Chapter 30: On Ongoing Strategic Planning and the Future of MD Anderson (2019)

Title

Chapter 30: On Ongoing Strategic Planning and the Future of MD Anderson (2019)

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In this chapter, Dr. Hicks talks about the strategic planning model Play to Win (Lafley Martin) that Dr. Peter Pisters brought to MD Anderson in the early days of his presidency. He outlines several positive features of the model and notes the importance of defining MD Anderson’s “aspirational win” (a key concept in the method), given the need to avoid “turning into a corporation.” He talks about how important it is not to “lose the people” of MD Anderson, as patients constantly mention the caring people the encounter during treatment and this gives the institution its edge.||Dr. Hicks then sketches what lies ahead for the institution: the need to succeed in a changing healthcare environment linked to politics; the need to fund research more independently of clinical revenue; and to develop a wide range of clinical service to be flexible. He also notes that MD Anderson needs to position itself advantageously in the region to manage risk and also work collaboratively with institutions across Texas.

Identifier

HicksM_08_20190321_C30

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; Leadership; On Leadership; MD Anderson in the Future; Critical Perspectives on MD Anderson; The Business of MD Anderson; The Institution and Finances; The MD Anderson Brand, Reputation

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:

That makes sense. Can I ask for a different sort of reflection now? I’m wondering about your view of the new strategic planning process. We have the McChrystal phase and now we’ve got segueing into this new phase with the Play to Win model by Lafley Martin, so I was wondering what your thoughts are about that transition.

Marshall Hicks, MD:

Read the book. I’m familiar with it, and we’ve been having a couple exercises with it. I mean I like the approach. I think it will be interesting to see --this is coming out of more of a corporate, almost in a commodity area sort of approach-- and to see what we come up with is what’s our aspiration or win, because I think that’s a key question. A win for Proctor and Gamble is to dominate in a sector and crush the competition. For us a win is probably health, well being of patients and curing them of an individual cancer, not competitively necessarily against who is our competitor. That’s one of the things we’ve been asking ourselves, is who are our competitors, and so how that approach translates and not. I think we’ve got to be careful --and I think we will-- not to have a perception be that we’re turning into this sort of corporation that isn’t more—isn’t patient focused, humanistic about what our real goals are. That our winning aspiration is about the people, and P&G has customers that are focused but their customer is ultimately a transaction, meaning profits to the bottom line.

T. A. Rosolowski, PhD:

What do you think of --I mean in the Division of Education and Training, which houses the library, there really has been an attempt to disseminate this model at every level of the organization. I assume that’s happening every place. What do you think about that method, you know is it new, is it different, what do you think is a prognosis for that?

Marshall Hicks, MD:

You mean the actual trying to get it disseminated?

T. A. Rosolowski, PhD:

Mm-hmm.

Marshall Hicks, MD:

I think so. I mean we did this with the pyramid thing and that was an attempt there with somebody I know within our division. We actually used that framework and we did concurrent strategic planning. I liked this framework in the sense that it asks questions, and I think if you’re having people—if you’re asking the same questions across the institution, I think that’s a good thing. There are, in a sense, a lining over those questions, and beginning to think about what are these questions, what’s important. We were reviewing yesterday at the new president’s Advisory Council, it used to be the Shared Governance Committee, that from all the activity that’s going on, whether it’s online or the focus groups, that they’re getting a lot of—they’re getting strategic, focused suggestions for themes. But they’re also getting —I’m blanking on what they call it-- but it’s more tactical type things. They’re talking about boxing, you know putting in a bucket rather. Things that we need to address but they’re not things that are strategic. It’s more like we need to reduce bureaucracy or reduce administrative burden and things that we do need to be taking care of but it’s not really in following the realm of strategy. I think that’s what happens, that we should be getting a lot more of those on a more strategic level, and that’s probably natural because a lot of people tend to think about what’s in front of them.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

It was interesting to me because the themes that are coming up strategically are probably fairly predictable themes and many of them are things that as well, kind of came out of a political process. We called them priorities at the time. There’s an overlap I think. Then some of the things that were in McChrystal, probably were more the tactical or operational stuff. I like just the framework of asking questions and really stimulating thought that way. Having its consistent but simple framework, which I think is the real strength of this. I think it’s just perhaps managing perceptions to make sure that people don’t think that we’re trying to turn into a Proctor & Gamble.

T. A. Rosolowski, PhD:

Right. Mm-hmm.

Marshall Hicks, MD:

And what is our real wining aspiration doesn’t—that we’re not trying to turn this into sort of a commodity based organization, or that we are not still losing sort of part of our secret sauce, which is that caring that we have for patients, that you hear over and over from people that come here. That it’s the people that make the real difference, which is really our edge, what makes us distinguished from others. Even Carol Porter [oral history interview] brought this up at a meeting where we were talking about this, as who is our competition. Maybe you could say Memorial Sloan-Kettering, but most would argue maybe not, because they’re so far away and they’re dealing with a very dense population around where they are. But the caring aspect there, between there and here, is something that people who have experienced both places differentiate.

T. A. Rosolowski, PhD:

Oh really?

Marshall Hicks, MD:

Yeah, just a different type of environment. That’s the thing. When I hear patients that are friends, family, that come here, it’s always about how well they were cared for. The breakthrough science and all that stuff is great, and the technology. But the thing that I hear that people really identify with is the caring of the people who work here. I like the framework, I think it’s good. And I like the structure, because I think we need the structure and I think it needs to be simple enough that people understand and can focus on. Because if it’s too much, they’ve got other things they’re trying to do and distractions. I think this is something as well, even though we tried to align with the pyramid, they were pretty broad. With this, we can all, within all of our divisions or departments, ask these same questions and say how do we align with now what is the institutional winning aspiration or support for it?

