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  Chapter 03: Building Collaborative Research Culture [Part I]

  Elizabeth A. Grimm PhD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Grimm begins this chapter by talking about the evolution of her career in the Department of Tumor Biology. She sketches the history of her working relationship with the chair, Garth Nicholson. She then talks about her work in the Department of General Surgery (soon to be renamed, Surgical Oncology). She talks about her first collaborations with surgeons and collaborative work on cytokines and notes resistance to some of this translational work. She sketches the process of its acceptance. She names individuals who trained in her laboratory. Dr. Grimm then talks about the significance of her collaboration with Waun Ki Hong, MD [oral history interview], who helped shift the research culture into acceptance of collaborative, translational work. She sketches the sources of resistance of medical oncologists to translational work. Dr. Balch adds comments on how Dr. Hong helped effect change.

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  Chapter 04: Collaborations in the Division of Medicine, Comments on the Needs of Women Faculty, and Final Thoughts on Collaborative Temperaments and Research Culture

  Elizabeth A. Grimm PhD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Grimm begins this chapter by mentioning several people she collaborated with when she moved to the Division of Medicine. She and Dr. Balch discuss surgeon, Raphael Pollock, who was the first faculty member to earn a PhD while employed at MD Anderson, and who represented the changing research spirit at the institution. They next discuss the role of women on the faculty, with Dr. Grimm noting the continued need for child care. In response to a question, Dr. Grimm talks about the personal qualities that have enabled her to stay on the cutting edge of translational research. Dr. Balch adds his observations on qualities that enabled her success. He then talks about how her qualities also reflect a commitment to “collective wisdom and collaboration” essential for translational research and team science. Dr. Grimm also notes that she has continuously focused on developing her own independent lines of research, despite changes in administration around her.

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  Chapter 01: Clinical Research at the NCI

  Jack Roth MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Roth begins this chapter with a few comments about his decision to come to MD Anderson from the NCI; he talks about his wife, Elizabeth Grimm, PhD, who was also hired into the Division of Surgery. He explains how he met Charles Balch [oral history interview] in 1973 at a conference where he was presenting the results of a study of immunotherapy and melanoma. Drs. Roth and Balch discuss the prevailing notion at that time, that surgeons did not specialize in oncology surgery. Next Dr. Roth talks about the research he conducted at the NCI while he was a Senior Investigator, Surgery Branch, Division of Cancer Treatment (1980−1986). He discusses his views of translational research, explains the limits for research at the NCI. He sketches his desire to make a professional change.

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  Chapter 02: Attracted to the Division of Surgery at MD Anderson

  Jack Roth MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Roth begins this chapter by noting that Dr. Balch called him in 1985 about a position as founding Chair of the Department of Thoracic and Cardiovascular Surgery. He explains why the job attracted him from the perspective of both research and administration. Dr. Balch comments on Dr. Charles LeMaistre’s [oral history interview] financial investment in the Division of Surgery’s recruitments. Next, Dr. Roth sketches his first impressions of the Division of Surgery and criticisms of the divisional model from long-term surgical faculty. He sketches his attraction to administrative work and explains that many of them believed that a surgeon could not be a great clinician and devote time to research.

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  Chapter 03: A Vision for the Department of Thoracic and Cardiovascular Survery (late Eighties): Building Research, an Oncology Perspective, and Multi-Disciplinary Collaboration, and Training Programs

  Jack Roth MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Roth begins this chapter with an overview of his first steps to build the department. He notes he needed to recruit people to set up his own laboratory, provides an overview of the department’s areas of activity, and discusses the organization of multi-disciplinary conferences to establish treatment plans. He discusses some research that resulted from these collaborations. Next, Drs. Roth and Balch talk about the process of shifting the focus of the Division from thinking of surgery as a reactive process to surgical oncology and the challenge of overcoming institutional silos. They then discuss key discoveries and events in the Department of Developmental Therapeutics that had an impact on shifting surgeons to a surgical oncology perspective. Next, Drs. Balch and Roth discuss the creation of the training program, first designed for fellows in thoracic specialties. Dr. Roth discusses the collaborations with Texas Medical Center institutions that fed MD Anderson quality fellows.

