Lately, a lot of health care organizations have been wondering why their strategic plans have dissolved into irrelevance in the face of unanticipated realities. In most cases, there are at least four reasons that this has happened: (1) bad assumptions, (2) lack of resolve, (3) lack of flexibility and (4) poor strategy. Organizations that fail often share these characteristics:

●  They stuck with the herd and ended up as lamb chop. Many health care organizations failed to challenge the conventional wisdom (e.g., "capitation is coming," "hospitals and doctors are cost centers," "health plans own the patients," "payers only care about price," "only integrated systems will secure and keep contracts"). Those bad assumptions cost some health care organizations millions of dollars and the industry billions. Today some of the same firms who sold those one-size-fits-all assumptions and strategies are still busy doing the same thing.

●  They gave up to soon. Pursuit is the second act of victory, often more important than the first. Abraham Lincoln was angry with General Meade after the Union general's victory at Gettysburg. Meade failed to finish off the southern army and thus prolonged the war. Many health care organizations have developed a pattern of abandoning investments long before they have a chance to pay off. They believe they are beaten before they are. They snatch defeat from the jaws of victory.

●  Having lost sight of their objectives, they redoubled their efforts. Wisdom is knowing you're in a blind alley before you hit the wall. When it was clear that things weren't panning out the way the experts had predicted, many organizations simply plowed ahead or froze in their tracks. Often they found themselves too invested (financially and psychologically) to change course. A strategic plan that's well conceived and effectively executed achieves a dynamic tension between "bullheaded resolve" at the level of vision and "opportunistic flexibility" at the level of strategies and tactics. In other words, it helps engender an organization that is steadfast in its commitment to what it intends to become but is not locked into how it goes about getting there.

●  They failed to realize that strategies have quality. Some strategies are better than others. And in that difference there often lies the distance between superior performance and mediocrity.

For more than 20 years, The Beckham Company has been working with some of America's most successful health care organizations to create strategic plans that challenge conventional wisdom while balancing resolve with flexibility.