How To Make A Vision That's Built To Last

Reflections From Day 1 Of The Middle East Forum On Quality And Safety In Healthcare

I’ve just got home from a day at the Middle East Healthcare Forum on Quality and Safety in Healthcare. As part of the leadership track I spent much of the day with Derek Feeley, President and CEO of the Institute of Healthcare Improvement and Dr. Jason Keitch, Clinical Director for Healthcare Quality and Strategy in NHS Scotland.

One presentation was based on a IHI White Paper called High-Impact Leadership which looked at what makes some healthcare organisations perform better than others. The IHI describe six domains which these organisations focus on. They are now built into a new leadership framework which the IHI has developed. The six domains are

  • Driven by Persons and Community
  • Create Vision and Build Will
  • Develop Capability
  • Deliver Results
  • Shape Culture
  • Engage Across Boundaries

My immediate thoughts about this model, which I will explore further, is that it pre-supposes there is already an organisational competency to do the work in the six domains. In a developing healthcare system, there may be a requirement one step back, which tests the capacity of the organisation to run the assumed leadership systems and processes which the model implies. That however is an argument for another post.

You can read the IHI White Paper here.

Here are my immediate post hoc reflections on the second of these domains – vision.


A Vision That's Built To Last

Every organisation that has ever existed, whether it is explicitly stated or not, is based on a founding vision. 

At the beginning, as Simon Sinek has pointed out it is easy for everyone in the organisation to know and understand the purpose that lies behind the organisation’s existence. 

As organisations grow, this clarity can dim. This might happen because the founders have moved on, or their message is diluted by the many more who have joined the organisation. It may also dim because of increased complexity – what once was a simple idea must now be reconciled with a range of new factors.

Such factors can arise from what the competition is doing. New and better ideas or better execution. The technology might shift, permitting things that were once implausible if not impossible.

Or the stakeholders, whether they are investors, shareholders, regulators or customers might want something new or different.

This is the natural history of an organisation operating in a world in flux. 

What makes one vision endure through such changes while others fade or lose their relevance?

Here are 5 factors which might indicate that your vision's built to last.

1 Be Relevant To The Customer Or End User. 

A vision that fails this test  is missing the point. No vision can be self-serving if it’s going to have longevity. It must speak to a need or a want that the people who will consume it’s products or services have. 

In most people’s eyes, the purpose of a healthcare organisation seems relatively clear. 

Keep me healthy, and care for me when I’m sick or dying. 

So it follows that healthcare organisations construct their vision accordingly. Not all of them do.

2 Speak To The Values Of The People Who Work Or Want To Work In The Organisation.

A vision’s purpose is to inspire action. The people who join an organisation want to believe in the organisation and what it stands for. They want to feel proud to work for it. If the majority of people who work in your organisation are clinical staff, then the vision must therefore touch on the values that these people hold in common.

A commitment to high quality, a belief in the value of training, an emphasis on teamwork and a willingness to support front line care are some of the characteristics which might reach and inspire staff who work in healthcare organisations.

3 Communicate an aim that ‘feels’ more like a cause than an organisational outcome.

A vision’s job is confirm that there’s something in play which is larger than ourselves. So in framing a vision it’s important that the message that it conveys carries beyond the organisation and projects into the world beyond.

Healthcare organisations which state they aim to be the provider of choice are talking about an organisational outcome. However important this is, it is a task not a cause. 

4 Not Be Constrained By Current Possibilities.

None of us are able to see into the future. One day it’s possible there’ll be a pill that reverses diabetes. Or technology that no longer necessitates surgery for certain conditions. Who knows?

At the same time much of the way we deliver services today may be unrecognisable twenty years from now. Outpatients as a mode of delivery of services is badly in need of a game-changing innovation. 

This is why healthcare organisations – when writing vision statements – should avoid references to what is currently possible. If they don't they are likely to be overtaken by events and thus become obsolete.

5 Must Be Hard-Wired To Leadership Behaviour.

Finally, for a vision to endure it must reflect in some significant way, people’s daily experience at work. Organisations which profess their commitment to a cause, but actually spend all their time discussing finance or short term targets will be communicating loudly what really matters.

There’s of course a need to keep the lights on and keep regulators and other external stakeholders at bay. The job of leadership – if it is sincere in its commitment to the cause espoused in the vision – is to ensure that every conversation takes place within the context implied by the vision. That’s not an invitation to cynicism or wordplay. 

It’s perfectly possible to have tough conversations about the here and the now – it’s just that there is always a bottom line that everyone accepts is in the room.

Question: What have I missed and what other factors do you think are relevant to a successful organisational vision?