Chapter 11: The McChrystal Group, the Rolling Operational Priorities (2015, and Observations on Strategic Planning
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Description
In this chapter, Dr. Tweardy sketches the institution’s work with the McChrystal Group to develop the “rolling operational priorities” to organize the stabilization efforts. He sketches the process of working with the McChrystal Group and the two major outcomes: a decision-making process leading to Shared Governance Committee approval and the organization of work groups that addressed different institutional issues (the ROPRs). Dr. Tweardy notes that he was in charge of the ROPR3, which focused on education. He describes how each work group’s activities were organized to identify priorities to address.
Next, Dr. Tweardy talks about the value of this system and notes that when the relationship with McChrystal ended, the institution was very functional in decision making. He explains that the ROPR system was built on the “pyramid” structure of strategic planning and, in turn, laid the foundation on which the current strategic planning process (under Peter Pisters, MD) is built.
Identifier
TweardyDJ_03_20190418_C11
Publication Date
4-18-2019
City
Houston, Texas
Interview Session
David J. Tweardy, MD, Oral History Interview, April 18, 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; Institutional Politics; Controversy; Critical Perspectives on MD Anderson; Understanding the Institution
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:
So tell me about kind of the next phase, working with the McChrystal Group and ROPR [Rolling Operational Priorities Review], which created these big fora for people to get together and start talking about what was happening. So give me your insight into that.
David Tweardy, MD:
Well, I think that McChrystal Group allowed for an outside entity to come in, evaluate what was going on, pretty much as they tried to in that one-year engagement throughout the institution in terms of how the decisions were made. I think their focus really was around decision-making.
Tacey. A. Rosolowski, PhD:
And that was 2015, correct, that they came?
David Tweardy, MD:
Yeah, as they began, yeah. And they were, in part—I think that’s one of the major contributions that Marshall [Hicks; hhh] had to the organizational transition was he was the one that tuned us into the McChrystal Group. They went through an open bidding process. There was an RFA sent out to determine what one of these leadership consulting groups would engage with MD Anderson to help us move forward, and they made the bid. They had a little bit of an inside track, because we’d already brought them in as a consultant—or I shouldn’t say “we.” I think at that point Marshall and Steve, as the leaders of the Chairmen of the Division Heads Committee, brought them in to start to get a discussion going, and just to see what an initial take would be. And then, when the RFA went out they won the RFA. Then they became fully engaged for a year or so contract. And, again, their focus—because I think one of McChrystal’s claims to fame was how he deconstructed and reconstructed the decision-making process within the special operations in Iraq and Afghanistan, and he moved it totally from a centralized process to a local. And that concept of decentralization of leadership really resonated with many people here, as you might imagine.
Tacey. A. Rosolowski, PhD:
Yeah, in that historical context, absolutely.
David Tweardy, MD:
In that context, exactly. And so they brought in—and that was what they … We all went over, or up to, Alexandria, their headquarters in Alexandria, Virginia. We had a day retreat, and they walked us through an exercise that was—they essentially … Their headquarters has got a large room which is built essentially like central command in a military operation. And they walked us through exercises to, in a way, not train us, because it was too short a time to truly train, but at least to give us an idea of how he, in his reconstruction of the division decision-making process in the military, in that field of battle, how he basically reconstructed decision making. And so it was a very helpful exercise. I think we then, essentially … That was the beginning of the engagement, or maybe a month or two into the engagement, and then we essentially came here. They came here, and stayed on campus for a year, to investigate or observe all of the committees and other decision-making bodies within the organization: how they proceed to make decisions, and basically made recommendations of how that could be improved. And there were two major work products that came from that. One was a presentation around the decision document. It was like a format of how you walk through decision making in terms of what are the issues, what information do you have, who are the stakeholders, what’s your timing for the decision, what input do you need beyond what you have so far, and then what are the options. And after this has all gone through the presentation, where it would go to a decision-making body, would then be given options, one, two, and three: these are the options; these are the upsides; these are the downsides. Then the decision-making body—this is where most of this sort of rollout was, at this time, at the SGC, the Shared Governance Committee—would then vote and advise the president from the point of view, in their minds, as the SGC, what would they recommend to the president. This, again, is already … At this point in time I think Ron [DePinho; oral history interview] is still in place, and the COO, Steve, was still in place. And so we began to exercise this model of decision making within the SGC.
