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  Chapter 08: Furthering Research through Partnerships with Drug Companies

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Gutterman offers several examples of how he learned to work with drug companies to further his own research. He was approached, for example, to test GM-CSF [granulocyte macrophage colony-stimulating factor] to restore platelet counts in chemotherapy patients. He also learned to protect his intellectual property. He attended meetings at the emerging drug companies and describes the impact of "seeing the power of venture money." He also observed how the biotech companies set up creative environments, sensing a kinship with the imaginative work they were doing.

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  Chapter 09: Research Money: The Economics of Drug Companies; Philanthropy

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Gutterman talks about working with "big pharma" and operating largely independently of MD Anderson. He discusses the economics of pharmaceuticals, noting a lesson he learned from philanthropist Mary Lasker, who said "money is frozen energy." He talkss about his own entrepreneurial spirit, linking it to his father's business ventures and critiques "conservative approaches" to drug experimentation. Dr. Gutterman ends this section with a passionate description of Houston philanthropy at that time. He then responds to a question about the downside of working with drug companies, concluding, "Don't count on the drug companies," because he discovered interferon's hairy cell leukemia at MD Anderson, with private money.

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  Chapter 10: R. Lee Clark, Charles LeMaistre, and Philanthropic Houston Oilmen

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Gutterman shares memories and observations about Dr. R. Lee Clark and Dr. Charles LeMaistre. This includes a narrative of how Dr. Clark worked with Mary Lasker to support Dr. Gutterman's work on chronic myeloid leukemia, resulting in the use of interferon to suppress malignant clones while normal cells return. Dr. Gutterman provides many examples of challenges that arose within the institution to hold back his work. At the close of the session, Dr. Gutterman sketches the formation of the Interferon Foundation by several Houston oilmen, several of whom visited Charles LeMaistre to insist he remove obstacles to Dr. Gutterman's work.

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  Chapter 11: Funding Innovative Clinical Research: Some Institutional Obstacles

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Gutterman comments on the reaction of MD Anderson "and then president Dr. Charles LeMaistre-- to the private funding of his interferon research." He also underscores how unique MD Anderson is, with all of its many resources, intellectual, creative, financial, etc. He also comments on his role as Chair of the Department of Clinical Immunology and Biological Therapy, noting candidly that he was not passionate about administration and unable to manage the Department adequately.

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  Chapter 12: Department Chair and Section Chief: Leadership Issues

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Gutterman comments on his role as Chair of the Department of Clinical Immunology and Biological Therapy, noting candidly that he was not passionate about administration and unable to manage the Department adequately.

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  Chapter 13: Going on Record with New Research: Avicins and Nutrition

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  For the first time, Dr. Gutterman goes on record with a discussion of his current research on avicins and nutrition, work that required him to "change fields" and study botany. He explains that in the mid-Eighties he found inspiration in an early article on the isoflavone Genistein, then speaks about the deaths of his mother and father, sources of the values that are personal foundations to that work. He notes that the epidemiology of cancer itself suggests that its cure lies in the understanding the interaction of genes with the environment. Near the end of this section, he notes that in 1994, financial difficulties at MD Anderson made it necessary for clinical departments to generate more revenue "another impetus for him to leave administration and find a new research arena."

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  Chapter 14: Establishing a New Research Focus: Experiments, Money, Organization

  Jordan U. Gutterman MD and Tacey A. Rosolowski PhD

  Dr. Gutterman then speaks at length about the intricacies of setting up his new research program. He describes his new collaboration with botanist Dr. Charles Arntzen at (the Biodesign Institute at the University of Arizona?) and the Clayton Foundation's role in financing his research. During the next half hour he details how he was invited to study desert plants in Tuscon. He believed that these plants must contain substances that protect them from UV light and dehydration, and that might be helpful in combating cancer. He describes the long process of making extracts from the plants and the studies that revealed that one extract, from the acacia victoria, would kill ovarian cancer cells (and not kill normal cells). He talks about the process of finding a lab to make a pure extract (needed in the late nineties), a goal achieved in October of 1998: "Now I have to learn chemistry," Dr. Gutterman recalls saying. He and colleagues successfully mapped the chemical structure of the active terpinioid and then embarked on discovering the mechanism of its action. Near the end of this section he talks about how they named avicin and applied for the patent, awarded in 2002. (This session ends abruptly, due to Dr. Gutterman's throat irritation from allergies.)

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  Chapter 01: A Path to Houston and the President’s Office

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale begins this chapter by sketching her family background, her education in a one-room school, and her early secretarial experience at Monsanto that made her application attractive once she moved to Houston and started looking for employment at MD Anderson.

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  Chapter 02 : The President’s Office Under R. Lee Clark

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hale provides a snapshot of how the President’s Office worked under R. Lee Clark. She notes that he was “very hands on.” As an example of Dr. Clark’s political effectiveness, she tells a story about how staff researched the backgrounds of significant patients and briefed Dr. Clark about them prior to his trips to Austin, so he could mention specific individuals to legislators. She notes that the development office was created under Dr. Clark and explains her own role of keeping up with all faculty records. She also talks about her own growing commitment to MD Anderson’s mission. She talks about staff office politics.

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  Chapter 03: Key Activities Under R. Lee Clark

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale talks about some key accomplishments under R. Lee Clark: selling land to raise funds to build the Lutheran Pavilion; breaking ground on the Bastrop research location; increased activities once Nixon declared the War on Cancer. Ms. Hale notes that her work for Dr. Clark shifted focus over the years: she spent more time working with international organizations as Dr. Clark was increasingly invited overseas to speak. She tells a story to demonstrate how Dr. Clark “would make a statement and have to make it true.” She shares other comments about his character and lists some of the individuals with whom he worked closely.

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  Chapter 04: Changes Under Charles A. LeMaistre, MD

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale begins this chapter by explaining that when Dr. LeMaistre assumed MD Anderson’s presidency, she stayed on with Dr. Clark until 1981 before transferring to the president’s office. She notes changes to the office under Dr. LeMaistre, who was a more distant administrator than Dr. Clark, with activities more focused on MD Anderson. She offers observations about Dr. LeMaistre and observes that Dr. LeMaistre “brought us together like a family” as well as greatly increasing fundraising.

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  Chapter 05: John Mendelsohn and the President’s Office

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale begins this chapter by explaining how she coordinated meetings with candidates for president of MD Anderson when Dr. LeMaistre decided to step down. She then talks about the transitions in the president’s office once Dr. John Mendelsohn took over. She notes that he had a very different temperament (a “researcher’s temperament”). As an example of the transition and intra-office communication, she explains how the staff was operating according to procedures established by Dr. LeMaistre, and Dr. Mendelsohn had to become aware of these policies and the rationale for them.

  She tells a story about Dr. Mendelsohn carrying a reminder card to help him be collegial. She also comments on a shift in Dr. Mendelsohn’s persona during his first years at the institution. She notes some challenges he faced.

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  Chapter 06 : Thoughts on the Presidents’ Communication Styles; the Challenge of Working in the Office of the President

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale begins this chapter with some observations about Dr. John Mendelsohn’s temperament and how he grew into the social dimensions of his role over the course of his presidency.

  Next she shares her observations about differences among the presidents’ communication styles. She also discusses the challenges of working in the Office of the President and comments on how better communication patterns could have made work run more smoothly. Finally, she reflects on the power that an administrative assistant has in an executive office. She gives examples of how quickly things would get done when she was assistant to Dr. LeMaistre (1978 – 1981) and how she felt her power dissipate when he stepped down from the presidency.

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  Chapter 07: Significant Accomplishments Under Each President

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hale identifies some of the primary achievements under each president. She notes that Dr. Clark was particularly concerned about the overall health of MD Anderson employees. She also tells anecdotes to illustrate his difficulty remembering names. She comments on the support Dr. LeMaistre was able to create for basic researchers via the PRS system. She talks about Dr. Mendelsohn requiring that faculty generate 30% of their salary via grants. She also tells anecdotes to demonstrate the Dr. Mendelsohn and his wife, Anne Mendelsohn, functioned as a team.

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  Chapter 08: Working on Dr. LeMaistre’s Book and Thoughts about Hierarchies and Retirement

  JoAnne H. Hale and Tacey A. Rosolowski PhD

  Ms. Hale begins this chapter talking about what motivated her to retire in 2005. She then sketches her work with Dr. LeMaistre (2006 – 2008) on his book about the first surgeon general’s report on cancer and smoking.

  Next she talks about returning to the institution in 2010 at first in a volunteer capacity, filing for Clinical Cancer Prevention. She talks about sifting to a part time position and reflects on the value of having past employees come back to work for the institution. Next she reflects on the position of women at MD Anderson and gives examples of how education was the biggest factor in determining the hierarchy among the administrative staff.

