Partnership Alighment Matrix

In the fictional state of Michiana, an integrated delivery system called Zippy Health was recently given a bold charge by its board: rethink partnerships to address unmet health needs in the community. Zippy Health turned to Epic Games, the company behind Fortnite, to explore how immersive content and massive commercial reach could engage young men in health. Together, they designed a gamified experience that delivered education, virtual care, behavioral health support, and referrals, all through a virtual reality (VR) platform. 

This scenario is a variation of outcomes that arose from a cross-industry exercise we ran with healthcare executives a few weeks ago. It left participants with a new appetite for ideas that might have once seemed too unconventional to pursue. 

In the current healthcare environment, as competition intensifies and resources tighten, many healthcare organizations are facing growing financial strain. In response, some are pursuing scale through new lines of business, while others are expanding via partnerships or acquisitions. A few are exploring adjacent sources of revenue, but most are seeking growth and stability by extending their reach in traditional areas of care and coverage or geographic expansion. These efforts are essential, yet may not be enough on their own. 

Partnerships can indeed expand both scale and essential capabilities. We like to encourage clients to think even more broadly and boldly about what partnerships could look like.  

Change and Uncertainty Likely Increasing 

The pace of disruption in the world around us is accelerating. Technology, politics, social change, and economic pressures are all moving fast, and healthcare is not insulated from these forces. In our 2025 Strategy in Action research, close to 70% of executives expected disruption in the next 2-5 years; up nearly 40% since the previous year. While the full impact hasn’t yet arrived, the pressure for change is unmistakably building. 

National carriers are actively working to reshape major parts of the healthcare system to gain cost advantages and strengthen their strategic position. At the same time, companies from outside the sector are pushing in, applying their strengths to disrupt parts of the healthcare workflow.  

Some of these disruptions may fail, it’s likely some of them succeed. And the shifts from those that move forward could make it increasingly hard to succeed by relying on year-over-year incremental improvements. The uncertainty is exacerbated by the fact that this is all happening in the context of a shifting political and economic landscape, and an uncertain regulatory climate. 

Some of what is coming feels deeply unsettling. Conversations I am having around the country are increasingly sobering. Last year, many organizations faced devastating losses and are also concerned about current forecasts. These are hard times. And I don’t mean to dismiss or sugarcoat them by suggesting that in the middle of all this disruption, that there is also an opening.  

An Opening in the Midst 

Long-held assumptions within this entrenched industry are starting to shift, creating an opportunity to rethink parts of the system that have long needed it. 

When we don’t have the capacity, capital, and skills to fulfill radically different ideas, another approach is to develop radically different partnerships.  

Strategic Alignment Matrix 

We have developed a simple framework that can generate powerful shifts in thinking. The outcome may shift understanding of boundaries of coverage and care, and expand ideas for potential partners.  

The results are often surprising and highly strategic. As such, I cannot share specific outcomes here, I would be glad to talk to further if you’re interest in exploring this approach. The matrix is customized for an organization, but a generic version is shared below.  

The goal is to expand the circle of potential, aligned partners by identifying others who share even part of your organization’s mission or goals. That might include those who want a healthier workforce, a stronger local economy, or collaborators willing to pilot new ideas or share data. The exercise can surface unexpected allies and create a foundation for reframing shared goals. 

We are always looking for ways to deliver high value with low investment, that help to secure competitive leadership for regional healthcare organizations. The work is both practical and invigorating. If you try it, let me know how it goes! 

With you in goodness, 

Nancy 

---

Recently in Scenario Planning

“There’s something powerful about being in the same room with people who bring different perspectives. That in-person connection creates a kind of understanding and energy that’s hard to get any
other way.”

⏤participant​

At Spring Street Exchange’s annual Scenario Planning Roundtable on September 23-24th in Boston, we used a shortened version of this concept in a Quest to address challenges for a fictional integrated delivery system. Two cohorts were charged to partner with the tools of technology giants to develop new approaches to addressing engagement with specific segments of health plan members in ways that changed what was possible. 

Wise Thoughts - Shifting Assumptions

This special edition of Wise Thoughts was co-authored by Nancy Wise and Quinn Pidgeon

New Assumptions

In Spring Street Exchange's 2025 Strategy in Action research, 70% of the healthcare executives surveyed expect major change in the industry in the next 2-5 years. Only 2% felt 'very prepared' to adapt to this level of change. With the passage of the 2025 Budget Reconciliation Act (the “One Big Beautiful Bill Act,” or OBBBA), many health plans are especially concerned about the future outlook. This rising uncertainty makes planning more challenging and the future seem more fragile than usual.

We became interested in exploring how healthcare stocks across industry sectors were performing in relation to key events. This was not only an inherently interesting question but also one that provided insight into how healthcare has been trending compared to other industries, how these dynamics have changed, and what opportunities or risks could lie ahead. We found that some of the long-held rules of the road about how the healthcare sector relates to other parts of the economy no longer hold true. This rerouting led us to think about shifting assumptions overall and consider active steps we can take to reduce risk moving forward.

Connecting events with stock performance 

This issue of Wise Thoughts was supported by rich and creative analysis conducted by Quinn Pidgeon, one of Spring Street Exchange’s Analysts. He developed a tool to track some of the key healthcare stocks by organizing them into four indexes based on the primary sectors they represent, including: 

• Medicare Advantage Index: UnitedHealth Group (UNH) and Humana (HUM) 

• Medicaid / Individual ACA Index: Centene (CNC) and Molina (MOH) 

• Commercial: Elevance (ELV) and Cigna (CI) 

• Providers: Tenet Healthcare (THC), HCA Healthcare (HCA), and Universal Health Services (UHS) 

Below is a chart showing the performance of each index year-to-date. This chart covers the period between January 2 and August 6, 2025, and reflects the four custom indices listed above, as well as SPY, an exchange-traded fund (ETF) that tracks the S&P 500 index. The indices are weighted to account for relative market size. We also added vertical lines to denote key events that may have affected stock performance during this time (see the end of this document for details on the vertical lines correlated with events).

Healthcare is traditionally a stable sector, especially during times of uncertainty. However, as the chart shows, 2025 has been a difficult year for healthcare investors. Year-to-date through August 6, the Medicare Advantage, Medicaid / Individual ACA, and Commercial Indexes were all below their January levels. The declines are steep: approximately -47 percent for Medicare Advantage and -53 percent for Medicaid / Individual ACA. By contrast, the Provider and S&P 500 Indexes were up approximately 20% and 8%, respectively, since January.

What’s going on?

Despite the historical view of healthcare stocks as a haven during turbulent times, such as during trade disputes (see the divergence between the S&P 500 and our indexes immediately after President Trump’s April 2 “Liberation Day” tariff announcement), many shareholders are now looking at alternative ways to balance their portfolio. For payers in particular, it has been a difficult year marked by declining profitability and missed targets. Government-sponsored plans faced some of the strongest headwinds:

• On the same day the Reconciliation Bill passed the US Senate, Centene, withdrew its 2025 financial outlook, citing lower-than-expected risk adjustment revenue and slower marketplace growth.

• Molina, cut its annual profit forecast twice in the past month.

• UnitedHealth Group had a disappointing earnings report in mid-April, attributing low profits to unexpectedly high healthcare utilization, especially within physician and outpatient services.

There are similar themes across the indices. As Morningstar Investment Services notes, “rising medical costs, heightened regulatory pressures, and disappointing earnings guidance (especially in Medicare Advantage products) have been a toxic combination to [payers’] valuations.” Some of these challenges may reflect the difficulty of forecasting in a highly disrupted environment. Many payer organizations are still adjusting their models to account for post-pandemic care patterns, particularly in behavioral health, where utilization trends have shifted quickly and unpredictably.

That said, not all national payers are in the same boat. For instance, Humana’s stock has remained relatively flat compared to the beginning of the year, and it is the only national payer to avoid an earnings miss so far for the second quarter. Humana addressed hurdles within Medicare Advantage before the other national payers, which may have given them a headstart in adjusting for some of the same trends.

The future does not always follow the past

Investors, planners, and healthcare executives often assume extended historic trends will continue into the future. For decades, the healthcare sector generally followed this pattern: its earnings and returns outpaced the broader market, and it tended to outperform during recessions.

But our data reflects a rerouting. The divergence between historical expectations and current performance suggests that some of the old rules may no longer apply. This is part of a broader pattern of disruption across the economic landscape. As key factors underlying our assumptions shift and new dynamics take hold, these familiar guideposts become less reliable. Accumulating shifts can compound unpredictably, increasing the likelihood of surprise and volatility ahead.

As assumptions change across healthcare and beyond, scenario planning becomes a powerful way to explore alternate routes. Scenarios help leaders navigate uncertainty by testing different paths, surfacing critical questions, exploring new implications, and anticipating how the rules of engagement may continue to evolve.

The variations that we test through these exercises can be sobering, as economic news remains uncertain. Payers and providers are recognizing that past successes do not mean that an organization is equipped to withstand future ones under new conditions. Many of you are likely already exploring both best- and worst-case scenarios as part of your ongoing discipline. The latter can be especially difficult and all the more important.

We’d love to hear about your metaphorical or physical Scenario-Readiness Room and are always happy to share our tried and tested methods on pulling these together.

In the meantime, we hope you find Quinn’s connection between events and healthcare sector performance interesting. His spreadsheet supporting this is fun to explore – feel free to reach out for a virtual tour!

We look forward to connecting with you.
Nancy and Quinn
 

Wise Thoughts - Scenarios in the Policy Landscape

by Nancy Wise and John Rucker

Post-Budget Reconciliation Act

Many of you may have heard the saying that “if you want to go fast, go alone, but if you want to go far, go together.” When I founded Spring Street Exchange, almost 10 years ago,  it was with the belief that we were not simply an advisory firm, we were an exchange serving to germinate ideas, foster innovation and catalyze collaboration across the industry.  I’m co-writing this issue of Wise Thoughts with John Rucker, who has recently been joining me to engage in scenario planning with healthcare leaders around the country. And nothing has been more top-of-mind for the leaders we have worked with than the Budget Reconciliation Act signed on July 4th.

Even after months of exploring what the bill was likely to include, for many there has still been a feeling of surprise and a heightened sense of gravity since its passage. Neuroscientists say this gap between anticipation and readiness is an example of how our minds struggle to truly envision and plan for that which has not yet occurred.

The Landscape Just Shifted, Again

This legislation introduces a flood of both change and uncertainty. The complexity it brings to the healthcare industry will take years to fully unfold. Many publicly traded national insurers and providers saw immediate impacts in the markets, as sentiment about the future of health insurance and care delivery business models eroded. While UnitedHealth (UNH) and CVS Health (CVS) saw declines in the low teens in the weeks immediately following the bill’s passage, other national payers with larger concentrations of Medicaid and Individual business such as Centene (CNC) and Molina Healthcare (MOH) facing price drops over 40%.1

These movements show clearly that, even after the long-anticipated legislation passed, we have not been freed from uncertainty. We still face variables that could shift the future: efforts to pull back some of the provisions, subsequent legislation that could amplify it, and even wild cards that could take us in another direction completely. This degree of uncertainty makes it difficult to know where to start.

Nancy’s Thoughts:

For many, the instinct is to apply discipline to what we know how to do best, act incrementally, and wait to act until we know more. Given the environment, it’s important to be disciplined and strategic, close gaps, and move forward. So, yes, let’s do that. But in parallel, as leaders we should also be thinking through scenarios of what's coming so that we can keep moving forward proactively.

John’s Take:

Scenario planning can feel like a time-consuming exercise, but in our experience with boards and leadership teams, it reduces internal friction, accelerates improved decision-making, minimizes risk, and aligns stakeholders; these are all time-savers. With focus, we can use this approach to trigger a cultural shift that equips an organization to work through ongoing uncertainty rather than around it. This kind of agility becomes a lasting strategic advantage.

Potential Scenarios Related to the Budget Reconciliation Act

There are hundreds – thousands – of variables that could impact the future of the healthcare industry as this legislation is implemented.  Through scenario planning, however, we can simplify the landscape by summarizing these into trajectories, without having to debate the particular variables leading to each. We would suggest that, through exploring scenarios and what they could mean for your organization, you will find yourself more prepared and less anxious about the future. Related to the Budget Reconciliation Act, here are four scenarios worth exploring: 
 

Nancy’s Thoughts:

We often see organizations thinking early on about what I like to call “wildcards.” These are factors that are either low probably or unusual occurrences, but that we consider because if they come to pass they would have a big impact. Some examples include a global pandemic, a major climate event, or dramatic shifts in the political landscape, could shift our realities yet again. There are more and more wild cards in our increasingly dynamic world, sometimes leading us to think that everything is uncertain. By identifying wild cards, choosing which to address, and even lightly exploring their potential impacts, we become both more agile in our thinking and more prepared for any wild card, even those not anticipated.

