Chapter 17: Transitions under Ronald DePinho and the Seeds of Shared Governance

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Chapter 17: Transitions under Ronald DePinho and the Seeds of Shared Governance

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Dr. Hicks shapes his response to a question about shifts in MD Anderson culture under Ronald DePinho by discussing the Committee of Division Heads that he chaired in 2012. He explains that the committee meetings first functioned as gripe sessions, but by 2012, the committee decided to be solution oriented. They addressed the lack of trust between these levels of leadership by sending an invitation to the executive committee and Dr. DePinho to come and talk to the division heads. He sketches the topics discussed and noted that Dr. DePinho and the Executive Committee attended the meetings when they could.||Next, he sketches landmark moments in the disintegration of leadership relationships which reached a low point in 2015, when Chancellor William H. McCraven took action. Dr. Hicks talks about the causes of the morale problems among faculty and notes his personal view of how frustrating the situation was at that time.||Next, Dr. Hicks explains that the Division of Diagnostic Imaging began to look seriously at the issue of leadership, shifting perspective and viewing leadership within the Division as an institution-wide role. He notes that there was a growing desire to help the division heads make a difference with leadership as well as growing frustration that the executive leadership was not listening to genuine concerns, a situation that resulted in an increased lack of trust, disempowerment. Dr. Hicks discusses many aspects of leadership style and how this factored into growing problems at the institution. He explains that it is important for a leaders to let go of the desire to micromanage, to trust lower levels of the organization to do what is best. He also notes that leaders can give in to the temptation to not show they don’t have expertise in an area.||Dr. Hicks then discusses the problem of siloing in at MD Anderson and gives an example of how silos prevented solutions from being implemented to resolve financial difficulties stemming from the transition to Epic.||He ends this chapter by noting that Hurricane Harvey (2017) was a “stress test for shared governance.”

Identifier

HicksM_04_20180724_C17

Publication Date

7-24-2018

Publisher

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

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Institutional Change; Leadership; On Leadership; MD Anderson Culture; Working Environment; The Business of MD Anderson; The Institution and Finances; Overview; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Ethics; Critical Perspectives on MD Anderson; MD Anderson History; MD Anderson Snapshot; Portraits; Multi-disciplinary Approaches; Research; Research, Care, and Education; Survivors, Survivorship; Patients, Treatment, Survivors; This is MD Anderson

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

T. A. Rosolowski, PhD:

Now let’s go back a little bit, because we got the financial timeline, obviously the news that everybody’s getting. I remember sitting in staff meetings getting this depressing news about the institution’s state month after month. What was going on in terms of any shifts that you might have seen, or maybe there weren’t any, in the culture, and the perception of the relationship between frontlines and leadership. Then, as the second story with that, what was happening at the department and division level to try to intervene.

Marshall Hicks, MD:

Right. Around the time that Ron came, which was 2011, I had been division head for about a year and we were in the process of having several division heads retire, turn over, and I was one of the first, I think. The division heads used to meet as a group and talk about their topics, but it was pretty clear that if we were going to make some progress on some of the issues that we saw, from our perspective, we needed to have a partnership with the senior leadership, Executive Leadership Team. Frankly, it was a complaint session. Then because of the turnover and some of the division heads retiring or stepping down, the chair of the committee fell to me, because I’m kind of the only one who hadn’t done it before. Tom Feeley, who was also the vice chair at the time, also felt very strongly that we needed to be more proactive in really reaching out and trying to be solution oriented and not just a complaint group. So we reached out actually, to Leon Leach [oral history interview], we invited Leon to come. He was executive vice president for Business and Finance, and we talked about some of the issues that we saw. Leon, we said, would you be willing to talk about these again and continue to help us work towards solutions? And we would have an open invitation to any of the EVPs and the president, if they wanted to come talk to us. Leon is credited –he not only said yes, but really went and advocated and garnered support for them coming. And so very soon after that, we sent a formal letter, I think, in the fall of whatever year it was, it might have been 2012 I suppose, and they started coming to our meeting on a regular basis. The reason we felt that was important was it felt like there was a lack of trust between the different levels of the organization, between the EVPs and division heads. Even I could see it. I think most of us could start to see it between the president at the EVP level, that there was starting to be some lack of trust there as well and it led to some changes at the EVP level. To everyone’s credit really, we kept meeting, kept talking, and that became really, a major forum for bringing up issues, discussing issues. It wasn’t --you wouldn’t find it on any org chart, but it was an important way to help build trust between those levels of the organization, and so that went on really for a couple of years.

