Key Takeaways
- Reframe critical care milestones with positive language, such as designating surgery as "Cancer-Free Day," to transform patient anxiety into empowerment.
In the complex and often fragmented landscape of modern healthcare systems, the quality of care extends far beyond clinical outcomes alone. While technical proficiency and successful treatments remain paramount, the experience of the patient throughout their journey has emerged as a critical determinant of overall healthcare quality. Patients are no longer passive recipients of care; they are active participants seeking empathy, clear communication, empowerment, and support that addresses their holistic well-being – physical, emotional, and psychological. Recognizing and prioritizing this patient experience is not merely a matter of satisfaction scores; it is a fundamental component of effective, compassionate care, and sustainable healthcare delivery.
Leadership within healthcare organizations plays a pivotal role in shaping this experience. Compassionate leadership sets the tone, defines the culture, allocates resources, and champions the initiatives that place the patient firmly at the center of care. This requires more than just lip service; it demands deliberate strategies, innovative thinking, and a relentless commitment to viewing care through the patient's eyes. Transformational leadership in healthcare is essential for driving this patient-centered approach and fostering a culture of continuous improvement.
This article delves into the practical application of patient-centric leadership strategies, drawing insights from a compelling conversation on the Clinicians in Leadership podcast. The episode features Dr. Allison DiPasquale, a breast cancer surgeon, Medical Director of Breast Oncology, and a self-described "quarterback for the patients." Dr. DiPasquale shares her deeply personal journey into medicine and her comprehensive, empathetic approach to breast cancer care, offering tangible examples of how compassionate leadership can profoundly enhance the patient experience and, consequently, healthcare quality. Through concepts like "Cancer-Free Day" and the transformative philosophy of "Livingship," Dr. DiPasquale illuminates a path forward where clinical excellence and profound human connection converge, ultimately leading to better outcomes and a higher quality of life for those navigating the challenges of illness. We will explore her strategies for fostering patient empowerment, integrating technology thoughtfully, ensuring honest communication, driving quality improvement, and cultivating a supportive team culture dedicated to patient well-being and safety.
Understanding the leadership strategies that drive exceptional patient experience often begins with understanding the leader's own journey and motivations. Dr. Allison DiPasquale's path to becoming a breast surgical oncologist and a leader in her field is a testament to early conviction, personal connection, and a persistent drive to improve the status quo. Her journey exemplifies the traits of good leaders in healthcare, particularly the ability to empathize with patients and drive positive change.
Hailing from a tiny town in Wisconsin with a graduating class of just 34, Dr. DiPasquale describes herself as an "early decision maker." Unlike many who find their calling later in life, her aspiration to become a doctor crystallized at the tender age of three, inspired by the children's television show "Slim Good Body," which explored the wonders of the human body. This early fascination, coupled with a later interest in sewing, solidified her desire to become a surgeon – a way to use her hands to heal. Coming from a family with no prior medical professionals, this ambition was perhaps unconventional for her background, yet it was unwavering.
As she progressed through medical school and surgical residency, personal experiences began to sharpen her focus. Witnessing the impact of various cancers – breast, brain, pancreatic – within her own family provided a firsthand perspective on the patient and family experience. She observed the care being delivered and began asking critical questions: "How can we do this better?" This intrinsic motivation to improve patient care would become a cornerstone of her leadership philosophy.
A pivotal moment occurred during her surgical training. While rotations involving procedures like gallbladder removals and hernia repairs often felt transactional ("I'd never see him again"), her experience in the breast clinic offered a stark contrast. She observed her mentor fostering deep, long-term relationships with patients, marked by genuine care and connection – knowing their families, remembering details like where their children went to college, and offering hugs. These patients weren't just cases; they were family. This relational aspect of breast surgery resonated deeply with Dr. DiPasquale's innate desire to connect with and support patients through challenging times. Coupled with her family history, the decision to specialize in breast surgery became clear.
However, her commitment extended beyond the clinical relationship. Driven by the question "Why are we doing it this way? How can we do it better?", she actively sought ways to improve the technological and procedural aspects of care. She challenged the prevailing notion that women diagnosed with cancer simply wanted the disease removed at any cost, disregarding aesthetics or long-term quality of life. Recognizing advancements in medicine, technology, and surgical techniques, Dr. DiPasquale championed a more holistic approach – one that aims not only to eradicate the cancer but also to help women "look beautiful, feel beautiful," and ultimately, transition from merely surviving to truly living after cancer.
