Chapter 09: A Decision-making Process Includes Lessons about Leadership

Chapter 09: A Decision-making Process Includes Lessons about Leadership



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In this chapter, Dr. Buchholz continues his discussion (in Chapter 08:



Publication Date



The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center


Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Leadership; Ethics; Professional Practice; MD Anderson Culture; Working Environment


Thomas Buchholz, MD:

But so there’s that art of human relationships that is important to make it all work. And this becomes, I think, very important in management of more senior faculty. And one of the strengths of MD Anderson, one of the things I enjoy most about MD Anderson, is the diversity of our culture, and the diversity of culture can bring in people who were raised in completely different traditions. For instance, in the Far East, the professor is idolized, and it’s almost as if the junior people are there to care and serve the senior professor. We don’t work in the Far East, and we have to have an appreciation for that. And if someone was in that tradition, we can’t say that’s fine to do in our context. But at the same time, we do have to appreciate that people bring value and wisdom and contributions in different ways. The experience of working in a field for 20, 30 years is highly valued, and that tradition is very important. That person might not be able to adapt to a new electronic health system immediately, compared to the first-year faculty member, but they might bring a certain element of depth that the first-year faculty member might not. And so to be hard and fast about requirements sometimes creates a little bit of a nuance.

Tacey Ann Rosolowski, PhD:

So how did you work through the cost-benefit analysis in the example we were just talking about, with those pilot studies?

Thomas Buchholz, MD:

I kept my end goal in mind, and I committed that we would get there, but sometimes you might have to take one step back before you move forward again, and you might have to alleviate a crisis, and sometimes you might have to compromise. One of the things I’ve appreciated in leadership is the landscape of your viewpoint changes dramatically. And it’s not as if you get brainwashed, or it’s not as if you’re smarter than anybody else. It’s just you have opportunity to have different experiences than most people do. And it changes your vantage point. I’ll never forget, as a department chair I ended up having a really great relationship with our faculty. I think they appreciated that I did have consistency, that I was focused on kind of the mission of our group, again, the greater good of our group. I didn’t have a personal agenda. I don’t think people were thinking of my leadership as, “Oh, Tom’s trying to use us as a measure of getting to some greater place for himself,” or that I wanted to divert all of our academic focus into the area that I was interested in. I think we had a good relationship within our department where I had the humility to not say that I had the answers, but I had the relationship ability to direct us as a group to find common answers that we wanted to pursue and move forward with that. Sometimes we even made the wrong decisions. There were a couple decisions that I look back upon now, and I say I wish I had made a firmer stance, because in the end it would’ve proven to be beneficial for the group. They didn’t have the same landscape that I did. Of course, I didn’t have the same landscape that they did. A prime example is actually the Pickens Tower. So these aren’t life-threatening type of major decisions (laughs) or anything, again, but I’ll never forget when I had a great relationship with provost and Physician-in-Chief as a department chair, and we were trying to consolidate our faculty into the Pickens Tower, and I was able to secure for our departmental faculty two and a half floors of the Pickens Tower. And I thought this was a win, because we have faculty who have offices in the Mays Clinic, and we have faculty who have offices in Clark Clinic, or the Blue Zone. I’m not even sure what... Really remote areas of our institutions. And you lose out on being part of the faculty community, and we lose the cohesiveness of having a department where you see your faculty colleagues all the time. So we discussed this, and I thought one of my best negotiating with the Provost and Physician-in-Chief about the beauty of moving to the Pickens Tower, which would be a central location, readily accessible still to our treatment units back in either direction—it was kind of equal distance—a perfect path forward. We could utilize conference rooms together down here, and just have... That created almost an instinctive reaction from our faculty of negativity. Oftentimes we are called to see patients on our treatment machine, etc. Oftentimes we need to be near our clinic. But that change was just, oh. And the reaction within our leadership council was very emotional, and feeling as if, Tom, you’ve been such a good listener to us through the years, but why is this coming down heavy-handed? You clearly don’t appreciate how important it is that we are here, and how devastating it would be to walk for five minutes to become... This is going to disrupt our whole clinic flow, etc., etc., etc. So after all this planning, I had to humbly go back. We reached a consensus that, no, we’re going to have a small group here in the Pickens Tower, and we’re going to continue to have a distributed faculty. And that was probably 80% consensus towards that.

