Chapter 09: Defining the Mission that Shapes MD Anderson Growth
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Dr. Mendelsohn explains how the unprecedented growth accomplished during his presidency was not growth for growth’s sake, but guided by the MD Anderson mission. First he explains the three factors enabling growth in the mid and late nineties. First the public was beginning to understand the complexity of cancer care. Demand for sophisticated treatment was building and patients wanted access to an outstanding facility. Second, MD Anderson had one hundred research programs in existence and they were producing knowledge about what cancer care might be. The faculty wanted to expand research dramatically. Third, growth was managed through discussions with the Board of Visitors and Leon Leach (Executive Vice President and Chief Financial Officer), so that growth occurred in accordance with the institution’s mission. The planned parallel expansion in four areas: Research, Patient Care, Education, and Prevention.
Dr. Mendelsohn then focuses on the area of patient care, noting that expansion of clinical services increases profit margins that can support research. He reviews some growth statistics for the institution and points out the importance, during this period of improving efficiency and streamlining clinical research programs. He also explains that he asked his son (enrolled at the Wharton School of Business) to draw up a reading list for him and he discovered Michael Porter’s Competitive Advantage. (He became friends with Michael Porter, who is now involved in the business management of medical care.) Competitive Advantage underscored the importance of a business understanding what it wanted to be: Dr. Mendelsohn uses Southwest Airlines to explain the concept and explains that decisions about institutional identity were made quickly at MD Anderson, given agreement that the institution should be the best. He notes that it was a ‘gutsy move’ at the time to add twenty million to the budget and he gives the Board of Regents credit for having the faith that MD Anderson knew what it was doing. He then turns to the subject of excellence, noting that physicians at MD Anderson want to be the best in their fields and that they are uniquely positioned to achieve this goal: MD Anderson physicians are “sub-subspecialists” in a team of similar individuals, a situation, Dr. Mendelsohn says, that breeds excellence, and that had the potential to actually be what the mission statement articulated. He then explains that this is why he did not combine MD Anderson with the Health Science Center –an idea entertained early in his presidency.
Identifier
MendelsohnJ_02_20120928_C09
Publication Date
9-28-2012
City
Houston, Texas
Interview Session
John Mendelsohn, MD, Oral History Interview, September 28, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Administrator; Understanding the Institution; Growth and/or Change; Institutional Mission and Values; MD Anderson History; Leadership; Professional Practice; The Professional at Work; The MD Anderson Brand, Reputation
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 Ann Rosolowski, PhD:
This is Tacey Ann Rosolowski, and I’m conducting my 2nd session with Dr. John Mendelsohn in the offices of the Khalifa Institute for Personalized Care.
Tacey Ann Rosolowski, PhD:
We were going to talk more in depth today about the processes of growth that the institution underwent. Just to start, I wanted to get a general perspective on the whole idea of growth of MD Anderson. Because you wanted to grow the institution, despite all advice, you decided to take that in a very bold way, and this was not just growth for growth’s sake. I wanted to ask you what that aim of all that growth was. What was the mission?
John Mendelsohn, MD:
Why did we want to grow, especially at a time when we’d been cutting back? There were probably at least 3 reasons. One is that, as the public began to understand more and more about the complexity of cancer care, there was a demand that was building up. When a person learned that they had cancer they wanted access to an outstanding facility with experience. In fact, between the East Coast and the West Coast, there were very few institutions that could provide that, and we were certainly one of them. We happened to be ranked the number 2 cancer hospital in the country, based on our reputation and some statistics and things like that, so people wanted to come.
The 2nd reason is that we probably had hundreds of research programs going on here, and a lot was being learned about cancer, and there were a lot of new ideas about what we could do in our research. Each research program wanted to grow. We wanted to do more breast cancer research. We wanted to do more research on genomics. We wanted to do more research on radiation therapy with new modalities. There were legitimate aspirations to expand many different research programs expressed by the faculty when I met with them during the first 6 months.
