March 2009
Feature Story

Anne Ford

As recently as a year and a half ago, CAP executive vice president Charles Roussel had little firsthand knowledge of pathologists’ role in patient care. That changed in early 2008, when his wife was diagnosed with carcinoid tumor of the liver. Like the family members of many cancer patients, he recalls feeling “so powerless in the medical system,” he says—particularly since her tumor had been thought to be benign before the surgical pathology report revealed otherwise.

“That experience really reinforced for me the importance of getting the right diagnostic information to patients and helping them interpret it,” Roussel says. “Having an advocate there from the beginning, the person who was looking at her cells or her tumor tissue, would have been greatly reassuring to me.” That experience has fueled his personal mission statement in his new role as executive vice president: “to help our members get the right science to the right people at the right time.” (Happily, his wife is now doing well.)

Formerly a director at The Atlantic Philanthropies (a foundation devoted in part to improving health care access) and a managing partner at global consulting firm Accenture, where his duties included serving as an advisor to pharmaceutical companies, Roussel joined the College Jan. 5. An MBA graduate of the University of Chicago Booth School of Business, he has served on the board of trustees of The Children’s Aid Society of New York and on the advisory board of the Mount Sinai Adolescent Health Center, East Harlem, NY.

Despite Roussel’s health care experience, he freely acknowledges that, as a nonphysician, he’s a nontraditional choice for the role of EVP at a medical society such as the CAP: “I have not led an association. I’ve spent time in the medical field in big pharma and biotech and elsewhere, but not in this role. What I bring is the understanding of what broad-spectrum change involves and how organizations can undertake that with success. My CV is about transformation. Their [the College search committee’s] choice of me, I think, signals something.”

Yes, it does, says CAP president Jared Schwartz, MD, PhD—the College’s dedication to transforming the field of laboratory medicine as new technologies emerge, trial-and-error medicine becomes a thing of the past, and pathologists become more visible members of the patient care team.

“We have quite a challenge, and that is to prepare our members for not only a change in how health care is delivered but also a change in the diagnostic tools we use. It doesn’t matter if you’re Sony or the College of American Pathologists, the environment changes, and you’ve got to continue to develop new strategies to deal with it,” Dr. Schwartz says. “In order for us to continue to be successful, we’re going to have to significantly change the way we do things. Not only how we do things, but perhaps even what we do.

“The feeling was that we needed an executive vice pres­ident—someone who’s an on-site leader and motivator, someone who’s able to walk the factory floor, as we say—who has the understanding of how you take an organization and help transform it. We wanted someone who would be very involved with helping us develop strategic objectives for the College and our members over the next several years. The search committee felt very, very quickly that Charles was the right person.”

One of Roussel’s primary goals will be to create a deeper understanding among CAP members and staff as to what transformation really means. “It’s one thing to say you’re committed to transforming the specialty,” Roussel says, “and another to make that real and tangible to the point where there’s broad buy-in, acceptance, and commitment, not only by people within the College but by other physician groups, the government, hospital administrators, lab professionals.”

To do that, he adds, it will be necessary to develop what he calls a “taxonomy of transformation”—one that clarifies the role of the CAP’s Institute for the Advancement of the Pathology Specialty as well as that of the Pathology and Laboratory Quality Center, and that answers the questions: “What do we mean by a transformation program? What do we mean by ‘enabling change in member ranks’? What do we mean by ‘competency building’? Creating some nomenclature that’s broadly under­stood seems to me to be an important goal,” says Rous­sel.

Establishing that terminology will be a necessary precursor to what he foresees as the three- to five-year process of developing a transformation program that begins to change the way pa­thologists are perceived and the skills they possess. It’s a generational undertaking, Rous­sel says: “It involves everything from how young pathologists are educated to what they do in their residency programs to what they do in their fellowship programs up through the way our more experienced pathologists are trained for what they do. Building understanding and momentum for that effort constitutes the front end of my strategy.”

That strategy may also include something Roussel calls a transformation program office—an integrative structure within the College that would provide shared resources to the Center, the Institute, and other transformation efforts. “For example, having a communication specialist or a project manager or a financial analyst assigned to each of the initiatives,” he says. “I think we’ll be stronger if we share resources.” Another possibility is a formal emerging business opportunities process. “It’s very hard to house innovation within existing divisional structures. So when you think about innovation, in my view you need to have a special structure for dealing with that. We’d harvest new ideas, incubate them outside of the current divisional structure, put a business case together, begin to do some pilot initiatives, and, if the pilots prove viable, roll them back into the divisions.”

Whatever form the College’s transformational efforts take, of course, they will need to be financially sustainable in an economically challenging climate. “It would be imprudent not to think about the economics of our business given the macroeconomic conditions that are out there. No organization, even a health care organization, is completely immune to an economic downturn,” Roussel points out. While the College has been successful financially, he says, “the challenge going forward will be to continue that revenue growth, and to continue to generate excess earnings so we can fund the transformation. For example, creating a knowledge exchange for allowing our members to work with one another online—that’s an expensive undertaking.”

On a related note, he continues, pathologists have to be acutely aware of what it costs to provide quality care to patients—and do what they can to contribute positively to the economics of their own institutions. “We as a profession need to be more focused on the unique value pathologists can provide better than any other physicians,” Roussel says. “And since pathologists have been behind the scenes historically, we need to come out of the shadows and not be afraid to talk about what it is we know, and that’s disease at the molecular level. In the context of personalized health care and genomic medicine, that level of expertise is highly valuable. That’s the story we’ve yet to tell broadly. And we have lots of people to convince.”

Transforming the practice of pathology, of course, will require strategizing in non-financial arenas as well. Dr. Schwartz says, “It’s going to require working together with many other organizations, both within and outside pathology.” He cites the College’s relationship with the American Society of Clinical Oncologists in developing guidelines for cancer prognostic markers as an example of the many alliances that will be needed.

“There’s strength in numbers,” Roussel agrees. “To the extent that the 15 or 16 pathology-related profes­sional organizations can align on a set of specific priorities in Washing­ton, that would be extremely helpful. There’s going to be a lot of noise in Washington as all of the medical specialties try to find a seat at the table.”

Amidst that noise, it will be crucial for the College to make sure all sizes of pathology practices are ­represented. “A large percentage of our member base consists of relatively small practices of five to seven pathologists,” Roussel points out. “The future is going to look different for them than it will if you’re the chair of the pathology department at a large academic medical center. We need to be able to articulate the value that that small pathology group will bring as much as we need to be able to talk about what’s happening in the Mayo Clinics and the Mass Generals and the Johns Hopkins.”

Of course, just talking about transformational pathology is enough to cause anxiety among some. “There’s a rising level of discomfort because of all the change that’s happening,” Roussel acknowledges. For example, he anticipates that not everyone will immediately feel at ease with the notion of having pathologists extend the value they provide by performing fine-needle aspiration for biopsies of the thyroid, a topic that will be discussed at CAP ’09. But discomfort in the face of change is just human nature, he says, and something the College will do its best to anticipate and ease. “As a professional society, we can help them [members] feel more comfortable in that capacity,” he says.