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Thinking Differently to Improve Healthcare
Episode 433

E. Ronald Hale, Network Medical Director, Radiation Oncology at Kettering Health Network

Thinking Differently to Improve Healthcare

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Thinking Differently to Improve Healthcare

Episode 433

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Thinking Differently to Improve Healthcare with E. Ronald Hale, Network Medical Director, Radiation Oncology at Kettering Health Network transcript powered by Sonix—the best audio to text transcription service

Thinking Differently to Improve Healthcare with E. Ronald Hale, Network Medical Director, Radiation Oncology at Kettering Health Network was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Dr. Ronald Hale. He is the Network Medical Director for Radiation Oncology at Kettering Cancer Care in Kettering, Ohio. Dr. Hale is board certified in radiation oncology and has more than twenty three years of highly specialized experience in the specialties of radiation oncology, including adaptive radiation therapy, brachytherapy and brain radio surgery, as well as public health and preventive medicine. His career in Dayton began in Wright-Patterson Air Force Base in 2005 after losing nearly everything to Hurricane Katrina, including his home and practice location while stationed at Kessler Air Force Base on the Mississippi Gulf Coast. He subsequently designed and supervised the construction of the 88th Medical Group Cancer Center Care Center and served as its first Director until his retirement in 2011 with the rank of Lieutenant Carlino culminating twenty four years of Air Force service. Dr. Hale is the medical director for a busy radiation oncology department consisting of a robust brachytherapy program, gamma knife, and five practice locations. Today we’re going to be diving into thinking differently, doing better, planning versus preparation. And it’s such a privilege to have a Dr. Hale here with us. And with that, I want to I want to give you a warm welcome, Dr. Hale. Thanks for being with us.

E. Ronald Hale:
Thank you very much. It’s good to be here.

Saul Marquez:
Yes, sir. And so as we as we dive into some of the topics that are near and dear to your heart. Firstly, I just want to say thank you for your service. It’s such a privilege to have somebody like you that will both, you know, work on behalf of the people of the US and then continue to serve as a physician. So I want to start by saying thank you.

E. Ronald Hale:
Well, thank you very much. It was a wonderful time and I would do it again in a heartbeat.

Saul Marquez:
That’s wonderful. As you think about your career, Dr. Hale, what would you say got you into the medical sector?

E. Ronald Hale:
Well, I originally started out as an aerospace engineering student in college when I had an epiphany moment and decided I wanted to be a physician and transferred from my engineering program to a biology program and got into medical school. I finished medical school and I really liked everything. I couldn’t decide on a specialty. And so I did a transitional internship exposing need to all different disciplines. And one day as working as a flight surgeon. So that’s essentially a primary care physician for pilots and their families at Keesler Air Force Base in San Assad, Keesler Air Force Base in Biloxi, Mississippi. I really enjoyed the public health and preventive medicine aspect of the job and did a residency at Johns Hopkins in that I got a master’s of public health and it worked for several years as a public health specialist at various bases. My dad was diagnosed with kidney cancer when he turned 60 and he had a basically terminal diagnosis. The cancer metastasized to his lungs at the time. I was at the time his diagnosis, I was still at Hopkins and was able to get a little bit of guidance for his treatment. And there weren’t a lot of treatments available at that time. But essentially we had the kidney removed and he went on a very primitive form of immunotherapy that was like it was shown not to be effective in clinical trial, but for him, for whatever reason, it started working. The tumor started shrinking. We had one tumor remaining on each lung and he had to come off the immunotherapy for toxicity issues, a new metastatic lesion formed in the center part of the chest mediastinum. And we serendipitously found out about a technique called stereotactic body radio surgery that was being used by Dr. Joe Lieberman at Staten Island University, sort of adapting what Timmerman, Dr. Timmerman was doing at Indiana University, but applying them to patients with limited metastatic disease. So he had that treatment really against the advice of a lot of his treating physicians. And it cleared his disease. And so twenty three years later, he’s still alive, an amazing tumor free. So, again, there wasn’t a pivotal moment when I was down at San Antonio working as a preventive medicine specialist, epidemiologist at Lackland Air Force Base, that I wanted to be a radiation oncologist. And so somewhat mid-career, I switched and did another residency, University of Rochester. They were one of the two facilities that had a new clinic. That was specially designed for radio surgery treatment and studied with Dr. Polyclinics and Phil Rubin. And it was fantastic training. And I really since then had felt that that was, in fact, my true calling.