This background – rooted in early passion, shaped by personal experience, inspired by relational care, and fueled by a desire for continuous improvement – forms the foundation of Dr. DiPasquale's compassionate leadership philosophy. It underscores her role as the "quarterback," coordinating multidisciplinary care, advocating for bespoke treatments tailored to individual cancers, and relentlessly pushing for innovations that enhance both clinical outcomes and the patient's overall journey and quality of life. Her approach embodies the principles of servant leadership, where the focus is on empowering and supporting both patients and team members to achieve the best possible outcomes.
The language used in healthcare carries immense weight, shaping perceptions, expectations, and emotional responses. For patients facing a cancer diagnosis, words like "surgery" can evoke fear, anxiety, and a sense of vulnerability. Dr. Allison DiPasquale consciously reframes this critical juncture by referring to surgery day as "Cancer-Free Day." This simple yet profound linguistic shift transforms the narrative from one of loss or fear to one of empowerment, closure, and new beginnings. It's a prime example of how compassionate leadership can reshape the patient experience through thoughtful communication.
As Dr. DiPasquale points out, the definition of being "cancer-free" can vary depending on perspective. A surgeon might pinpoint the day the tumor is removed. A radiation oncologist might mark the end of radiation therapy. A medical oncologist might consider it the completion of years of endocrine therapy. While acknowledging these different milestones, Dr. DiPasquale, from her surgical standpoint, emphasizes the significance of the moment the physical cancer is removed.
Calling surgery day "Cancer-Free Day" serves multiple purposes:
This intentional use of language is a powerful compassionate leadership strategy. It demonstrates a deep understanding of the patient's emotional landscape and actively seeks to reshape the experience in a more positive, hopeful, and empowering direction. It sets the stage for the next phase of the journey, moving beyond the immediate crisis of diagnosis and treatment towards a future focused on healing and thriving – the essence of "Livingship."
For decades, the dominant narrative following successful cancer treatment has been "survivorship." While celebrating survival is crucial, Dr. DiPasquale argues that the term itself can imply a state of merely getting by, of enduring the aftermath rather than fully reclaiming life. She introduces a powerful alternative concept: "Livingship." This philosophy aligns closely with the principles of transformational leadership, aiming to fundamentally change how patients and healthcare providers approach life after cancer.
"Survivorship. That sounds miserable," Dr. DiPasquale states plainly. "You shouldn't be surviving. You beat something. You're empowered. You did this, you know? And so, and I always say you should be living, period, cancer free. Not just surviving."
Livingship, one of Dr. DiPasquale's "deepest quality-isms," represents a fundamental shift in perspective. It's not just about being alive after cancer; it's about living well. It encompasses:
This philosophy has profound implications for how clinicians and healthcare leaders approach long-term patient care. It moves beyond routine follow-up scans and check-ups to encompass a more comprehensive assessment of the patient's quality of life. It demands a proactive stance on managing side effects and a willingness to address the often-unspoken emotional and psychological challenges that can linger long after treatment ends.
Championing livingship requires leaders to foster a culture where the patient's long-term well-being is a central measure of success. It means supporting clinicians in having deeper conversations, investing in resources to manage side effects, and celebrating not just cancer-free milestones, but also the milestones of patients fully re-engaging with and enjoying their lives. Livingship transforms the goal of cancer care from mere survival to the restoration and enhancement of a fulfilling life. This approach embodies the essence of compassionate care and servant leadership, prioritizing the holistic needs of patients beyond their immediate medical treatment.
Translating the philosophy of "Livingship" into tangible improvements in patient care requires specific, actionable strategies. Dr. DiPasquale highlights several key pillars that underpin this approach, demonstrating how clinicians and leaders can actively foster an environment where patients don't just survive, but truly thrive after cancer treatment. These strategies exemplify compassionate leadership in action, prioritizing patient safety and well-being at every step.
1. Radical Honesty and Proactive Communication about Side Effects:
A cornerstone of building trust and enabling livingship is upfront, honest communication about the potential side effects of treatment. Too often, discussions about long-term complications like lymphedema, chronic pain, changes in sensation, or impacts on sexuality are minimized or avoided, leaving patients unprepared and feeling isolated if these issues arise later.
Dr. DiPasquale emphasizes the need to discuss these possibilities before treatment begins. "I think the first thing that clinicians need to do is be honest with the side effects," she states. "Upfront honesty... needs to be discussed up front so patients have full understanding of what they could be. And then how we're going to mitigate that. Hey, this could happen, but these are the ways that we're going to fix it."
Her focus on lymphedema serves as a powerful case study. Lymphedema, the swelling that can occur in an arm or hand after lymph node removal or radiation, can be debilitating and significantly impact quality of life. Dr. DiPasquale calls it the "dirty secret" that "no one wants to talk about," often leading to buck-passing between different specialists when it occurs. Her approach is different:
This honesty builds trust and empowers patients. They know what to watch for, understand the preventive measures being taken, and feel assured that potential complications are being actively addressed, not ignored. This approach aligns with the principles of transformational leadership, fostering transparency and patient engagement in their own care.
