PETER YESAWICH: Cancer Treatment Centers of America is a bit of an aberration in the health care business, because, in many respects, it was well ahead of its time, principally driven by, I think, the vision and the compassion of the gentleman who founded the company, and who continues to function as the Chairman of the company. And the company was actually created as a result of his observation of his mother being treated for cancer and not being given what he had determined through his own research to be options for treatment that were not available by that provider. And what he generally would characterize was the very unsatisfactory quality of care she received.
So he made it a personal commitment that he would attempt to change all that. Now, that's a tall order. And he started along the way by a commitment to, not just providing what, in his judgment, was the best clinical care, but importantly, accessorizing that clinical care with the things that would allow the patients to focus on their care. And that's the key idea.
Obviously, when you get a cancer diagnosis, or any serious illness, there are all kinds of drivers of anxiety for those individuals. What's going to happen to my job? What am I to do with the kids at home? What about the fact that I might have a co-morbidity? You might be a diabetic, whatever it might be.
So a lot of that stress, we know through considerable evidence-based research, is very burdensome for the patients. What about things like spiritual care? You know, one of the things I often marvel at is regardless of what you believe from a position of your personal faith, if you have one, people tend to find God when they get a cancer diagnosis. So there's a dimension of care that oftentimes is not only overlooked, but is also dismissed I think by many clinicians.
Anyway, the point is that he had this vision that if you could create all of these services, many of which are hospitality-based, that would allow you to de-stress the patient. That would allow the patient to focus on getting well, on the clinical aspects of their care.
What does that mean? Fundamental things-- greeting people and transferring people from the airport. You fly into Chicago for the first time, O'Hare Airport is pretty overwhelming. Where do you go? How do I get my bags? How do I get to the hospital?
We actually have greeters that are standing there at baggage claim, ready to greet you. What they will do is they'll put you in one of our vans and transport you directly to the hospital. Along the way you'll get preregistered, actually in the van. You will learn a little bit about our approach to care, and all the services that are available to you.
When you physically arrive at the hospital, there is always valet service, 24/7. So if you're parking your own car, you can do that. But there's a greeter, so soon as you walk into the hospital, in the public area, there is a person whose job it is nothing more than simply greeting you as an individual.
We do not have the customary registration desks and so forth. It really appears more like an upscale hotel. Considerable thought has been given to the ambient design. The colors, the sounds, the aromas-- you know, all of the things that are really unobtrusive cues for people, but have been demonstrated to be incredibly effective in terms of providing a little more of a sense of-- not relaxation, but of de-stressing patients.
And then the whole patient experience is crafted around allowing you to try to minimize the side effects of treatment, and to encourage a more rapid recovery and wellness. What does that mean? We have Culinary Institute trained chefs that prepare 100% organic food, for example. In fact, one of the interesting comments we get from patients all the time is about the quality of the food. We make food available to them at a fraction of the cost. So they might pay $3 or $4 for a meal, for example.
In each one of our hospitals, we've either built in wings of guestrooms for caregivers and family members, or we have acquired hotels in the immediate vicinity that we operate, there-- where we provide the caregivers and family with accommodations at a very reasonable cost-- $30 a night, something like that. And I would characterize these as, kind of, Marriott-quality guest rooms-- full internet capability. You can order room service from the hospital kitchen, you know, all of the things that you would expect to find in a 3 and 1/2 star lodging facility.
The ancillary treatments that we find are of great interest and facilitate recovery are provided at no cost to the patient-- things like massage therapy, music therapy, which is an evolving science. It's got some pretty compelling evidence that it-- for people who are responsive to that-- is something that promotes relaxation.
Each one of our hospitals has a full beauty salon for women who are undergoing chemotherapy that would lose their hair. You know, that's a pretty traumatic experience, as it affects your appearance. And we have trained salon professionals that will help them actually address that issue to the extent they want to do that-- or maybe just get a manicure, you know, to feel better. We have massage therapy. We have acupuncture. We have chiropractic care. We have psychosocial counseling.
So one of the common side effects of a cancer diagnosis is depression, and very often that is overlooked in the diagnosis. And what happens is people go home after treatment. And they suffer from the effects of depression. And it's very debilitating for them. We're very sensitive to that, and obviously, can provide that medical care.
