![Chapter 07: Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care](https://openworks.mdanderson.org/mchv_interviewchapters/1692/thumbnail.jpg)
Chapter 07: Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care
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Description
In this chapter, Dr. Ecung discusses the period when she was managing Station 55 and was also tapped to reorganize Station 65, now known as The Breast Center. She explains that this was the first of a number of situations in which she would serve as a “turnaround agent.” She describes some of the skills she brought to that role and then sketches the situation in Station 65 when she took over. Dr. Ecung explains that she wanted to bring a new view of nursing and nursing culture through a rapid team transformation. She explains that she was successful in establishing a core group of people who supported her vision of empowering nurses as decision makers working in concert with physicians.
Identifier
EcungWB_C07
Publication Date
11-3-2016
City
Houston, Texas
Interview Session
Wenonah Ecung, PhD, Oral History Interview, November 03, 2016
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Clinician; The Leader; MD Anderson Culture; Working Environment; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Discovery and Success; Leadership; Mentoring
Transcript
Tacey Ann Rosolowski, PhD :
And we were strategizing a little bit beforehand, reminded ourselves that we left off last time talking about your role working on Station 55. And so now I wanted to kind of talk about that expanded role when you were in charge of both Station 55 and Station 65. So maybe you could talk a little bit about how that happened, and what Station 65 is?
Wenonah Ecung, PhD:
Okay. Or was, at that time.
Tacey Ann Rosolowski, PhD :
Was. Okay.
Wenonah Ecung, PhD:
Okay. So yes, I had Station 55. Station 65 was, at that time, the Breast Center. Or it saw all breast patients. It wasn't necessarily called the "Breast Center," but the patient population were breast patients. It was in quite a bit of turmoil. Leadership had turned over involuntarily. An individual had been let go.
Tacey Ann Rosolowski, PhD :
Can you say who that is, or
Wenonah Ecung, PhD:
I'd rather not.
Tacey Ann Rosolowski, PhD :
That's fine. And who took over?
Wenonah Ecung, PhD:
So I took over.
Tacey Ann Rosolowski, PhD :
Oh, okay.
Wenonah Ecung, PhD:
So they asked me to go in. And that was sort of the beginning. I think that was the beginning of where an area was in trouble, I became like a turnaround agent. When an area was in trouble, they'd ask me to go in to organize it, straighten it out, initially do an assessment of what was going on. Implement and then we'd hire somebody to come in and be the leader of the area, and I would move out. So it would take me usually about a year to do that.
Tacey Ann Rosolowski, PhD :
Can I ask you, I mean, what were the special skills that you brought to that kind of a role?
Wenonah Ecung, PhD:
I think what they saw in me was my ability to organize, my ability to listen, my ability to form relationships. Not just with the nursing staff, but with the faculty. And I think that'sI also had a good running center in terms of Station 55. I was respected by the faculty. I had a group of nurses that worked with the faculty. They were a cohesive team. And I think administration at that time wanted to transplant that in other areas. So I believe that's why. I'm pretty sure that's why I was asked to go in.
Tacey Ann Rosolowski, PhD :
Who was responsible for making the request to you, and
Wenonah Ecung, PhD:
Right. At that time, Cecil Brewer was my Director.
Tacey Ann Rosolowski, PhD :
And his title was?
Wenonah Ecung, PhD:
He was the Director of Nursing.
Tacey Ann Rosolowski, PhD :
Okay.
Wenonah Ecung, PhD:
He had inpatient areas as well as outpatient areas.
Tacey Ann Rosolowski, PhD :
Okay. And so he
Wenonah Ecung, PhD:
So he was the Director of Nursing. And Joyce Alt was the Chief Nursing Officer.
Tacey Ann Rosolowski, PhD :
Okay. And so they were the ones that approached you and asked you to take on this role?
Wenonah Ecung, PhD:
Cecil actually did.
Tacey Ann Rosolowski, PhD :
Okay. Did you think about it or say, "Yeah," right away?
