Running Head: AMERICAN CANCER SOCIETY: ACCESS TO CARE

AMERICAN CANCER SOCIETY: ACCESS TO CARE

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 AMERICAN CANCER SOCIETY: ACCESS TO CARE

Question 1: Organizational Structure

How has the organizational structure for ACS changed to support the Access to Care Strategy?

Explain in detail.

The structure of an organization is dependent on its strategy as stated by the contingency

theory. There has been a huge shift in the makeup of the board of the company not because of the

Access to Care strategy but to get the right board leadership. This structural change had been

implemented in the year 2008. A National Home Office had been created which was based on

Atlanta, Georgia and there were 13 separate regional divisions, all of which were independently

accountable.

Each of these 13 divisions consisted of the multiple local offices and division

headquarters. There were now around 43 total members in the board. The National CEO, John

Seffrin, is the only one who is accountable to the board and answers them. All the limitations and

the measurable goals for the CEO are set by the board. The National Assembly had elected the

national board of directors and it is comprised of around six volunteer delegates. A charter was

signed between all the 13 divisions, every three years. This ensured that the agreements and the

expectations of the National Home Office and the Board were same.

The progress for the agreed upon goals of each of the 13 divisions was measured by a

representative of National Home Office. The same auditor, which is Ernst & Young, audits all
the 13 divisions. It is evident that ACS follows a functional organizational structure and the

decision making process is centralized. This is evident from Figure A in the case. The board had

also formed a volunteer structure and the staff structure for developing, communicating and

executing new policies in each of the division to support the initiative.

This is a perfect structure for supporting the Access to Care Strategy because all the

divisional heads are working separately but similarly to achieve a common goal. They also meet

regularly through the chartering process to measure their progress. All the divisions are provided

with the incentives to collaborate. Finally, the 2015 goals provided a single roadmap to follow to

each of the divisions so that they can could achieve shared outcomes.

Question 2: Strategic Investment Decisions

How are the strategic decisions made by the board at ACS and what you think about Access to

Care Strategic Decision of ACS?

The strategic decisions at ACS are made through detailed discussions, meetings and

collaboration of the executive team and the. The board and the CEO had collaboratively formed

the Access program. The lack of access had been identified as a major cancer killer and it was

growing. The Access program had been developed to address this issue. However, each of the 13

division also had their own CEOs and their independent boards. They do not have to follow John

but, it is the communication process at ACS through which the major strategic decisions are

made and discussed among all the divisions. This is possible only because of the strong

commitment and support of all the volunteers for the cancer cause. One example of this
commitment is the formulation of the 2015 Goals, which were highly valuable in aligning all the

13 regional divisions.

If we talk about the Access to Care initiative, then this initiative fits strategically with the

mission of ACS. Previously, the organization was committed towards the prevention, detection

and research for cancer patients however, under the leadership of John Seffrin, it had been

realized by everyone at ACS that the biggest hurdle for the cancer patients was due to lack of

access to care and this was the gap which ACS wanted to pursue.

This strategic decision was not an easy one as this was a radical change in the strategy of

ACS. The aim of this initiative was to increase the number of the eligible Americans for the

treatment and prevention of cancer. This posed ACS to the considerable political risk but

however, John the case shows how ACS mitigated this risk through public policy changes and

advocacy, which shows the strength of strategic decision-making process of ACS.

Question 3: Performance Management & Compensation

Evaluate the Performance Management & Compensation System for ACS and identify any

weaknesses, if any.

Each of the 13 divisions was were responsible for its their performance and only the

consolidated financial information was presented to the public. In order to measure the

performance of the divisions, the organization had set a scorecard with specific criteria, which

were highly relevant to the particular region and also relevant nationally. For instance, one
division had a performance metric regarding its goal concerning the ethnic diversity; another

division had the performance metric regarding the total number of the legislative meetings,

which have been conducted by the staff on the tobacco related issues. Each of the performance

metrics of each division were tied back to the final mission of ACS.

Each of the division followed all the metrics in order to show the bets shared practices as

an organization. There is was no resistance from any of the division heads regarding this system

of performance measurement. Good performance systems of one division are replicated in the

other divisions to achieve the same level of the performance. This is evident by the New England

Division’s performance in the area of cancer control. This high level of sharing among the

divisions and transparency of the outcomes is the real reason for the success of the Access to

Care strategy so far.

Finally, if we talk about the compensation system, then there is not a lot of pay for

performance at ACS and only a decent wage is paid to the volunteers for nonprofit and since

they are volunteers then therefore, this is completely a fair compensation. The reason for this is

that all the volunteers have a personal connection to the organizational mission and it is the

primary thing, which motivates them to work for ACS to support the cancer cause. Most of the

people who work for ACS have a personal story about cancer.

According to Mike Dany, the CEO of High Plains Division, the board is trying to match

the competitive wages in the marketplace but still people are satisfied with what they get at the

end of the day. People feel contented and satisfied at the end of the day after supporting those

who have been hit by this life threatening disease. Their support for this cause and the support
for the achievement of the ACS mission, which is primarily based on raising awareness, is the

true reward for them.

