Latest / Becker’s Healthcare Podcast / Bringing Humanity Back to Cancer Care with Frantz M. Berthaud

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Bringing Humanity Back to Cancer Care with Frantz M. Berthaud · Becker’s Healthcare Podcast

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- Hello, and thank you so much for tuning
1:01
- in to the Becker's Oncology
1:03
- Leadership Podcast.
1:05
- I'm Elizabeth Gregersen,
1:07
- a reporter here at Becker's. And today, I'm
1:09
- talking to Franz
1:11
- Berthaud
1:12
- from University Medical Center of El Paso. Franz,
1:16
- thank you so much for taking the time
1:17
- to speak with me today.
1:19
- Thank you so much, Elizabeth, for having me.
1:21
- Absolutely. And before I dive into all the
1:23
- questions I have for you, I'd love it
1:25
- if you could share a bit about your
1:27
- background and your role at UMC in El
1:29
- Paso for our listeners.
1:31
- Absolutely.
1:33
- So I am, Franz as, you stated, and
1:37
- I'm the senior vice president of oncology services
1:40
- at University Medical Center of El Paso.
1:43
- We're a public,
1:45
- safety net health system,
1:47
- serving, I'd say one of the largest binational
1:50
- communities in the country. We are
1:53
- certainly a border,
1:55
- community bordering with the state of New Mexico
1:58
- and bordering with the country of Mexico.
2:01
- And I
2:02
- my role, there is looking at,
2:06
- and servicing our cancer service line. And a
2:08
- big part of that is the development of
2:11
- the Fox Cancer Center,
2:13
- which aspirationally,
2:14
- and I like to say it out loud,
2:16
- will be, an NCI designated cancer center,
2:20
- serving our region,
2:22
- sitting at the border.
2:23
- And I think making real,
2:26
- big impact
2:27
- on the community and hopefully,
2:29
- beyond. I've I've spent the the crux of
2:32
- my professional career
2:33
- in the cancer space and oncology.
2:36
- Spent about fourteen years at the Dana Farber
2:38
- Cancer Institute in Boston. Mhmm.
2:41
- Spent time running the cancer service line
2:44
- for four hospital,
2:46
- system here in El Paso,
2:48
- as well.
2:49
- So cancer has certainly always been a
2:53
- a focal point,
2:54
- for me just, I would say professionally and
2:57
- personally.
2:58
- And I I I'd be remiss not to
3:00
- state that our, the cancer center is in,
3:03
- partnership and collaboration
3:05
- with, Texas Tech Help El Paso here, who
3:08
- has been serving the region,
3:10
- as well.
3:12
- Perfect. And, you know, I I'd love to
3:14
- tap you to answer this question
3:16
- just given your experience, you know, at Dana
3:19
- Farber, the four hospital system, and your role
3:22
- right now.
3:23
- Are there any pressures that you feel cancer
3:26
- centers or, you know, oncology service lines within
3:29
- systems are facing right now that aren't getting
3:32
- talked about enough?
3:34
- I definitely think so.
3:36
- When I think about pressures, there's probably one
3:40
- that I would call the capacity
3:42
- conversation. Right? That's missing from the rhetoric, missing
3:46
- from even from a policy standpoint.
3:49
- Everyone talks a lot about drug prices,
3:51
- prior authorization, which
3:53
- that that
3:55
- plays a significant role and has a significant
3:58
- impact
3:59
- on on the entire,
4:01
- kind of cancer care ecosystem.
4:03
- But I think folks miss out on whether
4:06
- the system can actually absorb
4:09
- the patients that are coming. We're talking about
4:11
- the patients that are already here. When you
4:14
- think about
4:15
- survivorship
4:16
- and people are living longer,
4:18
- so the prevalence of cancer,
4:21
- but you also have a
4:23
- a really large population
4:26
- of in terms of incidence with new cancer
4:29
- cases coming.
4:30
- And with that incidence rising,
4:33
- the oncology workforce aging out, the demand is
4:37
- landing, I think, hardest on communities
4:40
- that already have thin capacity,
4:42
- you know, I e, the
4:44
- the border region, you know, the borderplex as
4:46
- we call it, here in West Texas.
4:49
- You know, we have
4:51
- a a lack of I wouldn't necessarily say
4:53
- resources, but specialists
4:55
- where we're wholly underserved in that aspect.
4:58
- So we measure access as is there coverage,
5:03
- not is there a chair, a clinician,
5:06
- and an appointment within a clinically
5:08
- meaningful window. And I think that is a
5:11
- big challenge for communities like mine, but it's
5:14
- something that we're not really talking about. Are
5:16
- we prepared and capable
5:19
- to absorb the cancer cases that are coming?
