How a surgeon made breast cancer treatment patient-friendly

How a surgeon made breast cancer treatment patient-friendly

If you have been through breast cancer or have accompanied someone’s struggle you may like this story. As all stories on this blog, this story has something to do with behaviour, in this case its about patient behaviour, organizational behaviour change, breast cancer treatment and the change brought about by a surgeon – Laura Esserman.

Let’s first start with the typical process of breast care diagnosis and treatment. The woman first notices a lump on her breast. Anxiously she calls a doctor and meets him/her after a few days by taking an appointment. The doctor confirms that the lump should be examined, so the patient is referred to a radiologist to get a mammogram. Getting the results takes few more agonizing days. The mammogram shows something suspicious, so she is referred to a surgeon who she meets after a few more days spent anxiously. The surgeon verifies that the lump is present, gets a biopsy done at a pathology lab to determine whether the lump contains cancerous cells. Meanwhile the woman is waiting for an answer. If cancer is detected, depending upon the stage, she undergoes treatment, which may involve radiation, chemotherapy and surgery, in whatever order recommended by the surgeon. Different departments of a hospital conduct radiation and chemotherapy typically with different booking procedures and delays. The sequence takes weeks and weeks to unfold, while the woman is wondering, “Am I going to live through this?”

This anxiety-filled process appalled surgeon Laura Esserman. She had a vision of a Breast Care Center where a woman could walk in at the beginning of the day and walk out at the end with an answer. But as an associate professor at University of California at San Francisco (UCSF) at that time she had few resources at her disposal. Plus, radiation oncologists reported to medical oncology, surgeons to School of Medicine, nurses to medical center, psychologists to someone else. So you can imagine the organizational challenge to bring them together. Even if she could start a breast care clinic, she would never be able to hire such talent at such salaries.

Like all big changes, Esserman started small. She set up the Breast Care Center for only four hours one day per week. She would see the patients in the morning, send them off for a break and ask them to come back at 1pm. During that time, she would go to radiology, look through all the images with the radiologist and decide the next steps. In the second year, she expanded to two days per week and soon enough the snowball began. Eventually the Breast Care Center got an entire floor. The number of patients skyrocketed and the Center became a major source of revenue for UCSF. Today when the patient walks into the Breast Care Center, Esserman can look at her films, do a biopsy, and consult a gynecologist, psychologist, and genetic counselor in the same place. “For the first time,” said Esserman, “we put the woman at the center.”

Source: Victoria Chang and Jeffrey Pfeffer 2003, Laura Esserman, Stanford Graduate School of Business Case Study OB-42A and Chip Heath’s interview of Laura Esserman in May 2009.

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