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Interview Information:

Four interview sessions: 20 February 2015, 6 March 2015, 1 May 2015, 5 June 2015

Approximate total duration: 6 hours

Interviewer: Tacey A. Rosolowski, Ph.D.

 

For supplementary materials:

Please contact, the Historical Resources Center, Research Medical Library:

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Dr. Alma Rodriguez (b. 11 September 1953, Robson, Texas) came to MD Anderson in 1986 as an instructor, laboratory researcher and clinician in the Department of Internal Medicine.  Today she has a primary appointment as Internist and Professor of Medicine in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine.  Her research has focused on treatments for lymphoid malignancies.  In administration, Dr. Rodriguez has served as Vice President of Medical Affairs since 2005.  Among her many activities, she has helped create MD Anderson’s Survivorship Program and developed services in psychosocial care.  She has also been involved in shifting institution culture to quality care.   

 

Major Topics Covered:

Personal and educational background

Research on lymphoma treatments

Shift in career focus from research to administration

Developing an administrative leader; Women and leadership

Unique qualities and impact of physician leaders

The Office of Medical Affairs: Evolution, Scope, Impact

Quality indicators and patient centered care 

The Survivorship Program

MD Anderson growth and changes in culture; evaluation of Ronald DePinho’s agenda

Economics of healthcare and impact on MD Anderson

 

Regarding the Transcript and Audio Files

In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions.  (Language has not been edited to conform to written prose).

The interview subject was given the opportunity to review the transcript.  Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered. 

Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.


 

Table of Contents

 

Interview Session One: 20 February 2015

 

Growing Up in a Migrant-Worker Family
Chapter 01 / Personal Background

 

Support from Teachers and Family Leads to a College Education
Chapter 02 / Educational Path

 

Going to Medical School
Chapter 03 / Educational Path

 

A Revealing Internship and Residency
Chapter 04 / Professional Path

 

The Problem of Diabetes among Hispanics
Segment 05 / Overview

 

Fellowship Research and the Move to MD Anderson
Chapter 06 / The Researcher

 

Shifting Focus from Research to Administration
Chapter 07 / Professional Path

 

Research on Lymphoma Treatments
Chapter 08 / The Researcher

 

 

 

Interview Session Two: 6 March 2015

 

Learning Administrative Approaches by Leading the Myeloma Clinic
Chapter 09 / The Administrator

 

The Role of the Physician-Leader at MD Anderson
Chapter 10 / Overview

 

Today’s Medical Paradigm Shift
Chapter 11 / Overview

 

The Survivorship Initiative
Chapter 12 / Building the Institution

 

Aimed Toward an Interest in Survival; Survivorship Care and the Affordable Care Act
Chapter 13 / Overview

 

Lessons in Administration as Ad-Interim Chair of Lymphoma/Myeloma
Chapter 14 / The Administrator

 

Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing
Chapter 15 / Building the Institution

 

Interview Session Three: 1 May 2015

 

The Office of Medical Affairs: Credentialing, Quality Indicators, and Building  a Culture of Improvement and Quality Care
Chapter 16 / An Institutional Unit

 

The Office of Medical Affairs: Patient Concerns, Patient Advocacy, Conflict Resolution
Chapter 17 / An Institutional Unit

 

Creating MD Anderson’s Practice Algorithms; On Blending Art and Science in Medical Practice: Practice Algorithms and Targeted Therapy
Chapter 18 / Building the Institution

 

Integrating Advance Practice Providers into Care Teams a Training Program for Physicians Assistants
Chapter 19 / Building the Institution

 

The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers
Chapter 20 / Institutional Processes

 

 

Interview Session Four: 5 June 2015

 

Patient-Centered Care: Formalizing the Practice at MD Anderson
Chapter 21 / Building the Institution

 

Patient-Centered Care: the Psychosocial Council, Advanced Care Planning
Chapter 22 / Building the Institution

 

Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson
Chapter 23 / Building the Institution

 

Transitional Moments in MD Anderson History
Chapter 24 / Institutional Change

 

Change Under Ronald DePinho: The Balance Between Research and Clinical Care
Chapter 25 / Institutional Change

 

Turbulence During Dr. DePinho’s Early Presidency; MD Anderson’s Future
Chapter 26 / Institutional Change

 

Creating a Future Under the Affordable Care Act
Chapter 27 / MDACC in the Future

 

Women and Leadership at MD Anderson
Chapter 28 / Diversity Issues

 

