Chapter 10: MD Anderson in Transition: Rebuilding and Integrating Relationships Before and After Dr. DePinho’s Resignation
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Description
In this chapter, Dr. Tweardy discusses the creation of the Committee of Division Heads and the Committee of (Department) Chairs, two bodies needed to build communication channels and strengthen faculty trust and engagement. He points out that the Committee of Division Heads recognized Dr. Marshall Hicks as the best person to serve as interim president after Dr. DePinho’s resignation. Dr. Tweardy talks about the impact of these committees during the reduction in force in 2015 and the implementation of Epic.
Next Dr. Tweardy talks about the role of Julie Izzo and Ann Killary in strengthening the impact of the Faculty Senate in restabilizing the institution: he notes that this added another layer of integration to the institution.
Dr. Tweardy then talks about the divisional issues he brought to the Committee of Division Heads. He explains how he saw his role. He also notes that he was struck by the “level of alarm” that the Faculty Senate expressed regarding the new governance structure that was evolving: he makes comparisons with the faculty senates at the colleges of medicine at Baylor and Pittsburg. He reflects on the communication channels that evolved and observes that new people were stepping into the role of communication broker.
Identifier
TweardyDJ_03_20190418_C10
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; Portraits; Institutional Politics; Controversy; Research; 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:
I’m Tacey Ann Rosolowski, and today is April 18th, 2019, and I’m on the 12th floor of Pickens Tower for my third session with Dr. David Tweardy, so I wanted to thank you very much for making time in your day for this.
David Tweardy, MD:
My pleasure. It’s always a pleasure chatting with you.
Tacey. A. Rosolowski, PhD:
Well, thank you. Yeah, it is, always interesting conversations. Well, we were strategizing before the recorder went on, and wanted to pick up with where we left off last session, where you had started to talk about the turbulence that was in the institution, reflected a bit on work the McChrystal Group did in instituting ROPR as a way of monitoring the re-stabilization of the institution. You also talked about the important landmark of appointing Dr. Stephen Hahn as Chief Operating Officer, and then the important work that Ann Killary and Julie Izzo were doing on Faculty Senate. So there were a number of—you called then the three factors, coming together to kind of put the institution on a track. So I wanted to ask you—I mean, start where you would like. I mean, certainly ROPR is one to go a little bit more deeply, but I’m interested in that process: Dr. DePinho resigns, how the institution begins to get back onto a stable footing.
David Tweardy, MD:
Right. So, in fact, those people that you recounted that we had chatted about last time are critically important, and, of course, with Ron stepping down a critical additional person is Marshall Hicks [oral history interview] to add to the mix of individuals who I think were critically important in having as smooth a transition as you could after Dr. DePinho’s stepping down as the President. I think that the critical—there’s kind of two—sort of at least two camps, if you will, within the institution that were critically important to stabilize. In my mind it was the camp that includes the President—interim President in this case—Marshall and Steve, and their communication with the two major leadership groups within the institution, the division heads and the chairs. And I think that that was very effective, and I think —maybe because it was already in existence, the division head community would meet regularly, once a week. And Marshall actually established tremendous credibility within the division head community by virtue of being the chair of the division head group. And, actually, Steve Swisher was the co-chair. And it was around the time that Dr. DePinho stepped down and Marshall stepped up to the interim role that the transition—there was a planned transition from Marshall stepping down as the Chair and Steve, as the Co-Chair, would step up to the Chair position. And that did transpire. Steve stayed on, actually, for almost two years in that role, as I recall, because this was during—because the first years, it was—maybe even towards right before Marshall stepped up that Steve stepped into his job so that he stayed on for a total of two years. But Marshall was --by virtue of his leadership within the division head community-- was immediately recognized as, arguably, the best person to take on the interim presidency. So he had immediate credibility within the division head community; and Steve, who had been a member of the division head community but hadn’t been long enough to kind of establish at least the sort of level of participation in that division head group that Steve had, I mean, he then moved up to the COO’s office. But by virtue of his participation in that division head community had earned tremendous regard and respect of that committee—of that group. And so having Marshall as the interim president, having Steve as the COO, I think there was immediate connection with the division head community. There was immediate establishment of trust and engagement, and it was bidirectional, and very important for the success of anything that transpired in terms of the transition. The thing that happened very quickly, too, was actually, it was a report that came out of … One of the strategic plans, or strategic initiatives of the strategic plan was developed in 2013, 2014, which was the pyramid plan that had multicolored … One of them, of the 130-some committees that were part of that strategic plan, was to reevaluate the chair position. And it turns out that charge, the charge for doing that evaluation and getting engagement from the chairs and others, it was chaired by Steve Sherman and Karen Lu. And they—it might even be before this time, this transition to Marshall and the interim President’s position, but they produced a report. One of the recommendations—there were several very good recommendations that came out of that report, but one that has particular bearing on what subsequently transpired was they felt, just as the division head had this committee that met regularly: that the chairs should form a similar sort of body, if you will, of chairs. And, indeed, what emerged from that was I think one of the, again, top five most important developments in the institution in the five years, four or so years that I’ve been here, which is the Community of Chairs was formed. That was a recommendation from that report that Steve and Karen put together. It turned out, as we were realizing—and probably, at least in my mind, as I was realizing how important the division head community was in the transition, because of the connection we had with Steve and with Marshall, it just—when the idea of having this Community of Chairs become a reality, as opposed to recommendation, it just made absolute sense. And actually Steve Hahn, I would say, as much as anybody, was a strong advocate for having that entity, the Community of Chairs, be created.
