On Aug. 5, two months into her job as CEO of the American Cancer Society, Karen Knudsen was in Burlington, VT, checking out the Hope Lodge—the third one she visited since taking the job.
In Burlington, Knudsen, former director of the Sidney Kimmel Cancer Center, EVP of Oncology Services—Jefferson Health, and past president of the Association of American Cancer Institutes, had just popped in to see Randall F. Holcombe, the new director of the University of Vermont Cancer Center. “This is his first week on the job,” Knudsen said. “When you just come in, it’s like drinking out of a firehose.”
Knudsen, too, has been confronting an enormous challenge: designing a new version of the American Cancer Society, a 108-year-old charity that, despite having one of the most recognized brands in the U.S., has seen steady declines in public support since 2007.
It’s an urgent task. Last year, the pandemic exacerbated the problems that have been driving the charity’s decline, bringing public support down to about $560 million, about half of its purse in 2007, without adjusting for inflation (The Cancer Letter, Feb. 7, June 19, 2020).
Knudsen is the first translational bench scientist, the first cancer center director, and the first woman to run ACS. After taking the job, she polled her peers—directors of cancer centers—to gather their critiques and suggestions for ACS to resume an important role in today’s cancer care.
It wasn’t always like this. Without a campaign orchestrated by Mary Lasker and ACS, there would have been no National Cancer Act, and the field of oncology would have looked very different.
In an hour-long interview with The Cancer Letter, Knudsen diplomatically steered away from criticizing her predecessors—who presided over the uninterrupted erosion of ACS’s mission and revenues—while emphasizing that her vision is wholly distinct from theirs. After a Knudsen re-design, the society will act and allocate resources very differently, she said.
In pre-Knudsen days, ACS functions were grouped into two categories: those that produced money and those that cost money. Hope Lodges, a $30 million program today, was, of course, a money-burner.
Now, the lodges are part of a consolidated unit (or “pillar,” to use Knudsen’s term) focused on patient support.
This is guided by an advisory group co-chaired by Otis Brawley, the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University and former ACS chief medical and scientific officer, and Gregory Garber, director of Oncology Support Services at Sidney Kimmel Cancer Center at Jefferson Health.
Brawley’s departure from ACS three years ago dealt a blow to the old regime and the society’s prestige (The Cancer Letter, Nov. 9, 2018). His return in a key advisory role signals the start of a new day at ACS.
Other members of the advisory board are:
- Electra Paskett, the Marion N. Rowley Professor of Cancer Research at The Ohio State University,
- Terri Armstrong, deputy chief and a senior investigator at the NCI Neuro-Oncology Branch,
- Alex Khariton, vice president, Cancer Service, and senior administrator, Sidney Kimmel Cancer Center, and
- Celeste Philip, deputy director for Non-Infectious Diseases at Centers for Disease Control and Prevention.
Critics have said the society’s weakened connection with its constituencies has contributed to the slide in revenues.
A new focus on mission would give the charity the purpose it needs, and money would follow, Knudsen said. The Hope Lodges, which offer patients a place to stay while undergoing treatment, matter because they are central to making the patients’ lives easier, and because they connect ACS with its constituencies.
“The patient support pillar is a new and important construct, to pull it all together under one decision-making unit—everything that touches the patient, including education screening, navigation and transportation, and lodging,” Knudsen said.
“So, who’s the head of patient support?
“Temporarily, you’re looking at her.”
The patient support link is so important that she decided to get the ball rolling while also initiating a process to recruit someone to step in as the founding ACS chief patient officer. This would be a permanent position.
At its core, Knudsen’s strategy is simple: maximize relevance and money will follow. Rebuilt, ACS will be an organization based on four pillars: patient support, research, advocacy, and resource generation.
Recently, Knudsen presented the new organizational goals to the ACS board, receiving unanimous approval. The final version of her strategic plan is expected to go to the board later this year.
