Managing Problems from Within: Convection-enhanced leadership (#375)

What can the treatment of brain tumors teach us about leadership in veterinary medicine?

In the mid-1970s (Yes – 50 years ago!), I found myself asking a question that would shape decades of my work:

What if we could treat brain tumors from within?

Not with radical surgery that carved away healthy tissue.

Not with radiation that damaged both tumor and cortex.

And not with chemotherapy that bathed the entire body just to reach a few rogue cells in the brain.

I imagined a treatment that bypassed the collateral damage altogether—delivering therapeutic agents directly into the tumor, sparing the healthy brain, and working precisely where the problem resided.

In the 1970s I pursued this goal with talented scientists of like mind at the University of California Brain Tumor Research Center in San Francisco.

Our research was funded by a bequest from the Petersen Foundation. Mr. Petersen had passed away from a brain tumor and loved his dogs. Hence the generous bequest that enabled us to establish the Brain Tumor Research Laboratory at the UC Davis School of Veterinary Medicine. Our goal was to use dogs with spontaneous gliomas as a model for novel therapies in humans.

That dream became a reality in the form of convection-enhanced delivery (CED): a targeted, intracerebral technique that uses pressure-driven catheters to infuse drugs directly into the tumor and tumor margins while sparing adjacent normal brain tissue.

CED was a scientific and surgical shift—from attacking the periphery to healing from the core.

CED bypassed the blood-brain barrier (in this case, the blood-tumor barrier) and minimized damage to healthy areas. The therapy was precise, local, and deeply strategic. It was about solving the problem from within.

Years later, I’ve come to believe that veterinary hospitals often face their own version of this problem. And perhaps, they require their own version of targeted therapy.

The Veterinary Hospital as a Living System

Veterinary hospitals are not unlike biological systems. They operate through interconnected pathways—between veterinarians, technicians, receptionists, managers, clients, and patients. And these days, we can add corporations and private equity partners to that list.

When things go wrong, the symptoms may show up as high staff turnover, poor morale, client dissatisfaction, or medical errors. But these are just the outward signs. The real pathology often lies deeper.

Too often, we reach for surface-level fixes: a mandatory training session here, a policy memo there, or perhaps a stern staff meeting. These are the equivalent of systemic chemotherapy for a brain tumor. They’re well-intentioned, occasionally effective—but frequently blocked by institutional barriers like distrust, burnout, greed, or ingrained cultural habits.

What’s needed to make real progress is targeted organizational therapy or “convection-enhanced leadership”—a metaphorical form of CED delivered with the same intentionality and precision.

Solving Problems from Within

Just as CED inserts the therapeutic agent directly into the brain tissue, bypassing the blood-tumor barrier, effective hospital leadership inserts change into the core of the organization, bypassing the more superficial layers of administration.

Not from above, but from within.

That means:

• Engaging the people most affected by the problem, not just issuing top-down solutions.

• Identifying root causes, even if they’re uncomfortable—like ethical fatigue, bullying, or inequity.

• Delivering change with pressure and direction—not by force, but through momentum: consistent communication, small wins, and visible commitment.

• Reaching the margins, just as CED reaches infiltrative tumor edges: support the quiet technician, empower the junior staff, restore trust where it’s worn thin.

• Monitoring and adjusting in real time, using feedback as fluidly as a neurosurgeon monitors infusion pressure and distribution on a live scan as CED does in real time, to ensure change is spreading, not stagnating. In CED terms - if the infusate stops spreading, then it may be time to reposition the catheter.

  
  

It’s not always fast.

It’s not always easy.

But it’s precise, intentional, and transformative.

Rick’s Commentary

If your veterinary hospital is experiencing persistent dysfunction, disengagement, or low morale, ask yourself: Is it time to stop reaching for systemic fixes.

Are you treating the symptoms—or the source?

Maybe it’s time to treat the issue from within.

Is your approach the equivalent of chemotherapy—broad and damaging—or something more focused and restorative?

In veterinary medicine, we have learned long ago that not every tumor needs to be excised, to be irradiated or to receive systemic chemo. Some just need to be diagnosed, accessed, and treated with precision.

Veterinary leadership should be no different.

Sometimes the best solutions don’t come from the outside.

They come from the inside, delivered where they’re needed most.

Just like a veterinary neurosurgeon facing a dog with a brain tumor, you need to ask:

What’s blocking the solution from reaching the problem?

What would it take to deliver an intervention directly to the source?

In brain tumor management (and perhaps in veterinary hospitals), the answer may lie not in stronger drugs or higher doses.

The answer may lie in finding a way to the core of the problem without causing collateral damage.

Selected Sources

EB Douple, JR Fike, JW Strohbehn, RA LeCouteur: Localized microwave-induced hyperthermia in dog brain. Annual Meeting of the Radiation Research Society, Minneapolis, MN.  May 31-June 4, 1981. (Radiation Research 87:475, 1981).

PJ Dickinson, RA LeCouteur, RJ Higgins, JR Bringas, B Roberts, RF Larson, et al.

Canine model of convection-enhanced delivery of liposomes containing CPT-11 monitored with real-time magnetic resonance imaging: Laboratory investigation. Journal of Neurosurgery (2008). https://pubmed.ncbi.nlm.nih.gov/18447717/

V Varenika, PJ Dickinson, JR Bringas, RA LeCouteur, RJ Higgins, J Park, et al.

Detection of infusate leakage in the brain using real-time imaging of convection-enhanced delivery: Laboratory investigation. (Journal of Neurosurgery 2008). https://pmc.ncbi.nlm.nih.gov/articles/PMC2725182/pdf/nihms125251.pdf

SJ Parvar, CI Wong, A Lewis, E Szychot, CJ Morris, D Shorthouse, K Dziemidowicz: Convection-enhanced delivery for brain malignancies: Technical parameters, formulation strategies and clinical perspectives, Advanced Drug Delivery Reviews (2025). https://www.sciencedirect.com/science/article/pii/S0169409X25001425?via%3Dihub

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