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0:00 - Segment 00D: Interview Identifier

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Partial Transcript: "All right, today is June 5th, 2015, and the time is about eight minutes after two. And I’m on the eighteenth floor of Pickens Tower in the office of the Physician in Chief, talking my fourth session with Dr. Alma Rodriguez. So thank you very much for making the time. I know this has been a lot of sessions."

Segment Synopsis:

Keywords:

Subjects:

0:31 - Segment 21: Patient-Centered Care: Formalizing the Practice at MD Anderson

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Partial Transcript: "So, we were strategizing a little bit before we turned on the recorder. And I first wanted to ask you about an area within the scope of Medical Affairs that we’ve touched on, but not really addressed, you know, forthrightly, which is the institution’s very explicit move to patient-centered care. So I was wondering if you could address that, and also talk a bit about the Psychosocial Council which is under the scope of your role, as I understand it."

Segment Synopsis: Dr. Rodriguez talks about the shift in healthcare to a focus on patient-centered care and addresses the specific ways that MD Anderson is putting this approach into practice.

She first explains that patient-centered care is a shift in focus and explains the value is shifting from treating disease to treating people (and seeing them as customers). She notes that MD Anderson patients experience the kindness and devotion of providers. She lists some patient centered practices instituted and notes others that need improvement.

Keywords:

Subjects: 1. Segment Code - B: Building the Institution 2. Story Codes - A: The Administrator B: Building/Transforming the Institution B: Institutional Mission and Values B: MD Anderson Culture B: The MD Anderson Brand, Reputation C: Patients C: The Life and Dedication of Clinicians and Researchers C: This is MD Anderson C: Volunteers and Volunteering D: The History of Health Care, Patient Care

8:04 - Segment 22: Patient-Centered Care: the Psychosocial Council, Advanced Care Planning

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Partial Transcript: "Excuse me. In addition, there’s also a very—one of the reasons that we formed the Psychosocial Council was that we wanted to have more interaction between the various disciplines that provide what in today’s terminology is called psycho oncology, that is, the whole realm of services, supportive services, that improve or address people’s emotional and spiritual well-being. We wanted to bring all of those disciplines together to have conversations about what might be programs or processes that are of critical importance that we should improve? You know, where do we need to move the needle, in what domains, or what specific care delivery issues do we have today that we should be addressing? So again, I see that you have written down in your notes Advanced Care Planning. The whole conversation, again, on the national scene around end-of-life decisions is part of this conversation of Advanced Care Planning. But I’m going to give you a different personal spin on Advanced Care Planning. And here’s my thought. Advanced Care Planning should be about thinking ahead of how your healthcare will be, how you will manage it, or who and when and why, and who will pay for it, and so on. That’s part of what should go into this; it’s like planning your child’s college education, right? So this is about planning your own health in the future, and how you will be cared for in the
future, through wellness, through aging and through dying, OK? For some reason, the conversation has been made entirely about dying. And for that reason, I think that it frightens many people, and it decreases willingness of families or patients to talk about it."

Segment Synopsis: In this segment, Dr. Rodriguez continues her discussion of patient-centered care. She discusses the work of the Psychosocial Council, in particular on the latter’s work on creating guidelines to talk to patients about advanced care planning, then talking about the Department of Chaplaincy and Pastoral Education.

She first talks about the Psychosocial Council and advanced care planning, offering her view that advanced care planning is not a conversation about death, but about health care planning for the future that needs to be integrated into a patient’s treatment plan. She explains strategies for bringing awareness to this at MD Anderson and also notes that this is part of a national conversation.

Dr. Rodriguez next talks in general terms about the Psychosocial Council (formed 2007), its roles, and the pushback it has received for treating disease from an emotional perspective.

Keywords:

Subjects: 1. Segment Code - B: Building the Institution 2. Story Codes - B: MD Anderson Culture B: Building/Transforming the Institution B: Devices, Drugs, Procedures B: Institutional Mission and Values B: Institutional Processes B: MD Anderson Culture B: Multi-disciplinary Approaches C: Patients C: Patients, Treatment, Survivors D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

24:24 - Segment 23: Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson

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Partial Transcript: "Yeah, makes perfect sense. You mentioned spiritual support. What does that look like? Because we talked about some social, some psychological, what about spiritual?"

Segment Synopsis: Dr. Rodriguez discusses the Department of Chaplaincy and Pastoral Education and its focus on spiritual concerns. She lists the kinds of issues that arise for cancer patients.

Dr. Rodriguez explains that, historically, MD Anderson has sustained linkages with spiritual/religious organizations and communities. This is one reason the Department of Chaplaincy at MD Anderson is so robust.

She then talks about the future of psychosocial approaches at MD Anderson, looking ahead to the creation of a Division of Psychosocial Oncology. She list some research studies the faculty are conducting in this area.

Keywords:

Subjects: 1. Segment Code - B: Building the Institution 2. Story Codes - B: MD Anderson Culture B: Building/Transforming the Institution B: Devices, Drugs, Procedures B: Institutional Mission and Values B: Institutional Processes B: MD Anderson Culture B: MD Anderson History C: Research, Care, and Education B: Multi-disciplinary Approaches C: Patients C: Patients, Treatment, Survivors D: The History of Health Care, Patient Care D: Understanding Cancer, the History of Science, Cancer Research

35:59 - Segment 24: Transitional Moments in MD Anderson History

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Partial Transcript: "Yeah, I mean, you know, you’ve been at the institution for a long time, I mean, you’ve seen it go through a whole variety of arcs and peaks and valleys. And you know, I kind of, I guess I’d like to throw the question to you. You know, what are some of the kind of big moments you think of as the key moments of change? And then I did want to ask you about, you know, the most recent period since 2011 when Dr. [Ronald A.] DePinho took over at the Institution. But you know, what have you observed in terms of big, key moments of change at MD Anderson?"

Segment Synopsis: Dr. Rodriguez sketches key moments of change in MD Anderson history since her arrival.

She first talks about the eighties and the “growing consciousness that MD Anderson is an economic entity,” moving on to the nineties and the complexities that evolved with more billing forms, rules, and concern for downstream revenue generated from patient care. She gives an example of chemo therapy orders and talks about pros and cons.

Dr. Rodriquez then talks about the MD Anderson’s physical expansion to the point where she “can’t embrace” the institution. She notes that the physicians and nursing staff have preserved their dedication and pride.

Keywords:

Subjects: 1. Segment Code - B: Institutional Change 2. Story Codes - B: Critical Perspectives on MD Anderson B: Growth and/or Change B: Industry Partnerships B: Institutional Mission and Values B: MD Anderson Culture B: MD Anderson History B: The Business of MD Anderson C: Research, Care, and Education C: The Institution and Finances C: The Life and Dedication of Clinicians and Researchers

43:27 - Segment 25: Change Under Ronald DePinho: The Balance Between Research and Clinical Care

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Partial Transcript: "What’s—is there—what’s been preserved? I mean, you’re alluding to things that have been lost, are there things that have been preserved throughout that growth?"

Segment Synopsis: Dr. Rodriguez states that MD Anderson has shifted away from its mission as a care facility since Ronald DePinho assume the institution’s presidency in 2011, moving toward a research-generating facility.

She sets context by discussing the growth of research under Dr. John Mendelsohn, noting that research still served patient care despite accelerated industry-sponsored research.

She next talks about MD Anderson’s focus on new drug development and the implications, specifically in the demand for financial and intellectual resources this requires

Keywords:

Subjects: 1. Segment Code - B: Institutional Change 2. Story Codes - B: Critical Perspectives on MD Anderson B: Growth and/or Change B: Industry Partnerships B: Institutional Mission and Values B: MD Anderson Culture B: MD Anderson History B: The Business of MD Anderson C: Research, Care, and Education C: The Institution and Finances D: Business of Research

53:00 - Segment 26: Turbulence During Dr. DePinho’s Early Presidency; MD Anderson’s Future

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Partial Transcript: "How are—how has this change in focus reverberated in MD Anderson culture, and kind of where you see, you know, sort of day-to-day priorities? You know, what’s your read on that? I mean, obviously, there’s been a lot on tension amongst the faculty, kind of questions on how the culture is changing. What’s your perspective on that?"

Segment Synopsis: Dr. Rodriguez comments on the changes created at MD Anderson under Dr. DePinho’s early presidency then talks about the future of MD Anderson under the Affordable Care Act.

