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DPI Client Interview
Cancer Treatment Centers of America

	Dick Stephenson, Chairman Steve Bonner, President and CEO Cancer Treatment Centers of America

Anyone who has been seriously ill or gone through the experience with a friend or relative knows the stress and frustration that often accompanies dealing with today's health care system. Most of us do the best we can with the situation and move on. Dick Stephenson felt compelled to change it.

In the early 1980s, Stephenson's mother was diagnosed with cancer. So dissatisfied was he with the way her treatment was handled that he decided to research and create an effective alternative to the established system of treating the disease. His dream became a reality with the opening of the Cancer Treatment Centers of America's two hospitals, or "Centers of Excellence," one in Zion, Illinois and one in Tulsa, Oklahoma. CTCA, as it is called, has gone on to provide new hope, a unique array of healing options–and excellent results–for many "late-stage" cancer patients.

"This all started when my mother was stricken with the disease and we observed how she was treated," Stephenson recalls. "She ultimately succumbed to the disease in 1982. It took us six years of research to discover more and more about the values of cancer patients–what are their values, what are the best treatments, and what are they prepared to pay someone to do? This led to the formation in 1988 of the Cancer Treatment Centers of America that has become the treatment center of choice for thousands of patients, a world leader in providing second opinions on cancer treatment, and a high quality source for cancer information. We get over 5,000 phone calls a week, easily 200,000 phone calls annually. We also host over 1.25 million unique visits to our www.cancercenter.com website.

"The first step is helping those who call us to understand what their options around the world are today for the cancer that is threatening their lives."

CTCA grew rapidly as it provided an effective alternative to the standard medical options. In its "Centers of Excellence" it provides not only the most sophisticated forms of "standard" therapies but also a wide range of alternatives.

"The business for us is 'patient empowerment medicine.' That's something we've framed, and coined, and used. It is all about the patient. It is not about the providers to the patient of any good or service. It is only about the patient," Stephenson says.

"We are talking first about the strongest set of shoulders in conventional medicine that you can imagine –advanced radiation therapy programs; advanced, complicated, but non-mutilating surgery; very clever and advanced chemotherapy regimes; immunotherapy programs and vaccines; cell biology programs, genetic medicine programs and a range of programs on the shoulders of so-called modern medicine.

"Then we are blessed by a bridge that has been formed–and we?re the only ones doing it–through Chinese medicine and Ayurvedic medicine, both of which stand on 5,000 years of experience, and 2,000 years of natural medicine. We have a wide range of highly qualified professionals in psychological care, physical therapy, pain management, and more nutritionists on board in our facilities than anywhere else, that provide really differentiated, make-a-difference nutritional support. We serve the finest food, including organic food, that is nutritionally beneficial to the patient."

CTCA's regimens of treatment are yielding excellent results in pancreatic, breast, prostate and several other cancers. "As an example," says Stephenson, "many of our patients with pancreatic disease are outliving the next best by one hundred percent, although too many are still dying from that disease. Yet we have planted numerous trees for pancreatic cancer survivors, as a celebration of their five year survival."

When I first saw Michel Robert's book Strategy Pure and Simple, I thought it was an oxymoron. I thought the words that went together were "strategy, complex and expensive."
        – Steve Bonner

The CTCA approach became so successful that they felt the need to deliver their unique brand of cancer treatment to a wider geographic area than the original facilities in Illinois and Oklahoma were practically capable of reaching. One way to extend that care and to gain referrals from physicians, they thought, would be to acquire oncology practices in various locations around the country. The approach ultimately proved to be flawed however, as they were unable to adequately convert these traditional providers to their unique methodologies. Expected referrals never materialized, and the company's financial situation was eroding as a result.

About that time Steve Bonner was brought in as CEO, and he immediately saw the need to clarify the company's strategy. Having used DPI's Strategic Thinking Process in previous situations, he and Stephenson agreed to go ahead.

