Smilow and Yale Cancer Center Clinical and Research Town Hall

Smilow and Yale Cancer Center Clinical and Research Town Hall | July 1, 2021

July 02, 2021

Hosted by Dr. Nita Ahuja

Presentation by: Drs. Marcus Bosenberg, Roy S. Herbst, Barbara Burtness, and Monica Fradkin, RN, MPH

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ID: 6771
To Cite: DCA Citation Guide

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00:00Alright, well good evening everybody.
00:02Welcome to town Hall and just a
00:05reminder before I get started.
00:06You know, these are meant to engage in
00:09and be a community of the wider community,
00:12and we're about 2000 people.
00:14If you think of the entire
00:16community of the Yale Cancer Center,
00:19the Smilow Cancer Hospital in
00:21our ambulatory care sites, and I,
00:23I hope that as these town halls
00:25sort of continue to happen,
00:27we start sharing and learning
00:29about our neighbors.
00:30Our metaphorical neighbors,
00:31and learn about each other,
00:33and perhaps then will lead to sort of
00:35more enriched community and engagement.
00:37So again,
00:38just a reminder that sometimes it may
00:41mean why are we doing all of this?
00:43Because it is to sort of understand
00:45all of all of the different parts,
00:48and I'll briefly mention that this week,
00:50Lori Pickens and I had the opportunity
00:52to visit Torrington Care Center.
00:54It was delightful to see all the the
00:57busy space and all the the staff and
00:59the physicians and the nursing teams.
01:01So I think it is such a great
01:04community we have.
01:05We just need to acknowledge that better.
01:07It's in our science whether it's our
01:09trainees are nursing staff or care
01:11centers in these sessions or these
01:12these site time we spend together
01:14we spend is to start to get to know
01:16each other and then start to get
01:18through a more richer space as a
01:20result of that we have a lot of things,
01:23but I do want to leave 10 to 15 to
01:2520 minutes at the end for questions
01:27I want to remind all of our speakers
01:30to sort of respect that so we can then.
01:33Really, our folks can ask questions,
01:35and with that,
01:36Renee if you want to move to the next slide.
01:41Oh, I'm sorry I forgot one more thing.
01:43Just a reminder.
01:44We don't have town hall in August
01:46because I do think everyone should
01:49take vacation and often August
01:50seems to be our favorite time of
01:52the year to take vacation.
01:54And we'll reconvene in September alright.
01:56New appointments,
01:57effective June 2021 these are.
01:58This is why we are here.
02:00You know this is the
02:02test stuff you celebrate.
02:03So it's really my pleasure to
02:05announce our new Chief of Pediatric
02:07Imunk and BMT service,
02:08or bone marrow transplant service
02:11Doctor Lakshman Krishnamurthi was
02:13just appointed recently and he will
02:15be starting with us on October
02:171st 2021 Doctor this recruitment
02:19was led by Doctor Cliff Bogart,
02:22Chair of Pediatrics and Doctor
02:24Krishnamoorthy is an accomplished
02:25pediatric hematologist oncologist
02:27and an international leader in
02:29bone marrow transplant and the
02:32treatment of hemoglobinopathies.
02:33He's coming to us from Atlanta,
02:36where he's professor of Pediatrics at
02:39Emory University School of Medicine.
02:41Director of the BMT program.
02:43I think we also want to thank Doctor
02:46Farzana push anchor who has been
02:48interim chief of PT Monk and I think
02:51I just learned this afternoon that
02:53not only is Doctor Krishnamurthy
02:55coming but his wife is joining us
02:58in the Department of Pathology so we
03:00really get our lucky and privileged that
03:02we get two in one so they will both be
03:06joining in the cancer space in October.
03:08Next is Doctor John Visal Marske who has.
03:11Been a long standing member of our community,
03:14but it was recently appointed section Chief
03:17of Endocrinology and Metabolism in the
03:19Department of Internal Medicine following
03:21a three year stint as our interim chief.
03:24He is a member of our Yale Cancer
03:26Center Signaling Network research
03:28program and also clinically as the
03:30part of our endocrinology program,
03:32so really excited that John is taking
03:35the leadership permanent leadership
03:36and then many of you saw the recent
03:39appointment of Doctor Barbara Burtness.
03:41Who is Professor of medicine as the
03:44interim associate Director for Diversity,
03:45Equity and inclusion?
03:46This is a new position and this is one
03:49that many in the Community are broader.
03:51Community felt strongly about
03:53the entire past year.
03:54There was a committee led by Harriet Cougar,
03:56along with Kevin Billingsley
03:58focused on that and they suggested
04:00this and as a result of that,
04:02we've had Doctor Burtness
04:03appointed as an interim,
04:05and you're going to hear
04:06from Barbara later today.
04:07So I don't want to give her Thunder away,
04:10but you're going to see.
04:12Why we all believed that she was the right
04:15leader to help us launch this program?
04:17But she has great leadership and
04:19innovative ideas and how to create
04:22a more inclusive workplace which
04:23then leads to you know engagement
04:25and why we all come to work.
04:27So with that next slide.
04:30OK,
04:30more new appointments.
04:31Doctor Marcus Bosenberg is also
04:33a new announcement you saw,
04:35and this is also he's the inaugural director
04:37of the Yale Center for Immuno Oncology.
04:40This is a bridge program which
04:42is you know part of living in a
04:44large robust universe as ours.
04:46As we live in the hospital.
04:48But we also live in the school and also
04:51the university and this bridge program
04:53links are a cancer menology program
04:55with the Department of Immunobiology
04:57and to take all the science the wonderful.
05:00Clients and translate it so no one
05:02could think of a better leader
05:04than Marcus and Doctor Rosenberg's
05:05research achievements and leader
05:07Exploder ship experience will be
05:09instrumental for taking us forward.
05:11And Doctor Boesenberg is also giving
05:13us a little bit of update on what he
05:16hopes to accomplish under this new
05:18program and then last but not least,
05:21it's really my pleasure to announce the
05:23appointment of Doctor Kim Blenman as
05:25an assistant professor in in medicine,
05:27also in medical oncology,
05:28doctor Blenman will also have
05:30a secondary appointment.