  Finally, Ms. Hale talks about her involvement in the MD Anderson Retirees organization.

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  Chapter 01: Resolving to Become a Volunteer

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison begins this segment by noting that she and her husband, Bedford Harrison, moved to Houston in 1947. She began as a floor hostess in about 1968, working with both adult and pediatric patients. When the new building was constructed, she chose to work with adults and explains that she eventually worked in the protective environment floor: she explains some of the requests that family members made, as she could interact with their loved ones in ways they could not.

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  Chapter 02: The Children’s Christmas Card Project

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison begins by talking about Page Lawson, “the most innovative person in the world” (who served as Director of Volunteer Services at MD Anderson from 1973 – 1991). As an example, she says that Ms. Lawson arranged for the volunteers to have t’ai chi classes as a relaxation technique. She also speculates that the Children’s Christmas Card Project was really Ms. Lawson’s idea, though Ms. Lawson circulated the story that the idea came from an unnamed volunteer who taught art classes for children at MD Anderson and discovered a particular piece of artwork she thought would make a wonderful Christmas card. Mrs. Harrison then explains how Ms. Lawson offered her a job as manager of the Children’s Christmas Card Project; her first main task was to develop a five-year plan to expand the project. She was fortunate, she notes, because MD Anderson was connected to the UT System: she actively promoted the project at all the UT Divisions. She also explains that an important expansion occurred when Randall’s Supermarket agreed to sell the cards at no profit (and continues to sell them today).

  Next, Mrs. Harrison talks about how funds from the Project were used: MD Anderson employees submitted requests for funds to a board of volunteers who decided how money should be spent. She notes that the aquariums one can still see around MD Anderson were one of the first projects funded. At the end of this segment, Mrs. Harrison talks about the importance of spirituality in her life.

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  Chapter 03: Details about the Children’s Christmas Card Project

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison begins this segment talking about several volunteers who worked on the Children’s Christmas Card Project. She then describes how the cards were selected: artwork up for consideration was presented at an event where volunteers could vote for the designs to be turned into cards. She describes one of her favorite cards and then notes that the five-year plan included an initiative to offer cards for the Jewish community. She goes on to explain that the Art Department turned selected designs into production-ready images and the Project then took bids for producing the cards. All this work first took place in a single room on the first floor of Volunteer Services, she explains, then moved to a larger room as the Project grew. She notes that there is a Karen Harrison Award given to a volunteer each year at the Volunteer Appreciation Luncheon.

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  Chapter 04: Expanding the Children’s Christmas Card Project

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison begins this section talking about “some political things that influenced the Project,” citing as an example the invitation extended to Barbara Bush to attend the Project kickoff party. Mrs. Bush’s presence had a very positive effect. She then goes on to explain that after Randall’s Supermarket began selling the cards, she hired a consultant to help the Project break into grocery stores nationwide. The describes attending a supermarket trade fair and the resulting success of selling MD Anderson holiday cards in markets around the country. She also explains that the Project eventually separated from Volunteer Services (coming under the management of Steve Stuyck in Public Affairs) because there was too much to do. She speaks briefly about the art classes offered to children and notes that Page Lawson offered an award to each child who entered a piece to be considered for a card. The children whose designs were selected participated in the holiday parade that circulated through MD Anderson.

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  Chapter 05: Creating an MD Anderson Annex to House Patients

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison explains that she purchased a very large home after her husband died and patients coming in from out of town stay with her. One woman gave her two robes to keep in the guest room, embroidered with “MD Harrison.” This is “another step in her love of Anderson.” Mrs. Harrison then describes the accommodating nature of people who work and volunteer at MD Anderson.

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  Chapter 06: On the Children’s Christmas Card Project, Volunteers, and Faith

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison tells of a holiday card that was sent into outer space and talks about the generosity of volunteers that kept the Children’s Christmas Card Project moving forward. She then clarifies the progressive expansion of her role as she worked with the Card Project. Mrs. Harrison next talks about Page Lawson, who was known nationally as an expert in volunteer affairs and sought after as a speaker. Mrs. Harrison shows a picture of Ms. Lawson and goes on to describe her character. She recalls support that Ms. Lawson gave cancer patients. Mrs. Harrison recalls some volunteers she worked with and talks about her plans to continue volunteering with the institution. She talks about qualities that a person needs to volunteer.

  Mrs. Harrison says that many people shudder when she mentions volunteering at MD Anderson, but explains that she always leaves feeling better than she did when she arrived because she has helped people.

  Mrs. Harrison talks about the importance of her faith in her work as a volunteer: “God gave me the job.”

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  Chapter 07: Memorable Volunteers and Caring for Patients

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison explains that when she began to volunteer at MD Anderson, she worked with young men with testicular cancer. She describes them as very determined to fight their disease and believes that she was able to give them confidence. Next Mrs. Harrison talks about working with patients on the protected environment floor. She describes the physical setting, in which patients were separated from their families by a glass window. Mrs. Harrison entered the protected environment (she put on scrubs), and she explains her role with patients. Often patients asked her to take personal items, such as a bible, to be sterilized so they might have it in the room with them. She tells a story of one woman who asked her to massage her daughter’s shoulder. Mrs. Harrison also explains that she served as an informal recruiter of other volunteers: she brought in her husband and a former classmate of her husband, Rock Rabinowitz, who worked volunteered many, many hours. Mrs. Harrison notes that people would often react very negatively to the idea of working in a cancer center, and explains how she countered their qualms. She explains that she established strong connections with patients and their families. She invited many of them for the holidays.

  In this touching story, Mrs. Harrison describes how she cared for a little girl who came from Hawaii with her family for treatment. After the child’s death, her mother asked Mrs. Harrison to help her choose the dress her daughter would be buried in.

  Mrs. Harrison says that she believes that her ability to connect with people is “God given.” She describes her relationship with a patient who now has an externship with MD Anderson. She then recalls Sister Alice, an energetic volunteer who was a “cheerleader” at one of the Children’s Art Project kick off parades. Finally she talks about Tom Jean Moore, the volunteer who took care of the rose garden and brought roses to be delivered to any patient who did not have flowers that day.

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  Chapter 08: Recalling Volunteer Events and Volunteers

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison first recalls the Children’s Christmas Card Project kick off parade, which took place in early fall. She describes the parade, recalling the young men pushing their IV poles, the St. Thomas bagpipers, and the fire truck that drove patients along the route. She describes the route and notes that the barbecue restaurant, Goode Company, served sandwiches for lunch. Next Mrs. Harrison recalls valued volunteers. She notes that when she was promoted from Manager of the Children’s to Assistant Director of Volunteer Services, her role did not change, though her income increased. Next Mrs. Harrison talks about Page Lawson, “volunteer extraordinaire,” who had good business sense, enthusiasm, and a gift for matching people to the right job. She recalls that Ms. Lawson told her she’d been watching her in the cafeteria and decided that she “had what we needed.”

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  Chapter 09: Memorable Volunteers and the “MD Anderson Annex”

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison explains that her husband, a chemical engineer, volunteered in the radiology department and could be comforting to patients, in part, because of his technical understanding of radiology. Mrs. Harrison then recalls a woman who became a volunteer after undergoing an hemi-hipectomy and who continued to volunteer, even after her husband died.

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  Chapter 10: The “MD Anderson Annex”

  Karen K. Harrison and Tacey A. Rosolowski PhD

  In this segment, Mrs. Harrison describes the “annex” she has been running for the past 8 years. She explains that she purchased a very large home after her husband died, acting on her son’s comment that she could turn it into an annex for MD Anderson. She explains how she invited her first MD Anderson patient to stay with her, then recalls some of the other patients and families who have stayed with her over the years when they came into town for treatment.

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  Chapter 11: Family Background

  Karen K. Harrison and Tacey A. Rosolowski PhD

  When asked whether she came from a large family (which might explain her gregariousness), Mrs. Harrison says that she had many, many cousins. She also explains that she was married before she graduated from college, though eventually she finished her degree, earning a degree in Political Science from the University of Houston in 1951. He notes that her husband did not want her to work, but she did, teaching third grade. She explains some of the challenges of teaching and recalls an autistic child in her class. She speaks briefly about the television and radio appearances that she made while working with the Children’s Christmas Card Project. She tells an anecdote to demonstrate that she inherited her public speaking skills from her “daddy.”

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  Chapter 12: At Eight-Three, Still Providing Service to Patients

  Karen K. Harrison and Tacey A. Rosolowski PhD

  Mrs. Harrison tells of her plan to accrue another 2,000 hours of volunteer time so she will be “neck in neck” with her late husband’s 10,000 hours. She notes that she has introduced people to MD Anderson. She ends by talking about what she has received from her years of service to the institution.

