Thirty Minute Mentors Podcast Transcript: St. Jude CEO James Downing

I recently interviewed St. Jude CEO James Downing on my podcast, Thirty Minute Mentors. Here is a transcript of our interview:

Adam: Our guest today is the leader of one of the best-known and most impactful hospitals in America. Dr. James Downing is the CEO of St. Jude Children's Research Hospital, which has helped push the overall childhood cancer survival rate from 20% to more than 80%. Jim, thank you for joining us.

James: Well, my pleasure. Thank you for having me.

Adam: You grew up in Detroit. And growing up, you weren't exactly a star student, but you were a star athlete. And you thought you would be playing major league baseball, you played football and baseball in high school. And it wasn't until you got to college when things clicked for you academically. Can you take listeners back to your early days, what early experiences and lessons shaped your worldview and shaped the trajectory of your success?

James: As you said, growing up as a kid, I was much more focused on sports and enjoying participating and playing and succeeding. And I remember there was nothing quite like the feeling of hitting a home run. And I was not a good student. I was capable, I clearly could do the work. I just didn't spend any time doing it. But as I look back, there were many important lessons I learned from sports, I learned the importance of that coach and their leadership of that team and bringing those players together, teaching us how to play the game and become better individual players. I learned I think that were very important lessons from my family, they were that family was important and that the teams you participated in were important and the community in which he lived were important. And the other thing is that we were absolutely no blue-collar neighborhood. And that has stuck with me forever. It wasn't high wealth. It wasn't a week it was working-class people enjoying life, and working to enjoy life and asking what problems need to be solved and what are the practical ways of solving that, despite not being a good student. And it became clear as I was in my last couple of years of high school, I wasn't really going to be the caliber player that would make it into top colleges or minor leagues, I realized I got to go to college and the family business was engineering. My father was an engineer, and he wanted all of us to be engineers. And so I got in the University of Michigan in the school of engineering to become an engineer. And that was a shift in the tension from not really going to be an athlete. And so I better focus a little bit and listen, think about it. And so two things that I realized very early that lessons have impacted me were that I applied that same discipline and dedication that I had to sports to my education, I could do pretty well. And I actually enjoyed it. I enjoyed the studying and I enjoyed the learning and I enjoyed fine to do well on tests. The other thing was that what I want to do, what did I enjoy doing? And again, I was in school of engineering and was questioning if this was what I want to do. I was very good in math. And I was good in chemistry. And I was good in physics. And I had no trouble with the coursework, but I had to take a biology class and I hated biology in high school. It made no sense to me, it was just memorizing stuff. It was just a complete waste of my time. That's the way I thought about it. And I had to take a biology course in college as part of the requisites to get a degree in engineering. And so I took this biology course and I literally misread the reading assignment and started reading in this book, and it was all about mitosis and meiosis and the mechanisms by which cells replicate. And I was just fascinated. And I fell asleep on that book that night. And as I woke up the next morning, I thought, I'm changing my major. This is what I'm going to do. I'm going to go into biology and medicine and biomedical research. I want to learn about this and keep moving. So those are some of the early formative things that shaped me more towards a career in medicine and biomedical research and then an academic intellectual career as opposed to a sports-oriented career as a kid growing up.

Adam: James, you shared a lot of great lessons there, you shared a lot that we could unpack. One thing that stood out to me is the importance of keeping an open mind. You shared that when you were in high school, you hated biology. When I was in high school, I hated biology. But in college, you approach it from a completely different lens, accidentally. But that opened up this whole new world to you. And I have a bunch of nieces and nephews who are young. And I joke around with them pretty often. And I'll ask them, "Hey, do you like this food? Do you like that food? Do you like this? Do you like that?" And sometimes they say, yes. Sometimes they say no. And when they say no, it's oftentimes foods that they've never had before. But they just instinctively say, "No, I don't like it. I don't like this. I don't like that." The reality is that no matter how old we are, we don't need to be a little kid, we could be in our 20s, 30s, 40s, 50s, or 60s, and we oftentimes have that same mindset where we have this instinctive reaction to things where we say, "No, I don't like that. That's not for me. I don't want to do that. I'm not into that." Whereas in reality, if we took a step back, and we're willing to approach things, with an open mind, we might enjoy things that we otherwise closed ourselves off to.