Question 4: Ethics & Culture

How would you define the culture of ACS and is it ethically right culture for ACS?

ACS is a nonprofit organization. The mission of the organization was to increase the

public awareness and fulfill all the gaps, which are faced by the patients in accessing the quality

health care. The culture at ACS has its roots from the religious devotion and veneration, which is

felt by all those working in the organization. All the people who are working at ACS are

religiously against cancer because either they want to work for such a cause or they have faced

similar problems in the past and lost their dear ones to this life threatening disease.

This is morally a very good thing as people feel for the people and work for them from

their heart. However, this cult feeling limits their analytical thinking, which is also important for

ACS and the Access to Care initiative. Most of the time, these people are not able to ask good

scientific questions because they do not think that way. However, getting the science right is

highly important for the Access to Care initiative and the organizational objectives of ACS. This

can at times affects the reputation of the organization.

For instance, in 1993, ACS had recommended that all those men who are above 50

should have a PSA test for the screening of the prostate cancer. However, subsequent research

conducted by the scientists showed that the prostate cancer screening does not save lives. This
shows that the organization had overstepped science and the reason was the organizational

culture. ACS had also made incorrect recommendations previously also such as the

recommendation for getting chest X-Ray for lung cancer. This was also made without any

supporting scientific evidence. Therefore, we can say that the organizational culture at ACS is

highly religious one and it might be ethically correct, but not scientifically. It needs to be

changed and science needs to be incorporated to support the organizational mission and the

Access to Care initiative.

Question 5: Management Control & Risk

Identify the risks faced by the Access to Care strategy. Evaluate the internal controls and

formulate recommendations for the board of ACS for mitigating identified risks.

The Access to Care initiative of ACS was a significant departure from the current

strategy of ACS and therefore, this posed many significant risks for the organization. John

Seffrin was fully aware about the risks faced as a result of this new initiative. This is because this

initiative has brought in a number of different dimensions of the public policy. If this becomes a

political issue and if the individuals start to believe that the is the strategy of the organization to

wade in the political arena, then it would affect the brand image negatively.

Moreover, the financials would also be impacted affected significantly because 97% of

the donations of ACS come from individual donors who can stop donating at any time. The only

reason for the emergence of the public policy risks and political risks was the strategic change in

the mission of the organization. Previously, ACS had only emphasized on solely focused on
cancer prevention, research and its treatment, but now with the Access program the organization

was proclaiming publicly that all the makers of health related policies need to think about and fix

the broken health care system. This could be thought of as if they were now accusing the policy

makers. This is the only and the most significant risk, which is faced by ACS and the success of

the Access program. There is also a risk that public might think that through the Access program,

ACS might take a political stance and support a political candidate.

Before providing recommendations to overcome such risks, we need to evaluate the

internal controls at ACS. The strength of the internal controls would determine how well the

above risks could be handled through our recommendations. The internal controls of ACS are

strong. ACS has developed a nationwide internal audit system and a system has been created,

which provides a conduit for all the volunteers and staff for any unusual questions or issues,

which are faced by them. The board can discuss the issues in the absence of the CEO or any

other staff. The independent compensation committees have also been created, which are

supported by the external consultants. The board receives advice from the full time general

counsel. Overall, the controls at ACS are strong and if any of the risks materialize, these would

be handled carefully.

The only solution through, which the above risks could be mitigated and removed is

through communication. The ACS executives should communicate publicly to everyone and

state clearly that they will not collaborate with any of the political candidates and oppose or

endorse any candidate’s political plans. This is being done quite well by ACS executives through

its $ 15 million media budget. Furthermore, the advocacy solution was supported through the

ACS Cancer Action Network. This had created huge benefits for ACS, such as the budget for
Institutes of Health had been doubled between 1998 and 2003 and this had been done through

advocacy.

It is also recommended for the executives to forward their messages in the public through

their three million volunteers as they had the power to influence their own elected officials. The

management should be committed to not collaborate with any of the political parties, give money

to these parties and their candidates, endorse, or oppose them. The organization needs to plan

another ad campaign on a much larger scale as compared to the one conducted in 2007. Finally,

the management should continue to track the progress of its ACS CAN measures through

changes in the public policy and laws. These recommendations would transform the Access

program and the thinking of the wider public.

 Appendix

Exhibit 1: Growth of Activities at ACS

GROWTH OF ACTIVITIES OF ACS

AVERAGE
2004 2005 2006 2007 S
Revenues
Contributions 596931 189899 200945 221694
-
Growth - 68.19% 5.82% 10.33% 8.07%
103932
Total Support from public 868440 929587 969287 5
Growth - 7.04% 4.27% 7.23% 6.18%
Total Revenue, Gains & other 103768 117192
support 926496 977851 0 0
Growth - 5.54% 6.12% 12.94% 8.20%
Expenses
Total Program Services 581590 605607 664940 700177
Growth - 4.13% 9.80% 5.30% 6.41%
Total Supporting Services 241030 260655 298592 288843
Growth - 8.14% 14.55% -3.26% 6.48%
123324 130439 147289 158672
Net Assets end of Year 9 2 1 5
Growth - 5.77% 12.92% 7.73% 8.81%