An evaluation of mission and vision statements from NCI-designated cancer centers and their affiliated hospitals

Abstract

Background

Effective communication of mission and vision statements (MVS) is important for medical institutions seeking to connect with patients, staff, and the community. This study assessed the composition, readability, and topics addressed within MVS among National Cancer Institute (NCI)-designated cancer centers and affiliated hospitals.

Methods

We extracted MVS data from institutional websites for 65 NCI-designated cancer centers and their affiliated hospitals. We determined statement composition using word count and time to read. Readability was assessed using Flesch–Kincaid (FK) reading ease and grade level scores. We reviewed MVS for 4 themes: equity, quality care, training, and research.

Results

Among 65 cancer centers, mission statements were identified for 93.9% (61/65) and vision statements for 63.1% (41/65). An affiliated university hospital was found for 59 centers; all provided a mission statement, and 86.4% (51/59) had a vision statement. Mission statements were 8-11 words longer than vision statements. MVS required advanced reading skills, with grade levels ranging from 13 to 17. FK reading ease analysis showed mission statements for cancer centers were significantly harder to read than those for affiliated hospitals (15.4 vs 35.6, P = .001). Notably, fewer cancer centers included “training” than affiliated hospitals (55.7% vs 79.7%, P = .005). No significant differences were found for other themes.

Conclusions

Cancer centers and affiliated hospitals have MVS with readability levels beyond those recommended for patients, underscoring a need for simpler language to improve public communication. These findings offer insights into cancer center messaging, providing a foundation for enhanced communication.

Implications for practice.

Cancer centers and their affiliated hospitals use MVS that require advanced reading skills, potentially limiting effective communication with the public. While MVS represent just one aspect of broader institutional messaging, simplifying language in these statements could improve accessibility and enhance engagement with patients, staff, and the community.

Introduction

Mission and vision statements (MVS) seek to communicate organizational goals and aspirations, often distinguishing one organization from another by showcasing unique characteristics.¹ MVS can influence employee behaviors and potentially assist in reaching institutional objectives, acting as a guide for decision-making.¹ Specifically, a mission statement is defined as an action-oriented declaration of an organization’s reason for existence, thereby communicating an organization’s identity, purpose, and present goals.^2,3 In contrast, a vision statement is defined as a future-oriented, aspirational explanation of an organization’s long-term goals and direction.³ The mission statement takes broader goals outlined in the vision statement and translates them into practical, achievable actions that ideally guide the organization’s daily operations.³ Previous work has shown that well-crafted MVS can positively impact a company’s performance.^4,5 Thus, MVS may play an important role in the functioning, decision-making, and direction of healthcare institutions.⁶ Hospitals can leverage these statements to potentially foster meaningful connections and communication with patients, employees, and the broader community.

While considerable evidence supports the important role of MVS for influencing outcomes among the organizations they are associated with, a dearth of research exists regarding MVS in healthcare settings.⁷ Prior work in the medical literature has examined the effectiveness of mission statements among for-profit and non-profit organizations, demonstrating that financial success and perceived effectiveness of MVS depend on factors such as their creation, implementation, content, structure, and individual perceptions.⁸ Minimal literature has sought to describe MVS in healthcare, and even less within National Cancer Institute (NCI)-designated cancer centers and their affiliated hospitals. These statements may play a role in communicating an institution’s mission and vision to patients with cancer, allowing individuals to find care that aligns with their needs, values, and preferences. Most existing work on MVS comes from the fields of business and management, with relatively few studies focused on healthcare. Research on the MVS messaging provided by trusted, leading institutions within the field of oncology is lacking. Investigating MVS across cancer centers and their affiliated hospitals may offer valuable insights into existing structures and themes of communication.

In the current study, we sought to assess the composition, readability, and thematic elements of MVS for NCI-designated cancer centers and their affiliated hospitals. We hypothesized that MVS from NCI-designated cancer centers and hospitals would generally exceed the recommended grade level of such content, reflecting a focus on professional and academic audiences rather than accessibility for the general public. We further hypothesized that thematic analysis would likely reveal a purposeful emphasis on research for NCI-designated cancer centers, considering this represents a key goal for these institutions.⁹ By examining the MVS from NCI-designated cancer centers and their affiliated hospitals, we hope to identify areas for improvement and motivate the development of statements that more effectively connect with a wider audience.

