“Clean It Up”

(A Life-Long Lesson in
Leadership and Management)


Leonard Zwelling

         I have just come from a two-day retreat with the Chiefs of
the Service lines at Legacy Community Health, my new work home. As many of you
know, Legacy is the largest federally qualified health clinic in Houston. In a
real shift from my previous life in academic oncology, my days are filled with
trying to get better health care for some of Houston’s most needy. Only 10% of
our patients have insurance, most children and pregnant women for whom we care
are covered by Medicaid or CHIP, and many of the rest of our patients have no
coverage of any kind and are self-pay on a sliding scale based on income. No
one is turned away.

         But what is so striking is not the vast difference in focus
and patient populations when Legacy and Anderson are compared. Rather it’s the
similarities in the challenges facing the leadership of these two historically
excellent Houston health care institutions. These include concerns about reimbursement
and the effects of the ACA, finding the correct balance between doctor and
other provider input into the care system and administrative and business
exigencies, strategic decision making and the ever shifting sands of health
care delivery in the nation’s 4th largest and least insured city.

         The similarities are the good news for me for the challenges
I face today as ad interim chief medical officer at Legacy are very similar to
the ones I faced at Anderson albeit on a much, much smaller and more manageable
scale.  The greatest similarities and the
ones the Legacy executives worked on for the past two days are optimizing the
way we executives work together and how we can all become better leaders and
better managers.

         Very early in the first day, we concluded that each of us
needed to be both a good leader and a good manager to be effective in our own
areas and in working collaboratively to solve problems that we shared and
advance Legacy’s mission.

         But what do we mean by leadership and managing?

         Having thought about this for over 20 years, I have
concluded that each boils down to two concepts. Leadership is vision and will.
Managing is resourcing and mentoring. All of us at the retreat will need to
improve our skills in all four areas.

15 years ago, Anne and John Mendelsohn and I spent a Saturday learning from
experts in communication. (Ann had won the training at a silent auction). I was
included then because I had become the institution’s spokesperson for crisis
management on the academic side of the house (and there had been quite a few of
those with more to come). The man who taught us the secrets of effective
internal communication said that there four things leaders must say when they
start their tenures and often during the course of that tenure:

I have a vision
for our future

I have a plan to
get us there

It will not be

But, it will be
worth it when we get there

encapsulates the important parts of leadership-a clear view of a better
tomorrow and the will to get there through expected adversity. This vision must
be so clearly articulated that every member of the organization can discern his
or her role in accomplishing the vision through an understanding of the
leader’s plan. Do you Andersonians believe that is where you are today with
your leadership at the institutional, divisional, departmental or for that
matter UT System levels?

is quite different. There are many management styles ranging from the micro
manager to the hands off boss from a distance and every nuanced stop in
between.  But the most skilled managers
make sure their direct reports in particular have the tools to be successful
(in academics that would be space, slots and money). Good managers are always
available for check in and advice giving that is the essence of being a good
mentor. How’s that all going for you out there?

where I sit on the outside, it appears that every week some big name at
Anderson is axed. This must create an air of anxiety and insecurity in which it
is unlikely for people to do their best work. Setting a tone is part of both
the resourcing and mentoring sides of managing. High anxiety and out right fear
are not tones conducive to progress in improving cancer care.

leadership can be very simple.

worked in the lab of a Duke physician and biochemist during my third year of
medical school in what was then known as the Research Training Program. This
was a federally supported endeavor (remember the days when the NIH cared to
develop new talent?) to educate physicians in how to do bench research. My
project one day was to extract the DNA from 20 liters of salmonella. The
bacteria were growing on a large shaker on the floor of a warm room in 10 large
glass flasks. I walked in to check on their growth density and 8 of the flasks
had shattered after shaking loose from the moorings of the rotating platform on
which I had secured them (obviously inadequately). Sixteen liters of
salmonella-containing media lay on the Sahara-like floor of the warm room. Yes,
it stunk!

         I ran into my mentor’s office asking him what I should do.

         He uttered three words, “Clean it up”.

         I don’t think I have ever forgotten his calm demeanor and
even, non-accusatory tone. It has been over 40 years and it still guides the
way I try to handle bad news when it comes through the door and I have
certainly had my share at Anderson and will surely have it at Legacy. I hope I can even approximate the control my mentor showed that day. Some times I can
do it, others not so much.

         Leadership and managing should not be confused, but at the
highest reaches of any organization, both are needed and should be expected of
those with fiduciary responsibility for the well-being of the organization and
its personnel.

         It is my contention that this has been missing at MD
Anderson since late 2001 and restoring competent leadership and management at
Anderson is the key to its comeback. Anderson may still be number one in the US
News and World Report poll of cancer care, but I doubt it is an ideal place to
work, especially for faculty.

         It certainly pained me to see Johnny Football come all the
way back against my beloved Duke Blue Devils on New Year’s Eve, but you had to
respect his leadership and his management of the clock, the field, his
teammates and the national spotlight.

         He had a vision of winning. He had a plan to do it. It
certainly was hard. It was worth it when he won—probably millions to him.

         Anderson could use a little of that Johnny Football magic in
its executive suite. To me it looks like they will need to draft a whole new
team to get it—especially at quarterback.

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