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  Chapter 01: An Early Interest in Health Care

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hay speaks briefly about her family background then explains that she elected to go to Southwestern University, Georgetown, Texas (B.A. conferred in 1996) because she was looking for a broad education. She lists her varied interests in college and notes that she was thinking of becoming a physician, but discovered she was better suited to a career in finance. She notes that she was always interested in health care and wanted not just a job, but a career focused on helping people. She describes characteristics she has inherited from various family members.

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  Chapter 02: A New Role at MD Anderson Reflects Changes in Health Care

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay begins this chapter by explaining that she came to Houston in 1996 because of her fiancé’s job and then began searching for a job in health care. She wanted to work for MD Anderson and describes the advantages of working for an institution with a single mission. She explains that MD Anderson was hiring college graduates to serve as Patient Service Coordinators (PSC). She explains the reasons why this role was being transformed and also recalls the period of change under John Mendelsohn [Oral History Interview] (who assumed presidency of the institution in ’96). She was hired to serve as PSC in the Department of Radiation Oncology. She explains why the job was difficult and her strategy of never saying ‘No, it’s not my job’ in order to advance. She describes her responsibilities as a PSC, noting that her early negotiation skills came from this period.

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  Chapter 03: Learning the Complexities of Institutions; Balancing the Goals of Administrators and Physician-Leaders at MD Anderson

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hay first reflects on how her role as a Patient Services Coordinator benefited her career. She developed a commitment to fixing the complexities and difficulties of institutions, prompting her to earn a Masters of Science in Healthcare Administration at Houston Baptist University (conferred 1999). She explains that she was awarded an Administrative Fellowship in 1999 and talks about the opportunities this afforded.

  Ms. Hay characterizes MD Anderson as a physician-led organization. She compares administrators to physician leaders, noting the need for true partnership between the two groups/perspectives to make an institution work. Business goals must be adapted to the goals of clinicians and basic researchers, she explains, rather than overlaying business goals over their activities. She notes that MD Anderson can advance and grow because the institution has figured out the right balance in this leadership.

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  Chapter 04: Planning the Proton Therapy Center

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay explains the mission areas that Dr. James Cox [Oral History Interview] assigned her when she joined Radiation Oncology, then focuses on her work developing a Proton Therapy Center.

  She tells the story of securing financial backing, eventually involving a boutique investment company, Sanders Morris Harris Group. She explains the advantages of securing local and “patient money” [meaning investors that could patiently wait for returns]. She tells about working with Hitachi o provide equipment.

  Ms. Hay then sketches the history of the institution’s interest in proton therapy. She talks about the advantages of the LLC status of the Proton Therapy Center.

  She explains why research demonstrating clinical efficiency of proton therapy was lacking. She talks about the use of proton therapy in treating different cancers and the effect on the quality of life.

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  Chapter 05: Establishing the First Satellite Center: “A Great Business and Clinical Story”

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay notes that the story of the Radiation Oncology Center in Bellaire, Texas, is ‘a great business and clinical story’ that led to the creation of the entire satellite system.

  She tells the story of setting up a health center in Bellaire, Texas. She explains why this was bold and controversial move. She talks about the negotiations with General Electric (which owned the note on the Center) and describes how the Center was opened, with immediate positive responses from patients. She describes the involvement of the Physicians’ Network.

  Next, Ms. Hay explains that the Bellaire site was the beginning of the entire satellite system and the expansion that was part of John Mendelsohn’s [Oral History Interview] vision for the institution.

  Ms. Hays talks about the selection of partners and factors that lead to the success of the satellite locations, including MD Anderson’s willingness to terminate ineffective partnerships.

  She reviews the growth of the use of satellite centers and stresses how important they are for the future of MD Anderson.

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  Chapter 06 : A New Role as CEO of the Proton Therapy Center; Lessons in Effective Leadership

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay talks her work after 2005, when she asked to leave MD Anderson to take a role as CEO of the Proton Therapy Center. She talks about the change in role and environment, where she had to bring a new focus to finances in addition to clinical care.

  She explains Dr. Cox’s approach of developing a clientele for the Proton Therapy Center. She talks about the lessons she learned through this process, notably the importance of accountability. She talks about how effective leadership finds ways of engaging clinicians in ways that are meaningful to them.

  Ms. Hay then explains that the Proton Therapy Center offers an excellent example of multi-disciplinary care that breaks down barriers between disciplines and institutions. She emphasizes that this approach is crucial to MD Anderson’s future and will help the institution “leverage everything we do.”

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  Chapter 07: Global Institutional Partnerships

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hay talks about her role in the development of opportunities for global partnerships, beginning with the American Hospital in Istanbul, Turkey in 2006, where there was no oncology program. She talks about building a basis for MD Anderson quality abroad and traces issues involved in opening the co-branded facility ion 2010. She notes that it “works seamlessly” and that plans are underway to expand this relationship so it can operate as a regional center.

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  Chapter 08: Adapting a Consulting Business to MD Anderson Needs

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay begins this chapter by explaining that when she was CEO of the Proton Therapy Center, she became interested in international consulting and set up a company, ProBeam, with some partners.

  She then talks about her decision to come back to MD Anderson as Assistant Vice President of Global Business Development , a move that resulted in ProBeam being integrated into MD Anderson and a focus on international and national business opportunities. She talks about refining the mission of the consulting initiative and explains work with a client, Albert Einstein Hospital, in Brazil.

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  Chapter 09: The Office of Global Business Development: A First Partnership in Banner, Arizona

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hay talks about her role in administering the negotiations and implementation process that resulted in a co-branded partnership with MD Anderson Banner, Arizona. She explains the process of reviewing the cancer center and lists the challenges of overcoming institutional differences that could prevent a full offering of MD Anderson quality care. She describes how these challenges resulting led to the service growing the service piece-by-piece, by subspecialities. She notes that MD Anderson required that Banner employ their physicians to take financial interest out of the equation of providing cancer care. She explains why this was a challenge and how it was resolved. She explains how the program came together to form a solid partnership.

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  Chapter 10: Strategic Expansion and Partnerships

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  In this chapter, Ms. Hay discusses how, in 2011/2012, MD Anderson hired Price Waterhouse Cooper to evaluate possibilities for strategic expansion. She notes that this represents a big shift in paradigm for the institution under Dr. DePinho –a move to expand very aggressively. She explains that this happened in concert with the formation of the MD Anderson Cancer Network. She talks about the two categories of partnership that can be formed and notes that MD Anderson will seek to establish four to six co-branded partnerships in the next ten years. A partnership is evolving in Cooper, New Jersey.

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  Chapter 11: The Center for Global Oncology: Background and Operations

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  She begins by explaining that healthcare institutions nationwide were seeking partnerships when the decision was made to form the Center in 2008. She the talks about how the institutions contacted MD Anderson, how their needs were assessed, and how she partnered with Oliver Bogler, in Global Academic Programs, to satisfy those needs.

  She sketches her main role, to identify and negotiate legal contracts with partner institutions, and provides examples, including consideration of financial gain for MD Anderson.

  Ms. Hay also sketches the challenges involved in bringing institutional (and national) cultures together in multi-disciplinary care.

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  Chapter 12: The Center for Global Oncology Becomes the MD Anderson Cancer Network, Part I

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay explains how institutional growth has resulted in reorganization that has brought the Center for Global Oncology into the new MD Anderson Cancer Network. The aim, she explains, has been to address the disconnect between business development and research.

  She talks about the “product line” of connections with MD Anderson: partnerships, sister institutions, and certified membership.

  Ms. Hay also explains the process by which the MD Anderson Network’s significance has been clarified within MD Anderson, winning support from division heads. Since division heads must approve physicians working in partner institutions, this facilitates expansion.

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  Chapter 13: Dr. Ronald DePinho and Institutional Change

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay comments on the early years of Dr. Ronald DePinho’s leadership of MD Anderson. She notes his emphasis on the “democratization of cancer.” In response to a question about criticisms of his approach from MD Anderson faculty, she says that the value of partnerships is now being demonstrated. She comments on all institutional change being a difficult, particularly in medical institutions, which are traditionally conservative.

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  Chapter 14: Planning for the Next Growth Areas

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  On the research side, she talks about big data and the opportunities to gather enormous amounts of data that can feed personalized care.

  She notes that MD Anderson has created a new position: Chief Innovations Officer.

  Next she talks about pursuing employers as partners, with MD Anderson supplying expertise in prevention, screening, and education. She talks about a pilot program that will begin in about a year and explains that there is more awareness of the practical value of prevention and employers want to offer such programs.