Dr. Rodriguez first comments on the magnitude of institutional change that Dr. DePinho’s administration has brought to MD Anderson. Making reference to literature from the field of organization transformation, she notes that change on such a scale requires a “message of urgency” that was not verbalized by the administration. Change has felt imposed from outside, creating tensions in the institution, she observes. She notes that the Board of Regents was slow to recognize problems.

Keywords:

Subjects: 1. Segment Code - B: Institutional Change 2. Story Codes - B: Critical Perspectives on MD Anderson B: Growth and/or Change B: MD Anderson Culture B: MD Anderson History C: Leadership D: On Leadership B: The MD Anderson Brand, Reputation C: Professional Practice

60:12 - Segment 27: Creating a Future Under the Affordable Care Act

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Partial Transcript: "What’s your prognosis? We’re in year four, coming up on the Moon Shot’s anniversary soon. You know, what—what’s the temperature now, and what do you think is going to happen, what needs to happen to get the Institution onto a track? It’ll be different, obviously, but how to get it on track into a place of where the creativity is recognized, where the culture is--"

Segment Synopsis: Dr. Rodriguez explains that MD Anderson’s future will be determined by changes to healthcare under the Affordable Care Act.

She first talks about the loss in revenue anticipated, then describes initiatives that the Office of Medical Affairs is setting in place to help address anticipated problems. She talks about the need to document all care processes in the spirit of moving toward more evidence-based care and shifting the mindset of providers away from an expert mentality to a spirit of self-reflection and improvement. She also talks about the importance of examining and optimizing all of MD Anderson’s resources.

Keywords:

Subjects: 1. Segment Code - B: MDACC in the Future 2. Story Codes - B: Critical Perspectives on MD Anderson B: Growth and/or Change B: Institutional Processes B: MD Anderson Culture B: MD Anderson History B: MD Anderson in the Future B: The Business of MD Anderson

70:40 - Segment 28: Women and Leadership at MD Anderson

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Partial Transcript: "Yeah. You want to shift gears right now?"

Segment Synopsis: Dr. Rodriguez provides her views of women and leadership at MD Anderson. She cites statistics in support of her view that “the workforce in medicine is about women.” She stresses that women have to know systems in order to succeed in leadership positions. She offers her view of coming up through the ranks when there were many fewer women and notes that MD Anderson does not have clear processes for filling leadership positions or establishing a pipeline of leaders.

She talks about her own strategy for cultivating leadership.

Keywords:

Subjects: 1. Segment Code - B: Diversity Issues 2. Story Codes - A: The Leader A: Experiences Related to Gender, Race, Ethnicity A: The Mentor B: Gender, Race, Ethnicity, Religion B: MD Anderson History C: Leadership C: Mentoring B: Critical Perspectives on MD Anderson C: MD Anderson Culture C: Women and Minorities at Work

82:00 - Segment 29: Accomplishments, Retirement, and a Love of Cosmology

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Partial Transcript: "I had—we’re at 3:30, but I had just a few more questions I wanted to ask you, if we could go over a tiny bit, is that OK?"

Segment Synopsis: Dr. Rodriguez begins by listing her most significant accomplishments: launching the concept of survivorship; imbedding into MD Anderson culture the role of quality officers; integrating Advanced Care Planning into treatment planning; serving as champion for the Physician Assistants Program; helping everyone who has reached out to her as a role model.

Next she talks about the interests she plans to pursue in retirement: psychology, art, reading, and cosmology. She notes that she minored in philosophy as an undergraduate and her thinking has been very influenced by process philosophers who believe that reality self-creates. She believes that the Universal Mind is also self-creating and explains that this spiritual component of her belief system helps her cope with change.

Keywords:

Subjects: 1. Segment Code - A: View on Career and Accomplishments 2. Story Codes - A: Character, Values, Beliefs, Talents A: Career and Accomplishments A: Faith A: Influences from People and Life Experiences A: Personal Background A: Post Retirement Activities A: Professional Values, Ethics, Purpose

0:00



ROSOLOWSKI:

All right, today is June 5th, 2015, and the time is about eight minutes after two. And I’m on the eighteenth floor of Pickens Tower in the office of the Physician in Chief, talking my fourth session with Dr. Alma Rodriguez. So thank you very much for making the time. I know this has been a lot of sessions.

RODRIGUEZ:

Not a problem.

ROSOLOWSKI:

And I really appreciate the gift of time that you have given to the project.

RODRIGUEZ:

You’re welcome. Thank you.

ROSOLOWSKI:

So, we were strategizing a little bit before we turned on the recorder. And I first wanted to ask you about an area within the scope of Medical Affairs that we’ve touched on, but not really addressed, you know, forthrightly, which is the institution’s very explicit move to patient-centered care. So I was wondering if you could address that, and also talk a bit about the Psychosocial Council which is under the scope of your role, as I understand it.

RODRIGUEZ:

Right. Well, I think that certainly the concept of patient-center care is not unique to our organization, it is part of a national movement that acknowledges that, obviously, that’s the reason that healthcare happens, is that we are taking care of individuals. And furthermore, that we are not—again, there’s a shifting in consciousness, if you will, that we’re not really treating a disease, or a series of disease processes, but we were actually treating a person. And so, which then, if you will again, shifts the elements of the experience that are being paid attention to. So for example, it would never have—when I did my training in medical school, it would never have occurred to us to ask a patient how satisfied were they with their experience of being in the hospital, because our assumption was, they were not happy, and it was a terrible experience.

ROSOLOWSKI:

Oh, wow.

RODRIGUEZ:

Why would we ask people that, right?

ROSOLOWSKI:

Yeah, that’s the first time anybody’s ever said that. (laughs)

RODRIGUEZ:

Why would you ask people that? The assumption would be that it is terrible, that is not—is something outside of your experience. So the novel thing today is that we are, if you will, customer-centered. And we wanted to know if the patient had a good experience in terms of how the lobby looked, how the meal was, how courteous people were. And frankly, I think that’s a valid question, because although on the surface, it might appear to be, how shall I say, a set of trivial events, the truth is that when you are ill, when one is ill, all of these other things can, of course, soften the blow, if you will. And so to a good degree, having just a pleasant environment and a pleasant interpersonal exchange with the individuals taking care of one can, in fact, make the experience of the illness bearable, if you will. So the realization that it isn’t just the therapeutic intervention that matters, that, in fact, all the other interventions are part of the success of that story of that narrative for the patient during illness is relatively new in the consciousness of healthcare. And so, we—imagine how much more dramatic all of that is when the patients have a diagnosis of really serious and potentially life-threatening illnesses, which many cancers can be, right? So we are sort of, if you will, we’re attempting to move in that direction. I don’t think that we’re there yet, I don’t think, that we have, if you will, for lack of a better word, mastered all the elements of improving the patient experience.

But in general, I think that patients have consistently, across time, experienced that MD Anderson is the kindness and the devotion of the people who work here, particularly in the clinical care setting; the nurses, the Physicians, the technicians, the Therapists. The people who are sitting face-to-face with patients have to be special to work here. And that’s my subjective observation, if you will. I don’t have the scientific evidence to say across the board we all have this particular psychological profile, and we all behave in this way. I mean, we don’t have that kind of profile, but I can tell you just from observing and interacting with the individuals who work there that in general, across the board, they’re kind, thoughtful, dedicated persons. And patients sense that. They know that. So many of the comments that we get in feedback pertain to that.

And in particular, one of the biggest treasures of our Institution, actually, are the volunteers that come to our Institution. Many of them are cancer survivors. They either have had cancer themselves, or they have been caregivers for someone who had cancer, so they understand what the experience is like, and they can relate to the patients. And if you will convey that empathic message of, you know, we understand, we care how you feel. So that’s one of our great advantages. We also moved sometime back to the concept of room service, that is that people could request their meals at their own time, when they were ready to eat. I mean, certainly people who are undergoing cancer treatments can have challenges in feeling hungry or being able to enjoy food, but it turns out that if you allow people to have control over the times at which they eat, and choose the kinds of foods they want to eat, that, you know, they can be better-nourished. So we’ve done that. And the food service usually is one of the things that gets better ratings in our—as opposed to many hospitals, where the food service gets terrible ratings! (laughs)

ROSOLOWSKI:

I was just going to say that. It’s like a joke about hospitals—

RODRIGUEZ:

Yes.

ROSOLOWSKI:

—the food is so terrible. Wow.

RODRIGUEZ:

So we do some things very well. You know, we still have to improve on other things; you know, the efficiencies of our workflows, decreasing wait times, improving our information and communication systems with patients so that they get information in a more timely fashion, all of those process changes we’re still working on.

