Chapter 27: Views of MD Anderson Presidents; Peter Pisters and the “Care and Feeding” of MD Anderson Culture

Chapter 27: Views of MD Anderson Presidents; Peter Pisters and the “Care and Feeding” of MD Anderson Culture



Media is loading


Dr. Hicks begins this chapter by commenting that the state legislature in Austin monitors MD Anderson because the financial health of the institution has an impact on the entire University of Texas system. He notes that MD Anderson has returned to a solid financial footing.||Dr. Hicks comments on Dr. Peter Pisters’ style, noting that he is a “student of leadership.” He also observes that leadership used to take culture for granted, but now there is a concerted effort to cultivate the culture of the institution.||

Next, Dr. Hicks sketches the leadership approaches of the MD Anderson presidents. He explains that Dr. Pisters is particularly attuned to the fact that healthcare is changing and brings skills in preparing the institution to navigate changes as the stakes and risks rise.||Dr. Hicks then explains that presidents need to resist the temptation to operate solely within their comfort zones. He comments on his own comfort zone and notes that he was tested by a financial crisis during his period as interim president.



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; Institutional Processes; MD Anderson Culture; Working Environment; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Understanding the Institution; The Institution and Finances; 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.


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


Tacey A. Rosolowski, PhD:

What was your understanding, or maybe we can talk about Dr. Pisters’ arrival, and then what was your immediate impression of how he was going to approach and going to insert himself into this change process.

Marshall Hicks, MD:

I think he had an appreciation: what we had been through, the changes we made, and the impact and the course that had sort of been corrected, and we were doing, like I said very well financially, which was a major concern at the Regents level and in Austin. Our fortunate position financially, it advantages the entire system, because the bond rating is affected. So any time certain things start to go wrong here, it draws the attention over in Austin. I think that knowing that, particularly as every month went by, and we were recovering pretty strongly from it, that there was a sense that the urgency had sort of passed by. It was really time to pay attention to, perhaps pay attention to the cultural aspect, kind of get back to the people. I think it was a sense of turning the page, a new chapter, with a new president coming and somebody that was familiar with the institution. So Peter’s style is to study and reflect. He’s a reader, a student of leadership, and so it didn’t surprise me when he came in and said that he’s going to take time, because he had the time --The urgency had passed--\, to make significant changes or do things that needed to be done from a financial standpoint or even a leadership standpoint at that time. Things were pretty stable, and I think he appreciated that. And since he had the luxury of being able to take time to study and absorb and get to know, reacquaint, he did that, and it was almost six months. I mean the books say it takes six months to realize, and it was really about six months later, it was May, when he announced the structural changes and different changes in the organization and things. So he came in and was afforded the ability to be very deliberate about change and thoughtful about it, as opposed to having to continue to be in a bit of a reactive mode of continuing the recovery, because we were, at that point, pretty solid. So it was a fortunate position to be in.

Tacey A. Rosolowski, PhD:

It’s kind of amazing that you were able to put that in place for a new leader. Am I correct in assuming that’s pretty rare?

Marshall Hicks, MD:

Yeah, it was pretty quick, and I think it was a credit to the institution, the people that stepped in, that stepped up, but everybody that contributed. I think that was one of the things --you go back to the first day, the first forum rather. It was we all need to own this. We all need to own the financial turnaround. We all need to own engagement. You can’t look to somebody else to do it, we all need to pitch in. That was the environment that we were trying to create, and maybe it’s connecting with our own culture of caring and helping each other, the multidisciplinary approach that we’re all in this together and there’s only one way out and that’s everybody pitching in and helping each other.

Tacey A. Rosolowski, PhD:

Well, from conversations I’ve had with leaders through this project and also especially through the interviewing work I did with the burnout project, it’s been interesting to hear people’s reflections on the place of culture in all of this, because culture is, just by definition, the water you swim in, the air you breathe, you hardly even know it’s there; and I think the experience that MD Anderson has gone through since 2011, has definitely made people become more aware that there is a culture here and that it’s something that has existed for a very long time and maybe has not been as intentionally cultivated, not through laziness but just through that’s not something we pay primary attention to. I think now it’s come to yes, you know, now we are paying more attention and there’s some real value in that.

Marshall Hicks, MD:

I agree, I think that’s true. I think it was kind of assumed or taken for granted for a number of years, and then when you go through certain things, you realize you can’t take it for granted and you have to continually—you know it’s the care and feeding of the culture if you will. It happens naturally, when I think the environment is good, when the climate is good, but if the climate turns then you’ve got to reestablish that. I think we are so blessed as an institution, to have our mission be what it is, and the connectivity of the people to the mission, it just, it makes it I think easy to recover when you’re trying to appeal to people to put the institution first, to do what’s right because it’s about the patients and it’s about our mission to eliminate cancer, to do the best job caring for patients. That’s just very clear in people’s minds and when they feel that you know, that draw to that mission, it makes it a lot less challenging in other organizations when they’re dealing with some of these issues of trying to recover, you know there’s no why question here, it’s we understand the why, now it’s just how.