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  Chapter 15: The Center for Global Oncology Becomes the MD Anderson Cancer Network, Part II

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay returns to the story of the Center for Global Oncology’s transformation into the MD Anderson Cancer Network. She explains that this was a sign of growth and maturation and became necessary so MD Anderson could develop a clear line of products that allowed affiliation with the institution.

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  Chapter 16: As VP of Business Development: Today’s Initiatives and What the Future Holds for MD Anderson

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Her current work focuses on refining the model of how MD Anderson establishes partnerships with other institutions in the U.S. and abroad. She talks about the need to develop payer products to address changes in the healthcare reimbursement arena. She talks about the need to diversify MD Anderson’s income streams beyond patient care revenue and lists roles that the Office of Business Development serves as other offices take on this challenge as well.

  Ms. Hay explains that in future she will focus on visioning business possibilities facilitated by technology and gives an example of discussions with Elekta about providing mobile treatment planning for radiation oncology.

  Ms. Hay notes that “we should be a cancer knowledge network” in a nation that focuses on genetic testing, molecular immunology, and the democratization of cancer care dovetail with MD Anderson goals.

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  Chapter 17: Personal Sacrifice, Women, and Leadership at MD Anderson

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay begins with comments on the personal sacrifices she has made because of her belief in the MD Anderson mission.

  She then offers leadership advice and comments on the experiences of women aspiring to leadership roles at the institution. She comments on what women in particular bring to leadership and negotiation.

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  Chapter 18: Resilience in Leadership and a Presidency Defined by Innovation

  Amy Carpenter Hay and Tacey A. Rosolowski PhD

  Ms. Hay begins by explaining that resilience is a key quality for a leader, particularly in a physician-led institution.

  She talks about the importance of innovation and strategic thinking at MD Anderson, observing that innovation may define Dr. DePinho’s legacy at MD Anderson. She explains that she visualizes a “perfect storm” coalescing, where the institution is on the “cusp of greatness.”

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  Chapter 01: An Early Interest in Science

  Kay L. Hermes and Tacey A. Rosolowski PhD

  In this chapter, Mrs. Hermes sketches her family background and her early interest in the sciences. She also talks about her education at Jamestown High School and Jamestown College and her transfer to University of North Dakota. She sketches her experiences during the years of the World War II, particularly her impressions that the public was given little information about what was actually going on. She compares WWII coverage with coverage of the Vietnam War.

  Mrs. Hermes then notes that she went to college as a premed student (BS in biology and chemistry conferred in 1950). She had been inspired by her chemistry and biology teachers in high school as well as her work in a hospital. She applied, but was not accepted at medical school.

• 

  Chapter 02:A Bold Step and Coming to Work at MD Anderson

  Kay L. Hermes and Tacey A. Rosolowski PhD

  In this chapter, Mrs. Hermes explains how she came to work at MD Anderson. She begins by telling the story of how, after not being accepted into medical school, she and a friend, Rosemary Sweeney, decided to take the bus to Galveston, Texas to look for jobs. The opportunity to work at MD Anderson came because a relative of Dr. R. Lee Clark’s assistant, Marion Wall, was a friend of Mrs. Hermes’ mother.

  Mrs. Hermes shares memories of starting work when MD Anderson was located in the old Baker Estate on Baldwin Street. She notes that she worked in the converted army barracks and that she was supposed to work with Dr. Trunelle on a project involving chick embryos, but ended up working for Eleanor MacDonald, PhD [oral history interview and video interviews].

  Mrs. Hermes talks about Dr. MacDonald’s recruitment to MD Anderson. She also explains that Marion Wall became R. Lee Clark’s assistant because she was his medical secretary during WWII when he served as an army surgeon. She talks about her memories of R. Lee Clark, Dr. White, who was in charge of surgery, and Jorge Awapara, PhD, who conducted discovered important amino acids.

• 

  Chapter 03: Working for Eleanor MacDonald: the Beginnings of the Texas Cancer Registry

  Kay L. Hermes and Tacey A. Rosolowski PhD

  In this chapter, Mrs. Hermes first explains that Dr. MacDonald was starting a pathology index and punch card system to code medical records. She was not writing any articles or other project aside from MD Anderson’s Annual Report. Mrs. Hermes and her friend Rosemary were hired to fill two 30-day typist jobs and Mrs. Hermes first worked on the pathology index. Dr. MacDonald next assigned her to code medical records. Mrs. Hermes describes this process as well as the coding systems. She explains that the codes that Dr. MacDonald was developing were much more specific for cancer patients than those otherwise available. Work was also in progress for the Texas Cancer Registry and information was coming from people working in the field with numerous hospitals in Texas. She notes that Dr. MacDonald received a grant from the Department of Public Health to fund the registry project.

• 

  Chapter 04: R. Lee Clark, Fundraising, and Recollections of Attitudes about Cancer

  Kay L. Hermes and Tacey A. Rosolowski PhD

  Mrs. Hermes begins with chapter by recalling that MD Anderson’s first permanent hospital location opened in 1952. In her recollection, it was built only with private funds (no government funding) which she attributes to Texan’s hostility to government funding of any projects. She explains that R. Lee Clark was a skilled fundraiser and that many organizations contributed –e.g. the Women’s Auxilliary and the MD Anderson Foundation—with the intention that MD Anderson be a Texas operation with Texas money that anyone in the state could come to.

  Next, Mrs. Hermes talks about the attitudes about cancer in the 1950s. She mentions the radical surgeries (the Halstead approach) and limited diagnostic tools at the time, however by the 1960s, attitudes were already changing. People could be fearful and despairing because of a lack of treatment options, but by the 60s and into the 70s, they were more assertive and might even go to Mexico for unauthorized treatments.

• 

  Chapter 05: Gathering Records and Conducting Follow-Up Training

  Kay L. Hermes and Tacey A. Rosolowski PhD

  In this chapter Mrs. Hermes continues to talk about her work on the cancer registry. This entailed traveling to cities in Texas to research records and enlist the staff’s aid in the process. She talks about going to Beaumont, Texas to set up a “cancer clinic” where she indexed and abstracted all information on patients going back five years. She also trained the clinic secretary to follow up on living patients to collect cancer related information. She also went to Austin to research death records in the effort to locate living patients in efforts to document the progression of their disease, if any.

  The goals of the project, she says, were 1) to promote the concept of good follow up, 2) to promote a model of clinical specialties working together, and 3) to collect comprehensive data. She notes that some physicians were reluctant to share patient records for fear of government interference, however the project was successful in securing records for all patients in all hospitals in Texas with over fifty beds. She notes that the head of the health department and Dr. MacDonald were active in convincing the hospital administrations to participate.

  Mrs. Hermes talks about some of the individuals she worked with and notes that she taught people to code records. She tells a story of how records were used: she talks about a study of thyroid tumors for which records were used to identity the characteristics of patients.

• 

  Chapter 06: Accepting Epidemiology as Part of Oncology

  Kay L. Hermes and Tacey A. Rosolowski PhD

  Mrs. Hermes begins the chapter with some memories of R. Lee Clark and the focuses on Dr. MacDonald’s relationships with faculty at MD Anderson and the process of building acceptance for epidemiology. She confirms that there were “not a lot of famous women” at MD Anderson at the time and also that clinicians were not particularly data driven. She notes that Dr. MacDonald has a poor working relationship with Dr. William Russell, the head of Pathology, but otherwise was well respected. Mrs. Hermes said that she worked closely with Dr. Clark, who took advantage of her strong science writing skills. She also notes that it took a while for epidemiology to take hold as an academic study. She recalls how much she loved working for Dr. MacDonald and what a “marvelous” data analyst she was.

• 

  Chapter 07: Seeing the Impact of Data Collection on MD Anderson Research

  Kay L. Hermes and Tacey A. Rosolowski PhD

  Mrs. Hermes begins this chapter by explaining how she came back to work at MD Anderson in 1973. Dr. Clifton F. Mountain had asked Dr. MacDonald who could manage a large lung cancer study he was conducting with the North American Lung Cancer Study Group. She then talks about the impact that data collection had on studies at the institution. She notes that there was little communication between researchers and clinicians at that time. This began to change through studies on sarcoma. She gives an overview of the evolution of different cancer treatments and how data collection and strategies for selection of patients to include in studies had an impact. She gives an example of a study that Eleanor MacDonald conducted: the duration of time between a patient’s first symptoms to seeing a physician and receiving a diagnosis had an impact on outcome of treatment.

  Mrs. Hermes then comments on how technology has had an impact on the use of data. She notes that prior to 1956, Eleanor MacDonald would take her data on mortality rates to Texas A & M for computer analysis.

  She talks about the surprising results of one study of cancer of the mouth: older women in rural Texas had high rates of mouth cancer because they dipped snuff.

