Chapter 09: Building Research from the Provost's Office

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Chapter 09: Building Research from the Provost's Office

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In this chapter, Dr. DuBois summarizes several of his first activities as Provost. He notes that he set up with staff then talks about how he addressed some issues in leadership of the UT Graduate School of Biomedical Sciences. He explains why he undertook to increase the amount of faculty salaries covered by grants. He then discusses how he improved reduced the time needed for IRB approval of research protocols, hiring a process engineer to evaluate the process and reduce the number of days from 250 to 80/90. Next he talks about initiatives for faculty support. First he discusses the importance of Dr. Elizabeth Travis' [oral history interview] role in identifying women and diversity candidates for awards. Next, he explains why he wanted to develop a mentoring plan. Next he discusses some attempts to address physician burnout and also mentions some of the Medical University of South Carolina's programs.

Identifier

DuBoisR_02_20181114_C09

Publication Date

11-14-2018

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; On Leadership; Building/Transforming the Institution; Research; Institutional Processes; Overview; Definitions, Explanations, Translations; MD Anderson Culture; Working Environment; Mentoring; On Mentoring

Transcript

Raymond DuBois, MD, PhD:

When an administrator like Margaret Kripke leaves and some of the administrative support leaves, and so you have to rebuild your staff and all that stuff, so that’s what I really focused on and luckily, Maureen Cagley, who had worked with Bernard Levin [oral history interview] in the Cancer Prevention Division, was interested in taking the job, and she and I really hit it off well and her work ethic was what I was looking for. She had been at the institution for a while, so she understood how things worked, and she really helped me out a lot in setting up the office and moving forward from there. I think she’s still there.

Tacey A. Rosolowski, PhD:

She is. The role, when you hired her?

Raymond DuBois, MD, PhD:

She was my administrative, executive administrative assistant or something. I can’t remember the exact title and I think now, she may have been promoted to a vice president.

Tacey A. Rosolowski, PhD:

Yeah, she is.

Raymond DuBois, MD, PhD:

There were lots of things that needed to be done, I mean we dealt with all of the policy and regulatory stuff with regard to the research operation, both clinical research and translational research, and there were some issues that had come up from time to time, on conflicts of interest and things like that. We sort of organized that in a way that worked more efficiently. There’s always issues with regard to education. We had the arrangement with the University of Texas Graduate School in Houston, and there was always concerns about who’s supporting what and who’s doing what, and so I started meeting with the dean of the school and we were working on issues to resolve some of that stuff.

Tacey A. Rosolowski, PhD:

And who was the dean in 2007?

Raymond DuBois, MD, PhD:

I’ll have to think about that. I see his face, but I just can’t remember.

Tacey A. Rosolowski, PhD:

Oh, was this George Stancel [oral history interview]?

Raymond DuBois, MD, PhD:

Yeah, George Stancel was the dean. One of the things we actually did during my time was we recognized that, so that we had co-deans; a dean from MD Anderson, and then a dean from UT Houston, and I think it really solved a lot of the problems they were having administratively, because both institutions were equally represented.

Tacey A. Rosolowski, PhD:

And when you say reorganized, what was the body you were creating for these deans?

Raymond DuBois, MD, PhD:

Well it was, I guess the leadership unit for the Graduate School, in terms of setting the programs, the coursework and recruiting students, and career counseling and all that stuff.

Tacey A. Rosolowski, PhD:

So this was the leadership unit within the Grad School, but then there were representatives from other institutions with this? I’m trying to understand.

Raymond DuBois, MD, PhD:

It was really between MD Anderson and UT Health Science Center at Houston. I think it had been chartered that way but the dean had always been just completely from UT Houston and sort of conferred with MD Anderson administrative staff about the school. We did provide support for it but you know, having an MD Anderson faculty and a Health Science Center faculty as co-deans, really, I think it brought the school together in ways that it hadn’t been before and I’ve head that it’s working really well, so that’s been positive. The other thing, going back to the attraction to Houston, you know just prior to accepting this role, the state had decided to invest $3 billion into cancer research, and set up the Cancer Prevention Research Institute of Texas, and we didn’t have anything like that in Tennessee. So I was very positive about that, because having that kind of state support really meant a lot. It was much easier to recruit faculty, and they even provided funds for the recruitment outside the state of Texas, to MD Anderson, and we were able to get a number of those grants for recruits that we had brought to Houston. So that was a very, very extremely positive attraction to go there.

Tacey A. Rosolowski, PhD:

Now as you’re recalling, I mean again, kind of that first year, first months, when you’re getting to know the institution, what had been set in place that you could build on really well and what were some of the obstacles that you saw, that really needed addressing to move forward this vision?