John’s Take:

My late grandfather used to always say “don’t borrow trouble” when I would start to worry about the future. Back then, the future I was worried about was a bit simpler than some of the things we’re currently facing, but his point sticks with me today.  When scenario planning, we give the future a face and a name, and we give ourselves a way to address it rationally together. It becomes something we can analyze, align with peers on what scenarios could mean, and envision what responses could be required. This enables us to think about the future in a structured way rather than through the chaos of worry, and to be more confident in our ability to meet the challenges (and opportunities!) that could arise.   

Rehearsing the Future

This complexity is just beginning; we are facing rapid change and growing uncertainty across nearly every dimension of life. New twists and turns will continue to emerge, bringing uncertainties we haven’t yet anticipated. That, at least, is something we do know.

This is why we lean so hard into scenario planning at Spring Street Exchange. It helps our clients plan and lead into the unknown while staying grounded in today’s realities.
How is your organization processing and responding to the latest uncertainties in the healthcare landscape? How are you working with your leadership team to remain strategic and proactive amidst headwinds? I’d love to hear your approach and am happy to share what I’m hearing across the industry.

With you in goodness,
Nancy and John

Wise Thoughts June 2025 | Personal Engagement with AI

Leading in healthcare will require personal engagement with AI.

AI talk is everywhere, but much of it is either deep in the weeds or covered in hype. I want to bring the conversation back to what it means for each of us personally, as healthcare leaders, and as people navigating real-world decisions.

Many of you are already making rich use of generative AI tools such as ChatGPT, Claude, Gemini, Perplexity, or others. If this is you, I’d love to hear how you are using them and what problems they have helped you solve more quickly or more effectively.

Yet, many of the healthcare execs I connect with are still hands-off or toe-dipping instead of embracing AI as an ongoing thought and work partner. 

If you're still hesitant to engage with AI, consider this an open invitation. It's becoming essential, and I believe you’ll find meaningful value once you begin.

At Spring Street Exchange, we developed a simple framework that highlights three progressive tiers of using AI for healthcare leaders: 

Tier 1: Boost Personal Productivity

Using Generative AI as part of your regular work can help to demystify AI for larger functions and can also significantly enhance the quality and efficiency of what you do. 

Tier 2: Gain Organizational Efficiencies

Most organizations I work with are actively deploying AI to increase the efficiency of various operational functions, typically to generate savings and improve quality.

Tier 3: Transform for Greater Consumer Value

By embracing a deeper understanding of AI and its capabilities, leaders can think more strategically about how to transform the delivery of services and create lasting market advantages. Tier 3 is using AI to change the game altogether.

Common focus on Tier 2

Many healthcare organizations I speak with are focused on Tier 2, and that’s a great start. But I often see this happening even when senior leaders have not yet stepped into Tier 1 themselves.

For busy leaders, it can be tempting to leave AI to the technical leads. This is what has been possible with other forms of technology....but this is not true with AI.

AI is more than technology to fulfill particular tasks. It’s a general-purpose tool like the Internet that can be applied across virtually all that we do. Can you imagine doing your job now without being able to access the web? Do you remember those executives who had their administrative assistant ('secretary') print out their emails, then mark up these hard copies, and have their admin respond to them? That’s not us.

The ways AI will be integrated in our lives and change what we do will be at least as powerful as the Internet, but in a different way. AI changes how we think about what is possible. 

Collaborating with AI for change

Generative AI models are evolving fast, often updating every few weeks. If you haven’t used one recently, you could be surprised by its evolution. I don’t believe it’s possible to lead transformational AI efforts (Tier 3) without first getting comfortable with Tier 1. You need to know what it feels like to think, write, and learn with AI. Once you do, you’ll find that AI changes your understanding of limits and expectations. 

Here are some use cases to explore:

• Reading assistant: You can upload a stack of articles you have been meaning to read and ask the model to pull highlights, patterns, and major takeaways. To avoid missing nuance, you can even ask it to recommend which articles you should read in full and which can be safely skimmed or summarized.

• Writing coach: You can ask it to review your content and make it smoother or shorter, or more or less formal. You can provide a list of key points you want to connect and ask it to take a first draft on the written output for you to then refine and translate into your own voice.

• Tone feedback: You can have it review a sensitive email you have drafted, and to provide feedback on tone, clarity, and how your message might be perceived. It will suggest edits that support your intent while preserving your voice.

• Rehearse encounters: You might be preparing to meet with a colleague to address a performance gap. AI can help you rehearse different approaches and suggest ways to frame the conversation that support your overall goals.

• A GPT trained on your company: You could train a private GPT in the specifics of your organization’s history, market position, operations, known gaps, and key strengths. With that backdrop, you can ask all kinds of questions related to how factors could impact your company, such as policy changes, market shifts, or long-term scenarios, all in a context-aware way.

These are just a few examples. Over time, you will likely find that in working with Generative AI in these ways, you can both save time while also improving the quality of your work.

Building a custom GPT with OpenAI is straightforward, although it does require some practice to refine the GPT to deliver the outcomes you want. We have developed a variety of custom GPTs focused on healthcare policy analysis, scenario planning, findings from our proprietary research, and other topics.

There is a world to explore here. If you are interested in some one-on-one coaching to enhance your use of AI, Katie Poole and others on our team excel at providing this.

Some Cautions

• Do not copy and paste AI-generated text directly into your work. AI isn’t smart enough and still needs your judgment, your experience, and your voice. Use it as a draft partner, not a substitute. In fact, using it will enable to you be able to detect the voice of underprocessed AI that comes to you from others.

• Hallucinations are usually subtle. AI doesn’t replace your expertise, and if you over-rely on it for content, it could lead to embarrassing mistakes. Be cautious and be sure to validate your work; it does not replace the need for knowledge. 

• Do not share sensitive, proprietary, or private information in a free AI tool without fixing the settings. It is also low-cost to use a secure, private instance of Generative AI . If you don’t know how to set this up, we can help you.

Take the leap!

I know it can be hard to carve out the mental space to take on this kind of engagement with new technology. I assure you, though, that once you get going, you will see benefits immediately and likely will actually enjoy it. With the pace of change, I don’t think it will be possible to credibly lead in the coming years without AI as collaborator. Take the leap! 

If you are interested in 1:1 coaching in using AI, setting up private or custom GPTs, or other aspects of AI as a collaboration partner, please reach out. (nancy@springstreet.exchange).
 
More and more change is on deck; so glad we're in this together. 

With you in goodness,
Nancy

Wise Thoughts May 2025 | AI Automation On Deck

Overcoming confirmation bias when it comes to AI

I am often learning about and testing AI use cases with a mind to improve my own work and imagine implications for the future. When discussing with others, especially peers in healthcare, I often met with a story about a failed AI experience such as a chatbot hallucination or an incorrect CPT code, usually coming to the conclusion that AI isn't worth all of the hype, and it’s a long way before it can replace humans.

This speaks to form of cognitive bias, confirmation bias,  where people tend to seek and remember evidence that supports our own theory or preference. Because it is difficult to think about machines being as good as humans, or because we don’t want to lose a critical jobs for an organization or community, it can be satisfying to recount evidence that confirms our preference that we have a long time horizon before we have to worry about AI replacing our current workforce.

We need to be clear-eyed and non-defensive when we look at AI’s progress and potential.

Exponential progress

But these anecdotes treat technology as though it is static or slow-moving. However, we know that AI is evolving at a rate not seen with other emerging technology, and this progress is not slowing down. We are well into the deployment of powerful AI models, and yet their capabilities continue to grow at a rate that is difficult for most of us to fully grasp. The development curve is exponential, meaning the improvements come faster and faster over time. Because this kind of growth is hard to visualize, researchers often use logarithmic scales in their graphs, which smooth the curve and make it appear more gradual. But in reality, the underlying progress is steep. Each new model isn't just incrementally better—it often represents a major leap forward. So when we base our assumptions on what today's AI can or can't do, we risk underestimating how quickly those boundaries are moving.

A recent episode of Exponential View with Azeem Azhar interviews Steve Hsu, about his startup, Superfocus (you can listen to the episode here: The Difference Between Early and Late AI Adopters). It highlights a model that directs a large language model to respond only from a fixed, trusted data source. This eliminates hallucinations while keeping the flexibility and depth of a conversational agent. According to the discussion, this approach could replace 80 to 90 percent of call center agents.

Such AI systems built upon Large Language Models (LLMs) can interpret diverse queries, access multiple data sets, and deliver personalized answers with accuracy. These systems are already beginning to outperform the human standard in speed, availability, and precision. And rather than requiring customers/consumers to navigate a clunky script, they can interact with the model by talking in their natural language and hear responses back in the same manner.

I love humans

Let me be clear. I am not saying that a technology solution is better and I am not arguing that AI should replace humans. In fact, I often yearn for a simpler world, one with fewer screens and more direct interaction. But our feelings about technology do not stop its progress.

Overriding our assumptions and even our own experiences

The example above focuses on customer service, but it also points to something larger. The promise of AI automation is going to challenge our assumptions in virtually every part of healthcare: administration, scheduling, documentation, clinical decision support, outreach, and more.

Many healthcare organizations pride themselves on the human touch. Some see it as a differentiator to have a local person always answer the phone. But if a competitor offers 24/7 conversational support through AI that is more accurate and less costly, how does this affect your own operating model? What happens when consumers begin to expect that level of response because they have already experienced it elsewhere?

This is not an argument to erase the human element – it will continue to matter. So, if this technology is already available and expanding, rather than preserving how we have always done things, we can ask ourselves some new questions:

• How can we bring it into our organizations in ways that reflect our mission, our culture, and our communities?

• How can we design for efficiency and value without losing what makes our institutions trusted?

• Are we checking the AI box with incremental improvements or are we truly looking at bold steps that can improve the patient / consumer experience while meaningfully increasing access and lowering costs?

• How do we ensure that our business model remains efficient enough to continue delivering on our mission in the healthcare landscape of the next era?

I know that many you reading this are well advanced on the AI journey, and could teach me everything above and more. And, others of you are still getting started. Wherever you are along the spectrum, I’d love to continue this dialogue.

With you in goodness,

Nancy

Wise Thoughts April 2025 | Navigating the Unknown: Sensitivity Analysis and Scenario Planning

Imagine you run an ice cream truck business. You’re stocking the freezer, fixing that squeaky axle, and, as a smart small business owner, you’re also planning for the season ahead, figuring out your pricing, your costs, and what might impact your margins.

Let’s say you’re building out your summer sales forecast and trying to understand how changes in fuel prices, labor costs, or ice cream supply could impact your profitability. This is where sensitivity analysis comes in. You’re testing variations in key assumptions, exploring which variables have the most significant impact to your business model.

But now imagine the questions get bigger. What if the city imposes new restrictions on where food trucks can operate? Or a national dessert chain launches its own mobile trucks and starts parking near your best locations? Or new dietary trends shift consumer preferences away from what you’ve been selling?

Those aren’t tweaks. They force you to reconsider core parts of your business model—what you sell, how you sell it, and who you compete with. This is where scenario planning comes in. It’s not about fine-tuning assumptions. It’s about asking: what if the landscape changes altogether?

The key difference? Sensitivity analysis asks how much your current plan can flex within a known frame. Scenario planning helps you consider when the frame itself might no longer fit. It assists you in recognizing when the environment changes enough that you may need to make more significant adjustments.

Understanding the Tools

Sensitivity Analysis: Testing Your Known Model
This approach works when your business model is stable but you want to test how changes in key assumptions affect outcomes. It helps you identify risks, refine forecasts, and make sound, data-informed decisions. But it assumes continuity. If the world around you shifts dramatically, it won’t help you rethink the model.

Scenario Planning: Preparing for a New Operating Environment
Scenario planning helps you imagine how external forces, such as regulatory shifts, market changes, and environmental disruptions, could reshape your risks, opportunities, and even your primary goals. It’s not about predicting the future, but rather, about being flexible and ready, no matter which version of the future comes to be.

Not every scenario is disruptive. Some are aspirational. You might be testing a growth strategy, exploring a new market, or expanding your fleet. Scenario planning gives you a chance to simulate that future and test your assumptions before making decisions.

At other times, scenario planning is key to finding resiliency in challenging situations. This is the primary benefit we have experienced using scenario planning with our clients in recent months. It is remarkable to witness the fresh thinking and resiliency that emerge from collaborating with trusted peers to tackle problems.

Strategic planning makes use of both tools, and often together.

Looking forward

Scenario planning is a powerful, low-cost, high-impact intervention. At Spring Street Exchange, we integrate it into nearly every engagement, whether we're doing strategic planning, growth strategy, or risk management. If you’ve ever done this work with us, you know that we have refined the process with continual learning over the past decade to make it meaningful and even energizing.

There’s no faster way to align leaders and transform a room than the purposeful use of creative, strategic thinking to explore what’s next. When this all comes together to align action, the moment is nothing short of magical. Effective use of strategic planning becomes another superpower.

And, just like running a great ice cream truck, planning for the future is best when it’s done in good company, with creativity, and maybe a few unexpected flavors (pineapple-cilantro sorbet, anyone?) Here's to navigating the road ahead together.

