Chapter 23: Implementing Change, the Influence of the Board of Visitors

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Chapter 23: Implementing Change, the Influence of the Board of Visitors

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In this chapter, Dr. Hicks describes an obstacle to implementing the shared governance system. He explains that the majority of the higher level individuals accepted the reality that their own roles had to shift and also recognized the institutional problems the new structure was designed to address. However, it became clear that neither the physician in chief, Dr. Thomas Buccholz [oral history interview] nor provost Dr. Ethan Dmitrovsky shared a view of the need for change. Dr. Hicks explains that it became clear they needed to be removed from their roles. As discussion evolved, he says, the process became contentious and members of the Board of Visitors “kitchen cabinet” became involved, meeting with him and attempting to guide the process (which is beyond the official scope of the Board of Visitors). Dr. Hicks says that he decided to focus on advice provided by MD Anderson about MD Anderson processes.||Dr. Hicks reflects briefly on his handling of this difficult situation. He observes that leaders must not allow personalities and emotions get in the way of doing what is best for the organization.||Next, Dr. Hicks reflects on Dr. DePinho’s leadership, noting that “he did not fail alone, he had a team.” He explains that the removal of Drs. Dmitrovsky and Buccholz was the last task before the institution could move out of the DePinho years and into a new transition. He also summarizes the Board of Visitors concerns and motivations for becoming involved in this process. He notes that removing these two key people and making the governance change had a positive effect on the new president’s administration [Peter Pisters, MD].

Identifier

HicksM_06_20181120_C23

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

Marshall Hicks, MD:

+ Then we also had other leaders that we felt weren’t really onboard with trying to make some changes in the organization, and understandably so. I also had a lot of feedback from out in the organization, including the Executive Committee and the Faculty Senate, including other chairs and division heads, where we needed to make those changes because it wasn’t working there. When you think about it, that was done in two and half months. It was done in June, and we had to move pretty quickly if we were going to turn things around. This was done with a lot of discussion with the chancellor and the vice chancellor. And, again, they asked questions, but they were supportive of what we were trying to do. It made sense to them. The same thing with the Board of Visitors Kitchen Cabinet. I talked to them at least three times about this and --even the proposed changes, including roles that needed a change. That ended up, at the end when we did this, to be problematic, because even though I had gone over it with them, just the timing of it, when we met and when we were going to announce the changes, was basically two days later. They, at the last minute, there was—they had concerns. It was difficult for me to understand those concerns because I think it was more, at the end of the day, it was more about how it was being handled and the discussions with the individuals involved, rather than the actual changes.

T. A. Rosolowski, PhD:

Let me ask you just a couple of practical questions. Who are the individuals who you put into the Kitchen Cabinet, I’m not aware of who actually is part of that.

Marshall Hicks, MD:

That’s the Board of Visitors, the chair of the Board of Visitors, which was Jim Mulva, formed what’s called his Kitchen Cabinet, which was really past chairs and future chairs primarily, of the Board of Visitors. He formed it as a small group that had not existed before he became the president of the Board of Visitors.

T. A. Rosolowski, PhD:

And when did he become president, do you recall?

Marshall Hicks, MD:

I think it was about a year before or less than a year before, so I think it was ’16, I think.

T. A. Rosolowski, PhD:

Two thousand sixteen. And I’m sorry, his name again?

Marshall Hicks, MD:

Jim Mulva, M-U-L-V-A.

T. A. Rosolowski, PhD:

Okay. I hadn’t heard that name, okay.

Marshall Hicks, MD:

He did it, I think to try to advise Ron [DePinho; oral history interview] because of the concerns, the financial issues. Normally --the Board of Visitors, as you know, is a huge group of what, 250 or whatever. Then there’s an Executive Committee, and normally it was the Executive Committee that would meet and advise --that was the chairs of the different committees within the Board of Visitors. He formed a small group to meet more frequently with the president and advise. These are individuals that led corporations, and they’re used to being able to give advice and have it followed. I had a good relationship with them, but at this point it became a bit contentious. We have a procedure that historically we go through when we make these changes, when you’re taking people and removing them from a role at that level, where it’s managed in a certain way with HR and Legal.

