Chapter 29: Transitioning out of the Interim President Role

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Chapter 29: Transitioning out of the Interim President Role

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In this chapter, Dr. Hicks focuses on his role as Head of the Division of Diagnostic Imaging after serving as MD Anderson’s interim president. He discusses issues the division was facing, including the discussion of how to move services out into the region as well as staffing needs occasioned by the implementation of the Epic electronic medical records.||Dr. Hicks also discusses challenges he experienced as he returned to a divisional role after serving at the highest executive level: after a few years looking at institutional issues from a very broad perspective has changed how he interprets issues that seem pressing when seen only from the departmental and divisional level. He explains that he is questioning whether he is best able to serve the institution as a division head and has been considering other options. Dr. Hicks notes he has enjoyed working on the In-Patient Planning Committee, and he reflects on the difficulty of making late-career moves.

Identifier

HicksM_08_20190321_C29

Publication Date

3-21-2019

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; Personal Background; Leadership; On Leadership; Professional Path; Evolution of Career; Professional Values, Ethics, Purpose; Influences from People and Life Experiences

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:

Well, would you like to talk a bit about the division now and in the future. I don’t recall if I asked you about the whole coming down from the interim president, you know what was it like to come back to—you know let go of that role and then come back to being division head? Sometimes those shifts can be dislocating.

Marshall Hicks, MD:

Yeah, it was more of an adjustment that I thought it was going to be.

T. A. Rosolowski, PhD:

Oh interesting, how did you find that to be?

Marshall Hicks, MD:

Well, I mean in that role at the level, a lot of what you’re thinking about is institutional risk, is institutional decisions at a very strategic level and relationships, a lot of it external, with --whether it’s our Board of Visitors, whether it’s our UT colleagues, whether it’s the UT administration, a lot of external facing interfaces and decisions. So it’s how you approach that and how you process that and how you approach it. Still you use the same skills and same approach that I used. That was … I think some advice that was given to me: don’t do anything differently, because you were chosen to do this because of what you’d done and it’s worked. So it was just at a different level; and frankly, fortunately, I found that it wasn’t anything that to me seemed magical about doing it differently. It was the same principles still worked. It was just different things you were dealing with, broader scale. I had great support and had developed a great team there. So coming back to the division where it’s a more narrow focus and, you know, one of the things --it was like you realize that we are working within our own narrowness. Things that seemed very big to us at an institutional level are not nearly so big. So you sometimes ask yourself, Why are we spending this much time on this particular issue? Let’s make a decision and move on. Or it’s, we need to put this in the context of the bigger institutional decision or the bigger institutional framework. It was a little bit frustrating sometimes, to not think that people could see that, when in reality I knew that I had a perspective, fortunately developed, that I could hopefully bring back. But it wasn’t always easy, you know?

T. A. Rosolowski, PhD:

Yeah.

Marshall Hicks, MD:

You’re always, it’s—because it would happen a lot. That’s expected, I guess right, to some extent, because people didn’t have that. Almost any issue we were dealing with, there was a broader issue at some level. It was really institutional, and trying to connect that and just really the energy of continually addressing that when you can’t really explain maybe everything that’s out there. For example, some of the internet security. Aspects like that. There are things going on and you kind of knew. Now that a lot of these have come to light, but at the time there was investigations, different things going on. I knew what we needed to do in DI [Division of Diagnostic Imaging], but it’s hard when you’re not as able to share as much information and so forth, about certain things. That was rare. It was more of the general aspects of how do you really deal with it at a fairly narrow level, and feeling like there was—you had been exposed to this, gotten a lot of the knowledge and workings and then now it’s a much narrower focus. It was also an adjustment.

T. A. Rosolowski, PhD:

Did people treat you differently or did you perceive any difficulties or changes in relationships from that?

Marshall Hicks, MD:

Not so much that I’m aware of. I don’t really—more people knew who I was, just from walking in the halls and stuff. People would talk to me or say hello that probably wouldn’t have before, because they wouldn’t know who I was. Some of these relationships I was able to develop across the institution in that role. I don’t think it was all that different politically, and that’s probably a good thing.

