Teaching Note: Master Change Agent: Katherine Gottlieb, Southcentral
Foundation*
Erin E. Sullivan, PhD, Center for Primary Care, Harvard Medical School, Boston,
MA, USA
Case Synopsis
The case opens with Gottlieb reflecting on her tenure at Southcentral Foundation and
contemplating the cadre of leaders she has built to sustain the health system. It then transitions to
provide readers with background information about Gottlieb’s leadership trajectory at SCF. The
case continues by outlining SCF’s mission, vision, and key tenants of the organization’s culture:
Curricular Positioning
This is an abridged version of the first case in a two-part series on SCF. This case focuses on
Gottlieb’s leadership of SCF over a 20-year time period and highlights the organization’s culture
and succession planning efforts. SCF has received national and international recognition for its
Learning Objectives
1) Understand SCF’s organizational culture, including how leadership, culture, and
clearly defined values enabled it to be a successful organization.
2) Evaluate Gottlieb’s impact on SCF’s organizational culture and success.
3) Identify the top three qualities for SCF’s next CEO.
Theoretical Linkages
When teaching this case, we often link it to organizational culture and succession
planning.
Organizational Culture
The seminal work on organizational culture is Schein’s book “Organizational Culture and
Leadership.” The first edition of this work was published in 1985, but the fourth edition,
published in 2010, was consulted for this note. In particular, part three of this book discusses a
leader’s role in building, embedding and evolving culture. For all intents and purposes, Gottlieb is
the founding CEO at SCF. SCF was founded in 1982 and there is no mention of any leader, CEO
or otherwise, prior to Gottlieb (in fact, we know from the cases that Gottlieb changed her own
Separate from the issue of the founder/leader’s impact on organizational culture, it is usually
apparent to students that SCF’s organizational culture is unique and is closely tied to the
organization’s success. Although the organization has 1,700 employees, there is one unifying
culture that has been carefully developed, maintained, and reinforced by Gottlieb over the course
of her tenure. The case demonstrates that Core Concepts are the foundation of SCF’s
organizational culture, along with the organization’s ties to the AIAN community and mandate to
serve that population. The case also highlights that SCF’s culture values transparency, constant
feedback, and improvement cycles.
Given that the fieldwork for this case did not include any dissenting opinions about the
organization, it is hard to predict if there are aspects of the culture that employees do not
like and/or would be ripe for change with a new leader. Often, we ask our medical
students if SCF’s model could be exported to another part of the United States or their
own health system, the organization’s culture is cited as a major stumbling block with
students, noting that you’d have to be willing to “drink the Koolaid” to work at SCF.
Students frequently point out that most health systems will not expend the resources for
physicians to spend three days in Core Concepts, focusing on individual narrative and
story.
Succession Planning
One of the biggest challenges that SCF will face in the next five years is choosing a
successor for Gottlieb, and potentially additional long-serving Vice Presidents. It is very
unusual for an organization, particularly a health-care organization, to have the same
CEO for over 20 years and to have most of its C-suite leaders in place for over 15 years.
In order to fully understand this, students are encouraged to consult an American College
Healthcare Executives report, “The Impact of Hospital CEO Turnover in US Hospitals.”
Gottlieb believes that she can identify a successor via her multiple in-house leadership
Research Methodology
Data for this case was collected during a two-week field visit to the Southcentral
Foundation in Anchorage, AK. The two-week visit included attendance at SCF’s annual
week-long conference as well as a week of key informant interviews. SCF is an
organization that cares deeply about its brand and raising the status of the AIAN people.
To that end, our field interviews were heavily chaperoned by senior staff and
interviewees did not have an opportunity to deviate from the “SCF script.” Additionally,
it was difficult to identify a significant enough “challenge” or “hook” to focus this case
on, as the organization is not willing to publicly speak about failures. Replacing a long-
tenured CEO was palatable to the organization, although as of May 2019, Gottlieb
remains CEO and President of SCF.
Suggested Teaching Plan
We suggest three pastures for class discussion, guided by the following questions and
prompts:
Discussion Questions
1. What factors enabled SCF to grow into a cutting edge health-care system?
a. Tell me about Gottlieb as a leader. Why is she effective?
b. Describe SCF’s organizational culture. How is it reinforced?
c. What are SCF’s most important values?