Taking a cross-section of key managers through the DPI process enabled the group to totally reassess CTCA's direction, and pointed them back to the enterprise's original concept–focus on the patient–in a hospital-based setting, and sourcing patients directly.

"When I came in, it was clear that we were strategically out of focus and I thought the DPI process would be the best way to get us back on track," Bonner explains. "I had used the process at two other companies and what I like about it is that it's simple. It forces you back to the soul of your business, to the things that truly set you apart from your competition.

"As I think back on my first exposure to Strategic Thinking," says Bonner, "the financial services company where I worked had hired one of these armies of consultants from one of the Big Five firms who sweep through an organization and come back and tell you what your strategy should be. Then at another company, Bain came in and did the same thing. I thought what they did was very provocative but not relevant. It never really converted to action.

"When I first saw Michel Robert's book Strategy Pure and Simple, I thought it was an oxymoron. I thought the words that went together were "strategy, complex and expensive". DPI's concept really resonated with me–their view that all the knowledge you need to create a strategy resides in the heads of your executives and that what you need is a process to extract that and look at it differently, and then translate that into an actionable set of tools. It just seemed so logical, and in Mike's word, simple, that it was clearly worth a try. I think it's a powerful concept, and it's the right concept for every organization. I've used this process in three different organizations, and in each case, the results have been spectacular!"

The most important revelation to emerge as CTCA's management team progressed through the process was that the company, particularly as a result of its acquisitions, had wandered away from its founding principle –the complete focus of all the company's resources on providing their unique type of care to its patients.

"We realized that we have to live by a Customer Class Driving Force– it is always and only about the patient," says Stephenson. "During the DPI process there was some healthy discussion about that. Some thought we could be Technology-driven. After all, don't we really need to be on top of the latest technology? But we already are– we're famous for that–we have the most modern of everything that's needed. But the process helped us to see we don't want to be in the business of developing the latest medical technology. That's somebody else's business. Technology for us is a subset of our Driving Force–which is the patient."

Says Bonner, "The process really allowed us to re-examine this issue of a hospital-based delivery system as opposed to an oncology practice-based system. It became clear for a number of reasons how important it is to do this in a hospital setting. We have inpatients and outpatients but we need a critical mass and a nucleus of patients to be able to have all these integrative therapies and practices available on a highly convenient basis to the patient. That became very clear. That made these oncology practices non-strategic assets."

The first major decision to come out of that conclusion was the divestiture of the oncology practices CTCA had acquired.

"We immediately did a number of things," Bonner says. "We started either selling or shutting down these practices. We also completely resized the corporate office because it had been sized to handle this big network of physician practices. And that then allowed us to take a deeper look at what we really meant by the patient as the strategic driver, and what we meant by patient empowerment. We pulled back to the top of the list the importance of being very close to the patient, of really gathering market research, which we had given lip service to but hadn't really done much of.

"We realized that we have to live by a Customer Class Driving Force– it is always and only about the patient."
        – Dick Stephenson

"We also were able to see clearly how we could redirect the resources that had been going into these other facilities and focus them on constantly improving our understanding of the needs of our patients and the treatments that will benefit them the most. So in the roughly four years since we used DPI's process, we became much more tightly focused and the financial impact has been amazing."

A set of essential actions– Critical Issues–were agreed upon by the group, with ownership for each assigned to an executive to shepherd to completion.

"We're way down the road on the Market Research Critical Issue," Bonner states, "which was a key issue. In our divestitures, we had thirteen practices at one time, and now we're down to one. We're also doing very well on the Integrative Approach to Medicare Critical Issue and I think the issue of Upgrading Technology in our treatment capabilities is coming along very well. Then there's the whole area of Talent, and we've focused our very sophisticated marketing expertise on that so that we will continue to have the high level of staff we'll need in the years ahead."

Looking toward the future, CTCA management has a clarified vision, and with that, a concise Strategic Filter to screen opportunities as they arise.