With you in goodness,
Nancy ​

Wise Thoughts March 2025 Vol 2 | Dinosaurs Ruled

Dinosaurs Ruled

For over 150 million years, dinosaurs ruled the Earth. Massive sauropods migrated in herds across vast floodplains, their long necks sweeping treetops and their footprints left imprints big enough for us to sit in. In the skies above, pterosaurs soared; creatures like the Pteranodon, glided on wingspans as wide as a small plane. And on the ground, smaller, quicker dinosaurs darted through the underbrush. As nimble predators and opportunists, they were built for speed and adaptability. For an unimaginable stretch of time, these creatures survived throughout several eras of ecological change through evolution and adaption.

Compared to the dinosaurs’ reign, humans have barely arrived -- we are at just 300,000 years and counting. When I think about the breadth and scale of the Mesozoic Era, it’s hard to imagine how it all came to an end...but it did, and not because dinosaurs were flawed, but because the world changed faster than they could adapt. The impact of a sudden asteroid hitting the earth turned their greatest strength - size, specialization, and dependence on a stable environment -- into vulnerabilities. In a relatively short time, the dominance of dinosaurs roaming the earth collapsed.

Nowadays, we call something a “dinosaur” when it’s outdated or too big to survive, but this association misses the point. The biology of dinosaurs were optimized for an environment that changed around them. 

Applying the analogy to healthcare

I sometimes worry that we could be facing a similar moment in healthcare. Many of the most historically successful and mission-driven providers and health plans, the backbones of our healthcare system, could be at risk not because they’ve done something wrong, but because they’ve been optimized for a version of healthcare that could be rapidly changing around them.​

Healthcare organizations are already feeling the strain. Recent years have been difficult for many and there is even greater uncertainty in the years ahead. Healthcare has evolved incrementally in recent decades. During this period most of us have watched predictions of change come and go while the healthcare system remained mostly steady. This history has made many healthcare leaders understandably skeptical about change.

But we all know that change doesn’t arrive because someone predicted it. Instead, it comes when the cost of staying the same becomes higher than the cost of doing something new. We are likely at this tipping point now… but even if we are not, there could still be a reason to take a fresh, bold look at the healthcare business model.

It’s largely believed that the Chicxulub asteroid, which hit the earth approximately 66 million years ago, caused a dramatic "impact winter,” stirring massive amounts of dust and sulfur into the atmosphere. This led to a significant shift in global temperatures which contributed to the mass extinction of the dinosaurs.

But, not ALL dinosaurs went extinct. The large, land-dwelling non-avian dinosaurs like the Tyrannosaurus rex and Triceratops disappeared, but a group of small, feathered dinosaurs, the ancestors of modern birds survived. This was likely because they were smaller, more adaptable, had varied diets, and could exploit ecological niches that vanished for larger species. The asteroid and its aftermaths served more like a massive evolutionary filter. The species best able to adapt in a new environment survived.

The great convergence

We are currently in a period in healthcare not just when the environment is changing, but during which many dimensions are changing at once: ​

Artificial Intelligence (AI) Adoption: The promise of AI is no longer theoretical, as its capabilities are being rapidly deployed to address an increasing number of gaps. In 2024, the AI in healthcare market grew by 33% and is expected to grow by another 26% in 2025. The compounding impact of such development over years is difficult to imagine. It’s driven not just in the power of the technology but, even more by the applications developed and adopted to change the nature of our daily lives. Even if we are not personally using AI, the industries around us will continue to, which changes the world for AI skeptics as well.

Financial Pressures: Operating performance in the U.S. health insurance industry has been unsteady in recent years. Health insurers faced significantly losses at the end of 2024 and continued high cost of care is expected in 2025. Hospitals and health systems are facing similar pressures with rising costs and declining patient populations.

Policy Shifts: With the new Trump administration taking shape, we can expect a sharper shift toward market-driven policies that favor scale, flexibility, and privatization. This could lead to increased competition and further strain traditional industry players. Regional payers and safety net providers that serve the most complex populations could be required to do more with less capital and political influence than their national and for profit competitors.

Competitive dynamics: Competitive pressure is also more intense than ever. National insurers, retail giants, tech-backed startups, and care delivery disruptors are seeking to expand. Many are redefining expectations around access, experience, and speed. In such an environment getting better at current models isn’t necessarily advancement; it could still be falling behind in an era of shifting requirements of survival.

Taking flight

In such a time of uncertainty, we can have an instinct to wait until we know more, or until the dust settles, or until several large projects are completed, before acting differently. It turns out that waiting for the literal dust to settle was too late for the dinosaurs. Not to over-extend the analogy, but, running the same playbook but with smaller budgets until things calm down is a risky approach, especially while competitors are escalating their own evolution and preparing for a rapidly advancing future state.

Over millions of years, the surviving dinosaurs evolved into modern birds. Their bones grew lighter. Their feathers became more specialized. Flight, agility, and flexibility became their keys to thriving in a radically different environment. The lesson isn’t that all giants fall, but rather that the chances of survival are greatest to those who can shift, adapt, and evolve when the environment demands it.

In healthcare, the organizations that endure are likely to be the ones that recognize the climate has changed and start moving, in a new direction, even as they address near term challenges. This doesn't mean starting big new innovations when in crisis, but I would suggest it means preserving a future-looking mindset as a sacrosanct steam of perspective informing strategy and planning.

And on the chance that the current expectations of change are just another failed prediction, what is truly the harm in developing a more dynamic, diversified, and compelling approach to healthcare?

I don't know anyone who thinks the current state of healthcare in the US adequately supports consumers, providers, or communities. Could it be that this moment of shifting assumptions, in what is a very difficult time for many in healthcare, to shake assumptions and think differently? 
 
Can we shake our wings, and maybe hesitantly at first, take flight? 

Would love to hear your thoughts!
In peace, with feathers,
Nancy

Wise Thoughts March 2025 Vol 1 | Telling Stories

Telling Stories

Forty thousand years ago, two human species walked the Earth: Homo sapiens and Neanderthals. Neanderthals were physically stronger, had larger brains, and had successfully survived in harsh climates for hundreds of thousands of years. If survival depended on intelligence and brute force alone, Neanderthals should have dominated. Yet, today, only one species remains. The reason isn’t just biological luck. Sapiens had something Neanderthals did not: stories. 

Unlike Neanderthals, who lived in small, isolated family groups, Sapiens formed vast, interconnected networks. They shared myths and knowledge across tribes, enabling them to develop a collective identity that stretched beyond blood relations. The stories weren’t just entertainment; they enabled trust, cooperation, and large-scale coordination, giving Sapiens a survival advantage. 

When food was scarce or disaster struck, a small Neanderthal band had nowhere to turn. But a Sapiens group could call on allies from distant tribes. They could connect even without knowing each other because they were part of the same shared mythology and tribal traditions. When a technological breakthrough occurred such as a better spear, a medicinal herb, a new survival technique, it spread quickly through the network. Five hundred Sapiens together were far more intelligent than fifty Neanderthals. 

Neanderthals were strong, but Sapiens thrived as a vast network connected through stories.  

Leveraging Brain Science for Leadership 

In early human history, effective storytelling became such a survival advantage that it is hardwired into our brains. When we hear facts and figures, we process them in our rational brain, or the neocortex, where logic lives. But when we hear a story, the limbic system is activated, the part of the brain responsible for emotion, memory, and decision-making. According to Yuval Noah Harari in Nexus, “evolutionary changes in brain structure and linguistic abilities gave Sapiens the aptitude to tell and believe fictional stories and to be deeply moved by them.” Instead of passively consuming information, listeners mentally simulate the story, engaging with it as if they were experiencing it themselves. 

Neuroscientists call this the Neural Coupling Effect—when someone hears a compelling story, their brain activity mirrors that of the storyteller. This is why leaders who communicate through stories don’t just inform; they also have the power to inspire, motivate, and drive action. Embracing this element of a natural human phenomena, when used intentionally and ethically, can be a powerful tool to align people, especially during times of upheaval and change.  

Most of us came to work in healthcare because we believe in something bigger—improving health, saving lives, advancing medicine, caring for people in their most vulnerable moments. We commonly recognize that the current healthcare system is still a far cry from where it should be on these dimensions.  

Storytelling in Transformational Change 

As the healthcare industry prepares to navigate shifts in policy, economic forces, technology, and changes in funding, coverage, and regulation, we face a new level of uncertainty. In such an environment, an adaptive approach may not be sufficient for survival. We will need to remain think differently, act quickly, communicate with others, and align broad stakeholder groups to work together in new ways.  

Perhaps we can lean into the lessons of the Sapiens and use storytelling as a means to drive greater alignment, inspiration, and action. Staff and partners want assurance that there is a plan not just for survival but for mission-driven leadership that can drive toward a stronger future. Establishing a compelling, challenging, and attainable vision can serve as a beacon during times of change.  

Drafting a bold vision cannot be done in a day. It requires understanding the shifting dynamics, an organization’s unique strengths, and what could be needed to lead in the next era. At Spring Street Exchange when we help an organization to develop a fresh and more concrete vision, we work with a leadership team to explore the future of healthcare through scenarios. Then, we ‘try on’ several visions with a view of opportunities, risks, and implications for the company and also its stakeholders.

To be clear, we are not talking about a vision to health consumers lead their best lives or other common abstract ideas. A compelling vision should be specific enough to force trade-offs and align on a destination. This can:  

• Unify teams under a clear, emotionally compelling purpose. 

• Improve engagement and morale by helping people see their role in something meaningful. 

• Provide clarity in uncertain times, guiding decision-making and investment. 

• Strengthen external partnerships by making the organization’s future vision clear. 

Some organizations resist or delay visionary work because they are overwhelmed by the day-to-day challenges. The truth is that there is unlikely to be a magical moment in the future when the pace of change slows down. With every month that goes by, our world becomes more complex and interconnected. If we wait to act, we also are likely to get further behind competitors who are seizing the moment to accelerate their own work.  

Storytelling with Purpose 

While defining a vision cannot be done in a day, it can be done in parallel to everyday work, and it can be done in months. It requires dedicated time where the brain can engage in creative work and collaborative processes. Building time for this kind of structured focus is difficult. Many of us are feeling overwhelmed, and being asked to squeeze in one more component of work could feel like a step too far for some. But we may find that the benefits derived from such a step free up time in the near-term and long run. The results can also serve to reduce friction, align action, and accelerate progress.  

Great shifts in history have often been driven by a compelling story. For us, the question isn't whether change is coming, but whether we will shape it or be shaped by it. If storytelling is an innate superpower, how will we use it to build the healthcare system we truly believe in? 

I'd love to hear your thoughts. 

Peace,

NW 

Wise Thoughts February 2025 | Developing Superpowers and Getting Ahead of Uncertainty

Developing Superpowers and Getting Ahead of Uncertainty 

Uncertainty is profoundly uncomfortable. As a species, humans are hardwired to seek stability and predictability. We are so driven to avoid uncertainty that many people prefer a known negative outcome over an unknown one that could offer a better advantage. When we find ourselves in times of significant change—especially when a new presidential administration signals a major shift from historic norms—it challenges even those of us who are usually comfortable navigating ambiguity. 

With such extensive change and so many unknowns, many leaders instinctively wait for greater clarity before taking action. After all, why invest in strategies that might quickly become obsolete? But waiting is itself a decision—and often a costly one. A passive "wait and see" approach not only risks missing emerging threats but also overlooks opportunities to mitigate or adapt to them. This mindset assumes stability will eventually return when, in reality, continuous change is more likely. It also underestimates the power leaders have to shape outcomes even in uncertain times. The longer organizations delay, the more likely they are to fall into a reactive, crisis-driven mode rather than a proactive, strategic one. 

I recognize that change is disruptive, and the risks ahead are real. I do not mean to gloss over fear, risk, or the weight of difficult decisions. Each deserves attention, unfiltered and unvarnished. Yet, as leaders, our role is to remain agile and resilient—finding ways to fulfill our organizations' missions no matter how the future unfolds. This moment may push us into unfamiliar and challenging terrain, but it also presents a chance to—dare I say it?—uncover new opportunities. 

Rather than being paralyzed by uncertainty, organizations can turn how they deal with uncertainty into a superpower. This superpower is built through three key steps: anticipating the unknown, strengthening resilience through near-term action, and building emotional connection, support, and alignment. 

1. Anticipating the Unknown 

The past two weeks have sent shockwaves through the healthcare industry, with major policy shifts being tested and signaled that could impact coverage, funding, reimbursement models, regulatory ground rules, and more. Should some of the policies and tenets shared through public discourse come to effect, they represent a radical transformation of the healthcare landscape. This is occurring at the same time as other critical challenges, such as workforce shortages, inflationary pressures, and the impact of AI and emerging technologies. 

While the full picture remains in flux, organizations can piece together the variables already in motion—examining the likely pressure points, identifying where disruptions could emerge, and assessing how different policy, economic, and technological shifts could interact. This work can be informed by historical experience, but also to anticipate new ground altogether.  

