Chapter 25: A Follow Up on Being Recruited for President and Views on Harvey

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Chapter 25: A Follow Up on Being Recruited for President and Views on Harvey

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Dr. Hicks begins this chapter with a brief follow up to last session’s discussion of his thoughts about applying for the position of permanent president. Despite his reservations, he explains, he was approached by a recruiter and after eliciting various opinions, decided to apply.||Next, Dr. Hicks talks about how Hurricane Harvey, which made landfall in Houston during 2017 and which was “a coming-together moment” and a test of all the structures and skills that the Shared Governance Team was putting in place. He describes how the institution was at first caught off guard because of meteorological reports that underestimated the amount of rainfall and the rapidly shifting nature of the storm of increasing magnitude. He describes how the institution quickly put the skills and resiliency to use to manage institutional operations and successfully rebound. Dr. Hicks talks about the impact on employees and The Caring Fund of about one million dollars that was established via donations to help.||Dr. Hicks shares his “most precious memory” of his time as interim president: the post Harvey celebration at The Park that acknowledged the way that the institution came together during the storm.||Next, he shares the lessons learned: specifically how the crisis revealed certain local areas of operation with less developed communication networks, resiliency, confidence in local decision-making, and abilities to ask for help. He explains that the McChrystal Group was still involved in mentoring the institution and helped them undertake an “After Action Review” to examine how Harvey was handled and identify areas that needed additional analysis and intervention.||Next, Dr. Hicks talks about the financial impact of the institution, explaining that at the cusp of the 2017/’18 and 2018/’19 fiscal years, MD Anderson was on track to achieve a $25 million margin. The storm's impact was around $30 million. Dr. Hicks explains that he decided to make various institutional awards, despite the fact that those would increase the shortfall.

Identifier

HicksM_07_20190117_C25

Publication Date

1-17-2019

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; Ethics; Professional Practice; The Professional at Work; Professional Values, Ethics, Purpose; 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.

Disciplines

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

Transcript

T. A. Rosolowski, PhD:

Today is January 17th—I’m remembering the date, 2019, and I’m on the 16th floor in the Division of Diagnostic Imagine, for my seventh session with Dr. Marshall Hicks, so thank you very much. I’m Tacey Ann Rosolowski and the time is five minutes after ten.  

T. A. Rosolowski, PhD:

+ So, you were saying that you had another thought after our last conversation.

Marshall Hicks, MD:

Right. We were talking about whether I was a candidate and it occurred to me after we talked that the reason I had to make a decision was because my name was submitted and the recruiter called me and asked. And I knew people copied me and told me they were going to submit my name, and I wasn’t surprised in a sense but I had not planned on submitting my name because of the earlier discussions. Then I got to—when they asked me, I actually talked to the recruiter about it because of concerns that I had that it might influence people’s perception of how I was managing or making decisions and things. And talked to Executive Vice Chancellor Greenberg about it and a couple of Board of Visitors as well, before I decided. So that was what prompted it. It wasn’t like I decided I wanted to put my name in the hat. I had to kind of make a decision on whether I was going to accept a nomination or whatever, so.

T. A. Rosolowski, PhD:

Okay, yeah, no that clarifies a lot because that kind of got lost in our conversation last time. Interesting. Well obviously, you had people who were very interested in having you take on that role and that’s kind of a nice vote of confidence.

Marshall Hicks, MD:

Yeah, no it was. That was incredible support that was there with people. I think people, as we were starting to recover and start to make some progress, that people felt like things were starting to go in the right direction. I think that was probably a bit of a vote of confidence about that. I think it was also just people coming together and making it. We had to, we had to come out of it, and there was a lot of work to do and a lot of people were involved and committed to making it turn around.

T. A. Rosolowski, PhD:

So tell me about the next stage, I mean after the decision. The new president, Peter Pisters, had been selected, and you had said that a lot of the work that you and the Shared Governance Committee were involved in prior to the search for the new president was about trying to set things in place, so whoever came would be stepping into a solid base. So tell me about those months before Dr. Pisters arrived, what are sort of the final touches on that?