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  Chapter 04: Research Into Gene Therapies and Immunotherapies, and Thoughts on the Research Culture of the Division

  Jack Roth MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Roth begins this chapter by discussing gene studies he initiated at MD Anderson, the first one focused on lung cancer and resistance to gene therapy (1986/’87). He notes this was pioneering work and he also discusses the need for the review boards set up to examine all such protocols at that time. He tells a story about the first patient injected with a retrovirus. He then talks about the progress made through this research, doubling the survival in Stage 3 lung cancer, with impact on the standard of care. Dr. Roth then observes that when he first arrived at MD Anderson, he saw an anti-research attitude among the more traditional surgeons, who believed that it was not possible to maintain clinical excellence and productivity while engaging in research. He expresses concerns that today’s focus on clinical productivity will cause research to regress.

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  Chapter 05: Evaluating the Division System (1985-1995)

  Jack Roth MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  In this final chapter, Dr. Roth and Dr. Balch discuss the impact of the Division system (instituted 1985) on the growth of surgery and the interrelationships between surgery departments. Dr. Roth begins by talking about the initial resistance to the restructuring then offers his view of its value and the common resources that were created for use by all surgery departments. He talks about the philosophy of servant leadership that Dr. Balch brought to the institution and gives an example of how the division system enabled surgical departments to grow and improve function: hiring advance practice nurses to address patient safety; reorganizing care delivery around disease sites; building new operating rooms with advanced technology; supporting translational scientists. Dr. Roth next observes that the division maintained the same focus after Dr. Balch left the institution –a testimony to the success of the system. Dr. Balch provides an overview of what was achieved under his leadership.

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  Chapter 01: Creating a Division of Surgery

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this chapter with the story of how he was recruited to MD Anderson. Dr. Balch then sketches the mission of this interview project, and the conversation explore the evolution of departments within the division and the individuals who spurred these processes. Dr. Sawaya comments that leaders help programs grow by providing resources, leadership, and supporting the creation of department identities.

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  Chapter 02: Developing a Comprehensive Neuro-Service

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  In this chapter, Dr. Sawaya discusses the growth of the Department of Neurosurgery under his leadership. He sketches his vision for the department, directed with the mission of providing excellent patient care and excellent surgical care, building subspecialties, and developing the faculty’s research mission to reinforce credibility. He discusses the creation of the department’s database, the need it serves, and the role it plays in supporting clinical research. Dr. Sawaya talks about systematizing the volumetric measure of tumors and the work he based on this data for a landmark paper on tumor resection. Dr. Sawaya then observes that neurosurgery is heavily dependent on technology and he discusses several key devices and advances. He says that MD Anderson leadership was supportive of the Department’s need to invest in technology to advance surgical practice and research.

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  Chapter 03: Shifting Surgical Culture and Research; Building Subspecialization and Training

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Dr. Sawaya begins this chapter by observing that his vision for developing the Department of Neurosurgery was controversial when he came to the institution. He explains that the culture viewed surgery in the mid- and late 80s viewed surgery as a “reactive practice.” A surgical oncology perspective did not exist widely at that time, though other researchers at the institution used a medical oncology particularly in treatments involving chemotherapy. Dr. Sawaya notes that Dr. Balch brought the vision that surgeons could establish their own lines of research and Dr. Sawaya explains that he implemented this perspective by establishing training programs in the Department of Neurosurgery. Dr. Balch adds that the training programs were designed to produce strong researchers and leaders as well as excellent clinicians. The discussion stresses that training was designed to produce surgical oncologists who could participate in multidisciplinary research and treatment teams. Dr. Sawaya next discusses recruitments that built the subspecialities in the Department of Neurosurgery.