2. Proactive Care, Early Intervention, and Patient Advocacy:
Livingship requires moving beyond reactive care to a proactive model, particularly concerning long-term side effects. Dr. DiPasquale's implementation of a comprehensive lymphedema screening program exemplifies this. Utilizing technology (initially a machine not covered by insurance and not yet in standard guidelines), her team screens patients systematically to detect subtle, subclinical signs of lymphedema before it becomes symptomatic and harder to manage.
This commitment involved significant leadership and advocacy. "I don't care if insurance doesn't cover it," she recalls saying. "It doesn't matter to me. I will take the hit because this is what's right for patients." This willingness to champion a patient-centric intervention, even when facing financial and systemic hurdles, highlights a crucial quality of compassionate leadership. Eventually, her persistence, coupled with growing evidence, contributed to the technology becoming recognized in NCCN (National Comprehensive Cancer Network) guidelines.
This proactive approach isn't limited to lymphedema. It applies to monitoring for other potential long-term effects of treatment, ensuring patients have access to physical therapy, counseling, support groups, or other resources needed to manage challenges and optimize their quality of life. It requires leaders to support clinicians in dedicating time to this comprehensive follow-up and to invest in the necessary tools and programs. This strategy embodies the principles of servant leadership, where the focus is on empowering and supporting patients to achieve the best possible outcomes.
3. Addressing the Whole Patient: Integrating Emotional and Psychological Support:
Livingship recognizes that a patient's well-being is not solely defined by the absence of disease or physical symptoms. The emotional and psychological impact of a cancer diagnosis and treatment can be profound and long-lasting. Addressing these aspects is crucial for true thriving and is a key component of compassionate care.
Dr. DiPasquale advocates for a simple yet powerful tool: asking direct questions and creating a safe space for honest answers. "From a leadership standpoint, I say sit down, take time for those patients, and just say, are you doing okay? And tell them it's okay to not be okay."
This approach requires clinicians to move beyond the purely technical aspects of care. It involves inquiring about:
By initiating these conversations, clinicians signal that these concerns are valid and important. Asking "Are you doing okay?" opens the door for patients to share vulnerabilities they might otherwise keep hidden ("You know what, this is happening, and I'm not enjoying this with my husband, or I feel self conscious about this..."). This dialogue allows clinicians to connect patients with appropriate resources, whether it's counseling, support groups, specialized therapies, or simply providing validation and reassurance.
Building this trust ensures that patients feel comfortable raising concerns not just immediately after treatment, but months or even years down the line. It transforms the clinician-patient relationship into a true partnership focused on long-term, holistic well-being. Leaders support this by emphasizing the importance of empathetic communication, allowing clinicians adequate time for these conversations, and ensuring referral pathways for psychosocial support are readily available.
These pillars – honest communication, proactive intervention, and holistic support – are the practical foundations upon which the philosophy of Livingship is built, driving tangible improvements in the patient experience and overall quality of care. They exemplify how compassionate leadership and a focus on patient safety can transform healthcare delivery.
Advancements in medical technology and research hold immense promise for improving cancer care, from diagnostics and treatment to monitoring and supportive care. However, integrating these innovations effectively requires careful leadership to bridge the gap between cutting-edge potential and practical, patient-centered application. Dr. DiPasquale outlines a pragmatic and principled approach to evaluating and adopting new technologies, demonstrating how compassionate leadership can drive innovation while maintaining a focus on patient benefit.
The process isn't about chasing the newest gadget; it's about solving real problems and demonstrably improving patient outcomes or experience. Her framework involves several key steps:
This methodical approach ensures that innovation serves the patient, rather than becoming an end in itself. It balances enthusiasm for progress with rigorous evaluation and a commitment to responsible resource allocation. Leaders play a critical role in fostering an environment where clinicians feel empowered to explore new solutions, while also maintaining the discipline to assess them critically based on their potential to genuinely improve patient care and advance the goal of "Livingship." It's about ensuring that technology enhances, rather than detracts from, the human elements of care – communication, empathy, and trust.
This strategy exemplifies how transformational leadership in healthcare can drive meaningful innovation while maintaining a steadfast focus on patient benefit and safety. It demonstrates the importance of integrative thinking, where leaders must balance multiple considerations – clinical efficacy, patient experience, resource allocation, and long-term impact – to make decisions that truly advance the quality of care.