Raymond DuBois, MD, PhD:

Dr. Kripke had done an outstanding job. She had set up a Leadership Academy that helped train faculty in different leadership skills, and I think that was working really well and was an important need for the institution. She had set up certain ways to deal with requests for space and resources, and set some requirements for that, and the space, the office space for each individual faculty was set at a certain amount of square feet and all that, so you didn’t have—when somebody wanted to get a throne or something for their office, you didn’t have to worry about that, because it was all standardized, and I really liked that. The other thing that Margaret had done was make things a lot more transparent, and I think that eased some of the faculty’s fears about who was getting what, and if they were getting as much as they deserved, whatever. That was already in place. There was a need to increase the faculty’s amount of salary they covered on their grants. I think it was set at 30 percent or something, and there were a lot of people that were not complying with those requirements. For example, here at the Medical University of South Carolina, our faculty cover about 60 percent of their salary on grants, and we’re also a state institution. It varies across the country but it’s usually much higher than 30 percent. I think the resources have always been plentiful at MD Anderson, so people haven’t had to worry about it, but it does increase the amount of external funding that comes in and also increases the quality of the science, because it’s all peer reviewed and people from outside the institution, outside the state, review it to make sure it’s of the highest quality, so that it can be funded. So we wanted to increase the bar a little bit there. So we increased that requirement to 40 percent, and that did create some angst among the faculty but most of them were able to comply. I don’t know what it is now, but I think that everybody got up to that level eventually.

Tacey A. Rosolowski, PhD:

I actually don’t have the figure in mind. Yeah, I can imagine it had caused some consternation, but it was making a culture shift too.

Raymond DuBois, MD, PhD:

Right, right.

Tacey A. Rosolowski, PhD:

And so that obviously was a huge part of what you wanted to accomplish.

Raymond DuBois, MD, PhD:

One of the things that I noticed after we got there, was that when one of the clinicians submitted a protocol to start a clinical trial to test a new drug or process, it took over 250 days, from the submission of that application, until the trial got activated, on average, so I could tell there was a real problem there, with that administrative structure. So I knew this person who had worked at Vanderbilt, who was at Seattle, at the University of Washington, and he was really what we would call a process engineer, and so he always looked at processes in place, try to find the bottlenecks and then come up with a solution to make it more efficient. So I called him in and he spent several days talking to all the people in the IRB and in all the regulatory components of the clinical process and he came up with several issues. One of the biggest problems was that it was a linear process, so once you started, you had to go through all these steps and you couldn’t go to the next step until you got the first step done, you couldn’t go to the third step until you got the second step done, even though these processes weren’t linked really. So the first thing we did was make it a parallel process, so they could go in multiple—meet for multiple approvals simultaneously, to get to the end, and then we had to staff up some of the offices to make sure they were properly staffed to deal with the load. By the time I left MD Anderson, we had gotten the 250 days down to about 80 or 90 days. I felt really good about getting that improvement in place.

Tacey A. Rosolowski, PhD:

No kidding, no kidding.

Raymond DuBois, MD, PhD:

The other thing that Margaret did just before she left the office was she appointed Liz Travis [oral history interview] to be head of Women’s Affairs, which I think was a really good idea and I continued to support that. The other thing that I did was I charged a committee that Liz led, that looked at all of our faculty, not just the women, but obviously, importantly, the women as well, and decided which ones were eligible for national prizes or awards. We started a systematic process to identify those folks and make sure that they were nominated for as many awards as these faculty deserved, and I think that actually has been extremely successful. There’s been a lot more national recognition of what the faculty do and the department chairs just didn’t have the time to do it, they were so busy, and Liz was able to have access to a writer who could help put all the documents together and edit them properly. Obviously, everybody has to look over those to make sure they’re accurate and say what they’re supposed to say, but that really made the process a lot more efficient and enabled them to make deadlines required to get those nominations in. And I know, there’s a number of faculty that are in prestigious organizations like the American Association for the Advancement of Science Fellows, the American Association of Physicians, and other things that require a nomination to get considered, and even in the National Academy of Medicine and the National Academy of Sciences. More faculty in those roles then were there before we put that process in place, and so I think that was something I was really proud of and something that was needed for the institution. And then, like we talked about yesterday, I really wanted to have a mentoring plan written out and well thought out, that was included in the offer letter, so that mentors could be identified and intervals for meetings could be outlined and those things could get going as soon as possible after faculty started their careers there.

