Fidget Spinners, Carousels and Strategy: Harnessing Alignment for Forward Progress

June 29, 2018  |  Mike Eaton


A friend of mine recently called to share the news that she was planning on retiring in late 2019 after almost a decade as CEO of a health system. Her news was not public yet; she wanted to talk through the dynamics of an extended transition period that she was planning.

My colleague had no ready successor on her team. The board would likely want to do a national search for an outside candidate; but, there was also latent board interest in selling to a larger, regional system that had been courting her board chair for years. Her departure would give fresh legs to that conversation.

As we spoke about the transition planning, I asked her a question about her legacy and whether the organization had achieved what she had set out as goals when she first assumed the CEO role (after an extended run as chief strategy officer). Her answer was simple and swift – no. “A lot has changed,” she said, “but I’m not certain much of it amounted to forward progress.”

Since that first conversation, I’ve given considerable thought to the CEO’s contrast of “change” with “progress.” I reflected on systems I’ve personally worked with to develop strategies that in many instances were only the most recent installment of longstanding calls to transform health systems that date back to before passage of the Affordable Care Act! Certainly, much is different with these systems today. How much of it translates into forward progress is not clear.

What is clear is that many leaders have fallen into the trap of pursuing change while showing limited progress. Change happens whether we want it to or not. It is a function of the macro, centrifugal forces pulling on the healthcare industry. Those forces create forward progress only when intentionally harnessed in constructive ways.

Consider the carousel. It goes around and up and down; it can be a delightful ride, but the point of exit remains unchanged. No forward progress is made. Fidget spinners can mesmerize people and occupy their time and attention for hours, but the world remains unchanged no matter how long or brightly the little toy spins.

Too often, strategy, like carousels and fidget spinners, captures our imagination but produces little, meaningful progress. I believe that the reason is rooted in a statement made by Jim Collins that both informs and yet haunts strategic planning efforts:

“Building a visionary company requires one percent vision and 99 percent alignment.” – James C. Collins

Vision channels inevitable change. Alignment creates progress. Strategy must encompass both. An inventory of health system assets finds that most have enough capital, smart people, strong service and competitive products to make positive change happen. What slows their forward progress is the reality that their brand, business, operating and financial strategies and individual performance incentives are misaligned. Sometimes that misalignment is obvious and tolerated; often it is an unknown that scrumptiously drains organizations of the momentum that they need to succeed.

Organizational Axles and Alignment
The invention of the wheel changed everything. Prior to the wheel, people dragged and pushed blunt objects across rough ground, making little progress before they wore out, gave up or decided “right here” was “good enough.” (As an aside, those are common sentiments of many leaders at the point of departure from their roles!)

After the wheel, movement accelerated and grew easier, to the point that today we can cover great distances fast. It was not the first wheel, though, that made that movement possible. It was the alignment with three more on axles that transformed simply going around into a powerful mode for moving forward.

“The guy who invented the first wheel was an idiot. The guy who invented the other three, he was a genius.” – Sid Caesar

The problem with many strategic planning exercises – and the reason people frequently roll their eyes when asked to engage in another immersive strategy retreat – is the awareness that past planning efforts produced great conversation and interesting observations, but – too often – only limited progress. Like carnival carousels, these planning retreats can be an interesting ride, but the point of exit never changes.

To change that dynamic, consider recasting your planning retreat from an exercise in “where to next” to a focus on how we better connect (the axles) and work together (alignment) to go faster to achieve our current performance goals. This focus on strategy alignment is especially important if you see one or more of the following red flags in your planning discussions or ongoing performance assessments:

In the case of my CEO friend, the issue has been the misalignment of business strategy and resource allocations. Her team was unwilling to disrupt the status quo to fund future growth. Politically, it was easier to allocate maintenance-level funding to mature and declining programs, rather than harvest those resources and redirect them to emerging growth opportunities. The result was almost a decade of effort and hundreds of millions of dollars in strategic investment, with a stagnant share of inpatient volume and total premium dollar.

Getting Started
If you are concerned about the flags noted above, I’d be happy to talk through how you might structure an assessment to identify opportunities to enhance alignment. Often, just calling out the misalignment becomes a catalyst for resolving it. Sometimes the leadership team must make hard choices and trade-offs to get the alignment needed to make faster progress. Either way, until brand, business, operating and financial strategies are aligned, progress can be as hard and slow as dragging heavy objects across uneven terrain.

To have a conversation, please reach out to me at [email protected] or (757) 784-1277. As my CEO colleague can attest, it is a much easier conversation to have early in your tenure than at the point of departure!


is a Senior VP at BVK

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