MD Anderson 2020 Interview Project
 
Chapter 04: Focus on Wellness and Safety

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Chapter 04: Focus on Wellness and Safety

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In this chapter, Elizabeth Garcia discusses the importance of wellness for employees across MD Anderson Cancer Center, especially amid the COVID-19 pandemic. She reflects on this era by describing staff appreciation and how the insiutition raised the minimum wage. Moreover, she paritcularly notes the import safety measure and procedures that were implemented during this period. Garcia also defines patient advocacy and her visions for the future of MD Anderson where inclusive leadership is the standard. She ultimately emphasizes her belieft that patients are not guests, but partners in the care journey.

Transcript

Elizabeth Garcia, BSN,MPA,RN

Oh, that’s okay. Yeah. So our focus on wellness has been tremendous and resounded with a lot of people in the different methodology it’s been delivered. I know Brett Belford and I know Mark, the director of EAP—Mark, oh gosh, I can’t remember his name. But he does a fantastic job. Mark Berg, sorry. He does a fantastic job. And at the beginning of the pandemic, he actually personally called me a couple of times to check on me. And I know that he checked on other leaders or his team did, and I think that that was very meaningful for me. I think that there was a lot of leeway given to people if they had family issues or if their families, God forbid, got sick, or if they personally got sick. I think that the other thing that we’re doing differently is that nobody is being called back to work. This is the new way of working. This is not—and I know other institutions, hospitals, even Methodist, at some point, they said, okay, everybody come back. They never—and I think it was too early even to do that. But the way that we’re looking at it like this is the new way of working, it’s working fine. There’s no reason why you have to come back into the building is very different than other organizations.

Nina Nevill

Wow. That’s fascinating. Yeah, you mentioned something earlier about some people, perhaps, not working the full 40 hours at home. And it makes me think of how many people in their place of work also are not doing—it’s not always the case that being—sometimes being in your home and being able to have increased accessibility to whatever it is that you need to perform the best, data is starting to come out to show that some people are better at their jobs or are better, more rounded.

Elizabeth Garcia, BSN,MPA,RN

A lot of people. But it’s not that they were home. It’s that their work was no longer there. For example, in academic department, the senior AA’s that support physicians, a lot of what they do is travel, conferences, research writing, whatever. A lot of that stopped. So they should have been screening. And they weren’t. I can tell you right now they weren’t. So that’s my example. We’ve found in the call center, food—every area that I am over, that is working remote, they will stay remote. They’ve done a fabulous job. There hasn’t been any decrease in productivity. The areas where there was decrease in work that needed to be done, they’re doing screening part of the time. So there’s not going to be any changes in our area, unless people want to after things are better.

Nina Nevill

Now, is there anything else, I guess, that you would want to say about kind of the beginning stages of the pandemic or kind of early on how MD Anderson began to handle things or do you feel like we’ve kind of covered the institutional responses to all of this?

Elizabeth Garcia, BSN,MPA,RN

I think the big thing is that we always made decisions first based on safety, which is our first service standard. So we were true to our service standards and our core values through every single decision as hard as it was. And it was hard. We were true to that. And we were very successful in keeping people safe, both our employees and our patients and caregivers. So I think that that is huge. I think that we learned, and sometimes we weren’t so perfect at this to begin with, that we all needed each other working collaboratively. It couldn’t just be one department bringing up screening, one changing the rules or whatever, that we all had to work collaboratively.

Nina Nevill

Absolutely, yeah. I’m trying to think if there’s anything else from the stages. It’s all still very fresh and it feels not too far from now. But this past year has felt very long. And so it can be kind of hard to remember some of the earlier stages for sure.

Elizabeth Garcia, BSN,MPA,RN

And the fact that we did not go back and forth on visitation, like we opened it, we closed it, that’s what other institutions did. And I was talking to Jose Rivera today about where he came from in Nebraska or in Michigan, I’m sorry, Michigan, and they would open and close and open and close visitation. That was much, much harder. I think us knowing that the pandemic was still on, and we could not open visitation. It was not the right thing to do, even though we really wanted to. That was very, very smart, and changing back and forth would have been worse.

Nina Nevill

Now in terms of keeping people—not being rushed as an institution to “go back to the way that things were” and allowing people to work remotely, how do the goals of someone who works in patient experience change then with this or do the goals and expectations remain the same, at least in your own experience?

Nina Nevill

The goals and expectations remain the same. And through the pandemic they have. I was just talking to the directors about how much we’ve gotten done in the pandemic. And Dr. Karen Luz always says, never waste a crisis. And we did not waste this crisis. We have brought up a lot of services that will not go away for patients that are good for patients and family, so that is fantastic. So nothing will go away and people will be—at first, the directors were like, well, when are we coming back? And I’m like, take that out of your vocabulary. We’re not coming back. You’re going to decide together as a team once everything abates with the risk of the pandemic, how much do you want to be remote and how much do you want to be in the office? And that’s up to you to decide. There’s no right or wrong answer here. It’s what your department works the best at.