T. A. Rosolowski, PhD:

I’m sorry to interrupt you but, if you feel comfortable with this, can you share some of the topics that came up during these meetings?

Marshall Hicks, MD:

Let me think back. I think it was, a lot of it was centered around some of the cultural things, the engagement of people feeling disenfranchised, around some of how we manage policies. Whether it’s issues around promotion and tenure or whether it’s around some of the travel policies, communications, things like that or as well, long-term strategy, even things like the long-term capital plan. Things like that where it really was areas where we didn’t, as division heads, didn’t feel all that informed about how these decisions were being made. Also offering to give input, give advice from our perspective and to have them understand, as a big part of the organization from the clinical divisions, where we perceive there to be some challenges and then opportunities as well for improving. So it was a gamut of things. It really wasn’t—it was more about the building of trust and the process than it was about the topics in and of themselves, because we were at that point in time. Ron and EVPs would come, essentially every one when they were in town.

T. A. Rosolowski, PhD:

Wow.

Marshall Hicks, MD:

And so it was a good discussion, and we thought it was a good way for them to listen in on what we were hearing and what we saw in the organization, our perspective, so that it better informed them in decision making as well. Then for us, being able to take what we could back to our divisions from a communications standpoint, and help improve that.

T. A. Rosolowski, PhD:

In terms of the timeline, moving towards 2017, you talked about Epic. Were there some other key landmark moments in the timeline that kind of created problem for the institution?

Marshall Hicks, MD:

So probably, dating back about a year before, that was, we were talking about some of the cultural issues or the changes and “morale” was the big word at the time. This was probably spring and summer of ’15. We had a new chancellor. Chancellor [William H.] McCraven had just assumed his role and there was communication back to him about concern with morale at the institution and it was pretty openly talked about.

T. A. Rosolowski, PhD:

What did you feel were the real drivers behind that problem with morale?

Marshall Hicks, MD:

I think some of it was a disconnect, not feeling like there was—people who were on the frontline in particular, were being listened to or understood or valued. I think a lot of it was about feeling undervalued. I think everybody, it seemed like, felt like they were—you know it’s always easier to look over and point at somebody else who has it better and say, well we’re not getting the resources that they’re getting.

T. A. Rosolowski, PhD:

Did you feel that there was a real basis for that feeling in any way?

Marshall Hicks, MD:

Hard to know. I think once you hit probably a tipping point with morale, that it starts feeding itself, you know some of the issues and the perceptions and misunderstandings and misperceptions. It takes a lot of communication, a lot of work and a lot of effort collectively and people have to feel like they’re engaged, I think, in order to kind of break that cycle. I think we were in just a cycle at that time where it was hard to break out of. People didn’t feel like they were as valued. Particularly on the clinical side, I think felt like they were shouldering a lot of the burden with regard to the expenses for research, so it became a divisive issue within the organization and that was unfortunate. It’s sort of always been that way, but I think when you get into situations like that, where the morale is already tainted, that it kind of feeds itself or it becomes something that people will point to or feel that it’s not fair. It was hard, it was hard to understand. I remember at the time, we didn’t have any discussions with Ron and EVPs about how to—ongoing debates about how to improve morale. It’s not an easy thing to do when you’re in the middle of it. But as we probably learned over time, a lot of it is the communication and the willingness to listen and engage, and have people feel a part of their destiny and to feel like they have collective ownership over where we’re going, was I think ultimately what helped get us out of that. At the time, there was distrust. People didn’t feel like they knew where all the money was going, where all the money was being spent. Even though there were efforts of trying to be transparent, it wasn’t always --the trust was gone, you know? So then it’s hard to rebuild that morale without the trust. I think part of it, when you rebuild the trust through communication and openness and transparency and engagement, it takes time, but that trust—there’s good people here and they want to trust. It just takes a little time and it takes a lot of effort. That’s kind of where we were.

T. A. Rosolowski, PhD:

It was interesting because obviously, I started interviewing people just before Dr. DePinho came, and then interviewed through his honeymoon period, and then through all of this. The phrase that kept coming up over and over was, This isn’t the same institution any more, I don’t recognize this place any more. There was a sense that there was something very substantial going on, that the people who had prided themselves on really contributing to making MD Anderson the place that everybody wanted to be at, that somehow that was slipping away. That is pretty subtle, and there are a lot of wheels that have to be in motion to make that happen, and it’s very tough to turn it back around.