Playing out a scenario is different than a what-could-happen brainstorming session. The scenario framework fosters a richer view of possibilities and intersections. It also makes the future feel more visceral and real, unlocking fresh thinking. As possibilities emerge, we often find that there are more ‘no-brainer’ interventions that are meaningful across multiple or all scenarios. This leads to immediate ‘unsticking’.  

There is also value in exploring where scenarios diverge. These offer a set of guard-rails that provide parameters of what is meaningful to explore. Anticipating risks, potential actions and opportunities in each of these futures makes a leadership team respond with greater readiness and agility should the scenario come to fruition. But more, the advanced thinking lays pathways for how to lead with a proactive and constructive reaction to change of any kind.  

OUTCOME: The future feels less uncertain, and leaders gain a sense of control by identifying key variables, defining strategic responses, and establishing guideposts for potential policy and market shifts. 

2. Strengthening Resilience Through Near-Term Actions 

Change does not happen all at once. While some policy shifts unfold gradually, others can take effect with little warning, requiring organizations to be adaptable in real time. The act of scenario planning is not just about modeling various futures—it also exposes immediate steps that organizations can take to build resilience along the way. 

By identifying key pressure points, leadership teams can put structures in place to manage uncertainty more effectively. Some examples of near-term interventions could include forming a rapid response committee to quickly assess and act on emerging developments, increasing the frequency and focus of employee and stakeholder communications to ensure alignment, or proactively investing in analysis and planning resources to strengthen the organization’s ability to react with agility. These actions create a level of preparedness that allows organizations to remain steady and responsive, even in unpredictable conditions. 

OUTCOME: Organizations strengthen their ability to remain resilient through uncertainty by implementing near-term actions that reduce disruption, improve coordination, and enhance decision-making. 

3. Building Emotional Connection, Support, and Alignment 

Navigating change is not just a technical or operational challenge—it is deeply emotional. Periods of uncertainty can create anxiety, disengagement, and misalignment, especially when there is no shared sense of direction and employees lack clarity on how key issues could impact them. But when organizations engage in forward-looking discussions, something powerful happens: creative engagement fosters emotional connection, collective support emerges through shared commitment, and alignment improves as teams develop a common way of thinking about the future. 

Through structured discussions and collaborative scenario exercises, leadership teams gain insight into areas of both alignment and misalignment, reducing friction and fostering more open, productive conversations. Leaders can see where perspectives diverge, uncover potential blind spots, and proactively address differences before they become roadblocks. At the same time, engaging in these discussions creates a shared narrative about what the future might hold, giving the entire organization a common language for thinking forward.  

This level of transparency also strengthens trust. Employees see that leadership is not simply reacting to external forces but actively working through challenges in a thoughtful, structured way. With regular updates, they feel included and respected, which fosters a greater sense of shared purpose and reduces fear. When teams trust that leadership is making decisions with foresight and inclusivity, they are more likely to stay engaged, aligned, and committed to navigating change together. 

OUTCOME: Organizations cultivate deeper emotional connection, shared commitment, and alignment—reducing friction, strengthening trust, and creating a common language for navigating the future together. 

Putting on the Cape 

Uncertainty is likely to remain a constant. Organizations that embrace preparation, resilience, and proactive leadership can turn how they deal with uncertainty into a superpower. The ability to anticipate change, align teams, and take decisive action is what sets them apart. 

This mindset isn’t about ignoring real fears or concerns. In fact, leaning into them—acknowledging challenges while staying agile and forward-thinking—is part of the superpower we are building. It fosters trust, deepens alignment, and strengthens our ability to lead through uncertainty. By doing this strategic work in uncertain times, we’re not just managing risk—we’re embracing a fresh approach to addressing near-term challenges and also creating new possibilities for the future. 

How is your organization managing uncertainty? Would love to swap tales. 

With you in goodness,  

NW 

Wise Thoughts January 2025 Vol 2 | VUCA - Amplified

VUCA-Amplified

For decades, we have been predicting transformation in healthcare, but to date, most changes have been incremental. However, the overall pace of change has been accelerating in recent years, and this momentum is sure to impact the healthcare industry in sizable ways. Now, most healthcare executives acknowledge that we are increasingly operating in an era of profound and unpredictable shifts. Beyond the usual challenges, healthcare leaders are facing heightened pressures from fierce competition, regulatory changes, shifting demographics, workforce issues, technological advancements, and more. And, now, the dramatic opening week of the new presidential administration is compounding this sense of uncertainty.

These forces come together in what can best be described as a “VUCA world.” Originally coined by the military, VUCA stands for Volatility, Uncertainty, Complexity, and Ambiguity. It describes environments where conditions are unstable, outcomes are unpredictable, systems are interconnected, and decisions are clouded by incomplete or conflicting information. Our world overall is increasingly operating within these conditions, making the concept of VUCA a useful lens to understand the challenges we face today.

• Volatility refers to the speed and magnitude of change, which has never been greater. Policies, regulations, and market conditions are shifting faster than ever, with significant consequences for organizations and communities.

• Uncertainty captures the difficulty of predicting future developments, as policies emerge and change course rapidly, leaving little time for confident planning.

• Complexity describes the deeply interconnected challenges that define healthcare, where a change in one area—such as funding or workforce policy—ripples across others, creating multi-dimensional problems.

• Ambiguity reflects the lack of clarity in many decisions, where even announced changes leave room for interpretation or adjustment, making it hard to chart a definitive course. 

Even before the announcements from the incoming administration of the past few weeks, the healthcare industry was already navigating a VUCA world. Now, with sweeping policy changes on the horizon, the uncertainty of this environment is growing - healthcare leaders are operating in what could be described as “VUCA, Amplified.” The intersection of rapid technological advances and volatile political and market dynamics demands foresight, agility, and a readiness to adapt.

VUCA-Amplified in Healthcare

The new administration is bringing a wave of uncertainty to the healthcare sector, fueled by the sheer number of areas potentially at play. From policy and regulation of government programs, insurance market rules, and other changes directly affecting the health policy landscape to broader actions related to the economy, immigration, climate and the environment, diversity, equity, and inclusion, workforce, international engagement, and more, almost no aspect of the system will remain untouched. While some priorities are beginning to take shape, others remain speculative or depend on legislative outcomes.

This breadth of potential change only heightens the VUCA nature of our current moment. The issues at stake highlight the complexity and ambiguity of the healthcare environment, requiring leaders to balance long-term vision with short-term agility. This landscape is further complicated by the fact that some members of the workforce may view these changes as dire while others embrace them, leading to a polarized and potentially volatile workplace environment.

This uncertainty and rapid change take an emotional toll on teams, consumers, and leaders ourselves. The human toll, personal impact, emotional drain, and professional exhaustion can all work together to leave leaders less able to act when needed.

Leading Forward

In times of VUCA-Amplified, healthcare leaders can gain an advantage by bypassing the instinct to wait for clarity and instead leaning into the resilience and adaptiveness of their organizations. While the future is unknowable, there are concrete steps leaders can take to navigate this environment effectively.

1. Stay Grounded in Mission
   When faced with unpredictable forces, an organization’s mission can serve as your north star. Decision-making grounded in your core purpose no matter what the external environment could increase alignment with long-term goals, even as external pressures shift.

2. Scenario Planning
   We do not need to know what will happen in order to prepare for it. Map out potential changes—such as in government programs or funding changes—and develop practical steps forward. Proactively exploring these variables increases the speed of action and adjustments that may be needed.

3. Engage and Advocate
   Stay connected to the policy conversation through industry groups, local coalitions, and direct advocacy. Your voice matters in shaping the regulatory environment and ensuring that policies reflect the needs of your organization and the communities you serve.

4. Bold Thinking

   The intersection of a shifting political environment with underlying industry changes creates a situation that may require bold, creative thinking. Accessing this superpower will require carving out time for reflection and discussion so that teams can think beyond traditional frameworks and innovate to align mission and financial goals. This mindset will be critical for the sustainability of many healthcare organizations, and for those with greater stability, it can still drive innovation, energize teams, and promote organizational cohesion. A clearly articulated vision for the future can act as a north star, guiding teams through uncertainty and change.

5. Communication and Connection
   Uncertainty can lead to anxiety and fear, both within your organization and among the partners, patients, members, and consumers served. Transparent communication regarding what you know, what you don’t know, and how you are preparing for change builds trust. Leaders may find themselves sharing their concerns, personal stakes, and hopes in ways that are more personal and connective to resonate more directly with people.

Because healthcare executives are often processing new information and changes as they arise, it can be easy to lose sight of the fact that others at all levels of the organization have less information and less time to process changes. Intentional communication and outreach will be even more important.

Embracing the Opportunity Within Uncertainty

While the challenges ahead may feel overwhelming, a measured approach focused on stabilization in the near term and preparing for adaptability in the long term can help. Not every change will be an opportunity, and some may bring real difficulties—but by staying committed to values and vision, organizations may even find new and sustaining opportunities for innovation through this complex and unpredictable time.

I’ve been talking with leaders throughout the industry, each with their own perspective and response. I’m happy to connect to reflect and share insights, as always.

With you in goodness,
NW

Wise Thoughts January 2025 | Tests of a Good Strategy

I’ve found that many healthcare organizations focus their strategy on their goals or mission, but this often does little to distinguish them from their competitors. In fact, some organizations lack a distinct strategy altogether and instead rely on a strategic plan filled with operational initiatives aimed at achieving sustainability in a stable market.

We define strategy as a means of sustainable differentiation. I’m a purest on the topic, meaning I don’t use the word ‘strategy’ to describe an approach for how to fulfill a goal. And while there are many wildly forward-thinking, imaginative, and business savvy healthcare organizations out there with distinct, differentiating strategies, there are many others that lack a strategy all together. 

Because healthcare is inherently mission-driven, the murky definition of strategy in the healthcare industry is often rooted in an organization’s original purpose. Many payers and providers were founded to serve specific communities or populations long before the competitive dynamics of today’s landscape. These companies and organizations have historically enjoyed protection through geographic boundaries, regulation, and local relationships. However, as the boundaries between healthcare sectors—and even between healthcare and other industries—continue to blur, and greater uncertainty in the landscape, future sustainability will depend on a more distinct and defensible value proposition.

Unfortunately, the forces of change that healthcare has long been insulated from are now breaking through, making it impossible for the industry to remain untouched.
A strategic plan anchored by improving quality and operational performance will struggle to remain viable in the next era of healthcare. That said, strategic niches grounded in mission and supported by bold, differentiating choices have the potential to create a competitive edge that drives both financial sustainability and also transformational change.

Below, I’ve outlined six key tests of a good strategy. Does your organization pass this test?

Those of you who have talked with me about strategy know that I’m mildly obsessed with these questions. I’d love to hear your answers and thoughts on them. Here are mine:

1. Does your strategy fulfill a need for your target consumer, customer, or community?

The unfortunate truth is that the current U.S. healthcare system, even in its most mission-aligned and robust form, fails to address the comprehensive needs of individuals, families, and communities. This means that getting better and better at how healthcare has always been will continue to underaddress consumers’ needs and that these gaps will continue to disproportionately affect those who have been historically underserved.

The healthcare industry shouldn’t be expected to solve all of society’s issues, but whenever we consider the broader struggles in people’s lives, even beyond medical and social factors, we widen the potential sphere of connection and impact. As the demands of the healthcare sector change due to emerging technology, workforce challenges, demographic shifts, and a fluctuating political and regulatory landscape, new opportunities may arise to provide more accessible and meaningful care solutions.

If your organization were to cease existing, how would the lives of those you serve change? Would their needs be mostly met through another entity? If so, how would their value proposition differ? Now, consider this question within the future landscape, where competitors and new entrants adopt artificial intelligence (AI), strategic partnerships, and entirely new business models. How does your organization convey its unique value proposition in this environment?

These essential questions have not been required in recent decades. However, they are essential for the road ahead.

2. Could your strategy also describe others in your market?

Even if your strategy feels meaningful and unique to your work, if it can describe other competitors, it’s less a strategy and has become more like table stakes. This means it remains important and even essential, but it’s not a differentiator. While many companies share their mission, vision, and values, many do not disclose their distinctive approach to achieving their goals or creating unique value in the market, keeping this confidential to maintain a competitive edge.

An important distinction here is not only what you think about your competitors but also how they present themselves and their services. It’s not uncommon for me to hear a regional organization refer to its competitors as having different values or priorities, which may be true when considering aspects of the work. However, when these competitors communicate their value proposition to legislators and regulators in marketing materials and while competing for contracts, they are telling a story that is equally values-driven.

A good strategy involves making clear, bold choices that distinguish you from others. For instance, if you assert that you provide “high-quality, patient-centered care,” consider: What does that mean in practice? How do we define quality and patient-centeredness in a way that is uniquely ours? If you claim to be more connected to the community, how does this provide sustainable and distinctive value that people can both experience and express?

If your strategy can describe others in the market, it is more of an aspirational statement than a strategy.

