Chapter 09: A New Role in the Department of Strategy and Innovation
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Description
Ms. Kaul explains the scope of her job and her strategy of learning about MD Anderson and how innovative solutions might serve it. She explains her philosophy of learning about institution culture, building relationships before introducing change, and learning why individuals find innovation threatening. She talks about her findings after several months at the institution.
Ms. Kaul assesses that MD Anderson is “way behind” the industry in developing technology and infrastructure, a situation connected to the institution’s status as a comprehensive cancer center. She goes on to explain that patients currently factor cost/care transparency into their selection of a healthcare institution.
Identifier
KaulR_02_20160425_C09
Publication Date
4-25-2016
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Leadership; Definitions, Explanations, Translations; Overview; Building the Institution
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T. A. Rosolowski, PhD:
So tell me a bit about, I don't know, the first hundred days, the first months, because you haven't even been here a year. So, when you took the position, there's sort of the mandate, you know, the goals you've been given. But then it seems to me you probably had some personal goals, you know, a personal vision of what you wanted to do. So, talk to me about that array of how you wanted the job to evolve.
R. Kaul, MBA:
I think my lessons learned taught me to take it slow in the first hundred days. My lessons learned in a big -- working in a large academic medical center is to learn the culture and to build relationships before being overly disruptive, because if you're disruptive before you understand that component, you will set even though it's in the interest of progress, it will set you back. And it'll take longer to overcome the damage you do than it will take to just take it slow and get to understand these things before you try to do anything too big, or too disruptive. Now I keep using this word "disruptive," and I don't know if I've said it before, but anything that's innovative is going to be disruptive. And it's not going to be popular, and it's going to be hard. So understanding how to navigate an institution like this takes time.
T. A. Rosolowski, PhD:
I was thinking earlier, too, I mean when you were listing the challenges of working in an academic medical center, and how it's difficult to get people to understand, and have credibility, you know, I was thinking, wow, part of that is just hearing the word "innovation." People think about generational differences, they think about young people are going to come in and they're going to kick me out, because they have a new and better and faster and, quote, "more innovative way of doing things." I think that's what a lot of people expect.
R. Kaul, MBA:
And people are threatened by it because they view the fact that we're going to come up with a new way of doing things as a -- they view it as a commentary on how they're currently doing things, and not necessarily a positive commentary. Now I would argue that they didn't have the tools that we are bringing to the table today yesterday, so it shouldn't be a negative commentary. You know? They were doing the best that they could yesterday, and now we're going to do the best that we can today, and we're going to do even better tomorrow. So it shouldn't be punitive. But people instinctually view it that way. So part of doing innovation is understanding how to communicate and how to deliver those messages in a different culture. And in a large culture like this. And something that I've learned in my first whatever it is, is that coming here to Texas is also a cultural difference for me. So there's a double learning curve. It's not just this institution. But it's the Texas culture, which is very different from the Northeast. So my goal, popular or unpopular, rightly or wrongly, was simply to start to understand the politics, the bureaucracy, the culture and how to get stuff done around here. Simple as that, so that I didn't do damage that I would have to overcome. Build relationships. Figure out who are those grassroots innovators, you know? Figure out what makes people tick, and how people are incentivized and how we can create those soft incentives. But that depends on the culture, it depends on the people, and it takes time to get to know people.
T. A. Rosolowski, PhD:
What are some observations you're making in those areas so far?
R. Kaul, MBA:
People here are not as direct, and they don't necessarily appreciate the directness that we have in the Northeast. I think this is a very research-driven and a very academic institution, which was not the case at UPMC. And so people are -- people come from a different frame of reference. People think in terms when they think about process for innovation, they create the analogy to drug development and therapeutics, where there is very little overlap in how you would model what we're talking about in technology to that other process. There's a lot of differences. You know, they're incentivized more -- when I say "incentivized" I don't mean formally, but they're motivated, is maybe the better word, by research dollars, not necessarily startup companies, or being an entrepreneur, or being in that community. It's sort of a different, it's a different set of priorities here, which makes me have to think differently about how we communicate and how we motivate to drive the agenda. Where we are in terms of technology, our basic foundation and infrastructure is, you know, well behind the rest of the industry.
T. A. Rosolowski, PhD:
How so?
R. Kaul, MBA:
I mean even something as simple as we just put in an electronic medical record. At UPMC we put that in more than 10 years ago. Probably the rest of the industry is somewhere in between. But that's just an example, I'm not saying that is the be-all and the end-all, I mean, but what I’m saying is, there's fundamental things that I think I took for granted that don't exist here.
