Chapter 19: The Shared Governance Committee: the McChrystal Group’s Recommendations for Change

Title

Chapter 19: The Shared Governance Committee: the McChrystal Group’s Recommendations for Change

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Description

In this chapter, Dr. Hicks reviews the assessment that the McChrystal Group performed (2016) to support the Shared Governance Committee as it restructured MD Anderson [document in Supplementary]. He reviews their key points: a lack of trust and transparency; siloing and lack of alignment; problems with accountability; and problems with communication. He also sketches how the McChrystal Group worked with the SGC beginning in February of 2017 to the end of that year to align groups and determine a new governance structure to facilitate transparency.

Identifier

HicksM_05_20180829_C19

Publication Date

8-29-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; 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

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:

I just wanted to say for the record, it’s just three o’clock on the 29th of August, 2018, and I’m here for, I believe it’s our fifth session.

Marshall Hicks, MD:

I think so.

T. A. Rosolowski, PhD:

Yes. With Dr. Marshall Hicks. And so I want to thank you for making time.

Marshall Hicks, MD:

Thank you.

T. A. Rosolowski, PhD:

I’m enjoying our conversations, so. [laughs]

Marshall Hicks, MD:

Me too.  

T. A. Rosolowski, PhD:

It’s certainly taking us through a fairly dramatic period in the institution’s history, which is important to reflect on. After we turned off the recorder last time, I believe it was --you had mentioned that you wanted to speak a little bit more about work with the McChrystal Group. So I did want to start by returning to that, if that’s okay with you.

Marshall Hicks, MD:

Sure.

T. A. Rosolowski, PhD:

One question I had was did—was the McChrystal Group called in first to meet with the division or was it specifically for the Shared Governance Committee?

Marshall Hicks, MD:

For the Shared Governance Committee.

T. A. Rosolowski, PhD:

Okay, okay.

Marshall Hicks, MD:

I just happened to be the contact because Danielle’s friend was working for McChrystal Group at the time, it was a friend that Danielle had, Danielle DiMonda Hay, had known from Long Island when they were crawling together. She had given me the book, Team of Teams, because she had met McChrystal through one of the events; her friend was the events coordinator for McChrystal Group at the time. She gave me a book, Team of Teams, I read it and I thought, there’s some things we could probably learn here, some similarities. I just made a comment to her, it would be great to get him here, and she said, “Well, I’ll see what I can do.” The next thing you know, he was agreeable to come and talk to the institution. So he gave a talk to an invited group of leaders and directors that we provided. We got 500 copies of the book, gave them to everyone.

T. A. Rosolowski, PhD:

And just as a reminder, we did cover some of this basic stuff last time, so we use our time well and I don’t make you repeat things.

Marshall Hicks, MD:

I’m sorry.

T. A. Rosolowski, PhD:

No, that’s quite all right.

Marshall Hicks, MD:

Yeah. But his condition --I think I may have mentioned it before, where he wanted to meet with the leadership group of the institution, which in this case was the SGC. So the main focus of their work --he was brought in to work with the—to talk really, and then to meet the SGC. Really it was the work with the SGC, was what was going to be the focus of the McChrystal Group efforts here.

T. A. Rosolowski, PhD:

Okay, and the approximate date of this?

Marshall Hicks, MD:

This was in March to April of 2016, I guess.

T. A. Rosolowski, PhD:

Okay. Because I’m just looking at the timing of when you were—so we have a number of months yet before you’re asked to step in as interim.

Marshall Hicks, MD:

[00:003:04] About a year. What happened over the course—I mean he had talked to—Stan McChrystal had met Ron [DePinho; oral history interview] separately during that trip, talked to him a little bit. There was interest there. They had communicated a little bit about them coming here and engaging. Stan had offered to send two people, General Vines and General Huggins, here to do an assessment. That was finally accepted, that was finally agreed upon. It was also the SGC, Shared Governance Committee, subcommittee on, I believe it was culture, governance and communication, that had continued to meet, as I had mentioned. So they kept the flame alive with this and ended up helping to host Generals Vines and Huggins, when they came in September of 2016 to do an assessment. They spent seven days here, I believe it says in the report, and then they generated a report on September 27th. I’ll give you this copy of it. Through their assessment, they interviewed a lot of different—they attended a number of forums and conducted 27 interviews, a lot of leadership, different individuals throughout the organization came up. That’s how they generated content for this.

T. A. Rosolowski, PhD:

So the levels of the individuals that they interviewed were pretty much, was it division head above? Department head above? How did that work?

Marshall Hicks, MD:

It was, I would say probably department or center director, CAD level in the centers. I think they met with a couple of them. Danielle can probably get you a list. She helped coordinate it. Some of it was availability but also, we wanted to expose them to a center that ran pretty well and maybe a center that didn’t run so well. And different department chairs and different individuals, division heads, they met with the division head group. It was trying to get a broad swath of the organization’s research people as well. To have them really try to understand, in a very short amount of time, but I think they nailed it. They really hit it on the head.

T. A. Rosolowski, PhD:

Did you want to identify the key points that they made?