Marshall Hicks, MD:

I think actually right after he was named we had [Hurricane] Harvey, and so that was like literally the next week I think or two weeks at the most, so that ended up taking a lot of acute attention on that.

T. A. Rosolowski, PhD:

Tell me about Harvey.

Marshall Hicks, MD:

Well I mean it came up pretty suddenly and it caught us by surprise. I remember sitting at a briefing on Friday afternoon and then had a follow-up call I think earlier that day. It was felt that once it was determined that we were probably going to be in the path, then they were calculating based on estimates of rainfall per hours and whether that would be enough for the bayous to breach and to have any sort of significant flooding. The estimates were, I think through our time on Saturday --at least early morning on Saturday or midday on Saturday, as I recall through that time-- that the rainfall amounts were going to be below what would trigger flooding off the bayous and stuff. Obviously, Saturday night was kind of a deluge. Then Sunday morning, waking up to see that this was—so it caught us off guard. Fortunately, there was enough people in the Clinical Service that some people had anticipated and came in. We had enough people here to sustain operations but it was thin. Getting people in and out was very problematic, so we had to make do with who was in, and that became our ride-out team. We didn’t have enough time to really declare a ride-out and have people change because the weather changed so quickly. I remember Matt Burkheiser saying it was as though the ocean had just been picked up and dropped right on Houston in terms of the amount of water and the suddenness with which it happened. So it really --that became then our coming together moment where we were able to enact the things that we had been trying to do over the few months in preparation for a new president. Preparation for turning things around. It really became a test of us coming together in a moment. The local empowerment. The sharing of information. The whole team of teams concept, and having the cadence of these calls every few hours. Having lots of people on these calls, 70, 100 people, and sharing information. Asking, what do you need, and sharing that information. And people being willing to say, we need help in this area, and having help. Empowering people to manage their centers, their clinics, because we shut down the outpatient side. Obviously had to keep the inpatient going, but pretty soon had to determine how quickly can we get back up to see certain outpatients, in particular the ATC areas and things, where we had to get patients in on an urgent basis. On these calls, we had Mark Moreno from Government Affairs making contacts with people in the city that could help us with transportation. We had --Amy Hay [oral history interview] was connecting with our network partners to see if we could get some relief coming from them. We had nurses come from different centers, and physicians. It was really a team effort of coming together and trying to do whatever we needed in the moment, sharing information and learning how to efficiently report that out and move on and get what we need, to make sure that we were operational facilities reports. Obviously and fortunately, we had very little damage. We had to move a few things, but no patients harmed, no employees harmed during the events and we’re very proud of how it came together. It kind of tested our ability really, to function at that level as a team of teams, and sharing information, helping each other: what do you need, what can I do that helps, helps you? So it was interesting. As I look back at that I say we were really doing all these things when we set up our decision making: our shared consciousness about how we were going to operate as a team of teams over that time, thinking it was really about how to turn the institution around and move forward. Kind of go into the next step. But in essence, for the last few months, we had been preparing for a hurricane.

T. A. Rosolowski, PhD:

Interesting.

Marshall Hicks, MD:

And so we were able to put those things that we learned and the skills to use right then. I think that’s why the resiliency was there. Why we were able to successfully navigate through it, and secondly to rebound as quickly as we did from it. Because we were back up pretty quickly, within a few days of really running 90 percent operations and, like I said, had fortunately no harm that came to any patients because of the disaster. It did affect an enormous number of our employees. We were trying to get assessments of that pretty early. We estimated it was probably somewhere between 15 and 30 percent, it was a broad range, but it was difficult to tell because immediately, some people had flooding, couldn’t get in, but they didn’t sustain any damage ultimately. So it was a fluid number going around. How many were affected. But we ultimately ended up estimating that it could have been up to 30 percent that had some property loss, whether it was a car or personal property, HAL or rental property or something, where it impacted. Then of course you’ve got people trying to recover and deal with those issues. That was where having the partners from Northwell and Banner and others come to help us, sending some relief so that people could actually go take care of their families and their houses and property and do what they needed to kind of get through the acute phase of it. And then of course we set up, we reactivated the Caring Fund. I’d have to look back at the number. I think it was $1 million. I believe it was.

T. A. Rosolowski, PhD:

What was it?

