Planning in an academic matrix research center.

Introduction

To reach a goal, concepts must be shaped into designs then set into a plan that leads to implementation. Strategic planning is a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does it, with a focus on the future. (Adapted from Bryson's Strategic Planning in Public and Nonprofit Organizations). So it is in the Rebecca and John Moores UCSD Cancer Center, an NCI designated comprehensive cancer center at the University of California, San Diego. This report will discuss our approach to planning, the essential elements, the manner in which we foresee the plan being actualized, and the metrics applied to measure progress. Planning in the Cancer Center is a complex, fluid effort due primarily to its matrix academic environment, but also because its goals intersect research and patient care components of the institution.

Although many use these terms interchangeably, strategic planning and long-range planning differ in their emphasis on the assumed Environment. Long-range planning is generally considered to mean the development of a plan for accomplishing a goal or set of goals over a period of several years, with the assumption that current knowledge about future conditions is sufficiently reliable to ensure the plan's reliability over the duration of its implementation.

On the other hand, strategic planning assumes that an organization must be responsive to a dynamic, changing environment (not the more stable environment assumed for long-range planning). A common assumption has emerged in the nonprofit sector that the environment is indeed changeable, often in unpredictable ways. Strategic planning, then, stresses the importance of making decisions that will ensure the organization's ability to successfully respond to changes in the environment. Rowley, Lujan, and Dolence state that it involves "arraying options through a process of opening up institutional thinking to a range of alternatives and decisions that identify the best fit between the institution, its resources, and the environment" (1997).

For the Moores UCSD Cancer Center, the needs for a strategic plan align with this principle, in that it has a certain level of stability in being funded in 2001 for five years by the National Cancer Institute. The Cancer Center has gained the status of NCI-designated comprehensive cancer center, and it also has begun construction of a 270,000 gross square feet multi-use building, presenting it with new programmatic and financial challenges. We approached the task of developing a plan by applying established principles of consensus and specificity.

Developing the Plan

The effort began in August 2001 with the consensus of the Cancer Center's senior leaders that a formal plan was of benefit and with their commitment to support the effort through their time and input. While the lead author of the plan was the Cancer Center's administrator, it was conceived and reinforced by the director and involved the thoughts of dozens of individuals. Ringle and Updegrove suggest that in order for a technology effort to be successful, key individuals within the community-faculty, senior officers, and others-must understand the importance of an initiative and, to some extent, take ownership of it. This type of understanding and endorsement is best achieved when those individuals play a role in the formulation of the initiative itself, as they might during the planning process (Ringle & Updegrove, 1998). Pfeiffer, Goodstein, and Nolan (1985) note that a consensus-based mission statement can serve an additional, practical purpose in management planning; it can act as a guiding force, or priority standard, for allocating limited resources. We also wished to recognize the cyclical nature of the effort; continuously monitoring, benchmarked annually and intensively recast every five years. We drafted a time line (Figure 1).

Drafting the Plan was launched by interviewing the senior leaders, soliciting their ideas about what the Cancer Center represents and where it is heading. From those initial interviews the skeleton of the plan was laid out in various elements: the Cancer Center's mission, goals, objectives, strengths and weaknesses, necessary actions and a set of benchmarks through which to measure and monitor its growth. The traditional format of a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis was applied, which evolved into a plan for the future.

The mission of the Cancer Center is the following:

   The Moores UCSD Cancer Center is
   committed to promoting and sustaining
   excellence in basic, translational and clinical
   research, cancer prevention, and the
   highest quality of clinical care. Toward
   this goal, the Cancer Center exists to
   promote interdisciplinary research and
   the rapid translation of discoveries from
   the laboratory to the cancer patient; and,
   to seek to control cancer through interventions
   to treat the patient and prevent
   the disease in populations determined by
   genetic and/or environmental factors to
   be at risk of occurrence.

This statement encapsulates the Cancer Center's identity and purpose and the message and the mission are simple and straightforward without specific details about the patient care and research being conducted.

