Chapter 13: Landmark Moments in the Growth of Diagnostic Radiology
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Description
In this chapter, Dr. Hicks summarizes key moments of change during his leadership of the Department of Diagnostic Radiology. He first notes the governance structure he helped organize and his role working within the Division of Diagnostic Imaging so the department could function as a full partner with other departments. He also notes the strategic recruiting that build the research and clinical capacity of the department, as well as the strengthening of infrastructure and administrative support for the new activities.||Dr. Hicks also explains that the Department began looking beyond the confines of the Houston campus to the region. He talks about the “groundbreaking moment” of developing very patient-centric radiology services at West Houston Imaging in the Bellaire area of Houston. On this theme he also notes that the department shifted from a faculty-centric to patient-centric focus, with Dr. Joey Steele leading the patient experience initiative. Dr. Steele worked with the Dean of the hospitality institution, the Conrad Hilton School at University of Houston, to improve customer service. Dr. Hicks shares a summary of the positive feedback to a study on patient satisfaction.
Identifier
HicksM_03_20180703_C13
Publication Date
7-3-2018
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; On Leadership; MD Anderson Culture; Building/Transforming the Institution; Growth and/or Change; Care; On Care; Survivors, Survivorship; Patients, Treatment, Survivors; Working Environment; Institutional Mission and Values; The Business of MD Anderson; The Institution and Finances; The MD Anderson Brand, Reputation; Professional Practice; The Professional at Work
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 A. Rosolowski, PhD:
I am going to ask you about some landmark moments in the development of the department, but can you give me an example of something that needed to be revisited?
Marshall Hicks, MD:
A couple of issues that came up. One is sort of the staffing for the different areas and sharing that. For example, our Radiology Outpatient Center, the ROC, is something where it was felt pretty strongly early on that we were going to have everybody sharing in that. Regardless of what section, somebody would be assigned over there, because they basically needed a physician over there for emergencies, so we’re all going to share that together. Then we realized, as time went on, that that wasn’t always the best use of people’s time. For example, in areas where they did procedures, you’re taking somebody that can be doing procedures and putting them over there, where they really are not able to do that. So it’s how do we work together to share and make sure that the right role is being assigned to the right place. Sometimes the quality and just making sure it’s all shared is great, but is that the best use of resources in the department? So revisiting that and be willing to say what --we’d rather have those proceduralists doing what they do best and what they’re trained to do, as opposed to just sitting in a remote area and not being able to help cover that. I think those are the sorts of things. When we looked at effort allocation, which is an ongoing issue, it’s what’s the appropriateness of certain effort for clinical and nonclinical allocation and making sure that’s consistent across the departments. Some of those things are just iterative, and you have to be willing to say, we’re not going to get this perfect the first time. We’re going to come back and we’re going to make sure and maybe we’re going to use the best metrics we know now, but maybe that’s not the best ones that we’ll be using a year from now.
Tacey A. Rosolowski, PhD:
That’s such a realistic approach too, because the situations in which these situations are made are so dynamic and complex. It can be really, really difficult to get it right. So having the provisional, “we’re going to try this out and then reassess,” sends a very realistic message about just how operations like this evolve. So tell me about some landmark moments during the time that you were department chair, because you held that role until 2012, from 2007 to 2012.
Marshall Hicks, MD:
I think establishing the governance structure was critical, you know having it become its own identity, establishing that identity was a critical moment for us, to kind of establish ourselves as a separate department. Being able to work within the division to become a full partner if you will, with other departments that were emerging, they were certainly some opportunities to shift in terms of recruiting, from pure clinical to saying now we have the opportunity, as things settled down from that pace of explosive growth in the ‘90s, to think about strategic recruiting. That was another pivotal moment for really looking at again, creating more of a longer term identity of the department, starting to bring in.
Tacey A. Rosolowski, PhD:
Now I assume that there were some financial implications of becoming a department, more resources. How did that all work out?
Marshall Hicks, MD:
That’s true. Building the infrastructure, because for a while it coexisted within the division really, and so it was really administrative support. Personnel, building that infrastructure was part of that new—part of the governance structure parallel to that I think, to support it. We also started looking at the region. We didn’t really have much outside of the main campus, and so we converted the Bellaire Radiation Oncology facility into a small but established outpost there in Bellaire. I think it had one MR, one CT, but it was something that was more convenient for patients --was starting to establish ourselves out in the community. Then we started planning, eventually built the West Houston Imaging facility, which is just very patient-centric. Have you been out there?
