Emergence of the BHAG in Oncology

Emergence of the BHAG in Oncology

David L. Graham, MD, FASCO

Sep 21, 2012

BHAG = Big Hairy Audacious Goal

The notion of the BHAG (yes, I know it sounds vaguely offensive) is a business concept I was first exposed to when I underwent orientation to join the Board of Governors of our clinic. It is a notion that resonates strongly to me. The concept is to set a dramatic goal with the understanding that it may not be met. It should be action oriented, innovative, and compelling in its reach. Noted examples have included:

  • Amazon - Every book, ever printed, in any language, all available in less than 60 seconds
  • Ford - Democratize the automobile
  • Boeing - Become the dominant player in commercial aircraft and bring the world into the jet age
  • Nike - Crush Adidas
  • John F. Kennedy - "I believe that this nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to Earth."

As a grand purpose, the BHAG can carry some significant advantages. By focusing on the grand vision, the mundane steps, once considered only possible to reach, become a given. If your BHAG is to be the predominant oncology group in the nation, surviving the next 2-5 years or getting a better payor mix cannot be a goal. It will be a given.

It can be an idea that is difficult to sell within an organization. Administrators and organizations tend to see goals as “having to be met.” It can also be a concern to some who prefer to “under-promise and over-deliver.” Personally, I can easily see having both concepts at play in a single institution.

Cancer research and funding of cancer research has not generally embraced this concept. NIH and NCI funding mechanisms have generally required a fairly rigorous step-wise advancement of knowledge and studies. Department of Defense grants, on the other hand, have been more open and even requiring of the “big risk/big reward” ideas. It has been enjoyable to be a reviewer on DoD panels and watching scientists used to the NIH approach have a very difficult time with that notion.

Now we have what may truly be considered the first, widely publicized, BHAG in the field of oncology. The MD Anderson Cancer Center has announced their Moon Shots program. With an initial focus on myelodysplasia/AML, CLL, melanoma, lung cancer, prostate cancer, and triple-negative breast/ovarian cancers, MD Anderson is committing major programmatic resources in the areas of prevention and early detection as well as expanding our ability to fight more advanced disease. The overriding idea is, as stated on the cancermoonshots.org webpage, “The time is now to end cancer.”

Yes, we have heard similar things before. We have, after all, been fighting the “War on Cancer” for more than four decades. The approach here has a true potential to differ. A single institution can adopt a mindset more like the Department of Defense's “big risk/big reward” approach. If MD Anderson does stay more along the NIH way of evaluating ideas, however, it will run the risk of trying to make incremental changes meet a quantum goal.

I thoroughly applaud MD Anderson in this step. We must acknowledge the bravery to commit to this magnitude of a goal, even while knowing that cynics may snigger about the audacity. It will be interesting to see if other organizations step up to make similar commitments.This could be a first step in revolutionizing our chosen field. There is no better description for that than a truly Big Hairy Audacious Goal.


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