• Barrow Neurological Foundation: The Change Paradox

    Author: Katherine Cobb

    I have the honor and privilege of being the President of Barrow Neurological Foundation (BNF), which was established in 1960 to raise awareness and funding for patient care, medical education and research performed at Barrow Neurological Institute (BNI) in the fields of neurology, neurosurgery and neuroscience. With an endowment in excess of $150 million dollars, BNF grants funding towards research programs that seek to treat patients with a wide range of conditions, including brain and spinal tumors, concussions, neuromuscular diseases, stroke, and cerebrovascular disorders. With a staff of 20, we have raised over $75 million in the past three years to aid the physicians and researchers at BNI.

    Just recently, I was awarded an opportunity through the generosity of Virginia G. Piper Charitable Trust to attend Stanford University’s Executive Program for Nonprofit leaders. One session focused on Professor William P. Barnett’s theory called “The Change Paradox.”


    Katherine Cobb with CEO, Michael Lawton and Chief Medical Officer, F. David Barranco

    Barnett postulates that we (and our successors) change what can be changed, each undoing the work of the predecessor.

    In essence, his theory argues that it is “better to set one thing right forever than to set many easy things right temporarily.”

    Without really being aware of the Change Paradox Theory, I realized that this approach is what I had intuitively taken when I first arrived at Barrow Neurological Foundation (BNF) nearly three years ago. I set out to change what was most difficult at BNF, after repeated attempts from previous regimes to change what could easily be changed. As a result, we have been successful in achieving a phased approach to our mission. Most important, we have created a successful partnership with our clinicians at Barrow Neurological Institute (BNI) to enable them to do what they do best. Save lives.

    When I arrived at Barrow I adopted a “Listen, Learn and Lead” approach to my onboarding. Part of that process was to prepare a SWOT analysis that could lead to a framework for a strategic plan moving forward. This SWOT analysis led to three key pillars of our strategic plan: (1) The need to capitalize on existing and new revenue opportunities. (2) The need to build an effective organization to meet these opportunities. (3) And the need to drive brand demand towards these opportunities. All of this would have to be executed under the umbrella of our new CEO, Dr. Michael Lawton’s Barrow 3.0 strategic plan. This contemplated new centers of excellence in brain tumor, aneurysm and AVM research, AI and deep learning innovation, and a new Neuroplex building to serve as the heart of Barrow, centralizing and integrating clinical research, neurology, and neurosurgery for enhanced patient care. As I would soon find out, these needs represented a degree of change within the Foundation that was the most difficult. In effect, my very own “Change Paradox.”

    In my due diligence and planning, I was fortunate to discover that I had a secret weapon; the Barrow Women’s Board who had, for over fifty years, raised a majority of the contributed revenue for BNI. It was clear to me that these amazing volunteers were doing all of the heavy lifting. I also discovered a study that had been conducted a decade prior that outlined the opportunity for revenue growth and opportunity for BNF. However, the organization had not followed the recommendations contained within the study. In fact, it had retrenched by ceasing to invest where the ROI was advantageous, had trouble executing effectively against key revenue streams, and most importantly, had misaligned with the research needs of the clinicians at BNI. It was clear that we needed to realign our efforts paralleling the priority research areas of Dr. Lawton and his Barrow 3.0 strategic plan. We needed to dedicate ourselves to working with the physicians and clinicians at BNI and create compelling case statements for each of these research and clinical care areas. In addition, we introduced a level of data driven decision making to the foundation and required all staff members to utilize and follow a series of KPI’s to measure our performance. Finally, we rebooted our approach to all of our traditional revenue streams including major gifts, events, employee giving, grateful patient programs, planned giving, and our board organizational goals.

    Next, I tackled our organizational effectiveness in order to build a team that could meet the needs of our new alignment with the physicians at BNI. We had to match the BNF organizational structure to the key research and revenue needs identified by our physicians. We needed the proper resources to reach these revenue goals. This required an investment in staff and additional head count at a time when the system was attempting to control costs. We then had to train staff to embrace the data that is available from our system resources to create levels of accountability and to manage performance accordingly. Of course, all of this change was difficult and it required understandable goals and working towards a common buy in from all constituencies. It also required that I identify and cultivate team leaders and quickly address any level of underperformance along with making sure that we were aligning our culture with BNI senior management including Dr. Lawton’s vision.

    Critically important to achieving our fundraising goals was to be able to motivate existing and potential donors in compelling ways. BNF had traditionally aligned with BNI communication, which often had objectives that were not geared towards fund raising per se. We needed to explore and unlock an alternate way to communicate with our donors and motivate them to contribute at ever-increasing levels and frequency. We needed to light a fire of brand demand and illuminate the incredible work being conducted at BNI.

    I initiated a research project to explore the best positioning and communication to donors. This included interviews with our senior leadership and physicians to understand, not only their work, but their intuitive sense of why Barrow was special and unique in its benefit to patients. In addition to the rational arguments that offered credible data around treatment, research and education, we knew that emotions are central to the decision-making process for donors. In discussions with our physicians, we discovered critical emotional and dramatic outcomes proving that the impossible was actually possible at BNI. We realized that these physicians and clinicians are heroes, accepting the challenges of patients previously deemed “inoperable” and tackling conditions labeled “untreatable.” Every day they reject the norms of common practice by developing techniques that change the existing treatment paradigm. They push boundaries by aggressively focusing on treatments that cure and save lives. And we learned that our patients are more than heroes. They are survivors. They are filled with life and stories that deserve to be heard. Particularly by our donors.

    With a new communication positioning strategy in hand, something that didn’t exist before at BNF, our team added strong emotional narratives to everything we did, on top of the rational data driven results that BNI can proudly claim. This change was difficult but hopefully will have maximum impact over the long run.

    This fundamental, difficult change across revenue opportunities, organizational effectiveness, and brand demand was truly the “Change Paradox” for Barrow Neurological Foundation. As a result, we are seeing dramatic growth in our fundraising efforts including a $25 million gift to establish the Ivy Brain Tumor Center, the largest brain tumor gift in the nation and the largest in Dignity Health’s history. Matched by BNF, this gift enables Dr. Nader Sanai to aggressively drive his Phase 0/I clinical trials, seeking to discover a cure for brain cancer.

    Yet, it’s time to face the Change Paradox again. Change Paradox 2.0. I need to take our foundation to the next level and continue to align with Dr. Lawton’s vision of Barrow Neurological Foundation as the world’s leading neuroscience foundation. As such, we have defined what that foundation will look like and are currently working with the board of trustees to craft our next evolution. This next step of change will also be difficult, but true to the Change Paradox, it should be lasting.

    But I have learned that this level of change for our foundation cannot happen without the support and guidance of and partnership with, the true heroes of Barrow. Our physicians, clinicians and medical staff who, day in and day out, face the most difficult challenges in their fields along with our patients and their families who are fighting for hope and survival, all provide the strength, courage and determination that inspire me to be part of this noble cause. Our foundation will continue to rise to the occasion and address the change we need to make so that we can “set one thing right forever.” Cures that save lives.


    > This level of change for our foundation cannot happen without the support and guidance of and partnership with, the true heroes of barrow. Our physicians, clinicians and medical staff who, day in and day out, face the most difficult challenges in their fields <

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