Accomplishments, Retirement, and a Love of Cosmology
Chapter 29 / View on Career and Accomplishments

 


 

Chapter Summaries

 

 

Interview Session One: 20 February 2015 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Personal Background)
Growing Up in a Migrant-Worker Family (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Influences from People and Life Experiences

In this segment, Dr. Rodriguez recalls her early life when her parents worked as migrant workers in the fields of Texas and in California.  She talks about the effect of experiences in her neighborhood on her later life and recalls the huge range of illnesses she saw in her community where there was little medical care.  Dr. Rodriguez also characterizes her parents as “survivors” who were committed to family.  She recalls that her family was very frugal, but she never felts as though she lacked for anything. 

 

Chapter 02 (Educational Path)
Support from Teachers and Family Leads to a College Education (listen/read)

 

Topics Covered

  • Personal Background
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • Experiences Related to Gender, Race, Ethnicity

Dr. Rodriguez talks about her educational path leading up to medical school in this segment.  She says that she was encouraged to study from elementary school, when she took an IQ test and scored very high.  She recalls that she was asked if she had cheated on the test.  Nevertheless, her parents were advised to encourage her to study.  Dr. Rodriguez explains that her mother was concerned about her plans to leave their small town to go to college, though her father supported the idea. 

She says that coming from her background, going to college “was a miraculous thing.”  She had little assistance applying to college, but explains that she was advised to apply for scholarships.  She recalls going to San Antonio to meet with the selection panel for a scholarship.  She was not awarded that scholarship, but one of the nuns on the panel arranged for a scholarship from Our Lady of the Lake College (BA conferred in 1975).

Dr. Rodriguez explains that, for practical reasons, she majored in Spanish with the intention of teaching.  However she did very well in the sciences and her advisor, Dr. Rigual, advised her to consider medical school.  Dr. Rodriguez recalls the educational environment at Our Lady of the Lake College, including a research program that was available and gave her experience in research methods. She began to think about going to graduate school to do research.

 

Chapter 03 (Educational Path)
Going to Medical School (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Patients
  • Cancer and Disease

In this segment, Dr. Rodriguez talks about her decision to go to medical school and describes her experience at the UT Medical School in Houston, Texas (degree conferred in 1979).  She recalls that African-American students from Baylor College of Medicine came to Our Lady of the Lake College to talk about summer research projects at Baylor and recruit minority students to medical school.  She applied to the research program, was accepted, and the experience encouraged her to consider applying to medical school.

Dr. Rodriguez talks about getting a full-tuition scholarship to the Medical School in Houston and recalls the reactions of her family to this new move.  She also talks about the unique and grueling three-year program and reviews the pros and cons of the different specialties she considered.

Dr. Rodriguez speaks about a rotation at MD Anderson. She talks about the “personality” of cancer patients, who were so appreciative of care, and explains the features of oncology that appealed to her (though she did not decide to go into oncology at this point).

 

Chapter 04 (Professional Path)
A Revealing Internship and Residency (listen/read)

 

Topics Covered

  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences
  • The Researcher
  • Understanding Cancer, the History of Science, Cancer Research

In this segment, Dr. Rodriguez talks about her residency and her decision to focus on oncology.  She explains that she chose to do her internship in internal medicine at te UT Health Sciences Center in San Antonio (1/1979−1980) because she wanted to focus on health issues in the Hispanic population, particularly diabetes.  She stayed in San Antonio for her Residency in Internal Medicine (1/1980−1982) and decided during her first year to focus on oncology.  Next she decided to do a fellowship and approached Dr. Daniel von Hoff about working in his laboratory.  (Research Fellow, Cancer Therapy and Research Center 1/1982−1983.)  She explains that she wanted a year to familiarize herself with this new field and to take time for personal reflection. 

Dr. Rodriguez also describes the research she conducted at the time, relating to Dr. Hoff’s theory that treatments could be personalized to the specific sensitivities of a tumor.  She explains the work she did on the research projects and notes that this intellectual environment influenced her thinking about cancer. 

Dr. Rodriguez then explains why she elected to do her fellowship in hematologic cancers (Fellow of Hematology/Oncology, University of Arizona Cancer Center, Arizona Health Sciences Center, Tucson, 1/1983−1986).

