MD Anderson 2020 Interview Project
Chapter 02: Navigating a Pandemic


Chapter 02: Navigating a Pandemic



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In this chapter, Dr. David Jaffray discusses how MD Anderson Cancer Center responded to the COVID-19 health crisis. He recalls the intital stages in which the institution began to plan and implement various proactive measures to navigate the local impacts of a global pandemic. In particular, he notes how MD Anderson maneuvered the tensions that came with restriciting access to certain areas, how the institution responded to remote work, and the challenges surrounding obtaining enough personal protective equipment. Dr. Jaffray also mediates on the impacts of this particular era, describing how it “reset people’s tolderance to distruption.”

Dr. Jaffray also discusses notable moments in hindsight and notes the cross collobration across the Texas Medical Center, implementing the MOAT system, and shutting down the Houston Livestock Show and Rodeo. Moreover, Dr. Jaffary ends by reflecting on the borader contexts of the time in regard to racial justice and how MD Anderson intends to address racial and socioeconomic equity in the future.


Nina Nevill It sounds like that’s a resounding almost fact that I’m hearing from those that I’ve interviewed so far, as how quick the institution was able to adapt and to jump into changes that would be helpful. And now, this is, for me, jumping a little bit ahead but I’m happy to just go ahead and talk about the pandemic now, and the early stages. I’d love to get a sense of how, from your point of view, MD Anderson traversed these initial few months, especially thinking back from March to the summer of last year.

David Jaffray, PhD Yeah. I mean, the conversation actually started in January. I remember coming back from Toronto—or, after Christmas. And I had experienced SARS back in 2004 in Toronto, and so had Fatima Sheriff. And what was happening in Wuhan was very alarming to me because I saw what SARS did to a hospital and how we had to mask and how disruptive it was to the entire organization and to the patients and their families and everything. it was just extremely disruptive for several months in Toronto back then. We were able to get SARS under control then, and in many ways, it kind of got forgotten. But I remember very distinctly trying to get headsets and stuff back in 2004 for people, and how can we keep meetings going, and so on? It was a much more difficult. The tools weren’t there by any means. So, we had a good conversation. Myself and Craig Owen, actually, were kind of thinking of, “If this really does happen, there’s going to be a huge dependence on technology,” so we had a lot of dialogue going on in January about, “Hm, what are we’re going to do?” And then the executive team, with Welela and Rosanna and myself and Fatima and several others, Peter of course, was involved, and Christa, Tadd Pullin and others, just starting to brainstorm around, what does this look like?

So, we had some very early meetings, I think they started, I would say in February—from February? Maybe even sooner, just watching and keeping our minds open about the implications were. So, we were very early. In fact, I think we felt like we were a little bit paranoia early, but it’s one of those things when the end of March, mid-March came, we were like, “No, that wasn’t paranoid. That was just good.” And so, we had already done a lot of work on limiting travel and things like that in the organization to start to restrict and be very thoughtful. And the team really came together very nicely and that was a good period there where we started planning and anticipating meeting in the conference room on the 20th quite regularly to understand what was happening around the planet and to adjust what our thinking was, what the risks were, how this might roll out, what percent of the population was at risk from a death perspective, from an infection perspective. The early numbers out of Wuhan, it’s a two to four percent death rates, and I remember very distinctly that we landed somewhere in the two-and-a-half percent, I think it stabilized there. And it was a pretty shocking number, of course. And then, when the US started to restrict travel, and it just started to go faster and faster with the restrictions. And then, we had to communicate to the organization. And in a very short period of time towards the second half of March, we basically realized we’ve got to get everybody to stop coming in and being around each other, yet we have to continue to deliver care.

And in a period of about a week, a little less than a week, I would say, we sent out this massive survey to the organization, “Who can work from home? What percentage of your staff can work from home?” And then we got that survey back in within, I think, about 48 hours, and then estimated how many people we could (inaudible) to home, and how much computer resources we had. We were fortunate, at that time, to have a pretty big stockpile of PCs and laptops because we were just about to go through a major transition internally. And so, we spun up very quickly. Chuck Suitor and Craig and John Gillman and others put together areas where staff could just go and get laptops and devices and take them home, basically, and giving the approval for all that for the department heads and so on and making all that work. And people who didn’t have connectivity and so on and so forth, so there was a max de-flux of staff, now, heading home with PCs under their arms and monitors and mice and the IT teams were just working continuously.