• 

  Chapter 08: More Lung Cancer Studies and Impressions of Changes at MD Anderson

  Kay L. Hermes and Tacey A. Rosolowski PhD

  Mrs. Hermes talks briefly about her husband and children (she married in 1955), then talks about her work with Dr. Mountain collecting data for a pathology reference center on lung cancer.

  Next she shares her observations on how much the institution had changed during her work hiatus (1956 – 1973).

• 

  Chapter 09: Reflections on Dr. Clifton Mountain and Data Collection Roles at MD Anderson

  Kay L. Hermes and Tacey A. Rosolowski PhD

  Mrs. Hermes begins this chapter with memories of how much she enjoyed working for Dr. Mountain over the course of 25 years. He taught her how to think about data, she explains, and she was listed as an author on a number of publications on lung cancer [see examples below]. She explains that Dr. Mountain left MD Anderson in 1993, but she continued to work freelance for him. She recalls that he set up the first conference on mathematics at MD Anderson, early in his career sometime in the sixties.

  Next she comments on how the unique openness of Houston culture fit well with the bold visions that both R. Lee Clark and Eleanor MacDonald held for oncology. She says that her most important work was on Dr. Mountain’s staging system for lung cancer and she explains why staging the disease presented challenges.

  She confirms that she was always interested in the implications of basic research for clinical findings. She credits Eleanor MacDonald for helping her to develop her curiosity and questioning style.

• 

  Chapter 01: A Career in Medicine

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks sketches his family background and talk about how his older brother influenced his decision to go into medicine. He also talks about his visual thinking skills, noting that he started out in surgery but switched when he became excited about the new imaging technologies that were introduced when he was a young professional.

• 

  Chapter 02: College and Medical School

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks about the economic realities behind his decision to go to college and to medical school at the University of Kentucky (MD, 1982). He tells stories about doing one of his rotations in Appalachia and the dedication and compassion of the physicians there. He shares stories of his mentor in medical school, Ward Griffin, MD, as well as his skills in visual thinking.

• 

  Chapter 03: Specializing in Diagnostic Imaging [Part 1]

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins by noting that he realized that “the diagnostic dilemma would be solved by imaging” while he was interning in general surgery at Memorial University Medical Center in Savannah, Georgia (1982 – 1983). This prompted him to undertake his clinical residency in radiology at the Indiana University Medical Center (Indianapolis, 1983-1986). He describes how imaging was used to enhance the surgical perspective and also comments on how the entire practice of medicine was changing at that time.

• 

  Chapter 04: A Child with Cancer

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks about the turbulent period that ensued after his son, Graham was diagnosed with kidney cancer at 8 months of age. He describes his experience as a parent, the lessons learned, and the impact that experience has had on his own work with patients.

• 

  Chapter 05: Specializing in Diagnostic Imaging [Part 2]

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks more about his experiences in his clinical residency in radiology at the Indiana University Medical Center (1983-1986) where he went on to serve as an instructor in vascular radiology (1986-1987). He talks about what it is like to practice medicine in an evolving field/specialty.||The recording cuts off mid-sentence at 36:30.||

• 

  Chapter 06: A Sketch of Research in an Evolving Field

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks sketches the research he did in his early career, prior to switching his focus to administration. He notes that he “loved anatomy” and focused on research to perfect early interventional radiology devices and quantify their value for patient outcomes. He gives an example of his work with IVC filters. He explains how this experience with research served him when he came to MD Anderson to become Section Chief of Interventional Radiology.

• 

  Chapter 07: Challenges for the Section of Interventional Radiology in 1998

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks explains how his experiences at the University of Washington in research served him when he came to MD Anderson to become Section Chief of Interventional Radiology. He notes that his mandate when he came to MD Anderson in 1998 as a section chief was to rebuild the Section of Interventional Radiology. He explains why the section had fallen into a period of dormancy with a very small faculty/staff and few resources. The section required new leadership and he describes his first steps. He also talks about the challenges of leadership during this period and how he set an example by pitching in.

• 

  Chapter 08: A Turning Point in Building Interventional Radiology in 1998

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks explains how the Section of Interventional Radiology emerged from its period of lassitude in the late 90s with the support of David Callendar, the Physician in Chief, who send Dr. Barbara Summers to help him devise an organized process for the section’s transformation into a strong program that attracted innovative, quality recruits.

• 

  Chapter 09: Choosing to Focus on Administration

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks reflects on what attracted him to administration and institution building. He explains how he relied on his supportive family. He talks about how the commitment of faculty and leaders at MD Anderson to patients helped him overcome any periods of frustration.||He notes that the patients at MD Anderson are inspiring and shares stories of meaningful patient interactions.

• 

  Chapter 10: A Discussion of Leadership Challenges

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this chapter with a few comments on growth in the Section of Interventional Radiology. He then takes the rest of the section to comment on leadership issues. He explains that he was part of the Faculty Leadership Academy, found it extremely valuable, and notes the long-term coaching relationship he established with Fred Schmidt. He talks about working with Dr. Schmidt to develop team alignments in the Division of Diagnostic Imaging.||Next he talks the importance of “in-the-moment coaching” and notes that the Faculty Leadership Academy began his “journey” to develop his own leadership. He talks about the importance of finding support via networks. He explains that he has contacted emerging leaders to support them. He explains his view that there are untapped resources for coaching among volunteers and gives an example of a former patient and volunteer, a highly placed individual at Dell, who was able to speak to MD Anderson faculty about leadership issues.||Session Three: 3 July 2018

• 

  Chapter 11: Chair of the Department of Diagnostic Radiology

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks discusses how he stepped into the role of Chair of the Department of Diagnostic Radiology and developed a vision for developing the department. He explains that there had never been a dedicated chair of the department, that the head of the division had always served that role. He explains that to date there had been difficulty getting the section heads to work together. Dr. Hicks talks about his goal of creating a true department identity with a clear governance structure. He reflects on the value of this process as a kind of leadership training for the young section heads in the department and talks about the identity that emerged.

• 

  Chapter 12: Leadership Lessons Learned with Growing the Department

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks summarizes what he learned from serving in this first major leadership role as department chair of Diagnostic Radiology. He begins by saying that his role required him to become “reacquainted with the broad field of radiology” in order to be able to properly understand issues in each of the sections. He also talks about gaining the confidence to elicit information and the challenge of creating an environment that fosters sharing of information.||Reflecting on his leadership style, Dr. Hicks explains that he allows others to air their views fully, often not sharing his own perspective in order to allow free flow of discussion. He notes that some colleagues have criticized him for being too slow to voice his own views and make decisions, but feels his slower style has served him well.||Dr. Hicks also comments on the importance of admitting when something didn’t go right, giving an example of the department’s inefficient first attempt to address effort allocation.

• 

  Chapter 13: Landmark Moments in the Growth of Diagnostic Radiology

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks summarizes key moments of change during his leadership of the Department of Diagnostic Radiology. He first notes the governance structure he helped organize and his role working within the Division of Diagnostic Imaging so the department could function as a full partner with other departments. He also notes the strategic recruiting that build the research and clinical capacity of the department, as well as the strengthening of infrastructure and administrative support for the new activities.||Dr. Hicks also explains that the Department began looking beyond the confines of the Houston campus to the region. He talks about the “groundbreaking moment” of developing very patient-centric radiology services at West Houston Imaging in the Bellaire area of Houston. On this theme he also notes that the department shifted from a faculty-centric to patient-centric focus, with Dr. Joey Steele leading the patient experience initiative. Dr. Steele worked with the Dean of the hospitality institution, the Conrad Hilton School at University of Houston, to improve customer service. Dr. Hicks shares a summary of the positive feedback to a study on patient satisfaction.

• 

  Chapter 14: Head of the Division of Diagnostic Imaging

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks about assuming the role of Head of the Division of Diagnostic Imaging in 2010 while also serving as Chair of the Department of Diagnostic Radiology –a doubling of roles he took on to encourage MD Anderson to appoint a permanent department chair. He explains that as division head, he was particularly concerned about “how do we develop leaders” and he lists the individuals in leadership positions at that time. He explains that the Department of Experimental Diagnostic Imaging was poised to make key changes regarding the evolution of research into areas of translational research and cancer systems imaging. He talks about the creation of CABIR [Center for Advanced Biomedical Imaging Research] and QAAC [Qualitative Imaging Analysis Core] as part of this growth. He discusses how challenging it is to develop new technological and research infrastructure in a complex institutional environment.

