Contributors: Jason Pradarelli, MD, MS, Carey H. Gallagher, and Jennifer Tomasik, SM, FACHE
To learn more about Jason, Carey, and Jennifer, click here.
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A health system CEO recently shared with us: "It feels like we're trying to steer a ship through dense fog. We see icebergs ahead in new and potential policy, regulatory, payment model and other changes, but we can't see their exact location or how big they'll be." This sentiment echoes across healthcare leaders today as they face unprecedented uncertainty that could fundamentally reshape healthcare delivery, economics, research, innovation, and education. Leaders must think systemically about how potential changes might affect different parts of their organizations while helping their teams maintain focus on more immediate needs.
Leaders can benefit from adopting an approach to change that is flexible by design and makes the best use of existing ideas and resources. This work is continuous within successful organizations, and is particularly essential to embed during inflection points, such as creating institution-wide strategy. The Campaign Approach to Change facilitates successful strategy implementation by partnering upstream with people to simultaneously shape strategy while driving change.
The Campaign Approach to Change in Strategy Development
Campaigns serve as a powerful metaphor for change, as they construct and drive collective action across a coalition, a broad group of people advancing a shared aim. They rely on an explicit strategic direction to clarify what success looks like and an opportunistic stance to fold in people and resources that amplify impact. Approaching strategy development with a Campaign mindset allows for early momentum in realizing strategic aims.
The Campaign Approach embraces three key principles which guide the development and activation of a coalition:
Change works best when it is both “top-down” and “bottom-up.” Traditional top-down strategy alone lacks the resilience and creativity found in grassroots efforts, while bottom-up innovation by itself lacks leadership commitment and resources. Effective change efforts integrate direction from leadership with energy and ideas from throughout the organization. While the path forward may be impossible to see, leaders need to provide clarity on a direction for the organization, while creating space for engagement and innovation at all levels.
We recently worked with a new medical school Dean whose vision was to reinvigorate its historic strengths, including basic science and improving the health of their community, to rise in rankings and deepen student engagement — all without tapping new resources. Using the Campaign framework as a guide, we helped the Dean develop the strategy, starting small with a working coalition of people who would be influential in shaping and implementing this strategic direction across all levels of the organization.
The future is already here, inside your organization. Though leaders often create well-reasoned ideas, a Campaign strategy starts other people’s thinking. Leaders look for “found pilots” — people and projects that already work in ways aligned with the desired direction. They offer opportunities to build the coalition and chances to learn about how a strategy may look on the ground. By identifying, connecting, and amplifying existing pockets of change, leaders can accelerate transformation by building on what’s already working.
In this case, the Dean knew that understanding student perspectives would be critical to realizing the strategic direction. They sought to learn from both “true believers” who would build early momentum and “friendly skeptics” who wanted a different experience but were frustrated. Both groups generated “found pilots,” footholds for change: true believers created opportunities for themselves in community-based and basic science research, while friendly skeptics formed committees to advocate for more equitable distribution of resources. The resulting strategy included uniform ways to promote research opportunities and permanent pathways for two-way communication of student concerns. Both groups became advocates for the strategy among their peers.
“Pull” is stronger than “push.” The Campaign Approach leverages that people commit more deeply to a strategy that connects to what they care about than one that feels like someone else’s agenda — creating “pull” for change. “Pull” strategies focus on creating conditions that draw people toward change — such as aligning with their interests, embedding changes into existing workflows, explicitly attaching efforts to a bigger purpose, and giving people clear ways to get started.
The strategy’s success rested on a strong research portfolio and high-quality education, which were difficult to achieve without robust new resources. Compounding the difficulty, basic science faculty felt underappreciated and under-resourced for their accomplishments and teaching effort. The Dean created pull for the strategic direction through introducing a prestigious award for teaching excellence, but knew that upcoming recruiting efforts would be more controversial and could derail momentum for the strategy. The new strategic direction would necessitate aligning recruiting with overarching school priorities, which intensified the chairs’ experience of underappreciation. The Dean expanded the use of clinically-focused administrative resources to support basic science, responding to a longtime request of the basic science departments. They also made the case the new researchers could enable investments in next-generation technological support, covered by their existing grants. Through these steps, the Dean pulled a larger group of basic science faculty into the coalition.
Campaign Guidance for Leaders
Campaigns shape successful strategy and develop flexibility in their organizations by setting a high-level direction, sourcing a coalition that facilitates top-down and bottom-up engagement, committing to finding the future through found pilots, and pulling people toward change. Specific steps that leaders can take include:
- Sketch a strategic direction. Establish what success will look like at a high level, as a guidepost for yourself and others, knowing the strategies themselves will flex.
- Map out your potential coalition. Consider people who will be essential for implementation, those who are “true believers” and “friendly skeptics.” Leave room for surprises!
- Create pull. Engage the different stakeholder groups, learn about needs and “found pilots,” give people reasons and ways to align strategically.
- Sustain the gains. Structure implementation to build on your existing coalition, powering a nimble engine for change.
The Path Forward
In today’s environment, healthcare leaders cannot wait for certainty before taking action. The Campaign Approach to Change can help leaders realize benefits of engagement, essentially implementing strategy, even as they develop it.
Contact Jason at: [email protected]
Contact Carey at: [email protected]
Contact Jennifer at: [email protected]
For more information on this topic or related materials, contact CFAR at [email protected] or 215.320.3200 or visit our website at www.cfar.com.