Chapter 16: Developing the Division of Pediatrics
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Description
Dr. Kleinerman discusses the growth of the Division of Pediatrics and the need to further develop services for adolescents and young adults.
She explains the business plan she developed at Dr. David Callender’s request when she assumed leadership of the Division.
Next she discusses the design of the Children’s Cancer Hospital opened in 2013 and the four advisory councils created to help guide the design and staffing.
Next, Dr. Kleinerman explains the need to develop services for adolescents and young adults (particularly in the area of fertility counseling) and explains why pediatrics is attuned to the special needs of patients. She talks about a failed attempt to open a special lounge area for this group.
Identifier
KleinermanES_04_20140618_C16
Publication Date
6-18-2014
City
Houston, Texas
Interview Session
Eugenie Kleinerman, MD, Oral History Interview, June 18, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionBuilding/Transforming the Institution Multi-disciplinary Approaches Growth and/or Change Research, Care, and Education in Transition Patients Philanthropy, Fundraising, Donations, Volunteers
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
Tacey Ann Rosolowski, PhD:
Okay. So the counter is moving. We are officially recording, and today is June 19th, 2014. I’m in the office of Dr. Eugenie Kleinerman today for our fourth session together, our final session together. The time is 9:28, and I want to thank you again for taking the time for this interview, Dr. Kleinerman.
Eugenie Kleinerman, MD:
You’re most welcome. You’re most welcome.
Tacey Ann Rosolowski, PhD:
Well, as I mentioned before we turned on the recorder, I just have some few categories of questions left to do, and I wanted to make sure to ask you some of the kind of final questions about your administrative roles of division head of Pediatrics. And one thing that struck me is I read somewhere in the background material that I was doing, that you were very interested in kind of the business development dimension of MD Anderson, and certainly you were involved with that in the new identity branding of Pediatrics in 2005. And so I wanted to ask you that general question. I mean, how do you think the development of Pediatrics has contributed or been part of the growth of MD Anderson, and vice versa?
Eugenie Kleinerman, MD:
So—
Tacey Ann Rosolowski, PhD:
And you can change the question if it’s not quite worded right. (laughs)
Eugenie Kleinerman, MD:
No, no. So I think, as we’ve spoken about before, when I took over, there really was not a citywide, national, statewide, local awareness that MD Anderson took care of children. There was the perception this was an adult institution. So one of my personal goals was to change that perception, because I think also as we had discussed, I think one of the advantages of being a pediatric unit in a Cancer Center is that everything’s focused on cancer. So new techniques in surgery that are developed and diagnostic imaging, interventional radiology, you have access to those types of things, and the battle is that people aren’t sensitive to the fact that children are not just little adults and you need to have special support systems, child life, although there was child life. But anyway, you needed to have a more age-appropriate environment. And at the time, I really didn’t think anything about business or marketing or whatever, but as I began to go out into the community and realize what the issues were in order to address things, understanding that resources were going to need to be made, and at the time, David Callender was the chief medical officer and his motto was also, “Bring me a business plan. You want resources. How is that going to impact the institution? It’s just going to be a cost or are you going to be a cost center or are you going to be—?” So, again, that was my introduction into if you’re going to be in charge of a division, you just can’t think about all the things you need; you have to think about using those resources to the maximum effect and how you’re going to bring resources into the institution. Why? Not necessarily money, but, you know, new clinical research or basic scientists that are doing novel things. So that’s really when I started to think about, okay, how are we going to raise awareness, what things can we do with the resources that we have, what other things need to be done. So I just sort of felt my way and realized that I needed to have advice from community members. What’s the perception? It was the first time I realized it’s just not what my perceptions of what people think, but I need to ask them, “What do you think? What would make your decision in coming here versus Texas Children’s? What are the things that you worry about in coming here?” So that’s when I began to focus not only on building the type of faculty and infrastructure that I thought was important, but also focusing on, okay, what’s perception? And perception doesn’t mean it’s real, but knowing that perception, what can we do to change that. And that was really the evolution of the advance team and their recommendation that we needed to change the name so that people understood that there was a separate unit that was focused on children, the branding, getting the logo.
Tacey Ann Rosolowski, PhD:
Now, to what degree—because I know you opened this new unit in 2012 or 2013?
Eugenie Kleinerman, MD:
Thirteen.
Tacey Ann Rosolowski, PhD:
So, ’13. To what degree did all of that work prepare the ground? And what’s the result been?
Eugenie Kleinerman, MD:
So, you know, it was an evolution. We became the Children’s Cancer Hospital. The Board of Regents allowed us to have the designation. We got the logo. And then I had an advisory board, members of the Board of Visitors, who were very focused on children with cancer, and they said, “This unit is not commensurate with the rest of the institution. Yeah, it’s in the Alkek Hospital, but it really is not up to what a children’s hospital would have.” So again they amplified my voice, and that was the decision, that we needed a special unit for children. And so that evolved. I think that in the past year, I’ve spent a great deal of time educating not only people outside of the institution, but people within the institution what this unit is, what it meant. We asked our customers. We designed according to our customers.