That was pretty remarkable. And then, a period of time where we didn’t know what the onslaught was going to look like in Houston, the numbers of people, because we were a little behind compared to New York and the West Coast. And so, we were brainstorming around, how were we going to accommodate what could be thousands of people coming to the hospital with their sick relatives, not being able to understand whether they should go to a cancer center or any hospital, so how are we going to manage this? And put up a big tent outside the hospital to anticipate that, and it got used somewhat, but didn’t used that much. And we didn’t know. We had to make decisions very quickly, working closely with Tom Aloia and Welela Tereffe and Rosanna Morris on decision-making. And then, we spun up this kind of TV studio of sorts where we could broadcast, I think twice a day to leadership in the organization about what the current status is, what’s going on, and that’s evolved now, evolved into a whole team that made decisions and calls, eventually evolved into this CCLT process, and then, also the cell, now, it used to be called the ECB, which was something that was used during the CMS initiative. We reactivated that piece during the CMS which was this daily briefing, and we used that twice a day for quite a while, early on in the pandemic. Even, we went to the weekends, we would come in—because people just wanted to know what was happening. And we’d have a couple hundred people on those calls, and then it’s slowly grown. And now, we have this very frequent broadcast, basically, from the teams both in the clinical side and the research side, with a research town hall and the (inaudible) that are now happening more weekly than bi-weekly. So

So, that all came out of that. And those early really concentrated meetings with people getting together to figure out what we’re going to do has evolved into the way we run the organization at some level, which has been a remarkable trajectory, and Rosanna has really led that. Welela has been very active. Early on, we had a lot of challenges around the testing question. How do we test? Can we test? Can we spin up our own testing mechanism? And that was amazing to see the labs come up with their own testing capabilities. And MD Anderson was ahead of the curve in this regard. We really established fantastic testing capabilities early on. And that was transformative for our ability to assess, I think, in the organization. Of course, those have evolved a bit, but that was an amazing period of time.

And then the travel question came up, who’s traveling? So, the team very quickly assembled a travel rouge application where you could log in and register that you’re traveling and if you were traveling, the fact that you’d have to get your testing done when you returned, and you’d have to quarantine, and the staff were incredibly responsive in completing and filling out that. And the IT team built that super quickly. It was quite remarkable.

And the other major topic that we had at the time was a lack of PPE. So, one of the things that I was assigned, I worked very closely with Matt Berkheiser on, was where is all the PPE? Is it secured? Is it locked up? How can we gain access to more? So, we pulled together a team to consolidate all the PPE, all the masks, all the goggles, all the face shields, get it all under one framework for inventory, get it all under lock and key, make sure we’re watching it, we don’t want anybody stealing it because there’s such a demand for it, and consolidate all that. And then, put together a process to repopulate PPE in each of the hospital areas and then keep track of the supply and calculate how many days on hand do we have? And if it got too low, what would we do? What’s the plan? And constant evaluation of best practices. And meanwhile, the CDC was saying what it was saying and we were trying to track along. And that was pretty amazing. Even to the point where I spun up a Technology Development Group to locate 3D printing of masks, 3D printing of face shields, all kinds of different devices that were developed through a core group of individuals from across the institution. Justin Bird was very active and the Innovation team led the conversations for us. Elsa, whose last name is escaping me at this moment in time, Diagnostic Radiology was very active. And many, many more from across the organization, I really should come up with that list.

And we had people from different organizations, from Rice, from different companies, Toyota, who helped to build systems for us from the face shield perspective. And we had a whole process that we established to try to evaluate, because these were not approved by any regulator. We just needed them. So, we spun up a quick process by which we could evaluate them, making sur they were safe, understand whether anybody would be getting hurt if they started to use them, and then we would buy them and release them for use within the clinical setting, all under our homemade approval process, because the urgency was there. It was pretty remarkable.

