Executive Spotlight—St. Jude Children's Research Hospital CEO James Downing on building a ‘global’ reach

When James Downing, M.D., first landed a job at St. Jude Children's Research Hospital, the then-laboratory investigator thought he'd stay maybe five years and build up some research experience before moving to his next gig.

That early career move turned into a life's work for Downing, who was named CEO of St. Jude about five years ago and is overseeing ambitions to expand the hospital's reach worldwide. “For myself, I have been recruited away by other institutions, but have always chosen to stay at St. Jude primarily because I think I can do more from this institution than I can from any other organization in the world," Downing said. 

That has included turning up the heat on efforts to impact global pediatric cancer cure rates, which have remained stubbornly low while cure rates have vastly improved over the decades in developed nations like the U.S. While St. Jude Children's Research Hospital is often best known for its prolific fundraising, harnessing celebrity appeals and millions of donations every year to help ensure families never have to pay for care, Downing said it's these efforts he wants to make sure the world knows about.

Here's more about Downing and what he had to say during a recent conversation:

More about Dr. James Downing
  • Age: 64
  • Family info: He and his wife Mariea have three children, Melissa, Suzy and Michael, and four grandchildren, Jude, Lucy, Charlie and Maggie.
  • Most important part of his routine: Keeping close at hand a list of my short-term and long-term goals and priorities—and assessing progress weekly.  
  • Three words that describe his management style: Always be fair.
  • Book he recommends: "The Idea Factory: Bell Labs and the Great Age of American Innovation" by Jon Gertner. 
  • Biggest pet peeve: People not asking the question “Why?” when assessing a problem or a proposed solution.
  • Favorite thing to do on his day off: I'm an active cyclist and on a bike racing team. Racing as a 64-year-old, I finally broke the 1-hour time for a 40-kilometers time trial: 24.8 miles in 58 minutes and 11 seconds.

FierceHealthcare: How did you end up in healthcare?

James Downing: Growing up, I never thought I would go into medicine. I was heading into college as an engineering student and, I remember, in an early engineering class with a professor we were drafting the cost of recalling a damaged product versus the cost of handling the lawsuits that would result from the death caused by keeping that product in an automobile. I remember looking at that data and thinking about those decisions and thinking ‘This is not something I really want to do. The decision is easy—you remove the product.’ At that time, I also had to take a biology course and I remember almost falling in love with it."

FH: How is the business of running St. Jude different than other nonprofit pediatric hospitals?

JD: We are very, very different from any other pediatric hospital. Our mission is to advance cures and means of prevention for pediatric catastrophic disease through research and treatment. Everything we do is geared toward achieving that mission. So we raise large funds to support the institution. Probably 75% of our operating budget is through philanthropy, and our current operating budget is above $1 billion per year. We raise funds to pay for all the construction and buildings on campus, and we like to say with every single patient that comes to campus, our business is to lose money.

FH: You recently released a strategic plan for the hospital which included a goal of recruiting more patients. How do you plan to do that?

JD: As we know more and more about pediatric cancer and the genetic reasons that underly pediatric cancer and we see the different kinds of pediatric cancer and they need precision therapy, the number of patients of a particular cancer type becomes smaller and smaller. To make progress, we need more children enrolled in those clinical trials to be able to pose the question and then answer the question in a reasonable period of time. We thought we could absorb a 20% increase in patients on campus that we could build facilities on campus for that and recruit the quality individuals we needed to care for those patients. But we also looked outwards and made conscious decisions to make protocols that run in a collaborative sense at other institutions. 

FH: What are some of your top priorities?

JD: If I had had cancer as a child, the cure rate would have been less than 5%. Today, children have an outlook of greater than 80% being cured of their disease. But as we look at that, there are a number of problems that arise with that number. First, that means one in five children with cancer are going to continue to die from their disease here in the United States. At one level, it’s how do we cure the incurable? At another level, of those 80% we’re curing, many of them suffer long-term complications as a result of therapy. How do we define who is at risk of developing these complications and how do we do interventions to ameliorate the long-term complications those children have?

At another level, if we actually took all the kids in the world and all the kids living in low- and middle-income countries, which is about 80% of the children in the world, the cure rates in pediatric cancer are probably less than 20%. Who is going to address that problem?