Tacey A. Rosolowski, PhD:

What do you see as the value of mentoring, why is it so necessary in this context?

Raymond DuBois, MD, PhD:

Mentoring is really crucial for a lot of reasons, because people who have gone through the process know where some of the places are that you can really get hung up, and also they have networks of individuals who are out there that the mentee can have access to. They can also write letters of recommendation for awards, promotions and things like that, and so they can really help make sure that your career stays on path and facilitate making some of those things happen directly, so it’s really important. It was something that I don’t think was done as much as it should have before I got there, I know Margaret was concerned about it and did some things to help out but let’s face it, the MD Anderson faculty and the chairs are so busy. You know, they were taking care of these extremely sick patients or engaged in their own research, and they just weren’t as engaged in mentoring as I thought was needed, so we did a number of things to try to enhance that. We had workshops where we brought in experts in grant writing and manuscript writing, and experts in certain aspects of conflict resolution and other things, and in those workshops these experts would give a talk and then all the faculty could ask questions and use examples in their own experience, about how to solve problems. I think it really did help out some of the faculty.

Tacey A. Rosolowski, PhD:

Now when you are instituting a change of that kind, was there any kind of accountability set in place for department chairs or division heads, to begin to kind of see how effectively people were doing the mentoring?

Raymond DuBois, MD, PhD:

Yeah. That was being tracked and there were reports that needed to be made, documenting those meetings and minutes of the meetings and other things. I don’t know that everybody complied a hundred percent, but there was a lot more attention to it and when I had meetings with chairs or division chiefs, it’s something we talked about. They were really in charge of recruiting new faculty for their group, so I think most of them took it fairly seriously and it was something that became a part of their evaluation, you know how their mentoring plan was going and how they were mapping it. And then obviously over time, you can measure the success of the new recruits and how they’re doing.

Tacey A. Rosolowski, PhD:

Right. Well, you know I ask because you can plan to attend a forty-five minute workshop or hour-long workshop, but then the problem of actually implementing it in your day, which already is straining at the seams with things to do.

Raymond DuBois, MD, PhD:

That’s always a concern there, just because there’s more work to do than anybody can physically do it. That brings up the issue of burnout, physician burnout and other burnout, and we also dealt with that, although it’s become a lot more recognized nationally now than even back then, during that 2007 to 2012 time period. I think it’s something that the faculty at MD Anderson are always at risk for.

Tacey A. Rosolowski, PhD:

What were you noticing that was bringing this to your attention?

Raymond DuBois, MD, PhD:

Well you know it usually comes out when there’s an outburst of anger or depression. At all institutions, their faculty have to deal with these issues. We did have a couple of faculty suicides that really opened my eyes, and some of those were not totally related to the workload but it always plays a factor in how their psyche is working. So we became a lot more aware of that and much more open to referrals for counseling and other things, in certain people that really needed some help.

Tacey A. Rosolowski, PhD:

What were some steps taken in addition?

Raymond DuBois, MD, PhD:

We had some people come in to talk to leaders and others, to make sure they understood the signs and symptoms of these kinds of things and then, you know, when people claim that they’re going to do something like that, we took it a lot more seriously and really made sure there was counseling for all those individuals that needed it.

Tacey A. Rosolowski, PhD:

The institution is continuing to address how exactly to identify and make it okay for people to say, “I had a conversation with so and so, I’m a little concerned, who do I talk to, how do we get help,” because again, it is a culture change. This thing happens when you observe behavior changes in somebody.

Raymond DuBois, MD, PhD:

In past years, in decades, for decades in academic medicine, everybody was trying to be as stoic as they possibly could and nobody wanted to talk about it. But I do think you’re right, having that conversation upfront and not feeling embarrassed about talking about it, is the first step to make sure that it gets dealt with.

Tacey A. Rosolowski, PhD:

Yeah. I mean, UT System is certainly taking it very seriously now, holding a big symposium a year and a half ago, all of that.

Raymond DuBois, MD, PhD:

Yeah, and I think the experiences there have influenced me even in my future jobs, because now we have developed a wellness program for our medical students, because they’re also faced with all kinds of stresses and strains. We started it right when I came here in 2016, and so we’re only two years into it, but I think it’s helped out a lot. It enables the students to talk in groups about things that they’re concerned about. We have a medicine cup day where we have all kinds of races, and they try to dunk the dean in the water well and stuff like that, to blow off some steam, and I think it’s really helped.

Tacey A. Rosolowski, PhD:

Well, research shows that medical students come in really ideological and then wow, crash and burn.

Raymond DuBois, MD, PhD:

Yeah, it can happen.

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