I’ve been giving some thought to what sparks a merger, and how that initial spark can influence success or failure. In our case, the catalyst was a researcher's answer to this burning question: Does social and psychological care help patients fight cancer? That external impetus has made all the difference to post-merger integration and our focus on mission and impact.

Flashback to 2007, when the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, issued the groundbreaking report Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. While The Wellness Community and Gilda’s Club, two cancer patient support organizations, had been in merger discussions in the past, the report utterly affirmed their work and reignited merger conversations. The IOM report, based on significant peer-reviewed evidence, concluded that psychosocial care must be integrated into quality cancer care. It outlined a series of recommendations and ambitious goals toward making social and emotional support part of comprehensive cancer care—goals that The Wellness Community and Gilda’s Club were already practicing. Upon examining the report in detail, it became clear to both nonprofits’ leadership that The Wellness Community and Gilda’s Club could be a much greater force for implementing the report’s recommendations together than apart. (See the just-released case study “Cancer Support Community: Becoming the National Leader in Psychosocial Cancer Care.”)

Since the Cancer Support Community emerged from combining The Wellness Community and Gilda’s Club in 2011, and I became its president and CEO, I have taken a keen interest in other nonprofit mergers. From my informal observations, I’ve noticed that the majority of mergers are prompted by internal factors—leadership change, financial pressure, donor pressure, program shifts, etc. While these factors can be a natural impetus for change, they also can be riddled with risks and pitfalls that in turn can be subjective, political, personality-driven, and emotional. While the Cancer Support Community merger had its own internal issues and politics, the IOM’s transformational report subordinated “family squabbles” to fact-based research; we could cite objective data and analysis to guide our actions and philosophy.

At the Cancer Support Community, we often refer to the Leslie Crutchfield book Forces for Good in which Crutchfield and her colleagues describe the attributes of transformational nonprofits. They ask: How do you move from leading an organization to leading a movement? The formula they find includes three essential elements: direct service, research and evaluation, and advocacy and policy. Direct service keeps you in contact with your constituents—the end users of your services. The research element proves that what you are doing is effective and having an impact. And advocacy and policy is where you combine the constituent experience with the research to advance system change.

After the IOM report was released, we realized that we could become the kind of transformational nonprofit that Crutchfield described. We could double in size, which meant we would serve many more people with cancer, accelerate and expand our research capabilities, and recruit a much larger, more vibrant grassroots advocacy network. In essence, the merger could accelerate our ability to effect change for patients and doctors and at hospitals, insurance companies, and national health agencies.

The report also became an objective, data-driven force when merger and integration activities began to go off track. It elevated us to a higher purpose and allowed us to put personalities and personal agendas aside. We consulted it often when we hit roadblocks and used it to help frame an integrated program model and guiding principles. At the same time, we helped form and lead a coalition of 40 organizations also committed to advancing the recommendations in the IOM report. This allowed us to flex our new leadership muscle and external position in the cancer community, while internally, we were finalizing the merger integration.

While I recognize that all groups considering a merger might not be handed a once-in-a-generation-type report, I think it might help to look more intensely at the external environment when considering a merger. How will the merged entity be able to effect change beyond operational efficiencies? Will a merger allow for exponential growth in terms of mission delivery? Will a merger catapult you forward and elevate your voice for greater impact? Are there external factors that could be categorized as a mandate to merge? I believe that by conducting such an analysis, you can reduce some of the emotion and potential heartache that can come with a nonprofit merger and elevate your mission more quickly and effectively.

The Cancer Support Community is now almost three years into its merger. There was a new IOM report issued in 2013, Delivering High-Quality Cancer Care: Charting a New Course for System in Crisis. This report also emphasizes the need for patient-centered cancer care and addresses the importance of an educated and empowered patient. In many ways, it is the rallying cry for our next phase of strategic growth. And it is a new anchor for our three-pronged model of direct service, research, and policy.

Kim Thiboldeaux is president and CEO of the Cancer Support Community, an international nonprofit that provides the highest quality support for patients and families through three key areas: direct service delivery, research, and advocacy. Prior to the Cancer Support Community, she was CEO of The Wellness Community.