Chapter 18: Impact of Institutional Growth on the Office of Health Policy
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Description
In this segment, Dr. Foxhall comments on how the MD Anderson’s growth since the nineties has had an impact on the activities of the Office of Health Policy.
He notes the huge expansion of external connections with network affiliates and also with international connections, with MD Anderson adopting the CDC’s Comprehensive Cancer Control Program to organize information provided to the external connections. He sketches the history of that program. He notes that the Lung Cancer Moon Shot is part of the Prevention and Control Platform.
Next, Dr. Foxhall talks about how the institution’s financial structure has changed: healthcare delivery has changed and it is increasingly difficult to secure funding for research and also raise income from patient care. He notes that the institution’s ability to provide personalized and compassionate care for patients has not changed, because it is imbedded in the culture and tradition of MD Anderson.
He ends this segment with comments on how MD Anderson is seen by the community.
Identifier
FoxhallLE_04_20140409_C18
Publication Date
4-9-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Institutional Change; Growth and/or Change; Institutional Mission and Values; Beyond the Institution; The Administrator; MD Anderson Culture
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:
I wanted to ask you, too, since you came to the institution, it’s changed enormously in terms of size, patient numbers, that. What are some of the ways that you would identify? What are some of the ways in which the institution has changed very dramatically, and how has that had an impact on your role with head of health policy?
Lewis Foxhall, MD:
I think the most obvious change has been the size of the organization. It’s certainly grown dramatically. The number of faculty we have has increased significantly, and just the physical presence of the organization has changed markedly since I started here. So it’s been also, I think, fascinating to see the growth of our external connections with our network affiliations, and in particular our regional care centers and the amount of work that we’re able to do outside the main campus has really been fascinating as well.
Tacey Ann Rosolowski, PhD:
Well, you mentioned to me the last time, actually, this was after the recorder was off, that you’d recently been to Colombia and you were going to be going to Korea. Can you tell me a little bit more? I mean, I don’t mean to derail you, but since we’re on the topic—
Lewis Foxhall, MD:
Oh, sure. That’s—
Tacey Ann Rosolowski, PhD:
—you know, a bit about these international connections.
Lewis Foxhall, MD:
Yeah, it’s certainly in the same vein. Another big change, I think, has been our gradual adoption of the Comprehensive Cancer Control Program. So this has gradually grown from a really disorganized effort and well-intended efforts of several of our faculty members to provide services usually related to research projects to the community, to one in which we have several organized work groups that address different aspects of cancer control primarily around prevention, screening, early detection work.
Tacey Ann Rosolowski, PhD:
Now, this phrase “Comprehensive Cancer Control Program,” is that an MD Anderson phrase, or is that adopted from the NCI?
Lewis Foxhall, MD:
Yeah, it’s from the CDC, NCI. So there’s been a national cancer control program for some time, mostly at the state level, but we’re just really beginning over the last few years to adopt that to the Cancer Center. So it’s really been intended to focus more on our efforts out in the community to provide these sorts of services, in particular to our low-income populations. So more recently, we’ve had the Moon Shot initiative, and part of that has been the adoption of a cancer control prevention and control platform. So this is a workgroup that’s been put together that I serve on, and led by Dr. Hawk and Mark Moreno, that is focused on these same efforts, although primarily prioritizing work related to the Moon Shots, which is lung cancer and skin cancer. So it was through that initiative that we developed our international, these more recent international connections, and they have really come from Dr. DePinho’s discussions with state leaders in Mexico and then subsequently in Colombia to reach out to us with interest to collaboration on these cancer control efforts, mostly on tobacco. So those are really just getting started. I think it’s interesting to see where those might go. We’ve had at least some initial exchange of ideas with both groups. So with Mexico it’s the entire country and some of the national-level leaders involved there, and with Colombia it’s a city [unclear], which is a very large metropolitan area about the size of Houston that is very forward-thinking in their public health efforts—
Tacey Ann Rosolowski, PhD:
Oh, interesting.
Lewis Foxhall, MD:
—that seems to be interested in working with us.
Tacey Ann Rosolowski, PhD:
And is the Korea connection also tobacco-related?
Lewis Foxhall, MD:
Korea is a conference. This is our Global Academic Program Conference, so every year we get together with our sister institutions around the globe and share information and ideas, present abstracts, and talk about research primarily that’s going on. We have a section on cancer control. We have a section on cancer survivorship, which is the one I’m going to be participating in. So we’ll be sharing with our colleagues in other institutions our ideas around how we approach things. So every year we have a conference that alternates between here and Houston, being hosted by us here in Houston and one of the global partners. So this year it happens to be Korea.
Tacey Ann Rosolowski, PhD:
And the institution in Korea that you’re connected with?
Lewis Foxhall, MD:
It’s the Goyang-si Cancer Center. So it’ll be interesting. So we’ll be presenting abstracts and have several presentations on survivorships. So I’m co-chairing on that group. And while I’m there, it turned out I had the opportunity to go to a symposium and present a couple of lectures to the other cancer center in town, which is the Seoul National University Cancer Center, so I’ll be meeting with them the day prior to our [unclear] conference, and then on the last day I’ll spend a little time with the Korean National Cancer Center in their Department of Health Policy. So we’re going to talk a bit about policy-related issues in that country. So that should be interesting. So it’s an interesting area to work in and get a little different perspective with the different countries that are involved. And Korea has a very similar incidence in mortality of cancer, although the types of cancer are a little bit different, but overall are fairly similar. You know, it’s now a very developed medical system. They do a great job of finding cancer and treating cancer. So I guess I shouldn’t be surprised [unclear]. It’ll be interesting to see. I think everybody approaches things a little differently in each country. Depending on what part of the world you’re in, has a slightly different balance of the types of cancers that are a problem and how they’re dealing with them.