Wenonah Ecung, PhD:
I'm sure I thought about it, but I'm also sureCecil never asked me to do anything he didn't believe I could do. So I saw it as a huge vote of confidence. He was not only my Director of Nursing, but he was one of my mentors throughout my career. And he had always shared with me, when you're asked to take on complex assignments, you don't say no. You go in and you do. So I did. I was assuredI felt good that he would be by my side to support me if I had questions, if I ran into areas that I didn't quite have a solution for, I knew I could go to him and we'd talk out loud about things. And that turned out to be true. I had to develop reports for him on a quarterly basis to share with him what my findings were at the time, what action plans I had put in place, and an evaluation of those action plans. At the same time they were also speaking with the faculty to see what their thoughts were. They were speaking with the staff to understand what their thoughts were. So not only was I asked to turn the area around, but the actions I was taking were also being evaluated. Yeah.
Tacey Ann Rosolowski, PhD :
I see. Now, what was yourdid you have a vision for what was going to happen in this turnaround? Or how did you approach the task?
Wenonah Ecung, PhD:
Well, what I understood back then was pretty much, there weren't any relationships. And you have to understand, this really centered around nursing and faculty. There weren'tthose relationships didn't exist. Nurses were quick to say, "That's not my job," so faculty didn't feel supported in the area. And it was just the opposite in Station 55. I hired in nurses that understood we work as a team. I think I used the word with you last time, "protégé."
Tacey Ann Rosolowski, PhD :
Yes.
Wenonah Ecung, PhD:
You kind of become a protégé of the physicians. I believe firmly, if they were within their skill range, in supporting the physician, because ultimately when we do that, we're supporting the patient, not just from a nursing perspective, but holistically. So that part was missing in 65. [There were] fiefdoms, if you will. And so my vision at that time was to bring those groups together, to help those nurses feel good about the work they were doing and the work that they could do, to help them understand it is okay for us to practice in a broader fashion. Yes, we are nurses, we are bound by what we can do in nursing. But if there's more that we can do, our license doesn't bind us. It actually says our duty is to protect the patients. So if that means double-checking a dose, then that's what we need to do. So I can remember vividly one of the first things I did withand Dr. [Gabriel] Hortobagyi was [the Chair and Dr. Theriault was] the Center Medical Director at the time, I believe. But one of the first things I did was, we had a meeting with faculty and nurses together and talked about how we were going to build a team. One of the things I always did, because this wasn't the first area that I'd gone into as a turnaround agent. But I would hold a meeting with the nurses, be very clear about what my vision was. And I was very frank in terms of they had a decision to make, whether they wanted to stay or they wanted to go. If they wanted to go, I was happy to try to help them find a position. But what I wanted was people that were willing to embrace the team's transformation that we were going to undergo. And it was going to be a quick transformation. So it meant there was going to be some pain with it.
Tacey Ann Rosolowski, PhD :
What was the reason for the pain? I mean, change is always tough. But what did you see? And what became the pressure points?
Wenonah Ecung, PhD:
Well, I think the biggest pressure point was that nurses didn't want to be handmaidens to faculty, to the physicians. And prior to me coming in, some of the tasks that they were asking them to take on, that was their view. It was creating this handmaiden situation. And I just didn't see it that way. So my challenge was to not only find what motivated them from a nursing perspective, but what would motivate them and help them turn that corner in focusing not on the handmaiden concept, but on the concept of the patient, and recognizing, again, what we do, even if we do it on behalf of the physician, is impacting the patient. And that's our ultimate goal. So I had to keep at the center, at the core, the patient.
Tacey Ann Rosolowski, PhD :
So how did you do that? I mean, what was the communication process to
Wenonah Ecung, PhD:
Well, one thing I did, the first thing I did was make sure after I had this talk about did you want to stay or did you want to go, I identified a core group of nurses that were willing to get in there and dive in with me. And I did that. Like I said, 65 wasn't the only place I did that with. I think it was Station 87 at the time. It was General Oncology, I ended up going in there and doing the same thing. But I'd surround myself with a core group that was committed to the vision that I had. So that was important, developing that team right up front. Then I would empower them. I wasn't there to be in charge, tell them what to do. They knew breast better than I did. I knew administration, and I knew how to organize. But they knew their disease. So it was pulling them [together] and empowering them. And you can be an important part of this decision-making team; it's not just taking orders from the physician, it's giving input into what's going on. I have to admit in each of the areas, the physicians were ready for this.
Tacey Ann Rosolowski, PhD :
Really?
Wenonah Ecung, PhD:
Mm-hmm. They weren'tthe pushback was on the nursing side. It wasn't on the faculty side.