 

Chapter 05 (Overview)
The Problem of Diabetes among Hispanics (listen/read)

 

Topics Covered

  • Professional Path
  • Character, Values, Beliefs, Talents
  • Personal Background
  • Professional Path
  • Inspirations to Practice Science/Medicine
  • Cultural/Social Influences

In this segment, Dr. Rodriguez explains why she abandoned her original intentions to work with diabetes in the Hispanic population.  She explains that obesity is a cultural and medical issue for all patients.  She talks about the centrality of (unhealthy) foods in Hispanic culture and the challenges of changing deeply engrained habits.

 

Chapter 06 (The Researcher)
Fellowship Research and the Move to MD Anderson (listen/read)

 

Topics Covered

  • The Researcher
  • Joining MD Anderson
  • MD Anderson History
  • Mentoring
  • Understanding the Institution

To begin this segment, Dr. Rodriguez sketches her research while a Fellow at the University of Arizona Cancer Center.  She recalls that is was an exciting time in cancer research, given the availability of DNA analysis and new techniques in molecular biology.  Dr. Rodriguez says she knew she wanted to be in a research environment.  Her mentors in Arizona eventually connected her with colleagues at MD Anderson.

Dr. Rodriguez recalls that when she came to MD Anderson in 1986, the institution was undergoing a reorganization that made times difficult in the Division of Cancer Medicine.  She explains that the turbulence made it difficult for a junior faculty member to settle in, as her mentors kept changing.  Over the course of her first four years, Dr. Rodriguez says she realized she would not be successful as a researcher and explains the importance of having an anchor point in the institution as a basis for becoming a truly independent researcher. 

Next, Dr. Rodriguez talks about her mentor, Dr. Fernando Cabanillas, who was passionate about advancing the treatment of lymphoma.  Dr. Rodriguez explains that she designed studies and tested drug combinations within Dr. Cabanillas’ laboratory.

 

Chapter 07 (Professional Path)
Shifting Focus from Research to Administration (listen/read)

 

Topics Covered

  • Professional Path
  • The Administrator
  • Evolution of Career
  • On Research and Researchers

In this segment, Dr. Rodriguez sketches how she began to shift away from research as her main focus.  She began, she says, by doing administrative work “in a surreptitious way.”  Dr. Cabanillas asked her to serve as Director of the Lymphoma Clinic, a role that gave her experience, demonstrated her knack for administration, and her commitment to making things better for patients.  She talks about working with clinical pharmacists, a new breed of specialists at MD Anderson, and the roles this connection led to.

Dr. Rodriguez then talks about how important grantsmanship is for researchers.

 

Chapter 08 (The Researcher)
Research on Lymphoma Treatments (listen/read)

 

Topics Covered

  • The Researcher
  • Discovery and Success

In this segment, Dr. Rodriguez describes studies she conducted on lymphoma treatments in collaboration with Dr. Cabanillas.  She first explains a study that showed the efficacy of ifosfamide among patients who did not respond to the CHOP treatment.  She next talks about use of the same drug for patients awaiting stem cell transplantation.  This study is still in regular use.

Dr. Rodriguez then says that the current atmosphere at MD Anderson focuses on developing new drugs rather than optimizing older drugs.  As an example of the value of retaining older ideas, she mentioned work by Dr. Wilson that shows that continuous infusion of drugs is more effective than bolus administration, an idea that Dr. Cabanillas originally explored.

 

Interview Session Two: 6 March 2015 (listen/read)

 

Chapter 00B
Interview Identifier (listen/read)
 

Chapter 09 (The Administrator)
Learning Administrative Approaches by Leading the Myeloma Clinic (listen/read)

 

Topics Covered

  • The Administrator
  • Professional Path
  • MD Anderson History
  • Building/Transforming the Institution
  • Devices, Drugs, Procedures

Dr. Rodriguez begins this segment by explaining that the Myeloma Clinic was originally jointly managed with Transplant Leukemia services.  She served as Clinic Chief of the Lymphoma/Myeloma Section from 1994−1996.  Dr. Rodriguez explains what she learned from working in this environment of shared resources and how she acquired basic knowledge of how to assess patient volume and flow and determine hours of clinic operation.

