Editor's Notes
Brian Kavanagh, MD, MPH, FASTRO
The staircase paradox is beautifully counterintuitive. As illustrated in the figure, the basic idea is that as the number of right-angled steps taken to cross a square of side length 1 diagonally approaches infinity, the sum total of line segment distances remains a stubborn 2. And yet the length of a straight-line segment from corner to corner is always the square root of 2, a lesser value.
The application of popular business strategies to the world of medicine presents a similar conundrum. As much as we might like to think that a classic like Jim Collins’ “Good to Great” might offer a blueprint for success for health care enterprises, the problem is that those entities do not operate in a free market system in the same way that a company selling groceries or razors or any other type of widget does. For example, there are variable government subsidies and rules impacting the business of medicine, not to mention patient behavior that, at least historically, has not exactly always been that of a rational consumer maximizing their personal utility. And so, a plan intended to lead from now to a future imagined state might end up being less a straight line and more a zig-zagging journey.
The current issue theme is a nod to the argument that small- and large-scale programs require both a strategy and a successful plan of execution to be successful, which is the essential premise of “The 4 Disciplines of Execution,” another best-selling business advice book by McChesny, Covey and Huling. We wanted to tell some stories about how a few innovative individuals and groups strategized and executed ambitious aspirational goals either within the domain of radiation oncology or in a closely adjacent sphere of influence. We had no preconceived notion of how those narratives should sound, and we invite readers to draw their own conclusions of how things played out.
We did, however, feel that three of the stories in particular stood apart from others based on their extra-large dimensions along financial, metaphysical or professional scales. It also seemed that Tobacco Free Portfolios, Life’s Door, and Targeting Cancer have all thrived in large part due to an alignment of stars and the passionate commitment of key individuals leading the charge. With apologies to anyone tired of dad-joke-level rhyming word play or astronomical references, please do have a look at “Syzygy and Resolution” anyway, because Drs. Bronwyn King, Ben Corn, Sandra Turner, and Lucinda Morris are all amazing people.
Equally extraordinary is this issue’s guest editor, Nikhil Thaker, MD. Dr. Thaker is arguably the most business strategy-aware person in the field. During his residency at MD Anderson Cancer Center, he completed a fellowship in health care management, where he worked with national leaders at MD Anderson and the Harvard Business School, including Michael Porter and Robert Kaplan at the Institute for Strategy and Competitiveness. He is double board certified in radiation oncology and clinical informatics, holds Master’s degrees in health care, information technology, and business administration, has served as a Chair of Radiation Oncology and Chief Medical Information Officer, and has also founded multiple companies that integrate artificial intelligence and management principles in oncology to drive digital transformation.
It takes about five minutes of conversation with Nikhil to realize that he is truly one of the brightest bulbs in the chandelier, with high energy and keen intellect — and as a bonus, he is a very nice young man. He was charged with organizing a systematic way to tell all the other stories so that maybe, just maybe there might be overarching themes to extract or common lessons to learn or even, dare we venture, inspiration to be drawn.
Bridging the Strategy-Execution Gap in Oncology
Strategy without execution is merely a dream. Execution without strategy is chaos. Those of us working in oncology — whether in clinical practice, research, industry or policy — live at the intersection of these two realities. We develop ambitious plans to improve cancer care, adopt cutting-edge technologies, or transform our institutions, but how often do we see these ideas falter in execution?
During my time at MD Anderson Cancer Center, I had the opportunity to participate in an extensive strategic planning initiative. It was a master class in high-level visioning, systems thinking, and innovation. But what struck me just as powerfully was witnessing how real-world challenges force pivots, how execution can often fall short, and how the best strategies evolve through constant iteration. It was this experience that helped me refine strategy and execution as I transitioned to other organizations, encompassing academic, community, private practice and even start-up initiatives. It led me to dive deeper into business principles rarely taught in medicine, namely health care leadership, strategic planning, informatics, and digital transformation, which shaped my approach to this issue of ASTROnews.
When Brian and I began discussing this edition, we wanted to move beyond abstract concepts and showcase real-world examples of strategy and execution in oncology. I crafted the interview questions with a simple goal: to uncover how leaders across different domains — clinical practice, startups, industry, and academia — bridge the gap between vision and reality. How do they set priorities amid competing demands? How do they navigate unexpected obstacles? And critically, what lessons can we extract from their successes and failures?
We grounded our approach in the oft cited “4 Disciplines of Execution” framework, which emphasizes: Prioritizing the few objectives that truly move the needle
Identifying the key actions that drive success rather than merely tracking outcomes
Making progress visible to sustain engagement and accountability
Establishing structured follow-ups to ensure sustained momentum
These principles are universal, yet their application in radiation oncology is uniquely challenging due to regulatory constraints, reimbursement complexities, and the high stakes of patient care.
Lessons from Our Contributors
To explore these ideas, we spoke with some of the most innovative minds in oncology, from academia, to industry, to the startup world, and beyond. These interviews reveal that transformative change in health care hinges on a blend of personal conviction and strategic clarity. These leaders demonstrate that by embracing agile execution — through iterative development, clear metrics, and continuous feedback — ambitious ideas can be turned into marketable products and impactful initiatives. Whether it's rethinking investment strategies, harnessing the power of narrative and hope, or fostering decentralized, accountable teams, the common thread is that adaptive, collaborative decision making is key to translating visionary concepts into measurable, lasting outcomes.
Where Do We Go from Here?
As radiation oncologists, we are increasingly called upon to think beyond the clinic — whether integrating new technologies into workflows, leading multi-institutional initiatives or shaping policy. But grand ideas are not enough. The difference between a stalled initiative and a game-changing innovation often lies in execution.
My hope is that this issue of ASTROnews serves as more than just an interesting read. I hope it prompts reflection: How do we, in our own work, translate strategy into action? How do we measure progress, pivot when needed, and sustain momentum over time?
The individuals featured in this issue don’t just have great ideas — they are actively transforming vision into reality, building something lasting. And that, ultimately, is the true measure of strategy.
