Case Studies
Administrative Consolidation

American Cancer Society, California Division: An Interview with Pat Felts and David Bonfilio

Background

In 1989, the American Cancer Society - California Division (ACS-CA) embarked on an extensive 5-year process of reorganization that was initiated when the organization realized it was not reaching about 50% of the population in California. Despite having a local presence through approximately 43 unit offices around the state, the majority of outreach efforts only reached patients and the public living within a 10-mile radius of where the ACS offices were physically located. Moreover, ACS-CA was not being effective in reaching the full diversity of audiences in California.

The ACS-CA reorganization process involved an examination of both the division (i.e., state) level and the field structures. The effort was led by a steering committee made up of division and field staff, and volunteers. The steering committee successfully involved field staff and volunteers throughout the state by holding local forums to solicit input and feedback throughout the change process. Despite a long tradition of a very strong volunteer and staff partnership, this was one of the first times that the division/state level had reached out to the local level to such a broad degree.

The reorganization was an expansion from 43 unit offices to over 100 units, with a new definition of the structure and functions of local "units." Local units are now solely focused on program activities, including patient support, information delivery, and advocacy. And, whereas in the past local units were synonymous with offices, units can now be communities or groups of people coming together in a geographic area or through affinity with a particular community such as race, ethnicity, or sexual orientation. Under the new system, any group that wants to organize to fight cancer can be a unit and use the ACS name if they meet specific guidelines.

In addition, ACS-CA's administrative functions were consolidated and distributed throughout 11 regions, which were delineated according to various factors including media markets, natural boundaries, and diversity. Each region has a Vice President and all field staff are now deployed from the regional level. Corporate control still rests at the division/state level.

The division/state level office also went through a reorganization, creating four functional groups with committee structures: cancer control, income development, administration, and field operation.

The excerpts below are from an interview with Pat Felts, CEO of ACS-CA, and David Bonfilio, a long-time division board member and former chair who served on the steering committee during the reorganization.

Pat and David noted that a particular challenge during the reorganization was overcoming a common misperception at the local level that the original units had governance authority. Though the only corporate body was and still is the division/state, local units previously had their own "boards," developed a belief in their autonomy, and acted accordingly.

Pat: From the volunteer perspective, there's no question about it, some people were upset about the reorganization. They were letting go of control. And that was very difficult for some volunteers, including local board members, advocates, educators and so on. There were a lot of meetings we went to that were heated. Some of these people had been with us for 20 years, and we had not reorganized since our inception.

David: The California division was founded in 1946. This was the first major change.

Pat: So there was a lot of ownership, which was a good thing. But we had to move them from ownership of governance to ownership of community impact. And that was sometimes very hard.

David: Probably the biggest single issue we had to overcome was the feelings of these board members and staff people in the units that something was being taken away from them.

The process of change in attitudes and acceptance on the part of some volunteers that I worked with actually took a couple of years.

We have a culture of strong volunteer/staff partnership at ACS. The high level of involvement of local staff and volunteers throughout the process was really key to our success. A steering committee of staff and volunteers led the reorganization, and we involved people at all levels. We organized forums and input sessions led by teams of staff and volunteers, and both staff and volunteers were invited. So we weren't trying to separate the functions. We wanted everyone's concerns to be heard.

Pat: And we did a lot of visits. A lot of work out in the field. A lot of forums. A lot of input.

David: And those were really helpful. People still comment about that because it was one of the first times where the division really reached out to the field and asked for input. And the first couple of times we did it, they didn't really believe we were going to listen to them. When we came back to them and they heard their own words and ideas incorporated into the reorganization, they were pretty amazed.

Pat: Once we got the regions figured out, at least how they were going to be grouped, we started bringing people together in those groupings, even though they weren't formalized yet. So they got to start to know each other. It was involved, but it paid off.

SS: How about the impact on the staff?

Pat: We have 550 staff. We really didn't downsize the total number of staff. We moved people. We reviewed all of the staff positions and rewrote all the job descriptions. It was an enormous personnel challenge.

We spent a lot of time communicating, listening, updating, letting staff know what was happening, being honest when we did something, telling them when we didn't know something. And I think we did a very good job. We lost very few staff because of the reorganization.

One of the challenges was the uncertainty that some staff members felt. I don't know what you do to get around that in any type of reorganization.

SS: How did you address the staff uncertainty?

David: Talked to them. Listened to them. Communication, communication, communication.

Pat: We had standard newsletters that went out regularly, giving information about what was happening with the process. A reorganization update - it had a name and it was always in the same format. Communication was critical.