05:31In the Department of Computer Science
05:34at Yale School of Engineering and
05:35Applied Sciences and her research
05:37interests is reducing radiation in
05:39therapy induced adverse reactions
05:41at breast cancer.
05:42So really, a wonderful set of
05:44accomplishments and then more good news.
05:46Next slide,
05:47Renee.
05:47This is really great news.
05:49We had just had an 8.5 million grant from the
05:52National Institute of General Medical
05:55Sciences, which really answers some
05:57other seeks to answer some of the big
06:00questions of the so called natural.
06:02Apple and this is really how sort of our
06:05body takes all of the pieces and makes
06:08them sort of work on a day to day basis.
06:12In this grant will be is led by
06:14Doctor Jason Crawford who's on the
06:16West campus in the Yale Institute of
06:18Biomolecular Design and Discovery.
06:20And then he joined by people
06:22in the Cancer Center,
06:24including Doctor Noah Palm, Carol Dr,
06:26Carolyn Johnson and Doctor Andrew Goodman,
06:28who all had researched
06:30backgrounds and chemical biology,
06:31immunobiology and microbial pathogenesis so.
06:33Really, a big news for us as a whole.
06:36And then come next slide.
06:38Continuing on the theme of good news,
06:41Morgan live doctor Morgan Levine
06:43just got the 2021 Vincent Christoph
06:45Low Rising Star Award,
06:47which is given by the American
06:49Federation for Aging Research Doctors.
06:51AVR Lord became the vice chair of
06:53the NCCN colorectal cancer screening
06:55guidelines panel Doctor Rachel Greenup
06:57got the 2021 National Endowment
06:59for Plastic Surgery grant from the
07:02Plastic Surgery Foundation fund.
07:03Her research on shared decision
07:05making for breast reconstruction.
07:07Working in partnership with our patients and
07:10then Doctor Pam Kunz was appointed
07:11as the Journal of Clinical Oncology
07:13consultant editor for meeting proceedings,
07:16which many of you may or may not know.
07:19It's one of the big journals for oncology,
07:21so really proud of all of our faculty
07:24and their numerous achievements.
07:27And just a reminder again for the
07:29agenda today it's a packed agenda.
07:31Kind of all the site first up
07:33will be ambulatory care discovery
07:35delivery by Monica Fradkin.
07:36And then we'll go to the next
07:38part with clinical CT updates,
07:40which is a recurring features,
07:42then that both the new leaders,
07:43Barbara Burtness and Marcus
07:45Bosenberg will talk
07:46about their new rules. With that, I'm
07:48going to turn it over to Monica
07:50to talk to us about care delivery,
07:52so take it away, Monica.
07:55Thank you doctor Hooja.
07:58Alright everyone, thank you for
08:00allowing me to spend a few minutes of
08:02time to share about the great work
08:05that has been done around the care
08:08delivery workflows and what I'd like
08:10to do is just spend a few minutes to
08:13talk about the high level work that
08:15has been done under the Ambulatory
08:18Transformation Committee for the Care
08:20Delivery workflow team and really,
08:22during this time I'm going to spend
08:24a couple minutes to highlight
08:26some of the assessments.
08:27That have been done as
08:29well as the deliverables,
08:31the tools and techniques
08:32that have been provided,
08:33and where we are now.
08:35So we will start with just a
08:38review of the assessments on how
08:40we got here and what we did is we
08:44spent a tremendous amount of time.
08:46Getting information not only from
08:48patients but also from physicians,
08:50staff from all areas,
08:52all disease teams and locations across
08:54the different delivery networks.
08:56To understand how we were doing and
08:59this was done at the you know last year.
09:03But really what we found is that
09:05there was a tremendous amount of
09:08opportunity with the work that's being
09:10done for improvement and so based
09:13off of the hundreds of responses that we.
09:16Received and many open comments,
09:19there were six different teams that
09:22really became that bubbled to the top
09:25around clinic and infusion that we
09:27had opportunities for improvement.
09:30So just to give you an idea about the
09:34broad span of the work that's being done,
09:39there are six different
09:41multidisciplinary teams.
09:42There are 15 team leaders
09:44that are supporting the.
09:46Work of these six teams we have
09:49more than 70 participants and
09:51about 20 different providers.
09:54Within all of these different teams.
09:57The projects are in various stages.
09:59There was no way to start
10:01all of them at once,
10:03so when we give this update
10:05as I share this update,
10:07there are some teams that have been
10:09working for many months and there
10:11are some that are just starting.
10:13And really what happened is
10:15part of this work.
10:16Is there were additional assessments
10:18and quality improvement methods that
10:21we used to gather more information
10:23to really dive into the work so
10:25that we can optimize optimize
10:26what is how we're doing.
10:28Our work so each of the teams also
10:32had deliverables and here is a
10:34snapshot of the different deliverables
10:36within the different teams.
10:37But there was there's even more that
10:40we could provide to information.
10:42But for visit scheduling criteria was
10:44created to determine what visit type
10:46should be in person versus face to face,
10:49face to face,
10:50versus Tele health.
10:51And we customized it based off
10:54the treatment modality and that
10:56team really created a lot of work.
10:58And then we're going to take.
11:00That information and use it within
11:03the pre clinic prep work and post
11:05clinic wrap up and the checkout
11:08teams so that's so we can sustain
11:11the different workflows that
11:12patients have a meaningful visit
11:14and that everyone is prepared
11:17appropriately. We have optimization of
11:20infusion flow and there were two areas
11:22that really came to light was around the
11:25pril at the pretreatment lab process,
11:28as well as looking at advanced release
11:31of orders when it's appropriate.
11:33And in addition the work that's being
11:36done around IQ and Lean TOS will also,
11:39you know, was going to support
11:41a lot of this infusion flow.
