Marin Cancer Institute Receives Outstanding Achievement Award from American College of Surgeons’ Commission on Cancer

One of only four programs in the state, only program in Northern California to receive award

April 13, 2015

GREENBRAE, CA — The Marin Cancer Institute at Marin General Hospital announces that it is once again among an elite group of cancer programs in the United States that have earned an Outstanding Achievement Award from the American College of Surgeons’ Commission on Cancer (CoC). The hospital’s cancer program underwent a rigorous reaccreditation survey in May 2014 after which it received Gold Level designation, the highest level of accreditation. In 2014, seventy-five programs out of the more than 1500 surveyed across the country received Gold Level designation, which qualified them for the Outstanding Achievement Award; the CoC announced the results in March 2015.

The Marin Cancer Institute is one of only four cancer programs in California, and the only one in Northern California to earn the award. This is the third consecutive time the cancer program has received this award, earning the distinction in 2008, 2011 and now in 2014.

Outstanding Achievement Award winners represent approximately 15% of the programs surveyed in 2014 and represent the “best of the best” according to David McKellar, MD, chair of the CoC. “Each of these facilities is not just meeting nationally recognized standards for the delivery of quality cancer care, they are exceeding them.”

Accreditation by the CoC sets quality-of-care standards for cancer programs and reviews the programs to ensure they conform to those standards. Accreditation is given only to those facilities that have voluntarily committed to providing the highest level of quality cancer care and which undergo a rigorous evaluation process and review of their performance. To maintain their accreditation, facilities must undergo an on-site review every three years.

In addition to exceeding the seven standards of care required for an Accreditation with Commendation, the Marin Cancer Institute fulfilled all 27 additional standards required for a Comprehensive Community Cancer Program.

“This national recognition not only demonstrates the high level of cancer care we deliver here at the Marin Cancer Institute, it testifies to the special work done here every day by our staff and physicians for patients, families and our community,” says Lloyd Miyawaki, MD, MPH, chair of Marin General Hospital’s Cancer Committee.

The CoC accredited cancer programs in the U.S and Puerto Rico represent approximately 30 percent of all hospitals. The accredited programs diagnose and/or
treat more than 70 percent of all newly diagnosed cancer patients each year.

Marin General Hospital’s cancer program has been continuously accredited since 1985.

About the American College of Surgeons’ Commission on Cancer
Established in 1922 by the American College of Surgeons (ACS), the CoC is a consortium of professional organizations dedicated to improving patient outcomes and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive quality care.

Peter Eisenberg and MIJ

Cancer gets personal for Marin oncologist

Peter Eisenberg and MIJ

Richard Halstead from the Marin Independent Journal, writes about Dr. Peter Eisenberg, a prominent oncologist who has been treating Marin cancer patients for more than 36 years, return to work after experiencing his own brush with the dreaded disease.

Dr. Peter Eisenberg, a prominent oncologist who has been treating Marin cancer patients for more than 36 years, has returned to work after experiencing his own brush with the dreaded disease.

Listening to Eisenberg, 68, recount his successful surgery for thyroid cancer in July, however, one might think he'd just recovered from nothing more serious than a bad cold.

"Look, this is a bump in the road. I had a little cancer, just slightly over a centimeter in diameter," Eisenberg said. "Frankly, I see people all day long who are quite ill, and I couldn't really mount a level of concern given how brave most of my patients are."

Thyroid cancer grows slowly and, when discovered early, has a high cure rate.

Eisenberg founded an oncology practice in Marin in 1978 that has become Marin Specialty Care, a group practice consisting of 13 doctors and support staff adjacent to Marin General Hospital in Greenbrae. Marin Specialty Care works in close cooperation with the hospital's Marin Cancer Institute and Eisenberg serves as Marin General's medical director for oncology services.

Facing mortality

Eisenberg said nodules were spotted on his thyroid, a butterfly-shaped gland at the base of the neck, about a year ago during a CT scan for another medical issue that turned out not to be serious. At that point, there was no reason for Eisenberg to assume the tumor was cancerous.

"The majority of thyroid nodules are going to be benign," said Dr. Romeo Agbayani, the Greenbrae surgeon who operated on Eisenberg.

A subsequent biopsy, however, indicated papillary thyroid cancer, a common form of the disease that most often affects people ages 30 to 50.

While Eisenberg downplays the hardship generated by his diagnosis, he acknowledges the experience drove home the fact of his mortality and caused him some worry about the future of his wife and daughters, who are ages 10, 12 and 24.

"That's the scariest thing to me," he said, regarding his family's welfare.

Second diagnosis

This wasn't Eisenberg's first experience with cancer. In his 20s, when he was in medical school, Eisenberg was diagnosed with a slow-growing type of blood cancer, polycythemia vera, after suffering a mild heart attack. The disease causes bone marrow to make too many red blood cells, which can thicken blood and produce clots.

"I've been treated for this with chemo-like drugs for a number of years," Eisenberg said.

