Leonard Zwelling

         That word is everything, isn’t it?

         Marriages are built on it. 
Soldiers in combat depend on it. Football and basketball teams live on
it so much that it is one of the five fingers of Coach K’s fist-communication,
TRUST, collective responsibility, caring and pride. Duke basketball teams are
built on turning these five fingers into a fist of power. And any
well-functioning business environment will require trust between the employees
and the employers if success is to be realized. This is not to say that Ronald
Reagan’s “trust but verify” is a bad idea. That’s what boards of directors and
contracts are all about, but in the end, no amount of legal maneuvering or
stacks of paper can replace real trust between and among people who share a
common goal.

         The latest faculty survey clearly shows a lack of trust
between the faculty and its leaders and now it is Austin’s job to try to move
the needle on the trust-meter somehow. It won’t be easy.

         An awful lot of prominent faculty members have been fired or
have left. Several have been taken to the courtyard and academically shot or given the Dan Fontaine “perp walk” without the handcuffs (including me). The new
leaders around the President have not given anyone any reason to trust them.
Rather, through a series of inept decisions, silly statements, and an
unwillingness to face reality, they have all proven to be no better than the
last crew when it comes to adhering to the core values of caring, discovery and
integrity. Especially integrity. To complicate matters, some of the current
leaders ARE the last crew and that really doesn’t help matters as they, not
being faculty themselves, have neither trust nor credibility with the 1600 or
so people who actually produce the product for which MD Anderson is famous AND
trusted. No, it’s not money. It’s knowledge.

         So in an effort to be uncharacteristically helpful, I would
like to submit a game plan for trust restoration. It involves three key groups:
the faculty, the executive leadership of MD Anderson and the UT Board of
Regents and its appointed academic overseers the Chancellor and Executive Vice
Chancellor for Health Affairs.

         I think that it is time for the faculty and Faculty Senate
to assume a posture of participating responsiveness. The faculty and its elected
representatives have tried everything short of a clinical strike to get the
attention of Dr. DePinho and his Kitchen Cabinet without success. The faculty
is left with no alternative but to either exercise a total work slowdown and
make demands or wait now that a survey has been done by the Austin crew that
reflects yet again the lack of faculty confidence in the executive leadership.
As I have said before, this is no longer the faculty’s dog or at least not only
the faculty’s dog. The faculty should help the other two groups when asked, but
should no longer be the leaders of the needed change.

         The executives could hasten this along with one of two
maneuvers. Either the President can resign and a search for his replacement can
begin or all those working directly for him can be removed. In the United
Kingdom a lack of confidence would cost the leader his or her job. Even Winston
Churchill felt that sting. In the US where the removal of the President is a
very rare occurrence without an election, troubled times usually see prominent
members of the President’s Cabinet fired (think Don Rumsfeld) or leave to spend
more time with their family (Colin Powell) or their money (Mrs. Clinton). Some
truly great and courageous Americans actually leave the Cabinet when they feel
they can no longer serve the needs of the American people or their President
(think Eliot Richardson or Cyrus Vance).  Alas, MD Anderson is neither a parliamentary
nor representative democracy as are the UK and the US. It is a monarchy and
unless the monarch is benevolent (last time that was the case, August 31,
1996), the faculty (loyal subjects) will continue to suffer.

is no longer a way that both Dr. DePinho and his immediate surrounding
leadership can be effective given the results of that survey. Every day they
are in place, is another bad faculty day and that is indeed unfortunate for the
faculty and the patients alike.

         That brings us to the group from Austin. If Dr. Greenberg does nothing but hand-wringing and quiet diplomatic assurance while
allowing Dr. DePinho AND his team to stay in power, faculty discontent is
likely to grow. If Greenberg does nothing, then all trust is broken for why
have bothered to do the survey if that’s your response to that awful result?

         I have no idea what will happen. My guess is, not much, for
there was more than enough evidence supporting the need for these changes 6
months ago and anyone who knows Tom Burke knows that replacing him with the
current CMO was not addressing the real problem. Tom had a great run and
perhaps he was ready for a new challenge, but this current crew is the Gang Who
Can’t Shoot Straight, and Tom Burke was and is a straight shooter.

my way of thinking, a change is long since overdue. The means by which the
current President was chosen was flawed as many possible contenders around the
country took themselves out of the running early on as they thought the
previous Provost had the job locked up. It is no surprise that an ego like Dr.
DePinho’s would not consider that a barrier and so plowed on successfully to
the Anderson Presidency, a job for which he is rather ill-suited—administratively,
clinically and interpersonally. And unfortunately, I see no evidence that he
has learned anything in any of those three realms.

than start again once Dr. DuBois was rejected, Dr. Shine decided he had to move
expeditiously, but expeditiously proved overly hasty and MD Anderson is
suffering the consequences as the most recent survey confirms.

the folks in Austin really want to get this one off their plates, they need to
restore trust and I am reminded of an old joke.

money says: “In God We Trust.” Everyone else pays cash.

of Regents, new Chancellor and Dr. Greenberg, it’s time to pay for the prior
team’s mistake. You already spent a ton of cash on your last pick. Call it a
sunk cost in couches and glass room dividers and move on.


Leonard Zwelling