The Burlington Hope Lodge is just opening after being shut down for the pandemic, with planned reduced capacity to facilitate social distancing. This is part of a phased opening plan in place for Hope Lodges across the country, including layered prevention strategies to keep patients and guests as safe as possible, Knudsen said.
Like all Hope Lodges post-COVID, the Burlington lodge is meeting the goal of operating at about 30% capacity after having been shut to patients for more than a year.
Located close to the UVM campus, it’s a white building with black shutters and an abundance of chimneys. Thanks to local quilting guilds, there are quilts in all of its 30 suites and most common areas.
On the tour, Knudsen notices a harp in the corner of a common area.
“Does somebody play the harp?” she asks Debra Weinstein, the lodge’s assistant manager.
“Nobody has ever played the harp,” Weinstein responds. “Not ever. Not once.”
“We’ve got to find a harpist,” Knudsen suggests.
Unlike the harp, the lodge is needed by cancer patients rich and poor, Weinstein said.
“Everyone who knows the Hope Lodge in Burlington knows that people wouldn’t be able to have care if we weren’t here,” Weinstein said. “They wouldn’t be able to get here, they would choose an alternative that wasn’t right.
“We have people who are financially insecure, and we have people who are well off that stay here. So, they’re elbow-to-elbow with each other, and their experiences. They walk away with a huge heart for each other, where normally they wouldn’t even know each other.
“So, that’s the kind of thing that makes Burlington Hope Lodge so great, because it’s small and we have a lot of community support in volunteers and donations.”
Knudsen said she is resisting the urge to project the 2021 financials, saying only that she is cautiously optimistic. Recently, she released $2 million, respectively, for patient services, research, and advocacy.
Knudsen has no interest in acquiring a glitzy office space to replace the “National Home Office,” which the society vacated almost overnight last year (The Cancer Letter, July 24, 2020).
“I don’t see that it’s needed,” she said. Moving around the country is more effective than being ensconced in an office building crowned with an aggressively illuminated logo.
The CEO’s office is now in Philadelphia, where Knudsen lives. The scientific office is in Atlanta, and the advocacy function—the ACS Cancer Action Network—is in Washington, D.C.
“The executive team and I communicate all day long on Slack and Zoom,” Knudsen said. “We’re big Slackers in the most positive of ways, but it is the case that we also get together face-to-face once a month in intensive retreats.”
Knudsen spoke with Paul Goldberg, editor and publisher of The Cancer Letter.
Paul Goldberg: Often, ACS has been run by people who come from the inside; there’s this kind of a culture. Sometimes, it gets to be isolated. And you come from a completely different planet. What’s it like to be out there?
Karen Knudsen: Well, I hope it’s a good thing. I hope other people have considered it to be a good thing.
It’s a good thing, if I may venture an opinion.
KK: From my perspective, given where we are in cancer right now, given where we are as a country right now, I think it’s really important that someone at the helm of ACS is tightly connected to oncology and stays tightly connected to oncology. I think that’s key.
And I’m very happy that the board also had that vision, and I hope that that’s why they selected me.
It’s certainly something that I imprint every day as we’re making decisions: What is the experience of someone who is right now trying to do research? What is the experience of someone who is right now trying to advocate for cancer patients? And what is the experience of someone who is right now desperate to fill gaps in the cancer care continuum that they know are drivers of cancer inequity?
And I think that’s brought a nice perspective.
Like any executive team, we’re made up of people who have disparate expertise, and I think that that’s a good thing. My ability to stay tightly connected to the oncology community will be an important role for me moving forward.
Are you getting a new headquarters?
KK: No. I don’t see that it’s needed. I don’t see that it’s needed. The executive team and I communicate all day long on Slack and Zoom. We’re big Slackers in the most positive of ways, but it is the case that we get together face to face once a month in intensive retreats.
We’ll move from the CEO’s office in Philadelphia to Atlanta where the discovery center is, to D.C., where the advocacy office is, to the many communities that we serve across the country once a month.