3. Does your strategy help you make trade-offs?

All healthcare companies face resource limitations and, therefore, need to focus on how to make decisions among various essential initiatives. A strategy assists executives in determining what to continue or expand upon, and what to discontinue. Trade-offs are the essence of strategy. An effective strategy should not only guide how your company prioritizes its portfolio of strategic initiatives, but the initiatives themselves should be intentionally designed and selected to fulfill the strategy. This could be a significant leap for some organizations, but it doesn’t have to occur overnight.

A strategy can empower leaders to align on how to pursue a vision and business model that provides unique benefits in a changing landscape.

4. Does the strategy help you fulfill your mission and vision?

For many healthcare organizations, the mission and vision are sacred. A strong strategy links daily activities and long-term planning to these guiding principles. It should serve as a bridge, offering direction on how your organization will achieve this vision.

Does your strategy keep your mission alive in a tangible way?

5. Does the strategy provide guidance through future changes and evolving market conditions?

Healthcare is a dynamic industry with constant regulatory change, technological advancement, and market disruption. A good strategy isn’t just a snapshot of the present—it’s a compass for navigating future uncertainty. It should position your organization to thrive no matter what challenges or changes arise. For instance, if your strategy focuses on ensuring that the benefits of emerging technology reach those who have been historically underserved, this provides guidance on how to prioritize resources as the healthcare landscape evolves.

A strong strategy can alleviate the stress of uncertainty for executives, staff, partners, and constituents by offering a clearer understanding of your organization’s role in new territory.

6. Is this strategy simple to say, remember, and act upon?

Can everyone in the executive and leadership teams clearly articulate the company’s strategy? Can they readily restate it in their own words and use it to prioritize their work? Sometimes, strategies turn into aspirational tongue twisters, attempting to encompass all the ways healthcare should change. For a mission-driven organization, this can help focus and align activities to fulfill the mission. However, if your team isn't regularly discussing and using the strategy statement, it isn't actually guiding your work.

A strategy must be known to be applied. 

The Case for Better Strategy

Even though the healthcare industry has been in constant motion, its structure has been stable for decades. There have been clear swim lanes for payers, providers, pharmaceuticals, and supporting organizations. We generally share an understanding of what to expect from each lane and have come to accept that much of healthcare is left under-addressed. With healthcare representing close to 20% of the US economy and also being a deeply personal priority for all of us working in it, it is unlikely that these swim lanes will remain sacrosanct into the future.

It's hard to step back and address strategy while an organization still has so many critical operational challenges and competitive threats. The good news is that these can be addressed in parallel, creating a path toward greater energy, purpose, and sustainability. Is updating your strategy on this year’s portfolio of initiatives?
 
Our world is changing quickly, and we can use strategy to lead into the future with purpose and intention. 

With you in goodness,
NW
 

Wise Thoughts December 2024 | Creative Collaboration

If we could bottle an organizational elixir that drives positive financial and operational outcomes, aligns leaders, and also sparks joy, I think all of us would invest. For healthcare companies, making regular, intentional use of this tool could become an organizational superpower.

Reflecting on our work at Spring Street Exchange throughout the past years, I’ve been struck by something almost magical—that this elixir is already at our fingertips. One of the most powerful ways to align leaders on challenges and opportunities and foster effective teamwork is a tool that remains dramatically underused. It’s low-cost, high-impact, and uniquely capable of providing energy, connection, and even smiles. That tool is creative collaboration.
 

Creative Collaboration

Creative collaboration is a process where individuals or teams work together to generate innovative ideas, solve complex problems, or develop new approaches by combining diverse perspectives, skills, and experiences. It often emphasizes open communication, shared goals, and cross-discipline insight, creating an forum for creativity to rise to the surface. Unlike traditional collaboration, which is more task and target-oriented, creative collaboration explicitly encourages exploration, informed risk-taking, and out-of-the-box thinking.

We use scenario planning and strategic visioning as means to bring creative collaboration into our strategic work with clients. Whether it’s a cross-sector scenario planning event or an internal session with leaders from diverse functions, magic happens when people come together to explore ideas or to address a problem, need, or goal.

The brain's role
Many executive teams hold regular planning, strategic, and operational meetings with tight agendas and a specific time allocation for each topic. The rapid-fire path through the vast array of issues is practical for status reports and quick decisions, and it is often necessary for busy teams. This activity engages the Executive Control Network (ECN) of the brain, which facilitates thinking focused on narrowing options to bring resolution to issues.

However, to think strategically and creatively, we need to engage the Default Mode Network (DMN), which is most active during rest and unfocused states. Accessing this brain function requires stepping back from the deadline-mindset to invite in divergent thinking. It is more difficult to find time and space for this type of cognitive activity because of the busy calendar tha most executives have and also because of the brain's tendency to avoid ambiguity and uncertainty.

With the urgent-issue-overload faced by many healthcare leaders, allocating more time to address issues can feel like time that is not available. Yet, failure to take the critical step backs will, by default, lead a leadership group to remain in react and respond mode, and rarely engaging in proactive, preventive, and strategic problem solving. WIthout divergent thinking, there is not a path off of the treadmill. 

Scenario Palooza, our recent scenario planning roundtable:

One stand-out example of this is the Scenario Palooza, a scenario planning roundtable we held earlier in December with 20 executives from across sectors in healthcare. We set out with a bold challenge: to design new sources of revenue to advance the strategy and sustainability of a fictional integrated delivery system. Over the course of 1.5 days, these leaders engaged in three rounds of scenario planning that led to a final presentation of a pitch for the new service.

Experiential engagement, a dynamic form of creative collaboration, often drives more meaningful and lasting change than logic and planning alone. While presenting a well-reasoned rationale for change is valuable, it can feel abstract, overly intellectual, or disconnected from daily reality. Experiential engagement shifts this dynamic by encouraging individuals to discover the "why" and "how" of change for themselves through processes that are tangible, interactive, and personal. By engaging people in an exploratory scenario, participants are more free to think differently and drive toward more impactful ideas.

Stepping away from daily demands for exploratory sessions such as this one can feel like a luxury. Yet, by the end of the event, participants reported that this type of perspective and activity wasn’t just time well spent—it was mission-critical. They recognized how easy it is to continue to step forward in familiar lanes even when clear analysis and environmental indicators are suggesting that this will not be a sustainable path.

Report Outs
While we can't step out for 1.5 days on the regular, taking larger blocks of time for greater exploration, problem-solving, and creative thinking is something that is imminently possible with proactive planning. When we do this work wtih clients, there is always a feeling of energy and relief. 

In fact here are some quotes from participants in recent scenario planning sessions we have facilitated:
 

Strategic thinking like this needs to be just as important as metrics like stars and membership.We need to be moving beyond routine goals like percentage growtho focus on bigger picture thinking
– Health Plan CEO

We have time carved out for strategy, or we call it strategy, but we needto shift the focus from report-outs to forward-looking discussions about where we’re going, not just where we are today.
– Health Plan COO

I’m now convinced we need to embed a framework into our infrastructure that allows us to think more proactively about innovation, new opportunities, and long-term success. We can’t keep pushing this off to cover sometime in the future.
– Health Plan CEO

This has been so powerful - we need to take this approach and this way of thinking deeper into our organization.
– FQHC CFO
 

Making the magic

The methodology used during our use of creative collaboration has been refined by the career experiences of our team in healthcare strategy and almost a decade of Spring Street Exchange as a company driving transformation with executives, boards, teams, and other groups. Our process has been honed to inspire bold thinking and focus on practical outcomes. In our experience, effective use of creative collaboration includes: 
 

• Data-Driven Insights: Grounding the sessions in robust analysis and data ensures that discussions are focused and relevant. It helps to align participants in a common understanding of the challenge and goals.

• Purposeful Structure: Intentionally constructing work sessions or scenarios with clear inputs, assumptions, and desired outcomes. Creativity for its own sake is unlikely to generate the desired business outcomes.a

• An air of play: We need people to let down their guard and suspend reality for long enough to explore the conceptual shifts. Carefully designed on-ramps into the creative work help to expand the boundaries of traditional thinking.

• Follow-up and sustainability. A one-off session is unlikely to drive change long-term. Participants need to see the fruit of their brain power lead back into their own work and the organization's performance. It also needs to be repeated to develop muscle memory and experience for when and how to use creative collaboration. 

A Commitment Forward

As complexity and uncertainty increase, creative collaboration could become the differentiating skill set. This type of engagement has the benefit of being both leavening and energizing while also being the most efficient path to alignment and growth. 

I'd love to hear how you are using creative collaboration in your own work and am happy to share our experience. The pressures and opportunities have never been greater. For those seeking to extend their company's mission into the next era of healthcare, this type of approach is mission-critical. Let's talk!

I hope that many of you are having a chance to step back over the winter break and holiday season. I look forward to connecting with your refreshed creative spark in the New Year! 

Until then, sending wishes of warmth and peace, 
NW 

Wise Thoughts November 2024 | Looking Forward

Many of us woke up on the morning of November 9, 2016, with the news that Donald Trump had won the presidency despite the best poll estimates. Spring Street Exchange was a brand-new firm at the time, and we were looking for ways to connect with clients. I began to email and call people, mostly with regional health plans, but also providers and vendors. With each person, I asked what their organization’s plans were in the case of a Trump presidency.

Very few people (if any?) I talked with had anticipated the election outcome, and most said their goal was to wait until more information was available to see what could happen next. Many seemed interested in trying to speed their way to an answer and professed to some kind of insider scoop from a reliable source, such as a connection to the campaign or the transition team. Yet, the various insider expectations were wildly contradictory at the time, and virtually none came to pass.

While the industry was grappling with this uncertainty, it became clear that no one had a definitive answer. In these conversations, I sensed an eagerness to move past the ambiguity, with many trying to piece together insights from various sources. This atmosphere of unease prompted Spring Street Exchange to step forward in a meaningful way. We decided to host our first industry-wide scenario planning round table, which ultimately grew into what we now call Scenario Palooza.

Uncertainty is a Human Nemesis

Humans are great at many things (Art! Music! Laughter!), but we are not so good at dealing with uncertainty. Our resistance to uncertainty likely evolved for good reason. The brain is always working to anticipate what’s coming, enabling it to prepare both the body and mind to respond to an unpredictable world. But when faced with unknown circumstances, this preparation is much more challenging – and in situations involving potential threats, like predators or hostile humans, a wrong move could be fatal. Consequently, it may have been advantageous to lean toward caution, either by steering clear of uncertain situations altogether or by shifting the brain and body into a heightened state, primed to adapt quickly to whatever happens next.

Because we tilt toward definitive answers, when we are faced with an uncertain situation, our natural instinct can be to go to experts for their predictions. In doing so, we are seeking additional information to reduce or eliminate uncertainty. This is a good instinct; informed predictions are likely better than uninformed ones, but the trouble is that ‘experts’ are no better at predicting the future than non-experts.

Uncertainty, by its very nature, refers to something that is multifaceted and unknowable – the universe is too complex for experts to account for all variables. But this doesn’t mean our only option is to remain in the dark until the future unfolds – we do not need to be able to predict the future in order to plan for it.

Navigating Uncertainty with Scenario Planning

Scenario planning is a powerful tool for managing uncertainty in complex environments or when the future is truly not known, such as how an administration will unfold after an election. Scenario planning embraces the inherent unpredictability of the future by equipping leaders to explore multiple plausible scenarios. The goal here isn’t to predict the future, but rather to understand a range of possibilities. The true reality is likely to be some amalgam of the scenarios. Some benefits include:

• Reduce Surprises: By identifying and examining different potential futures, organizations are less likely to be blindsided by unexpected developments.

• Enhance Decision-Making: Scenario planning encourages leaders to consider long-term impacts and various alternatives, leading to more resilient and informed decisions.

• Encourage Agility: When an organization has identified the impacts and how it will respond in a range of scenarios, it can adapt more easily to real-world changes, shifting resources or approaches as needed.

• Build Consensus: The collaborative nature of scenario planning often involves input from various departments or stakeholders, which can align teams and ensure a shared understanding of potential risks and strategies.

Ultimately, scenario planning enables companies to anticipate and proactively respond to change rather than reacting to events as they unfold. Because scenario planning makes future variables seem more real, it can help to ‘land’ uncertainty with potential discrete futures that can be named and easily discussed. And the cool thing is that engaging in scenario planning is high-impact and low-cost.

Scenarios and the Incoming Administration

As the new administration takes shape, we will gradually gain insights into cabinet appointments, policy priorities, and the Congressional agenda. Although it may seem prudent to delay planning until more details emerge, this reactive approach can leave organizations unprepared.

Instead, I recommend a proactive strategy that both addresses uncertainty and positions your organization strategically. A key factor to assess early on is whether the administration will adopt a constrained, continuity-focused approach or pursue a radical departure from current governance norms. This distinction will significantly influence planning, advocacy, partnerships, and other strategic decisions.