Tacey Ann Rosolowski, PhD:
Very interesting opportunity for cross-fertilization.
Lewis Foxhall, MD:
Mm-hmm.
Tacey Ann Rosolowski, PhD:
Are there situations in the past when you’ve gone to these cancer centers overseas where you feel that learning about these other approaches and perspectives has changed the way you see something here in the States?
Lewis Foxhall, MD:
Well, I’m fairly new to this international stuff, but the interactions that I’ve had with different cancer researchers and cancer control professionals has, I think, mostly been impacted by the particular country’s social and economic development status and the types of risk factors that their population’s exposed to. So we are fortunate here that most of our population is able to access care, but our low-income populations and low-access populations really are not a whole lot different from those in less developed countries.
Tacey Ann Rosolowski, PhD:
Wow.
Lewis Foxhall, MD:
So there’s certainly things to learn from [unclear].
Tacey Ann Rosolowski, PhD:
That’s sobering, isn’t it?
Lewis Foxhall, MD:
Yeah. So we have a real difference here in the levels of care that are provided to certain groups in our country. We certainly see differences in mortality and challenges with the cancer burden depending on where you live and what sort of income you make and those sorts of things.
Tacey Ann Rosolowski, PhD:
We were talking about changes that you’ve seen in the institution, and you mentioned growth and kind of got on the subject of your international connections. What are some of the other areas in which you’ve seen the institution change since your arrival and how that’s affected your work with policy?
Lewis Foxhall, MD:
You know, the other area, I think, has been the gradual change in the financial structure of the economy and how that impacts healthcare delivery, so our ability to generate revenues from patient care has certainly changed over time. The funding for cancer research has changed very significantly over the last several years, so those are major alterations in the firmament, and we just have to learn how to deal with that.
Tacey Ann Rosolowski, PhD:
And from the look on your face, I assume that the conclusion is that the amount of money generated is going down. (laughs)
Lewis Foxhall, MD:
Exactly. Exactly. So they’re not bringing in buckets of money. So, yeah, so it’s been more challenging, and our colleagues who focus on research have a much harder time of getting research funded, and it’s difficult, especially for young researchers to get started and start building a career. So those are big, big differences. Important, I think, is what hasn’t changed. I think the ability of the institution, everybody that works here, to really continue to provide personalized and compassionate care to our patients has really been preserved at a very high level. So you’d think that might be something that might get lost over time, but it really hadn’t. And this idea that we only take care of cancer patients and special needs of cancer patients, I think, is very upfront in everybody’s mind, and people try really hard and have been, as partners, successful in being able to maintain that. So that’s really a big differentiator for what we do here.
Tacey Ann Rosolowski, PhD:
Why do you think that hasn’t changed, despite the increase in size and kind of maybe even chaos in delivery system?
Lewis Foxhall, MD:
Well, I think, you know, there’s been such a long tradition here of doing that, it’s really embedded in the culture of the place and the people who work here and who’ve been able to pass that along to new employees who come on board and professionals who start working with our patients, and they can see the way people have been here for a while do this. And it’s really been a positive thing and a learn-by-seeing sort of approach. There’s a lot of effort, I think, in, you know, as we on-board new employees and as we continue to work to support the efforts of the institution, that training programs have been implemented and support programs to help people keep that upfront and do a better job of it. But, you know, I think just this idea that we’re not a general hospital, we don’t see lots of people with sort of issues that you would expect them to get over pretty easily and not require a lot of counseling and support for it, the cancer center only treats people with life-threatening illnesses, and, you know, the emotional support and the emotional connections that our team has with patients I think is really different and special. And somehow we’ve been able to keep that going, and I think that’s what a lot of people are proud of. So patients recognize it.
Tacey Ann Rosolowski, PhD:
How does the community see MD Anderson? I mean, what are the variety of images that the community has of this institution?
Lewis Foxhall, MD:
Well, I don’t know if I can speak for the community, but my perception from people who talk to me about their experiences here and health professionals who work with us are, I think, generally very positive. The institution has had a very good reputation as far as its ability to do a good job and to successfully take care of patients or do the best we can for people, and rightfully so. And I think our relationship with our professional colleagues in the community has, I think, been good of late. We have had our ups and downs. One of my first jobs here, I think as I mentioned, was to try to kind of patch up some rocky relations we had bumped into with community physicians, and I think we’ve continued to focus on maintaining a good relationship with those clinicians in the community who are both our collaborators as well as competitors at times, and have tried to do a good job of maintaining a professional relationship that’s respectful and providing each other with the information we need to take care of patients and get good outcomes. So, you know, that’s generally good. I think, you know, we are still are challenged the farther you get away from Houston with people not really knowing who we are and figuring that out, but we’ve got a great team of people in our Communications Office, and we’re working on that. But I think the reputation and the awareness of the institution has grown dramatically over the last couple of decades I’ve been here and is one that will continue to [unclear].
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 18: Impact of Institutional Growth on the Office of Health Policy" (2014). Interview Chapters. 867.
https://openworks.mdanderson.org/mchv_interviewchapters/867
Conditions Governing Access
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