Chapter 19: A Chemotherapy Clinic to Serve the World’s Largest Ambulatory Clinic Center
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Description
In this segment, Dr. Escalante explains her role as Medical Director of the Chemotherapy Clinic. She notes that services have grown immensely and that the Clinic serves the largest ambulatory clinic in the world.
Identifier
EscalanteCP_02_20140514_C19
Publication Date
5-14-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; MD Anderson History; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges
Transcript
Tacey Ann Rosolowski, PhD:
Let’s see. I know that we spoke briefly—let me change directions. Sorry. There’s something I need to check before I embark on that, so we don’t repeat any information. You had said that it would be important to talk about some of the committees that you served on. I have the Transfusion, Medical Practice, Credentials, and the Executive Committee of Medical Staff. So if you could speak to those and—
Carmen Escalante, MD:
So those committees helped me develop as a leader a lot and to meet a lot of different people from all over the institution and, I think most importantly, understand how the institution operates to some degree through the policies and procedures developed by these medical staff committees. So I think we had talked about when I first started in ’88 or so, I was first a member of what was called the Disaster Committee back then.
Tacey Ann Rosolowski, PhD:
Yeah, we did talk about that.
Carmen Escalante, MD:
And from that committee, I was asked to chair that committee, and I did that. And then I was asked to be on the—what did they call it—the Transfusion Committee, which was issues related to blood transfusions, platelet transfusions, and I was asked to chair that committee, so that was—my first chairmanship was disaster, which was a smaller, less important committee. So then I got up to a little bit more prestigious committee, Transfusion, but it was still kind of toward the lower ranks, and did that.And then the next step was I was asked to be chair of Medical Practice, which is one of the most important medical staff committees, because all of the medical practice issues, policies related to medical practice come through that committee. And I learned a lot. I learned a lot about how the committees function and how they report. So the Medical Practice Committee reported up through the Executive Committee of the Medical Staff. So I was Medical Practice chair, and then I was asked to be chair—I was first vice chair of Credentials Committee, which is one of the most important, and it’s one step below the Executive Committee so—
Tacey Ann Rosolowski, PhD:
Can I ask you, just before we embark on that, could you tell me some of the issues that you recall working on for Medical Practice, just so I can get a sense of the kind of work that you were doing?
Carmen Escalante, MD:
Well, Medical Practice, I think when I was on Medical Practice we may have started developing some of the algorithms for Medical Practice, which stemmed off into the new committee that—I forget what it’s called now, but it’s where all the algorithms are approved, and then it was a subcommittee under Medical Practice.
Tacey Ann Rosolowski, PhD:
And when you say “algorithms,” what are you referring to?
Carmen Escalante, MD:
Like care algorithms.
Tacey Ann Rosolowski, PhD:
Oh, okay.
Carmen Escalante, MD:
So how do you manage, say, a venous thrombosis embolism from beginning to end, like a flow algorithm, and then order sets related to those.
Tacey Ann Rosolowski, PhD:
I’m sorry, I missed—
Carmen Escalante, MD:
Like order sets, so you—
Tacey Ann Rosolowski, PhD:
I don’t know what—
Carmen Escalante, MD:
So here’s the algorithm that from, okay, the patient shows up with the venous thrombo embolism, the first thing you do is you get a scan or you get a this, and they have all the—so another example would be managing stage-one breast cancer. So the patient shows up. What do they do first, what do they do second? So you had a flow sheet. Then from those algorithms or flow sheets, you had order sets that make up, so—
Tacey Ann Rosolowski, PhD:
And how do you spell that word “otter”?
Carmen Escalante, MD:
O-r-d-e-r. I’m sorry. It’s my accent. (laughter)
Tacey Ann Rosolowski, PhD:
Oh, okay. Oh, all right. I thought it was an acronym or something. My apologies.
Carmen Escalante, MD:
And from that, you’d have like—so for venous thrombo embolism, maybe for outpatient and an inpatient, for the inpatient, and you’d have prophylaxis for venous thrombo embolism, so you needed specific orders for that, that people could pick from. It also helped decrease variation in practice so that you got the right doses and you got the right—everybody kind of doing the same thing. So there was numerous groups working—
Tacey Ann Rosolowski, PhD:
Interesting.
Carmen Escalante, MD:
—on all of these things, from cancer to supportive care-type topics, and now they have huge number of these that have been completed. Well, that group now is a separate subcommittee of Medical Practice, so these are approved first in this subgroup, developed and approved there, and then go up to Medical Practice and then go up to Executive Committee of the Medical Staff. So that’s one of the things, but we would review all the policies of medical practice on a rotating basis, revise, for example, end-of-life care, policies related to do not resuscitate, policies related to restraints of patients. All of those things were taken to Medical Practice for discussion.
Tacey Ann Rosolowski, PhD:
Okay. I just wanted to get a sense of the kind of issues that you worked on.
Carmen Escalante, MD:
Yeah. Any policies related to medical practice. But this development of this other group, this was a new thing. We didn’t have algorithms. I’m trying to remember what they called that.
