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VOL. 131 | NO. 102 | Monday, May 23, 2016

St. Jude CEO Talks Hospital Culture

By Andy Meek

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One of the first directives Dr. James Downing got from the board of directors at St. Jude Children’s Research Hospital upon his appointment as the hospital’s president and CEO in 2014 was blunt, to say the least:

For president and CEO Dr. James Downing, fulfilling the mission of St.
Jude Children¹s Research Hospital starts with ensuring employees have "a sense of pride" and purpose in their work. 

(Daily News/Andrew J. Breig)

“Don’t screw up.”

Downing, a longtime scientist at St. Jude before getting tapped as its chief executive, recalled what happened next – including a strategic plan he quickly set about pursuing for the hospital – during a recent address to the Great Places to Work organization.

Downing’s remarks add a bit of texture to the narrative about the hospital that tends to thrive in the popular consciousness – that it’s a place, for example, where the extraordinary is a routine occurrence, where big discoveries are made, world-class research is undertaken and lives are saved.

None of it happens by accident, though. And leading those efforts, which include serving more than 7,000 patients a year and overseeing a $1 billion annual operating budget, is an executive who freely confesses how much he felt he had to change to acclimate himself to the scope of the St. Jude enterprise.

When Downing – who’s been at St. Jude some 30 years, working as a scientist, pathologist and scientific director, among other things – got that first pointed instruction from his board, he asked himself what he thought was the next logical question: Well, what are the challenges he’d face as the organization’s new leader?

“And the first challenge was me,” Downing admitted. “I’m a nerd. I’m a scientist. I’m not comfortable inspiring and motivating people. I like sitting in the back of the bus, leading from the back and being a scientist. But that’s not the job. I needed to get up. I needed to lead this organization and be the face. And I needed to communicate and inspire and motivate.

“As a scientific director, I was the bad cop. I was the analytical, aggressive scientist that took no prisoners. I wanted hard, rigorous thinking. We were taking donor money, and I wanted the absolute best science so we could advance cure rates for the children we were treating.”

Being a leader and a chief executive, though, requires a softer touch than that, he says. It’s a more diplomatic role, but also a visionary one.

Speaking of vision, he also returned to that directive from the board. If the assumption was that the organization is perfect as it is, such that nothing should be changed – well, was that necessarily true?

He pointed to an 80 percent cure rate for childhood cancers. It sounds high, but he said it still means 1 in 5 patients who walk through St. Jude’s doors will die. Moreover, cancer remains the leading cause of death due to disease in children between 1 and 15 years old in the U.S., and globally it’s even worse.

The bottom line: Downing felt presented with an opportunity to lead the hospital to even greater heights.

He still recalls sitting in a hotel room and thinking through what a vision plan for the hospital might look like. He started writing and ended up with a nine-page document, single-spaced, covering the next 10 years.

The hospital, he explained in recounting the origin of that plan, needed things like new biologic insights and new therapeutic approaches. It also needed buy-in from the entire organization – “and maybe even my vision wasn’t right, so I decided day one I’d start a strategic planning process.”

The hospital has gone on to make strategic planning a core part of its culture. Downing has pushed for quarterly reviews and more transparent decision making, and has installed a leadership team “that’s not afraid to speak up and disagree with me.”

In short, his vision for the parts of the hospital that aren’t necessarily as visible from the outside includes making sure employees have a sense of pride and purpose in the work.

As a nonprofit, the enterprise’s human resources department has to be creative when it comes to benefits and perks. And yet, St. Jude employees get things like access to dry-cleaning services, on-site massages, a farmers market and even car detailing. What’s more, St. Jude doesn’t foot the bill; instead it invites vendors onto its campus.

The little things matter. Downing pointed out how, in a hospital built around children, St. Jude goes all-out for Halloween each year, even essentially shutting down for a couple of hours and getting staff to dress up.

When children end their last chemotherapy, the hospital throws a “No more chemo” party complete with a cake and singing. For older children, it has thrown proms that have included makeup, dresses, limos and a red carpet.

Downing likes to say the hospital has a “perfect mission,” which all of those small touches and big plans are in service of.

St. Jude “can deliver a kind of medicine that can’t be delivered anywhere else,” he said. “And we share our discoveries freely with the world. But despite our remarkable progress, we cannot rest until every child with cancer can be cured.”

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