Tacey. A. Rosolowski, PhD:
Why was that so important?
David Tweardy, MD:
Well, because what we needed—I think what the organization needed is a means of communicating effectively, particularly in the positions of the COO and the President’s office, effectively with the leadership within the organization. And that being somewhat of a traditionalist, in terms of leadership structures and my thinking around them at academic medical centers, you already have basically created this chair structure. Then here --which is they had the division head structure—and the division heads were engaged, but the Community of Chairs were not, fully. Frankly, they were critically important to get engaged in two-way communication for the purposes of understanding where leadership wanted to move the institution in the short term, until a new permanent President came. Also getting input from the chairs as to what was going on in your departments that were issues of concern and needed to be addressed in an immediate fashion. Because there was enough turbulence that you didn’t want anything to go -- as a leader in this organization, you didn’t want anything to go too far forward without some sort of oversight, or at least communication between all of the effective parties involved.
Tacey. A. Rosolowski, PhD:
Can you give me an example of a theme that came up real early, that these new communities of division heads and chairs, it was really helpful in pushing it forward?
David Tweardy, MD:
Yeah. That’s a very good question. Actually, probably the one that—there are a couple that I can think of, but the one that I think was immediately pressing was the reduction of the force. Preceding that was the implementation of Epic. But that --the implementation of Epic-- was managed more just in a standard operational process here. But the reduction in force decision and strategy needed to be vetted effectively throughout the organization. And I think the Community of Chairs, at least, were part of the—were engaged in, at least, the discussions around that, the need for that, and how best to proceed moving forward with that. I believe the Community of Chairs may have been in existence even before Dr. DePinho stepped down. So my timing here is—I may be blending or misplacing the initiation of events, because I think the RIF actually occurred before Dr. DePinho left, and constant—and that before he left, I think Steve had already been moved to the COO position. Then the budgetary implications of the Epic implementation became apparent, and there was an analysis done that in order for us to maintain our financial stability we needed to have a reduction in force. And I think the Community of Chairs helped to message that. That was the important thing: how to effectively message the first reduction in force this institution has had since 2008, 2009. And that was—I think their engagement helped to move that effectively throughout without having more interruption and destabilization, if you will, within the organization. So the engagement of the Community of Chairs, in addition to the division heads, which already had been in place, and the two new leaders in the COO and interim President position, with Steve and Marshall, I think that allowed for the kind of open channels of communication, bidirectional, that allowed for the leadership on the academic side to maintain stability and to move the institution forward in a productive way. The other major component of, I think, leadership structure that was critically important you alluded to, which was Julie Izzo, Ann Killary, and then there was a faculty member before, or Executive Council of the Faculty Senate president before Ann, or—because there were three. One of the things that we took from the Executive Council of the Faculty Senate in the Division Head Council, if you will, was engagement of the current president, past president, and future president. And Ann was the former—there was a gentleman in Radiation and Diagnostic Imaging who was very important—I considered them part of a triumvirate—and he—it was Gary Whitman—
Tacey. A. Rosolowski, PhD:
We can double check and it can be put in later, yeah.
