Steve Leibel, a radiation oncologist, became the first medical director of Stanford's Cancer Center in 2004
in new ‘one stop’ cancer center
Steven A. Leibel left his post as chair of the Department of Radiation Oncology after 16 years at Memorial Sloan-Kettering Cancer Center to return to California (he received his M.D. and house staff training at UCSF) as the first medical director of Stanford’s Clinical Cancer Center in July 2004. After a year on the job, Leibel, a professor of radiation oncology, talked about some of the challenges and opportunities he’s found at Stanford:
Q: Why did you take this job?
LEIBEL: This was a brand new cancer center — nobody had ever done this job before. There was a challenge to really develop a true multidisciplinary care system — one stop shopping — from nine different departments and 12 divisions all coming together to practice oncology in one place to see about 4,000 new patients every year. We have at least three themes. First, and probably the thing that occupies most of my time, is to help shepherd along our application to become an NCI Designated Comprehensive Cancer Center. That designation is a key to enhancing grant support, reassuring patients that we are a notable nationally recognized center, and is pivotal to our ability to continue to attract outstanding faculty to a facility that in reality is already outstanding. Second, on the patient side, we need to continue to work to develop processes that will ensure “one stop shopping" for cancer care services. And for physicians, we need to make sure that we serve referring physicians in a manner that will, quite simply, encourage them to send their patients to us.
Q: Let’s start with referring physicians. What’s going on in that arena?
LEIBEL: Some of what we’re doing is really cultural in nature. For example, I did my residency training and also served for more than eight years on the faculty at UCSF. Embedded into my work style was the basic rule that when you see a patient you dictate a letter to the referring physician. Communication systems, including electronic medical records, are making this process easier. It’s now much easier, for instance, for attending physicians and housestaff to do something as simple as copying the referring physician when dictating reports. The hospital’s new Physician Web Portal, which gives computer access to referring physicians, clearly facilitates two-way communication. The bottom line is we are very sensitive to the issue of patients who seem to get lost in the system. But we are working on this, and, I believe, we are changing the culture in ways that are helpful and not burdensome to our own physicians — whether house staff or attending.
Q: Can you explain a little more about the need for NCI designation, especially since, as you say, Stanford offers outstanding care and the university produces outstanding research?
LEIBEL: Yes, but first let me reemphasize that we are offering outstanding care here. It’s true that we are not a particularly large institution and we are recruiting new people in areas where we may only have one subspecialist. But we do have the full spectrum of subspecialties. It is very striking to see the really impressive interaction between clinicians and basic scientists, including those in non-medical school departments, as well as the relationships with the high technology community here in Silicon Valley. So certainly there are a lot of positives. But that being said, when a patient or a physician goes on the web to look for nationally recognized centers, Stanford doesn’t show up because the NCI lists clinical trials from designated centers. That means Stanford’s groundbreaking studies aren’t there. By the way, patients are telling us they do want be part of studies; I haven’t heard, “I won’t go to a teaching institution because I don’t want to be a guinea pig" for a really long time now. The lack of NCI designation also impacts our ability to attract new faculty and it certainly has the potential to influence referrals and patient self-referrals. But we will change this. Reviews by our External Advisory Board and a meeting on Aug. 25 with program officers from the NCI who visited Stanford were very encouraging. The institution hopes to submit the application in February, so we would expect an official site visit from the NCI in May or June of next year. By the way, this designation covers both the translational clinical research realm in which I’m directly involved, as well as basic science reserach. I’ve been able to work with some really outstanding leaders on the research end, including the director of the center, faculty pathologist Irv Weissman, as well oncologist Beverly Mitchell, who last summer joined us as deputy director of the center from a leadership post at the University of North Carolina.
Q: Will you tell your colleagues how you are pursuing some of your patient service goals?
LEIBEL: We’ve got a lot going for us, including geography. Everything is under one roof — I guess two roofs if you count the hospital. At Sloan-Kettering we had a long history of closely coordinated and integrated services, but on the other hand, the services were offered at fairly widely spaced locations — sometimes in separate buildings 15 blocks away. We have some really great people on the hospital side here who are helping us with process. Some of these steps have been rather technical and below the radar screen of most physicians. For example, we are trying to improve our phone systems, so that patients who call in get a live person who can help them with disease-specific appointments or issues. One way to accomplish that is to separate the staff answering phones from those who are actively taking care of patients at reception desks. We are also working to enhance patient education. For example, we now have a DVD explaining the rather complex options for patients with newly diagnosed prostate cancer. This is helpful to patients — at least if they watch the video they know what some of the terms they’ll be hearing mean — but a collateral goal is to help our caregivers use their education time more productively. And overall, we do have a terrific facility, including an enviable selection of amenities — concierge services for patients to help find what they are looking for, complementary medicine services, a health library, a cyber café, a restaurant, a pharmacy, a beautiful facility … the list is long.
Q: You mentioned physician recruitment. What areas are you looking for?
LEIBEL: The big areas are in the treatment of cancers of the gastrointestinal tract, lung, and head and neck, and then immediately following, breast, lymphoma (where Stanford has really been the founding father or mother), and hematology.
Q: You have quite a number of specialties under one roof. What are you doing to coordinate these services?
LEIBEL: It’s a work in progress. One of the first steps was to take a couple of teams, namely the urologic oncology group and the colorectal group, and create demonstration projects to develop systems so that patients could be seen by multiple specialists in one day. A patient comes in to see a surgeon, a medical oncologist and a radiation oncologist — how do we coordinate that? We undertook that with the hospital as a 90-day process improvement program. We continue to have numerous processes addressing improvement in service. For example, we are currently developing a process to align mammography with breast surgery visits.
Q: Guess I don’t need to ask if Stanford is different from Sloan
Kettering, but what were some of the most notable contrasts? Were there any surprises?
LEIBEL: (laughs) Oh, yeah. Probably the major difference was coming from a hospital to a university. Take purchasing of major equipment, for example. At a hospital instead of creating business plans as we do here through the capital improvement committee, you call up the head of the hospital and say, “Hey, I need this." Often you’re told, “Just go ahead and buy it." As for physician recruitment, if you target the world’s greatest person and you want to recruit them in a timely fashion, you’ll likely be told, “You haven’t done a full search. So go put together a search committee, get CVs." And then during recruitment, you have to tell a perspective new doctor about living costs if they expect to move here. And keep in mind, I’m responsible for a clinical service. I can recommend people, but recruitments are the purview of department chairs.
Q: Have you had a difficult time adjusting personally?
LEIBEL: No, in many ways this is a homecoming. I grew up in this area, and in fact I completed a three-month radiation oncology fellowship at Stanford back in 1976. Some colleagues, including my department chair, Rich Hoppe, are still here. By the way, it’s great to work for a chair like Rich. We have a good relationship. He supports my clinical leadership role, and I was a department chair long enough to know to stay out of the way of his prerogatives. On a more personal note, my parents live in the area, so certainly in that sense it’s good to be back.
Q: Are you seeing patients now?
LEIBEL — I am currently devoting my time to enhancing our clinical programs, assisting with our Comprehensive Cancer Center grant application and outreach initiatives. Patient care, while very important to me, would add one more level of complexity and worry at the moment. However, I am anxious to resume my clinical practice in the near future.