Leader's Toolkit: Challenging the Anchor

Strategic Crossroads: Defend Today or Design Tomorrow?

Health system strategic plans are commonly exercises in refinement: tuning operations, rebalancing portfolios, and defending share against traditional competitors. But the playing field has changed. Technology platforms, retail brands, private equity-backed disruptors, and most critically consumer preferences are now reshaping how, where, and by whom care is delivered.

I believe that the question for CEOs and boards is no longer “How do we protect what we have?” The better question is “What are we building that the next generation of patients and payers will value most?” This requires a shift not just in plan, but in posture.

We must move from brittle strategies focused on efficiency and stability to adaptive strategies that grow stronger from volatility. As Nassim Taleb argues in Antifragile, systems that are merely robust can survive disruption, but systems that are antifragile—that learn, adapt, and gain strength from disorder—can thrive in it.

This mindset is the difference between being best in market today and being first to market with what’s next.

Why Strategic Plans Fail to Predict the Future

Recently, I have had opportunity to engage with several health systems that are confounded by how badly their planning assumptions and financial forecasts missed the market. As one executive exclaimed "we're not even close."

The reason often is that conventional strategy development in health care tends to anchor to known constraints: annual budgets, current service lines, existing reimbursement models. The plans that emerge often stretch the status quo forward, adding minor innovations at the margins. These strategies may be rational, but they are not resilient. They insulate against change rather than mine it for advantage.

The author Amy Webb, in her book The Signals Are Talking, notes that most organizations are not blind to disruption. Rather, they are deaf. They see the storm clouds on the horizon but because they are listening to the wrong signals--peer benchmarks, internal dashboards, legacy KPIs--by the time the disruptions show up on a mainstream metric, the opportunity has already moved.

Webb argues that disruption begins at the fringes of early consumer behaviors, start-up technologies, and public policy experiments for example, and rewards those who see and act on these signals first. As in Taleb’s Antifragile, these signals are like small stressors to a biological system. For the fragile organization, they create anxiety. For the antifragile one, they are clues to what is to come and catalysts to change.

Learning from the Fringe to Move First (and Fast)

Webb outlines a six-step foresight process that any health system can adopt. This is not a futuristic exercise that is completed then tabled while a strategic plan is drafted. It is a process that creates present-day advantage even as it ensures that being shaken by external events will stir decisions and actions across the enterprise to accelerate gains at scale.

1. Find the Fringe Look beyond traditional sources. Innovation is often hiding in unrelated industries, underground communities, or patient workarounds.
2. Causal Layered Analysis Go deeper than surface trends. Ask what beliefs, incentives, or systems are driving change—because that’s where the leverage lies.
3. Construct Scenarios Build divergent narratives, not just best-case/worst-case. Disruption rarely follows a linear path, and neither should your assumptions.
4. Forecast Use these scenarios to predict directional shifts. This is about pattern recognition, not precision. Direction matters more than detail.
5. Pressure Test Stress-test your business model against each scenario. Where are you brittle? What assets become liabilities?
6. Take Action Place small, calculated bets. Taleb would call these “optionality”—moves with limited downside but asymmetric upside.

These steps form the basis of a strategy discipline, not just a plan. They strengthen your capacity to evolve and benefit as volatility increases.

And if volatility is the new normal, we would be wise learn to benefit from it. As leaders we must understand that volatility often starts in the fringe signals before it arrives to shake and too frequently shatter the core that feeds the enterprise balance sheet.

Five Tools for Leaders Who Choose Not to Be Left Behind

Here are five tools every executive team should embed into its strategy discipline to elevate from a plan for today to competitive advantage tomorrow:

1. Design for Uncertainty

Planning tied to calendar years or reimbursement cycles misses the curves of true disruption. Instead, leaders must create dynamic, rolling strategies that adjust to new data, not static five-year visions. Treat uncertainty as fuel, not fear and leverage volatility rather than try to build a seawall to prevent it. This is especially important if you are not the current industry leader.

2. Elevate Weak Signals to the C-Suite

Too often, frontline observations die in middle management. Formalize channels for surfacing early signs whether it’s patient frustrations, new AI tools, or policy quirks and get them on the executive agenda. Disruption is not the province of the C-Suite. It is the responsibility of every colleague across the enterprise and especially those on the front lines of patient care.

3. Place Bets on the Edge

Set aside capital and leadership bandwidth for experimentation. These need not be moonshots. Pilot a care model in a single ZIP code. Partner with a startup outside your region. Build “optionality” through multiple small moves that preserve the right to scale if conditions shift.

4. Measure Beyond Margin

Some moves will not yield traditional ROI in Year One. As leaders, we need the backing of the board to be patient. We should develop KPIs for relevance, agility, talent retention, and patient preference. These are the long-term assets that compound our value. Too often we lose sight of the fact that the metric that built our past success may not measure our future.

5. Challenge the Anchor

When a strategy conversation begins with “We can’t because…” you are defending the legacy, not designing leadership for future gains. Ask instead: “What are the conditions under which this would be possible?” Create space to imagine, not just to protect.

To challenge the anchor, every executive team should revisit its strategic operating model and ask:

• What are our processes for identifying and interpreting weak signals from technology, regulation, and consumer behavior?
• When was the last time we placed a strategic bet outside our core business?
• How often do we construct divergent futures—not just plans for the one we hope will happen?
• What are we doing today that—if done better by someone else—would render our business model obsolete?
• How would our organization behave if we believed that volatility and uncertainty were sources of advantage?

These are not rhetorical questions. They are the blueprint for dynamic leadership and strategy.

Leadership in the Age of Uncertainty

Health system leaders need to see that there is no longer safety in the middle. Strategy must evolve from incremental optimization to intentional provocation. It must be less about what fits neatly into the budget and more about what creates advantage from asymmetry where small bets can yield outsize returns and early insights can unlock market-making moves.

In Antifragile, Taleb writes: “Wind extinguishes a candle and energizes fire.” The same is true in healthcare. The winds of policy, technology, consumer behavior, and capital flows are blowing. Whether they extinguish your model or energize your transformation depends entirely on how your team positions relative to change. Health systems that anchor too deeply to what has been will find themselves trapped by volatility. Those that build the discipline and the courage (as modeled by the leaders) to operate on the edge will shape the future of care.

I believe that the future will not reward health systems that cling to linear plans while the world moves diagonally. The advantage will go to those who scan the fringes with rigor, who practice strategic foresight with discipline, and place intentional bets on tomorrow’s value.

The question is not whether your health system will face disruption. It’s whether you’ll use it to lead.

J. Michael Eaton — SVP, Healthcare Strategy, Nexcurve

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