David Tweardy, MD:
Yeah. Gary I’m pretty confident on, and I think it started on—Whitman is pretty close. Anyway, it was the three of them that started meeting with small groups with the division heads, and that engagement between the Executive Council of the Faculty Senate’s presidents, and a group of division heads helped to maintain stability with the entire Faculty Senate. And, indeed, the division heads and the Faculty Senate met on a couple of occasions. The meetings that we had with those three presidents, though, I think on a regular—on a monthly basis, actually, again, helped to stabilize it, even before Dr. DePinho stepping down. In fact, in that setting it was Steve Hahn, myself, and Patrick Hwu, and Steve Swisher, who tended to be the division heads that met on a regular basis with the Executive Council and the Faculty Senate. When Steve moved over to the COO, we kept meeting, and then the Executive Council of the Faculty Senate, particularly Julie Izzo, who was probably mostly—in the position of the president of the Executive Council of the Faculty Senate during the most, maybe, transitional time. She was critically important in maintaining civility, really, in some ways, between the Executive Council of the Faculty Senate and the Senate in general, and the Leadership Office on the 20th floor. Because I think there was some discord, clearly, between those—the 20th floor of MD Anderson and the Executive Council of the Faculty Senate. And I think—
Tacey. A. Rosolowski, PhD:
Well, I’ll just say for the record—I was sort of hesitating about it, but I will—and my office is on the 21st floor, which is right next door to the conference room where Faculty Senate would meet. So I was very aware of the fact that when Dr. DePinho, when his resignation was broadcast—which was I can’t remember what time of day—the Faculty Senate was meeting, and they cheered. So there was so much acrimony.
David Tweardy, MD:
Yeah.
Tacey. A. Rosolowski, PhD:
I think it’s very significant that pretty much everything you’ve described so far is the process of setting up lines of communication, which had been severely broken.
David Tweardy, MD:
Yeah. They had been. And that’s what I learned. When I came, there was an attempt to repair them, but that was something that had happened prior to my arrival. And pretty much a lot of—exactly. I think what I outlined to you is exactly that, is attempts to develop lines of communication to recreate or reconnect groups that had been disconnected—
Tacey. A. Rosolowski, PhD:
And were mistrustful, and—
David Tweardy, MD:
And—right, that’s right.
Tacey. A. Rosolowski, PhD:
Absolutely.
David Tweardy, MD:
So bottom line is those things—those were the two, or several sets of interconnected liaisons that were important. It was the division heads with Steve and with Marshall, as he became the President, and the division heads with the Executive Council of the Faculty Senate, and then Steve in the COO’s office, and Marshall as he stepped into the presidency, with the Community of Chairs. And, actually, there was also another layer, which was of integration that members of the Community of Chairs went through a similar sort of organizational mindset: they developed a president, past president, and future president, and members of those three would also come to the division head meetings on a regular basis, and still do. So there’s integration between the division heads and the Community of Chairs that’s very effective. But these types of efforts to communicate and to engage stakeholders across the leadership structures that exist were, I think, really, really critical.
Tacey. A. Rosolowski, PhD:
Now, as you were coming to these meetings at this time, as a division head, what were some thoughts that were in your mind about issues that you had locally that needed to be addressed?
David Tweardy, MD:
It’s a good question. My position often was to listen and learn about broken communications, and the dysfunction that that caused in other areas of the organization. When I came to be the division head, I was very fortunate to inherit a group of chairs and super-section leaders who were very integrated, very aligned with the mission, and very outstanding leaders of their units. Everybody could make, or some of them could make some improvement, but they basically started out at a very high level of function. My job was to, first of all, quickly recognize how effective they were, which I was able to do pretty quickly—maybe because I’ve been in the business for so long it’s not hard to figure out who’s doing a good job at leadership and who isn’t. Then just really reinforce them in their effort, and keep them informed. So I felt one of my major jobs was to communicate all of what was going on in the division head community before the Community of Chairs got fully engaged, and as they have become fully engaged my job of communicating to the chairs and the super-section chiefs here, it became a little less critical. But I needed, immediately upon hitting the ground here, needed to, in fact, do a couple of things. One is to make certain they understood what was going on at the division head level, and what I was doing to help represent them at that level. And I think I established my bona fides in that respect. I was considered a good champion and voice for the division, at the table of the division heads. So that was the first thing. But then communicating all of the changes that were going on to the Executive Council—that is, the chairs and super-section chiefs here—and take feedback from that group back to the division heads. That tended to be a little less of an issue because, again, our alignment as a division with the institution was, I think, much more substantial, or just more substantial; I won’t make that “much more.” But it was more substantial, or it was well-established. Let’s not do a comparison; it was just pretty well-established. We just had to kind of tweak it a bit, and by virtue of maintaining the communication, that alignment was able to be maintained without any major perturbations, despite all the things that were going on on the 18th and 20th floor. So being an honest broker in the view of my Executive Council, being open and absolutely honest