Chapter 01: A Dissertation Overview

Chapter 01: A Dissertation Overview

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In this segment, Dr. Leach describes the subject of his dissertation (entitled “Academic Medical Centers: A Framework for Strategic Repositioning”) prepared in completion of work for his Ph.D., conferred in 2011 by the University of Texas School of Public Health. (He worked on this degree while fully employed at MD Anderson.) Dr. Leach was interested in the factors that support the success of strategic initiatives. He explains that he built his dissertation around three case studies of strategic repositioning: The Baylor College of Medicine’s decision to own and operate a hospital; MD Anderson’s 2008/’09 attempts to improve operational efficiency; and The efforts of the UT Medical Branch at Galveston to expand service to additional locations. He lists the decision makers he interviewed and summarizes his findings.

Next, Dr. Leach clarifies why he pursued degrees beyond his M.B.A. while serving as Executive Vice President of MD Anderson. He sees both his Ph.D. and his M.A. in Christian Education (Southwestern Baptist Theological Seminary, 2001) as personal challenges. He describes the value of the process and discipline of working toward his Ph.D., which gave him an opportunity to serve on a restructuring committee at the Baylor College of Medicine. He gives examples of how the experience provided him with an appreciation for how different leaders view the same situation from different perspectives.<.p>

Identifier

LeachL_01_20121115_ C01

Publication Date

11-5-2012

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Educational Path; The Researcher; Professional Path; Overview; Definitions, Explanations, Translations; Evolution of Career; Professional Practice; The Professional at Work; Personal Background; Professional Values, Ethics, Purpose; Character, Values, Beliefs, Talents; Beyond the Institution; On the Nature of Institutions

Transcript

Tacey Ann Rosolowski, PhD:

We’re recording. I always check. I’m Tacey Ann Rosolowski interviewing Dr. Leon Leach for the Making Cancer History Voices Oral History Project run by the Historical Resources Center at MD Anderson Cancer Center in Houston, Texas. Since 1997 Dr. Leach has served as MD Anderson’s executive vice president and chief financial officer. This interview is taking place in Dr. Leach’s office on the twentieth floor in Pickens Academic Tower on the main campus of MD Anderson. This is the first of two planned interview sessions, and today is November 5th, 2012, and the time is 1:45. Thank you, Dr. Leach, for donating your time to the project.

Leon Leach, MBA, PhD :

Thank you.

Tacey Ann Rosolowski, PhD:

We really appreciate it, and before we turned the recorder on, you were telling me about your dissertation research and beginning to give an example of three ways or three case studies in which medical centers reposition themselves, as you referred to it.

Leon Leach, MBA, PhD :

Before I get back into that, let me just correct one thing that you said in the introduction. When I came here in 1997, I was executive vice president and chief financial officer. About three years after that we went through a reorganization where at the time it was principally the financial functions that reported to me, and we changed that about three years later when I became responsible for human resources, facilities, and information systems. I kept the title for maybe a couple more years after that, and then I dropped the title as we put someone else in that CFO position that reports to me. At the time, it was my right-hand person, Ben [Benjamin B.] Melson [CPA], who is now executive vice president and has basically my job at Texas Children’s.

Tacey Ann Rosolowski, PhD:

I see. Your title officially is—

Leon Leach, MBA, PhD :

Executive vice president. Well, that’s my title, and I am chief business officer for the university.

Tacey Ann Rosolowski, PhD:

But it isn’t given a separate title. It’s all amalgamated into the one.

Leon Leach, MBA, PhD :

Yeah, you can do it either way. What does it say on my business card? We’ll go by whatever is on that. Executive vice president.

Tacey Ann Rosolowski, PhD:

Well, it’s interesting. I mean, the story of people’s titles and also just the story of departments and divisions and sections and how they’ve morphed over the years. Thank you for the correction. Chapter 01 A: Educational Path Doctoral Work Provides an Opportunity to Develop a New View of Academic Medicine Story Codes A: The Researcher A: Professional Path A: Overview A: Definitions, Explanations, Translations C: Evolution of Career C: Professional Practice C: The Professional at Work A: Personal Background A: Professional Values, Ethics, Purpose A: Character, Values, Beliefs, Talents B: Beyond the Institution D: On the Nature of Institutions

Leon Leach, MBA, PhD :

