Chapter 22: Changing the Institutional Governance Model: Challenges

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Chapter 22: Changing the Institutional Governance Model: Challenges

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Dr. Hicks begins this chapter by reviewing how the shared governance committee was formed (Summer 2016). He notes that a good deal of the transformation process was set in motion when Dan Fontaine, Senior Vice President for Business Affairs, decided to retire. A reorganization was needed to ensure that the function areas and his people would have homes, and this was an opportunity to determine what would be the best structure for the organization. The Shared Governance Committee determined that a flattened structure would address the deep silos and communication issues and offer stability and flexibility.||Dr. Hicks then explains how the SGC worked out the reporting structure. He says that the Chancellor of the UT System liked the proposed structure and also put in place the Chief Operating Officer role to pull the silos together; however this new structure also changed the reporting structure and created stresses for people who previously reported directly to the president. He further clarifies the rationale for the new structure. He then begins to explain that it was very difficult for the VPs and others to take a reduced role.

Identifier

HicksM_06_20181120_C22

Publication Date

11-20-2018

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 - Building the Institution; Leadership; On Leadership; Professional Values, Ethics, Purpose; Professional Path; Evolution of Career; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; Institutional Mission and Values; Understanding the Institution

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’m Tacey Ann Rosolowski and I am on the 16th floor, sitting with Dr. Marshall Hicks, for our sixth session together, as we talk about the complexities of MD Anderson, what it’s going through. Today is November 20, 2018, and the time is about eight minutes after five. Thank you again for your time.

Marshall Hicks, MD:

Oh, you’re welcome.

T. A. Rosolowski, PhD:

Excuse me, eight minutes after four. I never reset my watch from going to Charleston, that was what that’s about. All right.  

T. A. Rosolowski, PhD:

+ So, we were talking last time about the process of implementing the new shared governance system, and I had neglected to ask you at the time, what were your views of that structure, if you had any concerns. What you felt were its strengths, if you had any concerns about how it had been designed. What were your thoughts about how it was actually going to be implemented?

Marshall Hicks, MD:

This was the shared governance structure from the chancellor? [00:1:09]

T. A. Rosolowski, PhD:

Yeah.

Marshall Hicks, MD:

The Shared Governance Committee was formed by him, I guess it was the summer of ’16. It was really just putting representation from different groups on there from the Executive Team, from the Faculty Senate, Executive Committee, and then from division heads on there. It was really to make sure there was representation, and it was formed as the foremost advisory group to the president. But it was an advisory group, and over the ensuring months, really looked at some of the issues that were brought out in the White Paper from the Faculty Senate. We formed subcommittees and groups that worked on these particular issues and tried to bring solutions back. I think it was a good start. We were finding our way and spent some time at the very beginning defining more issues around --I mean defining confidentiality and the rules around that and the principles. I think we probably spent a little too much time on the confidentiality part because most of these issues, there’s nothing really that confidential around.

T. A. Rosolowski, PhD:

I think you may have misunderstood, because we did talk about this part. I was referring to what the Shared Governance Committee came up with in terms of a reorganization administratively.

Marshall Hicks, MD:

Actually, the reorganization was done at the executive level, it wasn’t done out of the Shared Governance Committee.

T. A. Rosolowski, PhD:

Oh, okay.

Marshall Hicks, MD:

The main driver for that, there were a couple drivers for that, but a main driver was the fact that Dan Fontaine had announced his retirement, and he was one of the executive vice presidents at the time who had a huge portfolio essentially, and so there were a number of his key leaders that were—this was I guess in the spring of ’17 and he had announced his retirement for January 18th, and he had a number of people that were wondering what was going to happen.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

