Chapter 10: A Discussion of Leadership Challenges

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Chapter 10: A Discussion of Leadership Challenges

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Dr. Hicks begins this chapter with a few comments on growth in the Section of Interventional Radiology. He then takes the rest of the section to comment on leadership issues. He explains that he was part of the Faculty Leadership Academy, found it extremely valuable, and notes the long-term coaching relationship he established with Fred Schmidt. He talks about working with Dr. Schmidt to develop team alignments in the Division of Diagnostic Imaging.||Next he talks the importance of “in-the-moment coaching” and notes that the Faculty Leadership Academy began his “journey” to develop his own leadership. He talks about the importance of finding support via networks. He explains that he has contacted emerging leaders to support them. He explains his view that there are untapped resources for coaching among volunteers and gives an example of a former patient and volunteer, a highly placed individual at Dell, who was able to speak to MD Anderson faculty about leadership issues.||Session Three: 3 July 2018

Identifier

HicksM_02_20180501_C10

Publication Date

5-1-2018

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The Administrator; Leadership; On Leadership; Mentoring; On Mentoring; Education; On Education; Building/Transforming the Institution; Professional Practice; The Professional at Work; MD Anderson Culture; Working Environment

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Marshall Hicks, MD:

So the section chief evolution. I think as we continued to grow and develop, and a big step for us was moving over to Mays Clinic, allowing us really to develop. It gave us the clinic space for the PAs. We were carving out what we could for a couple rooms in the main hospital. We were able to design actually, a very nice clinic area to see patients, where our PAs and physicians could see them. Really developed very active outpatient service there. Patients loved this great, wonderful facility. Really just continuing to grow the research program, the education program, we were expanding the fellowship, all the different components, seeing people getting promoted, watching the team. We went through a couple of exercises, retreats, where because we’d grown so rapidly and because we had now, so many members of the family if you will, PAs, schedulers, PSCs, nursing assistants, medical assistants, trainees. We were all a family but we’re different members of the family. Learning to help each other to work with other and support each other was something that --the stresses of the day, sometimes you have to really step a step back and get a perspective. So some of these events where we would do that, either social events or retreats where we would talk through some of the things that were holding us back, helped us along.

T. A. Rosolowski, PhD:

Interprofessionalism is such a subject of conversation now and it sounds like maybe you were addressing some of these issues along the way. Can you tell me some of the things that came up and how you addressed them?

Marshall Hicks, MD:

One thing early on, I was given the opportunity to be a part of the Faculty Leadership Academy here, I think it was in the second cohort, second class, and got to know, at the time I think it was Steve Sperling, Linda Thompson and Fred Schmidt were the three that were involved in the classes I was taking. Through that—and Janis Apted, now Janis Yadiny [oral history interview], was really the one that brought them in, built the program and really began to appreciate the practical aspects of leadership, what it takes to help build a successful program, department, within the organization, and I found that extremely valuable. I had been through a little bit of that before but not a lot. I just found it to be very helpful to me as a leader. In particular some of the things you do when you’re talking things through with colleagues and with the facilitators there. I developed a relationship with Fred Schmidt there, who probably I’ve used eight or ten times over the last twenty years, to help really, at every step of the way for me, when I was section chief several times and then department chair, interim department chair for Diagnostic Radiology, division head, and even now. Not only as a coach but also as someone who helps us with team alignments and working through and talking and really understand that we all generally want the same thing. We want the highest quality care for the patients. We’re all connected to the mission, we’re here for the same reason. It’s really, how do we work most effectively as a team, get along, understand each other’s needs and work to really try and share information and perform as a team. We all need each other to be at our best and to provide the best care for patients, to do the best research, the best education, whatever it is.

T. A. Rosolowski, PhD:

Are there certain themes --and I’m not asking for you to talk out of turn or point fingers or anything but these kinds of things are real leadership challenges, I mean everybody confronts these. I’m curious if you have an example of a specific kind of challenge that arose and then what were the tools that you and Fred Schmidt came up with to address them and make things work better for your team.

Marshall Hicks, MD:

[00:40:005] I think there are several examples, but one that comes to mind was a challenge in really keeping up with the timely reading of CT scans when I was the interim chair of Diagnostic Radiology. So this is after I moved on from being section chief of Interventional Radiology. It was a bit of a new world because it’s diagnostic imaging, sort of daily reading, as opposed to procedures. It’s also a situation where we scanned during a large portion of the day, from early in the morning, seven, until eleven at night, and so these scans are being produced and patients are depending on them. A lot of times they have the appointment the next day, and we were behind and falling chronically behind. What was interesting is we were consistently behind by the same number, about 600 exams, and so you weren’t losing ground every day, we were just 600 behind every day.

T. A. Rosolowski, PhD:

That’s funny.

