This paper examines a critical gap in the American Cancer Society's (ACS) call-center HR policy, which prohibits Cancer Information Specialists (CIS) from providing counseling to callers who express suicidal ideation linked to cancer diagnoses. The paper argues that the policy should be reformed to allow specially trained CIS to handle crisis calls, particularly during evening and overnight shifts when supervisory and nursing coverage is limited. Drawing on Kotter's 8-step change model, the paper outlines a realistic implementation strategy that leverages existing training infrastructure, Texas state law liability exemptions, and a no-cost partnership with a local suicide prevention hotline. Communication strategies, diagnostic tools, and methods for sustaining the change are also addressed.
This paper demonstrates applied organizational change analysis: taking an established theoretical framework (Kotter's model) and translating each component into actionable, context-specific steps. The writer moves fluidly between theory, policy critique, and practical recommendation, showing how academic models translate into institutional practice.
The paper opens with organizational background and policy description, then builds a three-part rationale for change. It presents a specific policy recommendation before devoting the bulk of the paper to implementation — covering change strategy, resistance management, communication, diagnostic tools, and sustainability in sequence. The conclusion is brief and synthesizing. This structure mirrors a professional policy brief, making it a strong model for applied business or management writing.
The American Cancer Society (ACS) is the largest cancer-related charitable organization in the United States, and probably the world. It is one of the country's two largest healthcare charitable organizations, along with the American Heart Association. It receives millions of dollars a year in donations and provides funding for research, information, and programs for cancer patients throughout the United States. One of the programs it operates is the Cancer Information Center, a call center where specially trained Cancer Information Specialists (CIS) handle calls about cancer. These CIS are college-educated, highly trained individuals with access to a database containing extensive information about cancer. Most have backgrounds in the social sciences — such as psychology, sociology, and social work — and many have experience and training in crisis counseling. In addition, the ACS employs nurses in the call center to handle specific questions that may require additional expertise. The goal of the hotline is to disseminate information to callers, not to provide individual healthcare advice. CIS are prohibited from answering patient-specific questions and are to serve on an information-only basis.
In addition to being prohibited from answering patient-specific questions, CIS are prohibited from providing any type of counseling to a caller, even though it is not unusual for them to receive calls from people who express suicidal ideation linked to a cancer diagnosis. The policy is for the CIS to attempt to transfer the caller to a national suicide hotline or, if that is impossible, to find a supervisor or nurse to take the call. However, the majority of suicidal callers contact the ACS during evening or night shifts, when nurses are not available and supervisor coverage is sparse. Furthermore, even supervisors and nurses are urged not to engage in anything that could be considered counseling. The result is that CIS are placed in the position of telling callers who have already expressed significant depression or suicidal ideation that the CIS cannot help them but can provide referrals to other numbers. When the call ends, the CIS is left wondering whether the caller is safe. If a CIS does provide any type of counseling, they receive a written warning; accumulating three warnings is grounds for termination.
The policy should be changed. Not only should CIS not be punished for providing counseling to a suicidal caller, but CIS who work evening and overnight shifts should be given training to handle suicidal callers, and day-shift staffing should ensure that at least one crisis-trained CIS is on staff at all times.
The first reason this change is important is to improve customer service. Callers contacting the hotline of the nation's largest cancer charity expect to find answers and resources at the other end of the line, and depression is very common among those receiving cancer diagnoses. The second reason is that it is inhumane to hire people who come from helping-profession backgrounds and then ask them to ignore those instincts when a person is asking for their help. The third reason is that these calls are going to continue and CIS are going to continue attempting to help suicidal callers regardless; providing them with the training and tools to do so effectively would limit liability for the organization and make the experience less distressing for the CIS.
Currently, ACS policy prohibits providing counseling of any type to any caller. This policy should be changed. All CIS who work evening or overnight shifts, as well as any additional CIS who volunteer for the training, should receive training to become crisis counselors in Texas, the state where the call center is located. Texas law allows people who have been trained as crisis counselors — but who are not otherwise certified as mental health professionals — to handle incoming crisis calls for the purposes of suicide hotlines, and it protects them from liability for those calls. CIS who have completed this additional training could then respond to suicidal callers, helping to save lives and providing better customer service to distraught individuals who have turned to the ACS for help.
The change strategy will be based on Kotter's 8-step model, which continues to be a recommendable framework for organizational change (Appelbaum et al., 2012). Because calls are frequently recorded for coaching purposes, playing a recorded call involving a suicidal caller for supervisors from outside the call center during one of their scheduled visits should help establish urgency. Since many of these supervisors have never worked in the call center, they may have no understanding of the content of such calls. CIS should also be asked to log all suicidal callers so that the frequency of the problem can be presented alongside an example call.
Coalition creation is not a significant challenge in the call center; all in-house management has come from the floor, and all CIS and local supervisors are aware of the problem and want a solution. Developing the vision and strategy could be accomplished by asking CIS what they would want from additional training and using that input to help shape the training program. Communicating the vision would be straightforward given the established monthly team-meeting system, which allows for and encourages open communication by all team members.
The CIS have successfully implemented call-center-wide changes in the past, so reminding them of those successes would help empower broad-based action. One short-term win has already occurred: a CIS who received a third strike for providing counseling to a suicidal caller was not terminated after call-center supervisors spoke on her behalf to upper management. CIS should build on that gain and work for a change to the policy itself — not merely an exception for one employee — while momentum is still strong in the wake of nearly losing a valuable colleague because of the policy.
Anchoring new approaches into the culture should be relatively straightforward. The ACS already operates one of the best-trained call centers in the United States. New employees receive extensive training on all databases, attending a full week of comprehensive instruction before working on the floor, along with additional training and coaching once on the floor. Incoming employees could receive crisis counseling training as a component of their regular onboarding, while current employees could attend ongoing training sessions for the counseling component, as they already do for other job-related continuing education.
The primary resistance has come from management, which is concerned about liability if the ACS engages in counseling and about the cost of the program. The Texas location is central to addressing these concerns, since Texas law specifically provides an exemption from liability. Moreover, the call center is located in the same city as the national suicide prevention hotline, and that organization has already offered to provide training meeting the state's requirements at no cost to ACS employees.
Changing ACS HR policy to allow CIS to provide crisis counseling for suicidal callers is a change that the ACS could implement and sustain. The tools for implementing the change — such as additional training — are already embedded in the existing employment experience. The liability concerns are without merit given the call center's location and applicable Texas law. Finally, an appropriate organization has offered to conduct the required training free of charge, removing the cost objection as well. Reforming this policy is both a humane and a practical step that would improve outcomes for callers, reduce distress for CIS, and strengthen the organization as a whole.
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