Chapter 13: Cultivating Leadership at MD Anderson

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Chapter 13: Cultivating Leadership at MD Anderson

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Here Dr. Bruner talks about leadership development at MD Anderson, beginning with the courses she took via the American College of Physician Executives. She notes that MD Anderson offered few opportunities for leadership training in the nineties, but that changed in early 2000, when the Office of Faculty Development hired the Executive Development Leadership Group to offer formal training. She talks about the courses offered and also describes how the pace of the first courses was too slow for MD Anderson's high speed culture where minds move quickly. She then talks about the creation of the Faculty Leadership Academy (in 2002/3) whose goal was to offer a curriculum of basic leadership principles that faculty aren't exposed to during professional training, but that are needed in most roles: supervisory skills, conflict resolution, evaluation, mentoring, hiring and firing, etc. At the end of this chapter, Dr. Bruner gives an example of a departmental dilemma requiring complex skills

Identifier

BrunerJM_02_20120607_C13

Publication Date

6-7-2012

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Professional Path; Evolution of Career; Leadership; Mentoring; On Leadership; On Mentoring; Education; Building/Transforming the Institution; MD Anderson Culture; The Administrator; Professional Practice; The Professional at Work; Institutional Processes

Transcript

Tacey Ann Rosolowski, PhD:

Now you said that when you began thinking about administration as a possible goal in the future, you started taking some leadership courses and these—this was actually not on the MD Anderson campus.

Janet M. Bruner, MD:

Right.

Tacey Ann Rosolowski, PhD:

This was elsewhere. What courses did you take, and what did you learn about? What were the lessons that you took to your own first experience?

Janet M. Bruner, MD:

I think I did just general leadership-type courses. It was the American College of Physician Executives, which I tell people about, and they have two- and four-day courses in managing change, managing conflict—there’s some financial management—financial instruction. There’s instruction in health law. It’s just a very broad-based leadership curriculum, and their courses also do lead to—you can get a master’s degree from that organization by their—they are affiliated with several universities that you can take courses—their courses—and they count for credit toward a master’s degree. I never finished. I never got that far. There was a point at which I thought I needed to do this, and then I realized that I had gained the knowledge that I was satisfied with and the other parts of what I needed to do I didn’t think—it was just diminishing returns at that point. I didn’t go on. Sometimes I regret that, but overall I don’t think I have. Now, at MD Anderson we had—in the early ‘90s and then again around the late ‘90s or 2000—we had a couple of leadership instructional opportunities that were really bad, and the people who took advantage of those got totally turned off by leadership courses, so I think it kind of got a bad name. Leadership development got a bad name at that time.

Tacey Ann Rosolowski, PhD:

What was the problem with the courses at that time?

Janet M. Bruner, MD:

One of them I wasn’t involved with. It was given in conjunction with Rice University, and that was the one in the early ‘90s. The other one was in the later ‘90s, and that was given in conjunction with the University of Texas at Austin. The problem with that one was it was given by their business school faculty, and I guess they were good faculty, but they were talking in one direction, and we were listening in another. It just didn’t—it was boring. It was dry. It was irrelevant. I went to that just because I thought, “Maybe there’ll be something here.” It was awful! It was just awful!

Tacey Ann Rosolowski, PhD:

So was it they were just not on target for the experience of a medical community?

Janet M. Bruner, MD:

I think that’s true. I think they just—yeah. They just weren’t giving what we needed to get, and then starting in around 2000-2001, the Office of Faculty Development here started developing a leadership curriculum that we still carry through today. It’s called the Faculty Leadership Academy, and I was involved with that from the beginning. There was a committee of faculty and administration who interviewed various consulting firms, and we had our criteria that we wanted them to come in and how they wanted them to lead the courses and develop and what kind of curriculum would be used and what kind of format. We selected a small firm out of New Jersey who has been with us until today, and they have been terrific. They’ve almost inculcated themselves into the culture of MD Anderson. They know us about as well as we know ourselves. They send the same people out every year—the same two or three people—to give our courses, so they know us. We know them. I’ll never forget one of the issues we had with them at the beginning. They give some interactive courses. They give some didactic and some interactive work, and they kept—they were moving the coursework along, but we kept telling them, “You’ve got to go faster. You’ve got to go faster,” because people were just getting bored, falling asleep, and they kept speeding up and speeding up and speeding up and I think they had—they didn’t realize how fast they had to go. We here at MD Anderson move fast. We have to. There’s a lot of work to be done. We not only move fast physically, our minds move fast, and we can suck up information at a speed that people outside the medical profession and outside here can’t understand. So now they’ve gotten to a point where they’re moving fast, and the MD Anderson faculty who take these courses love them. In addition to that, there’s also an administrative leadership program—very similar only aimed toward administrative positions at MD Anderson. So we have opportunities for leadership development on the faculty side and the administrative side, and it’s really been two very good programs. The one regret we have is that they don’t come together more often. There’s this schism between faculty and administration and we started at the beginning—in the second and third years we had a couple of programs together, and it just seemed like the administrators came to those. Faculty tended not to, so we pretty much split again.