Saul Marquez:
Wow. Wow. That’s a… what a story. Dr. Hale. And and I’m so glad that your father, you know, made it. He’s still with us. And your career has been filled with these epifanal moments. And, you know, it’s interesting to hear the courage that you’ve had to actually listen to those moments because, you know, I feel like oftentimes we don’t listen to those moments. What is it that gave you the courage to change when things were going well and what you were doing already?

E. Ronald Hale:
Well, a couple of things. So I believe that we personally developed by continually getting out of our comfort zones. And I think the military taught me that very well, that we grow as human beings when we have the courage to step outside of our comfort zones. It’s also partly based on advice that my step dad, who is an ear, nose and throat surgeon, gave me early on, and he used to tell me pretty routinely that you don’t lead life. Life leads you. And and I think with that wisdom and the notion of getting out of your comfort zones, I kind of embraced life with this idea that there is a destiny for each one of us. And when we have that destiny revealed to us, it really becomes the courage to embrace the destiny. We have the free will to walk away from it. And sometimes when we do that, we are repeatedly reintroduced to what our destiny is. And it’s these opportunities that pop up out of nowhere that seem like they take you in a completely divergent direction from where you think you’re going that are really the opportunities in life. And so that has been my guiding light through this whole experience.

Saul Marquez:
Wow, that’s brilliant. And I love your your stepdad’s you know… belief that you don’t lead life. Life leads you. And you got to take action when you see those moments and especially when they continue showing up to your listeners. So what would you say, Dr. Hale, is a hot topic that needs to be on health leaders agendas today. And how are you approaching it?

E. Ronald Hale:
Well, the way we have been doing business, the business of healthcare is not sustainable. It’s not sustainable economically. And really for the amount of effort, money, investment that we’re making in healthcare. We’re not in this country really seeing the kinds of health outcomes that are commensurate with the level of investment that we have. And so things need to change and change has to happen at all levels. It’s not an issue of spending less. It’s an issue of improving the efficiency and the effectiveness of healthcare delivery. And so in that regard, everything needs to be on the table from the ground up in how we conduct the business of healthcare, how we take care of patients, about really integrating the continuum of prevention that most of what we do in healthcare is really what we consider tertiary prevention. What I mean by this is we think about the continuum of prevention. Let’s say that we have an entity of cervical cancer which can shorten a person’s life or certainly take away the quality of life. The opportunities to prevent that from happening, lie along this continuum prevention, where we’ve got primary preventive efforts such as the Gardasil vaccine, which could prevent the disease from happening in the first place, where we have screening, where we can detect the disease at a subclinical time and mitigate the morbidity and mortality associated with it, or if in fact it becomes clinically apparent. The tertiary prevention is optimizing the treatment. That means properly diagnosing, having properly stage the patient and then deliver the proper treatment to mitigate the morbidity and mortality associated. We in at least in the United States, have not done a very good job integrating this continuum of prevention and seeing every thing that shortens a person’s life or threatens more mortality and morbidity. Really, really quality of life lives on a continuum of prevention and that there are opportunities along the way and that investing on the left side of the continuum where we can prevent the disease and mitigate the effects, not even let it happen, yield big bang for our buck. And I think that’s where healthcare in this country is going to need to go in the future.

Saul Marquez:
Well, I think it’s really interesting. Dr. Hale, the perspective that you bring with the many different hats that you’ve worn, you know, as as a preventative physician, public health specialist, and now oncologist, you know, it’s fascinating how all of these worlds are converging. And this can this idea of the continuum of health prevention is a very fascinating one. And I’d love to hear what you are doing in your practice or at the facilities that you work to help move toward that direction.