With proper treatment, many people with the disease experience few problems. Eisenberg was a triathlete before his knees limited his running; he still rides his bike to work from San Anselmo.

Eisenberg said he learned several things dealing with the thyroid cancer.

First, "The skill of doctors is widely variable in giving news," Eisenberg said. "That should not be a surprise to anybody."

Eisenberg wouldn't elaborate on who taught him this lesson; he declined to identify the doctor who gave him his diagnosis.

"We're not going there," he said.

Eisenberg said Agbayani, a longtime friend of his, definitely knows the right way to deal with nervous patients and their families. Agbayani met with Eisenberg and his wife, Elizabeth Shortino, prior to the surgery.

Agabayani said he could sense that both Eisenberg and his wife were apprehensive when he spoke to them. Agabayani said in Eisenberg's case his knowledge of cancer may have been a double-edged sword.

"A little knowledge can be dangerous, so a lot of knowledge can be very dangerous," Agabayani said. "Your mind tends to run away, and you think of the worse-case scenario."

Providing comfort

Eisenberg said, "He was so reassuring I cannot even begin to tell you. Once he laid out the whole situation, the level of anxiety was reduced significantly."

Shortino said, "When Peter told me about the results of his biopsy I was completely frightened and felt like my worst nightmare was coming true. It all seemed so surreal. Thankfully his partner and our good friend, Dr. Jennifer Lucas, talked me down off the ledge and said all the right things."

She added, "A few days later when we saw Dr. Agbayani I was further reassured."

Eisenberg said some of his colleagues were surprised to learn he was having his surgery done at Marin General instead of the University of California at San Francisco.

"My response was, 'If Marin General is good enough for my patients, it is good enough for me,'" Eisenberg said.

After the surgery at Marin General, Eisenberg spent just one night in the hospital, and he returned to work three weeks later.

Eisenberg said another lesson he gleaned from the ordeal was that acts of compassion by friends and family — a neighbor cooking a meal or a friend sending a card — can serve as an elixir when one is ill.

"It really is therapeutic," Eisenberg said. "I always understood that from an intellectual point of view, but now I understand it from a heart-felt point of view."

Marin Independent Journal

San Anselmo doctor has helped Marin breast cancer sufferers for 26 years

Marin Independent Journal

Megan Hansen from the Marin Independent Journal has written an article about Marin Cancer Care's very own physician, Dr. Bobbie Head who has seen it all — witnessing the evolution of new medical treatments and watching patients handle their fears. "My goal in going into oncology was to relieve pain and make sure people can die a peaceful, dignified death. That has changed as fewer people I take care of are dying," Head said. "I enjoy reassuring people we can treat them." 

Head attended medical school at the University of Southern California, obtained her Ph.D. in experimental pathology at the University of California at San Francisco and after her fellowship in San Francisco settled in Marin. During her fellowship, her first husband died from cancer. That has had a tremendous impact on how she interacts with patients.

"It changed what kind of doctor I became," she said. "I became more empathetic and understanding of what they're going through."

Read the full article here.

Management Lessons From the MAYO Clinic

Mayo Clinic Model of Care 

Patient Care

  • Collegial, cooperative, staff teamwork with multispecialty integration.
  • A team of specialists is available and appropriately used.
  • An unhurried exam and time to listen to the patient.
  • A physician takes personal responsibility for directing patient care over time in a partnership with the local physician
  • Highest quality patient care provided with compassion and trust.
  • Respect for the patient, family and the patient’s local physician.
  • Comprehensive evaluation with timely, efficient assessment and treatment.
  • Availability of the most advanced, innovative diagnostic and therapeutic technologies and techniques.

The Mayo Environment

  • Highest quality staff, mentored in the culture of Mayo and valued for their contributions.
  • Valued professional allied health staff with a strong work ethic, special expertise, and devotion to Mayo.
  • A scholarly environment of research and education.
  • Physician leadership
  • Integrated medical record with common support services for all outpatients and inpatients.
  • Professional compensation that allows a focus on quality not quantity.
  • Unique professional dress, decorum and facilities.

The clinic has patient‐centric aspects in their scheduling system. Most importantly, it provides the physicians an opportunity to spend as much time as needed with each patient, a critical Mayo commitment.

The architectural intent has been to create a sense of substance that justifies patient confidence. “Patients immediately need to feel that they made a good choice in coming to Mayo Clinic.”

Further encouraging collaboration is an all‐salary compensation system with no incentive payments based on the number of patients seen or procedures performed. A Mayo physician has no economic reason to hold onto patients rather than referring them to colleagues. Nor does taking time to assist a
colleague result in lost personal income.

Dr. Trasek, CEO of Mayo, AZ, continually reinforces the principle of “teach don’t blame.” When something goes wrong, when a mistake occurs, it should be viewed as a teachable moment, an opportunity to get better.

Mayo Clinic and its patients benefit from a high level of volunteerism from the staff. Extra effort for the patients and the team is embedded in the essence of the culture. Most Mayo employees volunteer hard. “Mutual respect is important here,” asserts Bridget Jablonski, a nurse team leader for oncology. “ There is an expectation that you treat everyone with respect whether it’s your patient or colleague, physicians, housekeepers., everyone. You incorporate them as a member of the team. None of us could do our job without the contributions of others.”