RODRIGUEZ:

Excuse me. In addition, there’s also a very—one of the reasons that we formed the Psychosocial Council was that we wanted to have more interaction between the various disciplines that provide what in today’s terminology is called psycho oncology, that is, the whole realm of services, supportive services, that improve or address people’s emotional and spiritual well-being. We wanted to bring all of those disciplines together to have conversations about what might be programs or processes that are of critical importance that we should improve? You know, where do we need to move the needle, in what domains, or what specific care delivery issues do we have today that we should be addressing? So again, I see that you have written down in your notes Advanced Care Planning. The whole conversation, again, on the national scene around end-of-life decisions is part of this conversation of Advanced Care Planning. But I’m going to give you a different personal spin on Advanced Care Planning. And here’s my thought. Advanced Care Planning should be about thinking ahead of how your healthcare will be, how you will manage it, or who and when and why, and who will pay for it, and so on. That’s part of what should go into this; it’s like planning your child’s college education, right? So this is about planning your own health in the future, and how you will be cared for in the

future, through wellness, through aging and through dying, OK? For some reason, the conversation has been made entirely about dying. And for that reason, I think that it frightens many people, and it decreases willingness of families or patients to talk about it.

ROSOLOWSKI:

Yeah.

RODRIGUEZ:

But the reality is that today, almost seventy percent are going to be alive. And we touched upon that when we talked about the survivorship program. You know, today having a cancer diagnosis is not a death sentence. And so people need to anticipate that they’re going—many of them, most of them, are going to be alive after the diagnosis of cancer, and that their lives need to reintegrate into wellness. They need to anticipate that. How am I going to be—you know, who should be best—who should I address myself to, who would be best for me to go to to handle X, Y and Z? And so that’s what the whole survivorship program is about. But we have not really integrated that concept well into the topic of Advanced Care Planning. So my goal is to hopefully integrate well into every single patient’s discussion with their Physician, when their treatment plan is being made, that this conversation about what will the future likely be for you? Will it be wellness? May it be period relapses of this illness, because there are some cancers that can be put into remission for some periods of time, but they can re-occur. Is that likely going to be the future for you, or is it, unfortunately likely that your life will not be too long, but we can help you best, or we can help you deal best with the situation by alleviating pain, by relieving discomfort, etc. There is some form of care that is available and possible to deal with each of those scenarios, and it’s a matter of having the conversation about that, when the treatment plan is made. I think it’s totally appropriate to have at least a glimpse of the future so that people aren’t entirely left in the dark, or unprepared for what can come later. To me, that’s what Advanced Care Planning means. And I’m hoping that that’s going to be part of the MD Anderson culture in the future.

ROSOLOWSKI:

So—

RODRIGUEZ:

So that was one of the initiatives that became embraced by the Psychosocial Council.

ROSOLOWSKI:

I see.

RODRIGUEZ:

I finally have got around to where I started.

ROSOLOWSKI:

Yeah, no no, I had no doubt you would. (laughs)

RODRIGUEZ:

We decided that that was going to be one of our key initiatives. It’s not the only one. But it is one that is going—if it does get embedded in the culture, I think it would have a very significant impact in how patients experience cancer and cancer treatment.

ROSOLOWSKI:

So what are the steps that you’re taking to shift the culture so that these discussions are kind of part of the way a treatment plan evolves?

RODRIGUEZ:

Well, it’s a multi—of course, it’s a very—it’s a multi-layered process, and it will still take us a long time to get there. We always start, of course, first, with a conversation of why is this an important topic. That was part of the exploration of the Council. This is a topic that’s not just important from the perspective of, if you will, treatment planning, but it’s also important from the perspective of appropriate resource utilization, if you will. And let me explain. I’m not talking about saving money, cutting here, cutting there. But it is about ensuring that the resources, the categories of services that are going to be needed to provide this domain of care versus this other domain of care versus that domain of care are aligned with the expectations of the outcome for that patient. And that if, for example, again, I might consider that this patient is going to be well, I’m going to start to prepare that patient psychologically, as well as clinically, for their eventual transition to a survivorship care model.

Versus if a patient is unfortunately going to need to have supports, palliative care, symptom management, that I’ve appropriately, then, referred the patient to the providers that are going to assist the patient dealing with their symptoms. It’s about anticipating what resources might be most beneficial for the patient at the appropriate time. And that conversation, again, is not unique to us. I mean, I think it’s a conversation on the national agenda, as well. What categories of services, or what types of healthcare needs does America as a society need? Do we have the right kinds of people that are trained to deliver those categories of care? Do we need to devote more resources, to train more Physicians or more physical Therapists, or more—you name it, in a way. Do we really have—are we going to meet the need of the growing, aging population? How are we going to do that? So we anticipate, for example, severe shortages of geriatricians, of home health care providers. We don’t have enough nurses and Therapists to provide home health care services to people with decreased mobility, you know, and that’s one of the conditions of aging, that people have less mobility, less, if you will, geographic translation capacity. And so people need to come to them, rather than the patient going everywhere. So this is just setting, you know, in perspective, why it is that it’s important to think about this.

ROSOLOWSKI:

Right. Right.

RODRIGUEZ:

How are we going to have to adjust to that new reality? So the Psychosocial Council, again, is all of these specialists that deliver social, psychological and spiritual support services. And this is yet—you asked about the patient experience. People experience, of course, illness in an emotional way. Although there may be physical symptoms associated with it, the more, again, from the patient’s experience, the emotional effect of those symptoms is what they react to, or respond to. So chronic pain can lead to depression, can lead to anxiety, it can lead to a sense of debility, of uselessness, of worthlessness, and so on, which in itself, then, of course has a huge myriad of effects of the capacity of that individual to function as a member of their family, their workforce, the society, etc.

So going to the root of the symptom of the pain is important, but dealing then also with the emotional response to the pain is equally important, if you will. So the integration of psychosocial care into the clinical care framework is, or was, the initial drive for the formation of the Council.

ROSOLOWSKI:

Was there push-back against that?

RODRIGUEZ:

So there is a very—so conceptually, everyone agrees, right, it’s like motherhood and apple pie. It’s wonderful that we should take care of the emotional well-being of patients. The downside of that is that to really deal with the psyche versus the soma, dealing with psyche takes time. It takes a lot more time than dealing with physical—with a physical side of illness, or at least that’s—I can tell you that’s my experience in the clinical setting.

It’s—and perhaps it just comes with experience, but I can formulate a treatment plan for the lymphoma much more easily than I can formulate a treatment plan or a conversation or a therapeutic plan for the whole range of negative emotions that the patient is dealing with. That takes time. It takes time to—it takes very—the skillset for being good at that are totally different than the skillset for being good at clinical care, or at the expertise of dealing with clinical illness, OK, or physical illness, I should say, more correctly. So it takes time. If one is not trained well, and one has not developed appropriate, if you will, defenses or boundaries, it can also be very intrusive and in some ways, destructive of one’s inner emotional well-being. Certainly from a pragmatic perspective, the way that our healthcare system is set up, it does not value psychosocial health, and it does not, then, reimburse for it. It does not compensate for it. And time is very valuable. So having the right—or most of the barriers in, if you will, obstructive viewpoints about psychosocial health and psycho oncology is that we don’t have the resources, we don’t have the time, we can’t hire any more people. You know, it’s not that—and so the solution is to say it’s not that important or critical, right?

I think we’ve made a lot of progress. I think we’ve, over time, solidified, to a greater degree, the importance of psycho oncology. For example, we now have an independent and freestanding department of psychiatry. It used to be a small section embedded in neurology. It’s now its own freestanding department. We have more psychologists who are now practicing clinical psychology, whereas when the Council started, the vast majority were basically on the research side of the house, and there were only maybe two or three that were clinicians. That’s—

ROSOLOWSKI:

Well, just for the record, when was the Psychosocial Council started?

RODRIGUEZ:

Well, we were charged to begin, to form, in 2007.

ROSOLOWSKI:

OK.

RODRIGUEZ:

Although we really didn’t get much traction probably until 2008, 2009.

ROSOLOWSKI:

OK.

