Situation
Head Injury Rehabilitation Ontario (HIRO) is a provincial non-profit that directly delivers evidence-based rehabilitation services for adults with moderate to severe acquired brain injuries across Ontario. Through independent living skills training, behavioural therapy, nursing, and other regulated health services, HIRO supports clients to maximize quality of life and community participation following injury. With approximately 45,000 new ABI cases annually in Ontario, demand for these services is both significant and growing. HIRO's clients — many living in group settings — are among the most vulnerable to COVID-19: cognitively impaired, dependent on in-person care, and unable to manage a pandemic on their own.
Complication
When the workshop convened on June 8–9, 2020, Ontario was three months into the pandemic with no vaccine, no clear timeline, and no playbook for what came next. Lockdowns had partially dismantled HIRO's community-based care model — the very thing that made rehabilitation possible — and replaced it with virtual delivery that wasn't designed for this population. Frontline staff were managing high-needs clients under pandemic constraints while burning out at a rate that threatened the organization's ability to function. And underneath all of it was a mission drift that nobody had explicitly chosen: HIRO had quietly become a custodial organization — keeping people safe, doing cleaning, managing logistics — rather than the rehabilitation agency it was built to be. As one staff member put it: "Custodial work isn't our mission. Rehab is."
What They Tried — and Why It Wasn't Enough
HIRO's leadership had been working through operational challenges week by week — managing PPE supply chains, adjusting care protocols, troubleshooting virtual delivery, and trying to maintain staff morale under relentless pressure. But that continuous response was itself part of the problem. As one staff member put it: "It feels like we're always going in 10th gear. It would be nice to drop down a gear or two — not coast, but just catch our breath." The organization had become so consumed with managing immediate crises that it had drifted from its core mission without ever making that trade-off explicitly. What HIRO needed was not more operational management from the top, but a structured moment for leadership and frontline staff to step back together.
Question
HIRO had been operating in sustained crisis mode, managing workforce strain, service delivery disruption, and strategic drift simultaneously — and doing it reactively, one problem at a time. The challenge was to step back from continuous firefighting long enough to build a coherent, organization-wide plan that leadership and frontline staff could own and execute together.
Answer
MMG convened 22 HIRO staff — from the CEO to frontline workers — via Zoom on June 8–9, 2020. Rather than organizing the challenge around functions or departments, the workshop was structured around four pandemic scenarios: problem solved imminently, problem solved eventually, problems escalate, and something else entirely. This scenario-based design forced the team to build a strategy that would hold up regardless of what happened next — critical for an organization with no way of knowing whether it was three months or three years from a return to normal.
Output
HIRO left the workshop with three things that sustained crisis management had not produced:
- A clear operational diagnosis — a candid, organization-wide view of where delivery was breaking down: workforce strain and retention risk, mission drift toward custodial care, the mismatch between virtual delivery models and client needs, and the cost of running an organization at permanent Level 10.
- An integrated action plan across four scenarios — ten prioritized commitments spanning workforce stabilization and burnout management; evolution of the care model back toward rehabilitation; client and family education; and a commitment to shape HIRO's own future before the government did it for them.
- Alignment on execution — a leadership team and frontline staff who had worked through the trade-offs together, giving the organization the shared ownership it needed to act consistently under uncertainty.
Frequently Asked Questions
Why is a structured facilitated session more useful than strong operational management during a sustained crisis?
Operational management during a crisis is necessarily reactive — it solves today's problem and moves to tomorrow's. What it cannot do is create the organizational-level view needed to see that individual tactical decisions are collectively producing strategic drift. HIRO's leadership was managing PPE, adjusting care protocols, and handling staff morale simultaneously — all correctly — while the organization was quietly shifting from a rehabilitation agency to a custodial one. Naming that drift, and making an explicit organizational choice about it, required stepping out of the operational stream for long enough to see it.
How do you build a strategy that holds up when you don't know what the future looks like?
By designing for multiple futures rather than one. MMG structured the HIRO engagement around four pandemic scenarios — problem solved imminently, problem solved eventually, problems escalate, and something else entirely. That design forces a team to build commitments that are robust across conditions rather than optimized for a single assumed outcome. It's a more demanding exercise than conventional planning, but it produces a strategy that doesn't collapse the moment the assumptions change.
Why does it matter that frontline workers were in the room alongside the CEO?
Because the frontline staff were the ones with the most accurate account of what was actually breaking down — the mission drift toward custodial care, the mismatch between virtual delivery and client needs, the rate at which staff were burning out. Strategies built without that knowledge tend to be coherent at the leadership level and unrecognizable at the point of delivery. Including the full range of the organization — from CEO to frontline — also means the people who will execute the strategy were part of building it, which changes the ownership dynamic when it's time to act.
Our organization is in a similar situation — operating reactively, losing sight of the mission. How do we know when it's time to stop and do something like this?
When the pace of reactive decision-making is consistently preventing any strategic conversation from landing, and when the gap between what the organization is doing and what it was built to do is large enough to notice but too urgent to address in the normal course of business, that's the signal. The cost of stepping back for two days is real. The cost of not doing it — mission drift, staff burnout, eroding service quality — compounds quietly and then suddenly.