It’s a way of saying it’s another game completely.
KK: Well, I had some great experiences so far, out in the field. For example, I was in Chicago and I met with the cancer center director from Northwestern (Dr. [Leonidas C.] Platanias), with Dr. [Kunle] Odunsi, the new cancer center director at Chicago, and the leaders at Rush.
With each meeting, I brought the ACS cancer control person for that region, and someone from the field who would be responsible for raising resources for anything that we decided we would do together.
And they were great.
It was exactly the right kind of conversation. Examples: For research, what do you need? For advocacy, who is your public relations person? What are the things that you’re working on right now? Whom can we contact when we want to work with you on something?
And for patient support, who’s running your oncology social work team, because we need to connect with them and understand where your gaps are? And then, if we’re going to fill some of these gaps, how do you we partner and work together on that?
It was a great set of conversations.
What I realized as part of that is that sometimes ACS wasn’t connecting to the right person at a cancer center, so there were opportunities that were being missed.
I think I’ve been able to help them, I think, navigate the waters of the cancer center, if you will.
That’s hugely important, for everything, including disparities.
KK: I met with Dr. [Randall F.] Holcombe today, brand new cancer center director at University of Vermont, in Burlington, and I met with Suresh Ramalingam, the new director at Emory also, earlier in the week.
And Morehouse. My gosh, Morehouse is an amazing, amazing place, in Atlanta. I met with their president and CEO, Dr. [Valerie] Montgomery-Rice. She is a force. There are many alliances that we have right now between ACS and some of the incredible minority-serving institutions like Morehouse, and we are thinking much more deeply about what we can do together. We’d like to join forces more closely in the fight against cancer.
In this next phase for research, we talked about where the priorities lie. Some are to facilitate the oncology research and oncology care pipeline. We have funds that go directly toward the goal of investing in building diversity. Notably, these aren’t funds that we’ve raised yet, but we found funds in our new base and invested.
It’s going to be a several-year journey, but what I hope people see in the right now is a truly reactivated, up to an even higher level, ACS toward working tightly with the cancer community, to get the right things done.
Since we are at a Hope Lodge, what’s your plan for Hope Lodges?
KK: We’re looking at what the next phase of Hope Lodge might look like, let’s call it a Hope Lodge 2.0.
Examples: Can we use the kitchen experience as a way to provide education to patients about food nutrition, especially during chemotherapy, when things are really difficult, so they’re learning from us, but they’re also learning from each other in the kitchen?
It’s something we are thinking about, in the next phase.
Other questions are: Could we have digital technology in each of the rooms that’s preloaded? For example, for someone coming in for stem cell transplant could we pre-load information about their specific cancer, and in an ideal world, add a chat bot, to ask questions live and be populated by ACS-supported information, to give them what it is that they need?
In sum, we are thinking about what that next phase of what Hope Lodge looks like, and hoping to develop partnerships to accelerate plans.
As per Hope Lodge, having a place to stay is essential.
If we’re going to close the gap on cancer disparities, we know you can’t do it without lodging, transportation, and navigation.
Those are key enablers, and are almost more powerful than anything we can do. But can we take situations like this and learn from it, and learn what works, what we can do better? That’s the point.
I think that’s where the magic happens, is when the Hope Lodge experience can inform what’s needed for research priority, and research findings can inform what can help us even more, within a Hope Lodge environment, to help cancer patients navigate their journey more efficiently.
How many Hope Lodges are there?
KK: There are 30 in total, and we continue to invest. We actually invested greater than $20 million in refurbishing and building of Hope Lodges last year. In addition to that, we’re opening three more. We built three during COVID, one in Dallas, one in Houston, and one in St. Louis.
And then in six more that really needed renovation or expansion, including modernizing and overhauling. Those include New York, Philadelphia, Atlanta, Birmingham, Boston, Lexington, Nashville, and Cleveland. All in all, between 2019 and 2021, we invested $81 million in expansion and $6 million in renovating.