James: That's so true. And then there's an approach that not so much consciously, at least in the early part of my career, but I sort of use, I remember going through medical school. So what kind of doctor did I want to be I decided the first two years of medical school, you're just sitting in classes and learning how to do histories and physicals and understanding the basics of medicine, it's not till your third year that you start going through rotations, and get exposed to pediatrics and gynecology and obstetrics and surgery, et cetera. And I decided that I was going to start every single rotation with the question, could I do this for a living? And would I want to do this for a living it was a good approach because I started out enjoying it. I learned as much as I could, but I let time tell me is this where my skills truly are? Is this where my desire lives? And it helped me sort of understand ultimately, what it was that drove me and excited me. There's another example. I remember that my grandkids and I remember one of my grandkids asked, "Would you like to try this?" And she said, "No, I don't think so." And I stopped her. And I said, "You may not get this opportunity again, you should be open and try it." And she paused. And she did try it. And then she realized she liked that, it would have been a missed opportunity if she didn't take it. So being open like that is critical. As you go through your career, it's even more critical to constantly be open and to know what your field is, to look beyond your field to get insights and potential ways of approaching problems that you might not have thought of, if you just narrowly focused on your specific field and your darkest area of expertise.

Adam: What drives you, what excites you? What are you great at? You don't know the full scope of the answers to those questions until you try lots and lots and lots of different things. And in your case, you discovered you're great at something that you thought you hated. And that got you started. And then once you get started, you're off to the races. What were the keys to rising within your career? And what can anyone do to rise within their career?

James: You have to find something that you're passionate about. And don't be afraid to experiment and find out, am I passionate about this or about that? Once you find that you have to work hard. If you're not willing to work hard, you're not willing to succeed. We all have superpowers. A lot of people say. "Well, I'm intellectually capable, that's my superpower." It's like no, no, no, my superpower is I can outwork anybody. I can work harder than anybody on any problem on any day. Always. And that's my superpower. I work hard. And the other thing is, you can't read enough. The idea is to be just constantly reading and asking questions about what you're reading and then going to the next level. If you want to succeed in your specific area, you want to constantly be learning and pushing yourself and so working hard spending time reading, thinking asking questions applying that. The other thing is more about leadership, but once you're leading people, or leading organizations or leading teams, you've got to be fair. And I do remember, my father-in-law used to go for a ride and see it in the country after he retired, he was a manager at General Motors. And he said, "The most important thing to do when you're in charge is you got to be fair to the people, you got to make the decisions so that they're fair to all the people that they're going to affect." And that's an important lesson. So be fair, think about what those decisions mean to other people balance that and do what's optimal and best, for the organization for the specific problem we are addressing, and for the people that are in the team that are working on that problem and helping you achieve a solution.

Adam: What do you believe are the key characteristics of a great leader, and what can anyone do to become a better leader?

James: So those who are successful at being leaders, it has to start where it's not about you. This is not about getting a title, having power or getting the associated benefits that come with it, being seen as a leader to having respect, it's not at that. Leadership is defining the vision for the group you're leading, making that as clear as possible and a vision that people can understand why and what their role will be in achieving that developing the strategy to achieve that communicating that and listening and modifying it based on the input you get from the people who you're leading and inspiring them to achieve that. And then building the environment and the culture so that every single person that you're leading can do their absolute best work and sees their role in the organization or the team that they're on and are committed to it and committed to the other members of the team. The key elements of leadership aren't that hard. I've read many, many, many leadership books I read all the time about leadership. But the lessons, I bet many, are doing the hard part, how to listen to people, how to get that feedback, how to communicate more transparently, how to develop that vision, and then develop the strategy and move forward and modify. As time goes on, don't have etched-in stones. This is a Marshall Goldsmith quote, but it also is not about being right or wrong. It's not about you proving you're right and proving other people wrong, it's about making a positive impact. And so we all will have bosses and your job is in the fight with them to prove they're wrong and you're right. The job is to make a positive impact in the position that you're in. And so if you're a leader, it's to lead that organization or that team to make a positive impact, that I read on leadership all the time. I don't think you can read enough about it because it may not be that complicated, but it's hard to implement and constant reading about it helps you refine your approach and focus on areas that become challenging and gives you ideas about how to address those challenging areas.