E. Ronald Hale:
So there are two primary ways that I am doing this on a daily basis. So one is I am that the chair of our cancer committee, which really looks at the the programmatic issues of our cancer program and the network looking at opportunities to integrate the continuum of prevention for the population of patients that are that we’re responsible for here in the southwest Ohio area. The other is that I am absolutely a practitioner of tertiary prevention, so patients that come to me have cancer already. And so how do we optimize the treatment of their cancer in order to mitigate the morbidity and mortality associated with their diagnosis? And this is where we come in to the concept of decreasing variability and in an improving safety culture of safety through the use of care pads, the delivery of cancer treatment with care pets. And so back from my days as a flight surgeon, we used to somewhat jokingly say that pilots that fly airplanes by memory crash, pilots don’t fly an airplane by memory. They have checklists. There’s even a checklist to go to the bathroom so that you don’t inadvertently get up, go to the bathroom and leave the autopilot off. Everything is checklist based. And so in medicine, very much the same concepts apply, when we use this concept of a care paths to deliver a treatment. Now what I mean by this is, for instance, instead of prescribing radiation for a breast cancer patient, I would prescribe a care paths for the treatment of an early stage left sided breast cancer patient. That includes not only the radiation dose, but the localization parameters for that treatment. The constraints for the healthy tissue to avoid the radiation to treat those areas. The orders that my nurse could execute in the event that the patient has skin redness or whatnot that are evidence based according to our current nursing guidelines, the supporting documentation for what we’re doing, the supporting coding for the requisite coding for what we’re doing, and also the safety checklist. So that in order to move from step A to step B, the items such as obtaining a pregnancy test at the time of treatment planning is done in order to move forward. So by integrating the best practices for delivering the treatment with the safety checklists, we will have a care paths. And so care paths can be done on a number of different ways. But we now have the technology that’s able to use our electronic medical records. And instead of us working for the electronic medical record, we get the electronic amount, electronic medical record working for us where we can actually bake in the safety checklists and these care paths so that patient presents to us with early stage less side of breast cancer. The courses prescribed and really for the majority of patients, this is going to be perfectly appropriate treatment. So it’s the parade or principal that by a small intervention like this, we can standardize the care for the bulk of the patients that come through. Now there are going to be patients that will not fall under a care paths exactly that will need modification. And that’s where I need to be investing my time, not on the things that we are doing routinely every day, but to invest my time on the cases that are more difficult, that need my one on one interaction because of your situation.

Saul Marquez:
I think that’s a brilliant way to do it. And these these prescribed care paths with checklists are a fantastic way for you to really, you know, give the thought that to those specific cases that need that thought. I think it’s a really great way to do it. Your example of a pilot that flies by memory is going to crash is a really vivid example of what what does happen and can happen in care every single day. If you had to point to a setback that you’ve had that you learned so much from Dr. Hale, what would that be and what did you learn from it?

E. Ronald Hale:
So a couple of things. One is that we have a group of physicians, we have a practice, and it’s not so much a setback, but a challenge. And so in order to do this, you have to have a group of people and not just your physicians, but really it has to be everyone involved that can that has the capability to come to consensus. Consensus is not majority rules. Consensus is not unanimity. Consensus is that everybody can live with this decision. Well, in order to be able to have a team that comes to consensus, the team has to form as a team. And when we think of the four stages of team formation, with the forming, storming, norming and performing stages of team formation, a huge challenge so far has been in my three years here getting my team assembled and working them through these four stages of team development so that we can come to the point of building consensus. That has been a major challenge. It’s something that we at this point have momentum in a positive direction. But it is it is a big challenge that I think you have to acknowledge upfront. The other is that it’s a paradigm shift for our folks and information systems where, you know, we’re not here. For the information system, the information system is here for us and to get the pieces in place for the information system that truly support the evidence based care past delivery of our services. And so a couple of things needed to happen. We needed software developed and we also needed on our end. Our information’s team information system seemed to to put the pieces in place in order to implement the delivery of these care paths. Those have been pretty substantial challenges and setbacks really over the course of the past three years.