Achieving consistent, high-quality patient experiences hinges not just on individual clinician efforts but on the collective culture of the entire care team. Leaders are instrumental in cultivating an environment where prioritizing the patient is the unwavering norm. Dr. DiPasquale provides clear insights into how she fosters this culture within her own practice, offering strategies applicable across various healthcare settings. Her approach embodies the principles of servant leadership and compassionate care, creating a workplace where both patients and staff can thrive.
1. Hiring for Values:
The foundation of a patient-first culture starts with recruitment. Dr. DiPasquale is explicit about the type of person she seeks for her team: "I only keep good company. I always say only kind people here in my office." Technical skills are necessary, but empathy, compassion, and a genuine commitment to patient well-being are non-negotiable prerequisites. She looks for individuals who understand that their role extends beyond tasks and paychecks. "If you're just here for a paycheck or whatnot, that's not... what I need," she asserts. Her team includes individuals affectionately nicknamed "Care Bear" for their caring nature and a "workhorse" known for getting things done – indicating a blend of compassion and competence.
2. Setting Clear Expectations: "Patients First"
Effective leadership involves clearly articulating the team's core values and mission. In Dr. DiPasquale's office, the motto is unambiguous: "Patients first." This simple phrase serves as a constant reminder of the team's primary focus. She reinforces this by stating, "I love you all. You're all my family. All my staff is my family. Um, but the patients always come first." This clarity ensures that when faced with competing priorities or difficult decisions, the patient's needs remain the guiding principle. This approach aligns closely with the concept of servant leadership, where the focus is on serving and supporting others – in this case, both patients and team members.
3. Empowering Staff and Fostering Ownership:
A truly patient-centric culture empowers staff members to act as advocates for the patient. Dr. DiPasquale achieves this by framing their roles effectively: "They don't work for me. They work for the patients." This shifts the dynamic from a traditional hierarchical structure to one where every team member feels a direct responsibility to the individuals they serve. This sense of ownership encourages initiative, problem-solving, and a deeper investment in the quality of care provided. It's a key aspect of transformational leadership, where leaders inspire and motivate team members to exceed expectations and take ownership of their work.
4. Open Communication and Continuous Improvement:
Creating channels for open dialogue and feedback is crucial for maintaining high standards and adapting to patient needs. Dr. DiPasquale implements a structured process for this: "We also have a meeting every Friday afternoons after all the patients leave, um, where we just talk. What could we have done better? Uh, what could we have done? What did we do right?" This dedicated time allows the team to reflect on their performance, identify areas for improvement, and celebrate successes. Importantly, she explicitly gives her staff "the room and the space to come to complain to me, their boss, about things that could be better." This willingness to receive constructive criticism fosters psychological safety and ensures that potential issues are surfaced and addressed proactively. It's an example of how listening to criticism in leadership can drive continuous improvement and enhance patient safety.
5. Building Team Cohesion and Morale:
Recognizing the demanding nature of healthcare, particularly in oncology, maintaining team morale is essential. While the work is serious, Dr. DiPasquale injects elements of fun and appreciation, such as the occasional "Champagne Fridays" (with non-alcoholic options available) after the patients have left. This simple ritual helps build camaraderie, acknowledge the team's hard work, and create a positive environment where staff feel valued and supported. A supported and cohesive team is better equipped to provide compassionate and effective patient care. This approach addresses potential job dissatisfaction indicators and contributes to employee engagement, which is crucial for maintaining a high-quality, patient-centered care environment.
These strategies demonstrate that building a patient-first culture requires intentional leadership. It involves careful hiring, clear communication of values, staff empowerment, fostering open feedback loops, and attending to team morale. When these elements are in place, the entire team works in concert to prioritize the patient experience, translating philosophies like "Livingship" into the everyday reality of care delivery. This culture not only benefits patients but also contributes to staff well-being and job satisfaction, creating a virtuous cycle of compassionate care and continuous improvement.
The strategies and philosophies shared by Dr. Allison DiPasquale, while rooted in her experience as a breast cancer surgeon, offer valuable lessons for healthcare leaders across all specialties and organizational levels. The principles underlying "Cancer-Free Day," "Livingship," proactive communication, thoughtful innovation, and patient-first team culture are universally applicable to the goal of improving healthcare quality through enhanced patient experience. These approaches exemplify compassionate leadership and transformational leadership in healthcare, with broad implications for how we can reshape healthcare delivery to be more patient-centered and effective.
Key Takeaways for Healthcare Leaders:
Implementing these strategies requires courageous leadership – a willingness to challenge conventional practices, advocate for patient needs even when facing resistance, invest in long-term value over short-term gains, and consistently model patient-centric values. It calls for leaders to embody the principles of servant leadership, putting the needs of patients and staff at the forefront of decision-making.