Tacey A. Rosolowski, PhD:
Uh-uh.
Marshall Hicks, MD:
It’s definitely worth a visit. It was designed around sort of the patient-focused workflow, and so we actually sent a group of three or four people out to Virginia Mason clinic. They had a Lean Design workshop for healthcare facilities that they put on and we got a lot of great ideas, brought that back. Some of the concepts were --we don’t have a big massive waiting room, it’s more individual rooms that you go into and can have some privacy. Then you go into the exam room, a room where you can have your family, you can have electronics, or you can just have quiet. The doors actually slide so that you don’t have somewhat of a safety issue, but also a space conservation issue. So you don’t have doors opening into the hallway or opening into the room, and the doors area all this opaque --like bamboo shoots and glass and stuff, so it’s very calming. There’s a very large separate Women’s Imaging Center there that’s divided into screening versus diagnosis. So when patients come in and they’re just there for screening, there’s a lesser anxiety about that than when they’re coming back because maybe there’s an abnormality that was found on a mammogram. Those go into a different area. Regardless, they’re both a very spa-like atmosphere, with running water and all that, sounds.
Tacey A. Rosolowski, PhD:
What’s your impression? I mean you’ve got a smile on your face when you’re saying this, I mean is that something you think is—?
Marshall Hicks, MD:
Oh, I think it’s fantastic, I think it’s just—it really was sort of, I forget the word you used, landmark or groundbreaking. For us, that was a moment where we really said, we’re going to make this about the patient going forward. Now, it’s hard to retrofit everything we have down here. But we made that decision as we did renovate, or as we were going to be building more facilities out in the community, that that’s what we are going to use as a model.
Tacey A. Rosolowski, PhD:
Now let me ask you about this. I had gone on rounds with Carol Porter [oral history interview], in the Breast Center, and she and some of the other nurses were talking about how much that center needs to be redesigned. At the same time they were saying that there were serious objections to that idea from a number of faculty members who said no, MD Anderson is really about the science, it’s not about being a spa. Is that an attitude you’ve encountered or is that kind of a rogue attitude in this day and age, or what’s your impression of that?
Marshall Hicks, MD:
I have not really heard that. I think it’s change and any time you’re changing, you know that’s how we’re going to be. For me it’s the right thing to do. Secondly, it’s how we’re going to be judged and probably paid going forward, a lot based on that and the experience of the patient. So we have to—it’s a different world. I think we have to—we’re going through an experience right now with both my wife’s parents and my parents, and dealing with healthcare issues, and it makes a huge difference when you’ve got staff and facilities that are focused on the patient and the family needs, as opposed to this is what works best for the facility or for the staff there. It’s not only frustrating, it’s stressful. You know it’s stressful. So I think all of this to me is about creating that environment for the patient that is as stress free as possible because they’re dealing with the battle of their life, or the diagnosis, possible diagnosis that’s pretty scary and what can we do to make them—lessen that stress to make it as less unpleasant as possible or as pleasant as possible for what they’re experiencing. I think some of that --I’ve not heard those specific comments but you hear those general type comments that we’re about advancing the science and patients shouldn’t care about the comfort factors if they’re at the best place in the world, but I think there’s no reason we can’t do both.
Tacey A. Rosolowski, PhD:
Yeah, yeah. Also, there is all that emerging compelling evidence that low stress actually improves patient outcomes.
Marshall Hicks, MD:
Yeah, absolutely.
Tacey A. Rosolowski, PhD:
Good thing to pay attention to. Well thanks for telling me about that because you know, that’s a really interesting, as you said, groundbreaking moment. Were there other big achievements during the department years, and then I’ll ask you about the move into the division head.