T. A. Rosolowski, PhD:

So their concerns were specifically about Tom Buchholz [oral history interview] and Ethan Dmitrovsky [oral history interview].

Marshall Hicks, MD:

Ethan, yeah. Their concern was to have them more involved, rather than telling them that this is what we’re going to do. Even though I think that they had been involved in discussions where we had talked about a lesser role for those EVPs, so I think they were aware we were talking about making changes, that they wanted them—and I think it was a fair point. They wanted them to make sure that we gave them the opportunity to help with communication and announcements. The advice I was given from our team who dealt with those things in the past, from the legal standpoint, an HR standpoint, was that there was concern that there was a risk there. That if you telegraphed it too much or talked with them days in advance, that there might be opportunities for it not to be managed in a way that was best for the organization. You know, individuals may say things or do things.

T. A. Rosolowski, PhD:

Sure.

Marshall Hicks, MD:

At the end of the day, I just decided, after the discussion with the Board of Visitors, that we were going to pause and I was going to talk to the two individuals and then get them engaged in how they wanted this to be announced and managed going forward.

T. A. Rosolowski, PhD:

Let me ask you, why do you think the Board of Visitors was so concerned about these two individuals in particular?

Marshall Hicks, MD:

I think it was relationships that they had not only with Ron, because they were part of Ron’s team, but also a couple of the Board of Visitors had been on committees where these individuals were the chair of the committee or part of a committee where they had developed a relationship with them. Even though the feedback I got on an individual level was this was probably a necessary change at the time, when the group got together and heard it and again, they were more concerned that we were going to talk to them that morning and then announce it that same day, as opposed to talk to them, get them involved in how we might communicate it and frame it and talk about a role for them. I think that was a valid point. The risk that I was advised was probably not high enough risk to warrant not being more—I mean these are colleagues, these are friends of mine.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

People that I wanted to treat with respect. So the decision I made at the end of these discussions was that obviously I wanted to treat them the way that I would want to be treated. That’s ultimately what drove the decision to say, hey let’s talk to them and we’ll have a day to kind of plan all this and manage it and make sure that they’re involved in communicating how we want to announce it.

T. A. Rosolowski, PhD:

It’s a hugely delicate situation, I mean really a challenge. What were your main concerns? You talked about treating everyone with respect, but I mean for yourself, what did you find particularly challenging about this?

Marshall Hicks, MD:

They were, they were friends and colleagues and my former bosses, and now it’s a reversed role. I was always trying to do what was best for the organization. At that point it was just very difficult to move forward with them not wanting to be on the same page and to acknowledge and to be part of solutions, as opposed to wanting to keep it the way it was. That was just not working. We needed to move in a different direction, and it was hard, knowing that that was the best thing for the organization, but these were individuals that you wanted to treat with respect and dignity through this. You put yourself in their situation and it’s hard. It’s very difficult, but yet, I didn’t feel like it at the time, even though we talked about putting them in reduced roles and I talked to the Kitchen Cabinet about the chance for a vice chancellor, different options and so forth. It was felt that that wasn’t going to be a solution because you’re putting them in roles where they still have significant responsibility over those areas and if there were concerns about that presently, that that wasn’t really going to be something that was going to necessarily be an effective solution.

T. A. Rosolowski, PhD:

Yeah, you really need to guarantee alignment early in the game.

Marshall Hicks, MD:

Exactly. So that was it and balancing that against what you’re advised by people who have managed situations like this multiple times in the past where you don’t, as an organization, want to be vulnerable to information that gets out there that may not be accurate or that isn’t being representative of what was being done at the organization at the restructuring level.

T. A. Rosolowski, PhD:

As you look back, is there something that you would have handled differently going through that challenge?