Methods

We identified NCI-designated cancer centers listed by the NCI as of 12/2023 and included clinical and comprehensive cancer centers in our sample along with their affiliated hospitals.¹⁰ We excluded NCI basic laboratory cancer centers, as we sought to explore information across institutions with a clinical focus. A total of 6 cancer centers did not have an affiliated hospital. Our final sample included 65 NCI-designated cancer centers and 59 affiliated hospitals.

We extracted MVS from the official websites of NCI-designated cancer centers and their affiliated hospitals. We evaluated the composition of each MVS by measuring the total word count and estimating the time required to read the statement. We calculated the time to read based on a standard reading speed of 240 words per minute.¹¹ Using Flesch–Kincaid (FK) formulas, we assessed the readability of each MVS. This resulted in 2 metrics: FK Reading Ease and FK Reading Grade Level. FK Reading Grade Level ranged from 0 (young child) to 17+ (postgraduate education). FK Reading Ease scores range from 0 to 100 (higher scores indicate a text that is easier to read; scores between 81 and 100 correlate with a fifth to sixth grade reading level). The American Medical Association recommends materials be written at a sixth-grade reading, incorporating shorter words and sentences to ensure patient understanding.¹² We determined FK reading Ease and Grade Level scores by incorporating average sentence length and average syllables per word.

We selected 4 thematic elements to analyze within MVS based on prior literature evaluating mission statements in general medical/surgical hospitals.¹³ These 4 thematic elements were (1) equity, (2) quality care, (3) training, and (4) research. We constructed a qualitative approach to analyzing statements, building upon key words and phrases from a similar study evaluating mission statements in general hospitals (Table 1).¹³ Two extractors independently reviewed and cross-checked each statement for qualitative accuracy.

Table 1.

Approach for thematic and qualitative analysis of MVS content.

Themes	Subthemes	Coded word or phrase
Equity	Vulnerable populations	Poor, vulnerable, underserved, disparities, inequities
	All people	To all, serve all, all people, equality, population, culturally sensitive, equity, equitable, global, diverse, diversity, culturally competent, world, inclusive
	Accessibility	Access, accessible, available
	Wellness promotion and health improvement	Prevention, community health, healthier community, screening, of our community, wellness, promote wellness, promotion of health, promoting well-being, improve (the) health, improving the health
	Financial ability	Ability to pay, financial, economic status, affordable, afford
Quality care	High quality	Quality, high quality, highest quality, quality care, best care, extraordinary patient care, patient-centered, patient centric, compassionate, personalized, comprehensive, integrated, outcome, multidisciplinary
	High standard	Excellence, excellent, exceptional, exemplary, high standard, highest standard, world-class, extraordinary, outstanding, high caliber, premier
	Comparative	Best, superior, better care, provider of choice, unparalleled
	Effort	Strive, exceeding expectations
	Improving	Improve, improvement, enhancing the standard, transform
Training	Education	Education, educate, educational, teach, teaching, academic, learning
	Training and prof. development	Training, leadership, professional
Research	Research and innovation	Research, discover, innovation, innovative, novel, advancing, advance, pioneering, investigating, scholarship

Abbreviation: MVS, mission and vision statements.

Statistics

We used descriptive statistics to characterize data from MVS in NCI-designated cancer centers and their affiliated hospitals. Specifically, we performed a Wilcoxon rank-sum test to compare the composition of MVS for cancer centers vs their affiliated hospitals, including variables such as length, reading ease, and grade level of the text. In addition, we used a chi-squared test to compare the presence of the 4 key themes of interest (equity, quality care, training, and research) within MVS for cancer centers vs their affiliated hospitals. We performed statistical analysis using SPSS software.

Results

MVS availability, composition, and readability

Among NCI-designated cancer centers, 93.9% (61/65) had mission statements, compared to 100% (59/59) of affiliated hospitals. For vision statements, 63.1% (41/65) of NCI-designated cancer centers provided one, while 86.4% (51/59) of affiliated hospitals included a vision statement. The median word count for cancer center mission statements was 35.0 words, compared to 25.0 words for affiliated hospitals (P = .019). Vision statements were shorter, with a median value of 24.0 words for cancer centers and 17.0 words for affiliated hospitals (P = .046). The median time required to read cancer center mission statements was 8.75 seconds, while hospital mission statements median time was 6.25 seconds (P = .019). For vision statements, cancer center statements required 6.00 seconds to read, whereas hospital vision statements were shorter at 4.25 seconds to read (P = .046).