Nina Nevill That’s an incredible initiative.

David Jaffray, PhD Yeah. The meeting phase was very intense, running like every day or every second day on some of these meetings because things were moving so quickly. And Zoom and Teams and WebEx were incredibly helpful for us to do all that. The other thing that we did is, towards the end of March and April, we realized there was a need to learn how COVID-19 was going to impact cancer patients. And so, we had a really good conversation amongst a small group of us, Andy Futreal, Caroline Chung, [Sabetha Grisham?], Liz Burton, several others, who participated, Scott Woodman and others, in this conversation around how can we learn as fast as possible for the cancer patients who may or may not have COVID? And so, we launched an initiative called “Data Driven Determinants around COVID and Oncology Discovery Effort,” so that’s called D3CODE, there the E is actually a three, but we say “decode.” And that was an incredible effort. We met and we still meet every Monday, Wednesday, Friday for an hour. And we look at the processes to understand how the data is flowing, we look at the amount of data people are consuming, we look at the research results.

And that has started to shape the entire digital architecture for the organization and how we think about following data. And it’s formed the basis for a remarkable engagement between the technology teams, the clinicians, and the researchers, the administrative teams, the legal teams, and compliance teams. It’s really shaped the way we’re thinking about data moving within the organization. We started a little bit of the technology discussion before that, but this really crystallized the paradigm of collaborating around data. And we were worried that there was going to be a whole bunch of different initiatives and everybody would be publishing divergent results and it would be just a tower of Babel. So, we created one protocol, it was approved in a remarkable period of time, like well under 40 hours, and allowed us to aggregate data from across the organization for patients and employees, both, to try to understand what the impact of COVID-19 was going to be on the practice of medicine at MD Anderson and beyond. And on that protocol, I want to say there’s—the number is moving a bit, but over 70 projects have run and are still running, across MD Andersons, all feeding off of that single approach, to pull data together and to create a consolidated dataset that individuals can interpret consistently. And like I said that team this morning was on a call for 45 minutes solid, talking about what needs to happen next, are we thinking about how we’re sequencing the patients so we can study the presence of variance? That was a conversation this morning. And there’s action items, a huge list of action items that have been completed, and the IT team has been fantastic in responding and working very closely with the research and clinical teams.

Nina Nevill That’s incredible.

David Jaffray, PhD Yeah. It’s pretty great. A set of principles on how to work together on data has emerged, Dr. Chung shaped and crafted those with feedback from everybody in the organization. And that’s going on to become the blueprint of sorts for how we work on data across MD Anderson. And hundreds of people are involved. And during the most difficult periods of the pandemic, I would say that that Monday, Wednesday, Friday seven o’clock meeting was incredibly powerful. People just to get together and case through time and see that we’re working on something to address the issues we’re presented with was really powerful for those teams. That was a really great opportunity.

Nina Nevill Sure. Absolutely. It sounds like from a few of the things that you mentioned, including the broadcasting to get mass information out there as well as these teams working on the relationship between COVID and cancer, what other initiatives do you think that the institution will carry forward that were created in the past year?

David Jaffray, PhD I mean, I think the work-from-home activities will carry forward. That whole paradigm where people can work from wherever they are, and they can use that to support their wellness in their work, is a powerful capability to be able to engage like we can through digital tools, but at the same time, we have to use it to make sure that it’s used to support our wellness and doesn’t just draw us in, lets us work from different places, lets us work differently, work smarter, more effectively, increased communication to avoid rework, to avoid confusion and divergence. And I think that’s a skill we have to work on, but boy, the pandemic set us off in a huge direction. The other big one which we haven’t talked about that’s just massive was, these patients that were coming to see us, thousands of them, suddenly couldn’t come to see us anymore, and so, we had to build, very quickly, a virtual care paradigm. And it was in a period of under two weeks that we were able to activate virtual care across the organization, and there’s over 100,000 virtual care events since then, or 200,000, pardon me, since then. And that was remarkable effort. The Innovation Team, Rebecca Kaul and Den Shoenthal, working with Anita Ying and Fernando and [Mefren Dasmal?] and Craig Owen and many others across the institution really came together.