Next Dr. Rodriguez explains how the administrative issues shifted once the Myeloma Clinic became autonomous in 2003 and was stressed with challenged of internal utilization of resources.  At this point she began her habit of writing reports to ensure transparency.   (She notes that she used to have access to downstream revenue reports, but these have since disappeared.)  She talks about the biggest lesson she learned at the time: how an individual’s work has an effect on the whole.  As an example, Dr. Rodriguez explains that she became aware that the Myeloma Clinic was one of the biggest customers of the CT Scan Unit.  She details how this effected operations of the CT Unit and had an effect on other services.  She explains that this refined her thinking about how to strategize care delivery in an arena of low resources.  Dr. Rodriguez also notes that most physicians tend not to see the big picture in which the deliver care and use resources; she gives examples of stresses to the system that can result.

Dr. Rodriguez observes that she began to attend administrator education courses around this time.  As an example of slow administrative development at MD Anderson, Dr. Rodriguez notes that she never filled out a for-service charge form until the 1990s.  She talks about issues that arose once billing forms were introduced.

 

Chapter 10 (Overview)
The Role of the Physician-Leader at MD Anderson (listen/read)

 

Topics Covered

  • The Administrator
  • Overview
  • Definitions, Explanations, Translations
  • Building/Transforming the Institution
  • Leadership
  • On Leadership
  • On the Nature of Institutions
  • Understanding the Institution

In this segment, Dr. Rodriguez talks about the important role that physician-leaders can serve in an organization.  She explains that a primary responsibility is to explain the need for institutional changes in terms that clinicians can understand.  She stresses that physician-leaders must be able to listen, have a toehold in specific services, and demonstrate that they share common experience with clinical peers.  She returns to the example of the Myeloma Clinic’s heavy use of the CT Scan Unit and the pressures that created among all services.  She notes that she was first made aware of this resource issue by listening to clinicians vent their frustrations about difficult access to the Unit.

Next Dr. Rodriguez explains that physician leaders must be able to explain a larger reality to data-driven MDs who generally have a much narrower focus.  She talks about why, traditionally, there has been a gap between clinical and administrative levels of an organization. 

Dr. Rodriguez next talks about the history of physicians and leadership at MD Anderson, beginning with the first president, R. Lee Clark, who went to hire other clinicians with leadership abilities.  She explains that in academic institutions, most physicians assume leadership positions that carry academic titles and that reflect their knowledge rather than specific skill at administration or leadership.  Dr. Rodriguez believes that today one cannot excel as a clinician and administrator and this is why one is now seeing different titles for physician-leaders.

 

Chapter 11 (Overview)
Today’s Medical Paradigm Shift (listen/read)

 

Topics Covered

  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • On the Nature of Institutions
  • Technology and R&D;
  • The Healthcare Industry
  • Understanding the Institution
  • The Institution and Finances
  • Research, Care, and Education

In this segment, Dr. Rodriguez provides perspective on what she calls “the medical paradigm shift” that currently challenges everyone in healthcare.  She begins by sketching how landmarks in the history of research into causes of disease created paradigm shifts in the pass.  She begins with the long period in which doctors learned their craft through apprenticeship to other individual physicians.  She then explains that a paradigm shift occurred in the 19th Century, when hospitals became the primary setting for acquiring this training.  She notes that the growth of nursing also had an effect on the practice of medicine.  She then talks about the technical developments of the 20th century that led to another paradigm shift. 

Dr. Rodriguez explains that the current paradigm shift is not focused on technology, but on how care is delivered and diseases managed.  She stresses that the new paradigm focuses not merely on the doctor-patient relationship, but on the management of relationships between teams of providers and the institution to deliver optimal care.

Dr. Rodriguez says that MD Anderson is still in the investigational paradigm and may not have the skills to engage patients in being their own health care advocates.  She explains that there is a great deal of data available to help individuals prevent cancer and that nearly seventy percent of patients survive for five years.  Dr. Rodriguez cites several MD Anderson initiatives that focus on prevention.

 

Chapter 12 (Building the Institution)
The Survivorship Initiative (listen/read)

 

Topics Covered

  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Patients
  • Patients, Treatment, Survivors
  • Dedication to MD Anderson, to Patients, to Faculty/Staff

In this segment Dr. Rodriguez talks about MD Anderson Survivorship initiative, which began to take shape, she explains, after the Institute of Medicine released its presidential report From Cancer Patient to Cancer Survivor: Lost in Transition (November 3, 2005).  This report, she says, detailed why care for survivors was lacking.  Dr. Margaret Kripke, PhD [Oral History Interview] had been appointed to the president’s Committee on Cancer and became aware of the issues.  She brought this information to the president of the institution, Dr. John Mendelsohn, who decided to integrate survivorship into MD Anderson’s care delivery system.  A committee was formed and Dr. Rodriguez took on implementation of their plan in 2006. 