Nina Nevill

Well, that’s good to hear. It sounds very flexible to individual needs. And in terms of goals, is there anything that, on the broader institutional level, you’re hoping that would be gleaned from this past year to change the goals or advance the goals differently? Anything that if you could maybe in a dream world put into practice based on what we’ve learned to continue advancing these goals, what would that look like?

Elizabeth Garcia, BSN,MPA,RN

Well, I think infection control processes need to stay robust the way they are because we’ve decreased our flu, we’ve decreased nosocomial infections, infections transmitted in the hospital tremendously with the things we’ve put in place. And I think we need to leave them because once COVID abates, there’ll be something else, whether it’s the common flu or colds or whatever, that are so dangerous for our patients, but also sick time went down for employees. So it’s good for our employees too. So I think there are certain things that we should never get rid of. I think that we might be masking in certain areas of the institution for the foreseeable future. And I don’t think that’s a bad thing. It’s cheap, it’s easy, and it’s good for everyone. I think also being able to change things on a dime as needed based on the needs of the patients is something we should never get rid of.

Nina Nevill

Yeah, that adaptability is so valuable.

Elizabeth Garcia, BSN,MPA,RN

Yes. And we see it often. During Harvey, we saw it. During other crisis, the ice storm and other crises, we’ve seen it. Never did we see it better than now during the pandemic, and we’ve got to keep that in place because there’s no—I said, I’m a doer. There’s no reason to belabor, should we do something? Should we do something? If it’s good for the patients, if it won’t harm anyone, there’s no reason why we shouldn’t try it.

Nina Nevill

Absolutely. Well, in terms of patients and centering patients, which is something that you’ve mentioned a few times in terms of changing the culture—maybe this is a question that I should have asked much earlier, but I suppose it’s never too late to circle back. But what would you say—at any point in your experience at MD Anderson, what would you say that patient advocacy looks like to you?

Elizabeth Garcia, BSN,MPA,RN

Well, patient centered culture is really defined as every decision, every process, every policy that you develop in your institution, the patients are at the table. And they are at the center of those decisions and processes. What is best for them? What is most convenient for them? What will work the best for them? What delivers them safety, courtesy, caring, all those things we want? That is what keeping the patient at the center of everything is about and that’s what a patient centered culture is about. And you see the changes that have happened in our institution that have brought us in that direction, which is wonderful.

Nina Nevill

Absolute. Yeah, it sounds like a lot of the initiatives that you’ve spoken about already are had the goal of exactly that of changing that culture. So it is wonderful to hear that over time slowly these things can be accomplished. And it’s good to see progress having been made. I guess, is there anything in terms of the pandemic, whether it’s the events of racial violence last summer or the actual COVID itself, is there anything that you kind of wish that I had asked or that we had talked about, anything that seems like it’s kind of burning in the back of your mind?

Elizabeth Garcia, BSN,MPA,RN

I don’t think so. I think you covered—you’re a great interviewer. When we got on this call, I was like, is this really going to last all these hours? But here we are. So, no, I can’t think of a thing. I think we covered a lot.

Nina Nevill

Sure. That tends to be the response. People think really, you need two hours blocked out for this. And I said, hey, it’s a conversation. When you get going talking about this stuff, there’s a lot of good and there’s also just a lot of processing that happens in talking through it out loud. So it’s good on both ends. It tends to be a good (inaudible).

Elizabeth Garcia, BSN,MPA,RN

One thing I would add is that we had a lot of appreciation for the people often unappreciated, the housekeepers, the Food and Nutrition Service room service people, the front door screeners, the—we had a lot of appreciation. We have to keep that appreciation going because we cannot function as an institution without these people. And I’m so proud of the institution. One of the first things Dr. Pisters did was start raising our living wage. And we’re into the third one and final planned one in October up to $15 an hour. That’s impacting a lot of my areas. And I’m very proud of that. And we need to start showing appreciation to people who are keeping us going through all this, through not just the pandemic, but through every day caring for patients and make sure that we always pay attention to what their needs are and do everything we can for them.

Nina Nevill

And in terms of, obviously, you have seen an impact and you’ve seen a change in your time, but what do you have in mind for, let’s say, once you’re done with MD Anderson or the next generation of somebody to kind of take over where you’re at, what do you hope for them to continue or to be able to do or to change?