T. A. Rosolowski, PhD:

What did you—were there any decisions that you made in coming back? Did you have a refreshed perspective on what the division needed to do, what direction?

Marshall Hicks, MD:

I think it was a hard time for everybody, coming through all that. I think that for me, part of it too was just --particularly coming off of Harvey and kind of really getting on our feet again-- there was a bit of an emotional sigh of just saying we’ve got to take some time and regroup. So some of it for me was really figuring out where we were, because it had been about a year. What were some of the higher priorities? I think for us it was moving into the region, the HALs. We had continued our expansion at Memorial Hermann, on the breast imaging side, and it was how those fit into the larger context of where we were headed as an institution, were a couple of key things. From a clinical standpoint, we were doing well in terms of performance wise. But it was also a time when we were starting to ramp up out of Epic, to the point where we had not caught up on the staffing side. We’re struggling with that a little bit. It’s getting ahead of that, which is hard to do if you’re still on a trajectory that’s growing at a pretty significant clip. It’s hard to ever get ahead of it, so we’re trying to come up with some plan there. We were in recovery mode and a catch up mode if you will, for a lot of ’18, and that’s carried over into ’19, which is a good thing, because it means we’re going to come back pretty strong. People want to come here, but it’s finding the balance on the staff side. So it was a little bit of what’s next, you know? Just reflecting and then what’s next. I was meeting with the CEO from one of our major vendors that I’ve known for about 20 years. He was visiting yesterday, and he was asking the same question: how are things, how was the adjustment and all that. I said something like, I kind of need to in some ways figure out how—it was a tough adjustment, you know? I’m still trying in some places to figure out how to adjust. He just kind of looked off for a couple seconds and said, “Well, is it you that needs to adjust or is it the eye that needs to adjust?” I thought that was an interesting perspective. I think what he was getting at is that there are things you do—like I said, he’s a CEO, you know? He runs a large organization, and I think his point was when you’re in a role like that you learn things. You can take them back but the expectation maybe is that the vision needs to do things differently and can do things differently, that are a benefit to the institution, that you now know that maybe you didn’t know before. I think that’s where he was coming from out of it. But his comment caught me by surprise and I had to think about it and I’m still thinking about it. I think it was meant in a very positive way, you know? There are—as an example, because of spending a lot of time thinking about institutional risk and thinking of things from a broader picture, it’s how do you introduce that into the conversation with leadership in DI? The “well let’s elevate and think about this from an institutional perspective or think about the risk to the institution.” Because it’s often different from the risk that we see in the division, and it may cause us to make a different decision, allow us to make a different decision, putting that into the framework of the larger institutional perspective.

T. A. Rosolowski, PhD:

Is there anything else you want to say about what was tough about the adjustment? I mean, I’m not trying to be intrusive, you know. These are aspects of leadership experience and I think it’s an important record of what happens in that life cycle of leader.

Marshall Hicks, MD:

It was a much tougher adjustment, and I think it’s because you’re used to things at a certain level. It’s fascinating and it’s stimulating, and then you come back to something that’s much narrower and in some ways there were still some problems that were there when you left, and it’s like why haven’t these been solved? Why can’t we move forward? I think some of them weren’t solved for very legitimate reasons, or there was a focus on other things potentially, as we were going through all of this. But still, the natural instinct is well why are we still dealing with these things, and oh my gosh, don’t you realize there’s bigger issues we need to be dealing with? And then you start thinking, well is this the right role for me anymore, because you’re thinking at another level and you’re thinking differently about things. Is this now the best thing for the division, the best thing for the institution or the best thing for me, to be back in those role, and questioning it, and frankly still am.

T. A. Rosolowski, PhD:

Sure, I mean it seems very natural. I mean I hate to put it in these terms but once you’ve been to the big city how can you go back to the little bitty town. [laughs] I mean it would be shocking if there weren’t some of that. I mean honestly, for smart people who love to be intellectually stimulated and love to be making change and affecting things, to have the ability to have impact on that scale and then okay, now I’m not doing that any more, well where is my purpose?