Tacey Ann Rosolowski, PhD:
The name of that group. Okay, well—
Carmen Escalante, MD:
We can find out. I mean, I have to look at the—I can’t remember what the title of the subgroup. Basically that was created to address all these things.
Tacey Ann Rosolowski, PhD:
Very interesting.
Carmen Escalante, MD:
And so when JCHO came through, as chairs we had to be available if they wanted to meet with us, but especially—
Tacey Ann Rosolowski, PhD:
JCHO? What is—
Carmen Escalante, MD:
Joint Commission of Health whatever it is, stands for—
Tacey Ann Rosolowski, PhD:
Okay.
Carmen Escalante, MD:
—for accreditation. But that was especially important for credentialing, so I really learned about credentialing and the aspects of ---it’s a science of itself-- when I was vice chair and then chair of Credentialing Committee, which is a very important committee. This recommends credentials for individuals that are coming in and re-credentials people, departments that already have credentials, every two years.And we had a lot of transitions during that time. Before, we would kind of credential people on, okay, no metrics; you just re-credential them. During my credentialing time, we developed metrics to objectively look at groups of how they were doing, and subspecialty metrics that were developed by this specific group. For example, we started getting data on all practitioners about chart signage, about whether there were any advocacy issues with the provider, whether they had done their mandatory—it’s called EEE, which we have to do every year to—that covers infection control and a lot of other topics, to show that you’d trained that, whether you had signed your charts properly, dictated your charts properly. All of these things are now standard. They’re now electronic so that they can be done electronically. Back then, we were just developing them. At the beginning when I was either vice chair or chair, we didn’t even have them. We never had objective measures, so everybody was just kind of appointed based on, oh, yeah, they’re a good citizen, they’re doing well. Now it’s expected that you have objective criteria of how everybody—and you can compare them to the others in the group, and if there is a problem, then the department chair has to show that there’s an action plan to address it.Just learning about credentialing and what does that mean and how do you do it, you know, what are all the steps in credentialing and all the state rules regarding privileges for practitioners was eye-opening, and I learned a lot about that. I worked closely with Dr. Alma Rodriguez [oral history interview], who was the vice president of patient—I don’t know if it’s called patient affairs or patient—I think it’s patient affairs [Office of Medical Affairs], and she was very supportive in helping to get all these things in place. Dr. Burke was very supportive. And from that all these quality aspects have been—I think she’s further developed this, and this was after my time, but to quality officers.
Tacey Ann Rosolowski, PhD:
Right. But that laid the base line basis for it.
Carmen Escalante, MD:
Yeah. Now there’s quality officers that look at this data and work with the department chair to identify trends and changes, so it’s been a very good thing. But, you know, this is where I learned how to run a meeting and how to keep everybody focused and keep us on time so we can finish the meeting and get talkers to—
Tacey Ann Rosolowski, PhD:
(whispers) Shut up. (laughs)
Carmen Escalante, MD:
Exactly. And get people that needed to say something to say it. I mean, it takes a skill, and, I mean, you know, I got to be very on time, because everybody’s time is valuable, so, you know, limiting your discussions to appropriate and focusing people on the discussion. And I subsequently became chair of Credentialing, which is an important committee, and then I became vice chair of the Executive Committee of the Medical Staff, which is the top committee of the medical staff.
Tacey Ann Rosolowski, PhD:
Let me just interrupt you for a sec, because we are a little after one o’clock, and I don’t want you to be late for something that you have next. Should we stop for today and then we could—
Carmen Escalante, MD:
Yeah, that probably would be good.
Tacey Ann Rosolowski, PhD:
Okay. I just didn’t—you know.
Carmen Escalante, MD:
You probably don’t have too much left, right?
Tacey Ann Rosolowski, PhD:
Probably I can do what remains in an hour, if I could schedule another appointment [unclear].
Carmen Escalante, MD:
Okay.
Tacey Ann Rosolowski, PhD:
Okay. Well, why don’t we—and I’ll make a note that we—
Carmen Escalante, MD:
We’re almost there.
Tacey Ann Rosolowski, PhD:
Yeah. (laughter)
Carmen Escalante, MD:
And if I’m talking too much—
Tacey Ann Rosolowski, PhD:
No, not at all. I’ll just make a note of where we left off so that we can—
Carmen Escalante, MD:
Go from there.
Tacey Ann Rosolowski, PhD:
—resume with the Executive Committee the next time. All right. Well, thank you very much for—
Carmen Escalante, MD:
Thank you.
Tacey Ann Rosolowski, PhD:
—giving me your time today, and I am turning off the recorder at about two minutes after one.
Carmen Escalante, MD:
Interview Session Three: May 23, 2014
Recommended Citation
Escalante, Carmen MD and Rosolowski, Tacey A. PhD, "Chapter 19: A Chemotherapy Clinic to Serve the World’s Largest Ambulatory Clinic Center" (2014). Interview Chapters. 777.
https://openworks.mdanderson.org/mchv_interviewchapters/777
Conditions Governing Access
Open
