Chapter 11: John Mendelsohn's Plan for MD Anderson and the First Building Projects

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Chapter 11: John Mendelsohn's Plan for MD Anderson and the First Building Projects" The Mays Clinic and the Faculty Center

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Mr. Daigneau first reviews the challenge that managed care presented to MD Anderson. He recalls that Dr. Charles LeMaistre put all expansion plans on hold in reaction to the report on managed care submitted by the Sharp Group (the Sharp Report). Mr. Daigneau notes that the Archives contain plans he created to close facilities. In contrast, as Mr. Daigneau explains, Dr. John Mendelsohn arrived and announced the plan to expand the institution by fifty percent. He lists the key people involved in developing the expansion plan and describes how the Master Plan was redrawn to improve space utilization and address the four years of compression created under Dr. LeMaistre. Mr. Daigneau then talks about two new buildings planned 'the Faculty Center and the Ambulatory Clinic Building (also called The Mays Clinic)"” and Dr. Andy von Eschenbach's role in moving this project forward. He then explains how the new Ambulatory Clinic Building (the Mays Clinic) was designed to maximize clinic capacity. He tells a story demonstrating Dr. Andrew von Eschenbach's role in motivating faculty to move their offices out of the clinics and into the Faculty Center.

Identifier

DaigneauW_01_20131003_C11

Publication Date

10-3-2013

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center Building the Institution; The Administrator; MD Anderson History; MD Anderson Past; Institutional Processes; Discovery and Success; Building/Transforming the Institution; Growth and/or Change; Obstacles, Challenges; Professional Practice; The Professional at Work; Understanding the Institution; On the Nature of Institutions

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Tacey Ann Rosolowski, PhD

1:30:32.4

Right. Okay. So what was the project in which you were able to involve users from the very beginning? What was the first one that you were able to do that with?

William Daigneau, MBA

1:30:40.8

Well, this goes back, again, to a little—so we opened the new Alkek. Actually, the dedication was given by Dr. [John] Mendelsohn because Dr. LeMaistre had by then retired and Dr. Mendelsohn had been recruited. So the actual dedication for Alkek Hospital was in the main lobby by Dr. Mendelsohn. So Dr. Mendelsohn had arrived.

Tacey Ann Rosolowski, PhD

1:31:08.4

Alkek—let’s see, that was ’98—’99?

William Daigneau, MBA

1:31:14.7

Uh-hunh (affirmative). So remember I told you that that was supposed to be the last building project. So Dr. LeMaistre believed—managed care was sweeping through California, and what happened in California, some hospitals were closing because if they weren’t part of a network, then the doctors couldn’t feed the hospitals with patients; you were closing. So the number of beds were dramatically—because better utilization led to—you know—under the old system, you had to have X number of beds. Under our new system that improves the utilization, all of a sudden these beds become excess. So Dr. LeMaistre saw that happening and actually had a—I can’t remember the name of the group.

Tacey Ann Rosolowski, PhD

1:32:06.9

Was it the McKenzie Group?

William Daigneau, MBA

1:32:08.4

No. It began with an “s.” He brought a group in from California that had seen this dramatic change in healthcare.

Tacey Ann Rosolowski, PhD

1:32:21.6

Oh, the SHARP Report.

William Daigneau, MBA

1:32:22.7

SHARP Report.

Tacey Ann Rosolowski, PhD

1:32:23.6

That’s it. Yeah, the SHARP Report.

William Daigneau, MBA

1:32:25.0

The SHARP Report. And SHARP said that basically we would close a third of our beds and all these dire things—you know—our workforce would go back down to a third and all this terrible stuff would happen. Well, Dr. LeMaistre thinks this is like a tidal wave coming. It’s not a matter of if; it’s a matter of when. So we were started to downsize the institution. There was some criticism. Should we finish the hospital? Again it was restated, well, the hospital is a replacement. We’re going to reclose the old beds not the new beds.

So there were all those discussions going on. I sat through a number of strategic planning sessions based on the Sharp Report. Basically my role was, well, how could we downsize? I actually—somewhere sitting in the archives is a mothballing report about how we would close various facilities and mothball them. So that was the mental—the capital plan was we were doing land acquisitions in the mid-campus at the time. That came to a complete halt. The capital plan—you know—a new research building—Dr. Becker was arguing for a new research building—basic science research building. That kind of ground to a halt. All this capital plan was put on the backburner. Everything was in shutdown mode. Dr. Mendelsohn arrives. Dr. Mendelsohn looks around.

By the way, one key event happened before Dr. Mendelsohn arrived. Dr. LeMaistre was able to get through the legislature the self-referral. Up until then—that’s why he was so afraid of managed care, because he said the private docs will stop referring to MD Anderson and will start referring to the other hospitals, and that will close Anderson’s doors, just about. So he got through the legislature the self-referral, which allowed you as a patient to refer yourself to MD Anderson—key step—key step.