Saul Marquez:
Well, you know, it’s it sounds like you have a firm grip on them. You know what they are, but you’re consistently making strides toward toward getting it done and getting your entire team on this on this care pathway model. And and so I’d like to hear what you believe. Dr. Hale is one of the proudest experiences that you’ve had to date?

E. Ronald Hale:
Certainly so. I would say that when we first conceived of what a soft. Where application would look like to support the evidence based delivery of a care paths for the treatment of cancer with radiation, and that at the point where I actually saw the functioning software the way we had envisioned it as it was demonstrated to us. I think was probably the most exciting thing because it was a concept. And to see this concept come to fruition through the hard work of many, many people was absolutely amazing. And I would have to say that that was that was really a very important highlight, I think, of being able to make advancement and really anything that we do in life. But in healthcare in particular is there’s two ways to make advancement grow. And one is sort of what I call this, a me boy growth, where we are where we are now. And we sort of blob out in different directions that picking low hanging fruit and just like growing by default in sort of patterns of least resistance. But that’s not probably the best way to do this. I think the really the best way to get something remarkably done is kind of like what the farmer used to do in the old days, would walk to the end of the field and drive a stake into the ground. Go back to the plow and drive the plow to the stake. Not taking his or her eyes off of the stake that would establish your first straight line. And from there, the field would be plowed in an orderly fashion. And I think for remaking our health care delivery in any thing that we do, we need to envision the end state of what we want to achieve in two years, five years, 10 years. What we want to look like and then driving the organization to that end point. It’s a completely different concept than this sort of a me boy growth that we’ve grown so accustomed to. And this is the thing that makes great things happen. You know, we would not have the iPhone and other amazing things unless people had the vision and the tenacity to grow and develop things in this type of a fashion. And so when we saw the software developed and demonstrated, it was one of those moments, that it was extremely satisfying to see that this come to fruition.

Saul Marquez:
Wow, that’s fabulous. And when did you guys finish the software?

E. Ronald Hale:
So the software is ready for test in February of this year. Now we have a couple of sites that have implemented the software. I believe Yale and Thomas Jefferson have gone live with it. We have been working on content tirelessly, which really means taking all of our diagnoses, you know, left side, early stage breast cancer, right side, early stage breast cancer, everything basically that we treat and going through in a very systematic fashion, working through process and content, because once the software is deployed, we need to be able for practices to take their processes with a shell of process in the software and be able to easily adapt it. Because ultimately when you’re looking at the delivery of what you do, this is gonna be an iterative project.

Saul Marquez:
Sure.

E. Ronald Hale:
So they are you, you know, try something. You format the software to do what you think you want to do and you test it and you see and then you have to go back and you have to make tweaks and this has to be done at the user level. So this can’t be you know, you have to bring up a program or an or functional expert in to make these modifications. So part of this software working and supporting the people who do this is that it has to be able to be adjusted and tweaked on the fly. So software started going live in February. We’ve been working on the content tirelessly. We’re getting great reports back from the two sites that have been using at least the the whiteboard part of this. The whiteboard, meaning the ability to look at our panel meant a patient. So when we think about the delivery of a radiation ecology treatment course, we’re talking about the episode of Care, which, for instance, we go to the pediatrician for your child. You know, it’s that sort of care is maybe a half hour from the time you check in to check out the prescription and radiation treatment. It’s different. The episode of Care begins with the initial consultation, stretches through the simulation, treatment, planning, treatment delivery and also what we call the end of the global period, which is three months after the completion of the course. So our episode of Care lasts for several months. The patients that are all in our clinic during this episode of Care is what we referred towards as our own panelist. To know where those patients are at each moment during the process is critical. We need to have an understanding of who’s waiting for simulation, who’s waiting for their treatment plan, who’s waiting for insurance approval so that we move the patients through efficiently. Down the hall we have a multi-million dollar machine that we didn’t maximize the time of the patients on that machine. So it’s imperative that we know where those patients are. So the software also provides us, in addition to them, the ability to execute care pass. Decrease variability, improve safety, the ability to track patients through the episode of care and manage those patients actively.