Then the 3rd reason for the way we grew has to do with what I learned talking with the Board of Visitors and getting advice and having lengthy discussions with Leon Leach, who I recruited as my executive vice-president. He was the only one with that title for a long time and my first chief compatriot in managing MD Anderson. We sort of made a deal. I would provide expertise in academics and research and patient care, and he would provide expertise in business and the administration of a health institution, and we would work together. We decided that for MD Anderson to achieve its mission and its vision, growth in patient care and research had to be in parallel.We had 4 missions: clinical care, research, education, and prevention. We felt that it was very important to grow each mission area if we were going to meet the demand for more care and increase the number of patients. I picked a 50% increase in patients as the target. That was thought to be a huge, big, hairy goal. We actually achieved more than 100% in less than a decade. If we were going to grow in our patient care capabilities 50% and build the facilities and hire the people, if we were going to be able to give the same quality of research-driven care and provide the clinical trials and do the same thing for that increased number of patients, we had to grow the research program 50%. It was important to grow the education program 50% and the prevention program. Immediately, we were designing a growth strategy that encompassed the missions of MD Anderson, which is a little different than saying, “I’m going to pick 5 areas and grow in those.” There are arguments both ways, but for what I saw in 1996, I thought this was the right way to grow MD Anderson. When you grow in your clinical activity, you make more money, you have larger margins, and they can be used to grow the other activities too. There’s no question that the research going on here is subsidized by the clinical activity.
Tacey Ann Rosolowski, PhD:
What were some of the numbers that you achieved in terms of growth in the clinical activities to subsidize the other areas after 2 years or after 4 years? How was that worked out?
John Mendelsohn, MD:
After 10 years, we more than doubled the number of patients. We more than doubled the number of faculty. We tripled the number of trainees. We tripled the number of employees. We actually ended up quadrupling the amount of space.
Tacey Ann Rosolowski, PhD:
You achieved those goals pretty quickly, getting a good margin with patient care so that you could start subsidizing research and the other areas.
John Mendelsohn, MD:
We did very quickly; first of all, by the faculty being excited and anxious to do this, and then by doing some simple things to improve efficiencies, like fixing the communication system, like putting in procedures to reduce wait times so that you could get an appointment here. When you came to the clinic, you could get in without spending all day waiting. And by helping to streamline the clinical research programs so that we essentially doubled the number of patients on clinical trials. A lot of people who come to MD Anderson come because the standard therapies failed and they want access to clinical trials. It was impressive to me to learn that the majority of our patients don’t come from greater Houston, which is very different from what I saw at Sloan-Kettering, where 85% of the patients came from greater New York. That’s 20 million people. It means that a lot of patients that came here drove a long time or got on airplanes to come here. You’ve got to have a special reason to do that. It’s not just to get another opinion. It’s to go to a place that has real expertise and can offer something different.
Tacey Ann Rosolowski, PhD:
In your interview with Dr. Olsen, you said that you were really influenced by a book by Michael Porter, Competitive Advantage, around the time when you came here. He had that bit of wisdom that said you could be Kmart or you could be Saks Fifth Avenue, but you couldn’t be both.
John Mendelsohn, MD:
As I said to you before, when I learned I had this job, I said to myself, “Wow. I’ve had zero formal training in business,” although I’d learned a lot about business. I called my son who was at Wharton. I said, “Quick, give me a reading list.” My son thought for a while about what I was getting into, and he said, “Well, I advise you to read books by Michael Porter, who is an expert on competitive advantage.” I read his book, and subsequently, I read other books he wrote, and we became very good friends. He’s a friend of MD Anderson. A number of people here collaborate with him now, studying how to manage the business of delivering medical care better. This book explained a very important principle to me by giving the example of Southwest Airlines. Southwest Airlines focused on a certain market and had a standardized way of doing things as cheaply as possible. You didn’t get assigned seats, and you had to wait in line, but the planes were on time, they were clean, and they were able to provide the best, inexpensive way to fly. When other airlines that gave you assigned seats and first class and all kinds of special privileges tried to also combine with that some cheap seats and minimal services they couldn’t do it. You can’t do both. An example he gave was you can’t be a Walmart (the cheapest) and a Saks Fifth Avenue (best quality). You have to decide what you want to be, and then you have to be the best at it. When I got to MD Anderson, we had a lot of discussions about what we want to be that didn’t take very long, and there was no question. We wanted to be the best place to deliver cancer care, which means this isn’t going to be the cheapest, and we’re not just going to find the most efficient way to do things. We’re going to find the best way to do things in an efficient manner. The research had to be a part of it, and the time to do the research had to be guaranteed to faculty. We were not trying to create a product that would compete with well-trained oncologists in the community who were not doing research and who would refer their tough cases to us, so that really set a standard for how we would approach things. We are designing programs that are going to be the best, not necessarily the cheapest. That was not always what we were advised, but there wasn’t much argument internally once we thought it out that way, and I owe Mike Porter that insight.
Tacey Ann Rosolowski, PhD:
How long did it take to come to that consensus about what you wanted to be?
