The article by John Kania, Mark Kramer, and Patty Russell advances the discussion on the most fundamental question that program officers in foundations ask themselves every day: How do I balance following plans with seizing opportunities?

The authors give generous credit to the Rockefeller Foundation for the achievements of our impact investing initiative—achievements that could not have been realized without the amazing efforts of our partners who applied energy, resources, and ingenuity to a problem of common concern.

While reflecting on that success, I also find it interesting to examine one of the Rockefeller Foundation’s earliest achievements—the eradication of hookworm. In the early 1900s, one of the foundation’s initial programs was devoted to improving education in the United States, including a number of initiatives to improve public education in Southern states.

As Rockefeller-funded teams spent more time in schools, it became clear that student health was affecting student achievement. A particular problem was hookworm, which was rampant in those days. Infection rates were up to 60 percent among students in many rural counties. Hookworm makes victims lethargic and unresponsive; it was sometimes called the Germ of Laziness. It causes stunted growth, anemia, and digestive problems.

In 1909 the Rockefeller Sanitary Commission for the Eradication of Hookworm Disease was created with the intention of eliminating the disease across the region. The goal of the commission, according to its by-laws, was “to bring about a co-operative movement of the medical profession, public health officials, boards of trade, churches, schools, the press and other agencies for the cure and prevention of hookworm disease.” They recognized that it wasn’t just about medical cures, but also about communities and government.

Southerners initially distrusted these early efforts. Many took offense at what they perceived to be accusations of infection. Regional newspapers initially criticized the efforts. But in just one year public opinion turned in favor of the campaign. Commission staff innovated in their outreach, using demonstrations, illustrated lectures, and some of the very first movie public service announcements. After five years, the campaign was deemed to have been a success and the commission was disbanded. Not only were incidents of hookworm infection greatly reduced, the campaign was also a great contribution to creating public health institutions in many Southern states.

Was this strategic philanthropy? In essence, yes. There was a clear goal and the overall effort followed three basic strategies: conduct a survey to map out the prevalence of the disease, cure patients at mobile dispensaries, and provide education through lectures and demonstrations. But many innovations were developed after the work was launched. For example, the commission needed to figure out how to overcome the initial resistance that materialized as the work began. These innovations follow the authors’ articulation of emergent strategy.

This illustrates one disagreement that I have with the authors’ otherwise very good article: In saying that we must “shift from the prevailing model of strategic philanthropy that attempts to predict outcomes,” they may be throwing out the baby with the bathwater. Predicting outcomes and articulating a strategy are not the problem itself. The problem occurs when specificity leads to rigidity, as the authors rightly point out. But specificity itself is critical. Without it, many opportunities for learning and disseminating improvements are lost because they can’t be referenced to an initial hypothesis. It’s said that you learn more by being specifically wrong than by being vaguely right, and in many ways an initial strategy sets a wheel of ongoing learning and adaptation in motion. A strategy for a complex problem should be seen as a framework for action, learning, and continual improvement.

One aspect that could be usefully explored by the authors in future work is the challenge of establishing accountability when using emergent strategy to address complex problems. When is the failure to realize goals a natural outcome of working in a complex system, and when is it due to poor implementation? Defining management approaches for addressing this tension when working on complex problems would help make the valuable ideas in this article even more useful to practitioners.

Read the rest of the responses.