We next attempted to integrate the mission with the Cancer Center's goals. We wanted to limit the number of goals, lest they be unwieldy, so we combined the goals (longer term) with the objectives (shorter term) to arrive at the following aspirations:

In order to continue to build the Cancer Center, maintain it as a Center of Excellence and offer the highest quality service to our research and community constituents, the broad objectives for the next five years are to (a) create the optimal environment for collaborative/translational science, (b) strengthen/restructure weaker programs, (c) develop large interdisciplinary research programs, (d) reprogram developmental funding emphasizing program project grants and Specialized Program of Research Excellence (SPORE) grants, (e) reinforce the clinical trials program, and (f) enhance internal and community services of the Center.

To efficiently address these objectives in a plan, we had to dissect the multifaceted components of the Cancer Center and organize them under the broad headings off Research; Patient Care; Community Activities; the Role of the New Cancer Center Building. Under each heading we identified the current strengths and weaknesses, the objectives, the action plan and the metrics for evaluation. The selected strengths and weaknesses were a combination of comments from the NIH grant reviewers, our senior leaders, and the yardsticks we have applied internally to the performance of the programs.

The objectives, which were key to the plan, reflected the combined thinking of the Center's leadership in the direction it was to take for the future. For example, the objectives for Research are stated: The Moores UCSD Cancer Center, in building a cancer research program of the highest stature, seeks to:

1. Assemble the most promising and productive scientific programs relevant to the strengths of the Cancer Center and the needs of the community/region.

2. Infuse the Cancer Center continually with new investigators of extraordinary potential and accomplishment from both within and outside of UCSD.

3. Foster further interaction among cancer scientists and physicians to achieve optimal programs, productive collaboration, and the highest quality patient care.

4. Utilize fully and effectively the new cancer center building commensurate with the mission to join basic, clinical, and behavioral scientists in their common objectives.

Perhaps most important to the plan are the actions necessary for actualization. They must be neither too limited nor too broad, but realistic to achieve the objectives. We stated our action items for research in the following manner.

1. Identify the most significant research strengths and weaknesses of the Cancer Center in order to determine how best to build the Cancer Center.

2. Determine whether to focus on building on strengths or reinforcing weaknesses.

3. Build centers of excellence in major research areas.

4. Identify and implement the most effective channels for interaction.

5. Determine and prioritize the need for recruitments to the Center to complement existing areas of excellence, and develop weaker but promising areas.

6. Develop research and clinical programs for the new building that complement and integrate the other's areas of expertise.

7. Retain the existing program structure for the current core grant performance period to test its merit. Certain programs will be scrutinized more closely to determine whether or how they should be continued.

8. Review the utilization of the shared resources and survey the membership for new Cancer Center services.

9. Continue the use of seed monies to promote new discovery and peer reviewed grant support.

10. Study the creation of tumor based programs to target translational research in those tumors which meet the NCI criteria for creation of new research programs.

11. Study the creation of new basic science programs to exploit the Center's strengths in these areas.

12. Periodically review the membership of the programs to ensure reasonable productivity and proper fit. Participating members will be reviewed every three years and associate members will be reviewed bi-annually.

13. Create and implement more opportunities for collaboration and cross-fertilization of research.

Formulating objectives and implementing action plans comprised 50% of the plan, because without evaluation measures the plan would have no value. Thus, we needed to devise a means of measuring progress and productivity. We accomplished this by combining meaningful metrics with information readily available which minimized the risk of inaccurate or idiosyncratic data that could be tolerated in a strategic plan. Measurement of performance at least annually, but preferably more often, to evaluate the effect of specific actions on long-term results and on the organization's vision and mission is important. (Pfeiffer, Goodstein, & Nolan, 1985) We decided that the measurements would, for the most part, derive from data collected for the annual core grant progress report to the NCI because the progress report calls for considerable quantitative data and we could relatively easily identify them as metrics for the plan. For research they include the number of sponsored projects; the total direct costs; the total direct and indirect costs; the number of members in the Center; the number of publications which are intraprogrammatic and interprogrammatic; the number of seminars; the number of clinical trials; and the number of patients on trials. Pertinent metrics were developed for Clinical Oncology and Cancer Outreach, as well. Measures for the new building are deferred until its planned opening in 2004.

