Jerusalem Two: SMAC

I am writing this in the Atlanta airport, moving toward Jerusalem to gather with others from faith based healthcare organizations (

This makes me think of our work in Memphis in a global lens, which brings different things into focus. When we think locally, we’re feeling pretty good these days, breaking ground on new hospital, coming into partnership with the premier cancer group (The West Clinic), going to the White House and being named by US News as the #1 system in the region. Cool.

But when we see ourselves in global context, it is clear that we’ve been decent, with the low but still respectable expectations of the #2 system in a small, poor city. Now we are #1 in a small poor city and have begun to move to good to very good, where we can see (on our best days) how we might be great. And not just great inside the walls, but great for the city and region that is defined by terrible health. “Great” in Memphis demands that we understand and implement intelligence about the drivers of population health, not just clinical treatment. We have begun to show faith—that we can get there. But we are also intently aware of the treacherous, fluid, uncertain political, policy, economic and competitive environment.

How do you continue to move boldly toward great in such a time. Shouldn’t we be okay with decent, print brochures about “great” and wait for better weather?

In this context I read Jim Collins new book, Great By Choice, which examines companies that far exceed their peers even when operating in radically turbulent settings—like ours. It is, I think, his best book filled with surprises, mainly that the lessons of his earlier books that have been so key to informing how this management team thinks, still hold: you still need hedgehogs and level 5 leaders, BHAGs, flywheels and such. But you also need, surprisingly SMaC: systematic, methodical and consistent: durable operating methods.

Now I’ll tell you that is not good news to me personally. I love the new, bold, innovative, frame-breaking, game changing—and so on. But greatness, Collins counsels, lies as much in knowing what not to change, as in changing—especially in radically uncertain times. Of course values and mission persist, but the greatest (Southwest), also hold steady in their SMAC, changing them slowly over time compared to their more nimble, but less great, peers.

The point of all this, is that we can choose our greatness, but have to choose it every day down in the little things that only matter when they are done pretty much every time over years. All this comes at a time when the Congregational Health Network is getting a lot of attention as if it was already great. It is something of a prodigy, growing to nearly 400 congregations in under 4 years, winning enormous trust from pastors and, even more remarkable, women of the church who have a pretty cold-blooded eye for whether something actually matters or not to people they love. Well over 1,200 people have completed at least one seven week class so far, mostly women.

So I’m wondering what our SMac is; what we will look back on in 20 years and claim greatness. It will probably be in things that I am personally not great at, even a little bit: making sure that every single CHN members who has been discharged from the hospital gets a phone call every day until they are well enough to call somebody else. We’ll probably have been fanatic about ignoring the lines between physical, mental, social and spiritual health, relentlessly checking on all four facets of those who show vulnerability in any of them. These are the mundane revolutions going on in the lives of people blending what the hospital knows about disease and congregational caregivers know about life. We have begun to blend those intelligences, but not yet made the disciplines explicit enough that we make sure we do them over and over and over.

As I move to Jerusalem I’m going to be looking for those little things done well in India, Kenya, Germany, Taiwan and Norway. Do you know anything great like that in your neighborhood?

About garygunderson

Vice President, FaithHealth, Atrium Wake Forest Baptist Medical Center in Winston-Salem, NC. Author, Leading Causes of Life, Deeply Woven Roots, Boundary Leaders, Religion and the Heath of the Public, Speak Life and God and the People. Secretary Stakeholder Health (Health Systems Learning Group). Founder, Leading Causes of Life Initiative
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