By centering on this dimension now, your organization can start scenario planning, establishing a foundation that can be refined and adapted as new information becomes available.

A scenario cadence related to federal policy could include:

Acting quickly can help leaders feel more active, engaged, and grounded in their ability to plan and move forward despite the uncertainty, thereby reducing anxiety.

I’d love to hear how your organization uses scenario planning, and I’m always happy to share my perspective! Drop me a line – we’re in this together.

Peace,

NW

Wise Thoughts October 2024 | Prioritization

“There is too much to do, many employees are feeling burned out –we need to be serious this year about limiting the number of projects we put on the strategic portfolio.”

“How is it possible that Initiative X didn’t make it to the priorities list!? There is no way I can do my work without it.”

It’s that time of year again!

As healthcare executives wade through the strategic planning process, many run into the conflict between everything that needs to be done and the limited resources available to do the work. Finding the perfect balance between these demands is impossible. 

It’s a time when almost everything can seem both urgent and also essential, but not all of it can be completed. Even if the goal of prioritization is to lessen the workload, frustrations still flare when what feels like mission-critical initiatives do not make the cut. 

Many employees, especially those on the administrative side of healthcare, face a frustrating scarcity of time, resources, tools, data, and support. Limitations can lead some to feel like they are continually working against the current and can never catch up. Their work is difficult, often unsung and unrecognized, and yet is the backbone of keeping our healthcare system working. 

Hearing that an initiative has been unfunded can leave critical employees feeling undervalued and stuck. The dynamic can feel like a no-win situation for leaders at every level of the organization. 

There is no quick answer to this dilemma, which made me feel hesitant about writing about it. But this experience is so prevalent that I have been pondering a path to get off the scarcity train. 

Plotting a new path

Many prioritization exercises are focused on keeping pace with evolving industry norms. Some healthcare organizations are waiting to embrace innovation until they have caught up or fixed historical gaps. These gaps are urgent and do need to be addressed, but this doesn’t mean that plotting a new path has to wait. After all, competitors are certainly not waiting for this catch-up to take place before they move forward. And honestly, there will never be a magical moment when an organization is all caught up. 

The terrific news is that addressing urgent gaps can occur in parallel with future visioning without breaking the bank. Early work related to strategic and business model innovation should largely be focused on alignment, vision, and planning.

If it is not already on the portfolio, you can include a project to re-envision the organization’s future in the context of the dramatic shifts on the horizon. As a first step you can plan to kick off the New Year with a future-scanning retreat to align on trends, technology, and new possibilities. (I know you're too busy to think about this - pick a date in February or March and reserve the day on your team's calendar now!)

While it could feel non-intuitive to include a future-oriented project within an already-loaded strategic portfolio, such an initiative can also raise morale. Leaders throughout the organization know that change is on the horizon - it can make them feel less anxious or discouraged if they know that a broader path forward is being charted. Structured time to step back and look forward opens new doors for growth, partnership, and sustainability - this is drafting a path, over time, off of the scarcity fly-wheel.

What a time it is to be in healthcare! So many of us came into this industry to make healthcare better, and changes in the landscape could finally open this door. Prioritization season can be time-consuming and difficult - but hopefully also offer hope for the years ahead. 

Has your organization struggled with these prioritization challenges? How is your future vision being expressed in your multi-year roadmap? I'm always up for the conversation!

Peace,
NW

Wise Thoughts September 2024 | Strategy Season

September kicks off fall, my favorite season of the year. Fall has the hallmarks of new beginnings, as it was the start of a new year for myself when I was younger and, more recently, for my children. For me, fall is a time to look up, step back, take a deep breath of the crisp air, and look forward.
 
For many healthcare organizations, the fall also kicks strategic planning into full gear. And, with so much change on the horizon, strategy has never been more important.
 
Many healthcare strategic leaders are looking deeper at their ‘strategic stack’ to ensure that their organization is positioned to thrive in the coming era. With this in mind, and the early scent of fall here in New England, I thought I’d share some thoughtson how strategy has moved front and center as the most critical task of healthcare organizations over the next few years.

Revisiting Strategy

At Spring Street Exchange, we define strategy as a means for sustainable differentiation. This means offering something special to consumers, patients, members, and/or partners that generates value that cannot be duplicated by others.

Many healthcare organizations have relied upon their nonprofit status or mission as a means of differentiation. Yet, the mission of most healthcare organizations is shockingly similar and usually less visible to consumers. Leading in the new era is likely to require unlocking value for consumers that is realized through cost savings, better experience, or both in a way that is not industry standard. 

Strategic or table stakes?

Many healthcare organizations have missions or strategy statements that are too general to offer differentiation or that are focused on catching up with the same attributes of others in the industry. Some examples include: 

• Helping people to achieve their greatest level of health: Most sectors and organizations in the healthcare ecosystem are trying to help people lead their best lives available given their health status. It is a fantastic goal and focus, but not unique.

• Embracing whole-person care: There is growing recognition that social factors are a strong driver of health for individuals, families, and communities. As government programs and risk-based contracts increasingly recognize the importance of socially informed care, most payers and providers are exploring their role in this ecosystem. Without a doubt, there are ways to embrace socially informed care that lowers costs and improves health that are different from competitors. Almost all are talking about a listening approach to community partnerships. Because funds are limited, this will likely require additional strategic focus.

• Simplifying healthcare: I don’t know anyone who thinks the US healthcare system is simple, accessible, or truly consumer friendly. Therefore, everyone wants to work on this. Simplifying healthcare truly cannot be achieved by being more and more efficient at how healthcare has always been. With AI and other emerging technology, there are new ways to solve historic problems. Truly simplifying healthcare will require re-imagining the healthcare journey.

Many companies don’t make their strategy publicly known, but you can pull together the mission, vision, values, and what you can gather about the strategy of your competitors and place these in a framework for a strategic view of your market. You may believe that your competitors don’t live up to all of their promises the way your organization does, but they still are leading on these values in their communications.
 
Strategies are more difficult to compare because most organizations do not directly share their secret sauce. Still, you infer strategic direction through websites, annual reports, press releases, analyst reports, filings, and community giving. By placing these on brand and strategy maps, you can see where there is differentiation and overlapping messages in your market. Aside: We love this work – call us if you’re interested in developing a regional brand and strategy map.

Can we wait just one more year until our ducks are in a row?

The rest of the industry is not waiting to evolve until your organization catches up. Competitors are working at breakneck speed to form alliances, embrace new tech, and achieve efficiencies on new dimensions. Because the bar is always moving, there will never be a magical moment when the organization has caught up.
 
Even more, waiting to align ducks misses a critical opportunity. Updating vision and strategy is likely to influence how your organization takes on current gaps and challenges. Your team's mindset when addressing problems can be leavened and even invigorated if it is done in a manner that helps the organization drive toward an inspiring vision. Even if many of the same activities are taking place, that process feels more meaningful to a mission-driven team than fixing problems to catch up. 

How to connect future thinking with your current work plan

On a hopeful note, because there is little differentiating strategy in healthcare, the opportunity when adopting one is immense. Whether focusing on a unique position in the community, specializing in working with a particular demographic, or redefining the healthcare administrative and financing process, there are opportunities to carve out a value proposition that will make it hard for others to match.
 
The fall can be the perfect time to engage in an assessment of your current strategic planning process for recommendations to inform the following year. This period is an efficient time for such an assessment because it allows your strategic advisor to follow along in real time rather than having to come back later to review and re-construct the process. Many companies may want to consider including an initiative to refresh their strategy as part of their strategic plan for 2025. This can take place while you're still getting your ducks in a row!
 
I’d love to hear how your strategic planning process aligns (or not) with what I’ve described here. It’s absurd how much I love this stuff – feel free to reach out if you’d like to chat about any of it.

Warmly,
Nancy

Wise Thoughts August 2024 | Boards and strategy

Boards and Strategy

Preparing Healthcare Boards for the Future

In our proprietary data, more than 64% of executives from regional healthcare organizations expect dramatic changes in the industry over the next 5-10 years. Navigating this level of change will require healthcare leaders to have more agility and a closer level of trust with the board than ever before.

A board's unique function lies in its ability to provide high-level strategic oversight and governance while remaining detached from day-to-day operations. This higher-level view helps the organization to focus on long-term perspectives, vision, mission, and core values. Thriving in the years ahead will require executives and board members to work together to update the governance for greater agility, strategic focus, and innovation.

Is your board structured to support this level of change? Are they positioned to focus beyond the financial and operational performance and focused on where healthcare is headed?

Amping the Board’s Understanding of Strategy and Market Dynamics

The ‘rules of the road’ in healthcare are shifting, with evolving assumptions about how and where care is delivered, by whom, and how this care is financed and reimbursed. Large industry players are seeking to expand their footprints and remake the industry with themselves at the center. Big technology and retail companies are inserting themselves into the healthcare ecosystem with their capabilities, reach, and consumer relationships. All this is taking place in an era of artificial intelligence (AI) along with changing dynamics in demographics, social forces, political winds, and consumer expectations.

As these organizations recognize that their sustainability is going to require more strategic differentiation than in the past, strategic planning will need to expand beyond operational to embrace innovation. As become more connected with strategic issues they will need to align on what it means to have a strategy, how a strategy relates to strategic planning, and what criteria will be used to define success.

Boards have a good understanding of market dynamics and see the emerging trends, opportunities, and challenges that leadership is facing. This will enable them to anticipate the risks, support innovation, and provide strategic guidance that leadership needs. We have found that using data to inform scenario planning enables boards to get a deeper understanding of trends more quickly as they explore the implications for the organization and industry as a whole. 

Board Assessment

If you’re unsure if your Board is prepared for the future, it’s important to identify where to focus first.  Conducting a board future-readiness assessment evaluates how well the board is prepared to support navigating the future landscape and it pinpoints opportunities for modernizing structure, roles, composition, and approach. An external assessment offers an objective perspective on the board’s strengths and areas for improvement, typically including an appraisal of the board's effectiveness in governance, strategic oversight, and decision-making processes. It can also help to identify gaps in knowledge, expertise, and strategic focus, particularly in areas critical for success, such as technology, innovation, and long-term planning.

Outcomes from this assessment can be used to improve board performance and alignment with the organization’s mission and goals, as well as its readiness for the expected shifts in the years ahead. These recommendations should address the schedule, agendas, governance, board composition, education schedule, and succession plan.

Many boards have mechanisms in place for monitoring the performance of the organization they govern. Fewer have structures to support the continuous improvement of the board itself. Like any group or organization, boards will need to evolve, and an agile mindset at the board level can serve as a model for the organization overall.
  

Looking forward

In a period of increasing change and uncertainty, none of us knows precisely what will happen next. But we do have a lot of insight into the issues that are emerging and what trends are at play. Refreshing the board dynamics is a way to signal a new day and to model the spark and innovation that boards will need to embrace to be effective.
 
We work with many boards – let’s talk!
Warmly,
NW

Wise Thoughts July 2025 | Creating Spark While Reducing the Strategy Deficit

“I love it when our team works together strategically; I just feel like there is never enough time.” 

“I know we need to understand more about our competitors are up to, but I’m so tired in the evenings. It’s a hard time to make myself focus.” 

“Our strategic planning process is solid, but sometimes it keeps us from innovating. We don’t really have a vision of how we are going to evolve over the next five to ten years.” 

These statements all speak to the strategic deficit that many Regional and Community-Based Healthcare Organizations (RCBHOs) are feeling. They have a sense that the way they have approached strategy in the past is not flexible enough to lead them into the future, but they don’t have a good alternative.  

Over the next decade RCBHOs will need to enhance their capabilities in strategy, analysis, innovation, business model development, and change management to thrive in shifting market dynamics and embrace emerging technology. However, it is difficult to drive toward these capabilities while there is so much in flight.  

There is a quick answer to this gap that helps to bridge from the current day to the agile strategic structure needed – the Step Back Spark.  A few simple interventions, including quarterly scenario planning and a longer annual planning retreat open up time for strategic engagement while also increasing connection among leaders. Activities in the Step Back Spark achieve these goals efficiently while keeping executives free to focus on ongoing urgent needs. 

The Strategic Deficit 

In our Strategy in Action research from earlier this year, more than 60% of healthcare executives said that they expect transformational or disruptive change over the next decade. Despite this sentiment, only 19% believe that they have the strategy they need to manage this change, and only 18% reported that their strategy creates market value that cannot be reproduced by competitors.  

Executives from all industries are facing a strategy gap. It can be difficult to focus on the big picture when more pressing concerns emerge daily. Most executives feel that thinking strategically is critically important and yet few find the time to do it. While 97% of senior leaders in one study feel that strategy is critical to their success, 96% said in another study that they lacked time to think strategically.  

In healthcare, the stakes can feel especially high. Whether the issues are clinical, operational, legal, or financial, the consequences of making a mistake can feel like life or death. With healthcare executives reporting that they often feel overwhelmed by their own duties, it can be difficult to find the time to focus on strategy. According to 2023 research from Witt-Keifer, nearly three-quarters (74%) of healthcare leaders admitted to having felt burned out within the prior six months, with 93% of those experiencing burnout feeling that it is negatively impacting their organization. 