Our “COVID year” (2020) investment alone was $30 million.
Given the impact, I’m anxious to get Hope Lodges back open to patients. Note that we did offer to have them used for healthcare worker lodging even during COVID. We do require a vaccination, for all Hope Lodge staff, as well as anybody who’s giving a ride to cancer patients. We have a vaccine mandate there, TBD and what the next vaccination policy looks like for us.
That was an important criterion to reopening: The goal is to reopen at 30% capacity in the trial run and then scale up even further. Any kind of opening has to be in compliance with CDC and with local laws and regulations, whichever is the more strict of the two, obviously, that’s what wins. But outside that, we are ready to roll. [Knudsen has since announced mandatory vaccination for all employees.]
Beyond Hope Lodge, there is room for ACS to have some overarching strategy about patient support, and how it is that we invest our time and resources in the areas greatest of need. Food insecurity is a huge one.
As I do spend time in Southern Vermont, I avidly read the Brattleboro Reformer, and note the regular reports about food banks and produce sharing. I love the Vermont way of providing sharing opportunity for people to have a lot of produce at any given time, to give it to somebody in need.
It’s a culture in Vermont that I wish was everywhere, because there are Hope Lodges where patients are struggling to get through the cancer journey, so the opportunity for other patients or volunteers helping them with food, is a big one.
Given how huge the problem of cancer is, and given the magnitude of the problem of food insecurity, and all the manifestations of inequity in health care, Hope Lodges can solve maybe a small percentage of these problems. Can you expand that? Can you do more? Can you scale up?
KK: That’s what we’d like to do. In any given year, it’s about 28,000 individuals that are served through ACS lodging and the Hope Lodges. That’s already a lot, but not good enough.
We are thinking about the path forward. We talked about making the Hope Lodge a place where we can enhance education, because we know that’s a gap that promotes cancer disparities. We know that there’s significant challenges with health literacy—the Hope Lodge provides us a way to provide educational materials, quality of life seminars etc.
The concept that housing helps close the gap in cancer disparities, that transportation helps close the gap in cancer disparities and outcomes, are not subjective conclusions. It’s data-driven, based on research.
But can we do even more to increase health literacy?
We talked about the digital parts of the room, but what about digital literacy? How do we close that gap? Is this a place where we can teach someone how to do a telehealth visit?
This could be key, because when they leave the Hope Lodge and go home, in the new era, a lot of the follow up will be by telehealth. From my experience in Philly, low digital literacy is a massive issue. People have a cell phone, but not everyone knows how to use it like a smart phone.
They don’t know how to get an app, they don’t have an email address, and you can’t have a telehealth visit without an email address. So, is Hope Lodge a place where we can try to prepare patients for that next phase in the journey, so that they can leverage the telehealth component?
In sum, we have only 30 Hope Lodges. Patients come from all 50 states, on any year, to the Hope Lodge, which is good. In total, we have given out over 500,000 nights of stay to cancer patients and families since 2019. In a single year, that is estimated to reduce the cost burden of these families by more than $50 million in hotel expenses.
So, it’s a lot, but could you do more?
KK: I know we have many more patients in need than we can house. We don’t want someone to have to make the choice to skip or delay care due to lack of housing. So, then the question is, how does it get done? I’ve asked the ACS cancer control vice presidents in each of the six regions.
We just had a really terrific mini-retreat, and I’ve asked them to look deeply within their regions, to identify the highest priority areas of need for them.
Under the auspice of education, screening, where are the gaps? Lodging and transportation, where are the gaps? And navigation?
It might not be the same geography for all of those answers, but I asked them to identify the highest priority of need, and I have cancer centers also contacting me directly, which is appropriate!
So, what are we going to do about that?
We also have places wherein there is a Hope Lodge, but it’s not enough.
I was just in Atlanta two days ago, meeting with the cancer center director from Emory as well as the group from Morehouse. Emory does about 500 transplants a year—500. This is unbelievable, and most of those, adult transplants.