Spiritual support, as I mentioned-- I have listened to patient testimony in this company now for probably 20 years. And what's remarkable is that every board meeting begins with the appearance of a patient. And the patient actually is in front of the board, is given the floor for as long or as little he or she would like to talk about their experience.
And then what happens is they are grilled by the board members to say, well, how was the quality of the post-surgical care? Did they meet you at the airport on time? What'd you think of the food-- you know, that kind of thing. And they take as much time as necessary to share that. They serve it up raw with the board.
And it's very enlightening. But I haven't listened to one testimonial in 20 years where they didn't mention something about their faith. And I don't pass judgment on that. I just make that statement, because what that means is the availability of, not part-time visiting spiritual support, but full time pastoral care-- which we do, non-denominational, by the way-- in all the hospitals is immensely important to people.
So if you think about everything I've just described, all of that wraps the clinical piece, because that's where it begins. And it begins with what, in our judgment, is exceptional clinical care, as demonstrated by our outcomes. And one of the other things that really is a dimension that has affected hospitality, as you know, over the past, really, probably 8 or 10 years, is the transparency of consumer ratings, right?
So you can go to TripAdvisor. And we know that 2/3 of people, when they book a hotel room, are going to go to TripAdvisor first to look at the ratings, or to Yelp, or whatever it may be. That didn't exist in health care, you know, until a couple of years ago.
One of the things they're seeking is information about treatment results. So one of things you'd like to know as a person with a-- again, I'll talk specifically about oncology. If you have a cancer diagnosis, one of the things you'd like to know before you decide to treat someplace is, well, how well do they do?
Today there are about roughly 1600 hospitals in the country that provide some aspect of cancer care-- maybe not the full spectrum, but some aspect of care. And if I were to ask you the question, how many of the 1600 publicly report their treatment results? You presumably would not know the answer. But hopefully, you would be shocked when I told you that it's less than 100. So just think about what I just said.
So you might decide to contact any of a number of very well-known providers, and say, look, I just got diagnosed with a Stage 3 lung cancer. And I'm trying to make a decision about where to go. And I'm looking at these ratings, which is very helpful. But I want to know how you do.
In fact, in the seminar this morning, I think the statement that was made by one of the panelists was absolutely right. And that is if you're going to cure me, I can put up with lousy service, right? So the point is that that's the fundamental. You've got to have clinical excellence.
Well, as it turns out, among those 100 who report their results in cancer, overwhelmingly they report on one cancer type-- typically breast cancer. We report on 11 cancer types. And we started doing this 12 years ago-- posted our results on the internet.
Now you can imagine, it was very controversial that we did that. Still is today, because of comparability of samples. And, you know, there are certain clinicians that would say, well, you can't post anything, because no population of cancer patients is the same as the population treated. And that's absolutely true. But as a patient, you know, one of the things that I'd like to know is, well, give me some information to help me make an enlightened judgment. And certainly, some information is better than none.
And I guess I would conclude that by saying the philosophy that has been adopted and implemented at CTCA is really very unusual. But it's driven by first and foremost the commitment to clinical excellence. But after that, it's all about the things that we can do that will de-stress the patient, allow them to focus exactly on their care. And those things are really inspired by hospitality.
I think there's this discovery that this whole issue of patient satisfaction is more than a nice report to read. It's critical to patients. And increasingly, as you know I mentioned in my comments this morning, we know that patients are extremely inquisitive about not just the nature of their illness, but importantly the qualifications and the credentials of the providers that they're ultimately likely to select.
| the answer to your question is I think at the very minimum, there has to be crossover in terms of curriculum both for the hospitality professionals to understand the parameters that govern the ability to deliver care. And we've heard about a number of those this morning, a lot of which are regulatory, others which are driven by cost and financial management. And conversely, if you take a look at students in medical school, that they begin to understand that the engagement they're likely to have with patients, and the outcome of that engagement, is going to be enhanced dramatically through a basic understanding of the way people present-- beyond their clinical condition-- to understand them as human beings, and to understand their stresses, their desires, their fears, and the things that can be borrowed from the hospitality industry to go ahead and minimize those.
That's coursework. It's training. It's observation. It's measurement-- all of those things. And on that score-- and this was also mentioned this morning-- but part of the annual review of all of our clinical staff is this very subject, and that is the patient satisfaction ratings, right down to the individual clinician. And so they're aware of the quality of the engagement they've had with patients, and importantly, what those patients think.