Dr. Rodriguez explains the process she and her committee went through to determine how to implement survivorship care, a process that began with listening closely to all constituents.  She summarizes: they build the survivor care clinics in the same way they build acute care clinics.

Next Dr. Rodriguez sketches why a focus on survivorship was controversial when it was first proposed.  She touches on bond that forms between the patient and the physician and notes that a primary concern was survivorship programs would ask the patient to divorce him/herself from the main oncologist.  Dr. Rodriguez notes that this break can sometimes be more painful for oncologists, who say they enjoy seeing well patients –often the high point of their day.

Dr. Rodriguez explains that they finally settled on a model where one supervising physician determined the activities of mid-level providers in a situation that de-escalates the intensity of visits by focusing on wellness.  Dr. Rodriguez sketches the approach. 

She notes that a key issue they had to consider: at what point does the primary oncologist see the patient as a survivor?  This question will be answered differently in each treatment area and the committee built algorithms to determine the transition point to survivor care, when the risk of relapse is nil.  The entire care model for each service is built around four common domains: Surveillance, Prevention, Monitoring for Late Effects, Psychosocial Health.  Dr. Rodriguez explains how this model works using the example of lymphoma.  She confirms that all the survivorship services are amassing a great deal of knowledge about survivor care.

Dr. Rodriguez notes that MD Anderson began transitioning patients to survivorship in 2010.  There is now a significant body of patients and Dr. Rodriguez says her next step is to leverage the information that has been collected.

 

Chapter 13 (Overview)
Aimed Toward an Interest in Survival; Survivorship Care and the Affordable Care Act (listen/read)

 

Topics Covered

  • Fiscal Realities in Healthcare
  • The Healthcare Industry
  • Discovery and Success
  • Patients
  • Patients, Treatment, Survivors

Dr. Rodriguez begins this segment by sketching how the Affordable Care Act has an impact on care for survivors.  She focuses on the assumption payers make that it’s most cost effective to transition patients to their primary care physician after treatment, as oncologists are expensive.  She says that is premature for patient who have had aggressive tumors or treatments. 

Dr. Rodriguez notes that she spoke at ASCO about MD Anderson model of survivor care.  She communicated that the four domains MD Anderson uses to structure a care plan is relevant at all stages of cancer care. 

Dr. Rodriguez then explains that her interest in survivorship was a natural extension of her work with lymphoma patients, as lymphoma was one of the first malignancies that could be cured.  She understood early the four domains of Surveillance, Prevention, Late Effects Monitoring, and Psychosocial Health.

 

Chapter 14 (The Administrator)
Lessons in Administration as Ad-Interim Chair of Lymphoma/Myeloma (listen/read)

 

Topics Covered

  • Professional Path
  • Leadership
  • On the Nature of Institutions

Dr. Rodriguez begins this segment by explaining how her view of the institution changed as she stepped into the role of Ad-Interim Chair of Lymphoma/Myeloma when Dr. Cabanillas retired.  She sketches her new areas of responsibility and how this changed her view of operations and the institution as a whole.

Next, Dr. Rodriguez explains that traditionally, a Department Chair is seen as an “erudite expert,” but to be successful a chair must let go of her/his ego and bring forth future leaders in the field.

 

Chapter 15 (Building the Institution)
Vice President of the Office of Medical Affairs; the Value of Faculty Credentialing (listen/read)

 

Topics Covered

  • Institutional Processes
  • The Administrator
  • Fiscal Realities in Healthcare
  • On Texas and Texans
  • Ethics
  • MD Anderson Culture
  • Institutional Mission and Values
  • The MD Anderson Brand, Reputation

Dr. Rodriguez begins this segment by explaining how conversations with the outgoing and incoming physicians-in-chief around she came to her role as Vice President of the Office of Medical Affairs.  When Thomas Burke, MD [Oral History Interview] became physician in chief in 2004, her role was expanded to include medical affairs functions.  She was officially named in 2005 with service to the present. 

Next Dr. Rodriguez notes that learned a great deal about Texas law and regulations of medical practice.  She also had to familiarize herself with the roles of Physicians Assistants and Advanced Practice Nurses.

Next, as an example of a function within Medical Affairs, Dr. Rodriguez talks about the process of documenting the credentials that physicians present for employment.  She explains why this process is key to the reputation of MD Anderson. She also notes that employees have occasionally falsified documents.