Tacey A. Rosolowski, PhD:

Now, I’ve been interested in a couple of things, I mean one is how the language about the institution has changed. Dr. Pisters comes in with a new book, the Play to Win book by Lafley Martin, so there’s kind of a new rhetoric about change process and change management, as well as this new rhetoric that you and others set in place with the operational priorities. I had a conversation a little bit earlier today and someone said you know it’s so strange, nobody talks about the Moon Shots any more, are they still there? It’s not that research has gone away but it’s muted. Now what’s your impression about managing that kind of rhetoric? How is Dr. Pisters changing the language about what we do here?

Marshall Hicks, MD:

I think every president that comes in has --I don’t know if it’s as much about putting their stamp on things, but they have their interests and priorities and things that they believe need to be emphasized to move the organization forward in the right way at the appropriate time, at that time. I think it’s leaders are maybe meant for the moment. McChrystal has a new book about this, that not every leader—you can’t plug and play leaders and expect them to be successful, because people have unique talents and gifts as leaders, for certain circumstances where they can excel. So I think if you look at the history here, every president we’ve had who’s come in, has had a different sort of set of priorities and a different compass that they’ve used to move us forward, going back to [R. Lee] Clark setting the vision, the Pink Palace of Hope, and really, even the creation of the multidisciplinary culture that was going to be different in terms of how we treat patients. Certainly, LeMaistre [oral history interview] really raising the cancer cause nationally, raising our profile nationally. Setting the groundwork for the ability for patients to self-refer here, which carried into early into Mendelsohn’s [oral history interview] time, which led to extreme growth, and his goal of having every patient here be on a clinical trial, because the patients do better on trials. You’re advantaged by possibilities of those trials and even though there’s no guarantee you’re going to have a better outcome, it’s really that pushing the field forward. That was his vision. Ron’s [Ronald DePinho; oral history interview] was more of a goal to really up the research game and really put us on the map there and recruited in some great people, including Jim Allison, a Nobel Prize winner: really a proud moment in the history of the institution. Every leader does certain things better than other things and I think for Peter coming in, he clearly sees that healthcare is changing. It’s very fluid right now, navigating through some choppy waters that we’ve been in for a while. But as the stakes get higher, the risks get higher. I think that’s what he’s—I see him trying to help prepare us to be competitive, to be sustainable. I think it’s about balance. I personally think someone in that role needs to resist temptations to go to their comfort zone. Everybody has a comfort zone, everybody has what they really think is important, but I think the optimal way to lead in a role like that is to make sure that you have that balance there. Otherwise, you have the risk of it being divisive. People who are in that favored zone, everybody also looks at them as favored. Others can feel undervalued. I think you have to make sure that balance is there. I think the key to that is delegation. A big key to that is maintaining sort of the broad picture, the big picture.

Tacey A. Rosolowski, PhD:

How did that apply in your situation? What was your comfort zone and how did you have to be aware of not defaulting back to that?

Marshall Hicks, MD:

In some ways, the crisis of the moment made me fortunate in that it was pretty clear, what I had to focus on, so I didn’t have a lot of time to get back into my comfort zone, whatever that is. It probably is more on the clinical, on the operations side piece, and understanding that, but also was trying to put things into context, to understand that we had to keep the institution moving forward at sort of a macro level and all the different relationships we have externally, maintain those. We had the legislative session ongoing, we had our Board of Visitors --to make sure you were communicating with them. So there was just a lot that needed to be managed at the time. I really was able to resist that if you will, because of the—I think it was the urgency around certain things that had to be attended to. So I think it’s more the longer term, that you get into that. I think frankly for Ron, his was research. Early on, there’s a honeymoon period. There’s a time when people—and then as time goes on, if they see where your priorities are and people feel undervalued, it has the potential, particularly in a place like this, to create a bit of a wedge. I think that’s a risk, and I think it’s a risk for any president coming in. Certain ones, like John Mendelsohn, frankly, walked that balance as good as anybody. I think it was because—you know I just was at the memorial service for him and the engagement, the ability for him to connect with people and listen and learn, was a huge advantage. He just had this eagerness that was infectious, to learn and to listen, and to hear the lie behind everything, and people love that. People feel appreciated, people feel engaged. I think he also was good at managing expectations, so people didn’t feel like after a conversation with him, that he’s necessarily promising the moon but at least they’ve been heard. I think that’s a skill as a leader that he was a master at, frankly.

Tacey A. Rosolowski, PhD:

Well we’re actually a little bit over time and I know how busy you are, so why don’t we close off for today. So, I want to say for the record, thank you, and I’m turning off the recorder at about four minutes after eleven.

Conditions Governing Access


Chapter 27: Views of MD Anderson Presidents; Peter Pisters and the “Care and Feeding” of MD Anderson Culture