The journey through illness, particularly one as daunting as cancer, is profoundly shaped by the quality of the healthcare experience. Dr. Allison DiPasquale's insights powerfully illustrate that compassionate leadership is the critical catalyst in transforming that experience from one potentially marked by fear, fragmentation, and mere survival into one characterized by empowerment, compassion, holistic support, and the genuine possibility of thriving.
Concepts like "Cancer-Free Day" demonstrate the power of reframing narratives to instill hope and agency. The philosophy of "Livingship" challenges the healthcare system to look beyond clinical cure towards the restoration and enhancement of quality of life, demanding proactive management of long-term effects and attention to the whole person. Strategies rooted in radical honesty, thoughtful innovation, and the cultivation of a dedicated, patient-first team culture provide a practical roadmap for achieving these aims. These approaches embody the principles of servant leadership and transformational leadership in healthcare, focusing on empowering both patients and staff to achieve the best possible outcomes.
Prioritizing the patient experience is not a "soft" aspect of healthcare; it is intrinsically linked to quality, safety, and outcomes. Patients who feel heard, respected, and supported are more likely to adhere to treatment plans, engage actively in their care, and report better health outcomes. Leaders who champion patient-centricity are therefore not just improving satisfaction scores; they are driving fundamental improvements in the efficacy and humanity of healthcare itself.
Dr. DiPasquale's journey and approach serve as an inspiring reminder that clinicians in leadership positions have a unique opportunity and responsibility to advocate for change from within. By asking "How can we do this better?", by listening intently to patients ("Are you doing okay?"), by championing necessary innovations, and by nurturing teams dedicated to compassionate care, leaders can steer healthcare towards a future where clinical excellence and profound human connection are not just compatible, but inseparable elements of quality. The ultimate goal, as exemplified by the pursuit of "Livingship," is to ensure that healthcare not only saves lives but empowers individuals to live those lives to the fullest.
In embracing these principles of compassionate leadership, healthcare organizations can create environments where both patients and staff thrive. This approach addresses the challenges of the healthcare workforce crisis by fostering a supportive, mission-driven culture that enhances job satisfaction and reduces burnout. It also responds to the growing recognition of the importance of emotional resilience in both patients and healthcare providers.
As we look to the future of healthcare, the lessons from Dr. DiPasquale's approach offer a compelling vision for how leadership can transform the patient experience. By prioritizing empathy, proactive care, honest communication, and continuous improvement, healthcare leaders can create systems that not only treat disease but nurture human flourishing. This is the essence of compassionate leadership in healthcare – a commitment to seeing and serving the whole person, fostering healing in its broadest sense, and ultimately, elevating the human experience of both giving and receiving care.
<p>from a leadership standpoint I say sit down take time for those patients and just say are you doing okay and tell them it's okay to not be [Music] okay hello this is Zach with the American Journal of healthcare strategy and you are listening to the clinicians in leadership podcast where we focus on empowering Ians from bedside to boardroom today I am joined by Dr Allison de pasquali Dr de pasquali why don't you take a second to introduce yourself tell us a little bit about your experience and your current role and and how you got to where you are today well thank you so much Zach for having me first off um I'm Dr Allison D pasquali and I am a breast cancer surgeon also known as a breast surgical oncologist um but I like to call myself the quarterback for the patients because um my role is in leaders ship in the hospital I run uh out of Dallas Texas and I run our multi-disciplinary tumor board as well as I am medical director breast enology so in a lot of different hats as well as being the surgeon um my goal with a patient is to give them the best technology to give them the best care to give them bepoke Health Care based off of every their specific type of cancer not everyone's cancer is the same and I run a lot of technology or help a lot of technology companies just move that needle forward of how we can do our healthare better for women and so I'm super excited to talk to you today about life after cancer and where we're going with things because there's a lot out there yeah well and Dr dequal we're we're grateful for for you wanting to come on the show and and to just share some of those experience and and insights as well and I'm I'm I'm excited to dive into the different hats that you wear um and uh and the way that that you quarterback uh those hats well and and so but but before we get into that I I know that you have a a bit of history with with breast cancer and your family and and that helped shape not just who you are today but but decisions and and approaches to your career that that you've made um can you tell us a little bit about those early experiences and how that influenced your approach to Patient Care as well as leadership yeah sure no so I I mean I've always called myself an early decision maker so um there's no doctors in my family I come from a very tiny town in Wisconsin um 34 people in my graduating class so very small um and at the age of three I used to watch a show about the human body which is called slim good body it was on after Sesame Street and I watched the show and was like oh my gosh this is amazing like it showed to blow apart how the blood moves and I was like sign me up I'm GNA be a doctor and I remember my family being like Okay you're from this Tiny Town and really that doesn't you know but I knew I just knew it was born in me and then I knew I wanted to be a surgeon um when I got into sewing and so inside me with to help patients and how can I do that and using my hands I knew from an early age was what I needed so when I got more um focused into my career in medical school um there has been lots of cancer in my family um including close relatives with breast cancer brain cancer pancreatic cancer and I started saying wow this is the care that's