Marshall Hicks, MD:

I can’t remember, don’t quote me on that, we can go back, we can ask Tadd [Pullin].

T. A. Rosolowski, PhD:

Yeah, yeah, we can add it.

Marshall Hicks, MD:

I think it exceeded our wildest expectations of what we—which was employee donated and friends donating, philanthropists, that supported us, generating a huge amount of money. We set up, that employees could, if they sustained property damage, could apply and get immediate cash to help them through it. Because people were squeezed and at that time it’s hard sometimes, when you have a situation like that, to work through. You need money just to get through.

T. A. Rosolowski, PhD:

It’s kind of inconceivable. I talked to people who just had just high water in their place, I mean they lost everything, yeah, it’s incredible.

Marshall Hicks, MD:

It was amazing. And you know it was --once the water went away, the city looked fairly normal, as opposed to was it [Hurricane] Ike, when it came through and you had all the—

T. A. Rosolowski, PhD:

Yes, devastation.

Marshall Hicks, MD:

Yeah. You could see in the power and all that stuff. But here the power wasn’t really affected. So I mean they’re all different, I guess, but this was one was in a sense deceiving, because once the water went away, there was a lot of people who were still, still even today, are still dealing with the aftereffect. And yet, life got back to normal for the city, the hospital, whatever, fairly quickly. But people’s lives were still affected. That was a moment of really coming together. Of course what I remember most, and probably my most precious memory of the time I’m ad interim, was when we gave out the t-shirts in The Park as --that celebrating, coming together and resiliency through Harvey, and just appreciation. It was an amazing event. We had the place packed and gave out thousands of t-shirts in two hours. People I think were celebrating in a sense coming through. Because we had turned things around financially, we’d made it through Harvey, we’d come together and I think it was a celebration of the wonderful employees and how much effort they had put in over the last few months. So it was just a magical moment.

T. A. Rosolowski, PhD:

I’m not meaning to cast a shadow but I’m wondering if there were in the inner workings of all of that, if there were things that you observed it’s like, oh yeah, here’s a place where we need to tweak things to make it better, to get even better at what we’re doing. Lessons learned kind of things.

Marshall Hicks, MD:

I think it did uncover the areas that we struggled with, how some of the concepts; empowerment, engagement.

T. A. Rosolowski, PhD:

How did you discover that?

Marshall Hicks, MD:

When there would be problems in certain areas. They had trouble getting—with staffing or rebounding, coming back as quickly. Then you realized that the decision making and the empowerment and the ability, the connectedness in the areas. So then it exposes those weaknesses in those areas where there’s opportunities to improve. I would say it was a matter of degree. It wasn’t like there were any disasters, but it’s just you could tell people in certain areas, groups, were better able to respond than others. That kind of tells you, I think a little bit of a story about how things work on a day to day basis and long-term too.

T. A. Rosolowski, PhD:

For sure. I mean what we’ve been talking about over the past sessions is an enormous, complex process of change, a great deal of which was happening at a pretty high level of organization. And how that all filters down. I mean Harvey was a place, I mean the testing ground that you could say, well where are the places where it hasn’t really filtered down yet?

Marshall Hicks, MD:

That’s right. That’s exactly what happened, and it just exposed those. Everyone can improve, right? I mean there’s always room for improvement. So I think it was really more a matter of degrees. But you could see it by how it was working. Even to the extent of asking for help, being willing to put that vulnerability out there, as opposed to just trying to make it through it, and then you end up letting other groups down, or you’re not able to perform at a higher level. Even asking for the ability to go contact people, or help get people in, or rotate people out. Things like that, that we’re dealing with acutely.

T. A. Rosolowski, PhD:

So when these areas of less efficiency were brought to your attention, what was the response after the dust from Harvey had settled:, how did you address those areas?