Interview Session Three: 1 May 2015 (listen/read)

 

Chapter 00C
Interview Identifier (listen/read)

 

Chapter 16  (An Institutional Unit)
T
he Office of Medical Affairs: Credentialing, Quality Indicators, and Building a Culture of Improvement and Quality Care (listen/read)

 

Topics Covered

  • The Administrator
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • MD Anderson and Government
  • Understanding the Institution
  • The History of Health Care, Patient Care
  • On Care
  • The Life and Dedication of Clinicians and Researchers

Dr. Rodriguez explains a key function of the Office of Medical Affairs: to credential all individuals at MD Anderson to ensure their competence. 

She next explains that, since 2009, MD Anderson has been involved in developing performance and quality indicators for professional practice.  She explains this history of this focus and the different reactions of clinicians to professional evaluation, given that most evaluation is perceived as adversarial and punitive, rather than part of a culture of self-awareness and self-improvement.

She comments on Texas requirements that support a culture of improvement.

Dr. Rodriguez then talks about how the Office of Medical Affairs created an infrastructure to shift to quality indicators.

 

Chapter 17 (An Institutional Unit)
The Office of Medical Affairs: Patient Concerns, Patient Advocacy, Conflict Resolution (listen/read)

 

Topics Covered

  • The Administrator
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Understanding the Institution
  • The History of Health Care, Patient Care
  • Offering Care, Compassion, Help
  • Patients
  • Cancer and Disease
  • Patients, Treatment, Survivors

Dr. Rodriguez discusses another important role of Medical Affairs: to provide support for patient who wish to voice complaints.  This segment covers sources of patient complaints and distress, the importance of communication, the role of Patient Advocates and the sources of stress in that role.  (She notes that patients can become abusive because they would like a second opinion to be a different, hopeful opinion, but often a lack of options is confirmed.)

She notes that having an Advanced Directive conversation is a quality indicator and explains the issues that this raises.  She notes that there is more emphasis now on selecting health care providers who have communication skills.

 

Chapter 18 (Building the Institution)
Creating MD Anderson’s Practice Algorithms; On Blending Art and Science in Medical Practice: Practice Algorithms and Targeted Therapy (listen/read)

 

Topics Covered

  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Understanding the Institution
  • Professional Practice
  • The Professional at Work

Dr. Rodriguez tells the story of MD Anderson’s 147 Practice Algorithms beginning with the origin of this initiative in the 1990s movement to define “pathways of care.”  She talks about the process of establishing an algorithm and discusses the effects.  She also notes the different reactions of clinicians, who may immediately adopt the algorithm or who may take convincing.

Dr. Rodriguez talks about the dangers of dogmatism in medicine.  She notes that medicine is both an art and a science, but the poles need to be harmonized in order to be humane.

Dr. Rodriguez notes that limits of targeted therapy and sketches an emerging view that this approach will be replaced by a focus on failures in the body’s surveillance and regulation mechanisms.

She notes committees in place to support clinicians as they self-monitor the quality of their practice.

 

Chapter 19 (Building the Institution)
Integrating Advance Practice Providers into Care Teams; Training Program for Physician Assistants (listen/read)

 

Topics Covered

  • The Administrator
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Institutional Processes
  • MD Anderson Culture
  • Professional Practice
  • The Professional at Work

Dr. Rodriguez talks about the increasing reliance on advance practice providers in medicine and in oncology.  She notes that, at MD Anderson, General Internal Medicine is a hold out.

She sketches what an APP can bring to a care team.  She talks about her own experience working with a Physician’s Assistant.  She explains why she shares oversight of Advanced Practice Nurses with the Division of Nursing.

Next Dr. Rodriguez talks about the Physician’s Assistant Oncology Fellowship Program, started in 2008.  She sketches differences in the education of MDs and PAs and explains the need for an oncology fellowship.  She talks about the impact of the program and an e-course developed for fellows at a distance.

 

Chapter 20 (Institutional Processes)
The Office of Medical Affairs: Job Satisfaction Survey of Mid-level Providers (listen/read)

 

Topics Covered

  • Understanding the Institution
  • The Institution and Finances
  • Mentoring
  • MD Anderson History
  • MD Anderson Culture

After sketching changes to the office of medical affairs in the last ten years, Dr. Rodriguez discusses the purpose and results of the regular survey of mid-level providers at MD Anderson.  She notes that, in general, the workforce is very stable, but the institution wants to monitor reasons that pockets of high turnover exist. 

