What Matters Most on the Course from Good to Great
I am deeply honored to be NASS’ 23rd President. We are now over 4700 members strong and nearly 8000 attended our annual meeting in Austin—1600 more than our largest prior meeting.
As the incoming president, I have been frequently asked to give press interviews. The recurring question asked of me is “what do I hope to accomplish over the next year?” I answer this by saying “to retool the operations and management of NASS to reflect its vision and strategy.” Over the past several years, it has become increasingly clear to leadership that NASS needed a guiding principle. After all, our vision and strategy should articulate that which matters most to NASS members.
So how did we determine what singular guiding principle matters most? One year ago the Board of Directors, Executive Committee and our Executive Director studied Jim Collins’ book, Good to Great.1 In it, he outlined the key elements within organizations that achieved financial and market superiority. His study began with a field of 1,435 companies and emerged with a list of 11 good-to-great companies. To be listed as one of those 11, the company had to show a pattern of good performance, punctuated by a transition point, after which it shifted to “great” performance. “Great performance” was defined as a cumulative total stock return at least three times the general market average for 15 years after the transition point. Only 11 of 1,435 companies made the leap from good to great and sustained those results for at least 15 years. These companies averaged cumulative stock returns 6.9 times the general market average. Collins analyzed the inner workings of the 11 companies prior and subsequent to their transition.
Collins found that the critical difference among companies that attained greatness was
their leadership’s ability to get the organization to focus on certain things that created
value. First, they decided what their company could be “best” at. Next, each decided
what it was really “passionate” about. Then, they each decided what their “economic
drivers” were (or were going to be). Each of these values was represented in one of three
overlapping circles of a Venn diagram. Where the three circles overlap a clear central theme and guiding principle emerges. This central theme is named by Collins the “hedgehog concept.” Once the organizations had a clear idea of these three factors, they were able to focus the work product and resources to fostering the hedgehog concept.
Why is this called a hedgehog concept? An ancient Greek parable compares foxes and hedgehogs. Foxes pursue many ends at the same time and see the world in all its complexity. They are “scattered or diffused, moving on many levels,” never integrating their thinking into one overall concept or unifying vision.2,3 In contrast, no matter how the fox tries to outsmart the hedgehog in hopes of a meal, the hedgehog’s defense is simple and focused, it rolls into a tight ball protected by it’s sharp spikes. Hedgehogs simplify a complex world into a single organizing idea, a basic principle or concept that unifies and guides everything. It doesn’t matter how complex the world, a hedgehog reduces all challenges and dilemmas to simple—indeed almost simplistic—ideas. For a hedgehog, anything that does not somehow relate to the hedgehog idea holds no relevance.
The NASS board wrestled with these three issues and defined the society in those terms. The three concepts the board established are:
- Passion: evidence-based, ethical spine care
- Economic Engine: fees, donations, volunteerism, and brand recognition
- Best At: Defining optimal spine care
At the confluence of our three circles is our hedgehog concept: “Fostering the delivery of quality spine care.”
We now have a guiding principle which will allow us as a society and a board to make efficient and accurate decisions. We can also begin setting strategy to attain our hedgehog concept. It is important to remember that the process of refining NASS’ operations is not an event, but a continual process of re-evaluation and refinement.
The focus of this next year is to begin to operationalize NASS to efficiently set a course which will improve our ability to foster quality spine care for patients. Further, this will give us better understanding of how best to engage the different entities with whom we interact.
As an example of putting this new understanding into place, the board reviewed all of NASS’ current projects. Over time, good programs have been added to our list of activities but they have not always been evaluated with this kind of guiding principle in mind. For instance, in 2006, we published a guidebook called “Natural Doesn’t Equal Safe” which reviewed herbal supplements and their safety profiles. We were set to revise it this coming year. Although it is a great primer on herbal supplements, it does not meet our hedgehog concept of fostering quality spine care so the board elected to bypass this effort so we can better focus on other activities that are more germane to our hedgehog concept—such as promoting the use of our clinical guidelines to payers in the field. This type of scrutiny and discipline will help us channel our resources to improve the delivery of quality spine care.
The board and staff have their work cut out for them in achieving our hedgehog concept. We will do our part by focusing our energies on activities that help you provide better care for patients. We need you, the members at large, to embrace this concept as well. We need you to continue to volunteer for NASS committees and participate in our educational activities. As we approach the 5000 member mark, I hope each of you will take it as a personal mission to help NASS foster the delivery of quality spine care.
References
1. Collins J. Good to Great: Why Some Companies Make the Leap . . . and Others
Don’t. New York, NY; Harper Business; 2001.
2. Berlin I. The Hedgehog and the Fox. New York NY; Simon & Schuster; 1953.
3. Berlin I. The Hedgehog and the Fox. Chicago IL; Elephant Paperbacks; 1993.
PDF format available here. 
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