Walking the Walkabouts Is Not Necessarily Talking the Talk
Abouts
By
Leonard Zwelling
My
Random House Dictionary defines a walkabout in two ways. The first is British
and is a walking tour. The second and far more colorful is Australian. This is
a brief, informal leave from work taken by an aborigine to wander the bush,
visit relatives or return to native life. It is also defined as an absence from
work.
These
definitions make the President’s use of the word walkabout less clear than I
suspect he would like.
If
he talks about his walkabouts as the British do, we can assume he is walking
around the hospital and clinics observing what is happening in them.
However,
if he is coming from Down Under, it suggests his wanderings may be through
territory both wild and unfamiliar, like the bush around Ayers Rock called
Uluru by the indigenous people. It is one of the most desolate places I have
ever visited. It is in the middle of the Australian outback over 200 miles from
the nearest town of Alice Springs. It is a huge red sandstone mountain with
great spiritual significance to the native people. It is very hard to get to
and many tourists fly in, watch the sun set, the moon rise, retire early and
arise in the dark to watch dawn, leaving after breakfast. There’s not much else
to do out there so it may be no surprise that the aborigines wish to take a
walkabout break from the desert. Remember the dictionary says that a walkabout
is an absence from work.
When
the President has talked about his walkabouts, I believe that he is letting us
know that he is making the effort to understand what makes MD Anderson tick and
what moves the faculty and staff, positively and negatively. This is excellent,
of course. However, given our historical reliance on our patient care and
clinical research expertise, it is somewhat surprising that after taking his
walkabouts, he continues to pour his resources into bolstering what has
traditionally not been our strength, laboratory-based research. This does not
mean our laboratory faculty members don’t do investigation of the same quality
as our clinical, population-based or prevention faculty. They do, but that is
simply not what MD Anderson is number one in. We are number one in clinical
cancer care. We also derive the vast majority of our income from patient care
activities.
So
there seems to be some kind of disconnect between what the President is seeing
on his walkabouts and what he is emphasizing as he implements his plans, i.e.,
what he talks about.
Why
should this be?
It
is possible this is because walking about in a tertiary (or quaternary) medical
institution will only gain you insight if you come with the proper ears and
eyes. In essence, at MD Anderson, one would need a background in medical or
surgical or pediatric or radiation oncology, a deep understanding of the
provision of complex modern medical care, the use of advanced medical
technology in that care and a sensitivity to the enormously difficult task of
performing clinical cancer research where the research and the patient care are
inextricably intertwined and the investigator’s behavior is so federally
regulated. Clinical research is hard!
So
while I am more than willing to give the President major props for his
walkabouts, listening to him talk about his walkabouts leaves me wondering if
he really understands what he has seen, heard or walked through. Having
recently done a walkabout myself (British style only) of some of the clinics,
what I see would encourage me to invest heavily in them to facilitate the
efficient delivery of patient care through better logistics, information
systems and a wholesale restructuring of how we see patients and which patients
we see, especially if the goal is to increase the clinical revenue as we have
been told it is. I am impressed that the faculty is doing such amazing work
getting through the day given the support they have been given. If there ever
was a place for re-engineering to help both the faculty and staff do their jobs
more efficiently, not to mention make life better for all the patients in the
waiting areas (how many more can we realistically see?), it is in our clinics.
These many faculty and staff providers are just working too hard to get through
a day without major stress and that can’t be good for anyone!
Perhaps
we need a faculty forum in which the President and his leadership team explain
to us their level of understanding of the complexities of modern cancer care
delivery, clinical cancer research, clinical information systems, billing,
coding, scheduling and general all around getting through the day for an
average clinical faculty member. Then we can each judge for ourselves whether
or not the walkabouts are truly illuminating for the leadership or simply an
absence from work in an outback in which they have never had to operate.