MVS reading ease and grade level

Cancer center mission statements had a significantly higher median FK reading grade level of 16.6 (postgraduate), as compared to hospital mission statements, which had a median FK reading grade level of 12.8 (college) (P < .001) (Table 2). Cancer center vision statements were at a grade level of 13.3 (college), and hospital vision statements similarly had a reading grade level of 13.2 (college) (P = .777). Cancer center mission statements were significantly more difficult to read, with an FK reading ease of 15.4 in comparison to hospital mission statements with an FK reading ease score of 35.6 (P = .001). However, cancer centers and hospitals were comparable in the reading ease of their vision statements (30.5 vs 36.4, P = .944).

Table 2.

Word count and readability of MVS across NCI-designated cancer centers and their affiliated hospitals.

	Cancer center missions	Hospital missions	P value	Cancer center visions	Hospital visions	P value
Word count (median)	35.0	25.0	.019	24.0	17.0	.046
Time to read (s) (median)	8.75	6.25	.019	6.00	4.25	.046
FK grade level (median)	16.6	12.8	<.001	13.3	13.2	.777
FK reading ease (median)	15.4	35.6	.001	30.5	36.4	.944

Abbreviations: FK, Flesch–Kincaid; MVS, mission and vision statements (MVS); NCI, National Cancer Institute.

Thematic content

We evaluated mission statements to determine the presence of 4 themes (equity, quality of care, training, and research). Cancer center mission statements mentioned the theme of equity in 60.7% of statements, while hospital mission statements mentioned equity in 47.5% of statements (P = .15) (Figure 1). Cancer center mission statements mentioned quality of care in 68.9% of statements, and hospital mission statements mentioned quality of care in 57.6% of statements (P = .20). Cancer center mission statements mentioned training 55.7% of the time, a significantly lower frequency compared to 79.7% in hospital mission statements (P = .005). Cancer centers and their affiliated hospitals consistently referenced research, with 78.7% of cancer center mission statements and 76.3% of hospital mission statements mentioning this theme (P = .75).

Figure 1.

Mission statement themes communicated by NCI-designated cancer centers and their affiliated hospitals. NCI, National Cancer Institute.

As for vision statements, cancer centers included topics related to equity in 58.5% of their statements, while hospitals included them in 47.1% of statements (P = .27) (Figure 2). Cancer center vision statements mentioned quality of care in 41.5% of statements, and hospital vision statements mentioned quality of care in 41.2% of cases (P = .98). Cancer centers mentioned training in just 17.1% of their vision statements, while hospitals included training 41.2% of the time (P = .013). Cancer center vision statements mentioned research in 56.1% of cases, while hospital vision statements included research in 47.1% of cases (P = .39).

Figure 2.

Vision statement themes communicated by NCI-designated cancer centers and their affiliated hospitals. NCI, National Cancer Institute.

Discussion

In this descriptive study, we conducted the first large-scale analysis of MVS among NCI-designated cancer centers and their affiliated hospitals. We demonstrated that MVS of NCI-designated cancer centers and their affiliated hospitals are generally complex to understand, with high reading grade levels and varied thematic content. Specifically, we found that MVS are difficult to read according to the FK reading scale, with mission statements of cancer centers being considerably more challenging than their affiliated hospitals. Further, we demonstrated a lack of thematic consistency in “training” between the MVS of cancer centers and affiliated hospitals. This difference may reflect institutional messaging priorities. Cancer centers often focus on research and clinical care, while education programs are typically based at affiliated hospitals, which may explain the greater emphasis on training. However, given cancer centers’ roles in developing the oncology workforce, including training in their statements could more fully reflect the institutions’ purpose. Collectively, findings from our study highlight potential areas of improvement to help MVS communicate more effectively to the public.

Based on the FK reading ease and grade level scores, our results show that cancer center mission statements were most challenging to read and ranged several grade levels above the sixth grade recommended by health literacy guidlines.¹² The median reading grade levels across our sample suggest that MVS of NCI-designated cancer centers and their affiliated hospitals provide communication that is difficult to comprehend for the target audience. Previous work has brought attention to the survivorship webpages of NCI-designated cancer centers, highlighting that these webpages often presented information at high-grade levels (12+), with additional issues of accessibility, such as small font and low contrast color schemes.¹⁴ Our work provides compelling evidence supporting the need for improvement in institutional MVS to enhance accessibility.