• 

  Chapter 15: The Division of Diagnostic Imaging Creates a Leadership Development Program

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this chapter by talking about the vision he created for the Division in 2010, even before he took over as head, with a particular focus on developing internal leadership. Dr. Hicks explains that the division created a program of “Ten Things You Need to Know in a Year” to counteract the fact that the Faculty Leadership Academy did not address some practical skills that division leaders needed. These fell into three categories: knowing and managing self; managing others; systems management. He describes the pilot program the division ran and the positive results: the Leadership Academy began to absorb some of the division practices. He confirms that in the next fiscal year, the division will be working with HR and Faculty and Academic Development to continue the program. He also stresses that leaders need a support network for coaching and problem solving when challenges arise.||Session Four: 24 July 2018

• 

  Chapter 16: Transitions under Ronald DePinho: Epic and Financial Struggles

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks begins to sketch the period of institutional turbulence during Ronald DePinho’s [oral history interview] presidency. He begins by sharing his personal view of Dr. DePinho and his vision for developing MD Anderson’s commitment to translational research. Dr. Hicks notes that many people saw Dr. DePinho’s Moon Shots program as a divisive force in the institution, but he saw its potential for bringing people together.||
  
  Next, Dr. Hicks touches on factors leading to negative views of Dr. DePinho’s leadership: poor communication, top-down decision-making, and a growing feeling among clinicians that their perspectives were not heard.||Next he focuses on the financial crisis in the institution. He explains that MD Anderson came out of the recession to face a new financial environment in healthcare and that the decision to implement Epic (in spring 2016) greatly compromised the institution’s financial comeback, despite the fact that a $250 million loss was anticipated. The comeback took longer. He explains that the immediate fix –to see more patients—was not adequate to the situation. The measures needed to remedy the situation were complicated and difficult to implement. He explains that solutions were proposed from many sources, but the siloing in the institution as well as lack of responsiveness from executive leadership delayed the recovery and intensified the growing sense of mistrust in the institution. Dr. Hicks also observes that payroll expenses were out of control in 2017.l

• 

  Chapter 17: Transitions under Ronald DePinho and the Seeds of Shared Governance

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks shapes his response to a question about shifts in MD Anderson culture under Ronald DePinho by discussing the Committee of Division Heads that he chaired in 2012. He explains that the committee meetings first functioned as gripe sessions, but by 2012, the committee decided to be solution oriented. They addressed the lack of trust between these levels of leadership by sending an invitation to the executive committee and Dr. DePinho to come and talk to the division heads. He sketches the topics discussed and noted that Dr. DePinho and the Executive Committee attended the meetings when they could.||
  
  Next, he sketches landmark moments in the disintegration of leadership relationships which reached a low point in 2015, when Chancellor William H. McCraven took action. Dr. Hicks talks about the causes of the morale problems among faculty and notes his personal view of how frustrating the situation was at that time.||
  
  Next, Dr. Hicks explains that the Division of Diagnostic Imaging began to look seriously at the issue of leadership, shifting perspective and viewing leadership within the Division as an institution-wide role. He notes that there was a growing desire to help the division heads make a difference with leadership as well as growing frustration that the executive leadership was not listening to genuine concerns, a situation that resulted in an increased lack of trust, disempowerment. Dr. Hicks discusses many aspects of leadership style and how this factored into growing problems at the institution. He explains that it is important for a leaders to let go of the desire to micromanage, to trust lower levels of the organization to do what is best. He also notes that leaders can give in to the temptation to not show they don’t have expertise in an area.||Dr. Hicks then discusses the problem of siloing in at MD Anderson and gives an example of how silos prevented solutions from being implemented to resolve financial difficulties stemming from the transition to Epic.||He ends this chapter by noting that Hurricane Harvey (2017) was a “stress test for shared governance.”

• 

  Chapter 18: Transitions under Ronald DePinho: Creating Shared Governance

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks describes events of Spring and Summer of 2015 that marked the turning point in the institutional response to the institutional turbulence under Dr. DePinho. The Faculty Senate and the Division heads had been advocating for more of role in decision making, and the situation had become serious enough that UT System Chancellor McCraven visited in the spring. The Faculty Senate issued a White Paper (https://cancerletter.com/articles/20150713_1/) outlining issues underlying low faculty morale. Chancellor McCraven issued an invitation for a group of three members of the Executive Committee and three division heads to come to Austin to discuss the White Paper. This meeting led directly to the formation of the shared governance model. Dr. Hicks describes the mood of the meeting and the impact of the chancellor stepping in.||
  
  Next, Dr. Hick talks about the first actions taken by the newly formed Shared Governance Committee: addressing issues of confidentiality of meetings, defining committee identity and principles, and creating a strategic plan from the Faculty Senate White Paper. He notes that the committee divided into two (informal) groups: one was committed to looking at issues of culture and communication and the other more focused on the scientific and clinical activities at the institution. The concerns of the first group were eventually dropped by the SGC, however Dr. Hicks, who was part of the group, says they continued meeting to discuss how the climate of the institution could be changed to stress how people come together and work together to save the institution.||
  
  Next, Dr. Hicks talks about the impact of McChrystal Group in 2016. Dr. Hicks explains how he became aware of the book, Team of Teams, by General Stanley McChrystal, who was then invited to MD Anderson to speak when the SCG was still new. The Committee encouraged the institution to invite McChrystal associates to evaluate MD Anderson. Dr. Hicks explains that their four page assessment of the institution was on target and spurred concerned work [document in Supplementary Materials]. At this point, he says, people really began to come together. He also notes that at this point, the people working on institutional change began to realize the stakes of what they were doing.

• 

  Chapter 19: The Shared Governance Committee: the McChrystal Group’s Recommendations for Change

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks reviews the assessment that the McChrystal Group performed (2016) to support the Shared Governance Committee as it restructured MD Anderson [document in Supplementary]. He reviews their key points: a lack of trust and transparency; siloing and lack of alignment; problems with accountability; and problems with communication. He also sketches how the McChrystal Group worked with the SGC beginning in February of 2017 to the end of that year to align groups and determine a new governance structure to facilitate transparency.

• 

  Chapter 20: A New Administrative Structure and Lessons Learned from Working with the McChrystal Group

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks reflects on leadership lessons he learned by working with the McChrystal Group. CLIP: He explains that he learned to see decision-making as a disciplined process and details what he means by that, giving an example of a failure of process that led to poor decision making. He then discusses the importance of using a rational process to create alignments between teams and working group.||
  
  Next, Dr. Hicks talks explains the rationale the Shared Governance Committee used to transform MD Anderson’s administrative structure, creating a more functionally driven structure aligned with new operational priorities.

• 

  Chapter 21: An Interim President and His Team Address Institutional Challenges

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this session by explaining how he was offered to opportunity to become interim president of MD Anderson after Dr. Ronald DePinho [oral history interview] resigned. He explains his reasoning for accepting this role and clarifies how he saw his mandate for this short-term position. He notes that UT System did not intervene in MD Anderson’s change process. He describes the steps taken to use a team approach to turn around the financial crisis and return the focus of the institution to core values, multi-disciplinary care, and patient care.||Dr. Hicks discusses his working relationship with COO, Stephen Hahn, MD and the other members of the team he worked most closely with. He explains how Ben Nelson was selected to become CFO.||Next he discusses how a new administrative structure emerged from the joint work of the President’s Leadership Team, the McChrystal Group, and the Shared Governance Committee. He also describes the process of requesting input on the proposed structure from the UT System Chancellor and the Board of Visitors. Dr. Hicks talks about some challenges that emerged from this implementing this reorganization, which eliminated the need for certain formerly key leaders within the organization.||[The recorder is paused and the session is not resumed]

• 

  Chapter 22: Changing the Institutional Governance Model: Challenges

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this chapter by reviewing how the shared governance committee was formed (Summer 2016). He notes that a good deal of the transformation process was set in motion when Dan Fontaine, Senior Vice President for Business Affairs, decided to retire. A reorganization was needed to ensure that the function areas and his people would have homes, and this was an opportunity to determine what would be the best structure for the organization. The Shared Governance Committee determined that a flattened structure would address the deep silos and communication issues and offer stability and flexibility.||Dr. Hicks then explains how the SGC worked out the reporting structure. He says that the Chancellor of the UT System liked the proposed structure and also put in place the Chief Operating Officer role to pull the silos together; however this new structure also changed the reporting structure and created stresses for people who previously reported directly to the president. He further clarifies the rationale for the new structure. He then begins to explain that it was very difficult for the VPs and others to take a reduced role.