Tacey Ann Rosolowski, PhD:

So was it suddenly a conflict of values between the value of establishing departmental cohesiveness and community and the value of what do I need to know that I’m delivering good patient care?

Thomas Buchholz, MD:

It was portrayed that way. I think there was the inconvenience value. This is my work environment. This is where I’ve traditional sat. The traditional value of being able to be called and run downstairs and see the patient. And everybody does have circumstances. Well, sometimes I work in the operating room over here, and this would be another burden of me. I’d have to drive in five minutes earlier, or whatever. And, of course, systems come into play, too. Now you can check things remotely in the computer that you used to do in a treatment planning room across the street. So I kind of saw the future, and I said, this is a good move for our group, and it was a win for our group, but that was flat-out rejected. And I remember being disappointed in some of the faculty who kind of even were using trump cards, like, “You’ve always been such a good leader, and you’ve always understood us, but, boy, you’re really missing the point on this. Why are you not listening to us?” So in the end, I listened, and in the end we moved a very small contingent over to the Pickens Tower, and the vacuum of filling up the rest of the space was quickly done. And now, if you walk around to our faculty, our faculty say, oh, that was the worst move. Everybody wants to move into this little space. Everybody recognizes now that, wow, what I’d give to have one of our few offices over here. They’re the premium. And ironically, then, of course, the new hires or the junior faculty, the ones who need to be most integrated into the institution, are relegated now to Nome, Alaska over there in the Mays Clinic parking lot building. (laughs)

Tacey Ann Rosolowski, PhD:

But I can only imagine the negative impact if you had come down as a heavy and said “No, we’re going to do this.” Wow. Interesting. So what were the big lessons that you took away from that? I mean, that’s a really interesting scenario.

Thomas Buchholz, MD:

Well, I think the lessons are that it’s always important in any type of relationship, whether you’re a leader or being led, to try to understand the perspective, and really try to see and understand where people are coming from before trying to convince them that they’re wrong. I think that’s true of any type of relationship. If you could have the person who doesn’t want to move to the Pickens Tower stand up and argue for moving to the Pickens Tower, the one who doesn’t want to move, and vice versa, and have kind of a reverse debate, you could begin to maybe appreciate the differences. I think those are some of the... It’s in clinical medicine, too. I’m often asked to be on one of these debate panels of some new technology of some kind, and should we do it, yes or no, is it acceptable as standard of care. And it’s almost great to have enough open-mindedness that you don’t care which side of the equation that you’re asked to debate, right? Because that gives you the ability to see both perspectives of why it should be done. And then it enables you, if you feel like there is a right answer, at least to be addressing and be acknowledging that you hear what they’re saying. You’re not negating what they’re saying, but you do understand their perspective, and you appreciate their perspective. And sometimes we’re going to have to make decisions, despite not everybody’s perspective being realized, and that’s because we’re a group, and there’s complexities, and it’s more than just your dimension that enters into it. But at least we’re not discounting that you have a perspective on this question. And I don’t think leadership’s always about majority rules. I think there has to be some appreciation, just because not everybody could have every piece of information. And I learned this even more when I became an executive vice president. When you become an executive vice president, your day is filled with complex meetings about organizational structure, organizational finance. And it’s really important to be transparent about why, and decision making. But it’s frustrating sometimes that we have to appreciate that people have different skillsets, and it’s not really important that every assistant professor here divert from their academic career path to do a two-year MBA to learn how to be an accountant, because we have accountants who know how to do that very well, and that’s their job. And it’s important for our accountants and our CFO to be very transparent, and help educate issues about our finances. But at the same time, we have to be trusting that they have the skillset that’s not going to be replicated by everyone. When you’re Physician-in-Chief and you’re meeting on all these relevant, important issues, you can’t substitute the word “transparency” for feeling like every single 20,000 member of our institution has to sit in every one of those meetings so that they could understand the same landscape that the leader has, because leaders inevitably are charged with the responsibility of making decisions on the basis of what’s best for the mission and the group of the people. And there has to be an element that ultimately gets to trust, you know? Well, I trust that our accountants are really capable of this, and that they know accounting rules in a way that I don’t. And I don’t mind asking them, “Help me understand this.” That’s fine. But inevitably I’m not going to critique them that they’re doing it the wrong way, or I’m not going to require that everybody has to be involved in every type of decision-making in an organization. That would paralyze things, right?

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Chapter 09: A Decision-making Process Includes Lessons about Leadership