Death Is Certain. Strategy Isn’t.

Published: May 2008

Type: Teaching Case

This teaching case about the Robert Wood Johnson Foundation’s work to improve end‐of‐life care in America is about an alternative approach to linear conceptions of strategy.


Teaching cases are factual stories of one foundation’s in-depth experiences related to evaluation and learning. Stories highlight important challenges that confront foundations in their evaluation work, and put readers in the role of decision makers who are confronted with problems and options for solutions as the story unfolds. This teaching case was produced for the Evaluation Roundtable, a network of evaluation and learning leaders in foundations.


The Robert Wood Johnson Foundation’s investments in end‐of‐life work tell us much about the role a foundation plays in shaping and executing strategy. It also helps us to understand how a foundation can both facilitate (and impede) progress in a field by:

  • Identifying and framing an issue that captures public and professional emotion and attention
  • Coalescing ideas, knowledge, and professionals into a burgeoning field
  • Helping key leaders grapple with strategic choices
  • Focusing or dispersing resources
  • Ensuring that advances can be sustained.

For many in philanthropy, the word “strategy” has come to imply a de rigueur set of formal and sequential steps: research, analysis and development of a theory of change, and identification and tracking of outputs and outcomes. Research has shown repeatedly, however, that long-term and linear plans can be of little consequence to bottom‐line impact. Research also offers plenty of examples of organizations breaking through and innovating with structures that look chaotic to the outside observer, but, to internal participants, offer the freedom to create and achieve.

This teaching case shows how such breakthroughs can emerge within a field and how a foundation can contribute to them. It also shows how a foundation can hinder progress or foster indecision that ultimately wastes energy and resources and detracts from progress.