Well, it’s minor. That’s certainly not a news-worthy thing, because it was just that. It was morphing my—the only thing that really changed of substance was I picked up a lot—basically all the business functions rather than just the financial functions. But the dissertation was entitled Academic Medical Centers: A Framework for Strategic Repositioning. It was built around three case studies that I did, and how we got on to this topic was as you were setting up the recorder, I was reminiscing about interviews that I had done for this. But the three case studies were at Baylor College of Medicine, and specifically what I looked at was their decision to go into the hospital business. And what I was looking for were what I would call—a lot of people would call—the critical success factors. I didn’t use that phraseology, but what is it that you really need to pay attention to to make these things work, or if you don’t pay attention to them, they might not work as well? Baylor was their decision to get into the hospital business. With MD Anderson, it was some financial changes we made in the 2008-2009 period. Well, they were more than financial. They were strategic changes that we made then, and with the third case study it was the University of Texas Medical Branch in Galveston, and it was plans that they had to broaden their service area by moving a lot of components off the island that had been somewhat thwarted because of politics and some other things. But with the advent of Ike, and when Ike wiped out the island, and under a different administration, they had a great opportunity to go back and do that, which they did. Our situation was we just needed to get more efficient at what we were doing. It wasn’t that we were—we were expanding greatly, but it was pretty much in one location. We did do some—what we call regional offices that now are in Houston. But it was more about doing what we do where we do it but more efficiently. And then Baylor’s was to build, own, and operate their own hospital. When you look at—if these were dives, the degree of difficulty, we were the easiest. We were doing what we were doing but just trying to do it more efficiently. The medical branch was more challenging. They didn’t really change what they were doing, but they were doing it in different locations, a broader location off the island, and they were doing it in the face of a hurricane and in the face of some political challenges. Baylor basically—their college of medicine is a very good college of medicine, very well thought of, highly ranked. They decided to get into the hospital business. They’d always used hospitals. They’d had a long-standing partnership with the Methodist, which came apart, and that wasn’t part of the study. I picked up after they made the decision or as they were making the decision, looking at the elements of their decision to build the hospital. But theirs was by far the biggest change, because being a college of medicine is one thing. It’s kind of one strategic perspective. But owning and operating and building—a hospital—was at least another different perspective, and one could argue building it is different than owning and operating, and they were trying to do all three. Getting back to the dives analogy, that was at least a ten to try to pull that off. When I looked through what’s important—and I interviewed not quite thirty people. I think it was twenty-seven folks, and it included the folks that were responsible for strategic decisions and implementing strategic decisions. I interviewed the chairman of the board of Baylor, Marc Shapiro. I interviewed the chairman of the Board of Regents, who, at the time, when these changes were happening, was James[F.] Hofheinz [PhD]. I interviewed several board members at Baylor and their presidents, two presidents, because the shift actually started with Dr. [William] Bill Butler, and [Dr.] Paul Klotman came in. I interviewed their CFO. The same thing here. I interviewed John Mendelsohn, Dwain Morris. I had only interviewed the one board member here, but I did interview the executive vice chancellor of health affairs and the executive vice chancellor of business affairs, two different folks that were very much involved at the UT system level in those decisions. Several faculty leaders, and I interviewed faculty leaders in each of the three institutions, and at the medical branch I interviewed Dr. David Callender and his predecessor, Dr. [John D.] Jack Stobo, just to see what his thinking was. Then I used the tape recorder, and it was digital so I actually uploaded it to an Internet service that will—using voice recognition will give you a printed copy. Not 100 percent accurate. I mean, it’s not like having the transcriber person, but it’s close. But what I relied upon more than that was that the actual tape itself is now stored on the Internet online, and I would listen to the interviews and you could actually annotate—it’s almost like you’re highlighting, only you’re taking in and putting points in, and I was looking for, what are these people concerned of when they do this? The answers were 100 percent of the people that I interviewed mentioned leadership accountability or something very akin to that. But leadership accountability was the phraseology. One hundred percent of the people mentioned the strategic repositioning itself, and what they were talking about is how big of a change is it, the degree of change? I just recited about the three different institutions and then the various degrees of change they went through, and there was a distinct correlation. The smaller the steps, the more likelihood for success. The big steps got tougher.

Tacey Ann Rosolowski, PhD:

Did those responses surprise you in any way?

