Chapter 09: Stepping in to an Institution Undergoing Change
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Description
In this chapter, Dr. Tweardy begins to share his impressions of the period of turbulence MD Anderson was experiencing in 2012, 2013, after Ronald DePinho [oral history interview] became president. He begins by recalling what he heard about the institution while he was still at the Baylor College of Medicine and explains why he didn’t allow the stories to influence his view of MD Anderson. He talks about his respect for Dr. DePinho then explains how his view of the situation at MD Anderson shifted once he became division head and he saw problems with morale and other issues.
Next, Dr. Tweardy comments on the “three factors” that turned the situation around: Dr. Steven Hahn’s appointment as Chief Operating Officer; the impact of the Faculty Senate and the work of Julie Izzo, MD and Ann Killary, PhD; Marshall Hick’s [oral history interview] role as interim president and the shared governance model he helped institute. He also talks about the impact of the McChrystal Group and the creation of the ROPR system for tracking institutional performance and change.
Identifier
TweardyDJ_02_20190320_C09
Publication Date
3-20-2019
City
Houston, Texas
Interview Session
David J. Tweardy, MD, Oral History Interview, March 20, 2019
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Growth and/or Change; MD Anderson Culture; Portraits; Institutional Politics; Controversy; Research; Critical Perspectives on MD Anderson; Understanding the Institution; On Research and Researchers
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey. A. Rosolowski, PhD:
Now, let me just interrupt this piece of the narrative at this moment, because the one thing we haven’t mentioned—you came in in 2014, and, of course, Ron DePinho started in 2011, but by the time you’re coming in the honeymoon was very much over with Ron DePinho.
David Tweardy, MD:
Yes, the second survey, second and first survey was done. McChrystal—not McChrystal, but the former Chancellor—McCraven—had come and visited at the request of the Senate, the Executive Council, the Faculty Senate. The white paper was—he charged them with the white paper. The white paper was written. And—
Tacey. A. Rosolowski, PhD:
I mean, let me just ask, because when you were looking at this position you knew. I mean, stuff was in the news.
David Tweardy, MD:
Oh, that’s—okay, that’s right.
Tacey. A. Rosolowski, PhD:
I mean, so that had to be part of what you knew you were walking into.
David Tweardy, MD:
Good point.
Tacey. A. Rosolowski, PhD:
So just set that scene a little bit.
David Tweardy, MD:
Very good.
Tacey. A. Rosolowski, PhD:
And understand why I’m saying this: because this is really what MD Anderson is dealing with right now. I mean, it’s the transition, that transition that you are helping to manage right now with the leaders in place now was fostered by all of this stuff that began happening in 2011, so—
David Tweardy, MD:
That’s right. Very important point, and I kind of—you’re right, I skipped over that, and not intentionally. It was because—
Tacey. A. Rosolowski, PhD:
No, that’s okay. That’s why I’m here. (laughs)
David Tweardy, MD:
Right, there you go. To keep me on track. Well, you’re absolutely right. The thing that was resonating over at Baylor in the papers was—the one that sort of impacted us the most was the CPRIT shutdown based on a grant that didn’t get full oversight, that, in fact, Lynda Chin was the PI of. And actually rumors were circulating, or stories were circulating, around Lynda Chin’s management style. And then, of course, socially, well, that was Ron’ … Actually, there’s just disgruntlement of MD Anderson faculty that was attached to Ron and Lynda. And the part of the—I told you part of the story when I circulated around looking at the job. I said, fine, we have our own problems. We had Peter Traber at Baylor, and he was kind of an interesting character. And so not all leaders are perfect. And so perhaps that was an important experience I had. I mean, Peter basically—his actions led to the divorce of Methodist. He wanted to head up his own hospital. He did not want to re-sign the hospital agreement with Methodist. They were equally intransigent, and so the split happened. And, frankly, at the time, maybe because I’m a glass-half-full person, I thought, oh, this is great. We can really recapture our own destiny. Because Methodist was the academic DeBakey hospital at the time, early on, when it was first—Baylor College of Medicine moved from Dallas, they were our major [adult?] affiliate. And what you saw was that decline and separate; and, at the same time --as I mentioned to you about Texas Children’s being affiliated with pediatrics-- pediatrics’ prominence rising, medicine’s prominence, surgery’s prominence diminishing, relatively speaking. And I actually thought having your own hospital would kind of get us back to a better arrangement with an academic medical center. No, well, that was before 2008, and then 2008 happened and the building is still unfilled down the street.