RODRIGUEZ:

We’ve also increased significantly the number of social workers that we have. And I think that we’ve made—we were just looking at all of the accomplishments that we’d arrived at over the years, we’ve created policies that embed, now, you know, evaluation of distress, is one of the intake questions that we are—it’s embedded into the nursing intake forms for all patients. We’ve established policies on how to deal with symptoms, or how to assess for symptoms of depression and suicidal ideation. We’ve established, as well, a whole algorithm that is a care plan for addressing distress. We’ve, of course, established a policy about implementing in the future Advanced Care Planning. We’ve developed forms for documenting the discussions with Advanced Care Planning; they’re going to be embedded into our new Electronic Health Record. They’re going to be part of the intake of every person, every patient, and so on. So we’re slowly starting to, if you will, integrate this, interdigitate this process into the day-to-day workflow. And that’s the only way that you can get sustainable change.

ROSOLOWSKI:

Right.

RODRIGUEZ:

Most transformational gurus will say that. Unless you embed these changes into the routine day-to-day work of people, virtually all of these grandiose ideas come and go. It has to be in your daily routine before it really becomes engrained.

ROSOLOWSKI:

Sure. Sure.

RODRIGUEZ:

In the culture.

ROSOLOWSKI:

Yeah, makes perfect sense. You mentioned spiritual support. What does that look like? Because we talked about some social, some psychological, what about spiritual?

RODRIGUEZ:

Well, we have a whole department of Chaplains.

ROSOLOWSKI:

OK.

RODRIGUEZ:

And I think compared to most hospitals, it is quite robust, in that we have full-time Chaplains of several denominations, but they all have to be certified in healthcare Chaplaincy. And there is actually a whole discipline for that, and certification process for that. And the difference between healthcare Chaplaincy and, of course, a position of clergy in the religious communities is that a healthcare Chaplain, if you will, needs to focus more on the spiritual concerns around illness; the questions or relationship, if you will, to a higher spiritual being. Questions of, or issues of existential anxiety, for lack of a better word. Why am I here? Why did I get this illness? Why did I survive, versus my friend, my child, my neighbor? So Chaplaincies that are linked to healthcare are aligned with those—along those lines, that is, how illness then brings to the surface, the existential questions of why I exist, and what is my relationship to a—or do I have a relationship? Or am I worthy of a relationship to a higher entity, or higher spiritual being?

ROSOLOWSKI:

Is it unusual that a cancer center has a department devoted—you said that “The department is robust.” I mean, is that—

RODRIGUEZ:

Robust in numbers. Also in—

ROSOLOWSKI:

Yeah, I’m just wondering if it reflects sort of a different level of investment in this particular issue for patients.

RODRIGUEZ:

Mm-hmm. I’m sure, very likely. Again, when the hospital was established, remember that it was in the 1940s. Cancer, hardly anybody survived.

ROSOLOWSKI:

Survived, yeah.

RODRIGUEZ:

And so in those days, I think it was seen very much—if you asked people what was important, psychology or spirituality, they would have said spirituality over and above everything else, right? So I think it just has to do with the roots of how the organization was built.

ROSOLOWSKI:

Interesting.

RODRIGUEZ:

Or when it was built. But also, in addition, that I think although it may not seem this way, but I think that Houston as a community has very deep religious roots and deep spiritual roots. We have an established Jewish community, we have, of course, a Catholic community. We have Baptists, Methodists. The interesting thing is that one of our most supportive organizations comes from the Lutheran church. So it wasn’t necessarily—so there’s, across the board, a very broad, if you will, support for the Chaplaincy service here. It had the benefit of several lines, if you will, of spiritual practice and viewpoints to be built. So in addition to our full-time staff, we also have volunteer staff from the community, and we also have students who come to train here.

ROSOLOWSKI:

This is in the Chaplaincy department?

RODRIGUEZ:

Correct.

ROSOLOWSKI:

Wow!

RODRIGUEZ:

Correct.

ROSOLOWSKI:

Well, you know, I often ask interview subjects about their own spiritual beliefs; I mean, if I kind get a sense, you know, that that’s an issue. And I’ve been really surprised at how people have said, yeah, you know, everything in my medical practice is very deeply embedded in my spiritual life.

RODRIGUEZ:

Mm-hmm.

ROSOLOWSKI:

I mean, and so at the level of individ—on the provider’s side, you know, you find that as well, that it’s a very important, maybe not very often talked about—

RODRIGUEZ:

Right.

ROSOLOWSKI:

—but certainly a very important part of the ethos, if you will, of the institution.

RODRIGUEZ:

Mm-hmm.

ROSOLOWSKI:

Yeah, very interesting. So what’s the future, do you think, of the Psychosocial Council and this whole movement? Kind of what’s the next big thing to work on, and what’s the prognosis for—

RODRIGUEZ:

Well, it’s really interesting. We’re asking ourselves that.

ROSOLOWSKI:

Uh-huh?

RODRIGUEZ:

You know, since we’ve been in existence now almost—it’s been, I mean, not quite there, but almost ten years since we were given the charge. And the institution has changed. You were going to bring up the issue of change. The question that we are asking ourselves, is it time to really shift in a different direction? And I don’t know the answer, actually. We’re still—we are exploring that. I think that as the, if you will, academic infrastructure for psychiatry, psychology—clinical psychology and other disciplines, as the academic infrastructure strengthens, where there are no longer just the rare and small services that embedded into other larger departments, as they come into their own being, perhaps they will take the banner on. And we may not need to have the Council as the support structure—

ROSOLOWSKI:

Right.

RODRIGUEZ:

—for those efforts. So we’ll see. Only the future will tell. In fact, I’m rooting for the stronger formation of all of these professional groups to no longer be isolated in small, freestanding services, but that actually, hopefully, someday, there would be a division of what I would call, you know, psycho oncology medicine, or behavioral medicine, or behavioral and spiritual medicine—I don’t know what the office term would be, but that it would be its own entity, standing side-by-side with surgery and medical oncology and all the other disciplines of medicine.

ROSOLOWSKI:

Now, are academics in these various fields at MD Anderson also conducting research?

RODRIGUEZ:

Yes. Yes.

ROSOLOWSKI:

And, I mean, what—because you know, I’ve been in so many conversations, I mean, this is an evidence-based institution. And so, you know, if something is going to have an impact, then you want to document that it does, indeed have the impact—

RODRIGUEZ:

Right.

ROSOLOWSKI:

—I mean, for a whole variety of purposes; not only intellectual legitimacy, but also for, you know, the valued care movement.

RODRIGUEZ:

Mm-hmm.

ROSOLOWSKI:

So what kind of research are individuals—you know, for example, what kinds of research projects are people doing in these fields?

RODRIGUEZ:

Well, there’s one person who’s doing a project that we actually have supported through survivorship, through the survivorship grants mechanism, who has a very interesting field of study, which has to do with body image. How do we perceive—how does our physical—our perception of ourselves as a physical entity influence how we feel about ourselves, if you will, as a psychological entity as well. And her research has been predominantly with head and neck patients, although she also has done some work with breast cancer patients. But you know, when you have your face changed, you know, our face is actually the one physical entity of our bodies—if we lose our hand, we still consider ourselves to be the person we are. If we lose our legs, we still are the person we are. But if our face gets changed, how we feel about ourselves changes dramatically as well. And the degree to which—which is, of course that explains plastic surgery, right?

RODRIGUEZ:

Right. Sure.

RODRIGUEZ:

People want to improve their faces because they want to be more beautiful, for example. But imagine that your face is changed to the degree where you are less perfect, not more perfect, but less so. And in some cases, terribly disfigured.

ROSOLOWSKI:

Maybe unrecognizable.

RODRIGUEZ:

Correct.

ROSOLOWSKI:

Yeah. Yeah.

RODRIGUEZ:

That can have an enormous impact to psychological health, to the individual.

ROSOLOWSKI:

And I suppose there is even a complexity of people that have multiple surgeries, they have to kind re-go through that trauma—

RODRIGUEZ:

Yes.

ROSOLOWSKI:

—with each transformation.

RODRIGUEZ:

Right.

ROSOLOWSKI:

Wow, that’s—

RODRIGUEZ:

Right.

ROSOLOWSKI:

OK.

RODRIGUEZ:

So that’s her field of interest. And it’s interesting, we were talking about spirituality, but one of her observations is that people who have a stronger spiritual connection, in fact, deal with whatever change happens on the surface of their bodies much better.

ROSOLOWSKI:

Interesting.

RODRIGUEZ:

And so that, in itself, is a very important observation, I think.

ROSOLOWSKI:

Yeah. Interesting.

RODRIGUEZ:

So that’s one of the studies. Other people are doing studies on cognitive, the recovery of cognitive functions after people have brain surgery and after certain exposure to certain chemicals that can cause the so-called chemo brain. So the studies on the whole phenomenon of what is called “chemo brain,” what is it, to what degree is it reversible, versus not. Who might be at more risk for it than others.