Saul Marquez:
Wow, that’s fascinating. Visibility to that patient stage is critical. Increasing safety, reducing variability. And, you know, this idea of care pathways that you know of prescribing those really opens it up to not falling falling prey to that just, you know, one size fits all. How does this tie in to the rising wave of precision medicine?

E. Ronald Hale:
Well, it does it a very nice way, actually. So it precision medicine is an it is a wonderful new really a new concept. And, you know, there’s this notion and you see billboards around town. There’s no routine breast cancer, what have you. But the reality is that for the majority of patients, let’s say, that have low risk prostate cancer, early stage breast cancer, there are very well established consensus guidelines for how that cancer should be treated. And these guidelines have been around for many years. They’re published as the NCCAM guidelines, which is a collaborative effort among all the major cancer centers in the country where in fact, they’re functional experts have come together, reviewed the literature and periodically update the guidelines to render an opinion on how any type of giving cancer should be treated. And so what we’re really talking about is establishing a care path that supports the evidence based delivery of treatment, really according to what we consider the gold standard of guidelines, the NCCAM guidelines. Now precision medicine comes into place at various points along those guidelines. So there are times where, you know, germline testing or molecular testing is necessary in order to better understand whether, for instance, this systemic therapy is better than the other systemic therapy as indicated altogether and what have you. But again, that in and of itself, it can be baked into the guidelines so that a patient who has a glioblastoma, which is a very serious type of a brain tumor, has the appropriate testing done to make determination about the tumor or that that will have an influence not just on prognosis, but also on some treatment parameters. So in some regards you could think of the delivery of treatment through the use of care paths is limiting precision medicine. But in the way I see it, it enhances our ability to do precision medicine in so far as that, every patient will have the appropriate testing done right that will fine tune the treatment they should be getting.

Saul Marquez:
Yeah, that makes a lot of sense. That makes a lot of sense, and I could see how it enables the use of precision medicine.

E. Ronald Hale:
So I’d like to circle back for just a moment, because we were talking about redoing how we deliver healthcare in so far as the cost of healthcare, decreasing variability, improving outcomes and how this relates and at least what we do, innovation, ecology. So there’s a sea shift. It’s really underway with regard to the delivery of radiation oncology. The former model was we basically got paid every time we turn the machine on, we got paid for that. And so it encouraged a very long fraction schedules 33 to 35 treatments for breast cancer. Forty five treatments for prostate cancer, etc.. Every time we treated, we were basically rewarded. Well, a couple of important things are happening. One is a fundamental change in the way we’re looking at compensation for the treatment of cancer with radiation. Right now, there’s active discussion with the use of alternative payment models where instead of being paid per click of the machine going on, we’re paid for a person’s diagnosis of the patient has breast cancer, that basically things are bundled together and we’re paid for the treatment of that breast cancer. But also at the same time, we’ve got a better understanding regarding how many treatments. And what are called what we call dose fraction schedules for radiation are unnecessary. And so what we’ve been seeing is what I think of is shrinking, collapsing dose fraction schedules where for prostate cancer instead of treating forty five fractions that for many patients they perhaps can receive five or twenty fractions for breast cancer, reducing from 28 to 33 treatments down to fifteen or twenty fractions for palliative patients instead of receiving 10 fractions receiving just one or five fractions. So the shift there then becomes getting patients through the department with fewer fractions means putting more patients through the department. Because to be economically viable, to succeed in this type of environment, we need a higher throughput through the clinic. If they’re spending less time on the machine, the real cost them to delivering this treatment is getting the patient process through. It’s kind of the difference between a long stay versus a short stay hotel. The expense and putting a guest in a room is turning over the room, the housekeeping, what not. If you have a patient that comes in or if you have a guest in a hotel that comes in for a couple of weeks, you’re turning the room over once the guest stays for a night or two. You’re turning that room over many more times. It’s the same concept with what we’re doing. And so the delivery of our hour care paths a base treatment allows us to, first of all, really understand what is the cost involved in getting the patient on treatment. Now, that’s important for us to to be able to negotiate contracts favorably, but also we can get that patient on treatment with a lower cost. The human capital costs, the cost that it takes for me to use my time to get that patient on treatment. So there are a lot of consequences due to changing the paradigm with regard to how we deliver radiation, which supports a more cost effective model for the use of radiation. Stereotactic radio surgery is a way to treat definitively with between one to five treatments. And so we’ve seen a huge uptick in the patients that are receiving this type of treatment. Those patients still require a consult, note treatment, planning, all the other things that go with it. And so through the use of our our software called Smart Clinic, this is something that’s greatly facilitating our ability to get patients into treatment efficiently and quickly.