Adam: I love that you quoted Marshall Goldsmith, a great guy, who was a guest on Thirty Minute Mentors, we spoke a lot about the importance of leaders focusing on making a positive impact in our conversation on the podcast. You shared a lot of really important themes. The importance of vision, defining vision, and communicating vision, defining and communicating the why, inspiring, not ordering. Listening, great leaders are great listeners. A theme you've been pounding on which is so important. The importance of reading. The most successful leaders are lifelong learners. The most successful people are lifelong learners. I've done interviews with leaders across all kinds of disciplines, all kinds of fields. It's a theme that comes up over and over and over again. The most successful leaders are not satisfied with where they are today. The most successful leaders understand that wherever they are today is a byproduct of what they've learned in the past. And if they want to continue to be successful, they have to continue to learn they have to continue to grow, they have to continue to evolve.

James: I will completely agree. There are different kinds of leaders, but for a leader or his leadership team to function well, in any team, there does have to be this vision. What is it? One of the problems we're addressing or we're tackling and what's our vision? Where is it we're going? And some leaders don't have that as their story so they can assemble people around them that can help them with that. For me, it's been always one of my strengths. And it's something like that you got to work it. And even look at that landscape out there. How do you decide what opportunities you might take, that others won't take, or you'll take earlier than others will take? But always focusing on, well, these are the problems we're trying to solve. And so how might we solve those problems? What might we add to what we're doing or the vision of how we're going to go about doing that? And so again, that takes work, that takes thinking about it, reading about it, reading outside your field to see what's happening, doing deep dives in certain areas that may not turn out to be fruitful, but at least you're exposing yourself to that. Listening is also easy. Just listen. No, listening is unbelievably hard. And as I was getting rubbery in my career as a leader, I realized I wasn't listening with great clarity, I was hearing and formulating my response. While I was listening, I realized I was no longer listening, I was figuring out what I was going to say. And so I was listening to the first part of what they said, not the next part. And so I decided, well, I'm gonna learn how to be a better listener. And so what I did was driving into work, I would listen to courses on tape, and I would realize how often I would be daydreaming. And I'd have to rewind it and start again, and then rewind and start again. Then over the years, I became a listener, how to not formulate your response while you're listening, but formulate the questions to understand what they're talking about. And that's a skill that you need to constantly practice, and constantly work on to maintain at the level that you need to be able to listen to the people that you're leading and learn from them. And you just can't read or listen or not. Now, a lot of people are using podcasts. But if you have a very moment, read or listen, don't waste that time, it's pretty precious.

Adam: It speaks to the importance of being present, being intentional. The exercise you shared that helped you become a much more successful listener was centered around helping you become more intentional, and more present, which not only allowed you to become a more effective listener but a more effective leader.

James: Then an issue related to presence. We now have phones, we are sitting there looking at or falling and scanning emails and scanning social media sites et cetera. And you're not listening, you are not paying attention. You are not present when you're doing that. And we're all guilty of it. But it's a new challenge that we have to control. If you're in a group listening, don't even put the phone within visible sight. Put it in your pocket where you'd have to stand up to get it out. And just don't pay attention to it because it is a distraction that disrupts your ability to listen. It's also disrespectful to the people who are talking to you. Leaders have so many meetings. And so the meetings aren't all that much importance, but to the people who are in the meeting, it's their only meeting with you. And it's a lot of importance to them, and to disrespect them and sit there with your phone out scrolling through it as they're talking is a bad habit to get in because it's not only disrespectful, it prevents you from actually listening and learning.

Adam: You make a really interesting and important point, which is leaders need to understand the impact that they have on the people that are leading, the impact they have on everyone around them. I interviewed a retired four-star general who told me that while he was leading the army, he led the largest organization within the US Army. He started taking the elevator up to his office. And what he realized was that on the elevator rides up to his office, no one would get off on a different floor. Even if they were supposed to get off on a certain floor, they wouldn't get off. They waited until he got off. Why? Because that was the only time during the day that they had the opportunity to be around him, to spend time with him, to talk to him. He shared that his inclination, he's a guy who's really into fitness and health, and he would normally take the stairs and get some steps in. But he realized that, as a leader, it was his responsibility to take the elevator and maybe even take it longer than he had to, because that allowed him to impact people in a way that he otherwise would not have been able to.

James: I love coffee, and I love my espresso. And so in the executive suite, we have three or four different coffee machines. For every variation, you could want from automated Starbucks machines to nice espresso machines. But every day, I go down to our Starbucks outside the cafeteria, and I stand in line with everybody and I get my cappuccino and I spend a buck sorbet on the cappuccinos every day because I get the standard line with everybody, I get to stand in line with the patients and families and the employees. And I get to see people in the hallway and they come up and talk to me. "You can just go to the front of the line." "No, I'm just one of the workers, I'm going to stand in line. And don't worry about me, I'm fine." And I go get my food in the cafeteria, I don't need somebody to go get it for me, I want to go get it. And I talked to the sushi chef down there. And I stand in line and get that and it allows me to see people and see what they're seeing within the organization and to listen to them and to learn from them.