Marshall Hicks, MD:

I think you always look back and wonder. You know, the conversations. Were you explicit enough? How do you think this is working? Even though you have topics and things that you discussed that weren’t going to well, that you would point out the obvious even a little bit: what’s your perception and how do you think this is working? Some of the conversations seemed circular at the time and you wondered how could you have done a better job of communicating that this is not a level of performance that is acceptable or that is helping the institution move forward. There are things we need to pay attention to in certain areas. I think people see things that they want to see and they hear things they want to hear. Even though you can have conversations with them and be pretty explicit, in retrospect you wonder if it was explicit enough. It generally probably is enough. People should be getting that message. I mean, these are executive-level physicians in senior leadership positions in the organization. At these levels they have to have a situational awareness and understand that you need to be supportive. At the very least, are going to be asking what it is that I need to be doing, to help us move through the transition because it was a very difficult time. I think it was probably difficult to accept, when you’ve been in certain roles, at certain levels where it’s difficult to accept significant change like that to happen, that led to change in the presidency. But even historically, looking back even when the chancellor was involved in discussions --when we’d gone over to talk to him in the summer of ’16-- that generated the governance structure, there was that same resistance to change and listening which persisted and led to the inability to be able to move forward with changes.

T. A. Rosolowski, PhD:

Yeah, that’s interesting. I mean it makes you wonder what that was about, particularly if it emerged early in the process, when some kind of openness to the change that was coming could have secured their jobs.

Marshall Hicks, MD:

Right.

T. A. Rosolowski, PhD:

So what was that resistance about?

Marshall Hicks, MD:

The chancellor and the vice chancellor just wanted us to be fair, wanted me to be fair. I promised that I would give them a chance and I did. But when we’re still struggling and we were trying to make changes and do things, and even set—you know we had a morning huddle where everybody would contribute. It was pretty obvious that the sharing of information and the different things we were all trying to do wasn’t really something that they were buying into even. So you see these behaviors and it’s what they’re contributing and acknowledging, or not acknowledging that maybe things could be better, that there were issues or problems.

T. A. Rosolowski, PhD:

And it sounds like they were not buying in to basic values of the process that everyone was—because you’ve talked about the importance of creating this team and transparency and all of that, and so those aren’t good signs that these individuals want to take part in it at that level, for whatever reason.

Marshall Hicks, MD:

Yeah, for whatever reason. It was difficult. It’s understandable, but you had to just take a step back and say, “we’re really going to do this based on what we think is best for the organization, best for the institution,” because you can’t let the personalities get in the way or your own emotions about individuals and even the restructuring. We had to do something that was going to keep us stable through it. Even though I think as it rolls out --the communication-- we tried to do the best we could. We had obviously had the communications group involved, and we had forums and we had meetings with chairs, meetings with pieces of the organization. But it really does, as it cascades out, become more and more dependent on individuals out in the organization. There were clearly quite a number that --these were their silos. These were their pieces of the organization, and you could understand that they would be intimidated at the least and maybe fearful of losing their job, as you mentioned, at the most, or just didn’t agree with it. Maybe also thought everything was fine and why does this have to happen.

T. A. Rosolowski, PhD:

Well it’s funny, you know in talking to people at all stages and the reflections on changes in the institution, I think it’s hard, when you’ve spent many years in a position, not to have a proprietary sense about what you’ve created. I mean even if you’re not a mini-king over a fiefdom or kingdom, still it’s a sense that you’ve built something, and you did it for a reason, and suddenly it has to be changed, and so there can be some real resistance to that. There’s a sense of grieving and you know, does the change mean I failed, you know all of those questions that do come up for people.

Marshall Hicks, MD:

Well, my thought was, Ron did not fail alone. He had a team, and just because one person in that team who is the leader of the team, that leader still depends on the team to help him or her. I think that’s ultimately, when I looked at it—and I had input. I remember the Executive Committee and the Faculty Senate, we were talking about we vetted this with certain groups. We didn’t vet it with the entire groups, but we vetted it with certain chairs and certain division heads and certain Executive Committee members, the Faculty Senate. Because we were asked to kind of socialize it a bit and see. When we talked about possible reduced roles, I remember the Executive Committee of the Faculty Senate was on the verge of a no confidence vote on the EVPs, and I had to look at that as well. It wasn’t the only factor but when I knew that that view was shared by other division heads and chairs. It wasn’t that this was something that was pervasive: there was a lack of trust, there was a lack of confidence that if I didn’t do something fairly soon, it could precipitate another round of painful embarrassments for the organization, because that’s the sort of stuff that would get out into the papers and so forth. Again, it wasn’t the reason for the change, but it was one factor that was likely best for the organization. After it happened, I had a lot of leaders in the organization --and these were respected leaders, these were chairs, administrators-- that came up to me and said that it was the right thing to do. It was painful but it was the right thing to do. These are people that I respected and worked with a long time, that made me understand that as much as people don’t want anybody to lose their job --and they didn’t lose their position here, both faculty members, but they lost their administrative roles-- and so it wasn’t like they were losing their job here. They were just losing a role.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

And as painful as that was, people felt like it was the right thing to do for the organization.

T. A. Rosolowski, PhD:

Am I correct in understanding that this discussion and turbulence surrounding what to do about Tom Buchholz and Ethan Dmitrovsky was really that last symbolic piece before the organization could really move ahead, because it’s sounding like it was kind of the watershed.

Marshall Hicks, MD:

I think so, because it was still what was not working well in people’s minds, who felt that this was still, it was still siloed, it was still not transparent. There were things there that were --if we were really going to get to a place where we had a flattened organization where there’s transparency, where there was openness and sharing of information-- that that part of it had to kind of go. That was like I said, part of what people perceived as why we failed. You know, why you failed was still there in people’s minds.

T. A. Rosolowski, PhD:

And they were both very, very closely associated with Dr. DePinho.

Marshall Hicks, MD:

Correct.

T. A. Rosolowski, PhD:

So it’s symbolic in that sense as well, I mean whatever values they held, there was that association.

Marshall Hicks, MD:

And with each other too. They were often projecting a very symbolic sense of camaraderie and close collaboration. There’s no question in my mind they both wanted the best for the organization. But it became a point where if people felt like we couldn’t move forward unless we made that change --and I think it was not only change in personnel, it was a change in the structure to where it freed us up from having these silos-- where things had to go up and over, where people wouldn’t talk to each other or share information. We had to do something that symbolized a different way of operating.

T. A. Rosolowski, PhD:

Now aside from this enormous challenge that you had to address, were there other difficulties you anticipated with implementing this new structure, or things that you thought were going to go really smoothly?

Marshall Hicks, MD:

Well, we were concerned about how this would be—and the Board of Visitors, the Kitchen Cabinet was very concerned about how this will be perceived publicly.

T. A. Rosolowski, PhD:

Oh really? What were the concerns about that?

Marshall Hicks, MD:

That this was something, this was newsworthy, and it was one more thing that was going to look bad here. In fact there was an article, I can’t remember if it was only electronic, but it said something like “DePinho’s lieutenants removed,” and it was one article and that was it, so it was a blip, but they were very concerned. We were having daily calls with them because they thought this was, within the organization, going to create a lot of turmoil. I understand there was confusion, but it was also again, the feedback, there was a lot of positive feedback around it too. Ultimately, even --they announced at the next executive meeting of the Board of Visitors, Jim Mulva even said this was the right thing to do for the organization, to make this change, because it positioned us in a better. He said this in front of the group-- that in retrospect it was the right decision. They anticipated more issues with it than we did, because we knew that what we were hearing inside the organization was that we needed to make this change. Ultimately, they said it really helped the transition to the new president a lot easier, as much as it was confusing, as much as (inaudible), the reality was, I think that that’s probably true. I mean if you end up with Peter [Pisters] coming in, he made some rearrangements. He’s made some different changes, but he’s really not had to do any changes that resulted in people losing their roles. We had set it up so that there were some interims and there were also the ability to move things around. Some of those tough decisions like that were made in order to be able to free us up from being able to move forward, as opposed to have that linger, which was ultimately --I didn’t want to hand anything over to a new president that I knew I could have done something to change that would have been better for the organization.

Chapter 23: Implementing Change, the Influence of the Board of Visitors

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