Marshall Hicks, MD:

Right.

T. A. Rosolowski, PhD:

I can’t even imagine having to create a plan to do that.

Marshall Hicks, MD:

That’s a good descriptor of the times.

T. A. Rosolowski, PhD:

Yeah, it was very, very tough. What was your feeling about what was happening, I mean just the personal view of what was happening at the institution?

Marshall Hicks, MD:

I think it was frustrating for me and I know for my division head colleagues, as we filled those positions. I think that was a transition time from a leadership standpoint as well: that we started to look at leaders in the divisions as a leadership role, an institutional leadership role, and not just a divisional leadership role, that a lot of their focus should be up and out and working with the institution, working with each other. That there’s a sense that we’re going to make it through any challenges going forward. There were certainly many outside, as well as many that were inside at the time, we had to be working together.

T. A. Rosolowski, PhD:

Was this around the time the division started your own in-house leadership training process? How did that timing work out?

Marshall Hicks, MD:

That one I’m not sure about.

T. A. Rosolowski, PhD:

Okay. I was just curious, you know, because you really took the bull by the horns and sort of created your own in-house.

Marshall Hicks, MD:

Oh, within the division.

T. A. Rosolowski, PhD:

Yeah, for the division.

Marshall Hicks, MD:

It was actually a little bit after that, so this was probably—yeah, I’m sorry, I thought you were talking about something more institution wide.

T. A. Rosolowski, PhD:

Oh no, not the faculty leadership but your own in-house.

Marshall Hicks, MD:

The in-house was a little bit later because of some of the, probably because of some of the experiences that were going on at the time.

T. A. Rosolowski, PhD:

Absolutely.

Marshall Hicks, MD:

I think collectively as division heads, the role was changing to be more of an institutional leadership role, instead of more siloed in our divisions. It was how do we solve these problems together and realizing the impact we had on each other by our actions and decisions. That was also --I think the next extension of that was then reaching out to the institutional executive leadership, the president and the EVPs, as part of that engagement. That was a process we were going through but, yeah, it was frustrating because I think we all wanted to help. No one wanted leadership to fail and we were all trying to do what we could. We also, I think expressed some frustration about not feeling like we were being heard or listened to as well, because many of us had been here a long time, knew the institution well, and could identify some things that could be done to help not only financially but from a morale standpoint.

T. A. Rosolowski, PhD:

What do you think was the reason for the tone deafness about that. Oh that’s kind of a value judgment! Those messages weren’t going through. Why, do you think?

Marshall Hicks, MD:

I think some of it is that there’s a perspective when you are at an executive level position sometimes, that you can see things. You have a view that maybe gives you an ability to see solutions that no one else can see and that this is the right thing to do, instead of listening to those that are really at the frontline or really dealing with some of the issues, who know the problems well and can come up with solutions. I think it’s a human nature thing. People at that level want to fix things. I think it’s a pitfall of leadership frankly, that’s easy to get into if you aren’t willing to listen and aren’t willing to hear what’s going on out in the organization but also what are some solutions that people would have.

T. A. Rosolowski, PhD:

I mean it seems like a real delicate balance adding up to a big challenge. I mean, you’ve said yourself, and I’ve heard it from other people who said that every time you move up a leadership role, you effectively are operating in a different institution and you’re seeing it from a very different perspective. There is reality in that and you have to make decisions based on very different priorities from the people and the levels of leadership underneath you. So how to balance that.

Marshall Hicks, MD:

Right, yeah.

T. A. Rosolowski, PhD:

The information coming from below versus what you’re seeing at your particular level, I mean that’s a very tough thing.

Marshall Hicks, MD:

It is, and inherent in that is the trust that you have to have: people that are reporting to you are telling you the truth about what’s really going on out in the organization and empowering them to come up with solutions. I think that led to some of the perception of being sort of top down decision making: they don’t trust us, and we don’t feel empowered and hence, we’re disenfranchised, disengaged. Yeah, I think it’s --no question it’s a style thing too. Some people are more inclined to micromanage and some are more willing to delegate. I think to me it’s one of the differentiators in evolved leadership, is the ability to delegate appropriately and to trust and empower. It certainly not only develops leaders and empowers leaders and creates that engagement that has a positive influence on morale, but it also allows you, as a leader, to be much more effective broadly. Because if you micromanage or get too narrow into what you’re trying to accomplish in a particular area, you don’t have the bandwidth to be able to manage more broadly. So you’re leveraging all the talent, the brilliance of the organization that’s already there, to get more done and to be able to be more effective. That’s one thing that’s always been hard for me to understand totally, and I think it gets to be a little bit of a style issue or a feeling that I need to be more in control. It could be too, I think there’s a temptation when you don’t have all the answers or all the expertise. Sometimes people don’t want to admit it or show it, and people can dig into what they think may be the right answer and ignore help sometimes too. It’s complicated just because it’s people.