Tacey. A. Rosolowski, PhD:
Wow. So you—
David Tweardy, MD:
But so I understood leadership has its upsides and downsides. And so Ron’s—I understood Ron came here and was a disruptive force, but I actually, because I was mostly a basic scientist, I thought it was a positive thing, because my evaluation of MD Anderson’s scientific acumen and impact was that, gee, they should be getting more bang for their buck. I mean, let’s face it. I mean, there’s just—and their scientists that I got to know were not as impressive as Baylor scientists. I mean, if you put them side by side, Baylor was kicking MD Anderson’s butt scientifically, and it was doing it with reducing resources, and it’s still doing that, actually, frankly. So I thought Ron was doing something that needed to be done to get the scientific bang for his buck, or for the institution’s buck, that MD Anderson should be getting. And I knew how that creates disgruntlement. I was at Pittsburgh when this same transition occurred, where they were changing the guard, and they were moving unproductive faculty out the door, bringing in young, aggressive people. So it didn’t seem to me different, really, than the transition I’d seen when I first arrived in Pittsburgh in ’87. So I—and Ron, frankly, was inspirational. He was visionary. In fact, when I was—I think it was right before I took the job—Ron gave a presentation at this nano-medicine symposium at Methodist, and it was the most impressive talk I think I’d ever heard in healthcare. It was molecular to healthcare systems, and I’d never seen anybody do that with that bandwidth—
Tacey. A. Rosolowski, PhD:
He’s a very gifted communicator when he has to be charismatic. Very gifted.
Tacey. A. Rosolowski, PhD:
Yes. And so, boy, I said—I thought it was just, okay, disgruntled faculty who wished life was like it was and wasn’t like it is. And so Ron DePinho, I only had admiration for him, and I—so it was really kind of a nonissue until I got here. Then I realized the depths of the disgruntlement. And frankly, though, in the end, even now, I don’t fully get it. I really—I only have the highest regard for Ron. He hired me. I jokingly tell him he had the intelligence to hire me, (laughter) so that puts you in a certain high rank. And I think that when I learned … And the other thing about this is there are only a few people who really know the details, right? And I would say as I got to know—and I haven’t—as I got to know the details, I might think differently, but because the confidential nature of some of the information around what Ron did, I don’t know the details, and, frankly, I don’t really necessarily want to know the details. So maybe this is probably—summarizes and says Ron was not a problem for me. I understood he was a problem for many people in the institution, and to that degree I had to sort of incorporate that into my thinking about this was part of, now, the culture of the place. I got to know Julie Izzo very well, it turns out, because one of the things Julie Izzo did is she was, at that time, the President of the Executive Council, the Faculty Senate. We began to build bridges between the Division Head community and the ECMS, and those bridges were largely built by the new faculty, Steve Hahn and myself and Steve Swisher and Patrick Hwu. We were the ones who attended these kind of offline ECFMS division head meetings that we would have once a month. And it was through those meetings that I understood, I got a better understanding of the cultural impact and disruptive impact Ron had on leaders in the Faculty Senate, and I became more sympathetic in the sense that I understood the impact. And they knew, particularly Julie knew, a lot of the backstories that she was, rightfully, not willing to share; or I didn’t even—I didn’t ask her to share, because, again, I’m not one to really necessarily want to know information that—maybe I’m just a little bit opt—I don’t know. I’d like to think the best of people, maybe is what it is. I don’t engage in hearing stories that, without hearing the full story, will only give me a negative impression, if I can’t back it up. And when I was Chief Medical Resident I learned one of the most important lessons, I think, of administration from my boss at that time, the Chair of Medicine, from Chuck Carpenter. And there was a disruptive episode that led to shouting, and, I think, bad care in the end. And so it turns out it was the day after that we had a routine meeting, and he asked me, “Well, David, what do you know about this?” And I said, “Well, this is what I heard.” And Chuck said, “I don’t want to know what you heard. I only want to know what you know, and what people who were there told you.” Because he was very mindful, and I think I’ve learned that ever since, is that it’s that old telephone circle. That by the time it got to you, who knows how much of that information was actually accurate, versus being distorted by the perceptions and the emotions and psychological makeup of the person who’s recounting the story. So I tend not to want to hear stories that have been distilled, or—because I’m always uncertain about their veracity, so—
Tacey. A. Rosolowski, PhD:
I can understand that, certainly, but I think probably what you began to appreciate is that, I mean, the morale had been very much impacted.
