The Buffalo Niagara Medical Campus in Buffalo, New York is so successful today, it’s hard to imagine it didn’t always exist. But it dates only to 2002, when five institutions agreed to collaborate in planning their adjacent properties and recruiting others to join them on the 120-acre campus.

How successful has BNMC been? Matt Enstice, its president and CEO, recites the numbers off the top of his head: from 4.5 million square feet in 2002 to 9 million today; from 7,500 employees to 16,000; from five institutions to nine anchor institutions plus 150 nonprofits and companies. Fueling all this has been $1.4 billion in private and public investment.

So when Enstice and others began talking about the campus idea in 1999, everyone could see its merits, right? Well, no. The five original institutions, which included a hospital, a cancer research and treatment center, a university, an independent research institute, and a large medical practice, didn’t exactly oppose the idea but weren’t convinced it would work, either.

“It took a huge amount of volunteer time,” to get the medical campus idea off the ground, said one of the founders, Tom Beecher, an attorney and veteran civic leader. Assurances were made to the institutions: This would not be a governance organization and would not replace existing boards. Skeptical neighborhood organizations had to be convinced that these institutions would welcome their ideas. Foundations and political interests had to be persuaded.

And then there was the sheer weight of cynicism. You see, the idea of a medical campus in Buffalo wasn’t a new one in 1999. It had been tried before. Several times. At one point Enstice gathered all the failed plans. “I had a stack of plans up to my waist,” he remembers, “and I’m six feet tall.”

So how did Enstice, Beecher, then-Mayor Anthony Masiello, and consultant Richard Reinhard turn the idea of a collaborative, entrepreneurial medical campus from repeated failure to success?

They did it the way great civic leaders always do these things: They saw the way forward, creating not just a plan but a strategy. That’s a critical distinction. Lots of people, it seems, are good at creating plans, but it’s a rare leader who knows how to move from plan to reality.

This was the case in Buffalo in the 1990s, where many could see the city’s needs. (A big one: What could replace our fading manufacturing economy?) Some could even see solutions. (How about building around one of our bright spots, the city’s medical and biosciences economy . . . perhaps by centering it in a campus?)

But only an experienced and respected leader could see how to put the pieces together by assembling a team of planners, advocates, and strategists, anticipating the objections they would face, shaping the arguments, finding money for starting the effort, identifying early wins, and building momentum.

Fortunately, Buffalo had such a leader in Mayor Masiello. His talents lay in three areas: He had relationships with the right people, he knew how government worked and what it could do, and he was a natural cheerleader.  He also had a good sense of timing. He recognized that, in 1999, there were changes at the top of the medical community, so there was a little more openness to trying something new.

His first step was probably the most important one. Masiello picked the right people for this project. Beecher had deep relationships in the philanthropic and health care communities (he had chaired one of the hospital boards). Enstice and Reinhard, who had been Masiello’s chief of staff, were natural organizers with a deep understanding of communities. And Masiello was comfortable leading from behind, as cheerleader, early funder, and remover of political obstacles.

Along the way these four made smart tactical choices. Example: How they invited people into the planning effort. Their rule: You could participate only if you brought money, which they called “skin in the game.” This built commitment to the project and cleared out the time-wasters and political hangers-on who had bogged down earlier efforts. Another example: When they created the BNMC board, they suggested each of the large institutions have two representatives, one of whom must be the institution’s chair. Their thinking: While the CEO would be focused on the institution, the chair would have a longer, broader view of the city’s wellbeing. Again, it built commitment to the idea of a collaborative campus.

There were a half-dozen other things the team did well, from finding and exploiting early “wins” to involving the neighborhoods in exactly the right way. Knowing that Buffalo was, as Masiello puts it, a “seeing-is-believing town,” they led leadership tours of successful medical campuses around the country.

But none of this would have been possible without the decisions made early on by Mayor Masiello: When is the right time to get started? Who are the right people to lead this effort? What obstacles will they face? And what can I do to help them succeed?

A version of this posting appeared on the Governing website.

Photo of the medical campus and downtown Buffalo, courtesy of the Buffalo Niagara Medical Campus.