Chapter 10: Growth in Research and Clinical Care
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Dr. Mendelsohn clarifies the vision for changing the organization of the basic sciences. In creating the vision for change, his strategy was to appoint individuals on the front lines to define what was needed. The basic sciences, he says, were integrated in comparison to other institutions, but there were problems with their resourcing and management. Dr. Mendelsohn briefly explains these problems and the solutions instituted. Change was also made in the chain of responsible parties that faculty and staff would go to for resolution of problems or requests for resources. He describes the Executive Committee (Leon Leech, Kevin Wardell, David Hone, and Margaret Kripke) and their working style. He gives an example of how research was developed: by putting up the new faculty center and the Mays Clinic and expanding resources for imaging. The major limiting factor in research growth is space, and the Executive Committee planned which programs should migrate to Research Park.
Dr. Mendelsohn states that major growth occurred in research and clinical care, and this built on the consensus about developing ambulatory care, grouping physicians by cancer. He notes that the average hospital could not accomplish what MD Anderson has been able to because of competition within the institution between cardiology and cancer, for example. He notes that the reorganization of clinical services began under Dr. LeMaistre and continued to be led by the faculty. Returning to the subject of research, he notes that there were infinite possibilities for growth when he arrived. The Executive Committee targeted areas in which MD Anderson could become a leadership and that showed promise for patient care.
Identifier
MendelsohnJ_02_20120928_C10
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 Professional Practice The Professional at Work Understanding the Institution Leadership Growth and/or Change
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:
It’s really interesting how that was R. Lee Clark’s vision, and that independence is still the right way to go. You began to touch on my next question, which is what was your vision, or how did your vision evolve during that first 100 days when you were talking to all the faculty and other divisions about what they needed? How did that vision evolve in the first, say, year or 2 years and alter what you believed you wanted to achieve here? And then, of course, I’ll ask you how you went about doing it, which probably will be a whole different story. But how did it start?
John Mendelsohn, MD:
It turns out that there were many things that were needed. We needed a change in the way the basic sciences were structured. We needed to complete something that had begun, which was to reorganize our clinics around the disease entity rather than around the professional approach that’s taken. If you’re growing and building new space, then that gives you a wonderful opportunity to redesign things. Rather than picking a top-down approach and saying, “This is how we’re going to do it,” I think the right way to describe the strategy that I and the leaders took was to appoint people who were on the front lines, in the various areas, and task them with coming up with what they needed and come back and present it to the executive committee and get advice from the faculty. You can’t get consensus on anything, but I find that if the faculty and the leading administrative people here feel they’ve had a chance to have a role in the decisions that are made, once the decision is made, they’ll get behind it. Whereas if it’s all top-down and a team of outside experts come in and says, “Here’s how you’ve got to do it,” and they haven’t been really consulted and listened to, there’s going to be pushback. It’s just human nature. So we did a lot of the former.
Tacey Ann Rosolowski, PhD:
How did you feel the basic sciences needed to be reorganized?
John Mendelsohn, MD:
It’s a very complicated area, but in some ways, the basic sciences were extremely integrated here compared to at other institutions. There were a lot of laboratory scientists that were interested in cancer, but the way they were resourced and the way they were managed was different if the basic scientist happened to be in a basic science department compared to a basic scientist who happened to be in the clinical department. We still have the term basic science, but basically anyone who ran a lab was a laboratory scientist, and anybody who ran a clinical trial was a clinical scientist. They’re both scientists, and they both need resources. We tried to set a more uniform and transparent way of dealing with those things.
Tacey Ann Rosolowski, PhD:
How successful was that?
John Mendelsohn, MD:
About as successful as I’ve seen in any academic medical center. It was a pretty simplified leadership structure we set up with a chief business officer, a chief academic officer, and a chief clinical officer. Those weren’t the actual titles. When you’re the president, you don’t know, because unless you’re really doing a terrible job, people aren’t going to come tell you that you ought to be doing something differently. At least they didn’t here very often. They’d give me advice, certainly. If anyone had a problem, they knew who was accountable for the solution and who to go to. If you were doing research, you went to the person that we began to call the dean and the provost. If you were trying to develop a clinical program, you went to the person we’re now calling the physician chief. If you had anything to do that required money and space, you went to the people working under the chief financial and business officer. As long as the 4 of us were in sync, it seemed to work out fine. I met with each of these 3 individuals one-on-one every week, and the agenda was what’s going on that could be a problem, and what are you doing about this or that? Then we’d meet as a group and discuss things, and for most of the time, there were very few surprises.
Tacey Ann Rosolowski, PhD:
How would you describe the relationship that you had with this team? How did your personalities balance and working styles balance?