David Tweardy, MD:
Oh, that’s right. So irrespective of the—
Tacey. A. Rosolowski, PhD:
I mean, whatever other people were doing—(laughs)
David Tweardy, MD:
Right, that’s right. Irrespective of the accuracy of whatever, there was a morale problem, and, frankly, that’s where I picked it up. I mean, why there was a morale problem was important in terms of what was the perception. The perception was very important, and the perception was bad, and it needed to be—and the consequences of that bad perception needed to be rectified. There had to be more transparency. There had to be more openness, more—and I was all for that. And so the process that then ensued, which is … The fact is that Ron was asked to bring up a COO. Steve Hahn was asked to do that. I think the division head community felt very supportive of that, because by the time—this is almost maybe a year and a half into Steve’s position here, he had established himself as a very emotionally stable, intelligent, and just bright, articulate, engaging, energetic individual who really, really let everybody have their say whenever—and was very respectful of everybody. I think he had a great way about him. And so when he was moved into the COO position, I think that was certainly—many of the division heads felt that they had now a voice at a higher level. I felt we had just a very effective communicator, and a very emotionally stable guy in a position of great importance during this transition.
Tacey. A. Rosolowski, PhD:
Since we’re talking about morale, were there some ways in which you addressed it inside the Division of Internal Medicine?
David Tweardy, MD:
Yeah.
Tacey. A. Rosolowski, PhD:
Or, I mean, was it a factor for you?
David Tweardy, MD:
Yeah, I think it was, and the first thing I think I didn’t do --which was, I think, smart and it was a little bit against my initial instincts—was to discredit the Executive Council, the Faculty Senate, the Faculty Senate in general. There was a large fraction of the division that just thought they were a bit on the fringe, but I, relatively early on, once I got to know Julie and got to know the issues around the ECFS and the sources of their discontent --and the sources of the white paper-- I realized relatively early that this is not a group you can discount and ignore, because they were obviously—they were reaching levels in the system, and getting a voice, and getting heard in a way that made you want to realize you have to incorporate them. You had—
Tacey. A. Rosolowski, PhD:
Well, and they were going through a process, too. I mean, there were certain voices that were very loud—
David Tweardy, MD:
Yes.
Tacey. A. Rosolowski, PhD:
—in Faculty Senate early on but that transitioned over time and became much more effective.
David Tweardy, MD:
And I think Julie deserves a huge amount of credit. I’ve always—I’ve said that to her several times. We worked together on the SHC Committee, where we, I guess, probably got to know each other best, which was the Strategic Hiring Committee that during the Epic shortfall of resources and moneys there had to be a—there was the layoff, and then there was a post-layoff rehiring: it had to be done with a little more oversight, and SHC was put into place for six months to do that. I mean, I think Julie was critically important in that transition. I think that’s why she sits in the CMU’s office to this day, because I think she and Steve got along very well. And that dyad, if you will, was one of the elements of the success of the transition. And so the way I dealt with the morale problem within our division was—frankly, we didn’t have as much a morale issue as other departments or divisions had. I can only guess as to where they were really most problematic. But what I was very interested in doing was legitimizing the Senate here. And, in fact, I encouraged—in fact, initiated—I insisted that every month, every meeting of the Executive Council, we would rotate a report from the Senate, and making certain that their voice was being heard by the leadership in the division. It turns out we stopped doing that because each department started maintaining that practice.
Tacey. A. Rosolowski, PhD:
That’s interesting. Yeah, that’s interesting. I mean, it’s a transparency of a different sort. You talked about the financial transparency, and, yeah, that’s very—
David Tweardy, MD:
Yeah, this one was just—
Tacey. A. Rosolowski, PhD:
Cultural transparency.