• 

  Chapter 23: Implementing Change, the Influence of the Board of Visitors

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks describes an obstacle to implementing the shared governance system. He explains that the majority of the higher level individuals accepted the reality that their own roles had to shift and also recognized the institutional problems the new structure was designed to address. However, it became clear that neither the physician in chief, Dr. Thomas Buccholz [oral history interview] nor provost Dr. Ethan Dmitrovsky shared a view of the need for change. Dr. Hicks explains that it became clear they needed to be removed from their roles. As discussion evolved, he says, the process became contentious and members of the Board of Visitors “kitchen cabinet” became involved, meeting with him and attempting to guide the process (which is beyond the official scope of the Board of Visitors). Dr. Hicks says that he decided to focus on advice provided by MD Anderson about MD Anderson processes.||Dr. Hicks reflects briefly on his handling of this difficult situation. He observes that leaders must not allow personalities and emotions get in the way of doing what is best for the organization.||
  
  Next, Dr. Hicks reflects on Dr. DePinho’s leadership, noting that “he did not fail alone, he had a team.” He explains that the removal of Drs. Dmitrovsky and Buccholz was the last task before the institution could move out of the DePinho years and into a new transition. He also summarizes the Board of Visitors concerns and motivations for becoming involved in this process. He notes that removing these two key people and making the governance change had a positive effect on the new president’s administration [Peter Pisters, MD].

• 

  Chapter 24: Thoughts about Serving as President

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks traces the shift in his thinking about possibly serving as permanent president of the institution. He reports on conversations he had with Dr. Raymond S. Greenberg, University of Texas System’s Executive Vice Chancellor for Health Affairs: both he and Dr. Greenberg were concerned that looking ahead to permanent presidency would raise questions about decisions Dr. Hicks made as interim president. On the other hand, he says, he was energized by the thought of taking on the challenge of the permanent presidency and building a team-based culture for the institution. He notes that he received a lot of encouragement to apply and reflects on the challenges that a high profile, public role presents to an introvert, such as himself. He notes that he put in an application, which only went as far as the first round of interviews. At the end of the session, Dr. Hick talks about the challenges a leader can face that make you “lose a part of yourself.”

• 

  Chapter 25: A Follow Up on Being Recruited for President and Views on Harvey

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this chapter with a brief follow up to last session’s discussion of his thoughts about applying for the position of permanent president. Despite his reservations, he explains, he was approached by a recruiter and after eliciting various opinions, decided to apply.||
  
  Next, Dr. Hicks talks about how Hurricane Harvey, which made landfall in Houston during 2017 and which was “a coming-together moment” and a test of all the structures and skills that the Shared Governance Team was putting in place. He describes how the institution was at first caught off guard because of meteorological reports that underestimated the amount of rainfall and the rapidly shifting nature of the storm of increasing magnitude. He describes how the institution quickly put the skills and resiliency to use to manage institutional operations and successfully rebound. Dr. Hicks talks about the impact on employees and The Caring Fund of about one million dollars that was established via donations to help.||Dr. Hicks shares his “most precious memory” of his time as interim president: the post Harvey celebration at The Park that acknowledged the way that the institution came together during the storm.||
  
  Next, he shares the lessons learned: specifically how the crisis revealed certain local areas of operation with less developed communication networks, resiliency, confidence in local decision-making, and abilities to ask for help. He explains that the McChrystal Group was still involved in mentoring the institution and helped them undertake an “After Action Review” to examine how Harvey was handled and identify areas that needed additional analysis and intervention.||
  
  Next, Dr. Hicks talks about the financial impact of the institution, explaining that at the cusp of the 2017/’18 and 2018/’19 fiscal years, MD Anderson was on track to achieve a $25 million margin. The storm's impact was around $30 million. Dr. Hicks explains that he decided to make various institutional awards, despite the fact that those would increase the shortfall.

• 

  Chapter 26: Defining Operational Priorities and Preparing for Dr. Pisters to Step into the Presidency

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks discusses the identification of the operational priorities [ROPR] during October and November of 2018 to manage the institution’s change process before Dr. Peter Pisters arrived to become institution president.||[The recorder is paused]||Dr. Hicks lists the Operational Priorities: patient experience; enhanced information systems; geographic expansion; discovery; education; recruitment and development; financial sustainability. He explains how this type of planning was different from what occurred prior to Dr. Ronald DePinho’s arrival and how it was managed to provide structure and also flexibility once Dr. Peter Pisters arrived.||Dr. Hicks provides a summary of what Peter Pisters brings to the institution (having worked at MD Anderson before) as well as his lack of immediate familiarity with the recent turbulence.||He comments on the selection of Dr. Pisters and how it reflected concerns that the new president have adequate familiarity with MD Anderson culture.

• 

  Chapter 27: Views of MD Anderson Presidents; Peter Pisters and the “Care and Feeding” of MD Anderson Culture

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  Dr. Hicks begins this chapter by commenting that the state legislature in Austin monitors MD Anderson because the financial health of the institution has an impact on the entire University of Texas system. He notes that MD Anderson has returned to a solid financial footing.||Dr. Hicks comments on Dr. Peter Pisters’ style, noting that he is a “student of leadership.” He also observes that leadership used to take culture for granted, but now there is a concerted effort to cultivate the culture of the institution.||
  
  Next, Dr. Hicks sketches the leadership approaches of the MD Anderson presidents. He explains that Dr. Pisters is particularly attuned to the fact that healthcare is changing and brings skills in preparing the institution to navigate changes as the stakes and risks rise.||Dr. Hicks then explains that presidents need to resist the temptation to operate solely within their comfort zones. He comments on his own comfort zone and notes that he was tested by a financial crisis during his period as interim president.

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  Chapter 28: Experiences at the Mallinckrodt Institute of Radiology and Their Impact on Later Leadership (1988-1998)

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks about the ten years he spent in the newly established interventional radiology group at the Mallinckrodt Institute of Radiology at the Washington University school of Medicine, St. Louis, Missouri. He talks about the opportunities this afforded him immediately after his fellowship period to build a clinical and educational training programs and makes connections between these early-career experiences and his later leadership at MD Anderson, e.g. immersion in a positive culture at the Institute; the opportunity to build a clinical practice and develop excellent patient care. He also describes his experience observing issues that arose at University of Washington, the academic and healthcare delivery arms of the institution were divided into different financial areas.||
  
  Next, Dr. Hicks confirms that these experiences helped give him the skills to rebuild Interventional Radiology at MD Anderson and to recruit well. He also learned how to treat patients. He tells a story that illustrates how faculty in an emerging field can be tempted to push boundaries when the treat patients and how collaborative discussions can ensure responsible action is taken. He notes as well that he brought this team based approach to MD Anderson.

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  Chapter 29: Transitioning out of the Interim President Role

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks focuses on his role as Head of the Division of Diagnostic Imaging after serving as MD Anderson’s interim president. He discusses issues the division was facing, including the discussion of how to move services out into the region as well as staffing needs occasioned by the implementation of the Epic electronic medical records.||Dr. Hicks also discusses challenges he experienced as he returned to a divisional role after serving at the highest executive level: after a few years looking at institutional issues from a very broad perspective has changed how he interprets issues that seem pressing when seen only from the departmental and divisional level. He explains that he is questioning whether he is best able to serve the institution as a division head and has been considering other options. Dr. Hicks notes he has enjoyed working on the In-Patient Planning Committee, and he reflects on the difficulty of making late-career moves.

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  Chapter 30: On Ongoing Strategic Planning and the Future of MD Anderson (2019)

  Marshall Hicks MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hicks talks about the strategic planning model Play to Win (Lafley Martin) that Dr. Peter Pisters brought to MD Anderson in the early days of his presidency. He outlines several positive features of the model and notes the importance of defining MD Anderson’s “aspirational win” (a key concept in the method), given the need to avoid “turning into a corporation.” He talks about how important it is not to “lose the people” of MD Anderson, as patients constantly mention the caring people the encounter during treatment and this gives the institution its edge.||Dr. Hicks then sketches what lies ahead for the institution: the need to succeed in a changing healthcare environment linked to politics; the need to fund research more independently of clinical revenue; and to develop a wide range of clinical service to be flexible. He also notes that MD Anderson needs to position itself advantageously in the region to manage risk and also work collaboratively with institutions across Texas.

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  Chapter 01: Early Experiences with Physicians and Illness

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill links his choice of career to his own bout with osteomyelitis as a youngster and the care that his family physician provided. He gives an interesting portrait of disease in the thirties/forties–including being anaesthetized with cocaine—and the role of the small-town doctor.

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  Chapter 02: Developing Interests in Oncology and Pain Management

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill sketches his professional training, including his experiences in the 8th Air Force Strategic Air Command base in Plattsburg, New York, where he became Chief of Professional Services and encountered cancer cases that convinced him to apply for a residency at Memorial Sloan-Kettering Cancer Center. He then talks about the New York phase of his early career. He paints an interesting picture of the state of medicine and of different hospitals in New York at the time.