FH: What are you doing to address that?

JD: Twenty-five years ago, St. Jude developed an international outreach program that was humanitarian in focus and was designed to go into a country and partner with a single hospital and teach them how to treat children with cancer. It started in El Salvador and moved through South America into the Asian Pacific region into China and the Middle East. When I took over, we had 24 different programs in 17 countries. It was not scalable. It had reached its maximum size, it was humanitarian, we were doing good work, but realistically we were touching 3% of the kids in the world. Our goal is we’re going to extend our reach from 3% to 30% in a single decade and then move beyond that. To make this much more of an academic program where regions of the world are learning across that region and are learning from each other and a blanket of research over the entire effort would provide an understanding of what’s occurring across the globe and better communicate across the globe the tenets of the program, it’s called St. Jude Global.  

We’ve gone into partnership with the World Health Organization and became the first collaborating center for pediatric cancer of the WHO and invested $15 million to strengthen their pediatric cancer program. We are going to go to 100 low- and middle-income countries and do a detailed gap analysis to determine what is their healthcare infrastructure, their capacity to treat pediatric cancer, what do they need to treat pediatric cancer? 

FH: What capital projects are coming down the pipeline? 

JD: To cure the incurable, we really need to focus on basic fundamental research. There are many things about how cells proliferate, how they differentiate, how they develop into organs, how alterations in cancer affect those processes that we really do not understand. On campus, we have a new building going up that’s 625,000 square feet at a cost of $412 million, it’s eight floors and that is called the advanced research center and that is a basic research building that will really be a hub of interaction and discovery. It’s really one of the largest active research construction projects in the U.S. and is slated to open in 2021.

More immediately, we are expanding our structural biology and have recruited a new chair for that department, he’s recruited a number of new faculty members and we’ve invested $25 million in new equipment for structural biology essentially putting together the most advanced technology and having all the different modalities of approaching structural biology in a single institution.

FH: What is the culture like at St. Jude and how do you create and maintain that culture?

JD: St. Jude is like nowhere else. It’s 5,000 employees. Every single person who walks on this campus and works here knows what the mission is. Everyone knows the child is at the center of everything we do, and I think everyone that’s here realizes that what they do matters. I spend a lot of time thinking about that. Part of it is that strategic planning which we’ve made a true part of our culture. I took the job with a vision but said we’re going to do strategic planning and get almost 200 individuals across the institution involved in this, have work groups and really work hard to figure out is the vision I laid out correct or not or are we missing things? Then we developed those things, communicated widely. I spend a lot of time listening to the workforce. I have a town hall, … I host lunch with the CEO where I bring smaller groups together and I have coffee with the CEO where the patients and families can come to Starbucks where whatever they want is free and I sit down and listen to them.   

FH: What keeps you up at night? 

JD: The one in five children dying in developed countries and the eight out of 10 dying around the world. That keeps me up. I spend a lot of time thinking about the patients and the families here and trying to find a way to make that experience better. New housing facilities going up, new patient/family common area, new inpatient floors we just completed a little over two years ago now. Building new outpatient facilities. It’s that combination of the immediate for the patients we’re caring for and the bigger picture. How do we change the outlook for children?

FH: What is a mistake you’ve learned the best lesson from?

JD: It comes from my scientific background. I’m a laboratory investigator, I still run a laboratory. I like to say you can never be too rigorous. Many people will see a result they want and they’ll believe it. No, when you see something that gives you an answer, you should spend all of your energy possible trying to prove it wrong before you assume it’s right. I think that translates into the business too. One needs to see the data.

FH: What don’t people know about St. Jude that they should?

JD: We’re primarily known for our brand people see on the TV or in billboards. We are a place that cares for children and are the leaders of pediatric cancer care across the globe. But we are one of the most advanced research institutions in the world. They don’t realize we’re a degree-granting institution and we give out Ph.D. degrees in biomedical sciences. The level of science going on here is amazing. We’re making fundamental discoveries that are changing the way we think about pediatric cancer and also having a major impact on how people are thinking about adult cancer. It’s that research that's at the base of everything we do.