David Tweardy, MD:
It was, and it was not a … I wanted to remove the “we/they” concept and say, no, we’re all MD Anderson, and those voices need to be listened to and incorporated. And, frankly, that was completely … Subsequently, it was subsequently sort of reinforced by the creation of the SGC [Shared Governance Committee, and so if I had to say what are the most important things that transitioned us successfully during these turbulent times, from the Ron DePinho era to the Peter Pisters era, it was Julie Izzo and her leadership position. I think her predecessor was also very important. He just wasn’t there as long, and he was a radiologist, and I’m forgetting his name. Ann was also—Ann Killary. But I think Julie was probably the most effective. I think she was the most articulate, and really got—and willing to kind of bridge. One thing about Julie was she wanted to fix it. She didn’t want to say, “Hey, we got this problem.” She wanted to say, “Hey, we got this problem and we’ve got to fix it, and these are the things I’m thinking about. What do you guys have to say in the division head? How can we do this?” And that’s what was critically important about her role. I think that COO position, Steve moving up to the COO, allowed for more the smoother transition, because it could have been more abrupt and more disruptive. I think Marshall [Hicks; oral history interview] stepping in as the interim president was absolutely critical. I mean, Marshall was—and I’ve told him this on a couple of occasions—he was the perfect person for that position. They couldn’t have—he couldn’t have—they couldn’t have cast somebody and gave them the qualities that that person needed better than Marshall had. I think the SGC, which was—it kind of predated that, because it was—in effect, it was there, actually as a result of the white paper. It was one of the major action plans that emerged, that was implemented out of the white paper. The SGC was critically important. It allowed for the Executive Council of Faculty Senate to have a voice, a seat at the table, and it became a very important advisory and sort of clearinghouse for many of the issues that were bothering the faculty, and particularly the Executive Council of Faculty Senate. I think the McChrystal Group, the decision that Marshall and Steve together had to let’s go and take this to a group that has insight and has experience in management and in transition, and I think the retreat we had and the strategic plan emerged out of the McChrystal Group retreat, which was … Essentially, the most immediate residual of that is the operating priorities, the OPEs. And the quarterly rolling operational priorities reviews, the ROPRs, I think, is just incredibly important for transitioning the organization, too, because it allowed for issues that did bubble up or came to the SGC and needed to be resolved—there was an ad hoc mechanism that McChrystal put into place for dealing with them. McChrystal fully implemented, and wanted to see implemented, a cadenced operational priority system, and that’s what initiated and came out to be the operational priorities and the ROPR quarterly reports. I think they resolved a huge number of issues that were plaguing the institution for a long time.
Tacey. A. Rosolowski, PhD:
Let me say just that we stop here, because we’re almost at time, and also this was a great overview, and I actually would next time like to go in and ask for some specific examples, because I think that will add some richness to the story. But this has been really, really great, so thank you.
David Tweardy, MD:
Well, no, you’re welcome. It’s always fun. This is really fun.
Tacey. A. Rosolowski, PhD:
Yeah, it is fun. (laughter)
David Tweardy, MD:
I mean, you’re one of the best listeners I’ve ever met. I really—
Tacey. A. Rosolowski, PhD:
Well, thank you.
David Tweardy, MD:
No, no. Obviously, maybe you’re a professional listener and you’ve developed skills in the area.
Tacey. A. Rosolowski, PhD:
(laughter) Yeah, a bit.
David Tweardy, MD:
But still, it’s great to talk with you.
Tacey. A. Rosolowski, PhD:
All right, great. Well, thank you. Thank you so much.
David Tweardy, MD:
You’re welcome.
Tacey. A. Rosolowski, PhD:
And I want to say for the record that I’m turning off the recorder at about two minutes of 4:00.
Recommended Citation
Tweardy, David J. MD and Rosolowski, Tacey A. PhD, "Chapter 09: Stepping in to an Institution Undergoing Change" (2019). Interview Chapters. 1391.
https://openworks.mdanderson.org/mchv_interviewchapters/1391
Conditions Governing Access
Open
