Power and Influence

Preparation Assignment – PWI Day3 (Feng Xu, Steven)

1. What does Esserman Esserman want to achieve? State her goal plainly.

Esserman sought to:

1. Roll out the Breast Care Center’s integrated, coordinated model of delivering care to UCSF’s other departments, particularly those dealing with other forms of cancer, as well as to other breast cancer centers across the country.
2. Build an advanced and robust information system to improve the quality of medical care in order to decrease medical costs and improve mortality and morbidity rates.

Detailed Visions of Esserman:

1. Build a comprehensive breast care center (and roll out the model within other departments at UCSF and at other breast cancer centers at other hospitals)
2. Build a sophisticated and robust framework supported by an information system that served multiple purposes ranging from maintaining electronic patient records to capturing and sharing patient information for driving innovation in patient care and current and future research.

The intent was to create a knowledge management system, based on the re-engineering of clinical care delivery, that enabled the measurement of quality, rapid integration of research into patient care, and the sharing of information for patient care collaboration and research on populations of patients.

1. Analyze the power Esserman has at UCSF.

Positional power:

By 2003, Esserman held three major roles: 1) associate professor of Surgery and Radiology, a practicing breast surgeon and teacher, and an affiliate faculty member at UCSF’s Institute of Health Policy Studies, 2) director of the Carol Franc Buck Breast Care Center at the Mount Zion Medical Center, and 3) clinical leader of UCSF’s breast oncology program (research) (see Exhibit 1 for her resume).

Esserman could not control hiring and firing of her oncology related colleagues and physicians. Esserman also did not control salaries of those in the Breast Care Center, even though she was the director of the center. In fact, Margaret Tempero controlled key human resource decisions for oncology within the Breast Care Center, as Tempero was the deputy director of the overall Cancer Center.

This lack of control makes it really difficult to bring people together to achieve a common goal.

Personal power:

Esserman’s personal style was lively, flamboyant, boundless energy, and a passion and commitment that sometimes polarized those who interacted with her. A lot of people love her, But for some people, her style appears to be pushy and arrogant. People who can envision a different future are attracted like a magnet to Esserman, while other people who are embedded in the status quo wonder why in the world she is wasting time trying to change things that can’t be changed.

Many people at UCSF enjoyed working with Esserman and were intensely loyal to her. Esserman inspired those who worked closely with her, she was a very good mentor to her subordinates. However, some saw Esserman as being fiercely loyal to her allies and supporters but not being very accommodating with those who crossed her. She admitted to having a quick temper. Esserman’s passion and commitment also made it difficult for her to view things from other people’s perspectives. However, at UCSF, many of Esserman’s colleagues felt that she was spread too thinly and she had problems delegating. Some, such as Mendelsohn, went so far as to call Esserman a “micromanager,” at times. Lane commented: “Esserman doesn’t know how to say no. She just takes on too much. She was interested in too many projects and had a lot of clinical interests. She was a visionary in her research—very creative in coming up with ideas. However, the negative is that she was not focused enough when she pursues her hypothesis and what her specific aims are. In many cases, her hypothesis does not meet the scientific rigor of proof, but when one takes a step back, one can appreciate how the seemingly disparate aims can actually connect.

Esserman’s passion and commitment also made it difficult for her to view things from other people’s perspectives: “The hardest thing for me to do is to put myself in other people’s shoes,” said Esserman. “I try to see things the way others see it, but I just don’t see it. The problem is that I see it the way I see it and I can’t see what they’re seeing. I can’t see what they’re nervous about. I’m working on this, but it’s really hard.”

Relational Power:

Esserman had obtained a fair amount of publicity for her work. For example, she was featured in an article in Fast Company in March 2002, and had a large story about her and the Cancer Center in the San Francisco Chronicle in 2002. She was very visible at national conferences and at the National Cancer Institute, where her ideas were attracting a great deal of interest. Esserman had many key national supporters such as Dr. Larry Norton, attending physician and member, Memorial Hospital, and Head of the Solid Tumor Division, Memorial Sloan-Kettering Cancer Center. Norton was on the Medical Advisory Board of the Breast Cancer Research Foundation, an organization that awarded grants to researchers.