And the IT teams and innovation teams, working with the clinical teams, just had a fantastic period of very rapid deployment of the technologies. Also, our legal teams. Because the legal space was so complicated, the waivers that were being activated and operating across state lines and things like that, Krista Barnes and Dan Gospin and many others leaned in and really shaped the position that we could move to from a legal perspective. That was just huge. And very quickly, I remember one of the town halls, because we’d be having these phone calls and someone would ask the question, “I don’t have a camera,” and I was like, “Oh, that’s interesting. Well, [call for info?], that would be a good idea to see if you can get a camera.” There were no cameras available because there was a huge shortage of cameras. It was just this—every time you went to move, you would run into something else that would be a gotcha.

But we figured out how to do it. We had the teams even build a tool to use FaceTime so that they could talk to other staff members. And we launched that with the IT group very quickly. It was quite effective. And we could track who was speaking to who with the platform, we could record that all with the tool. And that really helped early on, until we got the Epic installation going with the Zoom and so on and so forth. But the team, the clinicians and the patients, they responded so quickly to what—it wasn’t easy, right? It’d probably very rough compared to when we’d roll out something normally. But the tolerance was there because people understand. I think that’s the biggest thing about the pandemic, is it reset people’s tolerance to disruption and made them realize that they can live through disruption, and things don’t have to be all so perfect in some ways. Things can change quickly. And that’s going to be a huge thing for all of society as we move forward, is this realization that we can adapt, we can respond, we can take a little bit of uncertainty and still come out the other side okay. So, that’s going to be huge. And for the institution, it’s been, I think, development of a realization that we’re big, but boy, we can make this bear dance if we want. It’s big, but it can be moving around pretty quickly. So, that’s pretty inspiring, I think, for a lot of the teams, internally, for sure.

Nina Nevill Absolutely. It sounds like in terms of adapting, one aspect that a lot of institutions, I think, were faced with is this work-from-home component and how to balance now that we have the ability to work from home, which is incredible and highly accessible, how to then balance the wellness aspect and not be overworking or not have yourself available at all times of the day. And so, you mentioned wellness which is why, now, I bring it up because a few other folks have talked about this, as well, but some of the conversation centering wellness talk about how it’s not an individual issue, so it can’t be an individual solution, that there has to be some sort of system-level or institutional level initiative put in place to help folks even know what they have access to or what they’re allowed to ask for, things like that. And so, I was wondering if you have witnessed any of that at all, seen the institution do that in any ways, or just folks that you work with trying to exercise that balance.

David Jaffray, PhD Yeah, no. There’s some tactical things that we can do, which we have done. A lot of us try to end our meetings at quarter to or 10 to the hour, or if it’s half an hour, (inaudible) for 25 minutes so we have a break. That’s the kind of Zoom stuff. Or, we have an initiative where we try to keep Wednesday afternoons off of the schedule. Didn’t happen this time. But it’s where we can clean up stuff. Otherwise, it’s like you’re swinging from vine to vine, from Zoom meeting to Zoom meeting, a little bit intense. But I think the bigger piece of the wellness conversation is, it’s not about what an individual does, really, it’s that interaction between individual and the rest of the organization. So, both parties have to be thoughtful. And how do we create an environment where we understand that you’re doing what you’re doing to stay well, and that if you’re working remotely to do that, or that you can spend some time with somebody you need to spend time with and you’re making your contributions, that’s okay. Otherwise, people will feel forced to make excess commitments. And it’s also important for us to watch when people are getting trapped in the vine swinging from one vine to the other and say you should take a break, or maybe we should stop loading so much on you.

Some people will just take a lot on them, and if you don’t think about what it’s doing to them, then you just keep adding stuff. And so, becoming more aware of our responsibility to make sure we aren’t overloading people, that’s something that I’ve learned over the course of the year, that some people just keep taking more and more, and you have to actually—you can’t ask them, because they’ll say yes, because you asked. So, learning to realize that you need to help them with that. That’s part of the system and the person collaboration. So, I think that’s a realization that’s very important. But it’s also breaking the feeling that you need to be here. If you’re not here, you’re going to miss out on something, that fear of missing out paradigm is very common. It can creep up. When you feel like you’re getting behind, and you’re like, “I don’t seem to be a part of something, what’s going on?” That’s very human. So, how do you get people comfortable with that? That’s a works in progress, for sure, for all of society.

