"Learn As You Go"Strategic Management
Forget about the overarching plan in highly uncertain times

A story from James Taylor, president and chief executive officer, University of Louisville Hospital, Louisville, Ky. (1996-1997)

Told by: Brenda Zimmerman and Curt Lindberg

Illustration of:

• emergence
• creating conditions
• action learning
• complexity and unpredictability
• reflection
• co-evolution
• attractors
  
  

The Board members of University of Louisville Hospital had just hired a new CEO. One of his early challenges was to be the creation a strategic plan for the next five years and beyond. The Board and senior management had already gathered some consultants’ proposals from highly respected national and international firms. It was expected that James Taylor, the new CEO, would choose between the proposals and carry out the work.

He struggled with how we was going deal with his new Board on this. He decided to be direct.

"The strategic planning idea didn’t make any sense in the rapidly evolving health care environment. I told the Board that we should put aside the proposals to do a $500,000 strategic plan and get on with addressing the strategic issues themselves. They already had identified the key strategic issues. We knew what they were. I said that I thought we should learn as we go from dealing with those issues if we are going to survive in this strange organizational environment. Let us learn and evolve."

Although Taylor was worried about whether the Board would see him as "some kind of weird guy," they accepted his ideas about acting on the strategic issues and learning through the process.

He fosters an action learning, issues oriented approach. Consultants are hired but only if they agree to work with the team as co-learners "to add richness and diversity to our discussion." "Consultants who propose to come up with solutions or figure out the process for us" are not considered.

Taylor found that most consultants and managers generally do not understand his request.

"It is hard to get people comfortable with the idea of step by step, good enough as you go, and not falling back into the idea that we can plan our way out of all this or avoiding the real issues by continually studying. The tendency is to get some experts, plan it and avoid talking about what the real issues are."

The hospital made progress on some of the key strategic issues facing the hospital including the relationship with two other hospitals in the city. Collaboration is not implemented on an overall basis but on an issue by issue basis to discover what works and what does not work. Mistakes are made. They learn from action.

"I was talking with my Board president the other day about some of the difficult strategic issues that we are working our way through. He said that he thought I was the most patient person he had ever run across. I looked at him a bit startled. He said that he meant it as a compliment. He said the unique organizational situation we were facing meant I was not in control. My ability to get things done, as in any complex adaptive system, is dependent upon a lot of others who I cannot command. I guess my view of the way things work makes me seem patient - not always without frustration."

Reflection: Strategic planning is built on concepts of separation of thought and action, separation of planners and implementers, predictability of the future within probabilities and the capacity to fill a niche or create a new niche. All of these concepts assume a relatively stable environment in which the players in the market are known or at least predictable, the shape of the industry or market is known or knowable and the levers of power or influence are known or predictable. Health care in the US and Canada does not fit these criteria. The one knowable concept is that health care will not look like it does today in a decade. It is not clear who the providers will be or the source of power or which new industries will emerge to assume some of the responsibilities traditionally assumed by hospitals or doctors and nurses.

The concept of emergent strategy is not new nor is the idea of the lack of separation between strategy formulation and implementation (see for example Mintzberg, 1994). However, the traditional approach of senior executives planning the strategy for others to implement still dominates much of the strategy literature and practice in organizations.

Taylor’s story does not deal with the identification of the strategic issues. Some were "known" and some "emerged." His concern from past experience was that knowing the strategic issues existed was the easy part. Knowing what to do with them was the challenge. His story is about how to address the strategic issues through a layered process of action and reflection - the "learn as you go" approach.

Taylor had the courage and humility to challenge the ideas of strategic planning at his hospital. His ideas of emergence, co-evolution and unpredictability are informed by complexity. His choice of interventions, including using minimum critical specifications and finding small actions which connect with the larger strategic issues, are also based on his belief in organizations as complex adaptive systems. However, for the most part he has not brought these ideas into the open explicitly. He has chosen to work with what he believes are the attractors in the system. He works with what will attract people to address a key strategic issue.

Taylor is tackling the hard issues in his organization. For example, he has worked on a collaborative model for a regional cancer care system. But rather than try to reach consensus on topics like this where there are politics, where there is little agreement and no certainty, he tries to find small actions and specific topics which they can act on to address the "big picture". Lessons from the actions are then fed back as learning for the next loop. It is learn as you go for Taylor. Reflection is important in this process. He uses reflection to recognize the patterns in the interactions between the people and issues. This pattern recognition is an ongoing process. He never assumes he understands it all. It is a never ending inquiry about himself, the hospital and health care.

"It isn’t a good expectation for people to think that their leaders can tell what the future is going to be. We’ve got to get people past that and not allow that to be an excuse for not stepping up to the hard strategic issues and working through them." (Taylor)

Copyright © 2001, Brenda Jane Zimmerman and Curt Lindberg. Permission
to copy for Educational purposes only. All other rights reserved. Excerpt
from "Stories of the Emergence of Complexity Science in US Health Care" -
paper to be published in a book edited by Eve Mitleton-Kelly of the London
School of Economics.