Tacey. A. Rosolowski, PhD:
Interesting. Okay.
David Tweardy, MD:
Yeah. Then the other major work product was a cadence around decision making, which is … So, first of all, what are you going to make—what do you want to make decisions about? And once you determine that there are four or five or six—and it turned out to be seven—areas that you want to be making decisions about, how do you decide what are the important decisions in those spaces? How do you decide, or how to operationalize the decision-making process within that space? So it turned out that this was the beginning of their operational priorities. There were seven. Education was number three. That was the one I was in charge of. And by being in charge, there was … So the operational priorities, and the rolling operational priorities review became the mechanism of decision-making and decision implementation. Now, the actual—the third concept that was critically important, and sort of a theme that drove through that process was the concept of dyads. Every leader … Every ROPR, every operational priorities group, was led by two sets of dyads, which was—at the highest level, these were like—there was a sponsoring dyad. I was the academic sponsoring dyad of the educational priority, and the administrative one started out being Steve Hahn, and then he just became too busy, as you might imagine. He stepped down and Marshall [Hicks; oral history interview] stepped in as he stepped down as the President, interim President. And then there was a true working dyad. These are the ones that actually did more of the work. A sponsoring dyad did an oversight of the processes that were ongoing in that operational priority, but the working dyad was a faculty leader and an administrative leader in that space. So the faculty leader was Diane Bodurka. The administrative leader was [Robert] Tillman.
Tacey. A. Rosolowski, PhD:
Bob Tillman.
David Tweardy, MD:
Bob Tillman. And for education. And so then they brought a committee of people together, interested people in education. I’m just giving the way the process worked for the OP3, which is the educational. They identified issues, and then prioritized those issues, and then ran them through a committee of sponsors for prioritization and authorization to move forward. The moving forward occurred in three steps. Plan it—okay, that sounds like an important issue, please go ahead and plan it. Secondly, then, budget it out; and then, thirdly, approval. And it was a really --really an exercise to do across these seven, original seven operational priorities: how do we decide—first of all, how do we decide what are the areas we need to really begin to think about in a more systematic way operationally, what are the problems and issues we should address in that area, and then how do we actually make decisions around those suggestions that were made at the grassroots? Which is a wonderful thing about it: we really got ideas from a whole group of stakeholders which heretofore had not really been engaged in making decisions in the institution. Then they were prioritized and then implemented. And, in fact, the beautiful thing was it went all the way through implementation, and some of the operational priorities actually were deactivated because they had done their job, or they had done what they could do. Like in education, they’d done a couple things and done the rest of the educational priority entity and existing decision making would roll into the new strategic plan, because we’re now about to begin. So it was, for me, at least, who --I am very process-driven. I don’t like to not finish what I start, because I don’t like to waste time. But to have something be as, I think, well-structured, in terms of—and go from start to finish, was really very edifying. And I think it was edifying not only for me but many others in this institution, who felt that … And I know Steve Swisher would say this a number of times: is that we’re really good at planning here, but we’re not good at doing. And this was a nice example of how we can change that thinking. We could actually not only plan and decide what we wanted to do, but we could execute. We could actually complete it, and then we could decommission it, too. And that was … Because the other thing about this institution that is well known to many is that once something gets started, it may not do much, but it never dies. It never gets decommissioned. It just continues to exist, because it—for unclear reasons. So that was, I think, a great exercise, and that really came out of the McChrystal engagement. So when they left—I think it was actually extended, maybe, for another six months—18 months later, I think we had in place a very functional means through which we would make decisions in important areas of our mission, implement them, and decide whether or not we could then decommission the group that made those decisions. So that was —and I that’s, I think, the foundation on top of which the new strategic plan will build. Because people sort of … I’m a little more optimistic in my assessments than many people, but I think that that pyramid plan was actually beneficial. I can point to one major benefit, which was the report on the chairs, on how to restructure the chairs, the fact that it led to the Community of Chairs, and led to a—laid the groundwork for the McChrystal Group to come in and even be more methodical in implementing a means of actual change creation that actually gets—the institution actually participates in and follows through on. So I view that McChrystal engagement as critically important in leading to ROPR, and I’m really very interested in how the strategic plan will then come together and build on what we now have as a very effective, I think, existing ROPR structure.