Tacey Ann Rosolowski, PhD :
So just so I get a clear idea, so because I'm a little thin on specifics, because I don't reallyI don't go to a clinic, I don't see these relationships in action. What kind of conversations would an empowered nurse have with a physician, in an ideal sense?
Wenonah Ecung, PhD:
Yeah. So traditionally, before I entered the area, basically they saw their job as putting the patient in the room, taking the vital signs, and recording that. Okay. They saw that as their job, and they were content to have that as their job. So where I wanted to move them to was, one of the things I did was reorganize where everybody met, so if I was going to beI changed things and started talking in terms of primary teams. And so I would assign a nurse to work with a specific physician. And that nurse and that physician would literally sit side by side together. And when he would write an order for pharmacy to carry out, like chemotherapy, that nurse was responsible for knowing how to calculate that patient's BSAthis was newknowing how to calculate that patient's BSA and verifying that the dose he had written was appropriate for that patient's BSA. That was a whole new mindset. That was a whole new level of responsibility, that some nurses didn't want, because not only did they not want it, but once a physician comes to rely on that, I mean, you have to understand, they were seeing, many days, 30 and 40 patients a day, and writing chemotherapy, mistakes can be made. But if I know as a nurse, I'm responsible for helping to check that dose, then suddenly I'm accountable if there's a mistake made, right? It didn't relieve the pharmacist of their responsibility, but we didn't have pharm Ds in the clinics at that time. So it was the nurse and the physician. So that's an example. Checking chemotherapy doses. Nurses were responsible for nowit's not just putting Wenonah in the room and taking her vitals. I expect you to go in and say, "Dr. Tacey, I've just roomed Wenonah. Remember, here's what we did for her last time." So it was taking him through that patient's history, what had been done, what his plan was for next time. Many times the fellows would do something like that. But fellows in the centers, and really in the inpatient area too, would come and go [ ]. They weren't permanent fixtures. I wanted the nurses to understand, [ ] you and your faculty member are the permanent fixtures for the patients, so it's really helpful if you know as much as [you can although] you're never going to know as much as your faculty member knows. But if you're truly a part of that patient's plan of care and you can help remind him of what had been done, and the direction he wanted to take. It also built relationships between the nurse and the patient. Patients came to rely onthey knew Wenonah was their nurse. So they had an increased level of confidence. What I knew about them, what I knew of the plan of care for them that their physician had designed. So there was additional trust there. But like I said, that was a whole new level of responsibility that some people just didn't want.
Tacey Ann Rosolowski, PhD :
So this was in kind of '93or, I'm sorry, I'm looking at this'89 to '90 was when you did that transition year.
Wenonah Ecung, PhD:
Okay.
Tacey Ann Rosolowski, PhD :
And, yeah, so what did youhow did the process go of kind of shifting this mindset, and what was really accomplished at the end, by '90, by the end?
Wenonah Ecung, PhD:
By the time I left, they were working in teams. There was primary care nursing, nurses were assigned to physicians. They weren't accessible to any and every physician.. Like you turn around and suddenly Dr. X is asking you to do something, and you turn another way and Dr. Z is asking. I had built the relationships to where there were cohorts of nurse, physician and the clerk [teams]. So they were functioning as small teams throughout the center. So I had been able to accomplish that. And the agreement was, once I go in, build the relationships, put in new systems, the agreement was always to hire a permanent leader for that area, nursing leader for that area. So after 12 months, I felt they had accomplished that. And we began to look for a new person to come in. And also, part of the agreement is that I would ease out. I didn't just drop things and go, it was, like, a three-month transition.
Tacey Ann Rosolowski, PhD :
Who was hired to take on the role full-time?
Wenonah Ecung, PhD:
I knew you were going to ask me that.
Tacey Ann Rosolowski, PhD :
Oh, that's okay, I mean
Wenonah Ecung, PhD:
And I don'tI know Fran Zandstra, but she wasn't the one immediately hired. Was it NancyI don't remember. Yeah.
Tacey Ann Rosolowski, PhD :
That's okay. It might be something that comes later, we can pop it into the transcript or something. Now, I had wanted tois this a good time to ask you about your observations about multidisciplinary care? Or
Wenonah Ecung, PhD:
Well, we weren't talking in terms of multidisciplinary care at the time. We were stillyou still had Medicine working. The patient would go see Medicine, they'd leave and they'd go to another area and see the surgeon, different station to see the surgeon. So we weren't talking in terms of the one-stop shopping, the multidisciplinary care [concept]. But the areas that I oversaw were unknowingly moving in that direction.