5:23
- Perfect. Thank you for kinda laying it out
5:25
- like that.
5:26
- I know,
5:28
- you know, our listeners will probably agree and
5:31
- relate and, be grateful
5:33
- that you brought it up. Shifting gears a
5:36
- little bit,
5:37
- we recently at Becker's had our,
5:40
- virtual oncology event,
5:42
- and you were a panelist. Thank you again
5:44
- for doing that. And you spoke about
5:49
- a concept called return on humanity
5:52
- and how you're taking that as seriously as
5:55
- ROI.
5:56
- For listeners
5:58
- of this episode who didn't get to join
6:01
- the summit and hear you speak about that,
6:03
- could you explain what return on humanity is
6:07
- and its importance for you?
6:10
- Yeah. For sure. So it's it's something I
6:12
- I kinda said spur of the moment as
6:14
- we were discussing
6:16
- ROI, and and it's it's such a focus
6:19
- on the, you know, the business of health
6:21
- care, if you will,
6:23
- and all the financial pressures in oncology
6:26
- and in the cancer space.
6:28
- And sometimes I think we forget
6:30
- to
6:31
- consider
6:32
- what that return on humanity
6:34
- is, And it's something I I,
6:36
- throughout my career, always
6:38
- turn to. It's a bit of a a
6:40
- point of orientation and I would say a
6:42
- point of destination.
6:43
- You know, what happens when a strategy is
6:46
- is it's clearly the right thing to do,
6:48
- But again, that spreadsheet doesn't capture why. Right?
6:52
- The ROI asks
6:54
- a strategy. It's
6:56
- the returns on it to the balance sheet.
6:58
- Whereas, I would say this return on humanity
7:01
- asks, what does the return to the human
7:04
- beings
7:04
- in the organization? What does the return to
7:07
- the human beings that the organization
7:09
- serves,
7:10
- that exists to serve?
7:12
- You know, and and those who are doing
7:14
- the serving. Right? The the clinicians and and
7:17
- any team member, that's part of,
7:20
- that providing that care.
7:22
- So in the example I have used in
7:25
- the panel,
7:26
- was centered around, patient navigation. Right? If you
7:29
- have a patient navigator program
7:31
- or or let's say you have extended infusion
7:34
- hours, transportation
7:36
- support, or survivorship clinic, these are not
7:40
- big
7:41
- margin producing,
7:43
- initiatives.
7:44
- But if you run those through that that
7:46
- traditional ROI lens, it's just not gonna work.
7:50
- Mhmm. But if we run them through this
7:52
- other lens, a ROH,
7:54
- and you see fewer abandoned treatments,
7:57
- families who don't have to choose between
8:00
- taking a shift at work and a chemo
8:02
- appointment,
8:03
- staff who feel like they're part of a
8:05
- mission rather than a margin,
8:08
- there's
8:10
- that return is exponential, I would say, to
8:13
- the financial.
8:14
- And I don't wanna diminish
8:16
- the financial returns and the importance of it,
8:19
- but the point isn't to replace the ROI.
8:21
- That financial discipline is what keeps safety nets
8:24
- like ours, our our systems alive.
8:27
- But the point is that the ROI and
8:29
- the ROH belong side by side in that
8:32
- same business case, evaluated with that same rigor,
8:35
- that same seriousness.
8:37
- And when we only
8:38
- fund what pencils out financially,
8:41
- we're slowly
8:42
- kind of
8:44
- we optimize the humanity out of cancer care.
8:47
- And that RoH is a way of of
8:49
- making sure that that human return is visible
8:53
- so it can compete
8:55
- for the resources on equal footing. So it's
8:58
- I'm not saying we're displacing or replacing
9:01
- that return on investment, but I am demanding
9:05
- that we invest in the humanity of the
9:08
- care,
9:09
- that we provide.
9:11
- Absolutely. And I just love the way you
9:13
- laid that out as, you know, it's not
9:15
- just a I think you said not just
9:17
- a a point of orientation, it's a point
9:19
- of destination as well,
9:21
- and kind of using that side by side
9:24
- with the financial aspect.
9:26
- Are there any specific measures or metrics
9:29
- that you think systems could be using to
9:31
- determine,
9:33
- you know, their performance
9:34
- on this concept of return on humanity?
9:37
- It that's a bit challenging. Right? Because, you
9:39
- know, the instinct is that human humanity can't
9:42
- be measured. Right? I'd I'd I'd wanna push
9:45
- you back on that a little. So we're
9:46
- not measuring humanity itself.
