and recognition, yet they are like lone fireflies in the sky—bright, interesting, yet fleeting. When recognized (with equal authenticity and personal courage) these singular moments are more often repeated and begin to attract similar action (and attitudes) from others. At those times the collective light is brighter. The resulting collective action—acting in community—is now felt by more people.

Every one of us in organizations will at some point have difficulty seeing beyond our own view. We seemingly get trapped on a repetitive treadmill of functional competence. While performance can run high for a time, I’ll argue that it’s not sustainable and it’s hollow—divided in Parker Palmer language. Stopping to imagine your organization exhibiting wise action in community produces the question of what your organization needs most of you, whether leaders recognize it or not?

It’s tough to express and demonstrate wise action regardless of your leadership position (e.g., leadership of a unit, a division, or an entire enterprise). Can you mandate organizational right being?  Can an “enlightened” leader demand her executive team adopt her mindset, achieve her motivation, and pursue her intentional practice toward right being? Seems unlikely. There will be arguments for differences and diversity of views being the source of creativity. Yet, I’m not talking about thinking the same; I’m talking about alignment of intention and attention. I’m suggesting this is more about a way of being in relation to oneself, to one another, to the work, and to the world.

What if repeated attempts to introduce right thinking to others falls flat or has only partial success because some adopt it while others block it? Do you fire the non-adopters? At what point is it counter-productive (for the organization, for the individual, and for you as leader) to continue allowing a non-adopter to distract and diminish the collective efforts of the team? The seemingly easy path is to remove those who don’t adopt. However, that action may only mask what the leader herself needs to recognize and learn about herself—say nothing of the legal and ethical ramifications of firing someone for “not being a seeker.” Guiding us toward finding true self, Palmer invites us to consider, “we must withdraw the negative projections we make on people and situations—projections that serve mainly to mask our fears about ourselves—and acknowledge and embrace our own liabilities and limits.”1

Implicitly, what your organization needs of you is to free yourself—and by demonstration, your colleagues—from organizational conceit and being so myopically mission focused that you lose sight of the whole system. Your organization needs you to model the balance of essential ingredients that the whole organization must adopt: open minds, open hearts, open will and resolve.2 More than technical prowess, this balance is key to fostering the conditions in which the “right team” can grow.

Look at the bottom of the U in the drawing. Only through the discipline to get and stay “open” will you, your teams, and your organizational colleagues uncover a shared perception and a common will to act with wise action in community.

march blog

What if the leader’s time and energy were on growing the wisdom of her team more so than pursuing the technical things (e.g., contracts, big deals, and all manner of “means to a desired end”)? Too often this technical dance devolves into a downward spiral of manipulation—unconsciously and without malice, but nevertheless every bit as limiting. The response from some will be: yes, growing the wisdom of my team is ideal but my board demands that I hit certain metrics, my compensation is tied to an achievement ladder, etc. Are these two pursuits contradictory? Can one pursue short term position-specific requirements and do so filled with loving kindness and deep intention? I believe you can and I believe that the most enlightened organizations require this balance.

1 Palmer, Let Your Life Speak, p. 29.

2 These ingredients, and the graphic that follows [drawn here by Ken Hubbell] is from C. Otto Scharmer, Theory U: Leading From the Future As It Emerges, (San Francisco: Berrett-Koehler Publishers, 2009).