Another factor that helped with staff was having the steering committee be very visible in the field. Seeing the same people constantly out there with the same messages and engaging lots of people in that role. We had a huge steering committee of volunteers and staff. Everybody out there in the field could answer questions. We had fun!

David: And the steering committee wasn't just division level staff and volunteers. We also had field staff and volunteers so that the field didn't think they were being preached to, but were part of the process. They could look at the steering committee and say, "I know that person. They're not on the division board. They do the same thing I do."

Pat: Yes, I think communication from the steering committee in the field was critical.

We reorganized and redeployed staff. And that was difficult because there were a lot of really close relationships between staff who were now being moved [to other offices], and that was hard for them.

One way we helped staff through that change was to focus them on the reason for the change by using American Cancer Society data about where the cancer problem is, where the populations are that contract cancer, and where people are at the highest risk. We really drove that data home and said, "This is where the people are that we have to reach. We can't continue to operate like we are."

So we always kept coming back to the cancer problem, the mission of the organization, and that's very compelling. Stick to the mission.

SS: Tell me more about how focus on the mission facilitated the implementation process.

Pat: We always came back to the mission when we were involving our staff and volunteers in the field in determining the reorganization structure and process. You know, if people got off on tangents during the forums or input sessions, we came back to the mission. We trained our facilitators for the sessions in the field to use simple messages, common language. And techniques for getting participants back on point and staying focused on the mission. It wasn't haphazard. We had a definite plan and we trained the facilitators so everybody was using those same kinds of techniques.

And, again, we used our data. In situations where forum participants said, "I don't like this because I don't get to do this anymore," we were able to refocus them to "This is the cancer problem in your community. We're about saving lives here."

I remember when I started working on reorganization of the units. We went to a unit-level retreat with a consultant who had worked with a ton of organizations. After he went through the whole process with us he said, "I've never been with an organization where no matter how contentious the situation, people always came back and were so focused on their mission."

SS: How did you work with changes within the former boards at the local level?

David: We eliminated bylaws at the local level. So all of a sudden the local units said, "Oh well, then I don't have to have a treasurer. I don't have to have a secretary." So they started to gradually change, and now we have some units that naturally moved from a very traditional board to initiative teams. One county, for example, has a team around breast cancer, a team around tobacco, and a team around prostate cancer.

Pat: We haven't said to the local boards, "You have to be this now." We've let them evolve. So it kind of varies across the state. Our attitude has been, "If you want to call yourselves a board, that's fine," but we are all clear that the work is focused on program activities, not governance. Some people feel using the term "board" helps them attract leaders in the community. That's fine.

David: And some of the new units that have sprung up are terrific. For example, the African American Task Force on breast cancer in San Francisco. It's a very loose group and they're doing wonderful things in the African American communities in San Francisco around breast cancer and raising awareness. But they have a nominal committee chair for want of anything better. Somebody runs the meetings and they get together. But there's no other structure beyond that on the volunteer side, and it works.

SS: Let's talk about leadership. Was there a champion for your organization's implementation process ?

David: I'd have to say it was Pat [Group Vice President for Administration and Support during the process and post-reorganization CEO].

SS How significant was it to have someone like Pat as champion of the process?

David: Very. When you're an organization of 550 staff and 100,000+ volunteers and you're all in it for the mission of the ACS, but you're doing a reorganization at the same time, you need somebody who can say, "This is the way we're going. This is how we're doing it."

And you need someone who is not doing it in such a way that it becomes oppressive, but is actually in a leadership role. You need someone who's actually down that path before us. It's key. She showed us that the change was not by fiat, that it made sense for us to go in this direction. There are other staff members here, senior staff members, who had very important roles. But it was clear that to us, Pat was the one who was actually leading the implementation charge.

SS: Is there anything else important to mention about the ACS-CA reorganization that we haven't talked about?

David: After the creation of the new units, the diversity of the people involved in ACS-CA exploded overnight, which has been really key to our successes here in California.

Pat: We went through a period where we did what we call our leadership conference, a once a year meeting where you bring in a lot of volunteers. Before reorganization, we were pretty lily white out there, and after reorganization we saw within a short period of time a tremendous change in the diversity of the audience.

David: And where I see the permanent change now is when I go to a division board meeting. Our division board was very white with the exception of a retired nurse out of LA, African American. Every year when it came time to elect the new board members and officers, she would get up and she would say, "You're all white. You're all male." And she drove that home. And in the last three years she hasn't had to say that.

Pat: It started out at the community level, and community members are becoming the leaders now.

David: That's what we were hoping was going to happen. That when we expanded into these communities and they saw that we were actually going to stay there, that we would start getting new leadership from these communities. And that's exactly what's happened.

Pat: And, now we're changing again. You absolutely have to do that - keep adapting to the changing world.