MD Anderson 2020 Interview Project
Chapter 04:  The Leadership Institute:  Teaching Accountability to New Employees


Chapter 04: The Leadership Institute: Teaching Accountability to New Employees



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In this chapter, Mr. Coffee provides an example of how new employees are taught accountability while thriving at MD Anderson. He mentions a Buddy system during onboarding. He concludes the chapter by talking about some of the obstacles that occur while having difficult conversations about accountability and tolerance of harmful behavior.

Lee Coffee Jr., M. Ed., Oral History Interview, June 30, 2021


Nina Nevill

I’m sorry, go ahead.

Lee Coffee Jr., M. Ed.

I just said, before you know it, you’ve put the watch back on the other wrist because it felt normal. Go ahead, I’m sorry.

Nina Nevill

Exactly. Exactly. No, that’s fine. I was just thinking as somebody outside of the institution or new to the institution, could you walk me through, in order to meet these goals of accountability and teaching accountability and teaching followership what does that look like in practice?

Lee Coffee Jr., M. Ed.

Well, it looks different in different departments. If you are within the Leadership Institute when you are hired, we introduce you to your fellow team members, both in a large forum, but then we’ll set up some one-to-one. So, Ms. Nevill meets Lee Coffee. Ms. Nevill meets Darrell Simmons. Ms. Nevill meets Stephanie Zajac, and you have a 30- or 45-minute conversation with that person. And then, you are going to work with someone who is going to be, pretty much, a partner or a preceptor, or a buddy, for 30, 60, 90 days, so that—and certainly, this changed during the COVID time period, not for every department but for some, because of social distancing, but you would work with me and if I’d go to lunch, you’d go to lunch. When I’d go to do a project or meet one of my clients, you’d come with me so I can introduce you, and then I walk you around the organization.

So, not just an orientation to the organization, but an orientation at the new employee orientation to the department and to the team members. And then, of course, you sit down with your leader and he or she says, “So, here’s what you said you could do, here’s what the position description asked you to do. What are the gaps that maybe we need to give a little more clarity on what that looks like on a day-to-day basis?” And if you have the skill, based on you being hired, do you still have the will now that you have the job to do those things, including those things that says, “Other duties as assigned on occasions?” And so, it gives you—and depending on the department and the resources, if I want to go out to a conference to continually home my skillsets, am I given the time to do that and the resources from the institution? And I have found for myself, as a lifelong learner, that those resources have been provided to me in various forms. Sometimes when I say, “I want you to pay for the conference, the car, the hotel, and the meals,” I was told, “Well, we can’t pay for all of it but we’ll pay for maybe the hotel and the meal, or maybe the flight and the rental car,” or something, some variation there.

But part of that is also I’ve got to ask. And there’s some people who come in and they don’t ask, so they don’t receive, and then they complain that they didn’t receive. And as a coach, I ask them, “Well, when’s last time you asked the specific question, ‘I want to go to this conference which also relates to the job that I do at the institution, and I’ll bring back a trip ticket that shares what I’ve learned so that others benefit that couldn’t go?’” So, that’s how I have—that’s been my lived experience at the Institute, within the Leadership Institute, as well when I was within the Office of Institutional Diversity. When I wanted to go, the monies were found in part or in full.

Nina Nevill

My understanding of this almost shadowing process of orientation, I know that’s not the word that you used, but do you think that this almost observation of culture of the institutional culture helps equip new employees to know that they can ask, and know what they can ask, and what the appropriate boundaries are there?

Lee Coffee Jr., M. Ed.

Most certainly. If you put that new employee with the right preceptor, because not everybody’s happy to work for an organization when they’ve got to get up at a certain time and come to work and be accountable, again, going back to the accountability. So, you want to make sure that you align your preceptor with a method of marketing that’s going to be supportive of what you want communicated. You don’t want to put the new employee with one disgruntled employee on your team. So, it’s important for success for the team as well as for that individual who’s coming on. I think it’s critical. And as a former nurse, I knew that that’s how we would do it. If I worked night shift, you worked night shift. And we’d do that for 90 days. And so, when I came to MD Anderson in ’09, we were talking about, how do we create this buddy program? And I was in the room when we had the conversation and then one of the think-tank breakout groups, we did on campus, at the time, it was one of the points that I made and it was well-received because we do want to have somebody who can tell you where is the lunch room, where is the parking, and how do I get parking? And what are the politics of the organization that I might need to know? Because if you don’t either understand the politics or play the politics, you can get played by the politics.

Nina Nevill

Now, this buddy initiative sounds very fascinating, and for the most part, successful. But I’m not convinced that all experiences in one job can be rosy. So, if you don’t mind could you tell me about a time that you faced some obstacles whether that be on a specific project or an initiative, and how you got around them?

Lee Coffee Jr., M. Ed.

