What's in a Vision?

As health institutions position themselves to respond to the policy and market driven demands of the emerging health care system, leaders in every setting are challenged to create new visions to help shape the future. We commonly think of a vision as that bright and shiny future state in which every problem has been addressed and everyone is happy. Leaders should get over such messianic impulses.

There are four things that a vision needs to do for an organization. Given the strains that leaders are feeling these days it might be useful to review them.

People like to live in settings that are coherent. In fact, this is such a strong trait of most societies that we pathologize those that are too disruptive with particular diagnosis. As Karl Weick pointed out two decades ago we take time and energy to make sense of our institutions and we resist change to them and the order and comfort we have derived from them. Then along comes a major disruption or a series of disruptions and we cling to the familiar. The leader's first visioning job is explaining why the old paradigm is no longer going to function, why the changes are beyond the control of the organization and that a new coherence can be achieved, but it will take some creativity, hard work and pulling together. This is the most challenging part of visioning work. If it happens too quickly people rebel against the change. If the image of the burning platform is not strong enough, then they think that not changing is an option and dig in their heels. Vision as coherence is the first step every leader should take, long before that idealized future state is articulated.

The second focus for vision should be the answer to the question: How will we get there? The first part of the answer will be the operational steps to move toward the vision. Lots of people want all of these details. Unfortunately, with complex visions for dynamic environments, such details are not always available when people want them. The more important answer to this question is determining how everyone will work together to create the future. Change means uncertainty and if a part of the vision is not addressed to how teams will function, what rules will they advance and how everyone will be treated, then there is a greater likelihood that at some point the wheels will come off of the change process. A vision for relationships is not always on the top of everyone’s vision to do list, but it should be.

This attention to values in the workplace should also extend to the traditional values of the institution and how they will find life in the world created by the new vision. There is perhaps no more powerful statement by a visionary leader then one that captures the essence of the values that have been served in the past, explains how doing the same thing that has always been done no longer serves the ends of those values and then takes the time to describe how the new order of things more genuinely meets the commitments that have driven action in the past. This does not mean that the values never need to change. Some values have to take on a new shape or form. Just think about the role of patient information, communication and involvement. In the past, for reasons that were assumed to be in the best interest of the patient, they were often left out of access to information and critical decision-making. The best interests of the patients are still a value; we increasingly see their role in relationship to information in very different ways.

Finally, the vision does need to affirm that future state and create some excitement about the trip. But leaders should remember to not trade too extensively on how excited people can be about a new order of things if the first three parts of the process have not been worked well into the overall vision. Too often the ambitions for the future, the ones that the leader has struggled to combine into the new vision, fall flat at the face of fear of the uncertainty of change. This is not to say that the leader advancing vision should be willing to give up in the face of resistance. Pacing the change may be the best aim a leader can have.