Chapter 02: First Steps as Division Administrator

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Chapter 02: First Steps as Division Administrator

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Ms. Sollenberger begins this chapter by sketching her first activities on taking on the role as Division Administrator in June 1991. She notes that her biggest priority was participating in a building project that would include the new Alkek Hospital and the Smith Research Building. She and Dr. Balch discuss important features of the hospital that showed the institution’s willingness to invest in technology. In response to a question about strategic planning, Ms. Sollenberger talks about the creation of the multi-disciplinary care centers (formally initiated in 1994), noting that the strategic value was demonstrated as this approach evolved into an MD Anderson signature. Ms. Sollenberger and Dr. Balch next discuss the value of having innovative IT support imbedded within the Division of Surgery. She tells a story to demonstrate how in-depth knowledge of the Division enabled IT to develop billing practices that would accurately capture all procedures performed.

Identifier

SollenbergerD_01_20190709_C02

Publication Date

7-9-2019

Publisher

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

City

Houston, Texas

Topics Covered

Building the Institution; Building/Transforming the Institution; Multi-Disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Institutional Politics; The Business of MD Anderson; The Institution and Finances; Technology and R&D

Transcript

Tacey A. Rosolowski, PhD:

So maybe we could continue with your lay of the land view, unless you [to Dr. Balch] have a specific question. What did you envision and what were first steps? I mean you folks were sitting down and having your conversations. You know, what’s our plan, what did that look like?

Donna Sollenberger:

I got there in June of ’91 . Kent [Sollenberger], my daughter, and I came out and looked and decided that we wanted to do this, make this move. So I started in June of ’91, and we were closing in on the end of the fiscal year, so one fiscal year was just wrapping up and we were wrapping up the budget for the following fiscal year. I remember that was one of the years that we had some largesse and I just happened to remember that we, as a division, we had put in for a number of new positions because of all the growth in surgery. That particular year, I just remember, we got 42 new positions, and none of us could believe it because there hadn’t been that kind of, shall I say investment, you know long-time as I understood it. So we were growing, I think starting to do well. So one of my first jobs was to finish the budget, and close out the year we were in, and be ready to start the new one with the new budget. When I got there, [Dr. Balch] and I talked about a lot of what people do. He encouraged me to meet with the different chairs, get to know them. I was also to meet with people from the hospital, people who worked for Dr. LeMaistre and so forth. But I think the biggest, what I remember Dr. Balch saying is the biggest, I guess priority that I had, was helping to plan the new construction that was progressing. We were going to do the largest construction project at MD Anderson that had ever been done at the Texas Medical Center. There were plans for building a new hospital, a new clinic, and then there was research space --and I was responsible for all the Division of Surgery aspects of these buildings.

Charles Balch, MD:

For the planning of divisions.

Donna Sollenberger:

Yeah, so I was responsible for the logistics of and working with the architects in the division, and the section chiefs and the department heads, in making those plans. [Interruption.] “Hi.” [Female Speaker: “Sorry.”] No, you’re fine. She got us lunch, in case anyone was hungry

Tacey A. Rosolowski, PhD:

Okay great, thank you. Female Speaker I keep forgetting you’re in actual live interviews. There is shrimp—

Donna Sollenberger:

Can we have some water? There she is, she’s so good.

Tacey A. Rosolowski, PhD:

Fantastic, thank you so much.

Donna Sollenberger:

This was part of our budget cutting, we now get a half a bottle of water. [Laughs.]

Tacey A. Rosolowski, PhD:

You get a little bitty bottle, that’s so funny. And just for the record, the name of these projects?

Donna Sollenberger:

It was what eventually would become the Alkek Hospital.

Charles Balch, MD:

How many operating rooms with that?

Donna Sollenberger:

Ooh gosh.

Charles Balch, MD:

I think it was around 30.

Donna Sollenberger:

I was thinking it was twenty-some.

Charles Balch, MD:

Twenty or thirty.

Donna Sollenberger:

Yeah. It was big, new operating rooms for the first time in a long time.

Charles Balch, MD:

I think when I came we only had about 12 operating rooms --so this was a significant expansion-- and those were in the original buildings, so that the infrastructure for adding new technology wasn’t there. Remember, we built a big interstitial space so we could drop down new widgets for electronic or for anesthesia from the ceiling, instead of trying to build things into the wall.

Donna Sollenberger:

And we increased the size because at the time the rooms were so small that we were using, on big neurosurgical cases or big Whipples and things that these procedures require. The Old OR rooms were so small that we had the machinery or equipment lined up outside the room and the circulator was taking equipment in and out.

Charles Balch, MD:

What I remember is the regional therapy of the limbs, where people had to be outside (inaudible) because there wasn’t room in the operating room.

Donna Sollenberger:

So we were some of the first to build really large ORs. I remember our largest ones were for neurosurgery, and they were 800 square feet. We could not believe how big they were. At UTMB, we just built one that’s 1,200 square feet, but at the time, there were a few that were 450, and then 600 square feet and 800 square feet were the norm.

Charles Balch, MD:

Donna, I can’t remember which building. When we put in the first intraoperative radiation therapy, I think it was in the old area.

Donna Sollenberger:

Was I there then? I don’t remember that.