Marshall Hicks, MD:
I think the other thing we talked about a little bit earlier, was the emphasis on—and again, it’s sort of the patient-centric emphasis is shifting from a focus of staff or faculty-centric care to patient care in about the time when they’re reading. So it meant coming up with innovative ways to staff, innovative electronic solutions to try to list the patients that had their appointment soon. Our goal became to read within two hours of the appointment, and so our lists would get prioritized that way. And having the patient be at the center of what we were trying to achieve, as opposed to the faculty or staff convenience or focus. That’s again, that similar thing you just mentioned, it’s doing both. One thing we did, it was subsequent maybe, to those years. It was when I was either doing both or was division head. But Joey Steele led an effort with the University of Houston’s Conrad Hilton School. Joey, who was the deputy division head and the quality officer, chief quality officer for the division, really led this effort in terms of patient experience, and reached out to the Hilton School because they’ve figured out the customer experience. That whole industry, restaurant, hoteling, and he was amazed when they came back from a conference where they got to visit the largest Marriot in the world, which is in Orlando, and realized that they have dinners that they’re serving thousands of people and they’ll have two or three or four going on at the same time. It’s kind of like DI, where we have 1,400, now 1,800 patients, going through a day. It seems like an overwhelming number but there’s other industries that deal with those amounts and much larger, and manage it, manage to get feedback and managed to understand what patients want or customers want. So he came back and reached out after that meeting with the dean at University of Houston, and the dean and one of the associate deans came over, and the associate dean ended up working with us for a couple of years, Stowe Shoemaker. He’s now the dean at the University of Nevada, Las Vegas for hotel and restaurant school, probably not the exact name. We actually did a study where we looked at—we surveyed and asked patients what they wanted and then we changed one or two of our CT areas, because we have several. So we could actually do a study where we would make the changes if they wanted, in a couple areas, not in the others, and then look at the patient satisfaction scores and really get the feedback. One of the things we found, first of all the closer they got to care, the more they wanted to be treated like a loved family member, so when they’re actually in a room or getting a procedure done or meeting with a physician or a nurse or practitioner. It’s less so when you’re at the valet, you still want to be treated respectfully. But as you get into encounters for care and diagnosis for us, and the CT scanners for example, they wanted to be treated like a loved family member. But one of their highest priorities is having the scan, having the exam read in time for their clinic appointment, because of the anxiety around that. We called it “scanxiety” because they get very anxious about it and they want to know the results. So when we were able to take that data and show it to our faculty members, it makes a much more compelling case that we really need to do some things to change how we practice, understanding that, you know put yourself in their shoes. Many of them are very welling to do that, are compassionate individuals, even though radiologists are not always interacting with the patients directly but they feel it, they know it. They know what’s going on with that individual patient that’s on the other end of the exam. That was a major change we made, to try to put an emphasis on that and to really put some goals and strategies around the timeliness of reading and to change the care. I’m proud to say, the comments that have been made over the years, that’s markedly better and it’s appreciated. A lot of colleagues and referring areas that make comments about that and that is something that we need to be very proud of.
Tacey A. Rosolowski, PhD:
How have those good reviews, good feedback, appreciation, how has that had an impact on the culture of the department?
Marshall Hicks, MD:
I think it helps, we try to share it. You know just like your reputation is made every day, I think getting the feedback and having the appreciation is something we—I don’t feel like we do if often enough but we try to get that feedback. When we established the Service Excellence Academy, some of that was around getting direct feedback from patients, sort of a little photo booth and different ways that we had to kind of get that information back to people so they understand it’s really important. I think it connects people back to the mission, which I think helps. It’s an ongoing challenge, I mean people, as much as they want to keep that in focus, there’s challenges they’re dealing with in their job every day.
Tacey A. Rosolowski, PhD:
Sure.
Marshall Hicks, MD:
Those sometimes get to a point where that takes the precedent or creates more of a threat to morale, than you will, than the altruistic piece of it. I think it is important to remind people. I think most of us want to be reminded, you know it’s very humbling. I just want to a physician, a doctor. I had an encounter with a dermatologist, had some eye issues recently, and dealing with my mother in-law and my parents, issues right now, you realize the struggles that patients go through and it’s very humbling. It’s easy to get remote from that when you’re not having the direct encounters, but the reminders of that and what they’re going through, not episodically like most of us do but chronically, constantly. I think it helps keep things in perspective.
Recommended Citation
Hicks, Marshall MD and Rosolowski, Tacey A. PhD, "Chapter 13: Landmark Moments in the Growth of Diagnostic Radiology" (2018). Interview Chapters. 201.
https://openworks.mdanderson.org/mchv_interviewchapters/201
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