Tacey. A. Rosolowski, PhD:
Well, let me ask you, because you alluded to the fact that the pyramid plan was controversial, maybe you could talk a little bit about that, and also alternative views of McChrystal, because I doubt very much that everybody was a hundred percent (laughs) behind that.
David Tweardy, MD:
You know, it’s interesting: I would say in terms of the first one, I think because my engagement—because it was already in place before I came, I came into the learning mode, not in the planning mode, of that strategic plan. I had been involved in strategic plans at multiple institutions, so I was more interested in learning and seeing what I could do to move that process forward. I didn’t think that because of its … I mean, it was a very broadly-based. There were lots of participants—it had 130 to 160 committees that actually—
Tacey. A. Rosolowski, PhD:
This was the pyramid plan?
David Tweardy, MD:
Yep.
Tacey. A. Rosolowski, PhD:
Oh my heavens.
David Tweardy, MD:
Yeah. It was a massive, massive sort of undertaking. I think the reason it failed, in some respects, is there wasn’t the follow-through that the ROPR implementation had. I think that’s why I feel many people felt, that the implementation of a plan that actually saw things through to completion was a welcome change for the ROPR, and what the ROPR sort of systems (overlapping dialogue; inaudible).
Tacey. A. Rosolowski, PhD:
Well, that’s kind of the classic problem with leadership: oh, it’s top down, it’s just an activity for leadership to say they’re doing something, but nothing’s ever going to happen on the ground.
David Tweardy, MD:
That’s right. And that’s the disconnect that was in existence when the pyramid strategic plan moved forward. I have to say that’s what I saw --it happened with it, except for one clear exception of very useful work product. It just seemed to wither on the vine, never seemed to kind of come to full fruition. And necessitated what actually turns out to be two additional strategic plans, if you—that was the one that happened before I came. Ron initiated a strategic planning effort about a year after I got here that also kind of didn’t have much in the way of sustainability, or was not sustained. And then the third was the McChrystal-initiated strategic plan, which I think of more as operational than truly strategic, but very important. I think that is, in my view, the first strategic … The pyramid might have been successful. I don’t know that I would say it was hugely successful. It certainly had some useful work products from it, like, as I mentioned, the Community of Chairs suggestion, and the reevaluation of the role of the chair. I think the Ron DePinho-initiated strategic plan, I don’t think that I could say that much useful came out of that. The McChrystal, yes, because of the ROPR, and I’m very optimistic that this next strategic plan will be successful, because I think it’s going to—I like the way it’s being developed. I like the setting in which it’s occurring, meaning where we are as an institution. And I think that the … I’m really optimistic that it’s going to come up with some very important work products that we’ll be able to take forward and use to great effect.
Tacey. A. Rosolowski, PhD:
And just for the record, I want to say that what you’re referring to as the new strategic plan is the process that’s based on Lafley-Martin’s Play to Win.
David Tweardy, MD:
That’s correct. That’s correct.
Tacey. A. Rosolowski, PhD:
Yeah, just to contextualize. Yeah, I mean, that’s … I also just really want to observe that I can tell that your intrigue with these sorts of processes fits very well with the kind of flow chart brain you bring to molecular processes and—(laughs)
David Tweardy, MD:
Yeah, I think that’s true. It’s that analytical, biochemical (overlapping dialogue; inaudible)—
Tacey. A. Rosolowski, PhD:
Yeah, all of that. You kind of see it. You see it.
David Tweardy, MD:
—pathway. Yeah, yeah, exactly, the pathway orientation.
Tacey. A. Rosolowski, PhD:
Stretching forward—
David Tweardy, MD:
Yeah, I agree.
Tacey. A. Rosolowski, PhD:
Well, it’s transferring your abilities from one area to another.
David Tweardy, MD:
Yeah. Well, if it works in one setting it might work in another one. It doesn’t always work that way, but I think so far I’ve been (overlapping dialogue; inaudible)—
Tacey. A. Rosolowski, PhD:
Yeah, but you use the tools you got, right? (laughter)
David Tweardy, MD:
Exactly, that’s right. Why invent a new tool if the old tool will work?
Recommended Citation
Tweardy, David J. MD and Rosolowski, Tacey A. PhD, "Chapter 11: The McChrystal Group, the Rolling Operational Priorities (2015, and Observations on Strategic Planning" (2019). Interview Chapters. 1393.
https://openworks.mdanderson.org/mchv_interviewchapters/1393
Conditions Governing Access
Open