Marshall Hicks, MD:

Really, they’re two, as they list here. The most consistently identified issues had to do with trust and transparency, and that was certainly something that even the Shared Governance Committee, as we talked about these issues in our subgroup, were things that we were concerned about. Those were the two big ones, but the other ones they identified were this lack of alignment. Particularly a lot of siloes in the organization. Accountability, ambiguity around roles and lack of accountability throughout the organization. Then this group thinks that accountability as well, you have to come to—you have to be in agreement. Everybody has to agree, and so nobody wants to disagree. So you didn’t have the richness of ideas and discussion around a lot of things. And then communication was the fifth thing, was really --channels up, down, across were really pretty inconsistent, so information wasn’t really shared, particularly in the bottom up way, to be able to get a real read on what was going on in the organization.

T. A. Rosolowski, PhD:

Now let me ask you, because I do recall, when you were telling a story about the subgroup that you remained a part of, you guys were kind of the black sheep of the Shared Governance Committee because the rest of the group really wanted to focus more on very practical, logistical sorts of things. This report isn’t addressing it from that perspective, so what was the reception to this report at the time?

Marshall Hicks, MD:

I think there was, even though our group kind of continued on, there was a general sense within the group that all these things that were mentioned … Once we shared the report with them and I think the report came to the subcommittee, we read it, discussed it with General Vines and Huggins and we put it forward and proposed that they work with us according to their—we put together a proposal on what they would do with this. The general sense is here but there were more specifics that came in the contract. There was pretty uniform agreement at the Shared Governance Committee that we needed to do this, that even though we had made some progress, we still weren’t where we needed to be as a Shared Governance Group and also as an institution. I think the trust and transparency issues were the cloud hanging over everything around that. So it was felt, as we read through this, that what they were proposing to do, a lot had to do with restoring trust and part of that is through transparency and the openness, and creating a culture where we want people to be able to bring up their points of view, even if it’s a disagreement. You realize that as a governance group, once we make a recommendation or decision were all supportive, but up until that point, we want that discussion to understand. As General Vines used to say, we have a moral obligation to bring up things that we perceive as risk for the institution or things the institution needs to know to make a decision. If we don’t do that, we’re not going to be likely making the best decision for the institution and understanding the risk or alternatives. Sometimes things would come, there was a sense, as you’ll see in here, the SGC agenda was sort of manipulated. That’s the word they used actually, that things would come there only if they would come already decided.

T. A. Rosolowski, PhD:

Interesting.

Marshall Hicks, MD:

It was felt that there weren’t option. There weren’t things being discussed, and it was ‘isn’t it great we all agree.’

T. A. Rosolowski, PhD:

Those pesky consultants, they tell the truth.

Marshall Hicks, MD:

Like I said, they nailed it. I think that was the general sense of the group. There were a few people that said, we don’t really need to do this, we can figure this out on our own. But the vast majority of individuals really sensed that this was an opportune time as well. I got a lot of feedback from the book, Team of Teams. The people that—I was really amazed that people took the time, read it, and said hey, there’s some things that we could apply here, even though it’s a military context and we’re healthcare. People were making that link and saying we have teams in different places. We’re not a team of teams, we don’t really have that cohesiveness, that ability to reach across the organization, work together and have a common mission.

T. A. Rosolowski, PhD:

Do you want to talk about how they worked with you? I mean was there something relevant that can learn kind of about leadership training from that?

Marshall Hicks, MD:

I think what they started primarily working with is they went into these different groups and the different forums and again, their focus was the SGC. But what forums, as they say, supported the SGC? Like the ECOT at the time, the executive committee, executive operations team, yeah, the ECOT. The division heads, the Community of Chairs was just forming. Some of these groups that existed, is helping to sort out what was the purpose of each group. What was discussed there, what were the agenda items, what was the role of those groups? And also the meeting hygiene. How do you run the meeting, how do you make sure that you’re promoting the ideas to be discussed and generate some of the discourse there? It was spending a lot of time as they really got to know the organization better and then started to help us work within each of these groups. A big focus of their efforts was at the SGC level. What should be coming there, what that should look like, how the discussion should be run. Getting prepared for the meeting, sending read ahead materials, making it an efficient meeting, focusing much less on these lengthy presentations but on discussions and creating options in decision making.

T. A. Rosolowski, PhD:

How long a period did the relationship with McChrystal take place?

Marshall Hicks, MD:

They formally started in, I think it was roughly February of ’17, and then went through the end of ’17 really. So it was that first few months of ’17, leading into the summer, is when the bulk of the work was done, through the summer. Really helping us with decision making processes. Creating that alignment between the different groups and really, also helped us understand how we could create an organizational structure that would support the ability to have transparency and the ability to have the integration across the organization. So when we changed the organizational structure and created a group of reports that reported to the president and then a group of reports that reported to Steve Hahn, the idea was that Steve Hahn, as the COO, was involved really, in the day to day running of the organization, whether it was clinical or research, or even some of the business advancement areas and the commercialization areas and things like that. The group that reported to me as president was a support group for the rest of the institution. So we were—that was a group that helped support the ability of the organization to run on a day to day basis. So you’ve got things like HR, IT, finance, institutional advancement, legal compliance, security and different things like that. Facilities,. Things that everyone needs and uses but it supports us as an organization. And of course Steve Hahn reported to me. That was how we structured it. Then Steve had the clinical and research areas coming up to him.

Chapter 19: The Shared Governance Committee: the McChrystal Group’s Recommendations for Change

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