So, the Hope Lodge there is at capacity, even in the pre-COVID time. That one was refurbished during COVID; it’s about to open.
So, what is the solution? Do we need to build a second Hope Lodge? It’s a thought on the table. Do we need to come up with a different strategy, where we take housing dollars that we would have used for operating costs in a Hope Lodge until we can build another one?
We do have other creative partnerships, for example with hotel chains, but that’s not a complete solution either.
Putting someone in the Hope Lodge environment gives them, I think, a quality of life that’s most similar to being at home, while not being at home. So, this is the ideal.
This is the connection to what people actually want. Isn’t it?
KK: It actually is. In addition to housing, the impact of the ACS transportation program—that’s for the people that actually do live in an area close to a cancer center—is incredibly important.
There is no cancer center that has enough transportation for their patients in need There just isn’t.
I think every cancer center director knows that to be true. When I was at Jefferson, on any given year, 16% of my patients would miss visits, because they don’t have transportation, so the transportation grants were key.
We did just release additional funds into patient support program, that ACS would release $2 million dedicated to transportation.
The cancer control group that I just talked about is now looking at their regions to make sure that’s the highest priority for this fiscal year. We’d like to make sure we get patients fully compliant with every visit.
Uber, Lyft—I don’t know if you’ve tried to get one recently—are tough to get right now. Ensuring safety from COVID for cancer patients during rides is another big challenge.
Ensuring that we have safe rides is one of the goals this year, while we think about the bigger strategy for 2022.
So, that’s how the rubber meets the road: the services of all sorts for patients. Or else who needs ACS, basically?
KK: Well, we also released funds into research mission, and into the advocacy mission.
I think that’s the magic of ACS, that can be capitalized on even, where all of those aspects work together.
The concept that housing helps close the gap in cancer disparities, that transportation helps close the gap in cancer disparities and outcomes, are not subjective conclusions. It’s data-driven, based on research.
Notably, we have research programs funded to address cancer disparities, and have identified activities such as transportation, navigation, and lodging, as key to the process. This underscores our commitment to invest in patient support.
It feels like the right thing to do, but the research tells us that it is the right thing to do from a data-driven perspective.
That alone won’t close the gap. If you take navigation as an example, there are plenty of data to show that navigation improves outcome for patients, they have a better quality of life, better understanding of their care, and lower cost of care.
Yet, navigation is not reimbursed. So, we fund research that helps to guide us in the right way. ACS endeavors to fill that gap and provide navigation, to cancer patients and health systems.
But the key to the solution is advocacy—ACS CAN. ACS CAN learns from our own efforts in the patient support on one side, from the research that we’ve done to measure the impact of support activities, and pools this information to serve as the tip of spear driving advocacy priorities and affecting change.
That’s the example of what ACS as an organization can uniquely do: thread through cancer challenges within the research, advocacy and patient support component, to truly induce change that’s durable.
In the fight against cancer, I think that’s what we all want.
Well, all of those pieces have always been kind of connected, but not really.
KK: After June 2, we emerged as an organization with three-pillar model to improve the lives of cancer patients and their families: research, advocacy and patient support, all in synchrony with each other, are moving toward common goals, and more than ever working together under the common vision.
More than anything, that is what I’ve been so enthusiastic about. Over the past two months, we have coordinated that effort and our strategy moving forward.
We’ve been mapping it out, we’re presenting our strategic plan it to the board at the end of this year.
The executive team moved quickly to effect change, and to increase impact. Combined with solid financial footing, we had the confidence to release additional funds, incremental to the budget, into each of the three pillars this year.
The leaders now are oriented towards the same North Star of improving the lives of cancer patients and their families, and that’s what we needed to do.
You’ve mentioned at some point in the conversation that you’ve gotten to the root problem with ACS. What is it, and how do you solve it?
KK: I think what ACS needed was a refresh of moving toward a single strategic vision built on what differentiates us. What can we do that is necessary and has impact that only ACS can do?
