Transforming a Southwestern Health Foundation Through Adaptive Strategy and Structural Innovation
By Doug Dobie | 10-minute read
Introduction
This case study examines a major non-profit health foundation in the Southwestern United States formed through a health system conversion transaction. The CEO is uniquely equipped with philanthropic experience, CPA-level financial discipline, and deep real estate expertise; partnered with legal advisors and strategy consultants to design an innovative philanthropic model. Rather than relying on traditional grantmaking approaches, the team sought to create systemic, long-term change addressing Social Determinants of Health (SDOH) metrics.
Origins of the Foundation
Following a successful transaction, the CEO led the formation of one of the largest health foundations in the region. Consultants and advisors contributed strategy, legal, financial, marketing, and branding expertise. The CEO’s team embraced a ‘How Strategy’, grounded in community listening, hands-on involvement, and local partnerships, favoring practitioners and lived-experience leaders over academic or government-trained staff.
Building a Multi-Disciplinary Team
To execute this new model, the CEO assembled five distinct groups of leaders: 1) Healthcare practitioners and system leaders; 2) Native/tribal health professionals with lived experience; 3) Real estate developers and investors; 4) Community data and health information exchange experts; 5) Experienced philanthropic leaders in education, workforce, and regional issues. This diversity brought strength but also complexity.
The Problem: Collaboration, Structure, and Adaptability
Despite strong strategy and expertise, the leadership team struggled with collaboration. Deeply rooted professional identities made compromise difficult. Philanthropic leaders pressured the organization to adopt conventional sector practices. However, these approaches have historically failed to move Social Determinants of Health (SDOH) metrics over four decades. Consultants recognized the issue was not strategy, it was structure, segmentation, and adaptability.
Insights from AQ.ai
Varying preferences across the leadership team on Motivation Style and Thinking Style.
To diagnose cultural and execution barriers, the team used the AQ.ai adaptability assessment. Results were striking: the CEO, advisors, healthcare, real estate, and data experts scored high in big-picture thinking, risk tolerance, unlearning ability, grit, resilience, and hope. In contrast, philanthropic and tribal leaders showed discomfort with ambiguity, higher caution, and lower overall adaptability scores. Work environment and team support scores were uniformly low, signaling structural misalignment rather than individual capability deficits.
Work Environment scores signaled structural misalignment.
Strategy-Aligned Segmentation of Communities
Community stakeholders had diverse needs and required a match with leaders who had: 1) domain expertise; 2) actionable data and insight; 3) partnership networks; 4) investment/financial acumen; and 5) the ability to issue multi-year grants. Because the foundation was not ‘leading with its wallet’, capacity-building and system change demanded a structural model capable of matching complexity.
New Organizational Design
The breakthrough was a shift to a CEO‑led shared services model with four specialized units, each led by an Executive Director with deep credibility, relationships, and domain authority:
Real Estate Unit: Addressing land, housing, facilities, and development capacity.
Tribal Health Unit: Supporting tribal nations through culturally grounded health innovations.
Healthcare Partnerships Unit: Collaborating with hospitals, clinics, and provider systems.
Community Health & Prosperity Unit: A more traditional foundation model focused on education, workforce, and economic development.
A centralized data & insights team supports all units through the shared services structure.
Governance and Clarity
Each unit is supported by a three‑member domain‑expert board. This enables sharper decision-making, increases alignment, enhances brand clarity, improves funder visibility, and frees the main board from operational overload. The design represents a novel hybrid of philanthropic investment, capacity-building, and systems entrepreneurship.
Impact and Recognition
The foundation’s new approach has attracted attention from academic researchers, national partners, and community leaders as a potential future model for health philanthropy. AQ.ai proved foundational in illustrating adaptability gaps, clarifying execution barriers, and catalyzing one of the most significant organizational transformations in the region’s philanthropic landscape.
About the Author
Doug Dobie is the founder and CEO of Dobie Associates boutique management consulting. Named Advertising Age’s “Marketer of the Year”, Doug has decades of experience advising boards and CEOs. He earned his MBA at the Anderson Graduate School of Management at UCLA and BA at James Madison College within Michigan State University.