in communications of what was going on. The other thing I did is that I was really struck by the level of alarm that the Executive Council of the Faculty Senate had with regard to the organizational structure, and you pointed it out, with the leadership. Unlike any other place … Although I think Pittsburgh was a little bit like this; the Faculty Senate at Baylor actually wasn’t even in existence until after I left; they created a Faculty Senate in the last four years since I left. Pittsburgh had a strong Faculty Senate, back in 1985, when I first—I started in ‘87—and it basically was—it became decreasingly powerful because of the massive transition that that organization underwent, and the Senate, which was sort of in the oppositional position, could not get great traction as the institution moved in what, in the aggregate, over time, turned out to be a very positive direction. I mean, Pittsburgh moved up to one of the top five medical schools in the country on the basis of all of the changes that the Vice Chair for Health Sciences was initiating, with substantial resistance on the part of the Senate. So when I came here, I drew some similarities in some respects to the University of Pittsburgh situation, but I also realized that there were some differences. In particular, I thought that the establishment—the Senate here was better established, had various sort of support of the faculty, in terms of the workaday ground, the faculty on the ground level, but realizing their very potent connection with the chancellor of the system, realized you could not do maybe what was done in Pittsburgh. There just was too strong a connection. Their voice was being heard by the chancellor in his office, so we needed to be very straightforward and open with our faculty, who were on the Faculty Senate. So what I established was a monthly report by a Senate member to come through and present to the Executive Council, just so our Council knew what was going on in the Senate. And by virtue of setting that example, then the practice of having the department faculty rep present at those faculty meetings at the department level kind of regrew a bit. And so I think what I demonstrated a little bit is my respect for the Senate, and my unwillingness to discount them. And that paralleled my regular meetings with the Executive Council of the Faculty Senate, is I learned their concerns and became more aware of what their positions were, and why they held those positions.
Tacey. A. Rosolowski, PhD:
Were there specific ways that you used that information at different levels to smooth waters, move—? Tell me about your roles in that regard.
David Tweardy, MD:
Well, what I did in terms of … In our division, among our chairs and section chiefs, there was not unanimity around the seriousness with which one should take the positions of the Senate. So I guess what I did is I didn’t necessarily legitimize every point that they were making, but legitimized them as a legitimate and important group to listen to moving forward, and—
Tacey. A. Rosolowski, PhD:
Yeah, you mentioned this last time, and now, given all that you’ve told me about these lines of communication, I’m starting to see more clearly how important that was, that really these lines of communication had really not been activated prior to that time.
David Tweardy, MD:
Yeah, and, in fact, the thing that—it’s—I don’t know. While I was a new kid on the block, and therefore a bit of an unknown entity when I came, there was no question that Steve was very similar in that regard. He came a month after I did. But it was very clear that the people who would meet with the Executive Council of the Faculty Senate in the division head role were—I mean, the ones that were volunteered to do that were the new guys, the new folks. It seemed to me that the reason for that was that some of the more longstanding division heads had had a history with that organization, and that leadership group, and it was maybe not going to necessarily lead to productive and open-ended conversations. So I think we were—Steve and I in particular, I sense, were viewed as sort of unbiased, maybe, and therefore neutral participants in conversation. I think they understood very quickly I realized the importance of having good communication with that group. So, bottom line is that it was very important for the Executive Council of the Faculty Senate to have a way of communicating with leadership. I think they felt, as you say, they felt shut off as a result of changes that occurred prior to my arrival, and the way that communications did occur between the 20th floor and the Executive Council of the Faculty Senate. So they needed to have communication with a leadership group, and I think the division heads served a useful purpose in that. And so, yeah, I would say we were—the sort of just open-mindedness that—and Steve Swisher and Patrick all … I think, actually, Patrick probably made the greatest move from being a little bit cautious about interacting with the Executive Council of the Faculty Senate, then became very strongly embracing them as very important voices to make certain were heard and integrated in the decision-making process. I think Steve and I came in with more of that a priori, but Patrick, who obviously had been here quite long, was able to change his thinking a little bit around that role, or the role of the Executive Council of the Faculty Senate. To his credit he was able to slightly change his opinion on that. And I think by virtue of him doing that, Steve Swisher, I think, came in pretty much openminded, as well, but obviously having more history, and then Steve and I. I think with the four of us legitimately and very conscientiously interacting with the Executive Council of the Faculty Senate, that really helped to sort of reduce some of the frustration that that group had with regard to communication with leadership.
Recommended Citation
Tweardy, David J. MD and Rosolowski, Tacey A. PhD, "Chapter 10: MD Anderson in Transition: Rebuilding and Integrating Relationships Before and After Dr. DePinho’s Resignation" (2019). Interview Chapters. 1392.
https://openworks.mdanderson.org/mchv_interviewchapters/1392
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