Chapter 12: Executive Teamwork and a Long-Range Vision for the Institution

Chapter 12: Executive Teamwork and a Long-Range Vision for the Institution

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Description

Dr. DuBois begins this session by observing that the evolution of his leadership at MD Anderson was tied to the close working relationship of the executive team, who may have had differences at times, but who all agreed on where the institution should be headed. As an example, Dr. DuBois talks about the economic crisis of 2008/09. He talks about the very rapid and measured response of the executive team and the success of averting a serious institutional crisis. In addition to the reduction in workforce, Dr. DuBois notes that clinicians were asked to see one additional patient per session. He explains that there was general agreement that the long-term vision of the institution focused on keeping patient care first and talks about what is involved in keeping the institution abreast of the highest standards of care, including recruiting the best faculty.

Identifier

DuBoisR_02_20181114_C12

Publication Date

11-14-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Collaborations; MD Anderson Culture; Institutional Mission and Values; The MD Anderson Brand, Reputation; The Business of MD Anderson; The Institution and Finances; Professional Values, Ethics, Purpose; Ethics

Transcript

Tacey A. Rosolowski, PhD:

During this time, was there a moment when you said to yourself, I’ve learned something being here, you know going through this process of taking on this new role? How were you evolving as a leader during this time?

Raymond DuBois, MD, PhD:

That’s a good question. I don’t think I had a specific ah-ha moment that I suddenly realized. It sort of evolved over time. But it did become apparent to me that this executive leadership team was really important and really hammering out and discussing the issues and what the plans were, before we made a decision, and then seeing what the ultimate final decision was, made that decision a lot more effective and likely to succeed. There was a team dynamic there and the positive thing about it was that we all generally agreed on where we wanted the institution to go. We did differ in some of the ways to get there and what things needed to be done, but whenever we got together, and we did get together on a regular basis and we all got to say what we wanted to say, and then ultimately decide on which direction we were going to take. I felt like that decision included all of our collective input and was probably in the best interests of the institution. I can remember when we were in that 2008, 2009 economic downturn, you know that had not happened in quite a long time, so Dr. Mendelsohn was really concerned about laying off employees. He just didn’t want to overreact to whatever those issues were, but in retrospect, we definitely came to the right decision, because if we had not decreased our personnel costs, we would have had a very difficult time managing our finances. At first, I was wondering, is that the right thing to do, and nobody really knows the future so you just have to react and do the best you can. But we had several discussions with Dr. Mendelsohn and ultimately, I think he saw that the potential downside was big and we didn’t want to get into a financial difficulty there, and it turned out to be the right decision.

Tacey A. Rosolowski, PhD:

So Leon Leach and Tom Burke and you were reluctantly in favor of it?

Raymond DuBois, MD, PhD:

Yeah, I was in favor of it but you know, we were reacting to something that happened fairly suddenly.

Tacey A. Rosolowski, PhD:

Right.

Raymond DuBois, MD, PhD:

I don’t know if you remember, but there was just a matter of days where everything went down the tubes on that economic downturn, I mean the government was trying to shore up all these financial agencies and stuff like that, financial institutions. We reacted fairly quickly, which for a state institution, sometimes decisions aren’t made that quickly.

Tacey A. Rosolowski, PhD:

So this came down to the team having long and immediate meetings.

Raymond DuBois, MD, PhD:

Yeah we, as soon as this all came out in the news, we made a list of things where we could reduce our expenses, and some of those are obvious, like travel is the big expense but it’s easy to regulate, and we just cut it. We made essential and nonessential travel and you know, any kind of expenses that required food or things like that, at meetings, we cut that down quite a bit. We also instituted this situation where we expected our clinicians to see one extra patient per session than what they usually did, just so that we can make sure our revenue stream stayed up, and believe it or not, that’s such a big number of clinicians that it makes a huge difference in the financial performance, and they all did that. I think people were really concerned about the adverse financial impact, and so they worked harder, and doing it collectively as a whole group of clinicians, really it made an impact on our revenue. And then decreasing expenses from those personnel costs really helped a lot and overall, we ended up, I remember distinctly that year, we had a significant margin. I can’t remember how much it was but it was over $100 million, so all of those decisions were right on target.

Tacey A. Rosolowski, PhD:

Now you provided that as an example of the value of this team dynamic, and you had talked about that as something that you were learning about yourself. I mean was that kind of learning you’re a team person? I just want to make sure I understand what was your lesson from all of that.