ROSOLOWSKI:

Wow.

RODRIGUEZ:

So those are just some examples of the, if you will, the psychological and the psychiatric aspects of cancer that are still being—that are just now, in many ways, still being—just being looked at.

ROSOLOWSKI:

So it’s kind of like entirely new fields—

RODRIGUEZ:

Correct.

ROSOLOWSKI:

—are evolving just as we’re watching.

RODRIGUEZ:

Correct.

ROSOLOWSKI:

It’s pretty—in which, you know, there are any number of fields that have evolved at MD Anderson and other cancer centers since the 1940s.

RODRIGUEZ:

Correct.

ROSOLOWSKI:

Pretty amazing.

RODRIGUEZ:

New knowledge.

ROSOLOWSKI:

New knowledge being created, yeah.

RODRIGUEZ:

And new ways of systematizing it.

ROSOLOWSKI:

From different perspectives.

RODRIGUEZ:

Exactly. And even old knowledge now being reframed.

ROSOLOWSKI:

Yeah. Cool. Can we turn to the issue of Institutional change at this point?

RODRIGUEZ:

Sure. Certainly.

ROSOLOWSKI:

Yeah, I mean, you know, you’ve been at the institution for a long time, I mean, you’ve seen it go through a whole variety of arcs and peaks and valleys. And you know, I kind of, I guess I’d like to throw the question to you. You know, what are some of the kind of big moments you think of as the key moments of change? And then I did want to ask you about, you know, the most recent period since 2011 when Dr. [Ronald A.] DePinho took over at the Institution. But you know, what have you observed in terms of big, key moments of change at MD Anderson?

RODRIGUEZ:

Well, I think coming to the Institution in the late ‘80s or so, the very first thing that I experienced as a real change in the Institution was the growing consciousness that we were an economic entity. When I first arrived at this Institution, believe it or not, we didn’t even talk about submitting bills for our services. There were no such thing as billing forms. You just saw the patients, somebody somewhere submitted a bill, but we never knew who did it, or what. You know, we were completely free of any link or any consciousness of the economics of what we did and the actually delivery of care. It was completely focused on taking care of the patient. Somewhere in the early ‘90s, I don’t know exactly the date; it was kind of a subtle thing. We began to have forms that we needed to fill, check boxes. You know? You simply checked boxes. And there wasn’t very much, if you will, complexity to the billing forms. And then suddenly, there were all of these rules. We had to learn about how you fill the boxes, and how many checks of this or that, and the complexity of the level of the care. You had to learn all the rules about that, to eventually people even looking at how much of this or that have you done? What is the downstream revenue that you have generated as an individual to the current situation, which is, you have to state what your commitment is to what percent of your time are you dedicating to the clinical service, and what does that translate to in measurable quantities of care delivery units? And there are all these formulas for calculating the care delivery units, and so on, per unit of service, and so on. So it’s become now its own, if you will, almost accounting discipline, keeping track of what is your productivity quotient—that, from a care delivery perspective, that’s been a radical change. It’s been—it has escalated over time, but it has been, in my experience, speaking of the day-to-day and routine work, that was a very dramatic shift in the way we did our care delivery. The second, of course, was the introduction, progressive introduction of more structured forms of documentation.

And one of those that I actually was instrumental in implementing was the development of structured forms for chemotherapy; structured forms for the orders, so that we were able to track several—embed into the orders several safety elements to ensure that we were consistently doing X, Y or Z. So consistently, we were, for example, ensuring people had anti-nausea medicines that were appropriate to the level of complexity of the chemotherapy; ensuring that we had specified, in a very specific way, that we had prescribed in a very specific way the types of medications that a challenge with handwritten chemotherapy orders, where sometimes the pharmacist couldn’t read the name of the drug. So these, of course, when you have typewritten, structure forms, everything is legible.

So legibility, safety measures, standards of best practice embedded into each of those. That has been a change, in my opinion—not in my opinion, actually—evidence-based across the nation, when you have certain standards embedded into structured forms for orders, it improves—it decreases the risk of errors, of grave errors. There are still minor errors; people misread this, or whatever. It still happens. But much less serious than when you couldn’t even read the names of the medicines. Structurally, I think one of the key changes that happened was the buildings across that way, on 1515 Holcombe [Boulevard], from the Lutheran Pavilion. Suddenly there is the Love Clinic, the [R.] Lee Clark Clinic, the such-and-such clinic. It was just expanding, exploding clinics. And then of course, now, across the way. So the expansion of buildings. It just has become, honestly, unmanageable. I don’t know MD Anderson anymore. I used to know MD Anderson, I don’t anymore. It’s just too spread, too far, too much. I know the clinical aspects of MD Anderson, I no longer know the research domains of MD Anderson, the breadth of them. Certainly the laboratory-based research, it’s totally alien to me now. I used to know most of the basic researchers when I started in the organization, I don’t anymore.

ROSOLOWSKI:

Yeah.

RODRIGUEZ:

So just the physical expansion of it has made it very difficult to, if you will, truly have a comprehensive, well, for lack of a better word, embrace of what MD Anderson is.

ROSOLOWSKI:

Intellectually, emotionally?

RODRIGUEZ:

All of that.

ROSOLOWSKI:

What’s—is there—what’s been preserved? I mean, you’re alluding to things that have been lost, are there things that have been preserved throughout that growth?

RODRIGUEZ:

Well, I would like to say—I would like to believe, and I think from being in the role that I currently perform, I can see, or I can speak to this, I think the one thing that has been preserved is that the physicians are truly dedicated to doing their best for the patients. I mean, people are very proud of being good doctors. And that’s—and they want to be good doctors, and they want to do their best for the patients. That I don’t think has changed. I think the nursing staff continues to be excellent and compassionate and dedicated to doing this very difficult task as well. That, I think, has been preserved. I think something that is changing very radically, or that has changed very radically as I said, has been this shifting away from—well, to some degree, shifting away from the missing of the organization as a cancer care facility. To some degree, shifting from that to a research-generating facility. And it’s not that research hasn’t been part of our DNA before, but that it had always been superseded by the clinical mission. I really don’t think that’s true today, at least I don’t—that’s not the messaging that we receive, and it’s not what is rewarded or recognized.

ROSOLOWSKI:

Is that part of the change that’s occurred since 2011? Or did that begin under Dr. [John] Mendelsohn?

RODRIGUEZ:

Well, it began to some degree under Dr. Mendelsohn, although I have to say that Dr. Mendelsohn repeatedly made his message, that the research mission was to personalize cancer care. For him, that was truly the research mission; to personalize cancer care, to make the treatment meaningful to every patient, or to make it relevant to every patient for their own particular disease. The degree to which industry-sponsored research was promoted did accelerate under Dr. Mendelsohn. That definitely was one of the changes.

ROSOLOWSKI:

And why was that important?

RODRIGUEZ:

Well, the importance of pharmaceutically-sponsored research was that we, ourselves, were not—we, ourselves, did not have, if you will, a pharmaceutically-produced, or a pipeline that was producing new drugs. We were not creating the new drugs. But we had the patient populations in which we could test and formulate the most appropriate—or investigate the most appropriate application for these new drugs. And so it was, in a sense, a symbiotic relationship. We have the patients, they have the drugs, why not work together? In addition, of course, the pharmaceutical industry had the resources, the financial resources, to support the research infrastructure that would be required to do those kinds of tests, in the scope that would be necessary. And, for example, one of the departments that became very prominent, very large, as a result of the drug, the pharmaceutical research interaction was a Leukemia Department.

ROSOLOWSKI:

Right. Now, the way you shaped that statement, I’m assuming that there’s been a change in that with indus—there is a different field to industry-sponsored research now?

RODRIGUEZ:

Well, not really, I mean, it’s still there, and it’s still very present. What has shifted is that we now have said, or Dr. DePinho’s vision is that we will be the new pharmaceutical drug pipeline producer, or that from the research that is conducted at MD Anderson, from the basic laboratory research conducted at MD Anderson, there will be new drug products that will be placed in the market. So we no longer are simply the testers of the drugs, but we will be the producers of the drugs, or the initiators of the drugs that would then be put into production. So do you see that—

ROSOLOWSKI:

I do.

RODRIGUEZ:

—shift in the—

ROSOLOWSKI:

And what do you feel are the implications of that shift?

RODRIGUEZ:

Well, the implications of that shirt are that that’s really—to be the pipeline producers of drugs requires enormous financial resources, number one. It also requires top-tier intellectual resources, which again is a financial resource requirement. I mean, great minds don’t come cheaply.