T. A. Rosolowski, PhD:

Yes.

Marshall Hicks, MD:

There’s no question everybody was trying hard and everybody wanted the institution to be successful and it was frustrating at so many levels when we were struggling, not only early on, with sort of the morale issues, but it then developed into the financial challenges as Epic came along, and they were related frankly.

T. A. Rosolowski, PhD:

Oh really? How so?

Marshall Hicks, MD:

I think when morale is poor and people feel like they don’t, they’re not really part of the organization, when you try to adapt to a challenge like Epic, people vote with their feet but they vote with their productivity as well and their willingness to go the extra mile. I think it’s a fatigue thing too. When the morale is low it’s hard to get motivated. I think everyone was trying hard to help the patients here, no question about that. But it’s how much can you do, it’s just fatiguing. I think again, as I mentioned before, I think structurally, we were so siloed, which I think contributed to poor morale. But we were so siloed that when we needed to adapt to Epic and find solutions, it was tough to reach across those siloes. It really wasn’t happening. And not only at the highest level but at the lower levels too. It eventually started happening at the lower levels, when people would find each other, find solutions and share them. But it really needed to be happening at much higher levels to be setting an example and to be really, much more impactful across the institution.

T. A. Rosolowski, PhD:

You know I think a lot of people don’t know what it means, the siloing here at MD Anderson. One of the things I’ve heard from interview subjects who have come here from other institutions is they say, “Oh wow, the first thing I really had to learn was that this is a very siloed institution, and that changes or influences just how you can get things done.” I think there are a lot of people who have come up in this system, spent a lot of their career here and it’s almost like it’s so much part of the culture they don’t see it. Can you give some examples of kind of jumping over those silo divisions? I mean it may be that they’re just minor and you don’t have an anecdote close to hand, but was curious if there was something you could think of that could demonstrate the siloing and then maybe how it was overcome.

Marshall Hicks, MD:

Coming out of Epic is an example I mentioned earlier. One of the solutions that was proposed was well, we just need to see more patients. But the reality was that we couldn’t get patients cleared financially to come in. That takes coordination between the clinical enterprise and the business enterprise. There wasn’t that connection, that talking, to be able to even recognize that that’s a problem we both need to solve together. It was finger-pointing. It was it’s them and it’s them. That was a classic example. And even trying to get the highest levels of the organization to talk to each other. As division heads, we appealed for that. Didn’t happen. And even pointed out that that was contributing. So it’s pretty deep seated and I think it was facilitated by the structure that we had, the EVP structures. Even though I think that they all probably got along, it’s just it became somebody else’s problem and not our problem when you’re in that sort of situation.

T. A. Rosolowski, PhD:

Do you think that’s changed?

Marshall Hicks, MD:

Well, it changed when we flattened the organization. But you know, one of the things we wanted to do last year was to engage people more, to make people feel like they had ownership. By flattening the organization, we did away with the EVP structure. Part of that was to have very visible points of responsibility and accountability across the organization, so you knew who you—and encourage you to go straight over to that person. Not have to go up and then over a silo and then back down. It was being able to matrix across the organization. Go straight to where you needed to go to, whether it was somebody in the clinical enterprise talking to somebody in the finance side of the business group. So that it was very visible who I needed to go talk to and empowered to be able to do that. I think that’s what also --our stress test became [Hurricane] Harvey. That was an example of how people were willing to just retry to cross and talk to each other and communicate with each other directly, as opposed to having to go up through some chain of command and then over, and then it’s too late to do what we needed to do to get food in here, to get people in here during Harvey or do whatever we need to do. To me that was our stress test of the organizational change and some of the cultural changes we were trying to do, of people feeling engaged and feeling like they had ownership of our destiny.

Chapter 17: Transitions under Ronald DePinho and the Seeds of Shared Governance

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