We shouldn’t be duplicative with the NCI, we shouldn’t be duplicative with what the cancer centers are doing from a research perspective. We should be filling the gaps.
What is the important cancer research that no one else is funding, that no one else is getting behind? It’s why I’m on this tour of talking to the cancer center directors, to find out what their concepts are for the intramural and extramural program, but mostly extramural.
It’s been enlightening. I also met with Dr. Sharpless, the head of the NCI. I charged him with the question, “Okay, Dr. Sharpless, what are the things that you think are high-priority that you’re just not able to fund?”
While there is work to do toward selecting new priorities, I was invigorated by the conversation of new potential partnerships with the NCI to fill gaps.
But because we’re ACS, I think we also want to fill the gaps by prioritizing research that is going to bring benefit to patients in a way is quite clear. That is our value proposition aligned to improving lives.
Thus, research at ACS has a refreshed mission. Part of that is also alignment with advocacy, so that advocacy is informed by the research we are doing, and also helping to inform research priorities. They are working together very well.
While research and advocacy are the avenues toward cancer eradication, they are complemented by ACS patient support efforts, which is what we can do right now. It’s the gap that’s so glaringly obvious, with regard to navigation, education, transportation, and lodging. I am thankful that all three of ACS pillar leaders are working now in synchrony with each other. There’s more nimble decision-making and communication amongst those leaders, under one clear strategic plan.
These last two months have just been unbelievable amounts of work for the leadership team—work of organizational reflection, discovery, and refining clarity of our mission. We have a clear benchmark we ask ourselves when making a decision between Plan A and Plan B.
The question is: Does it improve lives? Will it improve the life of a cancer patient and their family? If yes, proceed. If no, push it a little bit down the priority list.
Last year, 2020, was catastrophic for ACS—there was a huge drop in gross receipts. This is before you, of course. How did ACS handle that? How did they decide to apportion they money they have?
KK: That’s a good question, and I’m not sure I have the complete answer to that. My strategy has been to look at current state and move forward.
I truly respect the incredible leaders at ACS, and their abilities and capabilities. I view my role as CEO, as to maximize what we can do as a highly connected team with singularity of focus.
In the past, decisions were made to obviously downsize aspects of the organization, but because they were before my time, I don’t have as much insight into why. What I can say is, that we now have a very clear vision as to impact of our decisions, and that we are rowing in a single direction to make a difference for cancer patients and their families.
What about Hope Lodges? To whom do they report? To whom did they report before, and to whom do they report now? Actually, let me just split it up into three parts. What was before, what happened just before you came in, and what’s happening now?
KK: Great question. This one, I actually do know the answer to.
I talked about the pillar model that we have right now, of research, advocacy and patient support.
There’s a very clear leader at the head of research, that’s our chief medical and scientific officer [William G. Cance].
There’s a very clear leader at the head of advocacy, and that’s our president of ACS CAN [Lisa Lacasse].
The patient support pillar is a new and important construct, to pull it all together under one decision-making unit—everything that touches the patient, including education screening, navigation and transportation, and lodging,” Knudsen said.
So, who’s the head of patient support?
Temporarily, you’re looking at her.
Right now, that’s me, and I have been delighted to join forces with key leaders at ACS that were running aspects of what we now call Patient Support, into a committee. These are really, really wonderful people.
Dr. Laura Makaroff is a primary care physician and have been really working on implementation science and screening. She’s a key partner for me.
Chuck Westbrook, at Hope Lodge, who I just think so incredibly highly of, had been given a lot of oversight of the Hope Lodge, since he came in. Jennifer Greenwald, who is operationally helping to execute patient support activities, and Brant Woodward, who oversees all the six regions and field operations.
That’s how we’re functioning right now but, I don’t want to do this forever, because I am the CEO, so I’ve got this other day job.
It’s the case that we have written the job description, and are about to start the search for our first chief patient officer.