11:45Enhancing the patient education experience
11:47but also utilizing Tele visits or Tel
11:49technology so that we can provide
11:51education with patients and families,
11:53but maybe not when they're directly
11:55in the chair or in clinic,
11:57but at home and then diagnostic,
12:00imaging, optimization, and timeliness.
12:01We know that there's a lot of
12:04opportunity around understanding
12:05capacity and utilization and how
12:07that impacts our care on a regular
12:09basis and then really understanding
12:11what our volumes and what do we have.
12:15Do we have what we need to meet the
12:18demand and as well as there are there
12:21patients that are going outside of our
12:24our organization for these imaging tests?
12:27So just going to share some example
12:29of some different processes and
12:31clinical tools that have been created
12:33around the work that's being done.
12:35So we looked at cause and effect diagrams
12:38to really understand where where each of
12:41the work and barriers may come into play.
12:44We process mapped the different
12:46workflows and this is an example
12:48of something that was done for pre
12:51clinic prep and visit criteria.
12:53We looked at also assessment parameters,
12:55so when we're looking at those process
12:58mappings really understanding what
13:00are the questions and the tools
13:01that need to be used.
13:03Because this can also be used
13:05for the education when we go into
13:08our pilot and training phases.
13:10Utilizing epic tools that we really
13:13didn't realize were available to us,
13:15so using those tools to be more efficient
13:19as well as examples of a new visit
13:22type that was created to be able to
13:25use for Tele visits for patient education.
13:30And just some additional
13:31education that has been provided.
13:33And finally,
13:34in order for us to do all this,
13:37we need to be able to measure it and
13:40understand what we're doing is effective.
13:42And is it sustainable?
13:44So we are with it when it within each
13:47one of these groups we will have
13:49metrics for each one of them that we
13:52can that could be automated that were
13:55standardized to the best possible and
13:57that we can also measure pre and post.
14:00Implementation of these pilots examples
14:02is also to ensure that we measure
14:05provider staff and patient satisfaction
14:07using different surveys and looking at
14:10productivity and performance measures.
14:12So based off all that,
14:14where are we now?
14:16So just to give you a little
14:19bit of an update,
14:21the visit type scheduling criteria
14:23and preclinic prep have combined
14:25the work that has been done.
14:27Now our assessments are completed.
14:29Workflows and trainings have
14:30been done and we're at the phase
14:33of we're ready to pilot.
14:34So we've identified those initial sites and
14:37we have sites that are in the queue ready
14:41once our first site is up and running,
14:43the checkout team has three different
14:45work groups made up. Of stakeholders,
14:48workflows and epic optimizations,
14:50and really what they've done is they've,
14:53you know, used our resources of NCCN
14:56using best practices that you know
14:58the best practice committee to glean
15:01information we they've created,
15:03created a completed additional workflows and
15:05surveys of not only physicians and providers,
15:09but also the access staff so they can
15:12really understand what's being done
15:15where and and to understand that.
15:17Workflows.
15:18And using Epic in what I TS UM
15:21solutions could be available,
15:24so they're they're they're working
15:26through that as well right now and
15:29will really come up with some options.
15:32Optimal workflows for this that is using
15:35the disposition and the enhancing the
15:38checkout process to ensure nothing gets
15:41missed from a patient safety standpoint.
15:43And then the video enabled patient education.
15:46You know, tools are developed
15:47in 3 pilots or in progress.
15:50You can see that what's listed.
15:52The infusion flow optimization is reviewing,
15:55you know,
15:56has been involved with the IQ lean
15:59TOS initiative and other relatives.
16:02They've also come.
16:03Done some clinical optimal observations
16:05for pre releasing the different
16:07out for chemotherapy so we can
16:10have a real good understanding of
16:13current state and to understand
16:15where the opportunities would be.
16:17And finally diagnostic imaging
16:18optimization is really around.
16:20As I mentioned,
16:21they're creating a dashboard for
16:23utilization and capacity and
16:25what will that will allow is
16:27to understand where are where.
16:29We have opportunities to fill slots more.
16:32Or do we have?
16:33And over capacity issue in one
16:35location where we could maybe
16:37shift some of the imaging tests to
16:40other to other areas that are under
16:43capacity and then really looking as I
16:46mentioned earlier around the volumes.
16:48And the location of the outmigration.
16:51So in a real in short,
16:53that is the care delivery.
16:56Work group is a highly engaged team
16:58of a lot of different people that
17:01really want to take the opportunity
17:04to improve workflow and processes.
17:06And you know,
17:07I am speaking on behalf of many and
17:10that it really has been a great
17:13way to bring teams together,
17:16understand cross teams workflows
17:17and identify best practices,
17:19but also realize that.
17:20We could do some things better and
17:23utilizing the tools that are out
17:24there and taking a fresh look so.
17:28Thank
17:29you Monica, UM, for that update.
17:31I think I'd like to keep the questions
17:33for for the end for the entire panel,
17:36so will will ask the attendees to save
17:38the questions and start typing them.
17:40And then if you can answer them directly,
17:43that's also OK. With that,
17:44I'm going to turn it over to Doctor
17:46Herbs and just a reminder just to
17:49leave Question Time for Q and I'm
17:51just going to remind everybody.
17:53Keep keep the presentations brief
17:54so we can leave more time for Q&A.
17:57Doctor Herbs please.
17:59Yeah thanks Nita, Uhm can you hear me?
18:01We can thank you.
18:03Yeah, I'm I'm here in Hartford with
18:05the Hartford Care Center team or having
18:08a celebration for Jonathan Sporn.
18:09I'm sitting outside.
18:10Hopefully it doesn't rain first.
18:12I want to welcome Mary Ann Lessburg.
18:15Today was her first day,
18:16though it hardly seems like that
18:18because Maryann has been engaged
18:20ever since the minute we met her,
18:23she'll be leading the breast
18:24disease Center breast,
18:25medical oncology and we're so
18:27happy that you're on campus.
18:29Today, Mary Ann sorry,
18:30I didn't get to see you today
18:32I'll find you tomorrow.
18:33Uh, but uh, this is really a great recruit.
