Chapter 26: MD Anderson’s Focus on Patient Experience
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Dr. Fisch talks about two initiatives to involve patients as partners in planning processes: the Patient Experience Steering Committee and the Patient and Family Advisory Council. Dr. Fisch notes that though he received invitations to serve on both committees, he was given no charge or mission and there is no natural momentum on patient experience at the institution. He talks about the advantages to the institution of addressing patient experience and notes that MD Anderson’s attention to this matter is a response to an Institute of Medicine report that other institutions are moving ahead.
Dr. Fisch then observes that if an institution is not patient-centered, shifting focus is difficult. He suggests ways in which MD Anderson communicates that it is not patient centered. He then talks about Leadership Rounds, which help leaders see the institution from a patient’s perspective. He acknowledges that the institution is listening to patients more and coming up with creative ways of reorganizing care.
At the end of the session, he makes some final comments about working at MD Anderson.
Identifier
FischMJ_03_20150218_C26
Publication Date
2-18-2015
City
Houston, Texas
Interview Session
Michael Fisch, MD, Oral History Interview, February 18, 2015
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:
Let me just ask you a timing question, because I assume that you wanted to stop at ten-thirty this morning. Okay. So we only have about five, ten minutes left, depending on if we believe your clock or my watch. (laughs)
Michael Fisch, MD:
Yeah.
Tacey Ann Rosolowski, PhD:
So what would you like to do in these last moments? You began talking about—
Michael Fisch, MD:
Let’s see. I think I’ve covered a lot of different things: mindful practice, compassionate care.
Tacey Ann Rosolowski, PhD:
There’s the patient experience you began talking about a bit. Do you want to talk about that?
Michael Fisch, MD:
Yeah. So I talked social media, and in a sense, I talked social media and my little story, but then in the end—well, actually, let me finish the social media story a little bit—
Tacey Ann Rosolowski, PhD:
Sure.
Michael Fisch, MD:
—and then talk patient experience briefly, and maybe that’s about all. Are we still going?
Tacey Ann Rosolowski, PhD:
We’re recording, yeah.
Michael Fisch, MD:
Okay. Yeah. Well, so, in terms of backtracking to maybe the next step of the social media story, so I’ve been tweeting, I talked about Mike Thompson, I talked about ASCO initiatives, but then Chuck Blanke, who’s the chair of SWOG, one of the major network groups, as the network groups got consolidated and they were competing to be one of the four adult cancer network groups and writing those grants, Dr. Blanke, who was a fellow with me at Indiana University during my training so I’ve known him for many years, and along with Craig Nichols [phonetic], who was a faculty at IU during my tenure there, they approached me about involving social media as part of their grant. The question is, can we use social media to enhance enrollment on the clinical trials. They’re not interested in social media for social media’s sake at all, but they’re interested in anything that would help enhance clinical research and clinical trials participation. The question is, could social media be used to enhance clinical trial participation? I think the answer to that question is that it’s not yet clear, but it certainly seems like it has a lot of potential, because social media is the new media, and media can be used to improve cancer health literacy, to influence attitudes and beliefs about things people do in respect to their care. So it seemed like a very good idea to try to develop that. So we put a specific aim into that grant around using social media to promote clinical trials participation, and I wrote that aim, and it became part of the SWOG grant, and the grant was very successful and got funded. And then I was invited to give a plenary session at one of the SWOG meetings to talk about use of Twitter and basically, with Chuck’s support, make an appeal to the members of SWOG to get their hands dirty with social media and to sign up on Twitter or to start to become familiar with this so that we can begin to work together in this space to meet our common goal as part of SWOG, to make this not a silly little habit that is a way of wasting your time, but to make it part of the acceptable work that you might do for your professional organization, or in this case for your research organization. So just like it’s becoming acceptable from an ASCO point of view to be doing this, and from the cancer research SWOG point of view to be doing it, and now there’s social media policies at MD Anderson and other places. But the policies are mostly to tell you what not to do and how to keep yourself out of jail, but there’s not been organizationally somebody in a position of power who said, “We would love to see the department chairs working towards getting some of their stuff out through social media.” I mean, nobody has given permission of that sort, of the sort that Chuck did with SWOG, here yet. But I think that day will come.
Tacey Ann Rosolowski, PhD:
Yeah.