ROSOLOWSKI:

Yeah.

RODRIGUEZ:

And so that degree of financial infrastructure really requires big money investment. You have to have a pipeline of investors, of entrepreneurs who want to do that. They’ve never had, if you will, the know-how. We don’t have the skillsets to do that. And also being a state-funded organization, there probably are even legal ramifications to doing that. That’s outside of my scope of knowledge, I really don’t understand the complexities of all of that. But I’m certain that there likely are complexities to that, and barriers to that. So I see it as a challenge; clearly not an impossible one since we’ve embarked on it, and hopefully we will succeed at it. But there are enormous problems with taking that on as a new initiative. There are, of course, potential benefits, huge benefits in the future. Like all investment enterprises, if the investment pays off, the payoff could be huge for us, as well. It could, perhaps, lead to self-sustaining, a self-sustaining research infrastructure. I can tell you that at the present time, we do not have a self-sustaining research infrastructure that, you know, there is a significant proportion of the funds that are generated from the clinical side of the house that do go to support the research infrastructure.

ROSOLOWSKI:

Right. There’s also a lot of philanthropic support for it.

RODRIGUEZ:

And there’s a lot of philanthropic support for it. So whether we will—as one of the threats that we see to that is that, of course, we know for sure, given the national imperative to cut down on healthcare costs, we know for sure that the degree to which we will be able to support research in the future from the clinical side of the enterprise is going to diminish very significantly.

Sooner rather than later. I mean, everyone is anticipating very late, but we know that by 2019, we already have very significant likely reduction in the reimbursement for healthcare in general, but for cancer care specifically. We are one of the biggest cost items on the Medicare bill, and so we will be a target. And by “we,” I don’t mean just MD Anderson. I mean cancer care in general.

ROSOLOWSKI:

Cancer care in general, yeah.

ROSOLOWSKI:

How are—how has this change in focus reverberated in MD Anderson culture, and kind of where you see, you know, sort of day-to-day priorities? You know, what’s your read on that? I mean, obviously, there’s been a lot on tension amongst the faculty, kind of questions on how the culture is changing. What’s your perspective on that?

RODRIGUEZ:

Well, my perspective on how or why things have not gone so well is that the magnitude of the change, the magnitude of the infrastructural change, philosophical change and operational change of this new way of identifying MD Anderson, it’s a transformational change of such magnitude that it would require—from what all transformation literature says, it requires a really major imperative in urgency message to begin with. And I don’t think that the imperative of the message for change was verbalized. It was more—how can—I think that the imperative for change was seen as a change driven by the vision of a single individual, rather than a change being required by a certain dramatic threat, or a dramatic desire in the organization for the change. And it also was not seen as risking, if you will, from a groundswell, up. It was seen as an imposed vision. And so most transformation literature says that under such situations, if there isn’t an overwhelming threat to the survival of an organization, when the change is being driven by a single individual vision, it is not going to succeed, or it will have a really difficult time in begin implemented. Because the rest of the group will see it as a threat to their own identity; to their own personal vision, and so on. So—

ROSOLOWSKI:

At the very least, people like to be asked. (laughs)

RODRIGUEZ:

Exactly. Exactly. And it’s a matter of, you know, it’s a matter of identity, it’s a matter of integrity, it’s a matter of preserving, if you will, the wholeness of a group’s identity. I think that’s what happened. I mean, that’s how I interpret it, just from what I know of change, and how—you know, change in itself is difficult to begin with, even when it’s being mandated under a crisis. It is so much more difficult when there is no perceived immediate crisis and when it is not an integrated vision. And at the time, you know, we really did not have a perceived crisis. Dr. Mendelsohn had left us on a fairly good ground; we were productive, we were doing a lot of good work. We were expecting change, but I think we had hoped to all participate in the creation of the change. I think that the change process was imposed on very rapidly, with very little integration, if you will, grassroots.

ROSOLOWSKI:

Do you feel that the executive leadership has its certain moments, you know, recognized certain missteps and tried to take corrective action, and if so, how effective has that been?

RODRIGUEZ:

Well, I think so. I—or at least there have been several town hall meetings, things have been explained. We’ve had the Chancellor come. I mean, let me say that I don’t think that Dr. DePinho would have imposed his vision on our organization without the explicit support, and possibly even a mandate, by the Board of Regents of the University of Texas system. That would never have happened. So the people who really had to see how misguided that approach was had to be the Board of Regents.

ROSOLOWSKI:

Right.

RODRIGUEZ:

And it took a long time for them to pay attention. (laughs) So let me say that I am not impressed with the governance of the University of Texas system. And no matter how well-meaning the Chancellor is, we also know the Chancellor has only certain limited powers; because in the long run, the Chancellor reports to the Board of Rents, and they, in turn, report to the Governor. So I think in the longer picture, I think this is a symptom of the dysfunction of governmental bureaucracies and how authoritarian systems can be destructive to creative enterprises. The same thing happened with CPRIT [Cancer Prevention Research Institute of Texas], it almost went down the tubes because of meddling from bureaucratic, or at least governmentally-associated individuals, and so on. So it’s—

ROSOLOWSKI:

Or, pretty removed from the processes—

RODRIGUEZ:

Exactly.

ROSOLOWSKI:

—on the ground, yeah.

RODRIGUEZ:

Exactly.

ROSOLOWSKI:

What’s your prognosis? We’re in year four, coming up on the Moon Shot’s anniversary soon. You know, what—what’s the temperature now, and what do you think is going to happen, what needs to happen to get the Institution onto a track? It’ll be different, obviously, but how to get it on track into a place of where the creativity is recognized, where the culture is--

RODRIGUEZ:

Yeah—

ROSOLOWSKI:

—evolving in a productive way?

RODRIGUEZ:

Well, I’m not trying—I hope this doesn’t sound like I’m evading the question—

ROSOLOWSKI:

No.

RODRIGUEZ:

—but the answer is I truly don’t know in that regard. Because I’m actually much more focused on the real threat, the very real threat, very imminent threat of the changes, speaking of another authoritarian system, of the healthcare system governed by the federal new loss around reimbursement for healthcare, specifically for Medicare, which is a significant portion of our patient population, but that will be across the board, the overwhelming likely population in healthcare another ten years from now. And for us in cancer, the threat is really very imminent because, like I said, probably by 2019, given the number of changes that are coming, we likely will be seeing anywhere from five to ten percent reduction in reimbursement, or at least that’s what the pundits say, or predict. That degree of loss of revenue is certainly going to make certain enterprises in this organization unsustainable.

ROSOLOWSKI:

Which kinds of—what are the categories of activity?

RODRIGUEZ:

Well, I can’t predict entirely, but I can tell you that we would not—I already mentioned that we provide a very substantial support to infrastructure for research. We would not be able to afford that. We will not be able to afford that in the future. Now, so seeing that perspective of the future, I have to say I sincerely hope that Dr. DePinho’s vision comes to pass, that we will be able to generate revenue from the research enterprise of the house, because the clinical side of the house cannot support it.

ROSOLOWSKI:

Can’t do it. Yeah. Yeah. And as I understand it, the burden on clinical providers has a systematic—

RODRIGUEZ:

Is only progressive.

ROSOLOWSKI:

Yeah, it’s been increasing.

RODRIGUEZ:

It’s progressive, and the progressive increase is unsustainable. I mean, there’s a threshold above which really sanity, creativity, productivity, declines.

ROSOLOWSKI:

Yeah.

RODRIGUEZ:

And so for some Physicians, I can tell you that the burnout is imminent, if not already active.

ROSOLOWSKI:

And that’s even—and I’m thinking, too, of, you know—I mean, clinicians come in, obviously, with a presumption that they’ll also be doing research, and that it’s pretty impossible to keep that professional balance.

RODRIGUEZ:

Correct. That’s correct.

ROSOLOWSKI:

Yeah. Yeah. I mean, you know, I’m not sure what question to ask you about, you know, this specter that’s looming. You know, is your office looking ahead towards this moment, 2019? Or at least these other changes—

RODRIGUEZ:

Yes.

ROSOLOWSKI:

What kinds of questions are you entertaining? What kinds of actions are you starting to take?

