Driving strategies are part of a planning hierarchy that includes at its top a statement of mission (the never-changing purpose of the organization), values (what the organization stands for) and vision (what the organization aspires to become). Driving strategies answer the question “What are we going to do to fulfill our mission and, in accordance with our values, accomplish the aspirations embodied in our vision?” Mission, values and vision provide the boundaries within which driving strategies are focused — the outer boundaries of what the organization will and won’t do.

Organizations need more than one driving strategy. “What’s your strategy?” is the wrong question. Complex organizations operating in complex conditions need a handful of driving strategies that are complementary and synergistic.

It is the job of leaders to lead, not ask for a show of hands. Effective strategy-making is top-down. It doesn’t result from consensus generated out of a bottom-up group hug involving thousands at all levels of the organization.

The formulation and implementation of driving strategies is a leader's most important job. It requires tough-minded choices fortified with input from the organization’s management team overall. This requires strategic dialogue, facilitative leadership and trade-offs attuned to the volatility certain to confront academic medical centers.

Leaders of academic medical centers actually have advantages related to formulating strategy. Depth and breadth of capability yields richer insights. Proximity and collegiality make it easier to organize and facilitate strategic dialogue and decision-making. And strategic flexibility and tactical adjustments are enhanced by loose coupling.

An academic medical center’s core differentiators should be fully leveraged when leaders formulate and implement driving strategies. However, core differentiators are not strategies. They make driving strategies more robust and effective.

Core differentiators offer potential. But potential must be exploited. It has to be translated into advantages like a powerful brand derived from depth and breadth, and collaboration derived from collegial commitment, as well as higher productivity and innovation derived from loose coupling. When exploited, core differentiators can supercharge an academic medical center’s driving strategies. They are fuel for the fire of competitive advantage. And they are a wasted asset when they’re not recognized and used.

Core Competencies and Focus as Essential Ingredients

In addition to leveraging core differentiators, the driving strategies of academic medical centers should build on “core competencies.” These are operating capabilities that the institution is already really good at, or has a realistic potential to be really good at, and that translate into high value. A competency is useless if it doesn’t generate differentiated value for those served by the organization. Differentiated value is defined from a customer perspective and determined relative to the offerings of competitors. So, thoughtful understanding of customers and competitors is essential to defining and developing core competencies.

While all academic medical centers must first be good at delivering complex care, core competencies will vary from one academic medical center to another. There are a variety of other core competencies potentially available to an academic medical center, such as integrating and orchestrating care across a relatively wide geography. Such a competency might be complemented by another — for example, the disciplined application of clinical data generated through the care of relatively large numbers of individuals from a wide geography.