Leading from behind

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.

We usually think of politics in communities in two ways: as the “big-P” politics of campaigns and referendum—noisy, zero-sum contests that get lots of public attention—and the “small-P” politics of gaining approval for policies and projects. These are the nonzero-sum contests of compromise and tradeoffs that revolve around regulatory approvals, planning board and city council votes, and the occasional state law.

But there’s a third version, a kind of meta-politics that’s critical to progress but rarely gets noticed. It’s the politics of public opinion. How important is public opinion? Listen to Abraham Lincoln: “With public sentiment,” Lincoln said, “nothing can fail; without it, nothing can succeed. Consequently he who molds public sentiment goes deeper than he who enacts statutes or pronounces decisions.”

But how, exactly, do you mold public sentiment? And are most civic leaders good at it? The answer to the second question is no. The answer to the first can best be understood by turning to another president, Franklin D. Roosevelt, who, second only to Lincoln, was the greatest molder of public opinion ever to occupy the White House.

Roosevelt’s masterpiece was changing American attitudes about involvement in World War II. Yes, Pearl Harbor was the defining moment, but by December 1941 public opinion had already changed greatly, as Lynne Olson tells us in her recent book, “Those Angry Days.” And that was Roosevelt’s work.

He could not have faced a more daunting task. There was a strict “neutrality act” passed in the mid-1930s that banned arms sales to any nation at war. America’s own military was a shell. (Weapons were so scarce that only a third of U.S. soldiers and sailors had ever trained with them.) Congress was overwhelmingly opposed to intervention, and so were the American people.

So what did FDR do? He bided his time (to the despair of the increasingly desperate British) as he set in motion several forces that changed public opinion. The most important: He quietly encouraged nonpartisan citizens’ groups to begin campaigning for American support for the Allies. Then Roosevelt (to all appearances) gradually acceded to their demands, first in asking for changes in the neutrality act, then in offering more generous aid to the British, then in lobbying for a buildup of the military, and finally in asking Congress for a peacetime draft. It was a step-by-step process that took two years’ time, with Roosevelt never more than a half-step in front of the public.

Today we would call this “leading from behind”: letting others be the point people for change as you remain in the background. It requires a secure person to lead this way. Secure in two ways: First, emotionally secure enough to let others occupy the spotlight. Second, secure in the messiness but ultimate utility of public debate.

And this brings me to the single most serious mistake public officials make in trying to advance policies and change public opinion: They spring surprises. They announce sweeping policy proposals long before the public has accepted there’s even a problem. When they do it this way, they’re often shocked by the backlash

It is much better to do policy the FDR way: First, air the problem and its consequences. Then step aside and let others debate its seriousness and possible solutions. As the demand for action rises, step back into the discussion with a reasonable way forward. (And, yes, along the way you can do things to encourage the debate.)

Does this diminish your reputation by making you look indecisive? Well, Roosevelt was accused of that in 1940 and 1941. But reach in your pocket and pull out a dime. Which leader’s face do you find? Roosevelt’s or one of his critics’?

A version of this posting appeared on the Governing website.

Photo by UNC Greensboro Special Collections and University Archives licensed under Creative Commons.

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