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  Chapter 04: The New Division of System (mid-Eighties) and the Symbiosis of Departments within the Division of Surgery

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  In this chapter, Dr. Sawaya and Dr. Balch begin by talking about the rationale for the new division system and how the strategy worked to create a different culture among surgical departments. They compare the Division of Surgery’s decentralized operation with the more centralized Division of Medicine. Dr. Balch shares his philosophy of administration, and they discuss the impact that the Division of Surgery and the strategic plan had in facilitating planning, creating transparency in budget discussions. They discuss the role of Donna Sollenberger (Division of Surgery interview; oral history interview) in implementing the division system. Dr. Balch comments on the challenge all faculty face working in silos and how this has an impact on delivering multi-disciplinary care. They discuss the Breast Center as an early example of how the institution reorganized on this model. Dr. Balch then explains the foundation for multi-disciplinary care that R. Lee Clark, MD laid with the practice plan and discusses a landmark paper he published based on collaborative work. Drs. Sawaya and Balch next discuss Dr. Balch’s role in directing research resources to the departments.

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  Chapter 05: A New Hospital; Resources and Growth; Creating Multi-Disciplinary Diseae-Site Clinics; Divisional Strategic Planning

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Drs. Sawaya and Balch begin this chapter by talking about opportunities that opened up for surgery when the Alkek Hospital was being build. Dr. Sawaya talks about the new operating suites (in comparison to the older one). The discussion then turns to the renovation of the Clinical Research Building. Dr. Balch then observes that when he became Vice President of Hospitals and Clinics, he was in a position to reorganize delivery of care around disease-site clinics. He explains that the culture allowed it and there was little controversy. Dr. Sawaya confirms that the specialties worked well together, siting the fact that all faculty are salaried. He talks about research that the collaboration allowed. Dr. Balch then talks about how he used divisional strategic planning as a tool to build interdepartmental inclusion and connection. Dr. Sawaya observes that departments were also given autonomy in this system. They discuss the value of the division organization in competing for institutional resources.

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  Chapter 06: Key People in the New Division System; Final Comments on Teams

  Raymond Sawaya MD, Charles M. Balch MD, and Tacey A. Rosolowski PhD

  Drs. Sawaya and Balch begin with a discussion of the key role that the division administrator, Donna Sollenberger played as Dr. Balch implemented the new Division organization. They then go on to talk about many others, including David Hohn, Jack Roth, Taylor Wharton, Christopher Logothetis, Gabriel Hortobagyi [oral history interview], and Eva Singletary. In the final minutes of the session, Dr. Sawaya comments on the value of multi-disciplinary work. Dr. Balch discusses Dr. Sawaya’s visionary influence on the Department of Neurosurgery and then discusses the impact of Dr. Charles LeMaistre [oral history interview] on decentralizing leadership in the institution.

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  Chapter 01: Considering a Job Amid Controversy Over the Division System

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch and Ms. Sollenberger discuss the controversy over the division system that played out as she was interviewing for the position as Division Administrator of the Division of Surgery. Dr. Balch sketches how a division traditionally worked in medical institutions and explains why Charles LeMaistre [oral history interview] revised the organizational chart in his system to enhance the possibility for shared resources.

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  Chapter 02: First Steps as Division Administrator

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

  Ms. Sollenberger begins this chapter by sketching her first activities on taking on the role as Division Administrator in June 1991. She notes that her biggest priority was participating in a building project that would include the new Alkek Hospital and the Smith Research Building. She and Dr. Balch discuss important features of the hospital that showed the institution’s willingness to invest in technology. In response to a question about strategic planning, Ms. Sollenberger talks about the creation of the multi-disciplinary care centers (formally initiated in 1994), noting that the strategic value was demonstrated as this approach evolved into an MD Anderson signature. Ms. Sollenberger and Dr. Balch next discuss the value of having innovative IT support imbedded within the Division of Surgery. She tells a story to demonstrate how in-depth knowledge of the Division enabled IT to develop billing practices that would accurately capture all procedures performed.