Mayo Clinic’s two primary values‐“the needs of the patient come first” and “medicine should be practiced as a cooperative science” reign over all others.

After hearing comments about the unexpected efficiency of Mayo in patient focus groups, their marketing efforts added a question about efficiency in their patient satisfaction surveys. The results show that systems and processes that efficiently control the flow of the patient experience are as
important as the care provided to patients’ overall satisfaction.

Nothing is more important than finding the right individuals to lead, whether physicians or administrators. It is not enough to rely on the gifts of emerging leaders. “ The nurturing of physician leaders is extremely important.”

None of the Mayo four facilities has the traditional “hospital administration “ found in most hospitals. Rather, Mayo hospitals operate largely through a physician‐led hospital practice committee on each campus. The key members are the physician chair, the nursing chair and a designated hospital administrator. They serve as a triumvirate for day to day decisions within the hospital.

The Mayo management model uses many thousands of hours of the precious resource physician time. They have up to 80 committees to deal with issues across campuses. Much of the administrative work is accomplished through committees and task forces.

Mayo Clinic’s salary system is deeply rooted in the culture and the values that created this unique organization. The Mayo brothers were committed to paying all employees fairly and generously though not lavishly. Dr. William Mayo believed that the salaried physician was a crucial element in their practice model. It doesn’t matter whom they see, how long they spend, what they see, they just have do the best they can for the patient here.

Newly employed doctors earn a salary that will, with annual increases, max out in five years. Physicians earn more vacation time and academic rank but top off in income quickly. Financial incentives have not been necessary to motivate physicians who embrace the values and mission.

They evaluated their compensation system and concluded that a productivity‐based compensation system would not necessarily increase productivity significantly among physicians and, more importantly, could irreparably damage their culture. To sustain high productivity, the major management objective is “to foster an environment of unity and trust.”

The shared management structure at Mayo works well. “ The physicians have as much at stake as administrators do to ensure that the institution profits financially. Administrators have as much at stake as the physicians do to ensure that patients are well cared for.

Mayo thrives because a benevolent employer fosters a generous, giving spirit in its workforce. Those who need to bask in the starlight of personal recognition or wealth thrive elsewhere.

Most management decisions at Mayo are made by groups, not by individuals. The CEO is the spokesperson for the decisions.

The Mayo has continually nurtured the next generation of leaders who believe in its values. The term limits associated with most leadership ensures the rotation throughout the organization.

High performing organizations do deliberate hiring. They take the time necessary to find just the right employee. “ Mayo is not an easy place to get hired.” They have so many steps, so many people involved in screening and interviewing, even at entry‐level jobs. The people who survive really want to work there.

Panel interviews are standard across the organization. A panel may ask, “ Tell me about a time you had to disagree with your boss to make a mistake from being made.”

Candidates may be asked to describe a past project. Whether candidates use the word “I” or the word “we” is of particular interest to the panel.

Mayo focuses on values over skills. Skills can be trained and values cannot.

Mayo invests significantly in in‐service training. Many are a single session with several hours of education; others might extend over a few days.

They invest in their employees. In most cases, Mayo helps the employees who are failing or under performing find a niche that better fits who they are and the capabilities they offer.

Patients do not encounter physicians in casual attire . Unless they are in surgical scrubs. Mayo physicians wear business attire at work. “ The wearing of business attire rather than white coats is recognized by our patients as a unique dress code that projects an aura of expertise and respect for patients accompanied by warmth and friendliness.”

Mayo nurses wear white because research shows that is what hospital patients prefer. They require solid colored scrubs as well. Each unit needs to come to a consensus for the color from a list of approved colors.

No marketing textbooks or marketing consultants guided the founding of the brand. Mayo had a one person marketing staff from 1986‐1992. To this day, it uses little media advertising to promote clinical care.

The two primary sources of external brand communications are word‐of‐mouth –often conveyed via the Internet‐ and publicity, including reports in the news media.

Mayo Clinic is a benevolent employer. Because, Mayo Clinic takes good care of its employees, the employees are more likely to take good care of those they serve.

Mayo Clinic leads all other U.S. providers when you look at objective measures of outcomes, safety, service, preventable death, mortality rates adjusted to account for preexisting medical problems and health status, and adverse event with harm to the patients. The catalyst to change is transparency‐ there is open sharing of performance measures of the clinical groups.

Money matters at Mayo. The difference between Mayo and other organizations is that money doesn’t drive the bus. Mission does, and this is a key reason the Clinic can attract good staff members who do such good work.

The physician perspective wins out when there is a tie vote on decisions. Administrators are partners, but they are not equal partners, and this is purposeful.

Mayo is intolerant of prima donnas regardless of whether they are administrators, nurses, doctors or anyone else. You may find a few here and there, but they rarely hire these kind of people, and if they do, they don’t last long.