Tacey Ann Rosolowski, PhD :
And what were the signs that you saw? Okay
Wenonah Ecung, PhD:
The teams havingyou know, I think the first disciplines coming together were the nurse and the physician. Those two disciplines coming together. Now, when I went toit was after Station 55 that [ ] the discussion started on multidisciplinary care, one-stop shopping and the concept of centers. That's when multidisciplinary care actually began. And it was at the end ofI don't know what year it was, but there was transition year where allwe weren't called CADs at the time, Nurse Managers, I guess, is what we were called, even though I had a different title, because I had the two areas.
Tacey Ann Rosolowski, PhD :
And what does CAD stand for?
Wenonah Ecung, PhD:
CAD is Clinical Administrative Director.
Tacey Ann Rosolowski, PhD :
Okay.
Wenonah Ecung, PhD:
Yeah. But the discussion started, the plans were underway. Everybody that oversaw a station had to re-interview, because they were looking for a certain phenotype, if you will, although I'm not sure they were clear on what phenotype that was. (laughter) So we all had to re-interview for our jobs. And
Tacey Ann Rosolowski, PhD :
So this was in '93 when you moved into the new role?
Wenonah Ecung, PhD:
It was when I entered the Sarcoma Center. What year is that onI don't have my resume in front of me.
Tacey Ann Rosolowski, PhD :
Yeah, I'm justwell, let's see. I don't think I putoh no, I have yours in here, too. You can probably find it faster than I can.
Wenonah Ecung, PhD:
Yeah. Yeah.
Tacey Ann Rosolowski, PhD :
So is this still
Wenonah Ecung, PhD:
Right. Right. So I was actually with the Breast Center and 55 through '96.
Tacey Ann Rosolowski, PhD :
Okay. Oh, really? Okay, through both. Wow. Okay.
Wenonah Ecung, PhD:
Mm-hmm. From '93 to '96.
Tacey Ann Rosolowski, PhD :
All right. And so the transitionso the Ambulatory Administrative Practice Coordinator title, when and why did that happen? And did it reflect a different type of
Wenonah Ecung, PhD:
Yeah, so we've probably confused things, because the Ambulatory Practice Coordinator position was the combined role at 55 and 65.
Tacey Ann Rosolowski, PhD :
Got you. Okay.
Wenonah Ecung, PhD:
So it was to give me a broaderto differentiate me from the other Nurse Managers, a broader title, a larger title. And that was something I negotiated with Cecil.
Tacey Ann Rosolowski, PhD :
Can I ask you a personal question and see if you got paid more for that?
Wenonah Ecung, PhD:
I did.
Tacey Ann Rosolowski, PhD :
Yeah. And was that part of the negotiation process?
Wenonah Ecung, PhD:
It was part of the negotiation. Mm-hmm.
Tacey Ann Rosolowski, PhD :
What were your other parts of the negotiation?
Wenonah Ecung, PhD:
Well, there was an understanding that I would be paid more during the time I was overseeing the area, but I would give up that portion of the salary once I went back into the singular area.
Tacey Ann Rosolowski, PhD :
Sure.
Wenonah Ecung, PhD:
So that was fine. Yeah. The title was negotiated. The fact that I had deliverables due to him in terms of the progress, that was part ofit was contingent upon me continuing in the area. And he had meetings, like I said, with the faculty to find out what their perception was in terms of how things were going, were they turning around? Was there positive movement?
Tacey Ann Rosolowski, PhD :
Now, did you ask anybody for advice in negotiating this? Or how did that all work? Well, assessing your own value is tough sometimes.
Wenonah Ecung, PhD:
Yeah. Yeah, yeah.
Tacey Ann Rosolowski, PhD :
I'm just curious how you approached the challenge.