happening how can we do this better um so as an early decider and intern um in surgery residency I remember just doing gallbladders and hernas and these patients would come in I'd never see them again and then I went to the breast clinic and the my mentor gave every patient a hug she knew where all of where the children went to college you know she F them yearly for their mammograms they were her family and so early decider going into breast surgery and also my family had been uh pretty affected by that so for me it was not only doing this have a patient connection but how can I keep working to make technology better so again intern in residency decided and then went on for my fellowship and um really asked the question why why are we doing it this way how can we do it better which then let me to you know open up with different technology companies and help with leadership roles of really we need to rethink women's healthare um why women just show up and say I've got cancer take it out I don't care about anything else I don't care what I look like I don't care what I anything else happen happens I have a family and I need to go home to them so get rid of it but now we know it's not that urgent it is urgent but we have technology we have medicines we have new surgery techniques to make you look beautiful feel beautiful and not only give you life but give you life after cancer I'm excited to dive more into that that life after cancer and how how improvements in technology and and and just approaches to by your clinicians and your leaders can can have a bigger influence in in the quality of life that that a patient experiences after after that cancer and and surgery to remove that cancer and the treatments and I I think that's such a big thing but but regardless can cancer is a very prevalent uh disease within uh the world today and and it's a very scary thing that's a scary word um and and that I think hearing you talk about the the opportunity with with working as a part of the breast cancer team to to have a relationship with those patients and to follow up with those patients that the comfort that that must provide to your patients is is is phenomenal and and the ways that you can then influence and and have an impact on their life post cancer has is has got to be critical and so I'm I'm curious though we so we'll get into that a little bit later on but but one of the things that I I've Loved I've I heard you describe surgery day as cancer-free day and I and I think that is that is such just an incredible way to describe it it's this you're it's this moment the surgical day of of closure of of new beginnings with with patients and and for those patients and so how does describing surgery day is as cancer-free Day affect the care that you provide the care environment that you create and and the emotional experience that that those patients experience well I think it's you know it's important because patients say well when's when am I actually cancer free and if you ask a surgeon it's the surgery day right if you ask a radiation oncologist is when they finish radiation and if you ask a medical oncologist is when they finished their you know 10 or five years of txin or whatever they're on right but truthfully the removal of the cancer happens during surgery I'm not just biased it's what that's what we're doing and whether it's residual cells because they've had such great treatment from my partners and that's why we're multi-disciplinary that's great or whether it's a tumor but I do think that patients need to know that there is a light at the end of the tunnel and that when they show up on their surgery date I give them all a big hug and I say welcome to your cancer-free day um and then we add in bonus lifted ladies day if we're doing a little lift flat tummy day we add all this little silver linings that um would have never been included and covered under their insurance into their cancer-free day and so we make it more of a empowering moment for women because surgery of your Womanhood when you're sleeping is scary yeah and we are now taking that scare and saying this is empowering this is you taking care of yourself and this is you Crossing that Finish Line like let's do it and so it's just kind of an emotional moment and I my patients just I have a connection with them on that well I I love shifting shifting that Dynamic from from cancer which is inevitably feels out of our control and and and and is scary to to getting to that surgical day and and being and feeling empowered has got to be just such an incredible shift in in emotions and and experience for those patients and um I so then that you know surgery is complete cancer-free day and an incredible experience there um however I want to talk a little bit about this this concept that you've introduced called living ship and and uh just how that how you are intentional and focusing on how you can help your patients Thrive not just survive after breast cancer treatment and so but before we get into a little bit of living ship uh and and just talking through that and how that affects your approach to care but also leadership and decisions that are made um can you just walk us through what living ship is uh because that I don't think that's a word that maybe a ton of us are familiar with well it's one of my quote deep squal ISM I have a lot of I have a lot of words that just kind of flow out because I think they make sense and I think that they're relatable and it makes sense to a patient because I think that when you're cancer free right you do your surgery you do your medication you do everything you're supposed to do um and then you're just surviving survivorship that sounds miserable you shouldn't be surviving you beat something you're empowered you did this you know and so and I always say you should be living period cancer-free not just surviving so instead of calling thrivers or whatnot we just call it living ship you just in this living ship period where maybe you find a new heightened version of yourself throughout this process this is not a Sprint this is a marathon breast cancer Journey it is find different changes um in patients lives who's in their life who's not in their life anymore but it's this journey and this celebration at the end of how they're living and their new sense of self should be celebrated so that's the big Focus for me is how do we minimize all the other potential side effects or problems from the surgery from the radiation from you know chemotherapy if they needed it or endocrine therapy and make them living cancer-free not just surviving well I I I can't imagine that what the