Notably, the topic of research was mentioned at similarly high rates in the MVS for cancer centers and their affiliated hospitals, potentially revealing that both institution types place a relatively high valuation on the importance of research endeavors. Mission statements tended to have a greater frequency of all 4 themes (equity, quality of care, training, and research) compared to vision statements. While organizations often reference goals in broad or generalized terms, prior research in the public sector has shown that goal ambiguity can reduce clarity and contribute to lower employee satisfaction.¹⁵ Although not specific to healthcare, this suggests that vague or imprecise language in institutional statements may limit their effectiveness.¹⁵. When considering the influence of MVS on employees and patients, institutions must ensure that these statements are ethically crafted to accurately reflect the system’s current priorities and capabilities.¹⁶ By highlighting the proportions of MVS that discuss important topics, such as equity, quality of care, training, and research, our findings underscore areas for improvement while identifying current benchmarks for future work.

Mission and vision statements are one of the primary ways that health systems communicate with their patient populations and local communities. Today, many patients express distrust of hospitals and physicians, with declining confidence in historically trusted sources of health information.^17,18 While further research is needed, patients may be receiving MVS content at high rates through various channels, such as websites, television, and radio. Thus, organizations that provide effective, trustworthy, and easy-to-read messaging may help educate the public and also start to build trust and respect with patients.

This study has several limitations that merit discussion. First, we found no single definition or gold standard for defining a successful mission or vision statement. Further, differentiating mission statements vs vision statements can become challenging, as these terms may be used interchangeably in some cases. There is little evidence on whether patients read or benefit from MVS. Therefore, future work should seek to explore patient perceptions of the MVS at their cancer center. There has been little research investigating patient perspectives, including whether patients read or actually benefit from MVS. Surveys of patients, caregivers, and hospital staff could assess internal trust of MVS within a care center and gauge alignment with institutional values. These efforts could also provide a clearer view as to what makes for effective MVS from a patient perspective. Randomized communication trials could also be used to determine whether MVS influence patient engagement or satisfaction. While we acknowledge the difficulties inherent to isolating the effects of MVS on patient outcomes, these approaches may provide valuable insight on institutional messaging. In addition, FK scores do not consider the exact content or vocabulary of the text. We did not extract the information listed under “values,” which was occasionally provided by institutions and may have included additional information about the organizations’ goals and values. Finally, we collected all available data via institutions’ websites, and thus our data set excludes unpublished, or not posted MVS.

Conclusion

Our study provides novel insights into the current state of NCI-designated cancer centers’ MVS, with comparative data for their affiliated health systems. Specifically, we found that the mission statements of NCI-designated cancer centers were longer and more difficult to read than those of their affiliated hospitals. Cancer centers and their affiliated hospitals utilized MVS that exceed recommended reading grade levels, potentially limiting their accessibility to the target audience. Notably, the affiliated hospitals emphasized training at a significantly higher frequency. These findings underscore opportunities to enhance the content, clarity, and inclusivity of MVS, leading to improved engagement and more effective communication with the public.

Author contributions

Max J. Bouvette (Conceptualization, Data curation, Investigation, Methodology, Visualization, Writing—original draft, Writing—review & editing), Randall Dewees (Writing—original draft, Writing—review & editing), David Seo (Writing—original draft, Writing—review & editing), Jiazhang Xing (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Software, Writing—original draft, Writing—review & editing), Vanessa A. Moore (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing—original draft, Writing—review & editing), Anh B. Lam (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing—original draft, Writing—review & editing), Changchuan Jiang (Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing—original draft, Writing—review & editing), Nirmal Choradia (Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing—original draft, Writing—review & editing), and Ryan D. Nipp (Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing—original draft, Writing—review & editing)

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

None declared.

Data availability

This study utilized publicly available, de-identified data from the public websites. Specific extracted variables are described within the text. Datasets may be made available upon reasonable request.

Ethics statement

This study was not submitted for IRB review due to its sole use of publicly available, de-identified data that did not meet criteria of human subject research.