A strategy defines goals, and how organisations get from now and here to achieving their aims. Why do most organisations fail miserably on strategy – and their goals? A perspective based on my experience working in global health.
I confess that I have a love-hate-relationship with strategies. Every time I begin a new global health project or job, I ask my manager whether I can read the strategy, so that I know what I am working towards – and how.
“We don’t have a strategy.”
“Let me see if we have one. Here it is.” (It’s from 2002.)
“BCG/McKinsey/insert large consulting firm developed this (275 page) strategy last year (after an intensive three-year process), but it doesn’t work.”
“We use the SDG framework.”
Sadly, many strategies developed in global health are irrelevant, or not strategies in the first place. I have seen strategy documents that are work plans (“target events in 2015”), contact lists (“key partners, and their email contacts, from 2007”), budgets… you name it, it’s been included, and it’s absolutely redundant within two months. I have heard experienced leadership confuse strategy with sales pitches (“we do innovative financing!”), and many people confuse strategy with tactics (the latter are options how you could achieve your strategy).
A good strategy, in my experience, defines:
1) the context you are working in (yes, surprise, your organisation doesn’t operate in a vacuum!);
2) the main goals you aim to achieve (no, there can’t be 28 of them, and saving lives in poor countries does not tick the box of Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) targets;
3) the approach you will take (yes, you need to know how you will achieve goals, they don’t just happen miraculously because you tell everyone they are important);
4) indicators and review processes how you will measure whether you are on track;
5) risks, and how you will mitigate against these; and
6) list annexes that support your strategy (an annual work plan, budget, communications plan, etc.), but will be adapted along the way.
Developing a solid, relevant strategy is not easy. Currently working on health systems and universal health coverage, there are multiple dimensions, and various sub-categories that are integral and relevant to achieving goals. “Eliminate malaria by 2030” sounds crisp, is a measurable goal, and is easy to understand. “Strengthen health systems” most often results in the response “excuse me, I have no idea what that means.”
I have worked on strategy since I started my first degree. In my first area of specialisation before global health, I focused on security policy, and wrote my first master’s thesis on military strategy (literally: for military battles). In my second master’s, my thesis was on HIV strategies.
I have in my 20-year career worked with many organisations to develop and implement their strategies, and have overseen several strategy processes myself, and drafted dozens of strategies.
And it has been a painful process, every time.
One of the worst strategy processes I was involved in was a two-year, all-staff process. We held never-ending workshops, filling out Excel sheets (with a felt 200 columns and 400 rows, with sub-categories and sub-tabs) together, moderated by various consulting firms. I’m still not sure whether anything we did was ever used. It did, however, suck out any will to go to the office for a long time. I learned to meditate, while starting at Excel.
The saddest strategy processes I have been involved in have landed straight in the bin after they were completed. Some were in my view brilliant strategies, and the process to get there was efficient and ensured buy-in. But in these cases, leadership or management had no idea how to work with a strategy. Business as usual simply continued. And the strategy was never mentioned again.
Some organisations have entire strategy teams that do nothing other than develop, and redevelop strategies. If leadership backs the process, and the strategies are lived by organisations, there’s a fairly good chance that the organisations deliver on at least some of their goals. A caveat and spoiler here: the SMART targets apply here too, and strategic goals that are fully unrealistic with existing capacity or funding are bound to fail.
Most leaders and managers understand that they need to develop a strategy. If they work with boards or donors, this will also be expected from them. If a leadership and managerial role is well defined, it will include a task to ensure that a strategy is also implemented – while simultaneously constantly adapting to new changes and contexts (buzzword of the past year: agility).
This is also where managers play a key role: in developing and maintaining realistic and motivating work plans for their teams and staff, budgets that support this work, recruiting and managing staff that can deliver targets, and providing guidance on tactics (reminder: possible approaches).
In my experience in global health, very few organisations have nailed how to develop a relevant strategy, and know how to work with a strategy once it has been developed. But what most organisations currently seem to do – simply tick a few boxes using expensive consulting firms, or not trying in the first place – won’t help us achieve our goals.
Katri Bertram 