A few years ago, I watched a regional nonprofit in community health and wellness come close to imploding.
An executive director was let go over financial concerns. Several of her closest donor relationships walked out with her. The CEO scrambled to keep employees and additional donors from following, but trust was already strained. Within weeks the organization was in a slow exodus. The CEO eventually resigned and acknowledged she had become the problem.
What could have easily made it worse was the board’s first instinct: issue a press release. Get out in front of the story.
That would have been catastrophic. Staff would have heard about the change from the news, which would have triggered more resignations and unnecessary rumors. Donors would have heard the official statement before the staff had a chance to call them directly. A brand built on community and connection would have communicated to its closest stakeholders that they were the last to know.
What worked instead was putting the internal team first. The leadership team agreed on the message before anyone outside the organization heard it. Senior staff reached out to key stakeholders and their teams so the right people heard from the right people. Major donors got direct calls assuring them operations would continue uninterrupted. Every conversation reinforced the same point: the values were not changing, the work was not stopping, and the foundation was still solid.
The brand survived because the team was aligned and protected it under pressure.
This is more common than most healthcare organizations want to admit, especially anywhere a board, an administration, or a CEO has recently changed. Brand strategies that get disregarded are not failures of values; they are failures of understanding and preparation. There are three places that pressure typically shows up: governance, external influences, and leadership transitions.
Governance pressure
Most healthcare brand strategies are built in a conference room with the marketing team, an outside agency, and a sympathetic executive sponsor. Then they go to the board.
The board is not the room they were built in. It is fiduciary, risk-averse, and increasingly political. Half the room reads the strategy as a marketing document. The other half reads it as a governance document with reputational and legal implications they did not sign up for. When the brand uses language like equity, advocacy, or whole-person care without an operational definition behind it, the conversation turns into a fight over words. The compromise is to tone down the language to appease the room. The strategy ends up reading like every other system in the market, and the people it was meant for start wondering if it is for them.
The Nonprofit Risk Management Center finds three causes of unhealthy board-CEO dynamics surface repeatedly: lack of trust, unclear division of labor, and poor communication. All three are governance problems that show up as brand problems.
The fix is to connect every brand claim to a measurable operational behavior before the board ever sees the strategy. Not a tagline, a behavior. If you say you are patient-centered, the board needs to see the three things you do that competitors do not. If you say you are community-rooted, the board needs the partnership structure that proves it. The brand promise has to be defensible the way a financial statement is defensible.
External pressure
The instinct under external pressure is to pull the statement that drew the attention. The FDA learned the cost of that instinct when the January 2025 executive order on federal DEI dropped. The agency pulled its clinical trial diversity guidance from its website. Industry pushback and a lawsuit from Doctors for America forced the agency to reverse course nineteen days later. The rework did more damage than standing firm would have.
I see this play out across organizations. Leadership tells the team to adjust the values to reduce political pressure. It does not pacify the critics. It alerts the donors, members, and staff who invested in the original mission that something has changed. The people you were trying to keep happy were never going to be happy. The people you had are now uncertain of what you stand for.
Brands that defend their mission keep the people they had, and sometimes earn the ones they didn’t. Build the infrastructure first. A community partnership funded for five years is harder to drop than a statement workshopped last spring. A patient navigator program is harder to dismantle than a webpage. If your brand strategy can be edited out of the website over a weekend, it was never a strategy. It was just copy.
Transition pressure
The most common way a brand strategy dies is when a new CEO arrives. The nonprofit and healthcare sectors are both in a wave of it. In one recent January alone, fifty-one nonprofit CEOs stepped down, and ACHE research finds the CMO turns over 77% of the time and the COO 52% within twelve months of a hospital CEO departure. The room that built the strategy is often gone.
When a brand strategy belongs to a person rather than the institution, the transition kills it. The agency was hired by the previous CEO. The internal champion left when the CEO left. No one is left with a reason to defend it.
Build the strategy with cross-functional ownership from the start. Programs, operations, finance, marketing, and HR all have a hand in creating it. New leadership can disagree with where the strategy landed, but pulling it apart is a different story when the whole organization is actively implementing it.
What actually holds a strategy together
Consistency is the first rule and the hardest to follow. Stakeholders do not need leadership to have all the answers during a transition. They need the answers offered to connect to the ones offered six months ago. Confidence is built through change, not by abandoning what came before.
Strategic communications, a change management plan, and a crisis communications plan are not optional. They are the operational expression of the brand. Roughly two-thirds of change initiatives in healthcare fail, often because of poor planning and ineffective communication. When pressure hits, the plan for what to say is what carries the organization through.
Internal team buy-in has to come before board direction. When the board dictates a values shift and the team is told to execute, the people closest to the mission disengage or leave. The donors and members who trusted them follow. Leadership invites the internal team into the change first. The team shapes the response. The board sees a recommendation backed by the people doing the work, not a directive pushed down through them.
If you are sitting on a brand strategy right now, the test is not whether your team likes it. The test is whether it can be defended by someone who did not build it, to a board that did not commission it, by a leader who did not hire you.
If the answer is no, the strategy is insufficient. Better to know now than to find out the next time leadership gets tested.
Picture: DrAfter123, Getty Images
Erin Gregory is the founder of Erin Gregory Creative, a strategic communications and brand consultancy serving mission-driven organizations in healthcare, technology, and community development. She works as a fractional CMO and strategic partner to founders and mission-driven leaders navigating change, bringing marketing and communications expertise to the work of building brands that thrive. She is a Forbes Health contributor, ghostwriter for Nationwide Children’s Hospital and Wexner Medical Center, and writes The Self-Led Life on Substack.
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