Read, Then Delete

In preparation for my exit from SLHI later this year, I’m going through old files and tossing material I thought was important at the time, and now it isn’t. It’s turning out to be most everything in my office.

One of the things I came across was the strategic plan we adopted in 1996 shortly after the sale of the St. Luke’s Health System. We did it by the book: a community needs assessment, facilitated strategic planning sessions, a vision, mission, goals and objectives – the works. It was clear, focused and accountable. It was also irrelevant the moment we opened the door for business.

I like to tell people that if I had to apply back in 1995 for the CEO position as it exists today, I wouldn’t have qualified for the job. It’s all changed, and none of it was the result of strategic planning. Basically, we responded to opportunities that came our way and made up the plan as we went along.

From my perspective, the key concepts that have informed our work over the past 16 years are not clarity, focus and accountability, but connection, surprise and learning. This is not to deemphasize the former so much as it is to recognize the latter as the core ingredients in our organizational culture.

If execution trumps strategy, then culture trumps execution. If you don’t have a culture that affirms your core values and principles – and if that culture is not in sync with the communities in which you work – you will never be effective, no matter what you do.

Culture is emergent: it arises bottom-up and top-down simultaneously through the interaction of many different elements that can’t easily be reduced to their constituent parts. At SLHI, we have found that understanding and nurturing the relational aspects of people and organizations – the bonding and the bridging work – are necessary to sustaining a healthy culture, and therefore healthy communities.

Clarity and Connection. Relationships start in connection and conversation. Clarity emerges from these connections and conversations, and not vice versa. We are religious about connecting people, organizations and ideas because it’s a wellspring of energy and creativity. Building community is a collective, not an individual, enterprise.

Focus and Surprise. We have a healthy debate on whether we should focus our human and financial resources on one or two things – reducing obesity or health policy research, for example – rather than continuing to explore opportunities that usually arise by surprise: the serendipitous outcome of pursuing new community connections. It’s worth reflecting that our TAP program (Technical Assistance Partnership) and Arizona Health Futures (health policy research and education) – two long-standing areas of focus – began serendipitously. Focus, yes, but always remain open to surprise.

Accountability and Learning. Accountability is usually attributed to independent organizations, which are accountable to those they serve (the community, shareholders) for meeting standards of performance. In SLHI’s case, everything we do is in partnership with others, and performance is attributed to the whole enterprise, and not to one of its constituent parts. We find that as we evaluate our work together and share the results as transparently and widely as possible, accountability arises naturally in a community of learners.

At the same time, we continue to operate as an independent nonprofit with its own board of directors. Ironically, our governance structure forces us to look inward at our own performance in isolation from the collaborative work that is the very essence of our mission, principles and values. Until governance structures change to reflect the networked nature of our world, we will continue to live with the dissonance.

Irony is inevitable no matter what. I will file away these reflections on our work over the past 16 years, and in another 16 years, if I’m still alive and reasonably intact, I will review them and decide whether they still are as insightful as they seem today.

No doubt I will hit delete. It’s the most useful key we have at any age.

Feedback? Send it my way: Roger.Hughes@slhi.org.

*The Drift reflects the views of the author, and does not represent the official view of SLHI’s Board of Trustees and staff.