First….    May 28, 2013

By Leonard Zwelling

            If
you haven’t seen the video from the May 23 Townhall, you need to watch it. From
the camera angles on the video it is quite apparent that far less than a full
house was in attendance so the video record is important.

            The
leaders (DePinho, Burke, Buchholz, Morris) begin their presentations by
commending individuals and teams about how great a job they are doing. Then
they list all the problems. If those folks were doing such a great job, why do
the problems seem to be getting worse?

            One
reason becomes obvious immediately. The metrics to which the speakers refer may
not be the ones we wish to stress.

            We
have historically pursued a strategy of excellence in clinical care, clinical
research, population-based research, prevention, education and laboratory
investigations of all types. Yet all of the numbers presented were about size
and increases in the amount of what we do. No one addressed the QUALITY of what
we do (until the discussion session). This is the strategy of WalMart not that
of Tiffany. Is our goal to become the WalMart of cancer centers?

            The
other redundant term batted around besides size is efficiency. All of the
speakers describe efforts at efficiency and gains in efficiency. Yet no one
defines what he (and yes, again, all men) means by efficiency. To me it means
doing more for less, but does that mean foregoing quality for volume? I don’t
know. You watch and see if you can figure it out.

            Personally,
if I were an investor in this company known as MD Anderson and these were the
executives, I’d be selling short.

            An
example of the lack of focus I heard was the discussion around speeding up the
approval process for clinical trials with a goal of getting protocols activated
in 60 days. This would constitute a great improvement apparently. For goodness
sake, that used to be 48 days just a few years ago and the reasons for the
increase in time to approval were obvious.

            Years
ago, there was one office encompassing all of the functions needed to get a
protocol activated. That office was staffed by classified personnel experts in
clinical trials administration led by a team of managers who were in constant
contact with the faculty as to what was needed to get the protocols out the
door and ready for accrual. I was privileged to lead that office, but all of
those people did the work. At best, I was a conductor of an orchestra of caring
professionals. They were the experts, not I.

            All
required functions to go from protocol submission to first patient accrual
began on day one of receipt in that office—CRC and IRB protocol approval,
contract negotiation and cost analysis. It was all in parallel in one office,
not in the series design of today in many disparate offices. The situation
today is like the one in 1995 when the previous Office of Research
Administration had its beginnings. Reviewing the history of how this was solved
then might help the leadership now.

            But
this is just the aspect of the presentation that I understand. I suspect the
same is true on the clinical care side where the leadership of the care
delivery (the Division Heads) is relatively divorced from all aspects of
clinical operations—nursing, billing, scheduling, coding, etc. How can the
faculty assert any improvements in efficiencies of processes they do not own?
Despite the leadership’s requests for suggestions on improvements, I heard none
in the Q and A session. Either no one there had any ideas or the silence was a
tacit vote of no confidence.

            The
only thing more concerning than the presentations of the leaders were the
comments from the audience which were primarily cheerleading of various types.
This suggested that the president and the other leaders who had spoken had been
preaching to the choir for the previous 45 minutes and the rest of the flock,
missing from the Hickey, were either too busy in the clinic or simply voted
with their feet.

            Cancer
is as formidable a foe today as it was 41 years ago when the official War on
Cancer began. The leadership is presenting a very vague outline of a maybe
strategy for improving the efficiencies (still need that definition) without
really defining what we are and what we will become and how the heck we can do
this all by ourselves in a health care environment that is changing very
rapidly. The vision expressed at this Townhall is far too sketchy and far too
narrow to even remotely affect the cancer problem. Prevention is never
mentioned. Safety was only brought up in the Discussion session. Dr. DePinho’s
walkabouts would be the equivalent of the Secretary of Defense’s trips to
Afghanistan, useless for all but the Secretary and perhaps his PR machine. It
looks great on the evening news right before the next bomb goes off.

            I
suggest that the leadership define their strategy clearly particularly their
expectations for the revenue stream that will come from research investments.
Define what efficiency means. Decide if we are WalMart or Tiffany or perhaps
Zales. Mostly though, after two years of this administration, even a new
Provost is not enough. It’s time for some additional changes.