18:35Mary Mary had comes to us from
18:37Ohio State and, uh, well,
18:38I hope you'll all get to meet
18:40her very soon as we continue
18:42to build our breast program.
18:43Next slide, please.
18:46So I'm here to talk about clinical
18:48trials and give you a very brief update.
18:51July 1st update next slide.
18:56So I just wanted to just bring up why we
18:58conduct clinical trials and this is taken
19:01from the ICR website on some of these
19:04images and some from the YCC website.
19:06You know we're forced
19:07collaborating very closely,
19:08and you can see it's it's about education.
19:11It's about science and research.
19:13We want better treatments.
19:14We want to bring medical
19:16breakthroughs to the public.
19:17It really is important to think about
19:19clinical trials for the cutting edge,
19:21best clinical care and also by
19:23thinking about a clinical trial.
19:25One has to think about the best standards of
19:28care so it increases our quality of care.
19:31And a reputation and the next slide.
19:33You'll see this examples
19:34of how it helps patients,
19:36and several of these.
19:37In fact, I think most of them
19:39are Yale cancer patients who have
19:41benefited from clinical trial.
19:47Next bye. Safe and efficient trials network.
19:52We're working on that we're offering.
19:54Our systems were improving our standard
19:56operating procedures when processes
19:58that ensure increased investigator
19:59responsibility and oversight,
20:01we are now almost completely electronic.
20:03That's been along coming,
20:05but it's it's been great and we're recruiting
20:08a there's a lot of recruiting going on.
20:11I've interviewed someone today,
20:13focus on education and training
20:15of our staff at all levels.
20:17We're gonna do some retraining.
20:20Everyone needs to constantly be up on the
20:23regulatory data and we want to focus on
20:26activation of trials and closure of traps.
20:28Cloudsat, arner,
20:29crewing should be closed and
20:31we need more trials obviously,
20:33but selective activation.
20:34The trials that will really accrue
20:36across our network next slide.
20:41So just a little bit of
20:42good news, I got this.
20:46Our activation team just about 2 hours ago.
20:49There are 57 studies that are
20:52active in the startup process,
20:5490 percent, 90% complete.
20:56You see eight studies, 75% complete,
20:5813 studies and 50% complete for keen study.
21:03Opening a trial is like a scavenger hunt.
21:05There's so many different things to find.
21:07All I ask is everyone who's involved
21:10in trials on this Co-op work together
21:12and through your calls do your yrag.
21:14Let's get these things open 'cause
21:16these trials are for our patients,
21:18but we are working together as a team.
21:21Our regulatory team.
21:22We've got some outside stuff
21:23from your own who are helping us.
21:25Otherwise, CCI team Sarah and CTO team.
21:30Thank you everyone for doing this.
21:32We are getting trials open it it is.
21:37B grade new academic year.
21:39Next slide.
21:42Next slide, please.
21:43Uhm, so these are just two trials
21:45that were active this month is a
21:47third that I've been waiting for a
21:48phone call here on my other phone.
21:50I haven't gotten it yet,
21:51but any minute it's about
21:52to be another cell therapy.
21:56But ah.
22:00Roy, you're breaking up. I don't know if
22:02we're working very hard.
22:05OK. Next slide, please.
22:09And these are just the numbers.
22:11These are, our patients are on trial and
22:13I just show this to show you normally
22:15of the number of patients that we
22:18have on trial and and their accrual.
22:20This is as of last week,
22:22so we had about 50 patients
22:23accrued each year and that's good,
22:25but I'd like to see better,
22:27so I just implore everyone out there.
22:29Whether you're a patient,
22:30whether you're a physician,
22:31whether you're a nurse or
22:33a staff in the clinic,
22:34sink about clinical trials.
22:35Of course we would love
22:37to have more trials open,
22:38but we have plenty of trials open,
22:40so I think is there a trial that will work?
22:42Let's figure out how to make that happen,
22:44and then I think on the last slide.
22:48Uhm, thank you to our staff.
22:50Ummar newsletter will go out
22:52hopefully tomorrow morning and,
22:53uh, Mandy is one of the people
22:55we've spotlighted this month.
22:57Each month we're spotlighting
22:58some of the staff.
22:59It's you that are doing the work,
23:01and I really appreciate everyone
23:03coming together as a team to help
23:05our patients and to help fight
23:07this terrible disease of cancer.
23:09I think that's the last slide.
23:12And I'll just answer questions
23:14as long as it doesn't rain.
23:16Thank
23:16you Roy. Doctor Herbst and thank you
23:19to you and the entire team and I know
23:22that this is reflected in the work that
23:24we do in taking care of her patients.
23:27So again, I think it's nice to
23:29get the updates monthly so we can
23:31then just all sort of work towards
23:33optimizing our clinical trials network.
23:35Alright, I think next is Doctor Burtness
23:38talking about Diane her new role.
23:46Thank you need
23:47a UM, you know, for the opportunity
23:50to to work on on these issues
23:52and for the introduction.
23:54So I wanted to be brief
23:56because we are just starting,
23:58but the first thing that I wanted
24:00to say is I think inclusion is
24:02really a core value for all the
24:05components of the El Cancer Center.
24:08The Yale School of Medicine.
24:09Very explicitly, you know you know,
24:11envisions and inclusive community,
24:13where everyone's voice and contribution
24:16will be valued and respected.
24:17And we create a sense of belonging for all,
24:22and Yale.
24:23New Haven Health sees diversity
24:25and inclusion is important.
24:28Components of organizational values
24:30and is committed to providing
24:32an environment of inclusion.
24:34That's for patients, visitors,
24:36employees, suppliers, the community,
24:38and Yale.
24:39New Haven Health actually has won
24:42many accolades for its support of
24:46LGBT health for fostering a diverse.
24:49Workforce so we start.
24:51I think with a lot of strengths.
24:55Uh, let's see.
24:59Uh.
25:03Don't miss slides. So
25:06what are sort of?
25:08What are some of the challenges going to be?