Saul Marquez:
Well, I definitely want to just recognize you for and your team, you and your team for all the work that you guys have done in the development of Smart Clinic. There’s no doubt that there’s a changing tide. And folks, Dr. Hale is is providing us some some insights into how we could take care of our oncology patients better. Now, if the people listening are on the provider side and are curious and want to learn more about potentially how to get engaged with this program, the software, what’s the best way for them to connect with you or your team?

E. Ronald Hale:
I think probably would be welcome to email me. It would be fine. And then we can, you know, set up a phone conversation or what have you. But I really encourage this. I think that that talking about these issues is a great way to start. And and it gets you thinking creatively. And every time I talk to someone, I learn something as well, because that person brings me different insight, viewpoints and maybe other things that I haven’t thought about. So I absolutely encourage that. Yes.

Saul Marquez:
Outstanding. And folks in the show notes will leave a way for you to contact Dr. Hale. Just go to outcomesrocket.health and in the search bar type in Hale, you’ll find that the entire transcript show notes and contact there. Getting to the lightning round. Dr. Hale, we’ll do that, followed by a book that you recommend to the listeners. You ready?

E. Ronald Hale:
Yes.

Saul Marquez:
All right. What’s the best way to improve healthcare outcomes?

E. Ronald Hale:
The best way is to know what you don’t know. I think that the cost in not having the types of outcomes we want to have is really not understanding the pieces of information that we’re missing. So I think that’s a great way to start. It’s all about metrics. We need to know what we don’t know.

Saul Marquez:
What’s the biggest mistake or pitfall to avoid?

E. Ronald Hale:
The biggest mistake is to think that you have something mastered. Every time you have an achievement, you have things that are lurking that you are unaware of that could potentially take you down, that there are unintended consequences with every course of action and to anticipate to be prepared, as we said earlier in the discussion, being prepared immunizes you from changes that are unanticipated.

Saul Marquez:
And you did mention. Thank you for that. And you did mention sort of the the difference between preparation and planning. Oh, what would you say the distinction there is?

E. Ronald Hale:
Planning connotes that you have an expectation for what the future is going to look like. And you’re setting up your current situation, current environment to support some kind of a future that you think is going to come about. Preparations, different preparation is, for instance, being well read, being physically fit, about having a practice that has tight electronic medical record, that has proper documentation about having all of those elements in place so that when opportunities appear in the future, you’re able to jump on those opportunities. Because remember, we said early on that life leads you. And so this is gonna be an exercise where opportunities pop up and it will be the prepared that are able to leverage and take advantage of those opportunities.

Saul Marquez:
Wow. Love that. That’s a great way to articulate that. Dr. Hale, folks, be prepared. That’s the bottom line. How do you stay relevant as an organization despite constant change?

E. Ronald Hale:
Great question, too. So you have to be able to read the environment. You have to be able to watch what is happening around you. I call this situational awareness. I think about back in the days in the cockpit as a flight surgeon that pilots did something called cross-check. Even if you’re flying by visual flight rules, you’re looking out the window that you’re still checking your instruments to make sure that your airspeed, your attitude, your altitude, everything is in check. And it’s the same thing that we must do. We need to look at our competitor. We need to look at the advertising. We need to look at the data from internal. We need to look at internal data. We need to look at population trends. You need to be looking at all of this and understanding and cross-checking to make sure that if something seems like it’s an outlier, that you’re not dismissing that necessarily, that your understanding why that piece of data is not reading right. I think the biggest hazard in not staying relevant is losing your situational awareness.