the effects of that that has on one just that that clinician patient relationship showing that you care beyond what simply just what what your job is is is to treat the cancer you're showing you care beyond that and you want to help them not just survive but Thrive and so um going off of that this this concept of living ship it it it seems powerful so so how does this this concept or this this philosophy is a better word I think change the way that clinicians s should approach long-term care for for their patients um and then uh kind of a secondary question that how can leaders of these multi-disciplinary teams and and leaders of healthcare organizations champion this philosophy because it really is going an extra mile to to provide that extra empowerment and that extra uh step to to make sure that your patients have that quality of life that that they deserve um and so how can first I guess first question how can how can clinicians uh how does this change their approach to long-term care and and then secondly how can your the leaders of those clinics and disciplinary teams champion this philosophy amongst their teams well I think the first thing that clinicians need to do is be honest with the side effects I think upfront honesty of potential side effects of the medicines the surgery the radiation whatever we do needs to be discussed up front so patients have full understanding of what they could be and then how we're going to mitigate that hey this could happen but these are the ways that we're going to fix it so for me it's all about honesty I think that one of the things that's not touched on a lot is lymphadema we say oh as surgeons we operate you're cancer free you do your radiation we follow your mammograms and we love you and we take care of you but if anything would happen to that arm you know oops that's just part of surgery but being upfront to my patient saying these are the side effects these are the RIS of what I'm doing but this is the technology I'm going to use to prevent it or find it early when it's treatable and curable and so that's really where I got into this big lymphadema program so you know working with the leadership here um really being a champion of that and saying I don't care if insurance doesn't cover it in the beginning they didn't cover at all this machine that I've been using for years and I said I it doesn't matter to me I will take the hit because this is what's right for patients now fast forward five years it's now in the nccn guidelines which is the governing cancer um Consortium over what we should be doing to follow patients so lymphadema is a problem it can happen from chemotherapy taxan based radiation and definitely surgery even one lymph node being removed people are like oh I've only had one lymph node removed I'm fine but that's not true because if that incision is really big incision you've dissected through a lot of lymphatics to get that one lymph node versus taking out 10 so for me really championing and keeping on a screening lymphadema program um to prevent it because lymphadema is something again it's like the dirty secret no one wants to talk about it and when it happens everyone wants to pass the buck oh it was from here it was from the radiation oh it was from this no one takes ownership so for me it's about upfront you know discussion with patient taking ownership of what we do to patients how we mitigate it and finding it early to treat and cure it so they don't have symptoms moving forward and they really can live not survive well and I I love and I think you provided a very tangible example on just the importance of clinicians advocating for their patients when when you talk about you know you know 5 years ago implementing this this treatment and using this machine not covered by Insurance not necessarily within guidelines but but you knew it was better for the patients and that it would improve the patients quality of life and improve outcomes to to fast forward now it is part of the guidelines and it is covered by insurance and and just that that doesn't happen without you advocating and insisting on it and and as well as there's there's you know countless that that's how Innovation happens and that's how guidelines are and and insurance are changed for the better is by having your clinicians who have the patient centered perspective and and and understand the patients and and know what's best for the patients a part of that decision-making process and and a part of that Innovation process and so I'm I'm excited to to talk a little bit more um about that just just a little bit later but before we get into that there's one one more thing I just want to talk about just this in this concept of living ship but it's it's the it's the The Balancing Act of of the technical aspects of treatment with with the emotional and psycholog psych psychological needs that that patients have so the the the technical side which is the actual treatment as well as the going beyond that and providing that emotional and psychological needs that those PTI those patients have and to encourage thriving so so how can can clinicians better balance the technical treatment side which is needed but also incorporate that concept of living ship that philosophy that I love you talked about to to help their patients Thrive by also addressing their emotional and psychological needs I think ask just sit down listen ask your patients the questions they're not gonna tell you if you don't ask yeah and so I mean obviously ladema is something we could see or measure but like with the side effects of potentially a myectomy what does that mean in terms of maybe their culture or their sexuality or all of the different side effects that can occur Downstream from the endocrine therapy um they're not going to just upfront tell you you have to ask and so from a clinician standpoint from a leadership standpoint I say sit down take time for those patients and just say are you doing okay and tell them it's okay to not be okay so that allows and it opens that moment to say you know what this is happening and I'm not enjoying this with my husband or I feel self-conscious about this or it just allows that moment for them to get it out and that allows them to for you as a clinician to now help guide them down different Technologies or different areas that potentially can help them well and I would imagine also that that opens up that dialogue and and builds trust within that relationship so so that you know down the line if if there's a different side effect that is that is hindering them or or there's there's something else that comes up up they