Wenonah Ecung, PhD:
No, I didn't ask anyone for advice. No one hadno one on the ambulatory side, and to my knowledge on the inpatient side, had been asked to cover multiple areas. But certainly not on the outpatient side. So there wasn't anybody for me to go to, to ask. So why did I do it? Maybe because I knew it was going to take me a lot more time. I had, by that time, two girls at home. It was going to be taking me away from them, and it did. Even though the centers would close at 5:00 and 6:00, there wereI didn't give up my day job with 55. And 55 was a late-running center. So that meant that I had to be visible, not just in 65, but I couldn't diminish my visibility in 55. And I rememberso that was probably part of why I negotiated this is going to cost a little bit more, because I was going to be doingand I do remember having that thoughtI was going to be doing the job of two people, and I knew I couldn't have the salary of two people, but I well recognized that they could do something for me. Yeah. Yeah.
Tacey Ann Rosolowski, PhD :
Were you nervous about asking?
Wenonah Ecung, PhD:
No.
Tacey Ann Rosolowski, PhD :
Good! (laughter)
Wenonah Ecung, PhD:
No. My mother always said, "If you don't ask, you don't know. And all one can do is tell you, 'No.'" That's the only thing you have to
Tacey Ann Rosolowski, PhD :
Absolutely.
Wenonah Ecung, PhD:
Yeah. But what I was going to say, what came back to me in terms of visibility, I can remember I made a point to always take the stairs between 55 and 65, going from one center , one station to the other, at that time, because that gave me my mental time to change my hats. So and no one told me to do that, either. It just became a part of how I transitioned.
Tacey Ann Rosolowski, PhD :
Yeah. Those transitions can be really hard, wearing different hats. Very interesting. Well, it sounds like you had a good kind of "inner compass" about those career moves. I mean, I've had a lot of conversations with people about sort of those career markers; how do you ask, how do you negotiate? And they're tough moments. They really are. Where do you want to go from here? Have we talked about everything we should in this particular period?
Wenonah Ecung, PhD:
I think so. I think the important area, yes.
Tacey Ann Rosolowski, PhD :
Okay. So the next situation was the Preceptorship, and Clinical Exchange?
Wenonah Ecung, PhD:
Well, actuallyright. The Preceptorship Clinical Exchange, Program Director. I carried that title and enacted those duties while I was head oversight of 55, and while I had oversight of 65 and 55.
Tacey Ann Rosolowski, PhD :
Wow.
Wenonah Ecung, PhD:
So that was a third hat that I wore. And that was attributed to Dr. Robert Benjamin there. So he ran the Preceptorship program, and the Preceptorship program is where we had different pharmaceutical companies wanting to come in for a day, two days, or as much as a week, and spend time with our faculty, actually hearing their plans for the patients and actually visiting with the patients while they were there. So they wanted to see usually, if it was a drug that they delivered, how we were using the drug. And actually going on rounds with the faculty, sitting in lectures where the faculty would come in and share with them what we used to call the "MD Anderson experience," with their particular drug. So [one of the research nurses], Terri Armen, I do remember her name, we had a good relationship. But she was moving and he wasn't going to have anybody for this role. And at some point, I had worked a little with Terri, or absorbed what she was doing. There was a point where he asked me to take on that role. Now, he was the [ ] Medical Director for Station 55. And he was one of thehe was the chair of Sarcoma when I had Station 16, of which Sarcoma was one of the disciplines there. So I had been with Dr. Benjamin for years. So I took on that role when Terri left.
Tacey Ann Rosolowski, PhD :
Okay.
Wenonah Ecung, PhD:
But it was a role that wove throughout any other role that I had, until I became the Associate Vice President for Clinical Programs. And even then I maintained it, but there was a transition. I'm getting way ahead of myself. But I maintained it [for a while even as the] Associate Vice President. I had three Physician In Chiefs, so with the first Physician In Chief, part of the negotiation for being Associate Vice President was that I would maintain being the Preceptorship Clinical Exchange Director.
Tacey Ann Rosolowski, PhD :
That was your request, or their request?
Wenonah Ecung, PhD:
No, it was Dr. Benjamin's request.
Tacey Ann Rosolowski, PhD :
Dr. Benjamin's request, okay.
Wenonah Ecung, PhD:
To David Callender. With the second Physician In Chief, [Dr. Thomas Burke], he wanted that part of the role to go away.
Recommended Citation
Ecung, Wenonah B. PhD and Rosolowski, Tacey A. PhD, "Chapter 07: Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care" (2016). Interview Chapters. 695.
https://openworks.mdanderson.org/mchv_interviewchapters/695
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