Tacey Ann Rosolowski, PhD:

Interesting.

Janet M. Bruner, MD:

And it’s too bad, because I think that each side could gain a lot from that.

Tacey Ann Rosolowski, PhD:

What is the name of the firm you were working with?

Janet M. Bruner, MD:

It’s called Executive Development Group, and they’re based in Livingston, New Jersey, I think. They’ve been with us for ten years.

Tacey Ann Rosolowski, PhD:

This was actually a question area I was going to get into a little bit differently and a little bit later on, but if you’re game we can certainly talk about it now.

Janet M. Bruner, MD:

Sure.

Tacey Ann Rosolowski, PhD:

Because you’ve—you—I had on my list of—that I derived from your CV that you were very involved with the Faculty Leadership Academy, and I guess that was beginning in 2005? Is that correct?

Janet M. Bruner, MD:

Actually, it began a little bit earlier than that.

Tacey Ann Rosolowski, PhD:

Okay.

Janet M. Bruner, MD:

Yeah. The Leadership Academy began in about 2002 or 2003.

Tacey Ann Rosolowski, PhD:

Now, were you involved in setting that up?

Janet M. Bruner, MD:

I was involved in the committee who set the criteria and chose the consulting firm to do this, and then I was in the first class that went through that. It was in about—it must’ve been 2003 because I think we’ve just graduated our eleventh class.

Tacey Ann Rosolowski, PhD:

Wow.

Janet M. Bruner, MD:

And there were one or two years where we had two classes.

Tacey Ann Rosolowski, PhD:

So can you tell me about some of those conversations when you were deciding there was a need for this and defining what the mission and goals would be?

Janet M. Bruner, MD:

Well, the goals were to set up sort of a mini curriculum—something like I had been through at the American College of Physician Executives—with basic leadership development ideas, and we used a book called The Leadership Challenge, and I don’t know whether we thought of that or EDG thought of that—the consulting firm—but there are certain principles of leadership that are expressed in that book, and they still use that as a sort of textbook and guide. We wanted to get basic leadership principles taught to the faculty because you’re not taught those things in medical school or in college.

Tacey Ann Rosolowski, PhD:

Could I ask you to pause? I’m sorry.

Janet M. Bruner, MD:

Sure.

Tacey Ann Rosolowski, PhD:

I just started. Okay. I’m sorry.

Janet M. Bruner, MD:

See, I didn’t even hear it.

Tacey Ann Rosolowski, PhD:

Yeah. We were just—for the record, we were just commenting on a little beep that suddenly started but I guess that’s an environmental noise.

Janet M. Bruner, MD:

It is. It is.

Tacey Ann Rosolowski, PhD:

Nothing we can do about that. Okay. So you were saying that faculty are just not taught these things in medical school.

Janet M. Bruner, MD:

Right. You’re just not taught—as a physician and clinician you’re taught to work basically by yourself with a patient, and even from the moment that you’re hired in our practice, you have supervisory responsibilities for clinical fellows or research fellows, for a secretary or support people, for nurses, for laboratory employees that may be in your lab, so you need to know how to develop their careers. You need to know how to supervise. You need to know how to manage conflict. You need to know how to manage change. You need to know how to mentor and foster their work environment. You need to know how to evaluate them, how to hire and fire people, what questions you can ask when you’re hiring, what you can’t—that’s a big deal. I think those are the kinds of principles that we wanted to particularly educate faculty leaders, and the Leadership Academy started to teach people who were already chairs—department chairs and division heads and section chiefs—and moved sort of down from there. We still try to catch—in around 2005 or 2006 I became interested in continuing to participate and help facilitate some of those programs. I’m not good enough to teach people that stuff, but it’s wonderful to just watch these guys who are the masters, and they don’t let people slide out. They make people answer questions truthfully and participate, and it’s really great to watch them. They’ve also done quite a bit of coaching here of new chairs coming here and other people. They’ve done some teambuilding exercises. You have to really know how to operate in a team—you know—what does it mean if your team is doing well or not doing well—even things like running a meeting. We have the regular curriculum, and then we have other little side lectures that we bring in occasionally for people. In fact, we have two today on mentoring. We have two webinars on mentoring that we’re listening to. But all this is going on through Faculty Development, and I became very interested in doing more facilitation with some of the leadership participants. We try to catch all of the faculty chairs now as they come in within the first couple years and put them through the Leadership Academy and we are now to—we take—the people who go through that are suggested or nominated by their chairs or by division heads.

Tacey Ann Rosolowski, PhD:

I was just looking for—here it is. I was looking at some of the courses. Let’s see. You were co-facilitating with a man named Steve Sperling?

Janet M. Bruner, MD:

Right. He’s one of the participants. He’s one of the EDG principles.

Tacey Ann Rosolowski, PhD:

Oh, I see. Okay. So we have Creating a Culture of Faculty Mentoring at MD Anderson, Leveraging Your Influence, Team Development, so a whole variety of topics. Managing Conflict.

Janet M. Bruner, MD:

Right. Right.

Tacey Ann Rosolowski, PhD:

Yeah.

Janet M. Bruner, MD:

Yeah, I think the two that are the most helpful for me is probably the Managing Change and the Conflict Management. That is a continuing learning experience. Those are just—and if faculty chairs—department chairs could just be introduced to and practice some of those techniques, I think it would really serve them well.

Tacey Ann Rosolowski, PhD:

I don’t want to put you on the spot of feeling like you have to gossip or say anything, but is there an instance that you can share diplomatically that shows a lesson that you learned that other people could benefit from—about managing conflict, for example, which seems to be such a key issue in administrative roles?

Janet M. Bruner, MD:

Yeah. I think there is, and I can tell you about a faculty member. It’s not exactly a conflict, but I think of it as a conflict. When I was a chair, I had a few faculty members—and in this institution, we have two faculty pathways for careers. One is—well, that apply to us—one is a clinical pathway only, and the other is a tenured pathway. The tenured pathway is really meant for people who are doing research, so clinical faculty who are doing research can be on that pathway, but people who are not doing research really shouldn’t be on that pathway. There was a time—and it still is—where the tenured pathway is considered a little more prestigious, so faculty come in, they’re recruited, and they want to go on that tenured pathway. They rise up through the ranks, they do barely enough research work or clinical research to get tenure, but then they just don’t like it that much anymore so they don’t do it. They do more clinical work, and I had two different faculty members who were in that situation. They had gotten to be associate professors—or even one was a professor—and they were tenured, so they had done enough to get tenure, but they couldn’t make it to the next level on the tenure path. Every year at evaluation time there are certain criteria that you have to—certain things you have to do if you’re tenured or if you’re not, so every year I would have to say, “Okay, you’re tenured. This year you didn’t publish papers. You didn’t do this. You didn’t do that.” “Well, yeah, but look how busy I was! I was doing all this clinical work, blah-blah-blah,” and I said, “That’s fine. So shall we switch you to this clinical path?” “Oh, no. No, because I have tenure already, so I don’t want to switch.” I said, “When you’re setting your goals for next year think about this because, if you’re still on that tenure path, you’ve got to set goals for research and publications, and clinical goals aren’t going to be enough.” “Oh, yeah. I know I need to do research. I know I need to publish. I’ve got all these things ready. I just need to write the papers. I just need to send them in. I’m going to do that. Here’s my goals for next year.” I said, “Okay, now, these goals talk about research. They talk about publications. Are you sure you’re going to—?” “Oh, yeah. Yeah, I’m going to do that.” I said, “Well, you run the risk. This time next year we’re having this same conversation, and I’m going to have to check the box that says ‘did not meet goals,’ whereas if you switch to the clinical path, everything would be fine. I could check the box that says ‘met goals,’ ‘fully met goals,’ ‘exceeded goals.’” “No, no, no. I know I need to do the research. I’m going to do it. I swear I’m going to do it this year.” Next year comes. I’m checking the box that says “did not meet goals.” So this went on for a couple of years. Finally, one of the people who I had been having this conversation with said, “I do have tenure, and I’m coming up.” We don’t have lifetime tenures, so the tenure has to be renewed. So they were coming up for renewal of tenure, and I said, “You know, I don’t think your tenure’s going to be renewed because you haven’t met these goals.” “Oh, I know! I feel so bad about that, and I’m just a failure.” I said, “Look, why don’t you just switch off the tenure path?” And it turned out that one or both of them was afraid that if they went off the tenure path that their job might be at risk because then I could fire them. I said, “Wait a minute. You’re a great clinician. You do great diagnostic pathology. Why would I want to fire you? You are great clinically.” “Well, but I’m afraid then you could fire me.” I said, “Okay, how many faculty have I actually fired here since I’ve been the chair?” And I had been the chair eight years. “Well, none.” I said, “Okay.”