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  Chapter 03: Building Collaborative Culture: The Division and Multi-Disciplinary Care Centers

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

  Dr. Balch and Ms. Sollenberger begin this chapter talking about the strategic planning activities in the Division that were formalized when Dr. Balch created the Executive Group of Chairs. They discuss the key role Ms. Sollenberger was able to play in smoothing over conflict among the physicians in 1992 and 1993, creating a watershed period for building a culture of collaboration in the Division. They talk about the promotion of values to build collaborative culture. Next Dr. Balch and Ms. Sollenberger discuss the multi-disciplinary care centers. Dr. Balch begins with an overview of the organizational model that R. Lee Clark brought to MD Anderson in the 1940s and later efforts to break up the MD Anderson tradition of surgery this created. They talk about the successful collaboration established between Dr. Eva Singletary and Dr. Gabriel Hortobagyi [oral history interview] in setting up a multi-disciplinary breast center.

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  Chapter 04: The Challenges of Chaging Institution Culture

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

  In this chapter, Dr. Balch and Ms. Sollenberger discuss several facets of their work changing the culture of the Division of Surgery. Ms. Sollenberger begins by commenting on her role in managing faculty conflicts, noting that it was surprising how quickly conflict would fall away when parties began to talk to one another. She tells how she reduced resistance to a needed change when it was discovered that patient satisfaction was very low among head and neck patients. Next, Dr. Balch discusses the Division’s use of standardized tables to determine faculty salaries. Ms. Sollenberger recalls comments from faculty that demonstrated how MD Anderson’s old culture of surgery lingered and prevented change. Dr. Balch talks briefly about difficulties created with staffing during the AIDS epidemic. Next, Dr. Balch explains that in 1991, MD Anderson was dominated by a state civil service mentality that needed to change so employees felt they were employed by a private institution that was state supported and was devoted to patients who drove the business. This leads to more discussion of the patient focus of multi-disciplinary care clinics. Ms. Sollenberger explains that when the Alkek Tower and Ben Love Clinic were being designed, the planning team held meetings to get patient feedback –an unusual move for a cancer center at that time. Dr. Balch talks about the creation of the patient coordinator role to help patients with scheduling.

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  Chapter 05: A New Role as VP of Hospitals and Clinics; Comments on a Long Collaboration

  Donna K. Sollenberger and Tacey A. Rosolowski PhD

  In response to the interviewer’s comment that Dr. Balch and Ms. Sollenberger had a good working relationship at MD Anderson and at City of Hope, Dr. Balch explains that when Charles LeMaistre asked him in 1993 to become interim VP of Hospitals and Clinics, he asked Ms. Sollenberger to assist him to make the role successful. [Ms. Sollenberger took over the role fully in 1994 and served until she and Dr. Balch left the institution in 1997.) They both comment on their working relationship and how their skills and perspectives complemented on another. Next, Dr. Balch brings up the managed care crisis in the mid nineties and they discuss how they addressed this in collaboration with David Bachrach. They comment on smoothly implementing a reduction in force, which successfully ushered out many of the older employees who held onto practices of the older MD Anderson culture. Dr. Balch explains that this set the stage for the expansion work John Mendelsohn would do when he took over as president in 1996. Next, Ms. Sollenberger explains that she will retire at the end of August. Dr. Balch provides an overview of her career after MD Anderson. Ms. Sollenberger talks about her work mentoring others, defines the difference between a mentor and a sponsor, and credits Dr. Balch with sponsoring her. Dr. Balch comments on his reasons for capturing the history of surgery at MD Anderson. In the final moments of the interview he reads into the record many of the accomplishments he and Ms. Sollenberger were able to implement in the Division of Surgery.