Operational and Cultural Changes in Oncology: Are You Paying Attention to Your Teams?

Gail Thompson

April 2017, Vol 7, No 4 - Cancer Center Business Summit


“Change creates angst: it creates pressures, it creates employee dissatisfaction, it creates environments that most medical practices aren’t used to participating in,” said Erich Mounce, MSHS, Chief Executive Officer, West Cancer Center, Memphis, TN, in his introduction to an intriguing panel discussion titled “Operational & Cultural Change” at the 2017 Cancer Center Business Summit (CCBS).

With the rapidly changing payment models, the panel addressed the need for different kinds of expertise, including the need for more efficient, motivated associates who will be asked to provide more complex tasks. Practices are being forced to pay more attention to the people who make up their teams—their talents, recruitment, retention, motivation, professional development, culture management, and satisfaction of their human resources.

Practices no longer just hire staff: they are now hiring financial counselors, patient navigators, care managers, professional coders, specialized advanced practice professionals, oncology nurses, and data analysts. Mr Mounce said that at the West Cancer Center, they now have professional development and culture-building programs to assist and support its nearly 600 employees.

Core Values and Culture

Sarah M. Chavarria, Chief People Officer, NantHealth, Los Angeles, CA, introduced NantHealth’s vision for how the core values, behaviors, and culture of its members are shaped by the following forces and processes:

  • Strategy sets forth the goals of the organization; that is, “who we are”
  • Structure defines how we are organized, who touches the patient at what point, and who is accountable for goal achievement
  • Talent makes sure we get the right people in the right role to do the right work; talent helps us to “assess, develop, and grow the best and brightest”
  • Total rewards uses incentives to drive collaboration of the team to deliver on the company’s goals (total rewards is defined instead of compensation)
  • Systems and processes support effective execution and enable decision-making and responsiveness.

NantHealth’s vision “is built around the core values, behaviors and culture, and the idea that if you do not get the core right, you are not going to be successful,” cautioned Ms Chavarria.

Every company and every practice has a culture, but if you do not encourage and shape a deliberate culture, the one that evolves will likely not help you meet your goals, she said. A deliberately shaped culture will include the values of the practice or the organization:

  • What you stand for, and how you want outsiders to define you
  • Value-based competencies, such as expectations for how each of your team members behaves, interacts, and performs
  • Strong leadership capability, in which leaders model values and behaviors of the culture
  • Individual accountability that encourages ownership at all levels for shaping “who we are” and whom we reward
  • Collaboration that aligns everyone to the mission, the values, and the goals of the practice or the organization.

“This is healthcare; we are touching people’s lives every day. We need staff who will humanize their approach, and embrace the commitment to who we are, and what we stand for,” said Ms Chavarria.

She discussed examples of behavioral interviewing, which she used to find team members who would fit NantHealth’s core framework and values. It is more informative to ask, “Give me an example of how you helped a team member to do ‘x’” rather than, “Tell me what you did in this job,” advised Ms Chavarria.

Tenets of Success: Corporate Culture and High Reliability

James Grayson, Administrative Chief of Staff and High Reliability Organization Specialist, West Cancer Center, Memphis, TN, introduced the importance of corporate culture and “high reliability” as a key aspect of that culture. High reliability is about successfully avoiding failure states while operating in an environment in which failure states have been historically accepted because of complexity or risk.

“It is not just about safety being a top-line focus….Safety must become a bottom-line goal. Your organization’s people and their cultural norms are the roadbed that the high reliability superhighway is built upon,” said Mr Grayson.

“Don’t let your desire for immediate results compromise your work. Spend 90% of your time prepping and 10% executing. Doing so results in you being called proactive. Not doing so results in you being called a lot of other things,” stated Mr Grayson as one of his tenets of high reliability. “Clarity of purpose is an essential aspect of a highly reliable patient experience. Did you live your values, mission, and vision; did you honor your commitment to your patients and to your associates?” he asked.

Mr Grayson challenged the audience to have an absolute preoccupation with success. “How much of your organization’s potential did you realize today? Where did we not succeed today, and how will we succeed in the same space tomorrow? For highly reliable organizations, the victory on the scoreboard means nothing without victory in fully achieving their potential, growing that potential, and doing both in a way that honors their moral code. Ensure your internal bar is always higher than any external assessment,” he advised.

Highly reliable organizations must have an absolute unwillingness to simplify, to identify why human error happened, and what has now been done to prevent a recurrence of that error, said Mr Grayson.

“They must eliminate as much variability in the system as possible, because variability is randomness and the archenemy of excellence. Agility is purposeful and excellence’s closest ally,” he added.

Other tenets of success for highly reliable organization include paying attention to the importance of operations to avoid causing further problems from a shortsighted solution, recognizing knowledge content experts when making decisions, valuing the emotional growth of employees, and supporting collaboration over conflict, said Mr Grayson.

Innovator of the Year Oncology Practice: Embracing Value-Based Care

Barry Russo, MBA, Chief Executive Officer, The Center for Cancer and Blood Disorders, Fort Worth, TX, was named Innovator of the Year at this year’s CCBS meeting; he added his perspectives on his pioneering private oncology practice that has participated in every major oncology payment reform model for the past 5 years.

This 20-physician practice and its teams have prepared for the operational challenges of integrating care, by embracing the focus of value-based care for addressing the patient’s overall well-being through healing patients, rather than solely curing their cancer. This is a new perspective for practices and requires a significant and deliberate culture change within the organization.

The changes that The Center for Cancer and Blood Disorders operationally started more than a decade ago included implementing clinical pathways and using nurse navigators. Mr Russo noted that he sometimes forgets to mention these essential changes (ie, use of clinical pathways nurse navigators), because they were made so long ago, but these strategies are still new to the majority of practices in the country.

Other changes that this practice has made in the past few years include:

  • Centralizing all intake to the practice, such as phones, new patient coordination, and triage
  • Establishing triage as a separate business unit, with goals and accountability
  • Implementing an internal case management program, with an increased focus on proactive intervention, as well as risk stratification
  • Establishing a wide array of per­tinent support services, while seeking crucially important fund­ing for each component, including psychotherapy, dietitians, genetic counseling, complementary medicine, nurse navigators, chaplaincy, social services, and palliative care services.

However, many challenges remain, even within practices that are leading the way in cultural changes for value-based care. Information analyses and reporting that is specific to value-based care is lacking and will continue to evolve as we learn more about what value-based care actually means, he said.

Call to Action

Mr Russo offered the following strategies for leaders to prepare their organizations for change:

  • Deliver a consistent message: “Everyone needs to understand where you are going, why, and how you plan to get there,” he said
  • Staff and clinician education is a journey, not a destination: “Value-based care is an agenda item at every single meeting, in every newsletter, on our website, and in every employee meeting,” he stated
  • Nursing requires increased attention: “Nursing has the most contact with the patient, and the overall care process; nursing stability is of utmost importance, and needs complete understanding of the goals of the value-based care changes,” he said
  • Strong team building is important at every level of the organization; teams that can process constant change are required: “Team building is not for the faint of heart….Brutal honesty is essential to the organization—accept feedback!” emphasized Mr Russo.

Finally, Mr Russo cautions, “Change is not going to be easy….Those changes you are making are disrupting the clinicians’ and the teams’ life; you have to create a new norm that all the members of the care team are essential to healing lives, and that without your contribution, we are not going to be able to make that happen.”