"What do we want?" is different from "What do we want to avoid?"  This seems obvious, but in fact negative visions are probably more common than positive visions.  Many organizations truly pull together only when their survival is threatened.  They focus on avoiding what people don't want---being taken over, going bankrupt, losing jobs, not losing market share, having no downturns in earnings, or "not letting our competitors beat us to market with our next new product."  Negative visions are, if anything, even more common in public leadership, where societies are continually bombarded with visions of "anti-drugs," "anti-smoking," "anti-war," or "anti-nuclear energy."

Negative visions are limiting for three reasons.  First, energy that could build something new is diverted to "preventing" something we don't want to happen.  Second, negative visions carry a subtle yet unmistakable message of powerlessness:  our people really don't' care.  They can pull together only when there is sufficient threat.  Lastly, negative visions are inevitably short term.  The organization is motivated so long as the threat persists.  Once it leaves, so does the organization's vision and energy.

There are two fundamental sources of energy that can motivate organizations:  fear and aspiration.  The power of fear underlies negative visions.  The power of aspiration drives positive visions.  Fear can produce extraordinary changes in short periods, but aspiration endures as a continuing source of learning and growth." 

If you are leading physicians in your organization, it will be important to devote significant energy on the positive future vision of your organization.  You will be tempted to rally around a negative vision, or to use the negative scenarios as too much of a lever for change.  Ultimately people move willingly toward a compelling future vision, and move in spurts or temporarily when they are avoiding negative consequences.