25:11UM, as we attempt to?
25:14Make sure that we're as inclusive as
25:16possible, that we treat everybody
25:18as equitably as possible and that
25:21we're as diverse as possible and
25:23and so the first thing I think is
25:26understanding where we are.
25:28So I think you know,
25:30don't be surprised if we undertake some
25:33climate surveys or focused interviews
25:35so that we understand where we need to
25:38focus efforts on growing and changing.
25:40And I think one of the things
25:43probably the NCI is.
25:45Can expect from us one of the
25:47things the school may expect from
25:49us or the health system.
25:51If we're asking for resources,
25:52is to be tracking metrics about
25:55how we're doing overtime.
25:56I think Nita started out by by talking
25:59about how important communication is
26:01to building a sense of community,
26:04and I think that that's particularly the
26:07case for members of our Community who
26:09may wonder if they're fully accepted,
26:12or if they, if they're fully incorporated,
26:14so we will be having a part of
26:17direct connect every two weeks.
26:20Is is hopefully going to be
26:22highlighting successes in in diversity,
26:24equity, and inclusion,
26:25but even if they're not.
26:27Some huge steps forward.
26:29We will be trying to highlight resources
26:32and and and work that's ongoing.
26:35Many of us have participated
26:38in implicit bias training,
26:40either online or facilitated in person,
26:43but I think that repeating that
26:47potentially looking at it more extensive.
26:51Trainings and potentially more levels
26:54of the organization may be something
26:57that is worth thinking about.
27:00Certainly at the Med school and Residency
27:03and fellowship level across the country,
27:05there is a lot of work on bringing
27:08the eye issues into the curriculum.
27:12And so we'll be working with the
27:15education leaders on those things.
27:17Uh,
27:17I think one of the things that we
27:19want to see from our leaders is
27:22that they're successful in fostering
27:23an inclusive culture,
27:25and we want to be transparent
27:27when there are some.
27:29Issues of harassment or people
27:31or are having difficulty getting
27:33their their footing because they
27:36don't feel included.
27:37We want to be able to address that.
27:42We, uh, I think, recognize that among our.
27:50Faculty in particular.
27:52There are fewer investigators
27:54who come from groups that are
27:57underrepresented in medicine and science.
27:59Then we would wish,
28:01and so I anticipate in this probably
28:05will will roll onto the person who
28:08takes this role permanently after me,
28:12but that there will be a focus
28:15on recruitment and using a broad
28:18definition of excellence that.
28:21Some permits us to look around the
28:23country at a variety of institutions
28:25to identify people who could
28:27enrich our community,
28:29and then when investigators arrive here,
28:31make sure that there is mentorship
28:33and community that there are internal
28:36funding opportunities that if the
28:38COVID related story has been obviously
28:40very big for women and investigators
28:43of color over the past year,
28:45hopefully that's not going to
28:47be something that's in our
28:49future forever.
28:51Making sure that everyone has equal
28:53access to leadership opportunities and
28:55that we keep the conversation going.
28:57This is work that is going on across
29:01the university and across the school,
29:03and there are many people who are very
29:06passionate about it at many levels
29:08of the organization I just wanted to
29:11highlight three people from Cancer
29:13Center divisions and the Cancer Center
29:16leadership who are particular champions.
29:18So first of all, Harriet Kluger.
29:21Who headed the Committee for the past year,
29:24identified the need for
29:26an associate director.
29:27Really, I think passionately made
29:29the case and has been so effective as
29:32our associate Director of education
29:34training and faculty development and
29:36clearly issues of diversity are very
29:39important for education and faculty
29:41development and we hope to continue
29:44working with her and then two vice
29:47chiefs and hematology and oncology
29:49for dirs irisys Sophie and Pam Kunz.
29:52And then I just come.
29:54There are a lot of resources and they
29:58are all over the health system website.
30:01They are all over the Med school website
30:04and I just wanted to highlight a few
30:08the diversity and inclusion page on
30:11the Yale New Haven Hospital website,
30:13the minority organization for retention
30:15and expansion is a faculty group
30:18which works on welcoming investigators
30:20and faculty from underrepresented.
30:22Groups the Committee on the Status
30:25of Women in Medicine,
30:26which I've been a member of for
30:28about seven years.
30:30Has worked on many issues with regard
30:33to faculty leave compensation,
30:35representation on search committees and
30:38remains. I think a really strong ally.
30:42There is a Yale LGBTQ affinity
30:44group and you can link up with
30:47that through that website.
30:48The Dean has an Advisory Council
30:51on LGBTQ I plus affairs,
30:53and they also maintain an out list
30:55and I many people have already reached
30:58out to just say welcome to me.
31:01In this role.
31:02A few who have reached out because
31:05you have stories that you think
31:08it's important that I hear and I
31:10just wanted to to say bye.
31:13At least my virtual door is always
31:14open and I hope people will reach
31:16out to me and I hope to come back
31:19to you with more stories and in
31:21a couple of months. Thank you.
31:24Thank you Doctor Burtness and I also want
31:26to point out that Kim Slusser is also
31:29leading an effort for the hospital in.
31:31In looking into this from
31:32the health system side,
31:34and she's leading a committee,
31:35so hopefully we can chat and continue
31:37to keep this conversation as a regular
31:39piece both in smile or direct Connect.
31:41And in these sessions Next up is
31:43Doctor Marcus Bosenberg was going
31:45to talk about the new this new as
31:47the novel the director of ICIO.
31:50Thanks so much and and I just wanted
31:53to acknowledge too that we've actually
31:56had a Yale Center for Immuno Oncology
31:59since 2018 and Roy Herbst who was
32:02recently just presented was the
32:04inaugural interim director and I've
32:06functioned in that role since 2019.
32:09And as I think quite a number of
32:11you have noticed that we've had some
32:15very successful symposia annually,
32:17including over 400 attendees.
32:18Last fall there's a seminar series.