Elizabeth Garcia, BSN,MPA,RN

Well, I hope someday we see that patient and families are actually codesigning our administration and leadership of our institution. So as we go to design a building or have a new policy or talk about the strategy, that the patients and families are at the table from the beginning

through the entire process. They are part of our leadership organizational structure. And we started off by—for example, when we were developing our strategy, they went to the Patient and Family Advisory Council and got feedback from them, whatever. And I said, that’s not inclusive leadership. What’s inclusive leadership is actually having a seat at the table from the beginning, middle, and end. And so we started getting there a little bit more, like we have patient and family advisors on our access redesign committees. From the beginning, they’ve been on there, and they’re going to be on—not just going and getting their feedback, but they’re actually sitting at the table. So I hope that that’s the future that we see that they actually codesign our care models with us.

Nina Nevill

That would be incredible. It sounds like a great plan for the future. And, obviously, without divulging too much, I guess, I’m just curious, you also mentioned earlier that sometimes providers think they know exactly what patients need, and then when you get patients at that table, it’s actually maybe something completely different. Do you have any examples off the top of your mind that you’d be able to share of what something like that has looked like?

Elizabeth Garcia, BSN,MPA,RN

Yeah, so actually, they just implemented a new law in, I think, it was February, that we had to release patient information, including test results, much earlier than we do now because we always wanted our doctors to discuss it with them before they saw it on their own on MyChart. But this law went into effect that you had to release the results. So a lot of people when we went and got feedback from our patient and family advisors and talked to them about this, and what we needed to do, what we wanted to do, we said to them, do you want your results? Aren’t you scared you’re going to see something that you don’t understand, and your doctor won’t explain it to you, and you’ll go into a panic and blah, blah, blah, blah, blah? And they said, I have the right to choose. If you release my results to me, I don’t have to look at them. Just put something on there saying, warning, you may not understand these results. Your doctor will talk to you at your next visit or whatever. But I have the right to choose. How dare you decide that I don’t know what I’m looking at. And they’re, like, I’ve been a—one of the advisors was like I’ve been a cancer patient for 15 years. I understand a lot of those test results and I don’t panic, but I want to—those are my results. I want to know as soon as I can know. So that big brother type idea that the doctor always knows best and they need to tell you what to do and whatever, that’s not what the patient wants. They want the choice. Now, we had some advisors who were like, that’s fine, release it, I won’t look at it. That’s okay. That’s my choice. So that’s a good example of we don’t really know until we go ask them, do you want this? What do you think? What is your preference?

Nina Nevill

Yeah, that’s a great example. And I’m sure too from the patient point of view, being able to ask informed questions, having that data before meeting with the doctor for some people could be—

Elizabeth Garcia, BSN,MPA,RN

That’s what they said. They said I want to review my results, so I can ask questions when I go to my visit.

Nina Nevill

Well, that’s awesome. I’m glad that things are moving in this direction. And I like the idea of coworking towards the future and policies and strategies and the like.

Elizabeth Garcia, BSN,MPA,RN

So the patients—I always say to people, the patients are not our guests, they are our partners. So when we welcome them as our guests at MD Anderson, they’re not our guests. They’re our partners.

Nina Nevill

That’s wonderful. That’s a great framework. It would be lovely to see other institutions adapt something like that. Hopefully, in the future, that will just be the standard and that will be normalized. Unfortunately, now, it seems like we’re still at a place in healthcare where there is a very strong power dynamic and that will always be there to some extent with patients and providers and whatnot. But the partnership framework, I feel like could help with so much of that at any level cancer or otherwise.

Elizabeth Garcia, BSN,MPA,RN

Absolutely.

Nina Nevill

Well, I guess before we leave off today, is there anything else that you would like—since this is a collection of data if you want to think of it that way, is there anything that you’d like to add about your own experiences or your life or anything that we’ve covered or not covered so far?

Elizabeth Garcia, BSN,MPA,RN

Well, I think that the one thing I’ll add that I left off is both my children were born premature, and they were in the NICU for a long time. My son being sicker than my daughter. And so it really hit home to me. And, of course, this was 25 years ago, but it really hit home to me and everybody needs to understand that eventually all of us will be a patient or a family member of a patient or a caregiver. So what do we want in our health care system for us when we get there, when we’re on the other side? That is why we need patient centered care.

Nina Nevill

That’s a great addition to have in there. Well, if there isn’t anything else, I just have to thank you one more time for being willing to do this and to sit through this. And we’re just trying to learn from everyone’s experiences. And so this has been wonderful getting the opportunity to chat.

Elizabeth Garcia, BSN,MPA,RN

Yes, so nice to meet you. Thank you so much for your time.

Nina Nevill

Of course, I’m going to go ahead and—

Identifier

GarciaE_20210731_C04

Publication Date

7-13-2021

Publisher

The Historical Resources Center, The Research Medical Library, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

B: MD Anderson Culture;B: Obstacles, Challenges;B: Critical Perspectives on MD Anderson;C: Offering Care, Compassion, Help

Conditions Governing Access

Open

Chapter 04: Focus on Wellness and Safety
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