Fall 2025 Issue

Careers: Strategy First
By Linda Henman, PhD
For The Record
Vol. 37 No. 4 P. 30

In most hospitals, you’ll find no shortage of people who know how to run fast. The problem is, far fewer can tell you which race they should be running. Health care organizations are overrun with competent tacticians—people who can implement, execute, and hustle—but critically short on those who can pause, think, and choose the right strategic race in the first place. If your workforce is optimized for efficiency without direction, you’re sprinting off a cliff.

Let me be blunt: tactics keep you in the game today, but only strategy guarantees you’re still in the game tomorrow. Your daily to-do list might look impressive, but if you don’t tie it to a clear, bold, competitive strategy, then you’re just rearranging deck chairs on the Titanic. As the executive, your job is not just to row faster—it’s to steer the ship. You must understand what strategy is, embrace its disruptive implications, prioritize what others won’t dare touch, and put the right people in place to turn vision into victory.

Strategy Sets the Course
So, what is strategy? Simply put, it’s what you choose to do in the future to win. It’s not a financial forecast, a list of goals, or a vision board. Strategy is direction with teeth. It precedes tactics and transcends best practices. It is the unique, intentional path you choose to dominate your market—and make no mistake; domination should be your goal.

Too often, health care leaders fall into the trap of reaction: they chase potential, appease analysts, or make safe bets that promise near-term relief but guarantee long-term mediocrity. Instead of deciding where they want to go, they wait to see where others head and follow the herd. That’s not strategy; that’s surrender.

Common Mistakes by CEOs
Effective strategy involves the synthesis of data and imagination. It requires systems thinking, not tunnel vision. Strategy must be driven by the CEO—not delegated to consultants, not relegated to annual retreats, and not confused with execution plans. The uncertain nature of strategy means speculation and courage need to wed. But coupled with talent acquisition and development, it’s the most important function you perform as an executive.

Let me give you three common pathologies I encounter when advising health care leaders:

• They confuse strategy with tactics.
• They fail to hire or cultivate strategic thinkers.
• They treat strategy as an event, not a continual process.

Focus on Strategy
Strategy is the “what,” not the “how.” It’s the destination, not the GPS directions. If you start with tactical planning before defining strategy, you will suffocate innovation. Planning works bottom-up; strategy demands top-down clarity. Planning relies on facts; strategy transforms those facts into future advantage. Strategy must come first. Always. Here’s how to focus on it:

Don’t mistake operational excellence for strategy. Of course, you also need operational excellence, but don’t mistake it for strategy. Amateurs rely on best practices and benchmarking because copying is easier than creating—and your competitors can do that as well as you can. Real strategy is unique. It’s built around what you can do that others can’t replicate. That means you must reject the urge to be all things to all people. Focus creates strength; diffusion creates weakness.

Decide what to do and what not to do. Want a strategy test? Ask yourself: “If we weren’t already doing this, would we start today?” If the answer is no, stop doing it. Strategy demands trade-offs. Deciding what not to do is as important—often more important—than what you choose to pursue.

Take Cleveland Clinic. They’re not perfect. They’ve had financial ups and downs. But they think systemically. They expand with strategic intent, not opportunistic greed. They ground their growth in a clear understanding of their environment, their capabilities, and their positioning. In 2022, they faced cost pressures like everyone else—but unlike everyone else, they stayed the course. They didn’t panic. They didn’t compromise. That’s leadership.

Be wary of unchecked growth. Growth can be seductive— and dangerous. Too many organizations are lured into strategic drift by shiny new services or expanding footprints. But unchecked growth blurs identity and dilutes competitive advantage and unique contribution. Expansion without coherence is not strategy; it’s ego.

Adapt with intent, not panic. Your true strategic challenge requires deciding what you will respond to and what you will ignore. Penetrating current markets and reinforcing your unique position is more powerful than chasing every new trend. If the market shifts, adapt. But adapt with intent, not panic. Find new trade-offs, new leverage points, new systems of activity that only you can deliver.

Allow for uncertainties. Don’t let the desire to avoid mistakes paralyze your strategy. No one knows the future. Accept that. The best strategies align today’s commitments with tomorrow’s uncertainties. You’ll make mistakes. What matters is that you keep your eyes on the horizon and stay aligned with your unique strengths.

Make strategy your own. “Strategy,” the word we’ve abused beyond recognition, now serves as a euphemism for anything deemed important. But real strategy—true strategy—is rare. It affects critical outcomes, defines who you are, and clarifies what you do better than anyone else. You can’t copy another hospital’s, and no one can imitate yours. Strategy creates a competitive fortress that rivals can’t breach.

Build a process. And yes, you must build a process for it. Not because the process guarantees success, but because the process disciplines your team to think clearly. As Dwight Eisenhower said, “Plans are worthless, but planning is everything.” You need to carve out time, assemble the right people, and commit to strategy as a continuous dialogue, not a quarterly report.

Strategy First, Then Tactics
Here’s the formula: Strategy is what you will do to win. Tactics describe how you will do it. Make sure your team knows the difference. Make sure you don’t skip the first step.

In the jungle of modern health care, those who fail to strategize will die of irrelevance. Those who get it right will dominate—not just today, but tomorrow, next year, and long into the future. The question is: Which race do you choose to run?

— Linda Henman, PhD, is an advisor, speaker, coach, and author or coauthor of 11 books. She founded Henman Performance Group, a leadership consulting firm that works with C-suite leaders from organizations like Avon, Emerson Electric, Estee Lauder, Kraft, and Tyson Foods. Her new book is Healthy Decisions: Critical Thinking Skills for Healthcare Executives. Learn more at henmanperformancegroup.com.