RODRIGUEZ:

Right. So first of all, we need to educate people, and the message is slowly making its way down the ramps. In fact, this week, there was a symposium in which economic issues of healthcare were discussed. There are some very specific changes that we will need to make; number one, we will need to be much more conscientious about the documentation of what we do and how we do it, because those, in the end, you know, the attorneys say, if it’s not written, it didn’t happen. That’s a lawyerism. But that is a fact. If it’s not somewhere where it can be—that information can be retrieved, then that information cannot be conveyed; it cannot be reported, it cannot be seen. So managing information is going to be one of—it has to be an imperative that we take very seriously. And to that end, I’m hoping that our new Electronic Health Record will be one of the tools to facilitate that for us. But in the end, you know, any system is purely that; it’s just a system, it’s just a method, it’s just tool. It has to—everything hinges on human behavior; so how we do what we do and how we document what we do is going to be imperative. Secondly is that we have to feel comfortable with looking at this information, that we don’t get defensive, that we don’t get angry and that we simply see it as opportunities for change, or opportunities for self-reflection and self-improvement. And that’s a major psychological and cultural shift in medicine, simply because we tend to see everything as—anything that doesn’t align with what we hope or expect of ourselves, we see that as embarrassing, humiliating, deprecating, etc.

ROSOLOWSKI:

And get defensive.

RODRIGUEZ:

Then a defensive attitude is generated. We have to get over that, and we simply have to see it as just information. Information that might require some change, or might not. It may be fabulous. We may surprise and shock ourselves and do extremely well. That’s what I hope for. We happen to be a culture that is very, like I said, performance-driven. I’m hoping that that culture will show in its best light as one that will see this information towards better performance, rather than towards self-flagellation, if you will.

ROSOLOWSKI:

Right. Yeah. Absolutely.

RODRIGUEZ:

So those are very—so information, information, information—

ROSOLOWSKI:

Mm-hmm?

RODRIGUEZ:

—is an important one. The second one is acquiring a totally different set of skills that have to do with—I’m trying to think of the appropriate terms—but it has to do with shifting from the expert-centered mentality that we have lived with, which has been—and that many of us were trained with, as a matter of fact, which is, Dr. So-and-So is the most knowledgeable person, and whatever he or she says, goes, because they are the best. Going from that to saying, what do we know, what has been demonstrated, what is the best data? And it doesn’t have to be our own data; what is the best data from all our peers? And what is the most appropriate, taking all of these factors into consideration? Never mind that I am the Big Kahuna, what do my friends and peers think about this particular situation? So although we talk about evidence-based care, the truth is that culturally, we still have a great deal of the expert mentality. I think we’ll have to overcome that to a greater degree. Most of the young Physicians, actually, are very attuned to the knowledge-based decision-making process versus the expert. It’s also a generational thing.

ROSOLOWSKI:

Yeah.

RODRIGUEZ:

And I think as we move towards a younger workforce, we will, hopefully, also overcome the expert base mentality. That’s another cultural change that we will have to overcome.

ROSOLOWSKI:

Interesting. Yeah.

RODRIGUEZ:

And lastly, that we will have to also think very consciously about the value of all the resources we have; how fortunate we are to have as much as we have, and how at some point, we can’t keep demanding more, that we will have to make do the best with what we’ve got. How can we most optimally utilize resources? That’s the other skillset; resource utilization and consciousness and awareness about resource utilization. So managing information, managing knowledge and managing resources.

ROSOLOWSKI:

And resources, yeah. Yeah. Very interesting. A lot of change demanded. You know, it is a different Institution, in different times.

RODRIGUEZ:

Mm-hmm [affirmative].

ROSOLOWSKI:

Yeah. You want to shift gears right now?

RODRIGUEZ:

Yes, I’m—(laughter) I think I’ve said all I can about—

ROSOLOWSKI:

You’ve said—

RODRIGUEZ:

—the future of medicine!

ROSOLOWSKI:

Yeah, you’ve said a lot. No, I mean, it’s very interesting, because I appreciate your style of responding to questions, because you like to set things in a broader context, and that’s very useful. That will be incredibly useful for people who are listening to this. And it provides another layer of understanding of the Institution and how it’s responding not merely to an internal set of pressures, but you know is also in a much broader field of change. Yeah. I wanted to ask you about track for women at the institution. You’ve seen a lot of change in that area too, that’s something we really haven’t discussed.

RODRIGUEZ:

Well, I think that we are in a positive direction. And again, frankly, I don’t think that the institution can go in any other direction than in a positive one in this regard, simply because the workforce of medicine in the future is about women, even today. Today, at least there’s parity in the number of newcomers to the medical school classes, in fact, in some medical schools there’s even a predominance of female students over male students. I predict that that will be sustained, simply because as more medical schools are also integrating behavioral characteristics, not just intellectual or rational intellect as their selection criteria for classes, but also, they’re now doing the interviewing for interpersonal skills, I think that it’ll be a natural selection process, I think, that women will continue to be a major presence in medical education.

So the pipeline for new people coming into medicine is female. We will be seeing more female physicians come to the organization as well, I hope. And that, in turn, will also give us a bigger pool of potential candidates for leadership. The truth is that beside—you know, there’s the old ongoing conversation or arguments, are leaders born or made? The truth is, it’s both. I think you have to have certain interpersonal skills; it’s certain personality traits that direct people towards—or incline people towards leadership roles, but at the same time you also need to learn certain skills. You’re not just a leader because you feel like you’re one. You have to have—you have to learn certain things. And I think in the brave new world of medicine in the future, all of those skills that I mentioned, you know, knowing about information systems and infrastructure, knowing about best evidence, knowing about what others are doing, what the best practices are across various levels of the organizations in healthcare, and also understanding resource management—all of those are going to be really critical for leadership. You cannot just make good speeches. You have to know systems in order to manage well, to lead well.

ROSOLOWSKI:

I was really, you know, interested that—as you were describing the sequence and roles that you took on, you know, you spontaneously talked about the leadership training that each one of those roles gave you.

RODRIGUEZ:

Right.

ROSOLOWSKI:

So it was an interesting, you know, kind of second theme, you know, running through those parts of our conversation. And I was curious, you know, really how you felt your own leadership track has evolved. You know, what is smooth? I mean, did you encounter obstacles? Did you see other—your peers among women encountering obstacles at the Institution? In other words, what was the environment as you were coming up for kind of free growth into leadership, as a woman?

RODRIGUEZ:

Oh gosh, well, I don’t think it existed. I—well, first of all, there weren’t very many of us in the organization. So I have to say there’s both good and bad aspects of that. You know, if there aren’t enough of us, then the opportunities might be fewer. On the other hand, because there are fewer of us, we stand out more. And I think that depending on how much one is willing to put a foot forward, one can create opportunities in that kind of environment, where one is visible to some degree. I think that happened to me. I just simply—I was willing to do some of the tasks that other people were not willing to take on. And thankfully, I happened to have some aptitude for carrying them out well.

And so I think that that’s—I mean, to some degree, I think that that was how things happened for me. I don’t think anyone consciously was thinking, let’s create a career path for person X, Y or Z. Truly, I don’t think that ever has been in the consciousness of the organization, even today. I think that although we have a lot of leadership training courses and so on, we’re still struggling with, how do we select people appropriately for leadership roles? How do we encourage succession planning? How do we strategically think of that? I mean, you asked me previously about the organizational leadership on the larger scale. So, for example, it was no secret that Dr. Mendelsohn had on-boarded Dr. [Raymond] DuBois, because he wanted to have a succession plan in place when he stepped down. And he had envisioned all along Dr. DuBois, I think, was going to be his successor, or at least that’s what we understood. But that did not happen. And so even in the best-laid plans, the succession planning, we have not been successful at carrying that out. I can tell you that I don’t think that Dr. [Thomas] Buchholz was in any one succession plan to be our Executive Vice President for Operations. But he sort of was appointed to that. So the rules of how leadership is designed, if you will, or preemptively planned at this organization are not clear.

ROSOLOWSKI:

And then there’s the question of how women fit into it when there’s an absence of women here at the highest levels of leadership.

RODRIGUEZ:

Correct. Correct. My own personal strategy for this is to encourage as many of the women who I see express an interest, or a potential, for leadership. I encourage them to take on tasks that may be a little bit of a stretch for them. As much as possible I champion them or sponsor them, recommend them. But in the end, really it is an individual choice. People have to be willing to take things on and carry them forward. And then supplement their own innate skills of leadership with additional knowledge.

ROSOLOWSKI:

Were you involved in [Office of] Women Faculty Programs at all? Or in the original committee of women that began to review salaries, for example, in recruitment strategies?