Raymond DuBois, MD, PhD:

Each of us represent a very important part of the institution and it’s our duty to stand up for that part of the institution. So, I was over all the academic components and clearly, I felt part of my responsibility was to make sure that we continued to do all the things that fulfill our mission, but as an institution, there were these overarching concerns about you know, did we want to have a financial collapse or whatever, and so we had to make concessions in order to make sure that it was for the good of the institution, and that team was able to do that.

Tacey A. Rosolowski, PhD:

That’s interesting, yeah, yeah, that’s a very important value, and maybe it takes a crisis to show that sometimes.

Raymond DuBois, MD, PhD:

Yeah, and I think our layoffs weren’t as bad as some of the finance team thought they were going to be, because there was some give and take there in terms of how deep those layoffs were, and so I think having a team that has different inputs but willing to concede on certain things for the good of the institution is really important. So that was a life lesson, I think.

Tacey A. Rosolowski, PhD:

Now you mentioned, you know one of the strengths of this team is that there was a shared long-term vision of what the institution would be and what it could achieve. What was that?

Raymond DuBois, MD, PhD:

Well, I think everybody agreed with the number one priority of patients come first, so that was the top priority for all of us, and clearly research is a part of that, because it finds new treatments and new ways to diagnose cancer and make the outcome better for the patient, but getting the patient an appointment and making sure they got a diagnostic workup and a treatment plan formulated, and post-treatment care obviously was key. So we didn’t want to lose any of our staff or physicians that were involved in those frontline duties and we wanted to make sure those stayed as efficient as possible. We all bought into that, I think that was common, and even people in accounting and the hardcore finances really bought into the patients coming first.

Tacey A. Rosolowski, PhD:

And you know the shared vision, I mean aside from the economic downturn, what was that kind of shared dream of what you were all working for?

Raymond DuBois, MD, PhD:

Well, we certainly wanted to maintain the highest standard of care that we could possibly maintain, but also be involved in determining what the next most effective treatments were. That was very important to everybody, for us to have a role in that whole research process and coming up with new ways, more effective ways to treat cancer patients.

Tacey A. Rosolowski, PhD:

Was there conversation about rankings and practical things? I know it sounds gritty and dreadful, but you know it’s a factor.

Raymond DuBois, MD, PhD:

Rankings were very important, especially to our board and our donors. I don’t know how it’s done today, but we actually had an individual assigned to look at all the parameters that went into the ranking process and examined those carefully, and looked at what we were doing as an institution and make sure that those things aligned and that the information we were providing to the ranking bodies was correct and really reflected what was going on there. Then, there are a few things that we tried to shore up to improve our reputational score. We offered a lot of CME courses to people all over the country, in terms of what the latest cancer cure was, and that really helped them see what we were doing, because those individuals in the specialty are ranking all the institutions, and so the more they know about the great things that are going on, the more likely it is they’re going to give you a higher ranking, and so we were constantly aware of that and engaged in that. It’s a very competitive thing, because Memorial Sloan-Kettering also tries to be ranked number one, and so we didn’t want to lose the number one ranking and at least during my time there, we were number one in U.S. News and World Report every year. It was something that we were very conscious about and we wanted to maintain that and we didn’t want to lose any ground there. So every quarter, we would get a report from—Tom Feeley was the person that was in charge of that and he took that very seriously. He was head of the Anesthesia Division and he really, I think taught us what they were looking at, what we needed to do to make sure that everything was hunky-dory and how we could ensure that we continued in those high rankings.

Tacey A. Rosolowski, PhD:

Now when you came on in 2007—I’m going to sort of do a compare and contrast, because I’m thinking about the issue of ranking and reputation with recruiting. Did you see a change or were you aware of some problems with recruiting because of coming to Texas, coming to MD Anderson, all of those issues?

Raymond DuBois, MD, PhD:

I think MD Anderson has always had a very high reputation and it’s always been prestigious. I think there were some concerns about the overall quality of the science from top to bottom at the institution, so we were very aware of those potential concerns. We wanted to make sure the standards were as high as possible and that we got the best scientists onboard as we could, and so I did examine carefully, every recruit that we made, just to make sure they fulfilled some minimal criteria for the standard, and I think that did help, over my tenure, to increase the quality of some of the faculty that we recruited, but there was a lot of faculty there and they’ve been there for a long time. People love staying at the institution, so it’s not easy to turn that around overnight, because it’s a sizeable group and they’re very loyal to the institution so they want to stay there. Some people were nervous about moving to Houston, especially from places like Boston and San Francisco. There are some weather concerns and it’s a very big urban city, not a lot of green space. So there were some people that were harder to recruit than others, and we have to keep our eye on that. I think having the CPRIT recruitment packages that came along with it really helped to overcome that somewhat.

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Chapter 12: Executive Teamwork and a Long-Range Vision for the Institution

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