32:21That's been part of the Human Translational
32:24Immunology series of one date,
32:25a month up to now,
32:27on Tuesday afternoons at four,
32:29and we've had a number of working groups
32:31over the past year that we will be
32:34continuing and expanding in those roles,
32:36and I just wanted to give a very
32:39brief overview of sort of the vision
32:41and thought for the Center for
32:43Immuno oncology on a longer basis.
32:46And you know,
32:47in short the vision is to be the most
32:50impactful immuno oncology center.
32:51Anywhere, and that's a big and bold goal,
32:54and that will require likely some you know,
32:56raising money through development
32:58and philanthropy which has occurred
32:59also at other centers,
33:01but it builds on the strengths
33:02that we have in our Immunobiology
33:04department here at Yale,
33:06which is viewed as if not the best
33:08one of the very best in the world,
33:11and our strengths and cancer.
33:12So I think it really is possible with
33:15the talent that we have in hand and
33:18I just wanted to give an overview
33:20slide here of some of the core.
33:22Initial areas of interest and core functions.
33:25You know in terms of actual core
33:28like entities you know.
33:29T cell biology is just central
33:31to all of cancer immunology.
33:34There's many aspects of this.
33:36We're also interested in recruiting
33:38additional faculty member or
33:39members in this area.
33:41The tumor microenvironment is a
33:43unique aspect of cancer that doesn't
33:45occur in other areas of immunology,
33:48and those are more on the basic
33:50side but also have some.
33:52Translational and clinical applications.
33:54And then there's some other things
33:56that I'm sure in the future,
33:58either grand rounds or other fora
34:00that I'll explain in greater length,
34:02but looking at ways to personalize
34:04immunotherapy so that we can avoid
34:06immune related adverse events,
34:08which is another area where there has
34:11been some quite a bit of work at Yale,
34:13and I think some strength that we
34:16hope to increase efficacy of these
34:18agents and reduce side effects
34:20from that point of view.
34:22And the bottom 5 boxes.
34:23Here are core or core like functions that
34:26we hope to coordinate through why, CIO?
34:29Some of these exist already.
34:31Some of you are likely aware of the events
34:33cell therapy lab that Diane Krauss leads.
34:36There's a Center for
34:38precision cancer modeling,
34:39wish musami and myself have led that
34:41a number of you have used that.
34:44Does preclinical testing you know,
34:46including of immune oncology
34:47agents and we'd like to coordinate.
34:49And this is to add onto and to help make
34:52even more efficient.
34:54Some existing functions in light
34:56of an immune monitoring core
34:58informatics capabilities at Yale.
34:59But to make it easier for investigators
35:02that are IO oriented to do their
35:05work and also we'd like to add the
35:08ability to collect biospecimens,
35:09for instance bloods,
35:11prior to immune therapy,
35:12and this would add onto existing
35:14efforts at Yale by a number of people,
35:18including in Harriet, Kevin,
35:19Harold and Pat La Russo and others are now.
35:23We're also trying to do this.
35:25In in this space and so how
35:28are we going to do this? Well,
35:30you know there will be some new factor rooms.
35:33There are actually two
35:35slots that are currently.
35:36We had made an announcement last May and
35:39had made some recommendations in terms of
35:42candidates which are still in process.
35:44Now that will likely continue
35:46and we anticipate that this will
35:49continue over the next few years
35:51with a couple hopefully more
35:53slots happening over that time.
35:55And then the other part.
35:56That's really a core aspect of why CIO is
35:59to help yell faculty get into this space,
36:02get funding,
36:02learn about what they can do in this,
36:05and to come to pair them up with
36:07collaborators that are effective in
36:08both their discovery and grant funding.
36:10And you know,
36:11I think that's a real core aspect with all
36:14the talent we have at Yale to help others.
36:17So to add value by,
36:18you know,
36:19enabling the folks that are here at Yale,
36:21and to provide or recruit additional
36:23folks where there are areas.
36:25Or might be a little bit
36:27later in terms of depth,
36:28and I'll I'm actually looking forward to
36:31speaking with a number of you individually.
36:33I'll be reaching out on that basis,
36:35but anytime individuals would like to.
36:38Give input about what they think,
36:40why CIO should be doing.
36:42I'm always list ready to to to talk
36:43or or have a conversation about that
36:45and we will making some announcements
36:47about pilot funding over the next
36:49several months and it will be helpful
36:52to be AY CIO member to do that.
36:54Which basically is submitting a
36:56biosketch and a small paragraph
36:58about why you'd want to be a member.
36:59It's a pretty low bar in terms of
37:02trying to get people to be interested,
37:04but that would be one of the
37:06things that will be doing,
37:08and so I will stop.
37:09Hearing and allow for enough time
37:12for questions,
37:13hopefully.
37:14Thank you so much and thank
37:16you to all our panelists.
37:18I think I'd like to open up
37:20the agenda now for question,
37:22for Q&A and so folks can start
37:24typing it in the chat box.
37:26But while they're doing that,
37:28maybe Monocle asks you a question as we
37:30as as we wait for people to chime in.
37:33I guess you know clearly a lot
37:36of people are curious as to how
37:38implementation will happen and
37:39how do we and I think part of
37:42it reflects our sites, right?
37:44We are big insights.
37:45In scope, and we also then have
37:47so many different disease.
37:49So how do you see that?
37:51Taking across you know from?
37:53In terms of the different phases,
37:55because I think that could,
37:56there's a lot of interest in this
37:58because this effects all of her life.
38:00So maybe if you can spend a couple
38:03minutes on that Monica and I
38:05actually will start off with some.
38:07Each of our work groups has
38:09representation from not only the
38:11network and but the main campus
38:13and the different disease teams,
38:15as well as all the different roles.
38:17So we were purposeful in determining
38:19who was going to participate in each
38:22of the groups so that we had act
38:24adequate representation across all
38:26treatment modalities as well as areas.
38:29And we will do this in phased approach,
38:31so we'll start small with pilots
38:34because it's very easy to.
38:37Modify workflow changes or processes when
38:39you start with a small team and then
38:42as we get better and smoother we will
38:46implement that slowly over different
38:48disease teams as well as locations
38:51and I can tell you that each of the teams.