9:49
- Mhmm. We're measuring
9:51
- the the kind of
9:53
- the vestiges of it or the footprint that
9:55
- it leaves, you know. So I I basically
9:58
- offer,
9:59
- kind of a a catalog or a menu.
10:01
- What might that look like? On the patient
10:03
- side of things, right, it's time from abnormal
10:06
- finding to first treatment.
10:07
- We we talk about this like turnaround times,
10:10
- but these have real
10:12
- emotional implications for families.
10:14
- Someone who's waiting
10:16
- for a diagnosis
10:18
- so that they can start treatment. Like, that's
10:20
- a big, big deal.
10:22
- Treatment abandonment and no show rates,
10:24
- those have financial implications for, let's say, an
10:27
- infusion center, but those have real implications for
10:30
- making sure that
10:31
- patients aren't choosing
10:34
- taking care of other parts of their life
10:36
- over taking care of themselves,
10:38
- which I think often happens when we think
10:40
- about financial toxicity.
10:42
- And that even financial toxicity screening rates and
10:45
- the interventions that are delivered with that, That's
10:48
- also a very human thing.
10:52
- Patient reporting
10:54
- that they feel seen or heard.
10:56
- Again, navigation, how many lives have has navigation
11:00
- touched
11:01
- Because we know,
11:03
- and have literature and the numbers that tell
11:06
- us that navigation
11:08
- is important important and it's impactful.
11:11
- So measuring
11:12
- how many lives we've touched, you know, patients,
11:15
- that way. And then I think there's a
11:17
- a family and kind of a community side.
11:19
- Right? We're looking at caregiver burden. You know,
11:22
- can we score caregiver burden and really track
11:25
- that to ensure that not only are patients
11:28
- being taken care of, but we as a
11:30
- health system, are we caring for the people
11:32
- who are caring for our patients? It's a
11:34
- bit convoluted, but it it it our existence
11:37
- hinges on each other so much.
11:40
- And that's really that ecosystem of humanity that
11:43
- it it forces us to say, we need
11:45
- to also care for the caregivers
11:47
- so they can help the patients get better
11:49
- as well. Out of pocket burden as a
11:52
- share of household income, I think that is
11:54
- probably like a real number
11:56
- that we can speak to that we can
11:58
- probably put health policy,
12:00
- advocacy,
12:02
- energy behind,
12:04
- community trust.
12:06
- It's probably hard to kind of actually measure
12:09
- it from a volume or or kind of
12:12
- a a pure numbers or numerical perspective.
12:15
- But does your community trust you as a
12:17
- health system and and a provider?
12:19
- And again,
12:21
- that might look like
12:23
- screening uptake in historically underserved ZIP codes. You
12:26
- know, colleagues of mine, we've always,
12:29
- in kind of the health equity and and
12:31
- cancer care equity space specifically,
12:35
- like to say, you know, where you live
12:37
- should not determine if you live. And that
12:40
- has just a huge implication. So can we
12:43
- look at
12:45
- and pull those data analytics and say, are
12:47
- we not serving
12:49
- or are particular parts of our community going
12:52
- underserved?
12:53
- And how are we impacting that year over
12:55
- year? That has huge
12:58
- humanity implications.
12:59
- And then, you know, not to belabor the
13:02
- point, I think that work the workforce part
13:04
- is really important.
13:06
- Turnover,
13:07
- vacancy and oncology rules, burnout, moral distress.
13:11
- If we can score those things, right,
13:14
- you know, would you recommend this as a
13:16
- place to work and receive care?
13:18
- Like, those two things,
13:20
- can live in the same conversation
13:23
- because oftentimes,
13:24
- if you're a large health system like us,
13:26
- and let's say you have over 4,000 employees,
13:29
- there's gonna be a certain percentage of your
13:31
- employees
13:32
- that will also seek care within your own
13:35
- institution.
13:36
- Is this a place that they want to
13:38
- work and receive care?
13:41
- I think both of those things
13:44
- are important. So looking at the patient side,
13:46
- that kind of family or community
13:49
- perspective, looking at that workforce side.
13:52
- And then I would just say, like, in
13:53
- a real practical way,
13:55
- add an ROH section
13:57
- to every capital and program proposal. Right? Even
14:00
- if it if it starts kind of qualitatively,
14:03
- what gets
14:04
- what gets aligned on the template gets discussed.
14:07
- And so if we were to say, we
14:09
- wanna build, you know, this new clinic, and
14:12
- we need to be really thoughtful about, is
14:14
- it in an underserved part of our community?
14:17
- Again, looking at those ZIP codes, making strategic
14:21
- decisions that have real human
14:23
- impact and and that it's infused with humanity
14:27
- from its nascence, right, from that very
14:30
- beginning and building block. Like, let's really think
14:33
- about the people as part of the processes.