John Mendelsohn, MD:
A couple of months; we had to decide. As I told you, I was advised to cut the budget. One of our 2 financial people wanted to cut it another $70 million, and the other one said, “No. We only need to cut it $10 million.” We actually added $20 million to the budget, and I didn’t know where that was going to come from. Looking back on it, that was gutsy, and I have to give the regents and my bosses credit for allowing us to do that. It was an act of faith that, okay, we’ll get those patients in here. Forget the advice we’ve gotten from well-paid consultants. We’re going to have so many patients wanting to come here because we’re going to be the best place, and let’s look at it that way. Fortunately, it worked.
Tacey Ann Rosolowski, PhD:
Tell me a bit about that initiative in establishing excellence as a primary goal.
John Mendelsohn, MD:
It wasn’t a hard initiative. That’s the way we were. The doctors here want to be the best clinician in their field. We are sub-subspecialists. In many cancer practices, the same doctor has to treat breast cancer and lung cancer and colon cancer and maybe even leukemia. Well, almost every doctor here is a sub-subspecialist. He or she is treating one of those diseases and usually one modality, either surgery or radiation or chemo. Furthermore, they’re not alone. They’re on a team of between 2, 5, 10, and even 15 other people who are similar sub-subspecialists. That breeds excellence. There are no surprises after a while. You talk about your tough cases, you have conferences every week and review what you’re going to do, and pretty soon you’re an excellent expert in your particular area of cancer.
Tacey Ann Rosolowski, PhD:
You mentioned that articulating the values of caring and integrity really help solidify the culture of MD Anderson. I’m wondering if bringing this idea of excellence, being so much a cornerstone of what MD Anderson is about, to the surface and articulating it changed the atmosphere a bit.
John Mendelsohn, MD:
I think it gave people a vision. That’s the single sentence of our vision statement. We shall be the premier cancer center in the world based on the excellence of our people, our research-driven patient care, and our science. That was written with this very point in mind. If you walk around saying, “Hey, we’re going to be the best, and we’re excellent,” and it’s a sentence you can do in less than 1 elevator ride and it’s on the walls and it’s on the stationary and it’s said over and over again, if it’s phony baloney, it isn’t going to work. But if it’s an accurate statement of an aspiration that we could achieve, it gives you something to focus on and feel good about.
Tacey Ann Rosolowski, PhD:
It was certainly more than that, too. That word became part of people’s performance reviews and a benchmark that they begin to measure themselves against and having conversations about what that meant for staff members, for all sorts of care delivery, individuals as well as faculty and research. It became very thoroughly threaded through the fabric of the institution.
John Mendelsohn, MD:
I think every business and every medical center and every university wants excellence, but I think we’re fortunate here. We’re very focused. Most medical schools have to deal with aspirations in cardiology, and pulmonary and, by the way, GI and brain and surgery and the psychiatry department. They want to be excellent, one of the best. All of them want to be the best in the world. We’re just dealing with cancer, and that focus means there’s much less pulling and tugging. You’re trying to get people together in a room and say, “How are we going to be excellent?” There’s still plenty of pulling and tugging, because there are many kinds of cancer, and there’s laboratory research versus clinical research, but in most medical centers those same pullings and tuggings would go on in each of the various types of illness and disciplines. I love the focus here, and I think when I came here I understood that this place had the potential to be what our vision statement said because we are so focused. There have been opportunities in the past, and during the period when I was president, it was discussed: should we combine with the Health Science Center? Isn’t it silly to have 2 branches of the University of Texas next door to each other? You need cardiologists and pulmonologists, because cancer patients get sick. I said, “No.” When I came, we had a dozen of those people. When I finished being president, we had over 100 people in general internal medicine. They had a whole separate division, but they were full-time members of our faculty, and they were interested in problems in their disease that cancer causes. The pulmonologists were interested in what’s a “white lung” on the x-ray? Is it infection? Is it a drug reaction? Is it cancer? The cardiologists were interested in the side effects of chemotherapy that affect the heart. We developed the expertise we needed that kept it internal. We didn’t want to discuss joining with the Health Science Center. The Health Science Center has a School of Public Health, which is terrific. They have a medical school. They have a nursing school. It’s much harder to focus when you’ve got to cover all those bases and be fair to so many different constituents.
Recommended Citation
Mendelsohn, John MD and Rosolowski, Tacey A. PhD, "Chapter 09: Defining the Mission that Shapes MD Anderson Growth" (2012). Interview Chapters. 1425.
https://openworks.mdanderson.org/mchv_interviewchapters/1425
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