Marshall Hicks, MD:

It is funny. It’s because so many of them get done after five or six, when we didn’t have people here. So it was really working through saying what are the—really understanding the issues as a team, with all the section chiefs of Diagnostic Radiology saying what sort of ideas, what can we do together to address this. We have one particular section that’s struggling with this right now but it could be any of us. What are the tools and things that we need? So it was really understanding where—a lot of it is performance management, it was understanding where—and distribution of having people available to read images. Maybe we needed to think about doing things differently to look at our assignments to be able to continue to stay on top of the reading. Maybe it’s finding electronic solutions to figuring out which patients have the next appointment, and we prioritize those, put those at the top of the list. So I was looking for a number of those things, but what we always emphasized is those solutions tend to come from the people who have the problems, they understand what the problems are and they can tell you. It’s really a lot about providing the support, getting the resources, the technology solutions or talking it through, getting your colleagues’ best ideas, and also sometimes having the tough conversations. The leaders, we aren’t trained really, to have some of those difficult conversations about underperformance or about why it’s important for you to be here during your assignment, because we’re depending on you to help with the reading, and understand what the issues are in scheduling, having faculty members scheduled two different places at the same time or things like that. What are the issues, and really trying to address it in a non-punitive way but just understanding it a little bit better and trying to hear and listen to solutions.

T. A. Rosolowski, PhD:

It’s funny, when you start to refract a team, a lot of people have no concrete clue of how someone else does their work, and that’s often, that is where the problems lie, is just workflow and getting a sense of all right really, that’s how you—no wonder there’s a problem.

Marshall Hicks, MD:

Yean, and some of the things we do to ourselves, just the inefficiencies we create because we’re trying to solve one problem but it creates inefficiencies elsewhere. I do remember Fred once told me that when you’re dealing with leaders it’s generally --if there’s an issue, a lot of times it’s either a leader being unwilling or unable to be able to do something. A lot of times they’re not able, maybe because they don’t have the tools, the resources, the capabilities. So once you’ve determined that, if it’s the unwillingness that’s a different conversation, but if it’s the unable, they may not be able. They may not have been in a situation trying to manage all the variabilities in scheduling and all the different challenges that the institution or DI is creating by having so many of the exams. It’s great for patients, it’s convenient for patients, to be able to do the evening scanning but it creates a lopsided wheel when it comes to reading them, unless you’re able to adjust schedules. That’s a cultural change, so a lot of times, when you’re dealing with those sorts of changes it’s having those conversations. Helping the faculty members, physicians, to understand the importance of the reading to the patient. Why we need to be able to adjust and do things differently than maybe we have in the past. Because the pressure was on for more patients that would come in, stay for a short length of time but want to try to get everything done --is different than if they’re not in a destination place like this where they get a study done one day and then they come back a week later to get something else done. A lot of patients come from out of town. They want to try to get everything done and it’s understandable and we need to be responsive to that. A lot of it, I’ve found over the years was just the in-the-moment coaching, has been very helpful to me because it’s hard to imagine every scenario. Just when you think you’ve seen a lot of them, a new one pops up and it’s hmm, what am I going to do about this. The ability to be able to talk through that with somebody, particularly somebody who is not here, who you can kind of detach but knows the place well enough --like Fred and others in the Executive Development Group-- was really helpful over time because they knew Anderson. They knew our culture, they knew some of the challenges, but they weren’t—you felt like you were talking to somebody who wasn’t—you had a trust factor there that they’re not within the organization. They don’t have a vested interest in seeing something go one way or the other. It was really helpful to be able to talk through things and to think about the perspective of all the individuals that are involved, and talk that through and understand it. I think a lot of it is not … Leaders here, physicians, we don’t get trained in a lot of these different things of managing people and even managing operations is something generally you learn on the job.

T. A. Rosolowski, PhD:

Yes, yes. Well, we’re actually at four o’clock now and I don’t know how busy you are. [laughs]

Marshall Hicks, MD:

Well thanks.

T. A. Rosolowski, PhD:

Shall we close off for today?

Marshall Hicks, MD:

Sure.

T. A. Rosolowski, PhD:

And then maybe we can talk about your next transition the next time.

Marshall Hicks, MD:

Sounds good.

T. A. Rosolowski, PhD:

Thank you.

Marshall Hicks, MD:

Thank you.

T. A. Rosolowski, PhD:

Very interesting, I mean it’s a continuing refrain that physicians don’t get leadership training and yet how important it is for any institution to have physician leaders, so.

Marshall Hicks, MD:

I think they probably did a really good job with that, in that I think they tried to not only train current leaders but thinking about who is going to be on a leadership post. It was for me, the beginning of a journey, a leadership journey, where I began to realize how valuable it was and how little I knew about it. I had taken some classes with the American College of Physician Executives. Around that time they had some really great programs on managing physician performance, even finance, different things. That’s when I started to get interested in it, and I just couldn’t get enough of it. At the end of the day, I think some of the most valuable lessons that I’ve learned have been through the coaching experience. It’s nice to be able to talk things through in the moment, if you will, because that’s how life happens, in the moment. You can go to classes, you can prepare, you can think about it, but when something really happens to you, you need to talk something through to make sure. Rarely do things happen emergently in leadership, but there is an urgency to some of it, where it’s over the next few days you have to do something, but people will try to create urgencies or emergencies, but most the time you have time to talk it through and think it through, but it’s not like you can wait for your next class two months from now.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

You want to be able to talk it through and make sure that you’re considering the right things and making the right decision.