Overwhelmed and Isolated 

Significant responsibility and pressure can lead to feelings of isolation for many executives. As they ascend to higher positions, the number of peers with whom they can share concerns diminishes. This sentiment is particularly prevalent among CEOs but is common among other executive leadership team members (ELT) and functional leads. Often, those heading a department or division feel that their roles and responsibilities are not fully understood by their peers, and sometimes even by their CEO. 

In the post-pandemic era, the increase in remote roles has reduced social connections among coworkers, widening the gap in understanding between peers. With fewer opportunities for spontaneous conversations that link different areas of the organization, there is less visibility into how others are working together. This disconnection leads to higher levels of loneliness, which in turn results in lower productivity. 

Overwhelmed by Change 

The stress and pressures executives are feeling are real and unlikely to abate anytime soon. Emerging technology, especially artificial intelligence (AI), is accelerating the pace of change and can leave some leaders concerned about falling behind.  

When feeling overwhelmed, it can be difficult to step back and think strategically about addressing challenges. Instead, many feel like they need to work more and be more efficient. There are a plethora of books, articles, and podcasts, all providing insight into steps we can take to do more with our time. However, the executive self-help industry can sometimes lead us to feel that this feeling of overwhelm is due to our own failings rather than the circumstances around us. Yet, the world is getting more complicated and moving more quickly, and our brains have not evolved to manage the level of uncertainty we currently live. 

A Strategic Step Back 

Strategic work is challenging and requires more focus and concentration than is required when we react to problems before us. Despite this, I’d like to suggest that strategic work is actually an answer to the challenges of being overwhelmed and disconnected from colleagues. It also has the side benefit of helping your organization become more resilient and ready for the future.  

Quarterly Scenario Planning – A Strategic Spark 

Quarterly half-day scenario planning sessions can be transformative. Rather than reading reports and articles, the executive team takes part in exercises in which they collectively explore potential future scenarios. By exploring emerging trends and risks together, executives align on the impact of these issues and generate an understanding of risks and opportunities along the way. Because these scenarios are explored collectively, they also gain a deeper understanding of colleagues’ challenges and priorities. 

Scenarios can include content around competitive dynamics, new partnerships, future plans, organizational vulnerabilities, and more. These sessions give executives a chance to explore critical inputs in greater depth and with an eye on implications for the organization. The process is creative, often sparking ideas and helps participants to remain agile and open-minded.  

A Multi-Day Retreat 

In today’s world we have become more and more targeted in communication with bullets and instant messages (Slack, Teams, etc.). And yet, the challenges that face us have never been more deep and complex. There is so many urgent requirements that strategic needs are often under-addressed. 

While annual one-day retreats are common, consider extending this to a three-day retreat. This extended time allows for a deeper transition from urgent, reactive thinking to strategic, big-picture contemplation. A longer retreat provides the opportunity to introduce, explore, and resolve complex issues, leading to practical next steps.  

During such a retreat, you can bring in experts, conduct root-cause analysis exercises, explore scenario planning, and align on strategic goals. Some organizations may concentrate this time to focus on an update to their strategic plan or key business decisions. The depth of discussion and alignment achieved in this format can be game-changing. I can guarantee you that if your executive team sets aside three days for a strategic retreat, there will be requests for too many items on the agenda, and you will find yourself having to prioritize which topics to include.  

Alignment and Connection 

Something magical can happen as a result of these simple interventions of quarterly scenario planning and an annual multi-day retreat. There can be a sense of relief that time has been built into the schedule to ensure that critical strategic issues are being addressed. Additionally, even though strategic thinking can be tiring, participants in such sessions often report feeling energized and invigorated by creative process and by getting to ideas that have been on their minds but as yet unaddressed. By exploring new ideas and engaging in creative exercises, the team has time to become more aligned around issues and implications for their work. This discipline breaks down siloes and creates greater understanding across functional areas. And of special import, creative collaboration among co-workers increases connection and also reduces rude behavior.  

As a strategist, I believe in the importance of strategy for executive leadership. And I also understand firsthand the extreme pressures and challenges that come with the role. In a relatively small intervention related to strategic and creative engagement, leaders can build connection and also help an organization to be more strategically resilient in a changing world. 

Wise Thoughts June 2024 | Will the retail sector abandon healthcare?

When Walmart announced its decision to close Walmart Health Centers a few weeks ago, my text and email blew up with colleagues sharing thoughts and asking opinions. Could incumbents take a victory lap? Is healthcare just too complicated even for the big companies with deep pockets? 

At Spring Street Exchange, we’ve been following both in-sector and non-traditional competitors in healthcare since the firm’s inception in 2016. We focused on the retail and technology sectors as they ventured into healthcare. We have explored many such scenarios with clients and during our scenario planning workshops. Spring Street Exchange has become so closely associated with these explorations that when Walmart made its big announcement, many looked our way for reflection. But the trend we were all thinking about was bigger than Walmart: 

Walmart Health: In April 2024, five years into building out its Walmart Health Centers, the company announced that it would stop development and close all Health Centers as well as discontinue its telehealth/virtual care offerings. Walmart cited “complex reimbursement models, labor gaps, cost escalation, and staffing turnover” as a rationale for their decision.1

CVS Health: To maximize its store footprint relative to changing consumer behaviors and health needs, CVS has been closing 300 stores each year since 2021; by the end of 2024, this will represent 900 locations. These store closures also impact the number of MinuteClinics, but CVS is still investing in care sites. Currently, CVS runs more than 200 Oak Street Health clinics across 25 states and is reaching out to private equity firms for a potential joint venture to open additional Oak Street sites and planning to open another 50-60 clinics next year. 2, 3

Walgreen’s VillageMD: To cut at least $1B in costs, VillageMD has closed 60 clinics in Florida, Indiana, Illinois, Nevada and Rhode Island. Walgreens experienced a $5.8B loss in the second quarter, largely driven by the devaluation of VillageMD. 4

Amazon Health: Amazon has famously explored numerous ventures in healthcare, eventually shutting down its Haven partnership for employee coverage and its Amazon Care clinics. To reduce operating losses and save $100 million this year, hundreds of employees across Amazon Pharmacy and One Medical have been laid off. Still, as of June 2024, the company retains its footprint in health through the Pharmacy and One Medical and its online Amazon Clinic. 5

Each of these companies has its own healthcare assets and goals and is pursuing its own strategy. While the trends across them are important to register, we cannot conclude whether it is possible to disrupt healthcare. 

Was this proof that healthcare is too complicated for ‘outsiders’ once again? Perhaps partially

There are real obstacles with the model these companies were pursuing, many difficulties familiar to incumbents, such as:

• Workforce: The physician and ancillary clinical staff shortage amplifies the challenge of maintaining a high quality workforce. An experienced team is needed to support operational infrastructure and deliver primary care services efficiently.

• Slim margins on a declining service. Primary care clinics generally face financial losses in the first few years of operation as they build their patient base. A cost-efficient delivery model with high-quality care and comprehensive access relies upon high patient volumes, which is extremely challenging to develop and operate on an ongoing basis. Yet, primary care volume declined by 8.4% during the pandemic and has not returned to pre-pandemic levels, creating greater uncertainty and risk about profit projections. 5

• Referral-based business model: Primary care is often a loss leader that enables lucrative downstream referrals for care as well as drive consumer spending in other product categories. 6 Many thought that CVS, Amazon, and Walgreen’s could afford to break even on delivering primary care if this would increase the time and money spent in their retail locations; however, this offset may not have been sufficient.

• High Needs Populations: Disruptors are discovering that high risk populations are very difficult and costly to manage compared to the younger, healthier, and financially secure consumers that may be frequenting their store locations.

The need to withdraw or pivot by some retail healthcare solutions may have bought incumbents some time. This is a critical opportunity for traditional providers to update the customer experience, integrate healthcare delivery into the lives of consumers, and expand revenue models beyond the traditional swim lanes.

Are big tech and big retail still healthcare outsiders? Not really

Many companies in big retail and big technology can no longer be considered ‘outsiders’ to the industry. Not only are they able to hire lifelong ‘insiders’ to support their business model development, but most have actively been working in healthcare for a decade or more. Each test-learn-pivot sequence brings understanding, historical assets, and perspective.
 
Healthcare may indeed be a difficult ship to turn, but it is unlikely to remain protected forever.

Why is healthcare still a target for big retail and tech companies? Follow the money

According to the Centers for Medicare & Medicaid Services (CMS), US spending on healthcare in 2022 averaged $13,493 per person for a total of about $4.5 trillion, about 17.3% of GDP. Studies vary, but according to a 2022 metanalysis in Health Affairs, 25-30% of this number is considered to be waste, estimated in the following categories:

Waste in healthcare - an opportunity

This kind of waste is in an industry that is not serving its customers well and consumers are unhappy. According to a 2022 Gallup poll, fewer than half, or only 48%, of Americans rate the quality of our healthcare as excellent or good, and only 24% are satisfied with healthcare costs. In an industry that has been working on becoming more consumer-centric for decades, this is not good performance. 

As Thales S. Teixeira points out, disruption occurs not because new technology or new business models are available but because consumers are unhappy with the current solution. Healthcare consumers are clearly dissatisfied with quality, cost, and experience. This makes the industry vulnerable, even as past attempts have failed or shifted focus.
 
Big retail and big tech could be competitors, partners, or disruptors, but it is unlikely that they will remain so for long.

What will be the next steps for big retail and big tech in healthcare? In motion

 
These companies may not respect the current sectors and guardrails of healthcare: those defined by payers, providers, pharmaceuticals, and supporting vendors. Rather, they are seeking opportunities to extract profit and eliminate waste, trying to redefine the healthcare ecosystem with new roles for their approaches to services that delight consumers.
 
Emerging capabilities with Artificial Intelligence (AI) and analytics could enable would-be disruptors and provide new channels for consumer access. These companies have been working with advanced technology and analytics for decades with the goal of learning about their customers and finding ways to engage and connect with them. As the boundaries between sectors blur throughout our digital worlds, the guardrails that have kept healthcare in a special silo are unlikely to hold forever. 

What can we do? Monitor, scenario planning, think differently 

Many regional and nonprofit healthcare organizations lack the resources to effectively monitor their local landscape, the national landscape, healthcare trends, nontraditional competitors, and broader forces. Even when monitoring, it can be difficult to know what to do with the information. Exploring current dynamics and future possibilities as part of strategic planning and as an ongoing discipline keeps leaders sharp, agile, and looking forward.
 
Understanding the goals and potential of tech, retail, and others as partners and suppliers requires a broader competitive lens and a more agile vision of a healthcare organization’s role in consumers’ lives. When we lean into our mission and a differentiated strategy, the potential for improving health may be broader for regional and nonprofit healthcare organizations as well. This is where it gets interesting!
 
Healthcare is one of the biggest sectors of our economy. Big retail and technology companies may pivot, but they are unlikely to step out of an industry that comprises 17% of the US GDP. I would love to hear your thoughts!
 

Warmly,
NW

References:

1. Bruce, Giles. “Why Hospital Executives Think Walmart Health Failed.” Becker’s Hospital Review, May 1, 2024. https://www.beckershospitalreview.com/disruptors/why-hospital-executives-think-walmart-health-failed.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=8364G6000334C7C.

2. Diaz, Naomi. “CVS CEO Karen Lynch: Primary Care Is the ‘quarterback’ of Healthcare.” Becker’s Hospital Review, March 21, 2024. https://www.beckershospitalreview.com/disruptors/cvs-ceo-karen-lynch-primary-care-is-the-quaterback-of-healthcare.html#:~:text=%22Think%20about%20primary%20care%20as,that%20you%20might%20trip%20on.%22.

3. Wilson, Rylee. “CVS seeks private equity funding to open new Oak Street sites: Bloomberg.” Becker’s Hospital Review, May 23, 2024. https://www.beckershospitalreview.com/finance/cvs-seeks-private-equity-funding-to-open-new-oak-street-sites-bloomberg.html.

4. Bruce, Giles. “Walgreens-Owned VILLAGEMD Exits Another State.” Becker’s Hospital Review, April 1, 2024. https://www.beckershospitalreview.com/disruptors/walgreens-owned-villagemd-exits-another-state.html.

5. O’Donovan, Caroline. “Patients and Providers Concerned over Amazon’s Health-Care Expansion - The Washington Post.” The Washington Post, February 28, 2024. https://www.washingtonpost.com/technology/2024/02/28/amazon-health-one-medical/.

6. Jain, Sanjula. “Analyzing the Operational and Financial Challenges of Retailers’ Entry into Primary Care.” Trilliant Health, March 3, 2024. https://www.trillianthealth.com/insights/the-compass/analyzing-the-operational-and-financial-challenges-of-retailers-entry-into-primary-care.

Wise Thoughts May 2024 | Election Readiness

Is Your Organization Ready for the Coming Election?

