Chapter 06: On Executive Leadership Styles within the Division System
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Description
Dr. Cox talks about the varied leadership styles of people in the MD Anderson division system. Many, he said, “were considered kind of wild and crazy and off in their own world, and although they were enormously creative … they were always a little suspect.”
Identifier
CoxJD_01_20040319_C06
Publication Date
3-19-2004
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - Overview; Overview; Definitions, Explanations, Translations; Discovery, Creativity and Innovation; Discovery and Success; Professional Practice; Multi-disciplinary Approaches; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; Patients, Treatment, Survivors; Industry Partnerships
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
James D. Cox, MD
I think it’s fair to say that Dr. Balch got a lot of satisfaction out of saying what the Department of Head and Neck Surgery what did, the Department of Gynecology, and the Department of Neurology. He loved to control it. Now, it’s one thing if the division head is a facilitator and an enabler, and it’s another thing if the division head is a controller and micromanager. So on the one hand, it can be very beneficial, and on the other hand, it can get in the way. Under Dr. Balch, it got in the way.
Lesley W. Brunet, CA
How about under Dr. Krakoff?
James D. Cox, MD
It was harder to tell, because the people in the divisions and the department chairs in Cancer Medicine sort of adhered to a party line much more than the ones in Surgery. So I think in general that they felt better supported by Krakoff than the ones in Surgery. You know, of course, why Krakoff was brought in. I mean, you know. [laughs] Probably from Dr. [Emil J] Freireich you’ve heard, but—
Lesley W. Brunet, CA
You mean to get rid of Dr. Freireich?
James D. Cox, MD
No, to get rid of the Developmental Therapeutics.
Lesley W. Brunet, CA
The department. Right.
James D. Cox, MD
And that whole group as a structure and as an influence and as a frame of reference for MD Anderson around the nation—I mean—DT was well known.
Lesley W. Brunet, CA
But why did they want to destroy something that seemed so successful?
James D. Cox, MD
It was successful, but it was like— I’m trying to think of the right word. It was sort of— It will come to me after we’re finished. I’ll get just the perfect word to characterize it. But absent that word, they were considered kind of wild and crazy and off in their own world, and although they were enormously creative—many of them were enormously creative—they were always a little suspect.
Lesley W. Brunet, CA
And there were some investigations and things.
James D. Cox, MD
Yes, and there were some people who probably deserved to be suspect. [laughs] Without any names. I mean, there were some pretty wild people in that group who did some pretty wild things, in some sense very creative and in other areas maybe dangerous or risky or pushing the envelope too far. So when you looked at the other departments, if you will, of MD Anderson, which had a great deal of credibility throughout the nation, were having a big impact on— I mean, Head and Neck and GYN as two examples. General Surgery, Neurology—these were all departments that had a big influence around the country. There were not parallel influences except in DT, as near as I know, and they were always considered kind of at the fringe, creative but at the fringe. So you could view it either way. If you were a believer, you thought they were the best thing in the world. If you were a nonbeliever, you thought they were the craziest bunch of people in town. And people usually were on one side or the other. I wasn’t. In fact, I have enormous respect for most of the people, certainly all of the people in the department or that are a carryover of that, that are still creative and that have had a great influence. And I think of two. Freireich is one. Michael [J.] Keating [oral history interview] is another. They both know that I have great respect for what they do and what they’ve accomplished. But the Leukemia group has still been a little bit at the fringe in terms of some of the clinical research that they’ve done, and they’ve gotten into trouble. They’ve gotten critiqued and so on, and rightly so. But still, a lot of creativity there and a lot of— I mean, I refer my friends to them. I mean, I have great respect for what they do clinical and what they’ve done investigationally.
Lesley W. Brunet, CA
When you decided that you needed to dissolve the divisions, did you talk to LeMaistre before making that announcement?
James D. Cox, MD
Oh, yes. Oh, yes. I talked to him before. Did I talk with him immediately before I sent the memo? No. So he sort of seemed receptive to the idea. He didn’t say, “No, that’s the craziest idea I’ve ever heard of. We’ve got to have it for this, this, and this.” He never said anything like that. I was led down the path to believe— Let me step back one minute. I came in to the position of Vice President for Patient Care and Physician-in-Chief thinking it was a leadership position. It was not.
Lesley W. Brunet, CA
It was presented that way.
James D. Cox, MD
It was a manager position. So if one were to take the lead on anything, you would run up almost always against either LeMaistre or the division heads, because, one, they didn’t want it to be any different than it was. I remember sitting in LeMaistre’s office on the tenth floor over in HMB when it was still over there. This was probably six months after I was here and long before the letter about the division heads. This is a very interesting place. It’s an outstanding place, but it so resistant to change. If you suggested change, people said, “What’s wrong?” And instead of saying, “We’re good, but we can always be better,” which I think is the way people think now— I think John Mendelsohn [oral history interview] has done a fantastic job in that regard, and his whole team. Those of us who just always think that way—no matter how good we are, we can always be better. Why not? Take a chance. Do something different. Boy, you could not say words like that within these walls at that time. It was just anathema.
James D. Cox, MD
$$ + So to come in, in a leadership position, and to think maybe you wanted to affect change and that change was good, not bad, was just not fitting in with the culture of the place at the time. So my approach and my personality and what I would argue has made Radiation Oncology flourish over the last eight years wasn’t possible for them within the institution, not with the current set of players, LeMaistre, and the division heads sort of co-sharing that view. One of the people who was most resistance, in fact, who whenever I mentioned something about possibly changing it would really always say, “What do you think is wrong with that?” was Lester Peters.
Lesley W. Brunet, CA
Frankly, I was surprised that after you stepped down as vice president— For a long time I was thinking that that’s when you became chair, because there were problems.
James D. Cox, MD
I had three years in between.
Lesley W. Brunet, CA
There were problems with Dr. Peters. And maybe everybody has this in their file, and that’s just what they say—you know—two sides of things.
James D. Cox, MD
Dr. Peters and I have a fundamentally different style, a very different style. He’s a very smart and very talented guy, and what he did personally was really creative and good, but we have a very, very different style. And, again, Lester Peters’ style was very much controlling and directing, and my style is really to try to enable people, to try to not tell them where to go, have a vision of where they want to go, and then try to help them fly. And I do that, and I love to do it, and I get satisfaction out of doing it. I don’t get any particularly great satisfaction out of saying, “You do this. You do this.” And my management style is to bring in people and give them responsibility and let them do the good that they can do and come to me when they’ve got a problem, but otherwise, kind of not interfere with them. So it’s a very different style.
Lesley W. Brunet, CA
The reason I was asking about LeMaistre and whether you had discussed it with him earlier, I wondered about his management style.
James D. Cox, MD
Oh, do you really want to go there?
Lesley W. Brunet, CA
Yes, I do. [Cox laughs.] Do you want to wait? We’re almost out of tape.
James D. Cox, MD
Yes, we ought to wait for another time.
Lesley W. Brunet, CA
We’ll pick that up on our next meeting. Thank you for taking this time today.
Recommended Citation
Cox, James D. MD and Brunet, Lesley W., "Chapter 06: On Executive Leadership Styles within the Division System" (2004). Interview Chapters. 758.
https://openworks.mdanderson.org/mchv_interviewchapters/758
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