The plan concluded with action assignments to groups composed of members of the senior leadership to pursue the objectives. The assignments are now a formal part of senior leadership meetings in which progress reports are presented.

Developing a Business Plan

Accompanying the programmatic plan is the business plan, which seeks to place financial value and cost on the stated objectives. We determined to include in the business plan only the costs related to the growth of the Center, and not to its basic operations. We wanted to distinguish between the funds needed to operate versus those needed to reach the stated objectives. The budget represents three sources of funds: the NCI core grant, the University, and gifts and contributions. The major categories where funds will be applied are planning and evaluation, new research, shared resources, faculty recruitment, and outreach activities. Under each heading are specific cost categories; for example, under shared resources we have identified the major costs as new equipment, new shared resource development, technology opportunity support, and alterations/renovations. In addition to a categorical breakdown, we included a breakdown of costs by source.

Benchmarking Our Progress

We have now reported on two full years of progress using 2000-01 as a base. The statistics are on a positive slope in virtually all areas. Figures 2, 3, and 4 below illustrate the benchmarking of the strategic plan.

[FIGURE 4 OMITTED]

The creation, development and acceptance of the plan gives the Cancer Center a firmer foundation upon which to approach the future and measure our achievement. While the plan is not unalterable, major modifications will involve a process of consensus and approval. The project to create a strategic plan to project both the actions and timing for further development of the Cancer Center proved to be a very valuable exercise. We now have a foundation upon which to build the Cancer Center and a schedule to follow. Figure 5 demonstrates the planning cycle we have gone through and expect to follow in the future, beginning with the NCI Support Grant Renewal in 2001 and continuing in the same vein beyond 2005.

[FIGURE 5 OMITTED]

Figure 1
Time line

Outline                               June 2001
First Draft                           October 2001
Internal Review                       December 2001
Annual Benchmarking timed to the      April 2002
  grant progress report submission
Executive Level Review                February 2002
External Advisory Council Review      June 2002
Approved 5 year Plan                  July 2002
Annual Benchmarking                   April 2003
Annual Benchmarking                   April 2004
Preliminary discussion of revisions   October 2004
Revised 5 year Plan                   July 2005

Figure 2
Cancer Center Members

Year   * of Members

1999       171
2000       209
2001       216
2002       256

Note: Table made from bar graph.

Figure 3
Total Peer-Reviewed Publications

Cancer Center Programs        1998   1999   2001   2002

Cancer Biology                 113    137    243    252
Cancer Genetics                 46     52    114    157
Cancer Pharmacology             19     28     33     11
Cancer Prevention & Control     45     78     88     70
Cancer Symptom Control          37     63     54     75
Translational Oncology          68     61    150    124
Viral Malignancy                14     28     39     41
Totals                         342    447    721    730

Percent Change                        31%    61%     1%

Source for 1998 and 1999 data: CCSG 2P30CA-23100-17, 18

Source for 2001 data: CCSG 2P30CA-23100-19

Note: Data were not collected for Year 2000.

References

Pfeiffer, J. W., Goodstein, L. D., & Nolan, T. M.(1985). Applied strategic planning: An overview. San Diego, CA: University Associates

Ringle, M. & Updegrove, D. (1998). Is strategic planning for technology an oxymoron? [Electronic version]. CAUSE/EFFECT, (21(1), 18-23. Retrieved April 2003 from http://www.educause.edu/ir/library/ html/cem9814.html

Rowley, D. J., Lujan, H. D., & Dolence, M.G. (1997). Strategic change in colleges and universities. San Francisco: Jossey-Bass

Author's Note: This work was supported in part NIH grant P30 CA23100.

Contact: Ira S. Goodman, Associate Director for Administration, Moores UCSD Cancer Center, 9500 Gilman Dr., MC 0658, La Jolla CA 92093-0658. Ph: [phone]. E-mail: [e-mail].

Ira S. Goodman

Rebecca and John Moores UCSD Cancer Center

University of California, San Diego