Now I am standing in the hallway of one of our wards in our cancer hospital to emphasize that organizing needs to also take place within the walls of our hospitals to bring about meaningful change. And now we are going to talk about leadership, strategy, tactics, and action. When it comes to organizing, the ideal leader accepts responsibility to create conditions that enable others to achieve the purpose in the face of uncertainty. Samuel Adams fulfilled this ideal and created highly effective leadership teams throughout his 15-year campaign. The first and most important task of the leadership team is to decide on the specific goal or goals for the campaign. This is often a difficult task, and many leadership teams break apart at this juncture because of strong differences of opinion and an inability to achieve compromise or consensus. Key characteristics of an effective campaign goal are the goal must be closely linked to the personal narrative and clearly relate to the emotional forces and values that motivate the leadership team. Two, the outcomes of the team's goal must be measurable in order to determine the progress and success of the campaign. Finally, the goal should not be so narrow that it has minimal impact, nor too broad, rendering it impossible to achieve. A realistic goal might be to enhance physician/nurse communication on one hospital floor over a six-month period and monitor communication by nursing, physician, and patient survey questionnaires before, midway, and at the completion of the campaign. Effective campaigns should never be about a single leader. The charismatic lone hero takes the sunlight from others and quickly burns out trying to manage the day-to-day complexities of an active campaign. Just as Samuel Adams empowered other leaders to achieve the goal of independence from Great Britain, those organizing campaigns to improve health care must empower others to lead and organize. A true leader ascribes to the snowflake model. He or she recruits and trains new leaders, and these leaders, in turn, recruit and train additional leaders, progressively increasing the leadership quotient and human resources and progressively increasing human capital over time. Samuel Adams proved to be a brilliant strategist who outmaneuvered the British at every turn. He utilized a talented and diverse leadership team to formulate and discuss different strategic alternatives and to create contingency plans based on different possible outcomes. Many of the twists and turns of this campaign were unexpected, and changes in strategy were often developed on the fly. Strategy provides the means to convert what you have into what you need, to get what you want. Strategy turns resources into power. In nearly all campaigns, there is an initial power imbalance. And this imbalance can be corrected by building your human resources to continue recruiting and leadership training. Unlike money, which can be quickly depleted, effective campaigns continually increase people power. Strategy is a game plan while each individual play is a tactic. As an example, let's take the boycott. This is a tactic. However, determining how and when this boycott will be used represents a strategy. Organizers need to periodically look at the view from the balcony and review their successes and failures and ask what went well and what could we improve. They need to be flexible and to continually reassess the state of their campaign. Finally, when creating strategy, it is important to always keep in mind the ultimate goal. In the case of health care, the goal should always be the health and well-being of the patient. Given the complexity of the health care system, strategic planning promises to be challenging in this environment. The leadership team must fully explore the power structure and be familiar with the personal attributes and attitudes of the administrators responsible for the activity or process that the campaign is hoping to improve. Health care systems suffer from extensive regulation and are mandated to achieve certain quality measures and milestones. These regulations render many administrators fearful of significant change, because change has the potential to make conditions temporarily worse before they improve. Before launching any campaign to improve quality, you should first achieve alignment with the hospital administration. Campaigns within our hospital and clinic should be directed toward front-line caregivers. These organizing methods can be used to motivate personnel to follow accepted practices such as hand washing, using formal sign-outs for patient transfers, and following check lists. Although this course is focused on health care delivery, these organizing methods can also be used to improve health outside of the hospital by addressing issues such as obesity, smoking, hypertension, and drug abuse. Too often leadership teams continue to plan and argue about specific strategies rather than acting. An effective campaign requires participants to jump into the water rather than tiptoe around the shoreline. But how does an organization encourage action? Once a critical mass of campaigners has been recruited, first of all, you want to avoid too much doom and gloom, because this discourages action and leads to a sense of hopelessness. Emphasize the fact that you, too, can make a difference. Many small steps equal a large step, and there have been many remarkable successes in health care over the decades, and we are on the cusp, I believe, of a major improvement in quality and safety. Establish measurable milestones and share the successes of others. Don't forget to pause to celebrate victories. The group needs to create an effective action plan that first solves the problem and achieves the goal or goals of the campaign, secondly, strengthens the organization by increasing understanding, building relationship commitment, and generating new resources. And third, it should facilitate the growth of the individuals who participate in the action plan. Finally, let me share with you one of my first hospital campaigns. Based on many conversations and observations, I came to the conclusion that the doctor/patient communication needed to be improved in our health system. Using one-on-one meetings, I identified six fellow physicians who shared my concern. We chose to work under our hospital system's I Promise initiative, which was designed to encourage all hospital employees to make a personal promise about how they would improve the patient experience. As physicians, we wanted to do more than promise. We wanted to act as a group to improve the overall patient experience. We began meeting every other Wednesday morning at 7:00 AM in the hospital cafeteria. One of my colleagues suggested that we design a name tag, because most patients couldn't read our small-print hospital identification badges. They, and they often forgot our names. We set about to create a design. Who would have guessed the amount of discussion this engendered? As you can see, we had many different designs, but finally chose number one, because this would allow patients to address us by our first name. And many of my patients now call me Dr. Fred. I love it because this name makes patients feel more comfortable approaching me with their questions and concerns. We're very pleased by achieving our first goal. But now what more could we do to improve doctor/patient communication? We met for weeks proposing different projects. Finally, someone came up with the perfect plan. Why not hold a hospital-wide forum where patients, doctors, nurses, and others could openly discuss the state of doctor/patient communication and suggest ways communication could be improved. We set as our initial goal the recruiting of 30 physicians to join our Physician I Promise initiative by signing their name and providing their contact information, a modest first goal that we hoped we could achieve. But then came the action plan. Would anyone come? We recruited employees in our public affairs office to help promote our event. They did the advance work. We identified a perfect auditorium. What time should it be held? Should we offer food? After lengthy planning, we held our first Physician I Promise forum on a Wednesday at 5:00 PM. We offered them pizza and salad. As the clock struck 5:00, we worried, was anyone going to come? But they did. And we attracted 75 participants from nearly every department in the hospital. We began our program with two patients, who each presented a five-minute story of self. We then planned to present the story of us by presenting recent patient satisfaction data from several of our hospital wards. But after the two stories of self, the participants jumped in. They wanted to share their experience. They wanted to propose solutions. The energy in the room and the goodwill was palpable. The meeting flew by, lasting over an hour, and many thoughtful suggestions for improvement were offered. Our campaign had brought our committee together to focus on a common goal. We were off and running. I encourage every one of you to give organizing a try and follow our example. Organizing is not something you simply read about and study. The only way to become an organizer is to learn by doing. Jump into the water. You'll love it. Thank you.