Leon Leach, MBA, PhD :

No, actually, in the dissertation, you build a theory before you go into it, and before I even started the interviews, just based on the reading that I had done, I used different words to describe it. But what came out of the research was kind of a more refined version of what I was thinking going into it. But the other three things—there were five things that more than seventy percent of the people mentioned in the interviews, and of those five things, there was no other thing that got mentioned more than half the time. It gave me kind of a clean break for the critical few, and the other three were having the metrics to measure your success or failure, communication, communication, communication. You can’t over-communicate. Most people under-communicate. The last one was a little bit tied to the first one. It was the sustainability of the change, and the thinking is if you’re going to do it and expend that energy—and these can be pretty traumatic for organizations, the big changes. Don’t expend it unless you can sustain it. Part of another way of saying that is, don’t undershoot the mark. If you overshoot the mark, you may not be able to get there any how. This is what happened to Baylor. They wound up falling on their bottoms and boarding up their hospital essentially. Well, boarding up is probably too crude of a term, but they mothballed it. They never opened it as a hospital. They are now doing much better financially to stabilize the ship, and they are actually using that space for outpatient clinics, and they’re starting to utilize that space. But when they were on technical default on the bonds, they didn’t have the money to do that. That’s the essence of the dissertation.

Tacey Ann Rosolowski, PhD:

Why did you choose to do a graduate degree when you did? Leon Leach, MBA, PhD It was there. The Health Science Center has literally got—you can’t see it because we’re so close to it. It’s right off the walkway as you come over from the Mays Clinic, so the convenience was one thing, but education is an ongoing process. My genetic makeup is the business side. I have an MBA. But I also have a master of arts in Christian education, and I have the PhD. But the skill set I utilize the most is the MBA, obviously.

Tacey Ann Rosolowski, PhD:

Just for the record, I wanted to say the MA that you received was from—in 2001—Southwestern Baptist Theological Seminary.

Leon Leach, MBA, PhD :

That’s correct.

Tacey Ann Rosolowski, PhD:

And then 2011 was the conferral date for your PhD from the UT School of Public Health.

Leon Leach, MBA, PhD :

Yeah, you know, I didn’t realize it was exactly a decade.

Tacey Ann Rosolowski, PhD:

Yeah, I noticed that.

Leon Leach, MBA, PhD :

I guess I could have read the diplomas and figured that out, but you’re right.

Tacey Ann Rosolowski, PhD:

Yeah, it’s kind of interesting.

Leon Leach, MBA, PhD :

It was about a five-year process for the PhD, and I did have a full-time day job so it was kind of—and I think it was easier because someone told me—I was actually thinking about a PhD in theology. Somebody told me it needs to be something that you really have a passion about, because if you don’t, you’ll never see it through. Well, the theological degree, it’s very helpful. It’s something where you can’t take the knowledge away, and I’ve used it a little bit. But it was more for me to do as a personal thing, and I kind of approached the PhD in the same way. It was more of a personal challenge, but what I was living and breathing at the time were these restructurings. Repositionings is what I called them, because we had just gone through the process at Anderson, and I was very familiar with that. I was asked to serve on the restructuring committee of the Board of Trustees at Baylor, so I was very much involved in that, and I had the unfair advantage of knowing Paul, knowing their CFO, knowing the folks over there, knowing the board members. One of the more interesting things with my committee, one of the committee members was very concerned that I would not be able to get interviews to begin with, and he actually suggested I read a—it was a very well-done article about the reluctant interviewer. It said basically people in power who you’re looking at and second guessing, they won’t even agree to the interview. If they do, you really won’t get the full story, that kind of thing. Well, these people that I worked with—Marc Shapiro sat on our Board of Visitors and was chairman of the board of Baylor and actually has a copy of my dissertation. They were very open and very willing to tell me what their thinking was at the time. There was nobody that said no to me interviewing them, and there was nobody that I felt was giving me cagey-type answers. You could tell the conversation was coming from the heart. These guys and gals lived it. They lived through it.

Tacey Ann Rosolowski, PhD:

I think so often in interviews, when people think of an interview they think of the model of a journalist’s interview, which is often kind of inflammatory, whereas the kind of interview that you were doing for research purposes, like the kind of interview I’m doing, let’s take a critical look at this. Let’s evaluate this.