Michael Fisch, MD:
Just like I’m convinced that there will be a chief experience officer at MD Anderson in the future, because now there’s a Patient Experience Steering Committee. Dr. Buchholz invited me to work with Kay Swint, who’s an experienced nursing leader, and Barbara Summers, who’s the vice president of the Department of Nursing and chief nursing officer, and to work on patient experience. We have a Patient Experience Steering Committee and a Patient and Family Advisory Council. So this whole notion of patient engagement and getting patients directly involved, not just answering surveys about satisfaction and other Press Ganey-type marketing things and quality things, but to engage the lay public as true partners and have a carefully vetted Patient and Family Advisory Council, which was just created this year, again, under Kay Swint’s leadership and Barbara Summers’ leadership. I think it’s twenty-seven or so patient and family advisors who come to MD Anderson on a monthly basis and sometimes visit with us on themes. They’ll talk to us about the electronic health record and the conversion to Epic and what it means to them. We hear from Dr. Buchholz about our strategic framework, and so they get briefed and then they get a chance to interact and have positions about things and give us ideas and be truly part of the team.
Tacey Ann Rosolowski, PhD:
What was the reason for establishing these committees at the time they were created?
Michael Fisch, MD:
That’s a good question. One of the things that never happened for me was I wasn’t called into anybody’s office where they told me a vision and asked me to do something, and they’d say, “Mike, we think patient experience is potentially important. I’d like you to work with Kay and Barbara and explore this, and we’re trying to decide this or that, or we’re trying to see this or that.” So I didn’t get a charge. I just got sort of a secondhand invitation to get involved and start showing up. So I don’t know how to answer that. But I do think that, like I said, it’s pretty clear that there’s been momentum in Patient Experience. There are Patient Experience meetings. There’s a lot of dialogue about it that’s being talked about it in publications like Health Affairs. So I think MD Anderson, again, we’re still in the pack, using that analogy of running in the pack. But the pack was starting to speed up, so we weren’t ready to do our turbo charge and take the lead or try to take the lead, but we’re having to run faster because at the pace we were running, the pack was getting out in front of us.
Tacey Ann Rosolowski, PhD:
What’s the need for addressing patient experience? I mean, what’s the advantage of doing that?
Michael Fisch, MD:
Well, I think the advantage is that the expectations of patients and the public are changing, and people are expecting truly patient-centered care, and more and more patients are expected to be functional members of their own healthcare team. So it kind of resonates with what I was talking about, the purpose of “The Cancer Guys” and social media as well, cancer health literacy, and all that, but that engagement at the level of their care and their experience and what is it they want to see. We talked about patient-centered care as being one of the cornerstones of good care as part of the Institute of Medicine’s report this past fall on the quality of cancer care and this sort of crisis in the quality of cancer care, and part of it is that we don’t have enough prepared, proactive practice teams working with informed, activated patients and families and working together and getting the right health outcome, and also not enough integration of palliative care was another part of that report. So there’s a lot of these themes have been crystallizing as part of a gap in the quality of cancer care in this country. So I think MD Anderson is responding to the Institute of Medicine’s reports and the world around them, and, again, the pack is getting out ahead of us, and we’ve got to speed up just to stay in the middle of the pack and start to have some mechanisms to do that. I think it starts by getting caught up to the pack and then figuring out how to do things that are creative and innovative and get us to be leaders, in that sense, but right now I think we’re in the catch-up mode. But it’s very hard. It’s a sort of fundamentally big shift to go from being sort of centered on our own things to being centered on the patient, and this can even come up—I notice it in little things like tagline or we might have a conference or be saying, “We want to bring the best translational research forward. For us it’s bench to bedside and back. That’s going to be our theme.” We can say that all day long and not notice what that sounds like. Bench to bedside and back. So what that sort of sounds like is our mind starts at the bench. Who’s at the bench? We are, researchers in a lab. Then we’re going to the clinic, getting some ideas or fuel or energy, and then taking it back to where we are. So the patient is in the middle. That’s just sort of like the fuel to the engine, but it’s not the center or the purpose of the care. So you go around saying “bench to bedside and back” enough, it becomes part of your culture. You’re putting the patient as a necessary but not central part of what it is you think you’re doing. So, patient-centered care is a little different thing. It might be bedside to bench and back. That would be good. That would be a nice adjustment. But I remember saying that at a big meeting, and it almost just befuddles people to even—don’t even understand the distinction. It’s like it’s all circular. It’s like you’re arguing, it’s circular, it’s going around and around and around. Well, it doesn’t matter. But it does matter. I