 
Spring Street Exchange held its first scenario planning roundtable shortly following the 2016 election. After a brief recovery from my own shock, I started to call colleagues around the country asking about their organization’s plans in the context of the Trump presidency. Many claimed to have some form of inside scoop (incidentally, many of these ‘scoops’ conflicted with each other!), but few organizations had explored how the outcome of the election would impact their patients, members, employees, partners, and communities. This led us to bring together a group of executives to explore how the Republican platform for could impact various stakeholders in our industry. And thus, our annual cross-sector scenario planning forum, now known as Scenario Palooza, was born.

Fast forward eight years as the 2024 election approaches and even more is at stake on the ballot than back in 2016. For most of us, the outcome of this election has tremendous impact for their personal views and hopes for the country. For others, the issues being debated may feel vital to their very being. Rampant disinformation creates an environment with varying perceptions of reality, which can lead to fear and distrust.

The political implications of this election are even more uncertain because the Trump campaign does not issue policy papers that are typical of a presidential platform. Instead, we must surmise the priorities of his candidacy from speeches, social media, from views of right leaning think tanks, and from political leaders whom he may consult.

As healthcare insiders we cannot fix the social climate around us, but we can take steps to prepare our organizations both for election season and for potential outcomes.
 
1. Preparing for the election: We can provide supports both for employees who are unsure and on the front lines with consumers, as well as for consumers themselves who may be concerned about access to healthcare and safety.
2. After the election: There are myriad possibilities for the results of this election and the policy implications. We consider exploring three. 

• Biden: We can expect continuity in healthcare policy with continued focus on topics such as coverage expansion, consumer protections, health equity, and cost containment.

• Trump: With a Trump presidency, we explore two difference potentialities: 

• A restrained platform that assumes a shift back toward the healthcare policy platform of the previous administration and shared by right-leaning policy groups.

• An unrestrained platform that includes some of the more extreme rhetoric coming to pass, reflecting a radical departure from democratic norms. 

As mission-driven leaders, we can remain focused on how to fulfill our organization’s mission in whatever direction the healthcare landscape takes.
 
Note: The impact of the federal elections could vary by the state and many other factors. Healthcare organizations will want to explore the elections in light of their own political environment.
  

Preparing for Election Outcomes

A. Supporting Employees, Patients, and Members

Many voters in both parties believe that the future of our country is on the ballot this fall. For individuals who feel vulnerable due to policy positions the outcome can feel like an existential threat. This perspective could be held by people born in another country; racial, ethnic, and religious minorities; those concerned about reproductive health such as abortion, birth control, in-vitro fertilization (IVF); members of the LGBTQ community; those dependent upon government programs for benefits and healthcare; and more. To support these individuals, organizations can focus on support, providing training, and proactive communication: 

• Listening and Recognition: Acknowledge the environment and the fears that people may help to ease tension. Listening to how the election could be perceived by colleagues and constituents can help an organization to understand risks and help people to manage stress. 

• Provide Training and Support to Front Line Workers: Those who have direct contact with members and patients may receive questions and interact with people who are concerned. Some could be receiving information from unreliable sources and potentially have inaccurate beliefs about their own risks.

• Communication: Share positions on any of the issues that are aligned with your organization’s mission. Communicate about the steps your organization is taking to prepare for the outcome of the election and reflect back the climate people are living in.

B. Managing Conflict and Differing Opinions

The polarized political climate can lead to conflicts among stakeholders, especially when they feel their views or identities are threatened by differing opinions. 

• Promote Respectful Dialogue: Encourage open, respectful conversations and provide guidelines on civil communication. Highlight your organization's policies regarding workplace behavior and the handling of political discussions to ensure a respectful and inclusive environment.

• Create Safe Spaces: Where possible, identify spaces where people can ask questions, address fears, and seek assistance. Support affinity groups and employees who may feel marginalized or threatened by the views of others. 

C. Preparing for Potential Civil Unrest

Government agencies are preparing for potential violence and civil unrest both leading up to and following the election. The level of unrest is uncertain and could vary by geography. Expectations range from voter intimidation, to lone actors, to organized movements. Anticipating and preparing for this potential supports the safety and well-being of employees, patients, and members. 

• Crisis Management Plan: Ensure that your crisis management plan includes protocols for addressing safety during periods of civil unrest, including sustaining healthcare operations and administrative support.

• Communication Channels: Establish clear and effective communication channels to keep constituents informed about safety measures and any disruptions to services. Ensure that channels connect with public officials and community partners.

• Security Measures: Enhance security measures at your facilities to protect staff, patients, and property in the case of civil unrest.

After the Election

It’s difficult to plan for an unknown outcome, especially because there are many other variables that influence the political dynamics. Luckily, we don’t have to be able to predict the future in order to plan for it. We suggest the following three scenarios as a framework for anticipating what could be coming ahead: 

A. Democratic President

If a Democratic president is elected, we can expect continuity in healthcare policy. While we believe that this scenario warrants exploration, organizations pressed for time may choose to exclude this from their exercise. 

• Policy Continuity: Anticipate continued support for policies that expand healthcare access and protections for vulnerable populations. This could see a continuation of health equity targets built into quality metrics for government programs and a push for national-level protections around reproductive rights, women’s health, and health for LGBTQ populations. It could also reduce the gap between national and local carriers when it comes to community impact.

• Shifting Political Norms: Follow political shifts as older members of the voting population are gradually replaced by Generations Z and Alpha and who have different voting priorities.

B. Republican President - Constrained

A Republican president with a constrained administration suggests a shift toward right-leaning policies but with systematic checks and balances in place. 

• Policy Adjustments: Explore healthcare policy briefs shared by leading Republicans in Congress and in right-leaning think tanks. Identify key variables that could impact your organization and its stakeholders. Define scenarios around these to identify risks and actions that could be taken to mitigate these risks. There may be new opportunities for your organization to meet the needs of your stakeholders.

• Advocacy and Adaptation: Engage in advocacy to protect the interests of your organization and its constituents. This could mean shifting more resources toward monitoring policy, engaging in advocacy, partnering in the community, and working with others. Where policy changes take place, be ready to understand the impact and adapt to new regulations.

C. Republican President - Unconstrained

This scenario represents a significant shift towards authoritarian power, with potential threats to various communities and healthcare policy norms. While we do not know that this is a possibility, this scenario speaks to specific rhetoric by the candidate and some of his allies. 

• Plan for Immediate Steps: While long-term actions in this scenario are unknown, having a plan drafted for the immediate weeks following the election could help your organization to act quickly and mitigate risk. You may want to define positions your organization would be willing to take and an action plan to support those who may feel threatened.

• Support for Vulnerable Populations: Increase support for those most likely to be affected by the change in administration. This could relate to policy itself and also to the social and political climate of the country. Organizations can provide additional resources and time for affinity groups, create safe spaces, and offer direct support and encouragement.

• Emergency Preparedness: Revisit your organization’s emergency preparedness plans with an eye toward the risks associated with this election. For healthcare organizations, plans could include risk of civil unrest, protections for those at risk of harassment and threat of deportation, ensuring that people have access to needed medicines and care facilities, and putting protections in place for healthcare workers if needed.

• Community Engagement and Coalitions: Strengthen community engagement and partnerships to support collective efforts in advocating for and serving those in need.

 
These three scenarios do not cover all of the potential developments that could take place between now and the election. Either candidate could face health or legal issues that could disrupt their candidacy and there are always additional wild cards on the table. Organizations will want to continue to monitor the environment to determine when additional scenarios are necessary. 

Looking Forward 

The 2024 election is different than any other election of my lifetime. Professionally, I have led numer scenario planning exercises on policy and elections over the past several decades; this is the first that includes planning for civil unrest regardless of the election outcome. For me personally this is sobering. It drives me to think deeply on my own values and role that I can play in the healthcare ecosystem and in our democracy at large. Like many of you, these thoughts distract me, and the risks we face can be difficult to fully envision. While there is so much to be rightfully concerned about, I remain convinced that we all have much more in common than the loudest rhetoric would lead us to believe. I hope that this optimism is not unfounded, and I also feel compelled to remain active.
 
How is your organization preparing for the election?
Warmly,
NW
   

Wise Thoughts May 2024 | Why We Do Scenario Planning

Imagine that you are trying to get to an important appointment across town and you are stuck in traffic, unsure if you will be able to make it. If there is a high probability that you will arrive on time, you spend the rest of your drive anticipating your arrival and the meeting that will follow. If it is unlikely that you will arrive on time, you mentally prepare for the late appearance or think through a Plan B for the meeting. Either way, you spend the remainder of your drive planning and preparing for the likely outcome. In contrast, the greatest level of discomfort for most people is at the height of uncertainty when the chances are about even as to whether or not you will make it on time.
 

Managing Uncertainty 

As humans, we are generally wired to avoid the feeling of uncertainty, and instead crave a sense of closure or understanding. In fact, most people are likely to seek a definitive result over uncertainty, even if the landing place is one that is not favorable to us. This phenomenon is known as the Ellsberg Paradox, whereby most individuals are drawn toward known probabilities, even if there is a potential better outcome with an unknown alternative.  

Because uncertainty makes us uncomfortable, our natural state is to overestimate or underestimate the level of it. When we overrate the level of uncertainty, we assume that the world is too unpredictable to make plans, leading us to throw up our hands and take a wait-and-see stance. The risk with this approach is that we remain in a reactive mindset and are playing catch-up at a time when such a delay has increasing consequence.  

When we underestimate uncertainty, we tend to see the future as knowable and plan for what we determine to be the most likely outcome. In this context, without a credible alternative, we default to expect the future to look much like the past. With this approach our assumptions align with the status quo, leading us to miss both risks and opportunities that are emerging around us.  

Embracing uncertainty 

While we do not know what the future holds, we actually know much more about the future than we often think that we do. While we may not know the specific outcome of an election or a competitive merger, we have a great deal of insight into the trends that are impacting healthcare. We do not need to be able to predict the future in order to plan for it.  

If we can find a way to embrace uncertainty as an inevitable part of being alive and engaged in the world, we can use this insight as a superpower that gives us an advantage in business and in managing our own lives.  

Scenario planning 

Scenario planning is a low-cost, high-impact way to lead forward through uncertainty. It frees us from expecting to know ‘the answer’ and gives us an edge over our own limitations and biases. Rather than making one fixed prediction, scenario planning allows us to prepare for a range of possible outcomes, enhancing our readiness to respond effectively. Some of the ways that scenario planning supports our work include: 

• Experts' Predictions Are Often Inaccurate
  Experts, even those with deep knowledge and experience, often make inaccurate predictions about the future. Scenario planning allows you to consider multiple potential outcomes rather than expecting one to be accurate or known. 

• Human Biases 
  Human biases can lead us to make assumptions about where the future is headed. Scenario planning helps mitigate these biases by allowing us to explore a range of scenarios, including those that are both favorable and unfavorable. 

• Identifying No Brainers 
  Scenario planning can uncover steps, or ‘no brainer’ activities, that could be taken across various scenarios. There are often more of these than expected, freeing an organization from waiting unnecessarily to act.   

• Exploring Wild Cards 
  These scenarios may be unlikely to occur but would be so significant in impact as to warrant proactive attention. Examples could include pandemic, a climate event, major legislation, etc. 

• Encourages an adaptive and empowered mindset 
  Engaging in scenario planning helps executives to see the future as under development rather than fixed. This frees up thinking to be more flexible when change inevitably arises. It also helps participants to see themselves as actors in constructing the future.   

• Aligning on a future vision 
  When leaders align on a common vision of the future healthcare environment, of the organization, or of other variables, it creates common purpose. This vision provides clarity of action that both supports future planning and also impacts how to approach near-term issues.

Studying a trend, risk, and even opportunity from a thought piece or presentation deck is valuable but can also leave leaders overwhelmed and issues under-explored. In contrast, a data-driven approach to scenario planning leads executives to feel empowered by finally getting to some of the topics that have been weighing on them. Scenario planning can be part of an ongoing discipline (quarterly, bi-monthly), including in strategic retreats, a means to engage a board, as part of the strategic planning process, as a driver in adopting innovation, organizational change, and more.  

Imagine ourselves as back in that car, unsure if we are going to make it to our destination. Scenario planning allows us to explore multiple outcomes, helping the driver to feel calmer and prepared either way. Unknowns are just something we navigate, and there could even be new opportunities along the way.  

The healthcare landscape will be changing more rapidly in the coming years and many executives feel a sense a dissonance between the transformation ahead and the topics that take up most of their time day-to-day. Scenario planning helps leaders to keep an eye on the future while freeing time to remain focused on critical topics in the present. And the collaborative experience of exploring critical issues together often ignites a creative spark that can be uplifting and energizing.  

‘Uplifting and energizing’ are not words I often hear executives use to describe their meetings. And yet, a disciplined approach to scenario planning can be a low cost, low tech, and high impact way to get there regularly. 

I would love to hear how your team uses scenario planning, and of course, I’m always happy to swap tales!