Leon Leach, MBA, PhD :

And I did stay away from the “have you stopped beating your spouse” question.

Tacey Ann Rosolowski, PhD:

That’s always a good thing. (laughter) Save that for the drink afterwards, right? Well, it seems like you were really in the right place at the right time in terms of what was going on at MD Anderson and then what was going on in the other divisions that you looked at as case studies at the time. It seemed really, really fascinating.

Leon Leach, MBA, PhD :

Yeah, it was one of those opportunities that—was it career oriented? Not really. But it was intellectually driven, and it was kind of the—if you’re there at the perfect storm and have a chance to write about it or record it—and I’m not sure that mankind is going to be much better off because I did this, but to me it was worthwhile. It was very—just the discipline of going through the research—with interviews you actually have to go through the IRB. You do get an exemption. Well, I did because they weren’t patient-care types of interviews, but I had to go through that process, and I had heard our faculty kind of complain, and I didn’t have to go through MD Anderson’s IRB. I actually had to go through the School of Public Health’s IRB, which was a fourth entity, because the three other academic medical centers I was dealing with were the subject of a case study. And it wasn’t—they were very nice. They actually helped me with the forms. They kind of walked me through it, because they knew they had a novice on their hands. But it was a lot more paperwork than you think of. It did give me an appreciation of what our faculty has to do, and the interesting thing in writing this is I lived through these, but I could never talk about my experience. This is a scientific document, so I had to interview people and get their experiences, and there are several different perspectives. I mean, the board of directors has one perspective. The executive leadership has another, and the faculty has yet another, and I’m sure there are others out there, but everyone is looking at the same situation but from a different angle, from a different degree. One of the things I tried to do was correlate what did the board see as being important—the governing board that actually had the responsibility—fiduciary responsibility—see as being the critical elements? What did the executive team see, and what did the faculty leadership see? Interestingly, what they saw was pretty common. I mean, if you looked at each institution—I’m not trying to do a between-institutional thing, because the circumstances are different, but everyone saw the same five critical elements. The degree of importance that they put on this—and how I tried to measure the surrogate for the degree of importance was how many times a certain theme was mentioned. One hundred percent may have mentioned it, but the faculty member may have mentioned it once in passing, and the board member may have mentioned it a dozen times and dwelled on it. The only one that really surprised me was communication was rated higher by the board, and it was rated second highest by the faculty, and it was rated least highest by the executive team. But it was still in the top five, and when you really looked at the comments and not just take the count of when they talked about it, what the board was concerned with was the public communication. Are we going to get a black eye here? What the faculty was concerned with was, why didn’t somebody tell me? Of course they had been told. They just—and there was clear evidence of presentations that were made to faculty and the recall—something else on their mind. But the executive team, while they recognized it was important, they were more focused on getting it done, and that did vary by institution, because I did look at that one across institutional lines. Probably the one that did the best was David Callender at the medical branch. He took great pains to get out in front of people. To me, it’s not an interesting read, because I wrote it, but if you’re interested in that kind of thing, there might be some value to it.

Tacey Ann Rosolowski, PhD:

Sure. It sounds as though it was an interesting—it was an occasion for you to refocus your perspective a little bit through doing this work. Leon Leach, MBA, PhD Yeah, I’m glad that I did it, and I certainly got the appreciation for different perspectives, because I was the reporter. My role in an interview was basically, you’re going to do ninety-seven percent of the talking, and I’m going to do three percent, because I had five very broad, open-ended questions, and it was all designed to get the interviewee to talk. I got very good at going, “Uh-hunh (affirmative), uh-hunh (affirmative).”

Tacey Ann Rosolowski, PhD:

Is that a natural part of your style anyway? Are you a listener?

Leon Leach, MBA, PhD :

My wife doesn’t think so. (laughs) I try to be. I really do try to be. First of all, when I came to MD Anderson I had to be, because while I knew the finance side, I had never worked in an academic medical center. I never worked for a state government or a university, and I had never worked for a hospital. I had the financial background, and it was healthcare. It was all healthcare. But I was usually negotiating against the hospital, because I spent a lot of my time in the managed care companies and started HMOs and that kind of thing. I was very familiar with the environment, but again, it was a different perspective. I did have a lot to learn. You can’t learn and talk at the same time, I don’t think.

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Chapter 01: A Dissertation Overview

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