38:56Everything that one size doesn't fit
38:58all because we know that surgery is
39:00going to be different than radiation
39:02versus Med ONC and we have to be
39:05thoughtful and identifying what are
39:06the key elements within whichever
39:08team it is that we will are.
39:10The are the core elements of that
39:12work and then it may look a little
39:14different within how it is with
39:16rolled out within surgery.
39:18Or you know a specific disease,
39:20team or location.
39:21So we'll start small and
39:22we will continue to add it.
39:24So it's going to take a lot of times.
39:27Come to be able to do this work.
39:31So I see Kim Slusser has also joined
39:33us and maybe Kim would like to add some
39:35other comments or if there is any other
39:37things you'd like to highlight him. Uhm,
39:41no. I I agree with what Monica said.
39:44I think the most important piece and
39:46I know Monica said it a couple of
39:48times is that there is engagement
39:50across all disciplines and all sites.
39:53And we do recognize that the work
39:55may look different within the teams,
39:57but the core principles of what
39:59needs to be done to ensure all
40:01the team members are prepared for
40:03clinic to take care of patients
40:05that adequate coordination of care
40:07happens and that we have efficient
40:09workflows because everybody is really.
40:11Aligned in the work,
40:12I think that's the power of these workgroups.
40:15It's coming together to determine what
40:17those needs are for patients and for
40:19our teams and then creating workflows
40:20to make that happen efficiently.
40:22So, as Monica said,
40:24it's going to take some time
40:26to get across to all areas,
40:27but I think with each implementation as well,
40:30we will learn more and will
40:32keep adapting as we go.
40:33And that's a whole piece
40:35of the process as well,
40:37so it's not kind of this Big Bang.
40:39And then there's a lot of problems.
40:42That we have to go back and solve.
40:43It's that we do this in increments
40:45where we're learning as we go.
40:48And I'm going to just remind folks
40:50to type in their questions and the
40:52panel in the chat so we can see it.
40:55But perhaps the other part.
40:56You know, if if they were starting with the
40:59pile and given the scope came in and Monica,
41:01do you have a timeline in your mind
41:03of when you expect to sort of,
41:05you know, see, you know we're you
41:07know this is 30% of the workforce.
41:09So almost again chart where we can say, OK,
41:12we know we're on the right track and you
41:14know this is like a surgeon talking right?
41:17Everybody knows the surgeons.
41:18Wanna see you know a timeline but
41:20but just sort of bringing it and
41:22again all of this sometimes can be
41:24we can go a little buffer but I think
41:26part of as we start on the journeys.
41:28Also thinking about the finish
41:29goal and what does that look like?
41:31Not that you ever finish,
41:33but I'm going to put you out there a
41:35little bit just to sort of 'cause I
41:37know many people are probably eager to
41:39hear more. Yeah sure.
41:40I think the complaint.
41:41The one thing to think about is
41:43the complexity of each of the work
41:45groups so we know that there's
41:47a lot of effort and focus on.
41:48The checkout process and how can we
41:51make sure that the discussion and
41:53plan with the patient in the during
41:56the clinic translates to someone
41:58doing the next steps of that visit,
42:01whether it's scans, imaging, referrals,
42:03labs you don't or no follow up.
42:06And So what are the and we have
42:09to understand what's out there
42:11for us to use so that we can work
42:14smarter and that we're not putting
42:17burden on one specific person?
42:19So I'm gonna say that the
42:21checkout process is going to be.
42:23A much longer process potentially
42:25than the work that we're going
42:27to do around the pre clinic prep
42:29and the visit criteria so,
42:31so we're already starting the pilot for that,
42:33but I know that the work that's being
42:36done around check out or infusion
42:38may take longer and it's only
42:39going to affect pockets of people.
42:42So I would say that it's months of going,
42:44you know, picking away at this,
42:46but can I tell you that will all
42:49be done by the end of the year?
42:51Or I I can't give it?
42:54Timeline
42:54for no. And then I don't expect
42:55you to, so I I don't like.
42:57I would like to I would
42:58like to say you know what?
43:00By December 31st we're gonna
43:01have all this work done so that
43:03we can move on to the next part,
43:04but that's not the reality.
43:05So but I can tell you that.
43:08You know we've had, UM,
43:10the group of people that are participating
43:12are so engaged they attend our meetings,
43:14there's homework with each of our groups.
43:17They come back with the information
43:19because we asked them to go back
43:21to different teams and stakeholders
43:23to ask for feedback on things
43:25that we're working on.
43:26And all that is done.
43:28So it is.
43:29It is really I'm speaking on the
43:31work of many that are really spending
43:34a lot of time on this so that it
43:37is really valuable in the end.
43:39We don't want you know.
43:40The worst,
43:40the last thing we want is to spend
43:42a tremendous amount of time and
43:44then not see impact at the end, so.
43:47And I would just say that I think as we
43:49launch and we mentioned this last month
43:52that Kevin Billingsley and I are getting
43:55ready to launch the Clinical Council.
43:56I think that will be one venue that the
43:59ambulatory transformation team will be coming
44:01to on a regular basis to give updates.
44:04And then these town halls to continue
44:06to come back and give updates because
44:08I think it's important for the teams
44:10for all the teams to know where
44:13we're at and the progress.
44:14And as Monica said, all of these work.
44:17Close will have metrics attached to them,
44:19and that's critical to to know
44:21how much we are improving.
44:23You know our operations and our care
44:25delivery for our patients so and and and
44:27the environment in which our teams work.
44:30So I think that that's just critical
44:32to have those venues and I would
44:34say if there are areas that want
44:36to hear in more detail about the
44:38specific initiatives you know,
44:40please reach out and we
44:41can make sure that we have.
44:43There are lots of the leaders
44:45have been going on the road.
44:47So to make sure that everyone knows the
44:50work that's being done and that can and
44:53that they can contribute to that work.
44:55So don't be shy and just let us know.
45:00Thank you in Monica and Monica, Renee.