And out of discussions with him, it became obvious that his portfolio was huge but how—it was the opportunity really, to look at what was the best structure for the organization and the transition going forward, and a way to also give some reassurance to some of his key leaders, that we value them and wanted to retain them in roles here at the institution. But the reporting structure was a question in how that was going to be done in the interim. So we knew that we also had a situation where we had pretty deep siloes. We had three EVPs and we had a lot of communication issues across those siloes, coming out of Epic, that was one of the perceived main issues, was we had these silos, Business and Finance under Dan, the clinical under Tom Buchholz [oral history interview] and then Ethan [Dmitrovksy; oral history interview] was the academic side, but there was a lot of challenges --working through Epic, where you had the clinical side and the finance side-- that needed to be communicating at multiple levels and it wasn’t really happening as it needed to happen. Finance clearance is an example. Something where you had the clinical teams that needed to be working with finance. That process had been centralized, there were struggles with it. So we looked at the opportunity broadly to say what’s the best structure that could get us through the transition, give us stability but also give us some flexibility for coming out on the other side; and, particularly, transitioning Dan out of that role because he wanted to be able to help with that transition and have that go on during the ensuing months, up to his actual retirement in January, and not have it something that was left to us to figure out afterwards. He wanted to be a part of that solution, which was a real credit I think, to Dan’s leadership; and wanting to take care of his people to make sure that they had certainly or some idea of what was going to happen, rather than leaving them in limbo, because we were at risk of losing some good people there. So that was a main driver. Then the communication issue and the siloed nature of it. Really, the discussions that we had as the leadership group at the time, were of what was the best path forward. We actually looked at his portfolio and how it might best be rearranged. Which sort of structure made sense for the organization and how we could flatten the organization? That was something that --in discussions with the chancellor, when I had run some drafts past him, that he found appealing, was flattening the organization. That’s what he had done in the military in terms of the whole team of teams concept that came out of the McChrystal Group. He was part of working for McChrystal and we talked about the advantages of having a flattened organization structure and teams being able to identify who is in charge and reach across and work with the team of teams concept. So that was something that was appealing to me and seemed like the natural evolution of where we needed to go as we also worked with the structure that the chancellor had put into place, which was the COO role, which we talked about, which was Steve Hahn. The COO role was intended to try to pull those silos together, and it really was a challenge because we had not had anybody in that role before here. Even though technically the EVPs still reported to the president, they were supposed to work through the COO, and that was just something that was very difficult to work through for the EVPs, as well as for the COO.

T. A. Rosolowski, PhD:

Now are you talking in a practical sense or in more of a personal sense?

Marshall Hicks, MD:

I think both. On a personal sense, when you have somebody that’s put into a role like that and you’re supposed to work through them and you’ve, up to then been reporting directly to the president and still do, on a reporting line, report there, but how do you work through that role. It was really an integration role. But it was something I think that, as a leader, is probably difficult to figure that out and we hadn’t had that structure before. Practically also, it’s how does this work? What decisions are made where? So I think it was both. It was also, with Dan leaving and the issues of frankly, working through the structure, it was what’s best for the institution? That’s what my ask was. We had a sense of where things could fall through when I discussed it with Dan. Shibu was a big part of it, being in HR and helping figure out --Shibu Varghese-- what a structure might look like for the organization, and knew Dan’s portfolio well. So we had some drafts we worked through that ended up shifting some of the things around. But at the end of the day, I realized that we had to pull the entire team together, of my reports at the time, and the reports to Steve, and say how are we going to—actually, there were no reports to Steve at the time. So they were all my direct reports pulling together as a team and saying what would this look like? What makes sense? And so we actually had little sticky notes. Jim Huggins from McChrystal Group just did the facilitation basically. He didn’t do any of the advisement, but he made sticky notes of all the different reporting lines to each of the EVPs and to the president. We put them on a wall and we started grouping them according to what made sense together. That’s when it came to the concept of having the COO having reports directly to him, as Steve had responsibility for day to day operation. The reports to the president were more reports that supported the overall function of the organization, not the day to day operations, and also were more outward facing: Government Affairs is an example, and Development with Tadd [Pullin]. It ended up being split that way, where the day to day was under the COO, which was the way that the chancellor had designed it. Then the president was more outward facing but also had a team that supported the institution, like HR, IT, Facilities. Those would fall underneath Shibu at the time. Compliance and Legal reported to the president because those supported more broadly, the organization. Development and Finance with the CFO reporting, so all of those things, Government Affairs, all of those things ended up in Strategy with Chris McKee. All of those things ended up reporting to the president because they support the organization in general, whereas Steve had the clinical, the academic piece, some of the business development and the [MD Anderson] Network and things like that. The day to day runnings of the organization, whether they’re on the main campus or for satellites, our outreaches, and that seemed to make sense to get through. We put a couple people … We looked at whether we could—it really meant doing away with the EVP structure, and we looked at whether individuals could be in roles, the two EVPs outside of Dan that were still here. They were involved in all of these discussions, but it also became clear that they didn’t really—they weren’t really seeing it that way. They thought that the way it was structured was working fine, and there was general agreement with the rest of us really that it wasn’t working fine. So we had some of those discussions with the group, saying we don’t see the communication piece. We have issues of dealing with the finance piece, with financial clearance and things in Epic, and examples of things of where we were so siloed that we weren’t really functioning together as an organization. So it became pretty clear that that was a point of disagreement for the team. I can understand it, you know if you have a piece of the organization and your view of it is that things are working okay, that you didn’t see a need to change. But we also were hearing a lot out in the organization, as I went out in the organization and talked to people, and knew this from my own experiences before stepping into that role: that there were issues there and problems, and that we needed to go a different direction. What ended up happening, even though we considered them for lesser roles, as chief medical officer and chief academic officer, that we ended up deciding that it was probably better to have other individuals in those roles. It’s very difficult to go to a reduced role.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