Dr. Mendelsohn arrives with this now a law. He looks at all the statistics—Texas population. We’re not going to lose patients. We’re going to get more patients than ever. So we had been in shutting down—basically closing-all-the-hatches mode for about a year. In the facilities business, that’s really a difficult situation because of the timeline it takes to get new facilities online. If you shut everything down in the pipeline, it takes you three to four years to start a growth pattern, as far as space is concerned. Dr. Mendelsohn arrives and says, “We’re going to grow. We’re going to grow by fifty percent.” (laughs) Okay, so where are we going to see those patients?

So one of the challenges—and it was a great experience, and I have a great respect for these people. I’ll name them right off. Dr. Mendelsohn is number one. We’re going to do this. How can we do it? Number two, he recruited a team—Leon Leach. How can we pay for it? That was Leon’s role. Kevin Wardell, in charge of the hospital and clinical operations; Dr. [David] Callender, in charge of the docs; then there was Dr. Becker. Dr. Mendelsohn was—you know—we’ve got to see more patients because more patients allow us to fuel our research program. Dr. [Frederick] Becker liked that idea. Maybe he’d get his research building. More patients, who doesn’t like that? More clinical trials—growth is a wonderful thing to be in, you know? So who didn’t like that idea? And it was refreshing after all these doomsday—somebody came in and said, “We’re going to grow.”

Well, so how can we accomplish that with the facilities we have? We don’t have—some lunch? Yeah.

Tacey Ann Rosolowski, PhD

1:37:16.7

Okay, we will just kind of bring this to a quick close?

William Daigneau, MBA

1:37:21.7

So that laid out—first of all, redid the master plan. Number two is what is the strategy to try to accommodate more patients? Well, we had to improve utilization. It’s what I call the period of compression. There are some exam rooms that were being used as offices. No, we’re not going to do that anymore. So every exam room that had originally been designed as an exam room was put back into use as an exam room. Even to the point of shrinking some waiting rooms, compressing. Rooms that had been designed as copy rooms now became offices, negotiating new contracts with Kinkos, getting rid of the copy machine. There’s one of the floor—a copy machine on the floor. We’re going to share this. It required a pretty strong team effort to put a lot—but we went through the period of about four years that was called the Compression Period, where we just improved a higher utilization, moved rented space, moved every administrative office out the main complex that we could, which basically came up with the next two buildings. They were planned during that period of compression. They would relieve the compression eventually.

Tacey Ann Rosolowski, PhD

1:38:59.7

And what were those buildings?

William Daigneau, MBA

1:39:01.2

The Faculty Center and the Ambulatory Clinic Building, because we were trying to see more patients, so we had to have greater capacity. Both have interesting stories with them. Dr. [Andrew] von Eschenbach was still with Anderson. He had not left for the FDA—or what was his first—?

Tacey Ann Rosolowski, PhD

1:39:29.4

He went to the NIH, I think.

William Daigneau, MBA

1:39:32.4

NCI.

Tacey Ann Rosolowski, PhD

1:39:33.3

The NCI, right.

William Daigneau, MBA

1:39:34.2

He had not left for that yet, so he was still kind of the head of the faculty in terms of been there a long time, well respected, very good negotiator, had strong connections throughout the institution. So we were in a meeting, and I was presenting how we could increase capacity with what was called the Facilities Steering Committee that had been created at the Major Building Program stage by Mary Ann Newman that I then built into a more comprehensive decision-making group, because I had all the executives there. And it was chaired by the president. So I’m kind of going through options, and they want to build a new—more clinical space. Where can we do that? I argued. I said, “Well, I think the Clark Clinic and the LeMaistre Clinic were built as clinics, so if we can move anything non-clinic related out of them, we can literally expand in place.” “Well, what are you going to move out of them?” “Well, faculty offices.” And actually, that was—in discussing the options, that was one Dr. von Eschenbach basically said, “I can get the faculty to move. If you’ll give them more clinical space, I’ll get the faculty to move.” I mean, you know I talked about people? If you didn’t have people step up like that, willing to take on difficult tasks—I mean—you could be the greatest facilities person in the world and can’t solve a problem. But here we had a solution—the Faculty Center. That’s how the Faculty Center was created. Because originally it was just going to be an office building to accommodate administrative things, and it evolved into the Faculty Center.

Tacey Ann Rosolowski, PhD

1:42:06.3

Cool. Do you want to take a break at this point?

William Daigneau, MBA

1:42:08.5

Yeah.

Tacey Ann Rosolowski, PhD

1:42:09.5

That sounds good. All right. So I’m turning off the recorder. We’re just going to take a lunch break. It’s nine minutes after twelve.

Chapter 11: John Mendelsohn's Plan for MD Anderson and the First Building Projects

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