T. A. Rosolowski, PhD:

What do you foresee evolving? The what’s in the future question, either for the strategic planning process or for the institution as a whole.

Marshall Hicks, MD:

I think one of our biggest challenges is the changing healthcare environment and what that’s going to look like, and there’s a lot of uncertainty about it. It will continue down to some extent the political path. Where that’s—there’s a lot of conversation about Medicare for all, or single payer, or something, and who knows where that will end up. But those sorts of things will impact us for sure. Those are all concerns there. But --and like it or not, that’s where a substantial part of our revenue comes from, so we have to pay attention to that. The science side, the research side, I think is jeopardized to the extent that it can’t be supported. So where we’re going is we need to look to see how we can make the research part less dependent on the clinical side. I think from the clinical side it’s how do we develop a diverse portfolio to make us flexible enough to be sustainable and be able to continue to serve the mission. When I look at it, and I’ve been involved in this Inpatient Planning Committee, so it’s how many inpatient beds do we need, do we continue to grow and where should they be, is the two simple questions out of it. As we looked at that, it’s pretty clear that our region is still growing pretty phenomenally. Texas is still growing but Houston in particular is growing as a large city, getting even bigger. It’s getting harder as a city being sprawled out as we are, more challenging for patients. One of the things we heard from patients out in the region is they want inpatient, they want inpatient facilities out there. Many of them will not come down here if that’s the decision they have to make, because it’s just too much, and it’s going to get harder.

T. A. Rosolowski, PhD:

Right.

Marshall Hicks, MD:

So I think if we want to be competitive in the region and continue to grow with our population draw on the region, we’re going to have to probably continue to expand. The HALs that we’re building now are probably phase one. We’ll probably end up with an inpatient facility of at least one of those, but as we continue to start planning, what’s next.

T. A. Rosolowski, PhD:

I missed the acronym you used, HALs.

Marshall Hicks, MD:

HALs, Houston area locations. I think that just makes sense, because if you look, a third of our patients come from the Houston region, which right now is the surrounding counties. That may shrink if it gets harder for patients to come in even from the surrounding counties, but there’s an opportunity to grow it as we get further out. So if we want to maintain that or even grow it, but right now we have about 25 percent of the Houston area market and it’s not a lot really, when you think about it. So even if we increase that, even if we doubled that, which we really couldn’t do as an institution, we still wouldn’t have a majority of the market. We’d have right at 50 percent. But if we want to maintain that even as we grow out, we’re going to need to grow. So when I think about the challenges that may come if there’s a national network or as networks continue to narrow, the vulnerability we have nationally, of patients still being able to come here and even some of the Medicare –you know, the advantage plans, don’t let people come here, they’re becoming more and more popular. There are some risks nationally, as this continues to evolve. So it makes sense for us to position ourselves to where we’re—to me it’s the fixed cost concept and the variable costs. The fixed costs, the fixed revenue, can come from a region, as a portfolio. The more flexible variable piece is going to be probably what’s outside of the region, whether it’s international or national or in Texas. But also, as part of our responsibility as being part of the University of Texas System, is how do we work more closely with the rest of the institutions? This is something we started doing when I was the interim and even before it was Ron. It became much stronger as we actually formalized some of the affiliations, like San Antonio. I think there’s an opportunity there for us to help in areas where cancer is not a strength, in some of these institutions, to really strengthen it and to reach more patients in Texas and to really kind of be the leading partner in oncology in the state. So I think that’s part of the portfolio too. Then internationally, we’re still trying to figure out what the best opportunity there is. It’s a huge opportunity, but there’s also huge risk there as we’ve experienced, when patients come and you end up with patients that really shouldn’t be here and we really can’t do much more. It’s just impacting those that you really do want to serve. So how do we figure out how to really channel the right patients, the ones that can benefit, and get them here? The same thing nationally, to a lesser extent. That’s a little bit easier to navigate through because of just the communications and the distances and time and all that being less. So I view it as we’ve got to be flexible, we’ve got to be able to adapt to whatever changes happen in healthcare, policy and healthcare nationally, but that we have great opportunities. Our brand is so incredibly strong, as we found out when we were doing the focus groups and the interviews and surveys regionally. Patients will tell you that we’re the place to be, but they’re just not going to come down here.

T. A. Rosolowski, PhD:

Well you’ve been very patient with all of this time, and I wanted to ask you if there’s anything else you would like to add at this point.

Marshall Hicks, MD:

I don’t think so, just that I appreciate the opportunity and it really was an honor to be in that role, which is the only reason I’m sitting here.

T. A. Rosolowski, PhD:

Not the only reason.

Marshall Hicks, MD:

But no, it was quite an experience, and this has actually been very helpful, to just kind of put it all together, think about it, reflect on it, what I’ve learned, but also what we went through and how it can help better prepare us for the next chapters that happen. It was probably --the ultimate lesson was just the resiliency of our people and the commitment of the people that work here, because that was a major transition when you reflect on it, and it was a real credit I think, to everyone pulling together during that time. You wonder if other institutions, other organizations, how they would have weathered something like that. I think that we’re just fortunate to have the kind of people --it gets back to the caring aspect, who not only care about the patients but we care about each other and care about the institution, and that’s pretty remarkable.

T. A. Rosolowski, PhD:

Well I want to thank you.

Marshall Hicks, MD:

Oh, thank you, it’s been a pleasure.

T. A. Rosolowski, PhD:

Yeah. So I want to say for the record, I am turning off the recorder at six minutes after twelve.

Chapter 30: On Ongoing Strategic Planning and the Future of MD Anderson (2019)

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