Chapter 24: Transitional Moments in MD Anderson History

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Chapter 24: Transitional Moments in MD Anderson History

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Dr. Rodriguez sketches key moments of change in MD Anderson history since her arrival. She first talks about the eighties and the “growing consciousness that MD Anderson is an economic entity,” moving on to the nineties and the complexities that evolved with more billing forms, rules, and concern for downstream revenue generated from patient care. She gives an example of chemo therapy orders and talks about pros and cons. Dr. Rodriquez then talks about the MD Anderson’s physical expansion to the point where she “can’t embrace” the institution. She notes that the physicians and nursing staff have preserved their dedication and pride.

Identifier

RodriguezA_04_20150605_C24

Publication Date

6-5-2015

City

Houston, Texas

Topics Covered

Institutional Change; Critical Perspectives on MD Anderson; MD Anderson History; Institutional Mission and Values; MD Anderson Culture; Growth and/or Change; Industry Partnerships; The Business of MD Anderson; The Institution and Finances; Research, Care, and Education; The Life and Dedication of Clinicians and Researchers

Transcript

Tacey A. Rosolowski, PhD:

Yeah, I mean, you know, you’ve been at the institution for a long time, I mean, you’ve seen it go through a whole variety of arcs and peaks and valleys. And you know, I kind of, I guess I’d like to throw the question to you. You know, what are some of the kind of big moments you think of as the key moments of change? And then I did want to ask you about, you know, the most recent period since 2011 when Dr. [Ronald A.] DePinho took over at the Institution. But you know, what have you observed in terms of big, key moments of change at MD Anderson?

Alma Rodriguez, MD:

Well, I think coming to the Institution in the late ‘80s or so, the very first thing that I experienced as a real change in the Institution was the growing consciousness that we were an economic entity. When I first arrived at this Institution, believe it or not, we didn’t even talk about submitting bills for our services. There were no such thing as billing forms. You just saw the patients, somebody somewhere submitted a bill, but we never knew who did it, or what. You know, we were completely free of any link or any consciousness of the economics of what we did and the actually delivery of care. It was completely focused on taking care of the patient. Somewhere in the early ‘90s, I don’t know exactly the date; it was kind of a subtle thing. We began to have forms that we needed to fill, check boxes. You know? You simply checked boxes. And there wasn’t very much, if you will, complexity to the billing forms. And then suddenly, there were all of these rules. We had to learn about how you fill the boxes, and how many checks of this or that, and the complexity of the level of the care. You had to learn all the rules about that, to eventually people even looking at how much of this or that have you done? What is the downstream revenue that you have generated as an individual to the current situation, which is, you have to state what your commitment is to what percent of your time are you dedicating to the clinical service, and what does that translate to in measurable quantities of care delivery units? And there are all these formulas for calculating the care delivery units, and so on, per unit of service, and so on. So it’s become now its own, if you will, almost accounting discipline, keeping track of what is your productivity quotient—that, from a care delivery perspective, that’s been a radical change. It’s been—it has escalated over time, but it has been, in my experience, speaking of the day-to-day and routine work, that was a very dramatic shift in the way we did our care delivery. The second, of course, was the introduction, progressive introduction of more structured forms of documentation. And one of those that I actually was instrumental in implementing was the development of structured forms for chemotherapy; structured forms for the orders, so that we were able to track several—embed into the orders several safety elements to ensure that we were consistently doing X, Y or Z. So consistently, we were, for example, ensuring people had anti-nausea medicines that were appropriate to the level of complexity of the chemotherapy; ensuring that we had specified, in a very specific way, that we had prescribed in a very specific way the types of medications that a challenge with handwritten chemotherapy orders, where sometimes the pharmacist couldn’t read the name of the drug. So these, of course, when you have typewritten, structure forms, everything is legible. So legibility, safety measures, standards of best practice embedded into each of those. That has been a change, in my opinion—not in my opinion, actually—evidence-based across the nation, when you have certain standards embedded into structured forms for orders, it improves—it decreases the risk of errors, of grave errors. There are still minor errors; people misread this, or whatever. It still happens. But much less serious than when you couldn’t even read the names of the medicines. Structurally, I think one of the key changes that happened was the buildings across that way, on 1515 Holcombe [Boulevard], from the Lutheran Pavilion. Suddenly there is the Love Clinic, the [R.] Lee Clark Clinic, the such-and-such clinic. It was just expanding, exploding clinics. And then of course, now, across the way. So the expansion of buildings. It just has become, honestly, unmanageable. I don’t know MD Anderson anymore. I used to know MD Anderson, I don’t anymore. It’s just too spread, too far, too much. I know the clinical aspects of MD Anderson, I no longer know the research domains of MD Anderson, the breadth of them. Certainly the laboratory-based research, it’s totally alien to me now. I used to know most of the basic researchers when I started in the organization, I don’t anymore.

Tacey A. Rosolowski, PhD:

Yeah.

Alma Rodriguez, MD:

So just the physical expansion of it has made it very difficult to, if you will, truly have a comprehensive, well, for lack of a better word, embrace of what MD Anderson is.

Tacey A. Rosolowski, PhD:

Intellectually, emotionally?

Alma Rodriguez, MD:

All of that.

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