Adam: I asked you about how you rose within your career. And that's a topic that I explore with a lot of guests. And oftentimes, when people think about how they can become more successful in climbing the ladder and taking that next step, something that comes to mind is I need to be more visible, I need more people to see me within my organization. And as a leader, you need to have that mindset. And James, you have that mindset that is you being there, being present, waiting in line with everyone else for your coffee, just showing up and physically being there. There's no substitute for that.

James: Yeah. Well, I think that's right and you're common individuals who want to know how they can progress in their career, I think an important thing is not to enter it with that mentality. I didn't. I had no aspirations to be president or CEO of St. Jude, I had no aspirations of being a leader. Once I got into medicine and research, I just wanted to be a great researcher. There was a period where, well, might you want to do this. And I sat down and thought about it and thought, well, yeah, I can do that better than somebody else since I've set up the molecular diagnostic lab. And then five or seven years later, it's, would you like to be chair of the department of pathology? Yeah, I can do that. But even in those roles, I didn't think about the next role. I thought about how do I do with 8++. How do I be the absolute best at this and create the absolute best department, the best environment, the best people, and the best culture? And it never entered my mind that I might become a scientific director in just one day that you see outside. How would you like to be a scientific director? Well, yeah, I guess. As I got older, I thought, okay, I could be CEO, but that was never part of the game plan, getting into the field or even getting into leadership. And so don't look too far down the road, or whatever the job is, do it at your absolute best. Learn as much as you can from that. And don't worry about the future, commit to the present and commit to continued learning and being better at your present job. And that'll benefit you when that next opportunity comes.

Adam: I love that. I love every word you just share.

James: I've given a few college graduation commencement addresses. It's a principle I believe, and I'm talking to graduates that need to figure out what plan A is and commit to it. This is what you want to do, commit to it and do it. And don't even worry about a plan B, your plan B is you. Your plan B as you got a great education, know how to work, know that you can succeed and so commit 100% to plan A. Because if you only commit 80% to Plan A and 20% to Plan B, you'll never know how successful you could be. So don't worry about what you're going to do if you fail. Go all in. And just don't worry about it. Because you've got the greatest safety net that you could ever have, yourself and the education that you've acquired, especially as a college graduate.

Adam: What a great line, your plan B is you. Get at it, get after it, don't hold back, go all in. I love that. So much of what you do, both as a researcher and as a CEO, of a leading nonprofit organization, is focused on driving innovation. How can anyone get to a place where they are most likely to innovate? And how can leaders foster innovation?

James: Yeah, it's very topical. And everyone talks about frameworks for innovation and what innovation means. And do you have a chief innovation officer, and I like to say, blah, blah, blah. We are a place where our business, the business of St. Jude Children's Research Hospital, is to generate new knowledge, to make discoveries, that's our core business. Our mission is to advance cures against pediatric catastrophic diseases through research and treatment. And so the only way to advance cures is to generate new knowledge so that you can build new cures and learn how to use current cures better. And so it's all about generating knowledge. And so it's not innovation. Innovation, I think is taking current things and making them different, more usable, and practical. This is discovery science, how do we generate new knowledge that we did not have before one can use aspects of that towards innovation, but it then acquires only the kind of people that are focused on that. And then building the culture to allow that to occur, and that culture has to be one priority and what the problems are, the ability to take high-risk approaches to solve those problems and the ability to openly and frequently question and criticize the approaches and data that are being generated so that everything was done at a level of rigour that can't be surpassed, that you're as rigorous as you can to try to find the solutions or to develop the new knowledge that's needed and making sure it's clear and has clarity to what that new knowledge is. So we strive to bring in the best and brightest, we strive to make sure everyone going to work with each other and they're gonna learn from each other. And they're not going to say this is mine. And I want credit for it. It's not about credit, it's about actually advancing the field and then developing an environment where every single employee can do their absolute best work. Doesn't matter if they're part of the environmental services cleaning staff or the facilities operation and maintenance staff level, or the food service staff are the research technicians or the nurses or the positions of scientists, everyone can do their best work, and they're all in it together. And everybody's helping each other to succeed. And they know we are committed to them, and their career, and their advancements in their career. That comes constantly thinking about it and assessing the impacts and taking employee surveys and open town halls to hear from them and make sure everyone knows what the values are and what's expected of them and our performance reviews incorporate our values into their reviews. Are they living up to our values? When I talk to Marshall Goldsmith, you know, I said, "Well, what's your purpose? And he says, "We don't need to talk about that." St. Jude is there and I'm lucky while I am here. And I'm lucky that I stayed here. It's an unbelievable organization with, as I say, the perfect mission, and one that hasn't changed in 63 years. And everyone knows that, everyone's driven towards advancing it.