Charles Balch, MD:

This may have been before you came, but it was the world’s first radiation therapy unit in the operating room. It was actually outside the operating room but inside so that it could be used when it wasn’t being used interoperatively.

Donna Sollenberger:

Right, right.

Charles Balch, MD:

But it was one example of investments that the institution, through Dr. LeMaistre made in innovative technology, which that was probably the first big investment.

Donna Sollenberger:

Probably.

Charles Balch, MD:

Probably the microsurgery and the neurosurgery equipment were what really were very important if we are going to lead in those areas, and recruit the very best paid surgeons, and take care of patients with modern technology.

Tacey A. Rosolowski, PhD:

Did all of you feel that there had been adequate strategic planning around these particular buildings?

Donna Sollenberger:

I came in midway but there had been a strategic planning exercise that you would have been part of, that triggered this. I wasn’t part of that group, but there was a plan, and it was to comprehensively start growing and also plan as we did the clinics, which was really controversial to create care centers. We called them that, and really what it was, was a response to Eva Singletary.

Charles Balch, MD:

The first one was the breast cancer.

Donna Sollenberger:

Took a little stick that you roll along and it will tell you—

Charles Balch, MD:

Pedometer.

Donna Sollenberger:

Well it was a little bit different than that, but it basically measures the distance you go. So she had one of her breast cancer patients allow her, Dr. Singletary, to follow that person. It was some incredulous number of miles we were asking people to walk in a day, sick people. And at the time we were very open with letting patients have access to their records. In fact, the best way to make sure the record got from one clinic to another was to let the patient carry it, and so that’s what we were doing because otherwise, there weren’t systems to get them quickly there. But that measurement that she did resulted in us thinking, okay, we need to rethink the clinics because it’s way too far to make a patient walk. So during that planning process, we also were planning for what we called our care centers and it was where, in an outpatient basis, you could bring together radiation therapy, medical oncology, surgical oncology, and if it were a breast center, they would have mammography right there. It took us a year. Dr. David Hohn, who was the VP for Patient Care by then, took us through a year of meeting with all these different chairs and section heads. I think the division had got it but we were meeting in an auditorium --that’s how many people there were-- and going through why we would do this, what is the rationale. Got challenged on who controls the money then always gets asked, how are they governed. We had a year’s worth of meetings that were pretty brutal. I remember one meeting really well into it. We were getting closer, but Dr. Bob Benjamin [oral history interview], who was department head of Melanoma, he asked Dr. Hohn and me, “Well, how do you see this happening and how do you see that happening?” When we walked out, David and I looked at each other and said, “Oh my gosh we’re there, because now they’re asking how can we do this, not why are we doing it.” It took a lot of effort, but this project included creating these care centers that became more patient centric. I think that flipped Anderson from being perceived by patients as such a physician centric organization, although it still was very much a physician driven organization. You can organize any way you want, and it will always be, I think, a physician driven organization. But these care centers, I think strategically repositioned MD Anderson to be successful in the future because it was destined to get so big, and it did.

Charles Balch, MD:

In my recollection --and Gabe Hortobagyi [oral history interview]-- since this occurred in 1993, twenty-five years ago.

Tacey A. Rosolowski, PhD:

It was later. I was looking at your interview, the oral history interview, and initiating event you were describing was actually Thanksgiving dinner in 1994. And so that was a few years after you came, and I’m wondering, I mean we can either continue with that conversation but it might be better to give some context by talking about what preceded that.

Donna Sollenberger:

Yes. Well you had asked what I was—he asked me to work on and one was the planning of the actual facilities with the chairs and the section heads. Another was finishing the budget and the other was—I’m trying to think what else we were up to. So it was this, the facility, and then the planning for running the clinics.

Charles Balch, MD:

Everybody takes computers for granted but remember, one of the things we did was start a computer based information system within the division. That was a good example of something the departments couldn’t do. Do you have any recall about our information system that we started at the division, because that was really unique.

Donna Sollenberger:

What I think was even more unique is we had our own person, Paul, who was over the IT system in the Department of Surgery and we were reluctantly allowed to start it. They gave us some funds in that very generous year, probably would have been the ’92 budget. We were given a lot more funds to extend that and make sure each area of the Division of Surgery had access to what at the time was probably a local area network.

Tacey A. Rosolowski, PhD:

And that was involved in billing wasn’t that?

Donna Sollenberger:

We did do … Well that was the other thing that was unique. We had our own surgery billers; people who coded and did the coding, reviewed the documentation and dropped the bill, and the collection was done on the back end centrally. But we generated, we wanted specialized surgical coders and yes, a lot of Paul’s work was around refining the system to do things that they needed to do as changes occurred in billing. That’s all the time it seems like. But that was another key factor to success in surgery, as they were controlling that front end, and the coders were embedded in surgery and were meeting with the various department chairs about any issues relative to coding and documentation. So we were resolving that on the front end, dropping the bill, and then the physician’s referral service took it from there.

Charles Balch, MD:

And my recall is we greatly increased the revenue.

Donna Sollenberger:

We did.

Charles Balch, MD:

Because we were not losing income based upon not coding or not coding properly or not coding completely. That also involved educating the surgeons to document their procedures they were doing, especially if they were doing multiple procedures.

Donna Sollenberger:

Correct, yeah.

Chapter 02: First Steps as Division Administrator

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