Nina Nevill Oh, absolutely. I don’t think it’s something that anyone has necessarily found an “answer” to. It’s going to be a bit of a moving target. But that’s nice to hear at least from some people, the recognition that even asking can be sometimes the burden of not knowing how much people are willing to load on their plates, or not even recognizing that that’s happening, right under your nose that you could be doing too much. And it seems like there are a lot of conversations as well, especially in academia, I’m not as familiar in healthcare, but there are some underlying implications of perhaps race and gender and position, as well like junior versus senior members and what folks are willing to take on in order to feel productive, or to feel successful in the workplace. So, it’s wonderful to hear that it seems like, for the most part, the institution has been as accommodating as can be and has been as prepared as can be to at least—the willingness is there to shift and to move and to do what needs to be done.

David Jaffray, PhD Yeah. We have more work to do, I think, there, as well. It’s, first of all, getting someone to tell you that, “That’s enough, I can’t do anymore.” That’s a big step for them, especially depending on the role they’re in. So, having even them saying that is not easy, so we have to really acknowledge that. I think that’s a big part of it. And realizing that it’s good for them to say that. Because they very much can be in a difficult situation, as you know. They may feel that they’re struggling to make their career and if they say no it will be a negative event for them. For, having them step up and share that information is really, really important. And we have to listen, of course, at the same time. So, yeah. This is very important.

Nina Nevill Absolutely. Now, jumping back slightly in the conversation one thing that you mentioned that was intriguing to me that MD Anderson did differently over the past year is the testing capabilities. It just sounded somewhat unmatched to what others were doing. Is there anything else that comes to mind that you could say that MD Anderson did differently, for better, for worse, for neutral, but anything that stands out?

David Jaffray, PhD Well, I think we were quite aggressive in limiting access to visitors and the like, which was a pretty hard position to do, especially for a cancer hospital. And so, that was a big decision, for the support from patients, further from their family and friends, it’s critical. And I think that’s also a big burden on our healthcare workers who suddenly have to take up that role. And getting that working, and the teams we put in place to be at the doors to help people understand what we were doing was a pretty big challenge. And Tom Aloia and Liz Garcia, I think, basically managed this where they were managing the teams at the doors that were explaining to people that “You can’t come in with your loved one,” and that was not easy. Children and so on and so forth, you can imagine the complexities of patients in palliative care. And so, I thought we were very progressive and thoughtful in this regard. I think the creation of our moat and the isolation of the clinical spaces to minimize the spread of the disease within the hospital was, I think, quite progressive. The data suggested we create an environment where cancer patients that were exposed—the frequency with which cancer patients had COVID was quite reduced. And so, I think that’s a measurable quantity.

We’ll see how it compares to others once we get all the denominators figured out perfectly, but what’s been published is quite a bit worse than what we demonstrated internally, so there’s an opportunity, there. Also, just working across Texas Medical Center was also a big initiative that, trying to just get the whole Texas Medical Center on the same page, in terms of sharing information, resources, that was a massive piece of work that Peter led. Peter did a lot of work on this front, getting active efforts of the TMC to get someone to shut down the rodeo, which was a pretty big thing to do. But it was incredibly important for the city to have shut down that rodeo in terms of the number of cases and the load would have had on Texas Medical Center and other hospitals. So, it was just an amazing number of activities. I’m sure I’m missing something. Oh, the deployment of our N-95 sterilization process. The big UV irradiators and the like that were all developed, and the whole process that was flipped up was remarkable. That was incredible. The supply chain teams that were working to find new product from anywhere they could. There were all kinds of people working to ship product from various factories in China and other places and plane flights full of masks coming over and people were negotiating access.