She notes results of the survey: everyone at MD Anderson is committed to the job; some fear retaliation if they voice complaints; many feel they are not paid enough.  Dr. Rodriguez stresses that employees’ pay is in line with other state institutions.

She talks about requests for mentoring made via the survey and how that was acted on and to what affect.

 

Interview Session Four: 5 June 2015 (listen/read)

 

Chapter 00D
Interview Identifier (listen/read)

 

Chapter 21 (Building the Institution)
Patient-Centered Care: Formalizing the Practice at MD Anderson (listen/read)

 

Topics Covered

  • The Administrator
  • Institutional Mission and Values
  • MD Anderson Culture
  • The MD Anderson Brand, Reputation
  • Building/Transforming the Institution
  • The History of Health Care, Patient Care
  • Patients
  • This is MD Anderson
  • The Life and Dedication of Clinicians and Researchers
  • Volunteers and Volunteering

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.

 

Chapter 22 (Building the Institution)
Patient-Centered Care: the Psychosocial Council, Advanced Care Planning (listen/read)

 

Topics Covered

  • MD Anderson Culture
  • Patients
  • Patients, Treatment, Survivors
  • MD Anderson Culture
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Institutional Processes
  • Devices, Drugs, Procedures
  • Institutional Mission and Values
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care

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.

 

Chapter 23 (Building the Institution)
Patient-Centered Care: the Department of Chaplaincy and Pastoral Education and the Future of Psychosocial Approaches at MD Anderson (listen/read)

 

Topics Covered

  • MD Anderson Culture
  • Patients
  • Patients, Treatment, Survivors
  • MD Anderson Culture
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Institutional Processes
  • Devices, Drugs, Procedures
  • Institutional Mission and Values
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • MD Anderson History
  • Research, Care, and Education

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.

 

Chapter 24 (Institutional Change)
Transitional Moments in MD Anderson History (listen/read)

 

Topics Covered

  • Critical Perspectives on MD Anderson
  • MD Anderson History
  • Institutional Mission and Values
  • MD Anderson Culture
  • Growth and/or Change
  • Industry Partnerships
  • The Business of MD Anderson
  • The Institution and Finances
  • Research, Care, and Education
  • The Life and Dedication of Clinicians and Researchers

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.

 

Chapter 25 (Institutional Change)
Change Under Ronald DePinho: The Balance Between Research and Clinical Care (listen/read)

 

Topics Covered

  • Critical Perspectives on MD Anderson
  • MD Anderson History
  • Institutional Mission and Values
  • MD Anderson Culture
  • Growth and/or Change
  • Industry Partnerships
  • The Business of MD Anderson
  • The Institution and Finances
  • Research, Care, and Education
  • Business of Research

 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.    

 

Chapter 26 (Institutional Change)
Turbulence During Dr. DePinho’s Early Presidency; MD Anderson’s Future (listen/read)

 

Topics Covered

  • Critical Perspectives on MD Anderson
  • MD Anderson History
  • MD Anderson Culture
  • Growth and/or Change
  • Leadership
  • On Leadership
  • The MD Anderson Brand, Reputation
  • Professional Practice

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.

 

Chapter 27 (MDACC in the Future)
Creating a Future Under the Affordable Care Act (listen/read)

 

Topics Covered

  • Critical Perspectives on MD Anderson
  • MD Anderson History
  • MD Anderson Culture
  • Growth and/or Change
  • The Business of MD Anderson
  • MD Anderson in the Future
  • Institutional Processes

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.

 

Chapter 28 (Diversity Issues)
Women and Leadership at MD Anderson (listen/read)

 

Topics Covered

  • The Leader
  • The Mentor
  • Leadership
  • Mentoring
  • Experiences Related to Gender, Race, Ethnicity
  • Critical Perspectives on MD Anderson
  • Gender, Race, Ethnicity, Religion
  • Experiences Related to Gender, Race, Ethnicity;
  • Women and Minorities at Work
  • MD Anderson History
  • MD Anderson Culture

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.

 

Chapter 29 (View on Career and Accomplishments)
Accomplishments, Retirement, and a Love of Cosmology (listen/read)

 

Topics Covered

  • Character, Values, Beliefs, Talents
  • Personal Background
  • Influences from People and Life Experiences
  • Career and Accomplishments
  • Post Retirement Activities
  • Professional Values, Ethics, Purpose
  • Faith

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.