Of this capability, Bonner says, "We're a very entrepreneurial organization, and that's good news. But the flipside of that is that if you don't have a strong filter in place, you get all these ideas coming along and they all look like good ideas. We now have the ability to run these through a process. We've built this filtering process in advance to decide what's relevant and what?s not. We're still entrepreneurial and opportunistic, but much more strategic than we were prior to the 1999 run through the DPI process."

One "opportunity" that these filters helped CTCA management to turn down was a very large acquisition that was tempting but would have been a strategic step backward.

As Stephenson describes it, "We had the opportunity to buy the biggest network of radiation oncology centers in the nation. It looked like another way to develop a distribution point for our comprehensive care. We'd be the nation's biggest in cancer treatment. But we reinforced, through these filters, that it isn't the "biggest" that counts. It would have been another clash between a physician-driven organization and a patient-driven organization, and it would have put us in the middle of a technology-driven organization. Did that meet the requirement of serving the values and needs of our patients as they've expressed it? No. It would have been a huge mistake."

As an additional "filter" on CTCA's strategic assumptions, in 2002 Bonner decided to pilot DPI's Decoding The Future Process. They found that by examining future trends in each key segment of the business (i.e., technology, demographics, professional talent and other areas) in terms of each of five "futures," they were able to detect changes in their future business environment that they would otherwise have missed. This led them to utilize an extensive range of internal and external data and market research to look for ways to improve the care of, and build a stronger bond with, their targeted set of cancer patients.

"We explored the trends in the world around us with respect to how cancer patients are making decisions, and more importantly how they're going to make them in the future. People are taking a much more active role in their healthcare buying decisions. Through the Internet and other places, people have much more access to information. So we went down that road and said, if there's going to be a lot more of that, then what is information access going to look like in the future? It got us more focused on what we intuitively knew was an issue, but it's front and center now. It's an extension of our key driver–the way we provide invaluable information to cancer patients and their families," Bonner says.

"It also took our gaze out of strictly healthcare and allows us to look for other meaningful trends. There were some very creative connections made, some of which were counterintuitive. A lot of creativity is not logical looking forward. But looking back, it looks logical. The Decoding The Future Process helps you move ahead to look back. We looked at a variety of factors against all five futures. For example, one team looked at Technology and another team looked at Markets and Customers.

"In the roughly four years since we used DPI's process, we became much more tightly focused and the financial impact has been amazing."
        – Steve Bonner

"Can we predict exactly how the world will look in five or ten years?" asks Bonner. "No, but we've now got some great tools that will make us better at that. And more importantly, we've got a process that will enable us to look at these futures periodically and sharpen our ability to anticipate what's coming at us and be able to respond to it.

"The greater power of this is the general shift in thinking. A professor once expressed it well when he said "A fish doesn't know it's wet." That's the way we were–swimming around in this medium, but we weren't paying attention to it. It goes right along with the shift we've been trying to make in an organization that had been too inwardly focused. Part of the power of the DPI process is that it gets you thinking more about the sandbox around you, and the adjacent sandboxes, and so forth. We've jumped a couple of levels in getting people to look outside for new sources of information, and recognize the power of, and importance of, making sure that we look and keep looking at the world around us as we go forward."

As many hospitals struggle to remain profitable, CTCA is now doing exceptionally well financially, which enables them to continuously develop their effectiveness in fighting cancer.

"In these four years," says Bonner, "we have really accomplished a major turnaround here. We're now just finishing our fourth consecutive year of record earnings and we've got double-digit top line growth.

"We live in a world of finite resources, and if you're not real clear about how you allocate them, you're going to spend some of those resources on things that won't give you the result you're looking for. The DPI process has allowed us to be very clear about what's at the center of the bull's eye at CTCA."

And the bull's eye, in Dick Stephenson's words is, "our expertise in treating third and fourth stage cancer patients more comprehensively, more empoweringly and more definitively than they have been told they can expect to be treated anywhere else."

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