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.