I think this is going to be an incredible opportunity for someone who is tightly connected to oncology, who is not just thinking about what it is that cancer patients and their families need today, but what they’re going to need in the future, in this environment, post-COVID, where telehealth plays a major role, for example.
By another example, if we are going to continue to a needed onslaught of new advances in immunotherapy and would this require even more patients to be close to the cancer center, and if so, how are we going to handle that? We are seeking through leadership in an individual who understands (likely hailing from an academic medicine background and tightly connected to research), the drivers of cancer disparities, and guides us in how to fill gaps in the cancer continuum.
I’m very (underscore!) excited about finding our chief of patient support, as soon as humanly possible. This will complete the operational structure for our three key pillars; research, advocacy, and patient support.
Before you came in, I think ACS was split up into two general categories, the part that raises money and the part that spends money. And the part that spends money needed to be cut because the part that was not raising money, wasn’t raising money. So, that’s kind of a recipe for disaster.
KK: It was a different way of thinking, and that’s not what we’re doing now.
Leveraging business experiences from my previous executive leadership in health care, and also leveraging expertise within ACS itself, we have enriched practices that let mission guide us.
The ACS group that is responsible for identifying how we’re going to resource our mission, is headed by Mike Neal, who is just an incredible individual and had previously led field operations–galvanizing employees, volunteers, and communities across the nation. So, he has a very good understanding of what the disparate cancer-focused needs are, in the more than 5,000 communities we serve.
So, he’s truly excellent.
We’re doing something a little bit new. The new charge was ‘Now I want you to tell me what is one barrier that you see at the ACS, that’s associated with your part of the organization, and what’s your solution. Just tell me one solution that we can implement.’
All leaders—from the research, advocacy, patient support, resource generation, diversity equity and inclusion, field operations, communications, HR, and IT—just came from a three-day retreat, in Atlanta, where we were ticking and tying in our steady state, and identifying all the new initiatives that we would like to launch.
Sitting at that the table all along with us was Mike Neal, and his resource unit, giving us critical feedback we needed for mission planning—ranging from, “That makes total sense to me,” or “That’s a good idea, but I’m not sure that we would find enough support for that, to make it feasible.”
Our process, as such, is to lead with mission—leading with what it is that we want to achieve, but at the same time having the group that’s going to bear the significant, heroic responsibility to get this resourcing together, and to give concepts the feasibility check before we plan to drive in this direction.
It’s a way of doing business that is well suited for ACS, and one that I am well familiar with from my experience in leading cancer at Jefferson. Conversations about what we wanted to achieve were always coupled with a clear plan to resource an initiative.
I’m really fortunate to have a skilled team, and a very skilled CFO to help us also write the business plans to ensure we can achieve what it is that we’d like to do, in this lofty way, to further enhance each of the three pillars of ACS.
You also know how things grow, because what you’ve done at Jefferson, it grew pretty quickly.
KK: You grow when you have joint decision-making and you all agree on priorities, and when you replace reactive business decisions, with intentional choices. This is how the current leadership team functions.
I think we’ve got the right momentum, and we’ve got the right rigor. We’re going to make some mistakes in the first year or two of working together, as any new team would. But we’ll do what great scientists do, we’ll iterate; right?
We’ll look at the data, and the next year, refresh, and go on. I think that the ACS executive team has enjoyed this environment of collaboration and shared decision making, all directed toward one common goal.
How’s the money looking?
KK: Better.
It was about $560 million last year. What is it now?
KK: I don’t want to project before the end of the year, because we have variances in each month, of where we’re going to go.
Most of it happens towards the end of the year. It a good spring, but it’s an interesting profile, I’m learning still—very different than the revenue profile that a health system looks like, but from an annual basis, doing very well.
I would say to the point that, I did just release two million dollars into each of the pillars, to use this year.
Given our financial position, we are not waiting until the end of the year, for us to get more going.
So, it’s going to be in the 600s or 700s?