And our supply chain team under Calvin Wright was just working around the clock with Matt Berkheiser and others to try to figure out how to gain access to the product and make sure it was real, and was not stolen and was traceable, and so on and so forth. Even activating production of masks in Texas, which was very helpful, actually. So many initiatives that people were involved in. It’s going to be interesting to hear the whole story (inaudible)—

Nina Nevill Absolutely. You mentioned something, just as someone who is outside of the institution, could you explain a little bit more what the moat is when you’re talking about patient care?

David Jaffray, PhD Yeah. We really wanted to create an environment where we knew exactly what the status of people who were going into the space where patients were within the hospital, and that within the hospital, we wanted to avoid, for obvious reasons, anybody becoming infected with COVID-19. So, making sure our staff were screening at the door that are asymptomatic, measuring their temperature with cameras, many devices that we bought to measure temperatures of staff when they came in the door and patients, that whole screening process to know exactly with a high degree of confidence that patients and staff that were coming into the hospital were not also carrying and transmitting the virus. And so, that whole moat architecture, we couldn’t apply that everywhere in the organization because there’s too many small buildings, like research buildings, administrative buildings, but there was an area that we referred to as within the moat that had the screening posts, and people who were in there, we knew who was in there, we knew what their status was, and if there were any outbreaks or events that were tracked very aggressively by infection control and the ID teams. So, that whole machinery of the moat, yeah. It was a big challenge. We had research activities that were going on inside the moat, and how do we move them out, or how can they continue, or what’s the strategy for that? And because of the way the organization was built, we had people who transitioned through those areas, normally, to get access to the labs, and so on. So, those were suddenly restricted and interfered with their activities. And Julio and many others worked very hard to shape and craft that, along with Tom Aloia, to define the boundaries of the moat and so on. It’s pretty interesting. I remember—

Nina Nevill Well, everything that you have shared so far—oh, I’m sorry. go ahead.

David Jaffray, PhD Early on, we had an effort where we wanted to know who was coming in, so we figured out how to take the sensors for the doors, the automatic door openers and the security, we put those into posts at the entrance, so then everybody could tap, and they could attest, and the IT teams rolled out these Apple TVs that could then roll the attestation results consistently on the big screens, all that was spun up in, literally, a weekend, and still operating today. And we can monitor all the people who are coming into the organization, reams and reams of data. It’s remarkable.

Nina Nevill Wow, that’s an incredible pace to be working at. I’m sure it was all hands on deck at all times, or at least it felt that way.

David Jaffray, PhD There was no break in the first couple months, really. Even getting a Saturday or a Sunday was not possible. It was very intense.

Nina Nevill Well, everything that you have shared so far about how the institution has handled this past year has been incredibly helpful to get a sense on this, while it’s still relatively fresh and relatively raw, in a sense. I’d like to know if there was something that—they hindsight is 20-20 so this is obviously not a fair question but if there’s something in the moment that you could or would have done differently, regarding the pandemic, what comes to mind?

David Jaffray, PhD I’m thinking. Something differently. I think if we had an inkling that there was going to be a problem earlier on, we probably could have pushed a little harder on getting some additional resources in, from the point of view of PPE and the like. But hindsight is 20-20, so yeah, in retrospect, we could have acted on the hunch a little earlier, but that said, we did steer through pretty well. We did a pretty good job of stewardship of our PPE. There were some close calls, I think, around people traveling just around the start, and I think, in retrospect, logging down the travel earlier given how much fear it produced, those close calls, I think we would have preferred to run the risk of locking down the travel earlier. It wouldn’t have been much earlier, like a week or something, or a few days, (inaudible) possibly, but we’re fortunate. In terms of missteps and the like, the teams responded amazingly, I must say. I think getting that team together early on and really started to change the way we operate the organization was a huge thing. And then, transitioning that into a more formal structure, we probably could have done the same more formal structure for research earlier. It came later, but it probably should have come earlier, I think, in retrospect. It was obvious once it was like, “We need that.” We had the CCLT, we had our prior CCLT, but we needed our CCLT at the same time. So, we probably could have done a little bit better in getting that same structure spun up for research earlier, and that would have been helpful. But the focus was on patients at that level.