Adam: You don't need to worry about your purpose. But you do have to worry about a lot of big decisions, your job as a leader is to solve the big problems and answer the big questions that those in your organization aren't answering. Whatever is getting to your desk is getting to your desk because it's gotten past the desks of those who work for you. And sometimes those decisions can be life or death decisions. What have been the most difficult decisions that you've ever had to make? And what is your approach to and best advice on decision-making?

James: Yeah, I would say the most difficult decisions are always around people. Those decisions are even more business-related decisions or strategic decisions, there is an element of laying out the facts, being very analytical, and thinking through Watson's minuses, risks, benefits, competition, landscape opportunity, opportunity costs, and ability to accomplish it. But in the end, it was picking all rather than and then the more nuanced intuition assessment, what I believe, what do I think about this? How do I feel about it? Am I going to be able to support it? And to move it forward? Or am I doing it because the data tells me it's right, but I don't quite believe it? I think judgment is the value that everyone brings as a leader. And that judgment is built on experience, by learning from past decisions and how they play out. And so the rigorous approach is very important up front. But I do think one needs to then ours and reflect more intuitively, and that decision before moving forward. I also think discussing it with others is so good. And just two aspects of that, as we're developing proposals for research studies, when we set out this is what our aim is and how we're going to do the experiments and everything you need, typically, you're sitting in a room doing this by yourself on a computer for days on end, the simple act of getting out the hall talking about it with somebody saying, well, yeah, you know, I'm writing this and here's what I'm thinking right now. And here's why I'm structuring, as you verbalize that, you start realizing the subtle flaws or areas that might need to be modified. So the simple act of verbalizing can help you in thinking through, but then actually talking to people and saying, "What do you think?" And having that dialogue. I think it was Einstein who said his ideas, were from a combination of deep, hard, uncivil intellectual pursuit, and then coming out and discussing with somebody or an aspect of it, and then he'd go back and refine it even more and so you don't have to do this alone. You shouldn't do this alone. You should figure out who that network of supporters are that can help you and they vary depending on what the decision might be.

Adam: James, can anyone listening to this conversation do to become more successful personally and professionally?

James: Work harder. Don't think there's any substitute for work or anybody. And if you want to be a leader, first become better at your job. You have to be competent at your job, you have to have skills at your job, and you have to be seen as eight plus about your job at least to become as good as you possibly can become with what you have. That's the first thing and then as you start exploring leadership, read about it. Harvard has the 100 greatest books for leaders. I least I saw a list once and many of the books are classics - The Prince and Thomas Aquinas and Marcus Aurelius. And then there are more modern: Peter Drucker books and Marshall Goldsmith books. And all of these are very good things to help you think through and as you're reading them, how do I apply it to what I'm doing today?

Adam: James, thank you for all the great advice and thank you for being a part of Thirty Minute Mentors.

James: Well, my pleasure, so thank you for having me.


Adam Mendler is an entrepreneur, writer, speaker, educator, and nationally-recognized authority on leadership. Adam is the creator and host of the business and leadership podcast Thirty Minute Mentors, where he goes one on one with America's most successful people - Fortune 500 CEOs, founders of household name companies, Hall of Fame and Olympic gold medal-winning athletes, political and military leaders - for intimate half-hour conversations each week. A top leadership speaker, Adam draws upon his insights building and leading businesses and interviewing hundreds of America's top leaders as a top keynote speaker to businesses, universities, and non-profit organizations. Adam has written extensively on leadership and related topics, having authored over 70 articles published in major media outlets including Forbes, Inc. and HuffPost, and has conducted more than 500 one on one interviews with America’s top leaders through his collective media projects. Adam teaches graduate-level courses on leadership at UCLA and is an advisor to numerous companies and leaders. A Los Angeles native, Adam is a lifelong Angels fan and an avid backgammon player.

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