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  Chapter 03: An Evolving Specialty and Coming to Texas

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  Dr. Hill begins this chapter by describing how the politics of building a new medical school in Jersey City influenced his career path. He talks about meeting Dr. Ray Houde, who studied analgesics and spurred his early interest in pain medications. He also met Roulon Rawson who had treated thyroid cancer and radioactive iodine and “that rubbed off on everyone who worked with him.” He rotated through the general endocrine service at Bellevue Hospital, which helped convince him to focus on that specialty. He talks about the professional connections that alerted him to a position at MD Anderson.

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  Chapter 04: Thyrocalcitonin –Confirming the Marker for Thyroid Cancer

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill talks about his work in the Department of Medicine when he first arrived at MD Anderson in 1963. He describes discovering a “treasure trove” of cases of medullary thyroid cancer. He sketches his epidemiological studies of families and his study of the nature of thyroid cancers, then goes into much greater detail on his study of calcitonin in the thyroid, determined to be a marker for thyroid cancer, as well as gene-related calcitonin.

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  Chapter 05: MD Anderson in the Sixties –A Culture of Innovation

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill compares MD Anderson to Memorial Sloan-Kettering and the Mayo Clinic (Dr. Clark’s model for MD Anderson), noting that, at the time, MD Anderson could not replicate the cultures and traditions of these well-established services. Dr. Hill comments on Dr. Clark’s leadership style and vision and the innovative ideas he implemented at MD Anderson.

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  Chapter 06: Collaborations with Dr. R. Lee Clark and the Climate for Research at MD Anderson

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this segment, Dr. Hill talks about the research connections he shared with Dr. R. Lee Clark, also a thyroid surgeon. He talks about standard procedures for treating thyroid cancers. Dr. Hill concludes the interview with some comments on how basic and clinical scientists collaborated very informally during his first years at MD Anderson.

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  Chapter 07: Publishing the First Book on Pain Management

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this segment (which begins when the Interviewer switches on the recorder during an informal discussion) Dr. Hill talks about his efforts to publish the first book on his work in pain management, Drug Treatment of Cancer Pain in a Drug-Oriented Society. He explains that pain management is a complex societal and medical issue that is “like trying to pick up a greased watermelon out of a swimming pool.”

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  Chapter 08: Understanding the Problem of Pain Management in the 70s and 80s –at MD Anderson and Beyond

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill talks about pain management issues at MD Anderson. He begins by talking about the Pain Clinic, an ad hoc clinic that undertreated pain, a typical approach at the time, since chronic pain is a problem for patients who live, and cancer patients were just starting to live longer. He explains the three major causes of pain for the cancer patient and talks about his philosophy of addressing “pain in the cancer patient,” rather than cancer pain. He talks about the knowledge base about pain that needed to be created, including information about dosages, drug mechanisms and administration protocols, the individuality of patients, etc.

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  Chapter 09: A Pain Clinic for MD Anderson

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  Dr. Hill begins this chapter by explaining why he left the Directorship of the Ambulatory Care Clinics (Mays Clinic) specifically to start a true Pain Clinic with a multidisciplinary team of practitioners, including a therapist who worked with relaxation (inspired by the model of Dr. John Bonica). Throughout this discussion he mixes observations about administration, clinical practice and research to give a portrait of how he began to explore effective use of opioids, culminating in his realization that cultural/societal beliefs prevented other physicians from aggressively treating pain with opioid drugs.

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  Chapter 10: Pain Management and Opioids: Today and in Historical Perspective

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill explains that American culture does not easily distinguish between the abuse and legitimate use of opioid drugs. He summarizes points he made in an interview he gave for the television program, 60 Minutes related to a controversial colleague in pain management, Dr. William Hurwitz. Dr. Hill explains that misunderstandings about the nature of what addiction effect physicians, pharmacists, law enforcement agents, media and, of course, patients. To set context for this discussion, Dr. Hill sketches the history of drug regulations and the study of pain, going back to the Civil War (and the understanding of phantom pain), describing pain and pain control mechanisms (e.g. the ‘gate theory’) in vivid terms. He tells several stories about patients grappling with pain (at times to the point of suicide attempts), and the treatments he explored to ease their suffering.

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  Chapter 11: Pain, Opioids and the Challenge of Working with Patients –and with Government Regulations

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  Dr. Hill begins this chapter by explaining the problem that triplicate prescription forms present to pain management. Since one copy of a prescription for an opioid goes to the police, physicians can be reluctant to prescribe (adequate) pain medication for fear of legal prosecution. Dr. Hill then talks about his related work with Texas Lt. Governor Bill Hobby to write the “Intractable Pain Treatment Act” (1989), adding many observations about how politics can influence medicine. He also talks about lawsuits against physicians who prescribe opioids and the lengths patients will go through to acquire adequate medication. He discusses “My Word Against Theirs”…Narcotics for Cancer Pain Control (1990-’91), an award winning video ("Heart of Wisdom Award" SMF "Gold Award" [First Place] for the Eighth Biennial John Muir Medical Film Festival in the category of "Patient Care") he produced with the MD Anderson Media services and a 1996 episode of 60 Minutes, during which he discussed a lawsuit against physician William Hurwitz for prescribing narcotics. Dr. Hill then talks about obstacles that still prevent the medical profession from adequately treating chronic pain. He also discusses the need to teach pharmaceutical companies how to tailor medications to maximize pain relief and avoid toxicity.

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  Chapter 12: A Brookhaven Laboratory Study in the Marshall Islands

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter Dr. Hill speaks about his involvement (and that of other MD Anderson personnel) with the Brookhaven National Laboratory studies of the effects of nuclear fallout in the Marshall Islands. He describes his work with patients in the Islands. He then talks about how MD Anderson became an important treatment center for thyroid cancer because of the use of the “avant garde therapy” of radioactive iodine, noting that Dr. Clark was responsible for bringing the significant researchers together.

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  Chapter 13: The Emerging Need for an Ambulatory Care Clinic

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill explains that the need for a new clinic grew in part with the increasing use of (the controversially) aggressive chemotherapy promoted by Dr. Emil J Freireich [Oral History Interview], Emil Frei and others in the new Department of Developmental Therapeutics. He talks about the tension created between MD Anderson’s “Old Guard” as this “New Guard” increased the institution’s reputation and patient volume.

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  Chapter 14: Setting Up the New Ambulatory Clinic (Mays Clinic) –And Redesigning It

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill offers a comprehensive view of his work setting up the Ambulatory Care Clinics and serving as Director from 1974 to ’79 (noting that he learned to work with Dr. Clark’s leadership style effectively during this period). A new Clinic was needed to serve the crowds of patients standing around as if “in feedlots.” Dr. Hill discusses several topics: MD Anderson’s acquisition of the land and money to build the new clinic; the challenges of dealing with a new building whose architects had not planned well for specific medical uses and needs; personnel upheavals; evaluating the function of the building and staff once the departments moved in; his work writing educational materials for patients on the procedures they would undergo; change in the policy of allowing patients to handle their records. Dr. Hill also describes his working relationship with Dr. R. Lee Clark, president of the institution at the time. He talks about calling a key meeting held to address design elements of the clinic that resulted in dehumanizing treatment of patients that was “not the way that anyone here wants to practice medicine."

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  Chapter 15: Remembering MD Anderson Presidents and Dr. Eleanor MacDonald

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  Dr. Hill begins this chapter by noting that Dr. Clark supported any change that would improve efficiency and positive effects for patients. He then goes on Eleanor MacDonald [Oral History Interview], an epidemiology specialist with a visionary sense of records organization: she established a system of data and records-keeping for MD Anderson that influenced the entire medical system in Texas. Dr. Hill notes that Miss MacDonald’s work guaranteed the quality of MD Anderson research. He then offers additional observations about Dr. Clark, comparing his leadership style to Dr. Charles LeMaistre’s [Oral History Interview] and discussing the transition as Dr. Clark stayed at MD Anderson during the beginning of Dr. LeMaistre’s presidency of the institution. He recalls working with Roman Arnoldy, an engineer who organized the building of Rotary House (built on the model of a hotel attached to the Cleveland Clinic), which provides convenient and medically appropriate accommodations for patients. He also evaluates Dr. Mendelsohn’s [Oral History Interview] leadership style with the previous presidents, praising his science as well as his administrative and fundraising skills.

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  Chapter 16: Preserving the MD Anderson Brand Despite Global Growth

  C. Stratton Hill Jr. MD and Tacey A. Rosolowski PhD

  In this chapter, Dr. Hill discusses financial challenges that MD Anderson currently faces: challenges in expanding the MD Anderson culture beyond Houston while preserving the culture of care; competition between service providers. He also speaks about the new president, Dr. Ronald DePinho –what he appears to offer and also his lack of experience in the operation of clinical services.