they know they can come to you and talk to you about it because you've already established that you care about them and and that it is a safe spot for you and that that it is okay for them not to be okay and I I think that that just that's critical and I I love how that is that is something that that anybody can do is just to ask the question ask the patients you're not implementing a brand new initiative or implementing a new program it's simply just sitting down and having a conversation human to Human and and I think that's phenomenal and just the impact that that makes uh is phenomenal so moving on a little bit uh I I want to talk about advances in in research and and Technology uh and and how the just I mean we're we're artificial intelligence there's there's a there's a wealth of techn technological advances that that are uh you know being championed as as the next big thing and and the thing that's going to improve lives improve staff experience and and and change patient care how how do your the the clinician leaders how how can those clinician leaders bridge the gap between research advancements and and then the practical application of everyday patient care because because often what's what's newest is maybe not the most practical for what we need it and and what is helpful now so how can leaders balance and bridge that gap between recognizing which Technologies to introduce um and and research advances to pursue as as well as just what works how do how do you figure that out well I think you know for me especially dealing with a hospital leadership position it's all you know we have to be cognizant of our funding right in our funds and using healthc care funds and but for the right purposes it it can be we can figure it out and was call Roi return on investment right so you're we're going to vet the technology there's going to be first off we have to apply an issue what is the pro big problem that's happening in women's space so what is that problem number one number two what are the technologies that could fix those problems then vet those companies and see what is the actual you know preliminary data what do we have going on here um and then typically for me I don't just jump into something new and say okay I'll try you all but I do do Trials of them um just to see what what's going on do my own research studies um and then I also just do quality studies for patients because if I'm G to do something that's helping them I need to show that there is actually a quality improvement so quality improvement studies are super important as well um for leadership as well to adopt new technologies so I think you have to have a problem you have to have Technologies you have to vet them and I think you've got to prove their worth through your own clinical trials and quality improvement Dr de pasquali I grateful for your time today to and and and just your your insights and your your experience and getting to share this and and particularly the the grateful for the way that you've championed living ship and and helping your patients Thrive and and Sur not just survive but but to thrive um and just encouraging to me to hear the the passion and and the Heart uh behind that that philosophy and the way that that's being implemented so but before I go um before I let you go there just one one final question um so we we've talked about living we' we've talked about Bridging the Gap between techn techn technology and what's you know practical and what can be applied um we've talked about helping patients Thrive not just survive so so in all of these things what what are some strategies that you use to inspire and Empower your team to to prioritize the patient and prioritize innovations that prioritize the patient and and how do you promote that that buying because change is inevitably hard always and especially when you're dealing in a in the the field of cancer and breast cancer uh it's especially scary because there's a lot of change that's happening so so how do you how do you promote and and encourage that the patient to remain at the center of all that you do well I think I only keep good company I always say only kind people here in my office um the the motto to my office is patience first I love you all you're all my my family all my staff is my family um but the patients always come first so that is one of the prerequisites and again if you're just here for a paycheck or whatnot that's not that's not what I need I need somebody you know I've got my the best staff ever right now I've got my Care Bear we call her Care Bear because she cares so much I have my Workhorse my right hand who's G to get it done I've got my nurse so we've just got this good team but I think it's it's trial and error you don't know right away um in terms of Staffing or even in a hospital setting you know in leadership who's going to be the champion so I think for me as the leader of my office is I have to say patients first they know um we also have a meeting every Friday afternoons after all the patients leave um where we just talk what could we have done better uh what could we have done what did we do right um and sometimes maybe when all the patients are gone we have a little champagne called champagne Fridays but but for those who drinking we also have non-alcoholic but um we just make it fun environment for the people in my office to really say we are here for the patients they don't work for me they work for the patients and so that's really what we have to talk about talk about in our office and I give them the room and the space to com to complain to me their boss about things that could be better or things that did go right and so give them that that space as well um so they feel like they're in control and again they're not just coming in for a paycheck they're here for the patient well I I love that I love that open communication um as well as just the the constant feedback and and and Improv in areas for where you can improve because it especially in healthcare if we're not constantly evaluating in for areas that we can improve we're we're falling behind in in some way and so it's it sounds like uh to be a member of your team is is a pretty fun spot to work and so uh thank you so much Dr deep pasquali we're grateful for your time today um and for your willingness to come and and to to talk about living ship and in your experience and the way that you and your team have have helped change and save lives and so we're we're grateful for your time today and uh wish you the best going forward thank you Zach see you later</p>
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