Planning Small

The Case for Focused Ambition

by Annice Cody, President and CEO

If you’re reading this, you are likely part of an organization trying to make maximum impact in a world of limits. As you consider the many possible routes to good change, I have one piece of advice: Chart a clear course.  

PCC’s three-year strategic planning cycle and the annual operating plans that turn strategy into tasks are designed to do just that. They exist to turn grand visions into measurable itineraries. But even the best of plans are subject to scope creep. Without meaning to, we find ourselves scheduling the sort of course that requires 24-hour days of sailing, even as we know that’s beyond our physical limits. 

It’s easy to tell ourselves that the creeping process is the natural course of our social impact ambition, but doing so hides something important: the true cost of diluted effort. At a certain point, trying to do everything means we end up in response mode, shifting our attention based on the prevailing winds instead of our own organizational compass. 

Successful navigation requires a north star—the vision that anchors what we do and around which we navigate our routes. But managing successful teams also requires what I’ve heard described as a “near star”—the win we can achieve soon that reinforces that we’re on a right path. Improvement, be it of clinical quality or organizational operations, is a constant conversation between the state we want to achieve and the incremental change we can observe. It requires a step we can mark as done, so we can move our energy forward. 

"Trying to do everything means we end up in response mode, shifting our attention based on the prevailing winds instead of our own organizational compass." 

Consider, for example, how the Skilled Nursing Facility (SNF) Alliance creates change. There are many reasons patients land back in the hospital after discharge to a SNF, but plan-do-study-act quality improvement cycles require a specific plan to test. Such plans could be informed by all sorts of environmental conditions, but they need a specific target for action. The SNF Alliance noticed that acute infections caused a significant proportion of hospital readmissions and that 65% of C.Diff. infections were healthcare-acquired. If the SNF Alliance could decrease the infection rate at SNFs, they could impact the larger hospital readmission trends. They mapped out a route toward lower infection rates—including Centers for Disease Control certification in hand hygiene, environmental cleaning and disinfection, and personal protective equipment—then they pursued it. The team worked on other things during the same fiscal year, but only a limited number of other things, because testing requires focus. In the end, they exceeded target performance by 58.5%. This year, they’re moving to complex care transitions, congestive heart failure, and sepsis as areas of workgroup focus. 

For our FY27 operating plan, the Primary Care Coalition senior team and I were deliberate about right-sizing our ambition. We asked ourselves what we had already committed to doing through existing projects, where we could gain the most leverage, and what we could reasonably add based on current capacity. Any new addition during the year will require moving a current item off the list, either because it’s truly finished or because we have actively deprioritized it. That framing creates room for focus, without sacrificing our ability to reprioritize routes that are less viable. It allows us to be “all in” on the areas where we see the most potential impact and gives us permission to move others to the future travels backlog.  

"What if, instead, we acknowledge the paths we can't (yet) reach and be all in on the ones we can?" 

Too often, those of us in the nonprofit sector get caught up in the environmental headwinds, trying desperately to keep our eyes on a vanishing horizon. What if, instead, we acknowledge the paths we can’t (yet) reach and be all in on the ones we can?  

Oliver Burkeman writes about how time management fundamentally requires accepting the items that were not—could not—be included on your task list, about how the task of navigating life is really one of navigating choices. We can make our peace with it, he proposes, and make meaningful choices, or continue chasing everything with little, in the end, to show for it. No North Stars, nor near stars either.  

Not achieving the impact we’d hoped is rarely a lack of talent or dedication. It’s often a hesitance to make hard choices among many worthwhile paths. If you’re struggling to translate grand ambitions into operating plans, resist the temptation to do more with less. Consider, instead, doing the work with more intention.

You might find a constellation faster than you think.