Well, certainly. Having conversations around issues of ethnicity, sexual orientation, spirituality, I don’t throw out the word race, because race is a myth, although racism is a fact. But because I was very comfortable in having difficult conversations there have been times when I would raise my hand in a forum where we have leaders of various levels and I would ask questions that would sometimes not being appreciated. Questions like, “If in fact the people who serve are not being treated well, what is leadership doing about that? If in fact behaviors that undermine a culture of safety are being tolerated and normalized, why are leaders not holding people accountable?” And there was a time when I would ask those questions where people would kind of ease away from me when they were sitting next to me, or I would get texted and told, “Lee, they’re going to stop inviting you to the meeting if you keep asking those questions.” Now, to the institution’s credit, after a period of time, there are people that began to answer the question. And also, I would try to frame the question in a way that, I’m asking as a learner and not to challenge the person who’s on the podium. And in doing that, people became more comfortable with my style of questioning and I started being sought to help people have those difficult conversations. So, it took some getting used to, first of all, “Who is this guy?”

Nina Nevill

Sure, “Who does he think he is showing up and asking questions?”

Lee Coffee Jr., M. Ed.

That’s right. And as a diversity practitioner, you’re going to ask tough questions about, why is it that women are not given the proper positioning, whether they come in as an assistant professor, and they remain as an assistant professor, and they have published three times the documents and do four times the speaking engagements before they’d be promoted to associate professor and they don’t seem to be making it to the full professor-tenure track at the same speed as their male counterparts. And how is that happening if they’ve got the same credentials? And that’s a tough question, and not one of that some people very comfortable answering. And so, when somebody asked that question in a room full of leaders who were like, “Yeah, I want to know that, too.” But fortunately—so, that’s an example, asking tough questions, having difficult conversations in a conversational tone, and asking if employee A does something disruptive, are they held to the same standard as employee B if employee A has a positional power, and employee B does not but they both do the same egregious action, are they held the same standard of accountability?

And for a while, the answer was unequivocally no, because classism is—I’ve been in healthcare for a little over 40 years, it’s a part of the healthcare system. The one time, you’ve got doctors and nurses. And if you’re looking at doctors, depending on what level they are. If you’re looking at nurses, it’s also, are you, at one time, a licensed vocational nurse? Are you an associate degree nurse? Are you a bachelor’s prepared nurse? Masters? And that same thing can be said about, are you an intern, a resident, and how do we still recognize the humanity of every person that comes to the door? The housekeepers, for goodness’ sake. If you don’t do a good job of housekeeping, your healthcare system becomes a big petri dish.

Nina Nevill

Falls apart, yeah.

Lee Coffee Jr., M. Ed.

But housekeepers are not always treated with the same dignity as someone who has on a different attire. Does that answer your question?

Nina Nevill

I think so. Absolutely.

Lee Coffee Jr., M. Ed.

About difficulties?

Nina Nevill

Now, this is kind of changing pace a little bit, but some of the words that have been brought up in our conversation so far, I’m hearing diversity, disparity, advocacy, but also there’s this phrase, “diversity equity and inclusion,” and I feel that in the past year especially we’ve heard diversity equity and inclusion from many institutions in many different capacities. And so, I’d like to know what diversity equity and inclusion means to you, and of course, you can take that in any direction within the context of the past year or just within your own life experiences, professional experiences, et cetera.

Lee Coffee Jr., M. Ed.

In my professional lived experience, diversity simply means different. The question is, do you see the difference as deviant? Equity means being given the opportunity to achieve certain equality. But it might give you the condition so that you can have equality. Inclusion just means, if I’m doing an event, have I included you in that event? No matter who the you is, have I included you? And then, it’s important to recognize if we look at some of the federal statutes, start with Martin Luther King Holiday, Black History Month, Women’s History Month, Asian-Pacific Islander Month, Gay Pride, Women’s Equality Day, Hispanic Heritage Month, People with Disabilities Month, which is also October, Native American Month, those are great events to build awareness around the contributions that people have made to society. What it does not do though, it does not address the racism. It does not address the sexism, directly. So, it’s nice for me to be able to come to whatever the ethnic heritage or celebration, the diversity inclusion month, party, but if it does not change how we hire, who we hire, how we treat people after they’re hired, if it does not address the fact that sexism and racism are still alive and well, they are still diabolical biological twins that subordinate an individual based on his or her gender or ethnicity.

And if we don’t address that in our economic systems and our economic systems like pay disparity. We know women soccer teams across America winning more games than male soccer teams but paid a third. If we don’t address it in our social systems, healthcare disparities, people that couldn’t access the healthcare and still can’t get a COVID shot, right now. As well as education, based on tax. And then political systems, whereas I get stopped and I end up as a chalk mark on the ground because I had a taillight that was off, or I get stopped and put in jail, even if I’m innocent, if you run the numbers on how many people have been, that particularly are Black, and Brown in some instances, that are sent to jail, 20 years ago, 25, 30 years ago, and then through DNA analysis today, some of those people are told, “Okay, we made a mistake.” Some states give them compensation, other states say, “We’re going to set you free,” and they’re not getting compensation. You’ve lost 20, 30 years of your life. So, diversity equity and inclusion is a critical component of the discussion. But in the context of a swimming pool, it’s the shallow end of the pool, and if you want to have some impact, you have to address the systemic racism that can begin, doesn’t always have to, but is a part of the social fabric from the White House to the State House, to the church house, to the schoolhouse, to the outhouses. It’s woven throughout society. And until you address the system, the large system, it’s like rearranging chairs on the Titanic.



Publication Date



The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center


Houston, Texas

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Chapter 04:  The Leadership Institute:  Teaching Accountability to New Employees