KK: We’ll see how we do, but we should be outperforming last year.
American Cancer Society Total Public Support
How long would it take for this to work? How long would it take for people to understand that there’s a new way of thinking at ACS?
KK: One of the things that I’ve said from the very beginning, is that, “We are all mission.” Every single one of us.
Irrespective of your title and your role, you can be here only here for one reason. There’s only one reason to be at the American Cancer Society: to help cancer patients and their families.
It’s also the case that there are significant opportunities for communication. I should probably back up a little bit and say a few words about our physical structure. The ACS discovery center, which houses the research unit, will always be in Atlanta. This includes our own intramural program, and the extramural funding units.
However, our advocacy pillar is in D.C., the home of ACS CAN and the national advocacy home office. ACS CAN has offices and staff in all 50 states, and all 435 congressional districts.
For patient support and all other activities, the major way that we’re structured is through the six regions. There are six executive vice presidents and cancer control vice presidents out in the region that are getting the work done, and that is much of the communication cascade comes in.
One of the things that I wanted to do from the beginning, which we started on day one, is to bring in voice of the regions to the decision table. Brant Woodward, who looks over all six regions, now sits on the executive team.
As such, anybody from a Hope Lodge or anyone out at any site, works up through their part of the organization, ultimately to an executive leader and the CEO’s table. This communication chain is critical.
I also meet with the executive vice presidents and cancer control groups, to understand what’s happening across the country.
But what I realized in that process is that we have a lot of room for communication, so giving them information and then also ensuring that they have a mechanism to cascade down and communicate up.
Because it’s a big organization, we still have work to do, but we have made major gains in connecting teams across ACS. Communication is an area that we’ll be continually working on in the next year, and it’s, actually, one of the components of our strategic priorities.
Isn’t there some kind of a TV channel situation you have, or a webcast?
KK: Yes, we do have webcasts that serve many needs, including externally for educating, connecting, and convening. As CEO I’ve added a few other new venues. For example, I’ve been doing monthly town halls to connect with staff and volunteers. And it’s not me just getting up there opining on something—that’s not my style.
Before my first day on the job, I opened a URL line with the charge of, “I’m the new CEO. Tell me anything you think I should know.”
Ideas flew in, and I received a lot of questions, which I tackled them in the town hall, joined by a unified executive team. The executive team doesn’t see the questions ahead of time—it’s a URL line that’s only for me, so employee information is confidential. But I do bring in the executive team into the Q&A on the town hall, and they have been highly receptive to the process.
My last town hall, I, actually, did in Chicago, with staff present, and also asked employees to load up questions live. They voted up questions, and we covered a lot of important ground. While it’s only one step, this is my way of further reaching all 2,500 employees, so that they can ask me anything they want.
Next month, we’re doing something a little bit new.
The new charge was “Now I want you to tell me what is one barrier that you see at the ACS, that’s associated with your part of the organization, and what’s your solution. Just tell me one solution that we can implement.”
The creative ideas were fantastic!
At our planning retreat this week in Atlanta, each executive looked at the list (de-identified), and readily found projects to take up. From each, I heard with excitement, “I can take this on. I can take this on.”
Ideas ranged from solving software glitches, reducing paperwork, big initiative ideas, ideas for new research directions, ideas for advocacy plans, and small fixes that could make us nimbler and more efficient.
One that I absolutely loved—as the temporary chief patient officer—was a suggestion to refine strategic priorities in each region for patient support. My response? “Hallelujah. Yes, we’re already doing that, aligned with the entire cancer control team.”
In the next town hall, we’ll be reporting on some of the things that we’ve heard from all the employees, on these fast wins. It felt wonderful to tackle low-hanging fruit as an executive team and implement change to facilitate the mission.
It seems to be going in the right direction. I can’t help but think so. But I’ve got to tell you, Paul, I haven’t slept in a long time. I’m living on coffee.
Thank you for talking with me. And thanks for the coffee.