mean, it may matter to who’s this for. Is this all for you because you as researchers need it? You have jobs, programs, and you have things, and you need to do what you do, and that’s what you like to do, and you need us just so you can do what you like to do? Are you trying to help improve the health of Texas, the nation, and the world? What’s the purpose of the work? What’s the actual mission? Is it patient-centered, and if it’s really patient-centered, then how might we want our care to go? Do we want to be able to sit at the bedside in the ICU, or is it important for you to be able to get us out of there so you can do the work? What’s this for? (laughs) So it takes some doing, and if you do leadership rounds and go around—and I haven’t done this, but Kay and other have done this. They’ll go round on patients who are in the hospital and say, “How are things going?” Kind of like a maître d, “How’s your meal?” “It’s great. Everything’s good.” “Great. Thanks. I’m glad you’re appreciative of being here in the hospital. Is there any little thing you think we could do just a little bit better?” “Well, you know, I guess when I press my button, if somebody would come, because when I have to go to the bathroom, I hate—especially at night, or you know, whatever.” And they start to really understand what is it really like, what do people really want to see happen. Do they really understand the plan? How come they don’t understand what they’re supposed to do when they get home? How come they come back to the hospital because they’re confused about this or that, or they didn’t change their dressings properly, or this or that? Then it’s like, well, when the nurses do their checkout, they checkout with each other at the front desk, and then sometimes they get this stuff all wrong. What if the nurses checked out right in front of me so that I heard what one nurse is telling the other, and I could go, “Yeah, I’m part of this”? It’s all us, me and them, instead of them, and me here just—you know, stuff like that. So what’s this for? (laughs) Patient-centered care, patient experience.
Tacey Ann Rosolowski, PhD:
So these are the stories that you hear from the patient and family advisors?
Michael Fisch, MD:
Yeah. You don’t ask patients, “Is there any little thing that could help you suffer less and heal faster or heal better, feel safer, feel better cared for?” You’ve got to really want to know, and when they tell you, you’ve got to be willing to not say, “Well, let me tell you why we do checkout the way we do.” Say, “How might we do checkout better so that you feel safer, so that you feel understood?” It’s an attitude.
Tacey Ann Rosolowski, PhD:
Mm-hmm, and feel part of your own healthcare.
Michael Fisch, MD:
Feel part of your healthcare team so that we can help you get the best outcomes for this surgery that you’ve had. It’s an attitude of patient centeredness, patient experience being the reason that you’re doing and you’re willing to adjust things that are for your perceived efficiency or comfort zone as an organization or an individual provider for the sake of the larger goal of the patient getting the best outcomes and having a better experience. That’s a big shift. That’s a hard shift. Not everybody can do that well. Sometimes it takes massive reorganization to have any chance of doing that well. Even little things like—just think about this. What if people said, “I really wish I could get some of my chemotherapy between seven and nine p.m. on weeknights, after the kids are tucked in”? Well, that’s not very easy to do. That might be patient-centered, but exactly how you make that happen, and you have to pay overtime, you change your shift schedules and the workflow, and how does it work for—so patient-experience things are not always easy to figure out how to implement, but you’ve got to be willing to think about it, hear it, and deal with it. So it’s not like we just for the first time ever started to listen to patients, but I think it’s been ratcheted up what it means, what the conceptual models are around that, how important it is, how we do it. So not an invention, but maybe an acceleration of attention to that and some more creative things that are being done to reorganize care in certain ways, and it’s almost easier to start from scratch. People who are starting from scratch can design it better from the beginning, but when you have a big ship and it’s designed the way it’s designed, it can be hard to change and to keep up. So it’s tricky business, and so I notice things that we may be working on or that we may be seemingly behind on here and there, but it’s not without a sense of the challenge and the respect for the people who have to figure out how to get that done. So I had a chance to work with Kay Swint and Barbara Bowman during my final year here, to be part of that, and they’re off to a great start.
Tacey Ann Rosolowski, PhD:
Well, we’re a little bit over our time, and I wanted to thank you. Is there anything else that you’d like to add at this point before we close off for the morning?
Michael Fisch, MD:
Really only that I feel very lucky to be part of the MD Anderson family and to have worked here for fifteen years and have the relationships I’ve had, and I know there are great things ahead at MD Anderson.
Tacey Ann Rosolowski, PhD:
Well, thanks very much for your time, Dr. Fisch, and I really wish you bon voyage and good luck in Chicago.
Michael Fisch, MD:
Thank you very much. (end of session three)
Recommended Citation
Fisch, Michael J. MD, MPH and Rosolowski, Tacey A. PhD, "Chapter 26: MD Anderson’s Focus on Patient Experience" (2015). Interview Chapters. 849.
https://openworks.mdanderson.org/mchv_interviewchapters/849
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