T. A. Rosolowski, PhD:

Well it’s also you’re in the mist of the experience, which is not just an intellectual, but there’s an emotional part.

Marshall Hicks, MD:

Emotional, that’s right.

T. A. Rosolowski, PhD:

That can cloud vision or make you go to certain priorities that maybe are not the best in the long run.

Marshall Hicks, MD:

Absolutely. And a coach can help talk you through that and help you check into that self-awareness on it, you know I think that’s one thing. I think also, the network that we’ve tried to build throughout the institution is helpful too. Some of my closest colleagues are ones that I met in the FLA or that I’ve met along the way here in different committees or classes, and those are people you can seek advice from and talk things through. I don’t think we do that as much as we could. I think some of that is --I do sense some hesitation with people being entirely open. They don’t want any kind of confidentialities to be breached. I think also it’s a little bit of you’re vulnerable and having somebody that you’ve worked with or trusted is helpful. I’ve tried to do that as I’ve gotten further in my career, sometimes just reach out to people proactively that I see are emerging leaders, have lunch with them or talk to them and try to develop a relationship where they feel like if they need to talk to somebody there’s somebody they can talk to, talk something through. It’s really trying to prevent missteps or things --sometimes those are hard to go back, particularly when they get emotional and new relationships can be damaged, things like that. It’s hard, leadership is hard.

T. A. Rosolowski, PhD:

And it can be isolating too.

Marshall Hicks, MD:

Very lonely, yeah.

T. A. Rosolowski, PhD:

Yeah. So it’s important to have that group of kindred spirits who have gone through the same experiences that you have, who really get it.

Marshall Hicks, MD:

That’s the thing that --I look around and see all the different talent here and all the ability to help each other, and I’ve often wondered how we could do something a little more formal to connect people a bit. Most of the time now it’s informal or it’s just relationships you build. I’ve also wondered about talking the past with Janis and others about --you know we have an enormous volunteer group here and a lot of them, when you look around, you see them helping patients register or the coffee cart or things like that, but there’s probably—and I know a lot of them may be even retired executives, and how can we tap into that. They probably have a tremendous amount of knowledge and experience that they’d be willing to share. Just as much as they’re willing to share a hello when somebody walks in the front door.

T. A. Rosolowski, PhD:

Plus they know the culture and the institution, yeah, absolutely, bright idea there, that’s a good one.

Marshall Hicks, MD:

Well, I’ve been pushing it for a while, I think it’s just a matter of again, back to finding the right person eventually, to really want to help make it happen. We have actually, when I mentioned it years ago to Joey Steele, who was the interim division head when I was upstairs, he actually found a mentor, a guy that used to be at Dell, a senior VP at Dell, who is a patient here, and he’s tremendous. I’ve actually talked to him a few times and as a patient, he came to one of our employee meetings and he talked about how there’s two types of patients here: there’s sort of the new ones, the newbies that need guidance and direction and a certain level of help, and then there’s the more seasoned ones who they kind of know the ropes and they know what they’re doing and need to be aware. Both have different needs and both, they—to be able to kind of manage them or help them differently helps them as patients. But just also just the executive advice that’s given in terms of how you manage leaders and in some ways the predictability of circumstances that leaders can either handle or can’t. How they deal with it and how—and a lot of these things happen repeatedly. For example, the question of when does somebody reach their peak and when is it time to think about something else for that individual, even development. They had a program at Dell where they would reach down in the organization and pull that person up for a while, so they could see. We started to do that with the Provost Protégé Program here a while, so I think there’s some things like that, that we could learn from as an organization, from people like that, how they know it, they’ve been through, they lived it.

T. A. Rosolowski, PhD:

And tried a lot of innovative things which is great, you know why stumble around in the dark and reinvent wheels. Wow, great idea. Well thank you so much.

Marshall Hicks, MD:

It’s good talking to you.

T. A. Rosolowski, PhD:

Good to talk to you.

Marshall Hicks, MD:

Well, I guess I did most of the talking.

T. A. Rosolowski, PhD:

That’s what I’m here for. So, I will just say for the record, I’m turning off the recorder at nine minutes after four. Thank you very much, Dr. Hicks.

Marshall Hicks, MD:

All right, you have a good evening.

T. A. Rosolowski, PhD:

You too, bye.

Marshall Hicks, MD:

See you next time.

Chapter 10: A Discussion of Leadership Challenges

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