Tacey Ann Rosolowski, PhD:
What was—tell me about that process. What about the design?
Eugenie Kleinerman, MD:
So we have four councils. We have our Family Advisory Council that’s made up of parents whose children are undergoing therapy and parents whose children have finished therapy. We have a Supportive Care Council who’s made up of parents whose children died in our unit, because we think it’s important to get their input.
Tacey Ann Rosolowski, PhD:
Wow.
Eugenie Kleinerman, MD:
We have a Teen Council, and then we have something called IMPACT, which is young adults. So each council meets once a month, and so we engage them in the process of designing the unit, picking the colors, naming the pods, what types of things do you want on the unit, a kitchen, a laundry room, sleep rooms for parents whose children are in the Intensive Care Unit, having a locked unit, the furniture, everything. We ask them, “What’s important to you? What things matter to you?” For example, they told us that they have lots of questions during the day, the care team comes in, and they forget what the questions are. So we designed a board in the room that had “Questions for my Care Team,” and with a Magic Marker, so at ten o’clock in the morning, they write their question down. So in the evening when the care team comes in, they say, “Oh, these are the things that I’d like to know.” So, little things that you’d never think about from a medical perspective, because it really doesn’t impact the medical care, but it impacts the patient experience. So I think we were probably the first unit that started to think about the patient experience and change the way we do things based on what patients and their families told us. I mean, everybody talks about the Cleveland Clinic being the leaders in this, but I think Children’s Hospitals actually were probably the first to do this, and we capitalized on what we knew from our colleagues at Children’s Hospital.
Tacey Ann Rosolowski, PhD:
Remind me of the name of the unit.
Eugenie Kleinerman, MD:
So the name of the unit is the Children’s Cancer Hospital at MD Anderson. Now, some of the pods, one of the pods is the George Foreman Unit, because Mr. Foreman donated a million-three, a million and three dollars, because he said anybody can give a million dollars, but only he gives a million-one,” or a million-three. I don’t remember what it is. So one of the units is the George Foreman Unit. The Ambulatory Care area is the Johnson because the Johnson Family. Brenda Johnson, who was an ambassador to Bermuda, she’s actually a member of my advisory board, the Honorable Brenda Johnson. So her family gave money when it was in our outpatient clinic, when the Ambulatory Care Center was part of our clinic. So when we moved it up to the ninth floor, so that unit is named the Johnson Unit. But the name of the hospital is still open, so a donor has not come forward to name the hospital, so that’s still a possibility.
Tacey Ann Rosolowski, PhD:
What do you feel is, aside from the naming, is still left to be done in the hospital? Is it a work in progress?
Eugenie Kleinerman, MD:
It’s always a work in progress. It’s always a work in progress. You know, I had initially envisioned that we should have our clinic also in the same area, but they didn’t want to give up hospital space for clinic space, which I understand. What’s left? I think a great unmet need is adolescents and young adults. We do have one of the pods that’s dedicated to adolescent and young adults, but they are only the ones that are on our service. I think that there are a lot of patients in this age range, and the NIH defines it as fifteen to thirty-nine. Some people define it as fifteen to twenty-six or fifteen to thirty-six. But these are a group of patients, certainly in the late teens and through the twenties, that are certainly different than sixty-year-olds, fifty-year-olds that have many more needs. For example, fertility. I mean, a fifty-year-old woman is not going to worry about fertility when she’s getting her chemotherapy for breast cancer, but you’ve got a lot of young women that are getting breast cancer in their thirties, and so fertility is something that needs to be considered. These things need to be discussed, and I don’t think our adult colleagues are as in tuned to asking this. So, I mean, we have a team that, just because of our interest, formed where we look throughout the hospital and see where all the young adults are and then go and ask about fertility questions, for the men, sperm banking, things like that.
Tacey Ann Rosolowski, PhD:
Interesting.
Eugenie Kleinerman, MD:
But it’s not done on an organized basis. In 2004 and 2007, I had proposed an adolescent and young adult unit or waiting area, and we did focus groups, and what we heard from the teens was that, “Why do I have an old person’s disease? I’m sitting in a waiting room with fifty-year-old, sixty-year-old men. I have testicular cancer. He has prostate cancer. He’s got a urine bag. The magazines are Field & Stream or AARP. None of these people are like me. What’s wrong with me?” But the decision at the time of the institution was that these are usually patients who aren’t well insured because they’re in college or they’re between jobs or whatever. So I think the Affordable Care Act actually opens up an opportunity for us to reexamine this. I’m hoping the institution will reexamine it. So that’s sort of what I think the next step is. Okay, we’ve got children, we’ve got Family Advisory Councils, but we still have an unmet need in a very young group of patients.
Recommended Citation
Kleinerman, Eugenie S. MD and Rosolowski, Tacey A. PhD, "Chapter 16: Developing the Division of Pediatrics" (2014). Interview Chapters. 1412.
https://openworks.mdanderson.org/mchv_interviewchapters/1412
Conditions Governing Access
Open