A very successful part was Peter’s out-of-the-box focus on the safety of our patients, our staff, and our community. That focus from the very beginning was very, very helpful, and gave everybody a very common thing to drop back to. It helped us a lot in guiding decisions around, we lent our excess testing capacity to Harris Health, for example. We felt that was the appropriate thing to do for the community. So, that was good. We were actually being asked to contribute to testing activities in the NRG facility in the parking lots and a whole bunch of efforts that were being worked out across Texas Medical Center to do that. And there was a lot of interest in getting heavily involved in that. I think our strategy worked very well where we said, “Since we’re not a routine hospital, we’re a cancer hospital, we’d rather not use our IT systems to do that. We’d be happy to have our staff work on other people’s IT systems,” because it doesn’t make sense to have a patient having a follow-up in a cancer hospital. It just didn’t follow. So, we made that call early. I think that was a good call because it just made sense, just like it makes more sense for Methodist to call the patient and say, “Oh, by the way, you’re positive with COVID,” than a cancer hospital. So, we made some good decisions, I think, and that worked out fairly well for us. It’s very interesting. I think, mistakes, not that many. I’m sure I will remember some, (inaudible) now. So, it was pretty good, actually.

Nina Nevill Over time. Over time, I’m sure something will come up.

David Jaffray, PhD Yeah, in retrospect.

Nina Nevill It sounds like they handled it incredibly well.

David Jaffray, PhD Yeah. I’m trying to think of some examples that were missteps. There were a lot of thinking. A lot of people would lean in. I think if we were fortunate in this regard, having relatively few missteps, it was, I think, because there was a lot of dialogue, a lot of consultative approaches. The executive team was constantly testing against itself, here, and the other parts of leadership team were constantly asking questions, a lot of external validation, reaching out, asking what others were doing. And that’s an approach, right? The collective intelligence usually pays off. And so, that paradigm was running right from the beginning. The other thing, too, that was very powerful was, we stood up dashboards right away to try to get the data describing the number of COVID cases, and where they were, and so on and so forth. We spent a lot of time very early on getting those dashboards up so that we could understand and be very clear around the numbers, because early on, if you had any event, or any case, it was like, “Uh-oh,” and then, after a while, everybody had them. But those first few weeks where you weren’t sure about having a positive case, I remember that was like, “Oh, we have a person of interest that may be COVID positive,” and moving them through our mechanism for approval, and the chill that goes through the organization when it’s one that’s positive was like, “Here we go.” And no one knew how fast things would travel, and so on and so forth. So, we put a fair amount of time into getting those dashboards built. And Jana Baganz working with Craig Owen and many others, Jay Patel helped really get that shaped, and many, many people behind the scenes, of course, helped get that shaped. That was quite successful. I think there’s some learnings there, too, but I wouldn’t say mistakes. I would say realization about how do we manage it, how do we get those feedback and the like, it’s all very positive, I’d say. I’m trying to still think of something that went wrong.

Nina Nevill Now, in terms of—no, that’s okay. That’s obviously good to hear. There doesn’t have to be something that comes to mind. That’s usually a good sign, as we would say. But switching gears just slightly, talking about communication, one of the other two big pieces from this past year, we obviously have the pandemic, the COVID aspect, and then we also have a lot that was happening in terms of dynamics of race and racial violence, especially over the course of the summer. One thing that’s been in conversation quite a bit since then has been disparities in health, which of course, we know disparities in health, healthcare, and medicine, have existed long before pandemic, and many of which were exacerbated during. That’s something that I’d love to talk a little bit about, if you don’t mind, and just getting a sense of, maybe, first how you felt the institution addressed the events of the summer. I’m thinking specifically of the murders of George Floyd and Breonna Taylor and what was the communication like to the community amidst the other pandemic happening, how was this addressed?