14:37
- Perfect. And I you know, so much of
14:40
- what you said
14:41
- of how, you know, to quote, unquote measure,
14:44
- right, this return on humanity
14:46
- are, you know, pieces of, you know, cancer
14:49
- care that come up anecdotally of, you know,
14:52
- leaders know that this makes cancer care more
14:55
- effective, you know, all these different aspects of
14:57
- caring for the caregivers, financial toxicity,
15:00
- everything you mentioned. So, I do love kind
15:03
- of tying it together just to to say,
15:05
- okay. Now put that on the proposal.
15:08
- Right. You know, it's just as important.
15:11
- But I'd like to circle back to something
15:12
- you mentioned when it comes to the workforce
15:14
- and the staff.
15:16
- How
15:16
- would you suggest systems help communicate this kind
15:19
- of spirit of RoH to their staff and
15:22
- build it into their cultures?
15:26
- So
15:27
- I'm a huge believer in servant leadership. Right?
15:30
- And being that example,
15:33
- Leaders have to model the math. If executives,
15:36
- right, if we as senior leaders are only
15:38
- asking what's the margin, staff learn kind of
15:41
- that language and they learn that the mission
15:43
- statement,
15:44
- it tends to be a little bit of
15:45
- decoration.
15:46
- So asking
15:48
- what that return on humanity question, asking that
15:51
- out loud in budget meetings, asking it in
15:54
- boardrooms,
15:55
- really starting to live that. And and when
15:59
- you vocalize these stakes often enough,
16:03
- there's a a an odd thing that happens
16:05
- with humans is people start believing
16:08
- what you keep saying because you're saying it
16:11
- often enough. So telling the stories that are
16:13
- next to the numbers
16:15
- is really important. We know the power of
16:17
- narratives and storytelling.
16:19
- So connecting
16:22
- what we're discussing from a a a margin
16:25
- and a mission perspective to real people's lives,
16:28
- I think are important.
16:31
- Imagine happen having open leadership meetings with a
16:34
- patient or a staff story that's tied in.
16:38
- Maybe you're opening
16:39
- board meetings with a narrative like that, or
16:43
- you're including
16:44
- a a patient who has received care within
16:46
- the health system
16:48
- at every single board meeting. You invite one
16:50
- patient.
16:51
- I think those things
16:54
- are are real tactics and ways to embed
16:56
- it within
16:58
- a culture.
17:00
- And that because we know that the data
17:02
- is going
17:03
- to be helpful in convincing
17:05
- people. Right? It it convinces the head, but
17:08
- the stories are what will convince the heart.
17:10
- And I think
17:11
- we have to probably pinpoint to the heart
17:14
- of the organization sometimes
17:16
- to really move things along.
17:18
- And I would also say pushing the concept
17:20
- to the front line.
17:22
- We know
17:23
- that your schedulers,
17:25
- the the folks at the the proverbial front
17:28
- door of your organization, registration,
17:30
- etcetera,
17:32
- they're going to meet
17:34
- way more patients than any executive ever meets
17:37
- on a daily basis.
17:38
- So really pushing the concept there, whether it's
17:42
- your scheduler, your valet,
17:43
- that infusion nurse,
17:45
- if they can see the piece, if they
17:47
- believe in it and and the kindness that
17:50
- starts at that front desk,
17:52
- everyone will help to generate that RoH and
17:55
- it won't just be clinicians.
17:58
- It it it's it's huge. And
18:01
- where it really will be impactful is when
18:04
- we the organization
18:06
- itself are in hard times. Right? You almost
18:08
- have to be a bit more cognizant of
18:11
- the season that your organization's in and protecting
18:14
- the ROH. Because culture is what you refuse
18:18
- to cut in a bad budget year.
18:20
- So if ROH investments
18:22
- are the first thing sacrifice,
18:25
- staff will
18:26
- obviously conclude that it's just branding.
18:29
- Again, your your your mission statement becomes just
18:32
- decorative,
18:33
- and then no one actually believes in what
18:36
- you're doing. So I would say recognize it,
18:39
- promote for it, whatever behavior you celebrate in
18:42
- advance, you get more of. So we celebrate
18:46
- and we promote people
18:48
- because of how tied to the ROH concept
18:51
- they are.
18:53
- We're gonna see the financial returns, but I
18:55
- think you'll see the the kind of workforce
18:58
- and and cultural,
18:59
- returns within the organization as well.
