Chapter 05: Inside Institutional Structures: Personalities and Remaking the Division System
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Description
In this chapter, Dr. Cox talks about various personalities at MD Anderson and difficulties regarding its organizational structure, specifically related to its departments and divisions. He also shares what he considers his biggest mistake: his efforts to restructure the institution.
Identifier
CoxJD_01_20040319_C05
Publication Date
3-19-2004
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Leadership; On Leadership; The Administrator; Professional Practice; The Professional at Work; Institutional Politics; Understanding the Institution; Overview; Institutional Processes
Transcript
Lesley W. Brunet, CA
I’ll try to figure out a nice way to phrase this. It’s the personalities. How much is it simply the personalities?
James D. Cox, MD
[Pauses] Well, I’m not sure how to answer that. I don’t know what the real question is. There were people with whom I worked easily, and there were people with whom I found it difficult to work, and there were people who, I think, were very unhappy about the way I supported them or didn’t support them. Actually, I think probably Irv Krakoff and Lester Peters were not happy either one about the way I supported them, even though officially I was in Lester’s department. But I think Lester was uncomfortable with me, but that’s an aside. Put that aside for the moment. I think as far as the others were concerned, I think I worked with some difficulty with Irv Krakoff. I worked okay with Charles Balch. I worked very well with John Batsakis and Trujillo and Dr. Dodd.
Lesley W. Brunet, CA
A couple of big things, it seemed like. I guess we might as well shoot for the biggest.
James D. Cox, MD
Shoot for the biggest.
Lesley W. Brunet, CA
The dissolution of the divisions.
James D. Cox, MD
What was happening—and this was where probably the greatest problem was—in a few divisions, the divisions and the departments were identical. At that time, there was a Division of Pathology and a separate Division of Laboratory Medicine, so they were that. There was a Division of Diagnostic Imaging or Radiology, as it was called then. That was it. There were no departments. Pediatrics, no departments. Radiotherapy, there was one clinical department and a research department and physics department. The clinical and the physics departments were not working together very well. And there was a lot of unrest and, I must say, especially in the Division of Surgery, that decisions were being made that were preemptive of the department chairs by the head of the Division of Surgery. And to some degree that was happening also in Medicine. So one could argue whether the divisions were serving a useful structure or whether they were serving as an impediment to the people who really wanted to chart their own course. So I took the position at that time that the divisions were more problematic than they were useful and that it made sense to do away with the divisions. Now, let me tell you, there’re two advantages to the divisions. The one advantage of the division head that has multiple departments is that he or she has greater clout, arguably.
Lesley W. Brunet, CA
You mean the more departments, more money?
James D. Cox, MD
More departments, more money, more budget, more resources. But the other thing is that the divisions permit a number of people who would be divisions in other institutions to be called departments, so you have a department chair of this, that, and the other that you would never have in a university medical center. They would all be divisions within a department. The division structure is not understood outside MD Anderson at all. If you say a Division of Radiotherapy, they say a division of what? They don’t think of it as a superstructure; they think of it as a smaller structure, a flip. So there was the external perception. There was all of that. But in retrospect, it was not a battle worth fighting, and I probably should have just said to hell with it and gone on. And would it have made a difference? I don’t know. Probably it would have not been good, because I realize all the more that the divisional structure permits a variety of department heads, the head of a Department of Lymphoma Myeloma, that you would never have in a university medical center, a head of a Department of Melanoma, a head of a Department of GI Medical Oncology, you would never have. Those would all be small divisions. Now, Anderson is different, so there’s no reason why it shouldn’t have a different structure. But anyhow, that was a battle that probably wasn’t worth fighting, and it was one of the mistakes I made.
Lesley W. Brunet, CA
I could see it when you were talking about it in the records. You were trying to do away with the layering, and some of the examples were incredible, of the layering.
James D. Cox, MD
Right. It was trying to do away with layers. It was trying to do away with access to people who could make decisions on their behalf.
Recommended Citation
Cox, James D. MD and Brunet, Lesley W., "Chapter 05: Inside Institutional Structures: Personalities and Remaking the Division System" (2004). Interview Chapters. 757.
https://openworks.mdanderson.org/mchv_interviewchapters/757
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