RODRIGUEZ:

I’m not sure when—I mean, I’ve always had some link or connection to the Women’s Academic Affairs office. I’ve participated on and off in various committees, but did I consciously want to do the salary review initiative? No. It was not my initiative. I mean, that came from Liz [Elizabeth Travis, PhD]—

ROSOLOWSKI:

Liz Travis? Yeah. OK, I was just curious, because, I mean I don’t have perfect memory of the names of everyone who was—

RODRIGUEZ:

Yes. But actually, the whole initiative stemmed from the faculty senate, they wanted to know if their salaries were fair. It turns out women’s salaries were not fair, and so I was the beneficiary of that. (laughter) And I’m deeply grateful to the faculty senate for their interest in that topic way back when.

ROSOLOWSKI:

Yeah, absolutely. Absolutely. Is there anything else that you wanted to say about this issue of women at the institution? Or, anything else at this point?

RODRIGUEZ:

Well, I think that the women at this Institution are amazing, simply because I see them juggling so many roles. Most of them are mothers, wives, Physicians, researchers, leaders. They have so many hats. I just, I’m in awe of them, really. I don’t wear half as many as they do. And I think that they’re admirable in how well they perform at so many tasks. I, you know, from the perspective of—if you ask me do I think that MD Anderson has the talent to embrace the future? Yes, I do. I’m hopeful, however, that that talent will be appropriately harnessed.

ROSOLOWSKI:

I had—we’re at 3:30, but I had just a few more questions I wanted to ask you, if we could go over a tiny bit, is that OK?

RODRIGUEZ:

OK—

ROSOLOWSKI:

Or do you—

RODRIGUEZ:

Sure. There was one other—I know there was a meeting I’m supposed to go to.

ROSOLOWSKI:

OK. Do you want to check on the time?

RODRIGUEZ:

Let me check on the time.

ROSOLOWSKI:

OK. I’ll just pause this for a moment. [The recorder is paused] All right, we paused just for a couple of seconds. Well, I wanted to ask you, kind of, you know, retrospective look. What do you feel most contented to have set in place or accomplished during your time as VP [Vice President] of Medical Affairs? Or, in general here at the Institution?

RODRIGUEZ:

Well, I’m very happy to have been charged and to have successfully launched the whole concept of survivorship care. I’m also very happy to have initiated, and hopefully by this time sufficiently embedded into the organizational structure the concept and roles of quality officers within the departments, because I think that that is going to be a really integral role and process for the future of how we conduct medicine. I’m also hopeful that I will be able to, before I retire, to change the culture enough to embed into our day-to-day processes the whole Advanced Care Planning conversation, and to also embed into the consciousness that this is not just about talking about dying, for God’s sake, that’s not it! It’s about considering all aspects of one’s future, and how healthcare will be, how one will plan for healthcare in whatever faces of life come in the future; whether it’s wellness or protracted illness or end-of-life. Any of those are in the future of any one of us, really.

I’m also very happy to have been, and to continue to be, I hope, a champion for the Physician Assistants program, which was a relatively small group when I took on this job, and now has grown to really a major workforce in the organization. I deeply respect them as professionals; I think they’re very important and critical in helping us carry out our mission. And they’re going to be here to stay, as well. And I’m very happy to have helped everyone who, in some way, has reached out to me. I hope I’ve been an appropriate role model for them, and that I’ve stimulated them to extend their potential.

ROSOLOWSKI:

Exciting role.

RODRIGUEZ:

Yes, thank you.

ROSOLOWSKI:

Do you have retirement plans?

RODRIGUEZ:

Well, yes and no. I know that I do wish to retire. I don’t envision myself being here forever. I don’t have a defined date, but I do want—I don’t see myself lingering here forever, like some people have in the past.

ROSOLOWSKI:

What are you looking forward to doing?

RODRIGUEZ:

I actually am looking forward to learning totally different disciplines than medicine.

ROSOLOWSKI:

Such as?

RODRIGUEZ:

I’m very interested in psychology, I’m very interested in cosmology. I’m very—

ROSOLOWSKI:

Oh, really? How neat!

RODRIGUEZ:

—interested in art.

ROSOLOWSKI:

Uh-huh? Do you practice any kind of art form? Do you paint, or—

RODRIGUEZ:

I used to paint.

ROSOLOWSKI:

Really?

RODRIGUEZ:

I have not painted for probably twenty years.

ROSOLOWSKI:

Wow. That’s wonderful!

RODRIGUEZ:

I hope I’ll pick it up again.

ROSOLOWSKI:

Yeah. Anything else? Other kinds of areas that you’re planning on exploring during retirement?

RODRIGUEZ:

I think that’s enough.

ROSOLOWSKI:

Yeah, that is enough. And when you cosmology, do you mean astronomy, or do you mean, you know, reading the cards?

RODRIGUEZ:

Oh no no, I mean astronomy.

ROSOLOWSKI:

Astronomy.

RODRIGUEZ:

And understanding the birth of the universe.

ROSOLOWSKI:

Oh, cool. Very cool! (laughter)

RODRIGUEZ:

I’m looking forward to people finding out exactly what dark matter is. I hope that happens in my lifetime.

ROSOLOWSKI:

Yeah, I’m a big fan of dark matter myself. This sort of idea that emptiness holds us together is pretty cool. (laughter)

RODRIGUEZ:

But that’s the thing, it’s not empty.

ROSOLOWSKI:

It’s not totally empty, I always think that. What are they called, WIMPs? Weekly Interactive Massive Particles, or something like that? Yes. Very cool stuff. Very cool stuff. And is there anything that you would like to share about who you are as a person behind the role, you know, a special hobby, or fascination, or talent?

RODRIGUEZ:

Oh, gosh.

ROSOLOWSKI:

A book you read that changed your life?

RODRIGUEZ:

Oh, the book I read that changed my life, well, I think that book was one that I read many, many—it wasn’t a book, it was a whole discipline of books. I have a minor in philosophy from my college, and I was most influenced at the time by the process philosophers, which—maybe that’s why I like cosmology as well, because their point of view is that unlike the platonic classic view that everything is fixed, and there is an underlying structure to reality, the process philosopher’s point of view is that philosophy is a constantly evolving and self-creating reality. Or realty self-creates. Which, if one believes in the underlying force of reality being a god or a mind, or the universal mind, it’s exciting to think that the universal mind is self-creating as well, along with its creation. So it gives me a sense of being part of the creative process of the universal mind, and that, I think, is exciting.

ROSOLOWSKI:

Does that have a spiritual dimension to it for you?

RODRIGUEZ:

Oh, sure. Of course.

ROSOLOWSKI:

OK. Yeah. How does that—

RODRIGUEZ:

I think it explains everything.

ROSOLOWSKI:

It explains everything. (laughter) Does it play out in your professional life and your personal life? That fundamental belief?

RODRIGUEZ:

Well, I think in my professional life, it helps me to deal with change. I mean, there is no such thing as stability. I mean, nothing is static. Everything is in motion. The planet is in motion. I mean, here we are hurling through space, I don’t know how many thousand miles per second. We don’t perceive it, we’re not conscious of it, but it’s happening even as we stand here, so the next moment, maybe we’ll be coursing through a worm hole that will throw us into a totally different universe, how do we know, right?

ROSOLOWSKI:

And wouldn’t that be a cool event?

RODRIGUEZ:

Yeah! (laughter)

ROSOLOWSKI:

And in your personal life? Does that play out there too?

RODRIGUEZ:

I have to say my personal life, paradoxically, I like routine and stability. (laughter)

ROSOLOWSKI:

It helps you get [inaudible] change here.

RODRIGUEZ:

Some things have to be steady and stable, otherwise you could be hurled off into space, you know?

ROSOLOWSKI:

Absolutely true.

RODRIGUEZ:

There’s value to gravity, OK?

ROSOLOWSKI:

There is. Well, is there anything else you’d like to add at this point, Dr. Rodriguez?

RODRIGUEZ:

No. I thank you for the opportunity to have this conversation. It’s been very interesting, actually.

ROSOLOWSKI:

It has been. Well, I thank you for your time. I really do.

RODRIGUEZ:

You’re most welcome.

ROSOLOWSKI:

And it was a really interesting conversation.

RODRIGUEZ:

So I’m looking forward to seeing the transcript.

ROSOLOWSKI:

Yes.

RODRIGUEZ:

See how many “oops” moments I have.

ROSOLOWSKI:

Oh, there’ll probably be a few, everybody has those. But, well, I want to thank you for time.

RODRIGUEZ:

You’re welcome.

ROSOLOWSKI:

And I want to just for the record say that I am turning off the recorder at twenty minutes of four. Thank you.