David Jaffray, PhD Yeah. It’s remarkable, actually. The events in the summer and earlier, how the institution responded to that, I think was really, really powerful. And to do it in the context of a pandemic is even more remarkable. think it reflects on—it all ties together. It’s about a group of people trying to make their way through a very complex time, and then, having something highlighted in the context that we’re in, which is that there is a lack of equity, there is a lack of fairness, there is a lack of appreciation and diversity, and people are not included for reasons that don’t make any sense at all. But they’re there. And so, I was really struck by that. It wasn’t an aspect that I was in, so to say. I wasn’t involved in the conversations as much, but I was just as involved in it as any other human at some level. But I was really struck, as an observer, to see the leadership institution really lean in and make sure that they were sensing what the organization was sensing, and what the people were sensing, and to respond in a way that acknowledged that this is a deep and meaningful conversation that needs to be had, even in the middle of a global pandemic. And I think that was really powerful, and that individuals stood up and said, “Them is me. That’s what’s happening here. I’m here. I’m one of them.” And they brought forward their issues very clearly, whether it was race, or lifestyle, or whatever, they brought them forward and they shared them with the institution.

But I think doing that in the context of a challenging time like the pandemic, I think, is really, really powerful, because everybody had to work together. It was recognized, this will only work if everybody works together. And so, shining a light on those issues, I think, was—the pandemic really reinforced the importance of eliminating those barriers, I think. And we also saw it from a health equity perspective. We saw that the pandemic was harder on different populations, and different socioeconomic statuses, and that’s really worked its way into every part of the conversation. I mean, even when you watch the media and the public are much more aware of how the disease strikes people of different socioeconomic status differently, whether because they had to work in the service industry, or because they’re genetically predisposed, or their lifestyle prevents them from having the same degree of health and exercise and the like because of wealth and access to good food and so on and so forth.

It really shined a light on the lack of access and equity for many parts of the population, but in a way that everybody could see it. And so, I was really struck by Peter’s decision to lean in very heavily on this topic and bring it to the foreground. And there were many other political factors at the same time, of course, that were emphasizing this, particularly from a progressive institution like MD Anderson that were also brought to bear with executive orders and the like. And it really fortified the institution’s desire to address this in a serious way. And I think it did for many companies, many different institutions worldwide. So, it’s remarkable to think about going through that while going through a pandemic, and the institution’s response to that, I was very proud at that point to see how well the institution responded and the leadership that it took to do that, and the engagement that came from that. We’re not finished by any means. We just had a recent town hall talking about our investment in an individual or just to lead this dialogue, and to keep that dialogue in the foreground. I think it has to be something that is active, all the time, for sure. It’s crazy, (inaudible)—

Nina Nevill Well, it sounds like—yeah. You may not be able to speak to how the institution addressed these inequities before the pandemic, just due to the time that you came in, but in addition to these dialogues being opened up, first, do you think they will be continued, as some initiative to address inequity, especially along lines of race and gender and socioeconomic status will be continued, and if so, what efforts do you see unfolding?

David Jaffray, PhD Yeah, absolutely. I think Anderson’s gone through a huge transformation in a couple of years. I wasn’t here before, but I’ve seen a lot of change. And I’ve seen an orientation and a philosophy that’s come across that has put us, I think, very powerful and I think it’s the future of how organizations like ours should operate and work. I think it’s a lot of communication, a lot of engagement, and I think that’s just the way these organizations will work. And if you really are listening, and you really are communicating, not just broadcasting, you will hear the inequities. You will observe the lack of reflective diversity. And you will realize that you need to be inclusive as an action to make sure that you’re adjusting and supporting to address those issues. I think that’s just the future of organizations. Everything else will look very, very, very old in the few years ahead. And so, I think that’s key. And we’re seeing it. We’re seeing an increase in diversity on our leadership teams, which is fantastic. And I think we’ll see more and more of that. But we have to lean into it. It has to be an active decision. It’s not a passive activity of slow change. It has to be active. And I think the leadership’s behind it and we’re also investing in the idea of leadership. And we’ve built the initiative, what does it mean to be a good leader? And addressing the issues of diversity at all aspects of the organization is the job of a leader. They want to make sure the organization’s being all it can be, and the people are contributing as much as possible as they’re each able to. So, I think that stitched into the leadership effort will have a long, long run in the organization. I don’t see it fading, no, which is exciting.



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Chapter 02: Navigating a Pandemic