Tacey Ann Rosolowski, PhD:

(laughing) Reality check.

Janet M. Bruner, MD:

“And don’t you think you’re a better clinician than some of these other people over here?” “Yeah.” I said, “Okay, well, don’t you think I’m going to fire them first?” Okay. So one of the people switched off the tenure track, became a clinician, and worked on. They were approaching retirement. They worked another four or five years and had a great career! Every year they were happy. I could check the box that said, “fully exceeded goals.” They never looked back. They still participated in clinical research, collaborated, but there was a huge smile on their face every day coming into work. They could do clinical work and take pride in the fact that they were great at it—one of the best in the department—and had a great life. The other one I never could convince them to switch off. They were an associate professor, and had been there for twelve or fifteen years, which is a long period of time to be at one rank. And I said, “You know if you switch off, I think I can get you promoted to professor on the other path.” “Oh, no, no, no.” They never verbalized it, but I knew it was in the back of their mind, “Because I’m afraid you’ll fire me,” because they had behavior problems in other ways, but I still probably wouldn’t have fired them. Never did switch off, blamed me—to this day—for the fact that they couldn’t get promoted because I wouldn’t put them up for promotion. Finally, just before they were I think ready to go up for tenure renewal, they took early retirement because they were so afraid they weren’t going to make it, and they weren’t going to be able to stay here, and I had never said that. So the communication just wasn’t there, and communication skills is another thing—another big, important thing. I feel like the person who actually switched off that—I had a conflict with each of them every year at evaluation time. The person who switched off finally had a great life and a great rest of their career. The other person prematurely ended their career. I believe they were sorry they did that, and it was sad because they were a very good diagnostic pathologist—could have taken the same path as the other one, but I just could not get through.

Tacey Ann Rosolowski, PhD:

Interesting.

Janet M. Bruner, MD:

And other people tried also to convince him, and he just would not listen.

Tacey Ann Rosolowski, PhD:

Interesting. Interesting. Yeah. Well, thank you. That’s very revealing of all kinds of things—the prestige factor, communication—all those elements. I remember in my academic brush I had with academia, there was some talk in the humanities of establishing a teaching track, and you can only imagine how lowly that would have seemed in comparison with the research track.

Janet M. Bruner, MD:

Right. Right.

Tacey Ann Rosolowski, PhD:

So that didn’t—that was floated very briefly but kind of went away.

Janet M. Bruner, MD:

And I still think that that clinical track here is viewed less prestigiously, but regardless of that, the salaries and benefits are the same for people, so there’s no reason not to do that. Faculty really need to be on the track where their heart is, and that’s the bottom line. I try to convince people of that both as they’re coming in and as they’re progressing because we’re—a big decision point, too, is the promotion from assistant to associate professor.

Tacey Ann Rosolowski, PhD:

Right.

Janet M. Bruner, MD:

That’s where the tenure kicks in and if they’re not doing research—if they’re not doing their own research—their own independent research—then they really don’t belong on that track, and it’s just going to make their lives miserable to stay there. There’s no reason for that because here, really, the clinical people are arguably more important than the research people.

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Chapter 13: Cultivating Leadership at MD Anderson

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