In principle, we've done a very good job in what is clearly a young discipline. And I say that just because of my observation of the elements of design that ultimately are reflected in our hospital product. Just a couple of examples-- we know that, for example, patients will have a lot of time they'll spend with caregivers. Many times, caregivers will want to spend the night in the patient's room. And so what we've designed is, in all of our patient rooms, essentially it's a retractable second bed that is available for caregivers or family members who would like to spend the night with their loved one.
The ability to use technology to ensure that patients get access to what they need, when they need it. By that I mean everything from Wi-Fi in the patient rooms, to the ability to order a meal off the television set through remote control, to a full selection of cable television and music channels to provide a sense of diversion while they're in the guestrooms, to actually a very innovative design such that each of our patient rooms facing the corridor, which is where the clinical staff would travel up and down, has been designed in such a way that the clinical staff can always look into the patient room.
Now, certainly they can close off the blinds for privacy. But the nurses stations are literally right outside of the patient's room. They're not centralized. So what happens is the nurse can literally, at any given time, see you. And understand, now, you get privacy too, if that's what you want.
But the idea is knowing that we've all been through this anxiety-producing experience where you've got to go to the restroom, you want a drink of water, or whatever it may be. And you call the nurse or the attendant. And it takes 40 minutes for somebody to respond. That doesn't happen in our hospitals. And it doesn't happen because we've designed them in such a way to make sure that the people who are providing the care are able to observe 24/7 exactly what's happening with the patient-- so simple things like that.
Even things like amenities in the bathroom-- you know, pretty customary, certainly, in the hospitality business. It's certainly not in the hospital business. In terms of understanding the quality of the amenities, right down to things like the quality of the towels in the bathroom, the quality of the pillows on the bed, you know, those kinds of things.
We've actually custom designed a lot of the way we outfit-- accessorize these rooms, all driven by patient care and patient desire. So hopefully that's helpful. But it gives you an idea that we want to, again, minimize the distractions and the things that produce anxiety for patients so they can focus on their care. And those things are driven by a sense of hospitality.
Every hospital we have, since the initial acquisition, did not have any staff. They're ground-up built construction, so we started fresh. And one of the things that did not come out this morning, that I was going to comment on, was this very subject. And that is it really begins with not just a vision at the top that this is important, but it also begins with the way you screen and hire employees.
And we have a very rigorous system that enables us to not just look at the professional credentials of prospective employees, but really more the attitudinal issues. You know, it's-- I would liken this-- and please, don't misinterpret the comment-- but I would liken this to the effective screening and employment practices at, like, Southwest Airlines, where you have people who are always happy. Our staff is, remarkably, always happy. I say always-- there are no extremes here-- but predominantly-- in very, very difficult and stressful situations.
And that's a direct result of the way we screen and higher. I'll give you an example. The newest hospital we have is in Atlanta, about 20 minutes from the Atlanta airport. And that hospital opened about 3 and 1/2 years ago.
And the process through which we went to go ahead and identify, and ultimately screen and employee the initial stakeholders, as we call them-- we were looking for about 400 full-time people to open the hospital. We had over 20,000 applicants for 400 positions, if you could imagine that. Now obviously, that sheer volume of interest allows us to be able to screen, you know, the better one-- the best ones out. But it's also a question of the tools that we use. And our talent team has developed a whole series of predictive tools over the years that allow us, through testing, to get a better sense of the probability of whether or not this is someone that's going to align with the value system that we have.
Now the other thing that happens is, once you're hired, it is mandatory that you go through an orientation process that we call Hope, Joy, and Pride. And Hope, Joy, and Pride is a full week-long immersion in the principles of the company. So the first thing you do on the job is you're going to spend time understanding the philosophy that drives the organization, getting exposed to senior management, understanding our mission, vision, values-- you know, those kinds of things.
And It's not like you go through a-- kind of a obligatory training program, and then boom, you're on the job. That is also a process of orienting them to the cultural foundation of the company, which is essential. And it's proven to be highly effective.
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Peter Yesawich, SHA '72, MS '74, PhD '76, Chief Growth Officer, Cancer Treatment Centers of America, was interviewed during the Cornell Hospitality, Health and Design Symposium, "In Search of a Healthy Future" on October 10, 2016.