3. If you were on the hiring committee for SCF’s next CEO will you hire from within SCF
or look outside?
a. What are the top three qualities you would prioritize for Gottlieb’s
successor?
Questions and Answers
1. What factors enabled SCF to grow into a cutting edge health-care system?
Answer: Leadership, culture, ownership, transparency, and relationships (all
Answer: Gottlieb is a highly effective and authentic leader. She draws
legitimacy and authenticity both from being herself an American Indian
b. Describe SCF’s organizational culture. How is it reinforced?
Answer: SCF’s culture might be described as one that emphasizes the
importance of building relationships (between staff and staff and
customer-owners), maintains a strong connection to Alaska Native culture,
and embraces change (seen in their improvement work). What is valued at
SCF comes through in the mission, vision, and key points. The culture is
set up to continuously respond to this feedback.
c. What are SCF’s most important values?
Answer:
Ownership: The history of the AIAN people is one of having land, rights,
and cultural heritage taken away from them. As the most fundamental
determinant of health is agency, control, or ownership, it is critically
important that the most foundational and consistent action taken by
Gottlieb and other SCF leadership is valuing the AIAN people’s
2. How is SCF going to sustain its success?
Answer: Gottlieb has built an organization with a strong organizational culture,
focus on improvement and customer–owner feedback, and has established a
number of systems to grow SCF’s employees into leadership positions. By
a. Do you believe that SCF will be just as successful and impactful as it is
now, five years after Gottlieb steps down? Why or why not?
Answer: Gottlieb has established a firm relationship of trust and
transparency with her board. She made the walls of the boardroom glass to
reflect this focus on transparency. Board members are also customer-
owners and there is a very clear organizational structure. The VP’s have
all been with organization for more than 15 years. Gottlieb and the VPs
make decisions by consensus, and Gottlieb does not bring a new idea or
concept to the board without 100% of the VPs on board. Provided that the
3. If you are on the board of directors, will you hire the next CEO from within SCF
or look outside?
Answer: In discussing Gottlieb’s successor, participants are likely to raise the
concern that the organization’s success is largely predicated on Gottlieb’s
extraordinary vision and abilities. No matter how effective SCF’s next leader is,
it’s unlikely that they will be a MacArthur Fellow and have the drive or the ability
to showcase the organization on the world stage. But, it’s also possible that SCF
may be entering a different stage in its life cycle as an organization, one that is
less focused on innovation, demonstrating to the world what is possible, and being
cutting edge, and more focused inwardly on continuing to deliver excellent
clinical and population health services and having a deep and lasting impact on
the health of the AIAN people.
a. What are the top three qualities you would prioritize for Gottlieb’s
successor?
Answer: (1) Leadership ability: Gottlieb’s successor must be an
experienced and seasoned leader in his/her own right. This leader will be
inheriting an organization that will likely only continue to grow in terms
of employees and customer-owners, as the AIAN population moves to
more urban areas. This leader will need to be able to balance SCF’s
financial resources with the ever-changing and unpredictable health-care
landscape and demands of the shifting AIAN population. This leader will
also need to be experienced in working with diverse constituencies in
terms of working with the board, VPs, SCF employees, customer-owners
Epilogue
As of May 2019, Gottlieb remained President and CEO of SCF. Her executive team also
remained stable with the exception of a new Vice President of Behavioral Health Services,
appointed in 2016, who had joined SCF in 2003 and rose through the ranks to a VP-level
position. The board and Gottlieb continued to discuss succession planning for the CEO role and
had continued to train senior leaders to assume executive level positions.
During remarks in responding to the SCF “A case” in our executive program in June 2016,
Gottlieb revealed that at the time of the case the board had gotten worried about replacing
Gottlieb and asked her to increase her efforts to train leaders. The result was the creation of SCF’s
I think that they need to have balance of life. Their life needs to be balanced before they walk
in that door. Whatever that means, just like our mission statement says: physical, spiritually,
emotionally, and mentally. They also need to embrace the culture that we have. If they don’t
embrace the culture of Southcentral Foundation, I’m hoping our board will not even look at