That was part of the advice that I got actually, in talking to some of the Board of Visitors, individuals that I talked to about this in terms of restructuring. That was one of the pieces of advice that I got, was that it’s very difficult for people to adjust to reduced roles. So we ended up making those added on positions, to give the new president flexibility, and also for those individuals that stepped into those roles, at the time it was Karen Lu and Steve Sherman in the clinical and the academic officer piece, respectively: made them an add-on because they were both chairs, and if they wanted to go back to a chair role and not continue on permanently, but also allow the president to appoint those roles or make changes as he or she would see fit. Most of the other pieces of the organization, the individuals that went into those roles, were already in a similar role, mostly under Dan. So when you look at Shibu for example, or Steve Hayden as the chief legal officer, he was already in that role. Ben [Nelson] was already in the role of CFO, reporting to me. Tadd [Pullin] was already in that role, reporting to me previously, Mark Moreno as Government Affairs, was already reporting to me, but at the time, the ones like Ferran Prat, who was reporting to Dan, would report to Steve, because that was sort of more the day to day. The individuals that fell under those roles that reported to Steve, most of whom were already in that role reporting to Dan or they were already in those roles, reporting to Dan but then reported to me in those same roles, like Tadd.

T. A. Rosolowski, PhD:

So there was a kind of consistency there.

Marshall Hicks, MD:

We tried to keep that, because we wanted to be as least disruptive. But we knew the issues in the clinical arena, the chief medical officer and the chief academic officer, those were pieces where there was some shifting around of things. For example, in the chief academic officer’s office, Oliver Bogler [oral history interview] at the time, had oversight over conference services and things like that, that we thought probably should go under facilities or other things. It’s historically not—we didn’t really have the knowledge of why, but it really didn’t make sense. There was some academic development components that really at the time, we were like let’s work through it. Those are the things we’ve got to work through, whether that belongs in HR, whether it still belongs in the CAOs office as a separate piece. One lesson out of that --and the same thing with the chief medical officer’s area-- We knew there were going to be people that were going to feel that they were going to need—we were going to need to do a good job of communicating and explaining or else it was going to be confusing to people. In fact that’s what ended up happening, frankly. Right after we released this, Steve was traveling a lot. Steve left, I think he had a wedding in his family. His daughter was getting married, and there were some things he had to do. So I ended up witnessing what it looks like when you’re trying to implement that when you don’t have everybody all hands on deck, trying to make sure and stay ahead of things and be able to talk to people as questions arise, as opposed to laying it out and going and talking at forums. All that is great, but at the end of the day, the individuals that are affected want to know. They have some questions where they want to know the answers and you have to be available. If you don’t know you don’t know, but it’s talking them through: hey, we need to talk through how this is going to work out. Because you can only at some levels go down so far and then beyond that, it needs to happen within each shop: what makes sense for the organization at that level. You can’t really think through every level.

T. A. Rosolowski, PhD:

It was hugely confusing.

Marshall Hicks, MD:

It was, yeah.

T. A. Rosolowski, PhD:

And as the farther down you went, I think the more worried people were about their jobs and how all of this was going to trickle down, because it was really—the thought was if there is so much turbulence in reorganization at these higher levels, what kind of decision making processes are going to happen lower down. So yeah, it was a challenge and it’s endured. I mean I was looking at the dates and Ronald DePinho resigned on March 8, 2017 and it’s over a year and a half later and there’s still a feeling of turbulence in the institution.

Marshall Hicks, MD:

Yeah, yeah, and I think there were two drivers that happened out of it: one is that we needed a better system for managing the issues that we had at the time. A lot of them are financial issues that we had to deal with, and better means of communication. So we had basically the two reporting lines and a structure that we felt like would help us make sense through the transition. I think what you see is it has to be—it’s communication and the clarity around that and conveying that, and sometimes you need leaders—if you have leaders in roles where you have issues to begin with, when you go through a transition like that and that leader is still in place, it’s probably still going to be a problem, because they may not be onboard with it. They may not want to support it, and if they’re not then communicating what you’re trying to convey or there’s not consistency there, it can be a problem. That was actually a couple of the issues we saw with individuals. We knew there were going to be problems. We didn’t want to make changes but ultimately, those changes may have had to have happened. We were trying to be, even though it may not seem like it, as least disruptive as possible, but still manage a transition where Dan was retiring and we had to have a huge piece of the organization allocated to where there was stability.

Chapter 22: Changing the Institutional Governance Model: Challenges

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