45:02If I miss any questions
45:04please keep me honest.
45:05I think the other part Barbara.
45:07I know you mentioned in your chat
45:09in your conversation that many
45:10have already reached out to you,
45:12but if people want to reach out to you,
45:14I presume it be nice to highlight your email.
45:17I presume most people know how to
45:19get in touch with you, but if not,
45:21I'll ask Renee to highlight that information.
45:23I was thinking about that that we
45:25probably want to make sure people
45:27know how to reach you easily and I
45:29don't know if.
45:30If if the slides get shared on,
45:33people can find it, but it was.
45:35It was the last resource on the
45:37slide and it's Barbara. Ducker will
45:38share so people can. I
45:40know you're just both.
45:41You and Marcus are just beginning
45:43the journey, so I don't want
45:44to put you on the spot, right?
45:46I'd like to come back with one
45:48question and I know many people I've
45:50been listening to various groups,
45:52the Clinical Trials Office are
45:53physicians who are on the front
45:55lines as well as the leaders,
45:57and I guess as I'm learning about the
45:59clinical trials, I'm stuck by how many.
46:01Details are there.
46:02A lot of people have expressed
46:04their desire to help.
46:05How can they help us?
46:07I mean, I think you mentioned some of this.
46:10You know, answer those you know.
46:11Get those things.
46:12Perhaps you can speak a little bit on that.
46:15How can folks help?
46:16'cause I know there's a big
46:18desire to make these things you
46:20know start activate on time.
46:22But how can folks help you
46:24and look CTO office? Thanks.
46:25That's a very good point.
46:27There's so many processes involved
46:29in getting trials activated,
46:30and it often involves.
46:31Input from the dark until investigators,
46:34what's? What's it?
46:35What's a billable item for
46:37a clinical versus research?
46:38Sometimes you need a form style 1572.
46:41There have been people who have had
46:44expired trainings, so when you get
46:46an email from the CTO for that,
46:49please try to do it right away.
46:52Work with your administrative support.
46:54We really need that.
46:56Things like filing the actual paperwork.
46:58I'd rather have a CTO team do you.
47:01You know,
47:02I know people have offered to do that too,
47:04but I think we should have, you know,
47:07the regulatory work is so precise,
47:08will have the team do that,
47:10but we do have so many things that go
47:12back and forth and everything takes time.
47:15You know, it's it's like any other project.
47:17Project management is so important
47:18we're making progress.
47:19We have.
47:20We're hiring more regulatory
47:21staff of our own.
47:22We already have some amazing people you know,
47:24like basically.
47:25And then we're also bringing
47:26in extra help from your on.
47:28But we need the investigator that
47:30the dark teams, uh, the nurses.
47:31That the staff to all they'll be engaged,
47:34and it also doesn't hurt to push you.
47:36I don't mind people pushing.
47:37I push you have your trial.
47:39It's your research, you know,
47:40make it happen and again,
47:42you know with limits.
47:43But we want to try to get
47:45these things going in,
47:46and I'm certainly I'm an investigator
47:48myself so I know what it means and I care.
47:51And I'm certainly around to help as well.
47:54Thank you doctor.
47:55So I mean it's positive engagement and
47:57we want though all the oars rowing in
47:59the same direction than any comments
48:00from you on the broader things.
48:02I think we had a lot of good news.
48:05Anything else you want to point out?
48:07I know you're here and joining us on
48:09the panelist here. No,
48:10I think we had a good summary today.
48:14The director search is ongoing.
48:15They understand that they have
48:17completed the first round of
48:19interviews for a new director.
48:21And we make a recommendation,
48:22or at least a list of suggested names
48:24to the Dean by the end of the month.
48:26And that in the meantime,
48:28we are proceeding with our renewal for
48:30the major Cancer Center support grant.
48:32Will get were actually just this week
48:34we started giving instructions to
48:35write to start writing the new grant.
48:38So let let going on.
48:39Yeah and lot going on
48:41and thank you and I think
48:43from what I've heard.
48:44Although I'm not on the search committee,
48:46but I've heard lots of great candidates.
48:48So I think the search committee is
48:50really excited about our next director.
48:52Alright, if there's no more questions.
48:54I know it's a long holiday and I want.
48:57Sort of safe.
48:58We're done 10 minutes or 9 minutes early.
49:00I don't think anyone's going to be upset.
49:03It's again, I do encourage the folks if
49:05they want to ask questions. You know,
49:07there's only a certain number of ways,
49:09so typing the questions
49:10either directly to me.
49:11If you don't feel comfortable sharing it
49:13with everybody is also a way to do this.
49:15I know all of you want to ask questions,
49:18so I know you're not shy,
49:20but I do encourage you to ask if
49:22we don't know what's on your mind,
49:24we can't answer that question, so again,
49:26hopefully will build up that interaction.
49:27And those muscles.
49:28But thank you to all our panelists.
49:31You're very good.
49:31You kept it on schedule and we're even
49:34finished a few minutes early, Renee,
49:36just I think you wanted me to remind them no,
49:39no town hall in August.
49:40And if they have agenda items in mind,
49:43I think I'm going to get this right.
49:45Cancer answers at yale.edu.
49:47If you have questions and things you want,
49:49see here.
49:50Again, if you send us those things,
49:52we can bring them up.
49:53But if if I if we don't hear from you,
49:56then I will kind of.
49:58Shooting in the dark,
49:59but I will try to bring all the news.
50:02Good bad positive news things we
50:04want to talk about as a community.
50:06So thank you all.
50:07Please enjoy the long weekend.
50:08If you do have some time,
50:10I hope everyone gets some time off this
50:12weekend to enjoy and hopefully it'll
50:14cool down a bit and everyone can enjoy.
50:16So thank you everybody.
50:17Thank you to all our panelists.
50:19Doctor Hurst.
50:20Thankfully we heard you and it
50:22didn't rain so it but the clouds
50:24back behind you look really dark
50:25so I would get inside alright.
50:27Take care everybody bye bye.