19:03
- Absolutely. And, I mean, I'm sure every listener
19:05
- here knows how important that is, you know,
19:07
- and all the downstream effects. So it's a
19:10
- it's a crucial piece to the puzzle for
19:12
- sure.
19:13
- Any listener of the podcast knows I always
19:15
- love to end conversations with oncology leaders with
19:18
- a look to the future
19:20
- because I just find the optimism
19:22
- so energizing.
19:24
- I'd love to hear from your perspective what
19:27
- is giving you hope about the future of
19:29
- cancer care right now.
19:31
- Wow.
19:33
- It's like a big existential question right now.
19:35
- Like, what gives me hope?
19:37
- I would say a a lot of things.
19:39
- And
19:40
- and, honestly, what gives me hope
19:43
- is
19:44
- where the science is starting to show up.
19:47
- You know, we're building
19:49
- with Texas Tech and UMC. We're building a
19:52
- cancer,
19:53
- center here
19:54
- at the border. Right? In a community that
19:56
- historically had to travel hours across
19:59
- into
20:01
- other states and or or hundreds of miles
20:04
- and other health systems
20:06
- to get comprehensive cancer care.
20:08
- The fact that a public safety net system
20:11
- and and the academic partner
20:13
- can come together and say, our community
20:16
- deserves this level of care
20:18
- here at home tells me that the field
20:21
- is finally taking geography and equity
20:24
- seriously.
20:25
- We often talk about
20:27
- what's happening on that rural front or what
20:30
- I like to say, even some of these
20:32
- fringe communities
20:33
- like El Paso, Texas. Right? We we abut
20:36
- and then a close proximity with real,
20:39
- really rural areas, and yet we are a
20:42
- a county of 875
20:45
- or so thousand people.
20:47
- And when you have
20:49
- what I like to call urban, right, it's
20:51
- like it's your rural and your urban mix.
20:54
- So Yeah. We have less
20:56
- resources
20:57
- here
20:59
- and but are expected to perform
21:01
- like our metropolitan
21:03
- counterparts.
21:05
- So how do we actually do that? And
21:07
- I think when we look at where technologies
21:10
- go, we look at where the science and
21:12
- health care is going in, and that equity
21:15
- is still an underpinning
21:17
- of all of it. I mean,
21:19
- I love it. And I'll and I'll say
21:21
- this. Right? Shout out to the next
21:24
- generation. I think the next generation of of
21:27
- the executives
21:29
- of the nursing workforce of the the clinicians.
21:32
- Right? I think the next generation will often
21:35
- gets,
21:37
- it it may be ill categorized as not
21:39
- having enough grit
21:41
- or,
21:42
- you know, maybe they're on their phones too
21:44
- much.
21:45
- Mhmm.
21:47
- But I think the next
21:49
- generation of of the students and and career
21:52
- colleagues,
21:53
- there aren't there aren't asking
21:55
- whether equity and excellence go together. They assume
21:58
- it. Right? They walk in the door believing
22:01
- the return on humanity matters.
22:03
- They have
22:04
- created a little bit of boundary around things
22:07
- that they will and will not do.
22:10
- And I love that for them. So our
22:13
- jobs as leaders to build institutions
22:15
- worthy of that assumption, the assumption that equity
22:18
- and excellence
22:19
- go together.
22:21
- And and for me, so that the science,
22:23
- the next generation,
22:24
- they give me hope
22:26
- because they will be
22:28
- who will take care of us
22:31
- when, if and when that time comes.
22:34
- And I think that's
22:35
- really important. So
22:37
- we have to build for now. We have
22:39
- to build for the future and let hope
22:42
- be,
22:43
- part of that brick and mortar.
22:45
- Absolutely.
22:46
- I feel like we could record a whole
22:49
- new podcast episode on equity and excellence. You've
22:52
- given me another
22:54
- you've given me another idea. Right, part two
22:57
- of the sequel. Yeah.
22:59
- I just appreciate your your answer though because
23:02
- it it just proves my point that oncology
23:05
- leaders are the best at get fueling us
23:07
- with optimism
23:09
- for the hope not just about, you know,
23:10
- the health care industry, but about cancer and
23:13
- oncology. So I I can't thank you enough
23:15
- for coming on the podcast today and for
23:17
- sharing your insights.
23:18
- It was an honor. Thank you so much,
23:20
- Elizabeth.
23:21
- And thank you to our listeners for tuning
23:23
- into Becker's Oncology Leadership podcast.
23:26
- I invite you all to check out even
23:28
- more Becker's Healthcare podcast
23:30
- at beckerspodcast.com.
23:33
- Thank you again to Franz for joining me
23:34
- today and to our listeners for tuning in.
23:37
- Have a great day.