T. A. Rosolowski, PhD:
Do you have the sense of why MD Anderson is lagging behind? You know, and understand the spirit in which I'm asking; it's, you know, nobody sets out to be inefficient. It's just that there's a history of decision-making or reasons why things ended up this way.
R. Kaul, MBA:
I think that it goes back to alignment of incentives. The way that the regulatory environment is set for a freestanding cancer center like us. And when I say "alignment of incentives," I actually mean, be outside of our institution. We are paid on a cost basis, which means the more expensive it is to care for a patient, the more we get paid. I mean the implication of that, if you think about it, is that you are not incentivized, therefore, to be more efficient, right? So, we are not subject to many of the metrics, incentives-slash-penalties in the industry that other institutions are in terms of meeting certain quality standards, meaning you have certain patient satisfaction standards, meeting certain technology standards, the rest of the industry was forced to do, implement certain systems and move ahead, whereas we were not because our incentives. [ ]
T. A. Rosolowski, PhD:
And that’s -- and you mean MD Anderson as a comprehensive cancer center..
R. Kaul, MBA:
Yes. MD Anderson as a comprehensive cancer center is not incentivized to operate that way. So I think it makes perfect sense. Like, I wouldn't be critical of it, but it wasn't something -- because I don't come from a comprehensive cancer center, that I was overly familiar with coming in. It's something I've had to learn. And what that means, and how that changes how people view in terms of urgency or how people view some of the things we could be doing -- even if you think about the emerging markets, everything in the emerging marketspace and healthcare has to do with the changing regulatory environment, and how are we going to transform from a fee-for-service to a value-based care model? And how do people do more for less? How do we consumerize healthcare, because any more with all of the new regulations, patients are having to be -- having to look into their own pocketbooks to manage their healthcare. We've kind of shifted the payment models with respect to patients. So shifted towards patients in the sense managing the cost of -- managing the expenses of healthcare, and making decisions on where they're going to go and how they're going to treated, and what they're going to do from a treatment perspective based on more cost-quality transparency, right? I mean, that's where the healthcare market at large is going, but not really where your cancer centers are going, because we're not subject to any of it. So people are entering into more risk-based contracts and things like that, but not necessarily us. So --
T. A. Rosolowski, PhD:
Do you think --
R. Kaul, MBA:
Everything I kind of study and follow and look at, and especially coming from an institution that's on the other end of the spectrum, I mean, we were a payer provider, so we were, in a sense, an ACO before there was the word, "ACO." Right? Because --
T. A. Rosolowski, PhD:
"ACO" meaning...?
R. Kaul, MBA:
Accountable Care Organization. You know, before the industry termed "ACO," we were already one because we were a payer provider. So I came from the opposite end of the spectrum. And so it's taken me some time to readjust to a different way of thinking, because -- and it's not right or wrong, it's just different. We're subject to different things here, therefore our priorities are different. I mean, what's so great about the situation we're in is the fact that we're not reimbursed -- we're not being forced to drive our costs down to such an extent. We get to pay more attention to our patients. We're not sitting there going, I've got to churn through this many patients in this amount of time in a day, and bill a certain amount, and have this many codes, and this and that. We're just focused on taking care of that patients, whether that takes 10 minutes or 10 hours, or whether that takes, one procedure or 10 procedures. We're just focused on the best patient care, and I love that. So I'm not -- when I'm saying all this, I'm not being critical, I just came from a different setting.
T. A. Rosolowski, PhD:
Well, it also means that you kind of see the need for change differently, because you've seen what's necessary and possible in the new healthcare environment, whereas it sounds like people at MD Anderson have been operating in a bit more of a protected environment.
R. Kaul, MBA:
Yes, that's exactly -- this is kind of -- we live in a bubble here. And so what it's made me start thinking about is, will this bubble burst? What part of this bubble will burst? Maybe it's just going to shrink, and what does that mean? You know, because innovation is about thinking about the future, right? So is the future of MD Anderson that maybe the size and shape of this bubble is going to change? So what I'm starting to have to familiarize myself with is to start to understand, will everything I'm familiar with from kind of the rest of the healthcare world, what pieces of that will begin to apply to us, and how can I take the learnings from there and prepare us for that?
T. A. Rosolowski, PhD:
How have you --
R. Kaul, MBA:
Which takes time to think through. You know? I mean, to learn and to think through, and I'm not sure I have an answer for you on it. So...
Recommended Citation
Kaul, Rebecca MBA and Rosolowski, Tacey A. PhD, "Chapter 09: A New Role in the Department of Strategy and Innovation" (2016). Interview Chapters. 1268.
https://openworks.mdanderson.org/mchv_interviewchapters/1268
Conditions Governing Access
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