Of Hedgehogs and Flywheels

With the publication of the tenth volume of the Anthology series, the Robert Wood Johnson Foundation has reached a milestone. In his foreword to the first volume, my predecessor Steven Schroeder wrote, "The chapters selected for this volume offer only a glimpse of the richness and diversity of our interests. A more complete picture will emerge with the publication of future volumes of the anthology over the coming years."1 A decade later, the Anthology has published more than 100 chapters that do, indeed, offer a more complete picture of the ways in which the Foundation has worked to fulfill its mission of improving health and health care for all Americans.

Because the appearance of a tenth anniversary volume is significant, I felt it would be appropriate for me to provide a context for the book by examining how the Robert Wood Johnson Foundation, in carrying out its mission, strives to be not simply a good philanthropy but a great one. I do not use the word "great" lightly nor do I wish to be immodest in stating our aspiration so boldly. But all of us—board and staff alike—take our work seriously and are committed to making the Robert Wood Johnson Foundation as great as it can be.

In this regard, we have benefited from the work of former Stanford Business School professor Jim Collins, whose two books, Built to Last2 and Good to Great,3 analyzed the factors that distinguished great companies from merely good ones. Collins extended his analysis to the nonprofit world in a recent monograph, Good to Great and the Social Sectors.4 His thesis can be summarized succinctly: Greatness is largely a matter of conscious choice and discipline—disciplined people, disciplined thought, and disciplined action.

Applying this to the Robert Wood Johnson Foundation leads us to take away four lessons.

First, defining greatness for a philanthropy is less clear cut than in business, but it is essential to agree on a definition.

While the Foundation uses "impact" as a shorthand term, Collins would say that greatness for nonprofits must encompass superior performance and lasting endurance, as well as a distinctive impact. In other words, the Robert Wood Johnson Foundation can claim to have had an impact when it causes or facilitates enduring change in an area that improves health care delivery or people's health and thus their quality of life.

Inevitably, we fall into the trap of enumerating specific programs or actions that have caused enduring improvements in health or health care. Yet research suggests that it is not single blockbuster programs that produce impact but rather the combination of disciplined people's thoughts and actions that create greatness over a sustained period of time. The key is to rigorously and routinely assemble the evidence—be it quantitative or qualitative—that allows one to assess performance, discipline, and momentum.