Marshall Hicks, MD:

Yeah, and it was a struggle as well, because you think well, you just went through this experience. Hopefully learned a lot from it. Gained a lot that could benefit the institution and yet, you’re back to a more limited role where you know people would say well, you’re going to have a great perspective. And that’s true. But it’s still not the same and you’re still, you find yourself asking that question.

T. A. Rosolowski, PhD:

Have you kind of turned over any possibilities of next steps in your head, I mean really at a fantasy level, I know that this is early days.

Marshall Hicks, MD:

I have, but on a personal level, what happened was my dad’s health has been poor and struggling and in a slow decline with his Parkinson’s. I didn’t want to get preoccupied with exploring or committing or doing something. Frankly, it’s just been a real struggle for him. I go up at least once a month now and I’ve been doing that really, since I remember in August of 2017 he was hospitalized with pneumonia. I really thought that was going to be the end, frankly, and that’s been a year and a half ago. He’s just been hanging on and it’s great to have him but it’s a struggle for him.

T. A. Rosolowski, PhD:

Well and a struggle for the family.

Marshall Hicks, MD:

And the family. So really, almost in some ways thought it would be selfish for me to try to not be able to help when I can and be distracted by something. On the other hand it’s like you’ve got to still think about there’s a window of time that I have left in my career and how do I work through that? I’ve found challenges as I’ve come back, and been able to help out, but I’ve been selective. I’ve been really pulled out of all my other commitments, while I became interim president, so I wanted to allow other people, some of them might have been in those roles for a while as chairs of certain committees and things, so as I came back I was trying to be selective about which roles I can be in that I can really help, like with the Inpatient Planning Committee and different things like that that have come up. I want to make sure that it’s something that was interesting to me, but also somewhere I thought I could add value. It is something that I keep thinking about too, what type of role, because this was when you compare us as an institution, to other institutions, we’re so fortunate. So some of the issues --I love challenges but some of them are real challenges. Like when you look at what some of the other groups even in town are going through as healthcare institutions. There’s a deanship or something like that, in an academic institution. Even that is very different than it is here, because we don’t have a medical school. We don’t have the sort of traditional thing. Then you’re not dealing with the—and again, that’s a more limited role, whereas something where—so it’s really trying to find what will be a good fit. What would be something that would be stimulating but something where I would bring value as well, into a role like that? It’s not been easy for me to think of those things. When you think of the role of this institution and the role of the CEO here, translating into something that could parley into another opportunity. You get into the CEO of a healthcare system, even if it’s a small or moderate one, there’s so many challenges in medicine right now that a lot of them are getting into cost cutting, cost reduction side of it, not how do we have opportunities to grow. So you have to look at roles, and even in deanships now, where resources are declining. There’s other issues you’re dealing with and some of these roles, I think could be pretty challenging. It could be there’s opportunities, and then there’s sort of setups for failure, and distinguishing those.

T. A. Rosolowski, PhD:

Not a good move.

Marshall Hicks, MD:

Yeah, exactly. [Interruption: Hi, excuse me, you left your phone in your office and it was ringing.] Okay, thanks, okay thank you.

T. A. Rosolowski, PhD:

Should I pause this here?

Marshall Hicks, MD:

No. Yeah, thanks. I purposely left it in there, bless her heart. [Tacey laughs] That’s kind of it, I mean I’ve been—and to move. I mean it’s a great institution but from a family standpoint too. It sounds like well yeah, it’s got to be something else but if you look at it, it’s like these are major life decisions and changes.

T. A. Rosolowski, PhD:

Absolutely.

Marshall Hicks, MD:

And I think probably also, when you’re on a track where you’re moving, I mean I’ve made one move as a career, as a faculty member. I think if you’re in a mode where maybe you’re doing it for five or ten years and you’re moving up, it gets easier probably, to say well I’ll take a chance on this. Then if it doesn’t work out here, it’s like yeah, I don’t—I want to make sure it’s something that is a good fit for me. So I purposely haven’t been as active in putting my name out there, doing something until it feels like a good time.

Chapter 29: Transitioning out of the Interim President Role

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