Chapter 20: A New Administrative Structure and Lessons Learned from Working with the McChrystal Group

Chapter 20: A New Administrative Structure and Lessons Learned from Working with the McChrystal Group



Media is loading


In this chapter, Dr. Hicks reflects on leadership lessons he learned by working with the McChrystal Group. CLIP: He explains that he learned to see decision-making as a disciplined process and details what he means by that, giving an example of a failure of process that led to poor decision making. He then discusses the importance of using a rational process to create alignments between teams and working group.||

Next, Dr. Hicks talks explains the rationale the Shared Governance Committee used to transform MD Anderson’s administrative structure, creating a more functionally driven structure aligned with new operational priorities.



Publication Date



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


Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Overview; Leadership; On Leadership; MD Anderson Culture; Working Environment; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; MD Anderson History; MD Anderson Snapshot; Institutional Mission and Values; Understanding the Institution; The Business of MD Anderson; The Institution and Finances

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.


History of Science, Technology, and Medicine | Oncology | Oral History


Tacey A. Rosolowski, PhD:

A couple of questions. The first one is in your work with all the McChrystal Group, how did your perspective of the institution change and what did you learn personally from that process?

Marshall Hicks, MD:

A lot. First, understanding how important it is to be open and be transparent in how we make decisions and understanding that decision making is a process where you want to make sure you’re getting the best input, but you establish the rules upfront. So you establish what data you’re going to use, who is going to be involved, who the stakeholders are --getting all of that structured upfront so that the end result is inputted by all the right information. So it’s really understanding that the best process for a decision making journey if you will. And understanding that that often involves disagreements and abilities for people to bring up different points of view. You want that, and it’s all part of the healthy dialogue that goes, on but it needs to be done professionally and respectfully, and structure meetings around that.

Tacey A. Rosolowski, PhD:

So how was this understanding that you came to different from your understanding of decision making before, because obviously, an administrator’s life is just decision making, decision making. What was different about this?

Marshall Hicks, MD:

The key point for me and for all of us was the discipline around it, adhering to the discipline. Don’t cut corners, go to the effort upfront, to define again what data you’re going to use, and make sure everybody is in agreement with that. Making sure that you have a process for incorporating all the stakeholders. You know, that was a big flaw for us in the past. We wouldn’t have all the stakeholders in the room or we would assume what their interests were. HipLink was a great example of that, HipLink, which was our paging system that we adopted temporarily. It replaced all of our pagers and it was basically an iPhone application. We bought all these iPhones and it was I don’t know, $6- to $8 million worth of investment. It turns out it didn’t really serve the function of being able to page people in certain areas of the hospital. It didn’t allow for emergency codes, code-type paging reliably. It didn’t allow for group interactions like we had before with the BlackBerries and pagers. The functionality of it wasn’t what was promised, and so we ended up having to go back to the regular old pages for a while.

Tacey A. Rosolowski, PhD:

After millions spent.

Marshall Hicks, MD:

After millions, and that’s not even including the time and effort of training of people trying to understand it. It was because the right stakeholders weren’t in the room at the very beginning. We didn’t define what we wanted out of this. We didn’t say, hey, what are the—what is it that we want to be able to do with this? And to be clear about that from the beginning. A lot of that –weren’t disciplined around it, because I think it’s as simple as that in a lot of ways. If you have the discipline to do all these things and structure it that way, get the right information to people, get the right people in the room, promote the right kinds of conversation, come up with options. You know it’s not just one solution that everybody has to agree to upfront. It’s let’s come up with some options. Let’s discuss those and come up with them and just have a process that is clearly defined. There are clear expectations around it, you’re going to make better decisions and that’s best for the organization.

Tacey A. Rosolowski, PhD:

I’m thinking too, I mean there is just the impact of a failure like that. That people get mad. They’re annoyed at the waste. They’re annoyed at the time, and in a scenario where there are already issues of trust and transparency and people feeling disempowered. I mean each little one chips away at an eroding morale.

Marshall Hicks, MD:


Tacey A. Rosolowski, PhD:

So saving everybody all of that stuff.

Marshall Hicks, MD:

Well, and you can multiply that times a number of things. And it’s like how are these decisions made? Somebody is making them, and didn’t ask for input from the right people and were just yeah, and it’s a lot of wasted effort and time, and then frustration as you said, the whole thing just really, it erodes morale and trust and leadership.

Tacey A. Rosolowski, PhD:

Were there other kind of key, big key takeaways from the McChrystal process for you?

Marshall Hicks, MD:

It was understanding that as we looked at how we would create these alignments that we were fairly inefficient. People would go around to different groups and present and then get approval from all the different groups and then you’d get recommendations. Then the next thing, you know you change it. So then you had to go back to make the rounds again. So it was very inefficient of understanding how the linkages are important and clearly defining the processes and decision space around that. Who is going to make this decision, who owns it, who else is working on things, trying to streamline that within the organization? But then the way we reorganized and flattened that structure, it made it much easier to know who is responsible for what area. You didn’t have these major siloes that were fairly structured in a way that they were fairly hard to penetrate at times, unless you went to the very top and had the people there talking and then it would go back down. I can just go over there to that person and talk to them because they’re in charge of this or that, and I know who is in charge. And then when you create your committees or groups, or as we started to form particularly the operational priorities --as we got into that, which was a big outcome of the McChrystal effort-- that we knew who needed to be on those groups because you could pull people from the different components of the organization. It was flat, it was transparent, it was easy to see who needed to be involved. So that was part of the work with them as well. You had a day and a half retreat that SGC went to, in Alexandria, Virginia actually. We assessed that because we knew it was going to be expensive to do. But we voted on it and we all agreed that we needed to do it. It was more expensive not to do it than to do it if we continued on. It was minimally cheaper to do it here than in Alexandria, because they would have had to brought a number of people here in the facilities and so forth, and it was great. We actually did a monument walk at five o’clock in the morning, six o’clock in the morning, with them, with physical training. Some of us did the run, some did a walk. But you went around and they would teach you about all the different monuments on the walk, and the symbolism there and all that. So it was a bonding experience for the group too, to go away and focus on this. What come out of it really, was relooking at our mission and vision and --I think we were comfortable with that and we wanted to do a little word-smithing but in the end decided we were pretty comfortable with what we had. But then established the seven operating priorities, which were things that we felt that we needed to be doing in the next several months to get ready for the new president coming in and to get to right the ship. That was the main outcome of the retreat, was to establish those things.

Conditions Governing Access


Chapter 20: A New Administrative Structure and Lessons Learned from Working with the McChrystal Group