Saul Marquez:
Wow. And the question that comes to mind is what am I not seeing? What do I not know?

E. Ronald Hale:
Well. In terms of my situation right now, what do I not see or what do I not know?

Saul Marquez:
Well, yeah, I guess I’m just I’m just thinking, like as the listeners think about, you know, what you’ve sort of discussed. You know, asking those questions so that they could, you know, not miss those.

E. Ronald Hale:
I got it. Okay. So…

Saul Marquez:
Yeah.

E. Ronald Hale:
A useful exercise is is to first you have to have a good grasp of what you do know and you have to have a thorough understanding of your metrics and what you do know. And then it’s useful to take your team and brainstorm and say, “Okay, let’s think of all of the things, all of the areas where we could be surprised of situations that could pop up that just take us by surprise.” These are the outlier data kinds of things. The things that, you know, that we’re not contemplating right now, but maybe in a brainstorming session, somebody comes up with something. You have to have a culture where every person is valued. And so that is kind of the craziest thing that comes out that we just ponder it. We consider it and we put that on the back burner so that we’re aware of these elements. The other thing is you’ve got to have a quest for data, is that you have to look for evidence. You can’t make assumptions. You have to change the assumptions and the facts by acquiring the data to either support the assumption or refute it.

Saul Marquez:
Love it. A great exercise. And what would you say as one area of focus that drives everything in your organization?

E. Ronald Hale:
One area of focus is a collective vision. So I think that it’s important as a leader like putting that stake at the end of the field to continually articulate the future state. Now, I’m not talking about again, plans. I’m talking about a model, a concept of how we want to do this. Articulating that repeatedly to drive the organization, to make remake ourselves and what we want to be in the future. And that would be, you know, the place the a nationally recognized… and this is what I tell my folks repeatedly that our vision within the decade is to be a nationally recognized center of excellence for the delivery of community oncology. And they hear me say that again and again. What is it going to take to make us that? And that has been the single most powerful coalescing factor for our team.

Saul Marquez:
Wow, that’s a great vision. Doesn’t get any clearer than that steak at the end of the field, you’re doing such a great job. Dr. Hale and I really appreciate the insights. Before we conclude, I love if you could just share your your book. Favorite book that you recommend to the listeners. And then we could conclude with the closing thought.

E. Ronald Hale:
Oh, gosh. Well, this goes back a few years. And it was a book probably that really influenced my life in every way in terms of being prepared. And, you know, I went through the Air Force at a time when we had this suck quality Air Force initiative. And one of the books that I read early on that really made an impression on me was Covey’s 7 Habits. And I think even if you don’t do the seven habits, it gives you a great set of ideas for how to make yourself personally prepared for a changing future, because really, that’s a book about preparation. That’s one of my favorites.

Saul Marquez:
What a great recommendation. Dr. Hale. And and so what our fantastic conversation with you today. We’ve we’ve covered so many valuable, valuable points from building teams to thinking differently and reforming the way that we treat patients with radiation oncology. I can’t thank you enough and really would love if you could just leave us with the closing thought.

E. Ronald Hale:
Absolutely. So the time is now to adapt and change that our lives are very short. We’re here for a very short period of time. The time to engage and do this isn’t tomorrow. It’s not next year. It’s right now. Because the moments are fleeting. And before we know it, we’re done. And we passed the torch to somebody else. So I implore the folks listening that the concept of carpe diem, seize the day. This is the opportunity right now. Dig in. Make a change. Start today.

Saul Marquez:
Love it. Dr. Hale, again, just want to thank you for your inspirational leadership and your clinical expertise here and with that, I just want to say a big thanks for joining us.

E. Ronald Hale:
Definitely. Thanks for having me. Appreciate.

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