Three mission-driven rationales can guide successful nonprofit mergers: an aim to grow scale (e.g. broaden reach), to increase scope (e.g. broaden services), or to streamline operations (e.g. increase efficiencies). Each comes with its own set of challenges and lines can blur between them. The merger of The Wellness Community and Gilda’s Club Worldwide illustrates how a merger to maximize operational effectiveness led to increased national prominence and policy influence.

The Rationale: Consolidate Two Networks to Maximize Operational Effectiveness

Harold Benjamin and his wife Harriet, a cancer survivor, founded The Wellness Community (TWC) in 1982 in Santa Monica, CA, to provide social and emotional support to cancer patients, their families, friends, and caregivers. The late comedian Gilda Radner attended TWC during her treatment for ovarian cancer, and in 1991, two years after her death, her friends and family founded Gilda’s Club Worldwide (Gilda’s Club) to fulfill her wish for a similar place on the East Coast. Over the next several decades, TWC and Gilda’s Club developed networks of local, licensed, independent affiliate organizations through which to deliver free national cancer education and support programs. Despite some philosophical differences, TWC and Gilda’s Club were virtually indistinguishable to the general public because of their shared history and mission. By consolidating the two networks, Gilda’s Club and TWC aimed to increase operating efficiency, reduce costs, and deliver program services at a staffing level and budget not significantly higher than either one of the two independent organizations. In addition, the boards hoped that the merged organization would have greater resources and influence to strengthen affiliate training, research, policy, and advocacy functions, and to spearhead advances in the field of cancer care.

The Catalyst: A Groundbreaking Report

In the mid 2000s, TWC and Gilda’s Club entered into merger discussions. The talks broke off after nine months, primarily because of poor lines of communication between the national organizations and their affiliates. In 2007,however, the Institute of Medicine published a groundbreaking report¹ affirming the importance of the TWC/Gilda’s Club philosophy of treating cancer patients’ emotional and social needs in addition to their medical ones. This report proved to be the catalyst for reviving merger talks, motivating board members from both organizations to talk about ways to work together to advance the field of cancer care through their programs. It soon became apparent that by consolidating operations, TWC and Gilda’s Club could become the national leader in the psychosocial realm of cancer care. Both boards agreed in 2010 that Gilda’s Club would merge into TWC. TWC’s President and CEO Kim Thiboldeaux would lead the combined organization.

The Challenges: Branding, Integration of Affiliates, Program Standardization

The merger required blending two networks and more than 45 independent affiliates into one organization. The combined board decided early on to rebrand the national organization as the Cancer Support Community (CSC), but, to accommodate loyalties to original founders, gave affiliates the option of either adopting the new name or retaining their original names with the additional tag—“an affiliate of the Cancer Support Community.” To date, more than half of the affiliates have adopted the CSC name.

A second merger challenge was to unify the network. To accomplish this, the new CSC board formed a CSC Affiliate Council, comprised of affiliate CEOs, board members, and program directors representing various geographies and organizational sizes. To deal with a third major challenge—creating uniform program delivery standards to assure commonality of mission and practice— the CSC board created a number of tools to establish optimal adherence to CSC standards, such as a basic training program, monthly teleconferences, network- wide operating manuals, a comprehensive affiliate and network database, and an online resource directory of relevant program documents and best practices.

Integration Tactics: Formal Transition Structure, Inclusion, Communication, Transparency

In preparation for the merger (finalized in 2011), TWC and Gilda’s Club formed a Transition Leadership Committee (TLC) comprised of board members and staff from both organizations and the affiliates. That committee, in turn, established four task forces (also with broad representation) to make recommendations for integration in four strategic areas: governance, programs, communications and development, and information technology. From the beginning, the affiliates were an integral part of the decision-making process. The TLC circulated a compilation of FAQs to the affiliates, as well as regular updates on progress. In short, the two boards made the process as transparent as possible so that affiliates could provide timely input.

Results: Cost Savings, Richer Programming, National Prominence

In the three years since the merger, CSC has achieved significant programmatic and operational efficiencies, saving millions of dollars. Cost savings have made it possible for CSC to enhance both programming and infrastructure, especially with respect to integrating and expanding its online presence. The merger has catapulted CSC into the top ten cancer service providers in the country by both size of budget and number of patients served, enabling CSC not only to expand its policy and advocacy activities but, most important, to increase exponentially its impact in the cancer care field. In 2012, the American College of Surgeons (ACS) invited CSC to be one of four cancer patient support/advocacy organizations to contribute to the development of new cancer program standards for the delivery of patient-centered care at all hospital cancer programs accredited by the ACS.