Chapter 11: Making Changes in an Institution: Goals, Following Up, A Philosophy of Communication
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Description
Dr. Dmitrovsky notes the overall goals of the changes he has made to the institution. He also reflects on the processes by which changes have an impact and are recognized by an organization's community. He discusses the round of meetings he conducted to report back on measure taken to address faculty concerns and reflects on communication within a large organization. Dr. Dmitrovsky notes his observation that faculty have a skepticism about administration and that they were not speaking their minds in meetings. He explains how he addressed this.
Identifier
DmitrovskyE_02_20150506_C11
Publication Date
5-6-2015
City
Houston, Texas
Interview Session
Topics Covered
The Interview Subject's Story - The Administrator; The Administrator; The Professional at Work; Leadership; Mentoring; Research, Care, and Education; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Controversy; MD Anderson Culture
Transcript
Tacey A. Rosolowski, PhD:
Just so I understand that, I'm not quite sure I understood why you're telling me that. You know, this this are you kind of waiting to have a kind of critical mass of
Ethan Dmitrovsky, MD:
Oh, no. I I think that sometimes, we overpromise and underperform in academic medicine. And I have a different philosophy. I think you want to underpromise and overperform. And part of my view is that therefore, you don't tout successes until people come to you and say, "Oh, I notice I'm saving time.I think in the academy, it's much easier to have the faculty appreciate the change. And they then be respective spokespersons for a change being a good or less good, rather than have an administrative leader say, "Oh, look what I've done.And I think that's more a subject of sociology than so I was actually making a very different point. (laughter)
Tacey A. Rosolowski, PhD:
Yeah, OK. But, you know, I was going to ask you about what it goes to the issue of what's been the impact of all of these initiatives you've taken, on that original problem of morale.
Ethan Dmitrovsky, MD:
Yeah, so the whole goal so the whole goal is to reduce the time taken by frontline faculty to reduce their time on less productive activities, and to increase their time available for more productive activities. And I would view taking care of patients, conducting clinical trials, and making discoveries as examples are a productive use of their time. Filling out forms is less productive. And so I would hope that the community will recognize that there's actually starting to become more time available. Now, a bit of a steady state, because there's always new roles and regulations put in place. But I'll give you just one final example, that we have annual recertifications for so many process and procedures to make sure you're annually certified, the use of endowed funds, and the compliance to a number of mandated compliance issues, like animal care, human trials, all these things. There's a long list. And it turns out that some of these mandates are not actually annual. And so what we've done is gone to the federal guidelines. Some of them are every other year, some are every three years. And rather than imposing on ourselves an annual recertification, why don't we just adopt what the federal government is asking us to do? So we've actually done that, too. It doesn't seem too creative, but it saves, if you can imagine And so if you ask someone in the administrative community, well, why did you make it annual when the guidelines say it's every other year, or every third year? And the response is always that, well, we want to set our standards even higher. And so I accept that. But then you have to ask another question, which is does that yield the desired outcome? Are we being more vigilant? Are we complying more readily? And so I've always asked that question, give me the data? Are we can we do an experiment, so to speak? Can we test the hypothesis that we will be equally safe if we do it every other year? And so those are the sorts of things that we're doing. And so frontline faculty realized that an annualized certification that becomes every other year, they do notice that.
Tacey A. Rosolowski, PhD:
(laughter) I bet they do.
Ethan Dmitrovsky, MD:
So this is the third topic of excessive regulation. And then, in order to address some of the concerns of the faculty, I recently, in partnership concert with our physician in chief, Tom Buchholz, I circled back to all the departments and divisions again. But this time, more in terms of at the divisional level. And we reported back some of these investments that we've made, and in town hall-like settings. So we had, oh, about 10 town hall meetings recently to circle back. And I guess that would be the fourth subject, is communication. Like, what we're doing right now, is that in an institution of roughly 21,000 people, you cannot have personal communication with 21,000 people. And I hope your oral history will be delivered to many of our community members, that just a meeting with one-on-one is not possible to meet with 21,000 people, one-on-one. And so even if you meet in small groups, and you might do it once or twice a year, that's not the only way you can communicate. And so I've tried to use, you know, every opportunity I can, such as this project, to communicate back to the faculty.
Tacey A. Rosolowski, PhD:
Can you are there other outcomes that you've perceived maybe even at just a personal, anecdotal level? You know, change, positive changes in faculty morale and feedback that you've seen as a result of these efforts, which had been considerable, obviously?
Ethan Dmitrovsky, MD:
Many people have a healthy skepticism about administrative leaders. You may be surprised to hear that. (laughter)
Tacey A. Rosolowski, PhD:
I'm not, actually. I see I interview creative people all the time who are suspicious of authority and structure. (laughter)
Ethan Dmitrovsky, MD:
And so I take that as a given, because I I'm a faculty member first and foremost. And I've tried to always to always act. And certainly, I consider myself a faculty member first. So when I first arrived here as a new member of the community, I was struck by the healthy skepticism, that frontline faculty had and have towards administrative leaders. And as a faculty member, I am aware of that thread to the academy. But it seemed to be particularly robust here. And when I first arrived, I was struck by that. And I was familiar with people in private meetings, feeling very comfortable speaking their mind. And people weren't here, and I didn't really understand why. So I wanted to provide more opportunities for people to have direct interactions with the provost's office. And I was charged to overseeing an office that would serve the needs of the faculty. So I then established a series of breakfast meetings, largely, sometimes lunch meetings, with many different groups who had no administrative titles. One group was junior faculty, had multiple meetings with junior faculty. Another was long-serving faculty, and many meetings like that. And this is in addition to all of the departmental meetings that I had. And so after a few months of this effort, I noticed the changes, that people actually started feeling very comfortable, reporting whatever they were concerned about, be they integrity issues, be they retention issues, be they recruitment issues. And I felt that the community had accepted the premise that I was putting forward that the Provost's Office was, for want of a better word, a safe place for people to come and report their concerns. And I tried my level best whenever someone would raise an issue that was important to them to carefully, thoughtfully, fully review and act upon and report back. And so now, I notice a very different dynamic, for want of a better word, is that people do feel comfortable communicating. Here, they're concerned, and my hope is that if this extends beyond faculty to staff too, I would say that's my impression, that they then will feel comfortable thinking that the administrative leadership actually has a goal to serve their needs and to make their work easier, and their day-to-day professional alliance easier. So I've noticed the change. It might be that those are the only people that are coming to meet with me. (laughter) But I do meet with many, many people. I have met with most of the faculty in small groups at this point, usually many times. And so I think that people do feel very comfortable.
Recommended Citation
Dmitrovsky, Ethan MD and Rosolowski, Tacey A. PhD, "Chapter 11: Making Changes in an Institution: Goals, Following Up, A Philosophy of Communication" (2015). Interview Chapters. 646.
https://openworks.mdanderson.org/mchv_interviewchapters/646
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