John Mendelsohn, MD:
Overall different, but I think we locked arms. When the rubber hits the road, we’re the ones that are accountable for achieving this vision, and let’s help each other do it. It was very collaborative.
Tacey Ann Rosolowski, PhD:
Can you give me an illustrative example of that collaboration?
John Mendelsohn, MD:
We wanted to grow our research programs, and there was initially a tremendous emphasis on making sure the hospital and the clinics were okay. We put up a new faculty center for physicians’ offices and their support staff, we raised the funds to put up the Mays Clinic, and we expanded the resources for imaging. We had 1 new research building, the Mitchell Building, that went up but to make a major growth in our research, we had to think about putting up buildings for which we had no adjacent space at the time. This is when we considered going to the South Campus, and that was a big deal. It was a mile and a half away. In the UT system, it had been considered a big deal when we started building across Holcombe Boulevard, put up those walkways, and you sometimes have to walk 10 minutes now to get from 1 clinic to another area. It’s supposedly better for your health; although I see the same obesity problems here I see everywhere, unfortunately. It has to do with fructose more than walking, I think. The South Campus took a lot of give and take and planning, because it was a big change in the community and a big financial investment. We had to put the clinical activity in proton therapy down there. And we had to make decisions about which research programs would go there and how we would bundle them together so it made sense, because they are a mile and a half away. There were a lot of meetings, and it worked out pretty well.
Tacey Ann Rosolowski, PhD:
I want to come back to the story about Research Park again, but it seemed like that was such a key working relationship to have this team of individuals who were really in sync about the vision, and then to have that sense of transparency that they were getting the ear of individuals who were coming up with new ideas for new programs or to get the feedback from the front lines about how things were happening on the ground. In terms of growing those 4 dimensions of the institution, how would you tell the story of how one grew a bit and then the other grew a bit? How did you 4 manage that process?
John Mendelsohn, MD:
Of course, the main growth was in clinical care and research, and in the clinical care area there was pretty much a consensus on how to grow. We wanted to continue to emphasize ambulatory care. We wanted to create an ambulatory environment where the doctors were grouped together by the type of cancer, and the Mays Clinic made this possible. When you go to the Nellie Connally Breast Center, you’re entering an area the size of a football field that only deals with breast cancer and has 1 hello window. Now they have more, but it started out with 1 hello window. The breast cancer patient checked in there and saw all the people that they needed to see.
Tacey Ann Rosolowski, PhD:
Was instituting that at MD Anderson in the wind nationally? How innovative was that?
John Mendelsohn, MD:
It was in the wind nationally, but we were doing it much more aggressively and in a more committed way. Now, let me say that in the average hospital you couldn’t do what we did. The average hospital had to build hello areas for heart disease, lung disease, kidney disease, brain disease, gastrointestinal disease. There are huge competitive influences. Every one of these clinics, except for 1 clinic that’s called General Medicine Clinic are dealing with a kind of cancer, so it was easier to do here. It was a commitment that we made. We tore down walls. We redesigned things. As I mentioned, we pulled doctor’s offices out of the clinic and put them in a separate building, because if you’re going to have a clinic that has surgeons and medical oncologists and radiotherapists there, they can’t all have their offices in that area. Previously, many medical oncologists had their offices in the area. It involved a whole lot of planning, but on the clinical side, I think there was a pretty good consensus on what we wanted, and it was started before I got here. I really want to give credit to the people that planned that. I certainly had a role in moving that along, but this idea of reorganizing care came up through the faulty and some of the faculty leaders. Now in the area of research, there are infinite opportunities. The way Dr. Margaret Kripke and I handled that was to have meetings and listen. When we finally made the decision we were going to have a south campus and we were going to pick out some areas to emphasize, then we solicited from the research faculty leadership: what do you think we should expand in? And my question was: what are the areas that are ready for growth and research that MD Anderson already has strength in so that we can become leaders? We don’t want to take on something we’re going to be 10th best. And where do you think that there could be an impact on patient care if we expanded that research area? I think we got a list of 40, and we had a series of 4 or 5 meetings, each of which lasted a few hours. We appointed champions of each of those areas, and we went through and we boiled it down to 5 or 6. The faculty knew that there was going to be a fair amount of money put into the selected programs and the new space. Honestly, I got no complaints, because the faculty felt that a fair selection process had been put in place and this wasn’t top-down. This was a consensus built out of their own leadership. They accepted the fact we would expand in metastasis and immunology and in experimental therapeutics. This made sense in the overall mission of being the number 1 cancer center, so they were very different processes.
Recommended Citation
Mendelsohn, John MD and Rosolowski, Tacey A. PhD, "Chapter 10: Growth in Research and Clinical Care" (2012). Interview Chapters. 1426.
https://openworks.mdanderson.org/mchv_interviewchapters/1426
Conditions Governing Access
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