Marshall Hicks, MD:

I think that’s more for the long-term solution. I mean in terms of --its training, its leadership, for the most part I think. So that ends up being more of a longer term. Like I said, I don’t remember any disasters where we actually had to make significant changes acutely in order to get things. What happens is on a routine, day to day operational normalcy for the institution, there’s always those areas that aren’t as good as others, or others that excel. What this did is just showed --you know. And so sometimes you kind of know that those areas aren’t running as well as they could and this just made it more obvious I think. So then it becomes … I think it did call some self-reflection in certain areas where changes were made. It was really made more at the local level. Or in the areas, the groups, the areas that are responsible—people are responsible for those areas. In the COO’s office at the time, things like that, there were ways that we could address it. Hopefully it caused—some of the things, like just the connectivity, reflecting back on it, the confusion about what’s expected of employees to come in; some of the messaging was difficult to interpret. But, what’s the best way to communicate with people, particularly now, with all the different means? Then also clarifying some of the pay practices for employees, particularly in a disaster like that, when people still have to pay the bills or deal with acute issues. Property loss and things like that. I think we were very generous with our pay policy through it. It was also what’s —reflecting on those things. Often those things, including the communication, become problematic acutely. Then the disaster goes away and then it doesn’t really get solved in between. So that was one thing where we tried to have an After Action Review, we called it, and really look at it. I think that was one thing we did more intensely than had been done in the past. Again, that was part of a process of working with the McChrystal Group. They were still here, they were helping us –they deal with a lot of the military, so it was helping us sort of say what can we learn from this? How do we make some of these changes to improve it going forward? I think again, back to the process, it was just a kind of continuation of the process optimization that we were trying to learn and that was a part of it. And generating action items out of that.

T. A. Rosolowski, PhD:

Interesting. What was the financial impact? I know that there were a lot of discussions and concerns about that at the time.

Marshall Hicks, MD:

Well, my understanding, and we’d have to get Ben Nelson to kind of give us the final tally, but I think we were in the, it was tens of millions. Like $30-, $40 million sort of thing. I know that as we closed out that fiscal year, as you recall, it was the last few days of the fiscal year and the beginning of the next fiscal year, so both fiscal years got affected. We were on target to hit our margin of $25 million for that fiscal year, which you know, when we were at a loss in the spring, of you know it was $150 million loss at that time. It was quite a remarkable turnaround. We ended up in a situation where in order to do the Anderson Award and the Faculty Recognition Award, all the different payout recognition awards, we had to hit our margin of $25 million. This caused us to—we were actually in a unique situation where if we didn’t pay that out, we hit $25 million margin. If we did pay it out we’re below margin. Since it’s the president’s prerogative to make that decision, I made the decision in consultation with the chancellor, to make sure that there wasn’t an issue there. Given what we had been through and everyone’s effort through not only Harvey but the whole latter half of the year, that we would pay out the recognition awards. And we did, and I believe we ended up being minus $10 million or something like that. So if you looked at it acutely, we probably lost $30 million or so acutely. But then we’d need to check with him to see what the real impact, if you look at it really over the longer term, more than just the few days there. Because it took us a while to ramp back up, probably two weeks, to get back up to close to a hundred percent.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

If you look at the fiscal year, I guess it was—

T. A. Rosolowski, PhD:

Two thousand fifteen, 2016.

Marshall Hicks, MD:

This was actually, this was ’17, the calendar ’17, so it was fiscal year ’18, that we had some—we started out the year kind of in the hole. Came back pretty strong from it, but it impacted both years. I think that was well deserved, to get the recognition out to the employees.

T. A. Rosolowski, PhD:

And important I think, to sustain the buoyancy of the morale at that point, which had been so low, yeah, yeah.

Marshall Hicks, MD:

Yeah. I don’t think there was really a choice, unless we were a lot further off. But we had come back and, like I said, we were in the last few days, going to be clearing that margin enough to really hit the target. Then that happened and it just sunk us.

T. A. Rosolowski, PhD:

What do they say, make plans and the gods laugh. Right.

Marshall Hicks, MD:

It was pretty ironic, that we worked so hard and that’s beyond your control. It just kind of comes out of nowhere.

T. A. Rosolowski, PhD:

Literally, yeah.

Marshall Hicks, MD:

It literally did, because a week before that, there was just a little disturbance down in the north of Mexico I think, around the border. Then the next thing you know, they’re projecting it to head up and it did.

Chapter 25: A Follow Up on Being Recruited for President and Views on Harvey

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