Chapter 12: Associate Vice President of Clinical Operations, an Evolving Role

Chapter 12: Associate Vice President of Clinical Operations, an Evolving Role

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Description

In this chapter, Dr. Ecung talks about her role as Associate Vice President of Clinical Operations (2003 – 2014). She explains how she was selected for this position then talks about the steep learning curve she had during her first two years: it was a few years before a task crossed her desk that she had performed previously. She gives examples of the tasks she took on during Hurricane Katrina and during the Joint Commission Survey to accredit the institution.

She observes that after five years, she was familiar with the role. She gives examples of how she instituted processes that could be repeated: evaluating faculty salaries; the holiday letter program; advisory board contracts. She compares her view of the role to Dr. Barbara Summers, who had held it previously.

Identifier

EcungWB_C12

Publication Date

2-27-2017

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; The Administrator; Overview; MD Anderson Culture; Working Environment; Institutional Processes; Growth and/or Change; Obstacles, Challenges; Institutional Politics; Professional Practice; The Professional at Work; Collaborations; Leadership; On Leadership

Transcript

Tacey Ann Rosolowski, PhD :

Because Iat the end of our last session, or near the end of our last session, we began talking about how you were positioned to assume the Associate VP of Clinical Programs position. That was in 2003. And so I wonder if you could begin clarifying that role. Kind of what was the scope? What was your vision for the role? Maybe if there was a little difference between what your official mandate was and what you saw your mandate as being?

Wenonah Ecung, PhD:

Those are all interesting to learn. My vision for the role, what the official mandate was and the gap, perhaps, I think interestingly enough, my vision for the role was that of being a staffer, if you will, supporting the Physician In Chief. And that vision came strictly from the piece of paper that had been given to me in terms of the position description. I hadn't sought that role. David Callender, as I said, had approached me and asked me to throw my name into the pool of applicants that would be interviewing for the role. And I have to tell you, there were literally two go-arounds. The first time I threw my name in the hatand I may have shared thisit came down to two candidates, myself and Barbara Summers, Dr. Summers. And Dr. Summers ended up getting the role. Again, at that point, I had to make a conscious decision as to whether or not I wanted to stay at MD Anderson, or it was time to go. Because if I stayed, for me, I would need to support Dr. Summers in that role. Obviously I chose I wanted to stay. From that, I think we became just great colleagues. She's one of the most revered persons that I've come across in my path at MD Anderson. And I learned a lot from her. After she was in the role for probably five years or so, she called me up one night at eight o'clock, I remember that vividly and asked if I would take a phone call from her boss. Well, her boss was David Callender. And I wasn't going to say, "No, I'm not going to speak to your boss," so I said, "Yes." So when he got on the phone, he asked me if I would be willing to take that position. And he explained to me he had plans for moving Barbara to the VP for Nursing, but they wanted somebody that could hit the ground running for that role. So my only thing to him at that time was, "Sure, I'd be interested, but I'm not going back through the 21 interviews that I had to do initially. And he chuckled and said, "Of course not." So that was the beginning of the 2003 stint. So in terms of my vision, I didn't really have a vision. I was comfortable in the role I had as the CAD for the Sarcoma Center. The phone call at 8:00 that night was a surprise. All I had in my head was what had been on the position description several years ago. When I transitioned into the role, I was fortunate in one regard that Barbara was still there. She had been in the role as AVP, and she had transitioned to VP. So I was fortunate that I had somebody that I could walk down the hall and say, "How did you do this?" Or, "What did you do in this regard?" So she could provide guidance. But her role grew so big, until she reallyand it was new for her. It was brand new for her. She really wasn't available anymore. And what I found was the first two years, there wasn't one single item that came across my desk that I had experienced at some point in that two years. And soand I remember that, because it was a little bit past two years that I received an item, and I went, out loud, "Oh my God, I know how to do this one. I've done it before." So the first two years, I didn't have a vision. It was actually responding to what was coming across, and being agile enough to adapt and move in and out as David [and/or Tom] needed me to do.

Tacey Ann Rosolowski, PhD :

What were some of these new tasks that were coming across your desk?

Wenonah Ecung, PhD:

Oh, analyzing division administrator salaries, and me deciding what components were going to be used to analyze that job. So me coming up with a rubric that would include, like, space and number of people, different variables, if you will, in the rubric. So Barbara had never done that, so I had to come up with it. There was a point where we were presenting toit wasn't the Board of Regentsour Board of Visitors [BOVs]. And Barbara became ill, and in a meeting with [the BOVs], David said, "Well Wenonah will give her presentation." Well, I didn't know. I didn't have deep knowledge over what Barbara was doing in nursing. But I had to be responsive to it. So I had, well, she has people that [came in to] debrief me on what was going on. So I called in her big people, and they came and sat until I felt comfortable with the information that I had to deliver. So it ranged the gamut from doing analysis of jobs to faculty salaries, to being able to step in and be the person presenting at any given moment, to being if there was a newwith Tom Burke, if there was a new project that we needed to study, like the Emergency Center, and patient wait times there, me being the support for the faculty member that he was going to assign for thatand when I say "support," it wasn't the take minutes support. It was the faculty typically haven't been exposed to leadership don't know how to get organized in that regard. So I would be the one to say, "Here are the areas I think we need to explore, what do you think?" Then I would set out to get that individual organized, make sure we planned our dates, who's going to be there for minutes. If any work came forth from that that needed to be done by my office, support it, then we would do that. To administering the holiday letter program, I was responsible for our advisoryHealthcare Advisory Board contracts for the entire institution. It was just muddled. And part of that was what made it extremely challenging, quite exhaustive, but so much fun. Yeah.

Tacey Ann Rosolowski, PhD :

So some of this sounds like it's business as usual, and some of it sounds like it's kind of pushing things in new directions. Is that accurate?

Wenonah Ecung, PhD:

I'd say it was business as usual.

Tacey Ann Rosolowski, PhD :

Oh, it was business as usual.

Wenonah Ecung, PhD:

I would say it was business as usual. That job, that position, there weren't any clear-cut guidelines; these are the tasks and this is the path. It was molding as it went.

Tacey Ann Rosolowski, PhD :

As it went along?

Wenonah Ecung, PhD:

As whatever was going on, whatever the temperature was of the institution at a point in time is the way that that role needed to be able to respond, because the Physician in Chief had to beof course there was planning, I don't mean that it was disorganized by any means. But with any large institution, the best-laid plans are derailed frequently. And we have to be responsive to what was going on. So it was business as usual.

Tacey Ann Rosolowski, PhD :

Can you give me an example ofbecause I really want to try to get a little bit of an insider view of what this role is like. So infrequently can you kind of getlift the curtain on all of that. So, and also, I'm kind of asking for your guidance on how to kind of organize the story about this piece of your career. So what would be an example of the sort of best-laid plans, and then having to redirect?

Wenonah Ecung, PhD:

Well, I can remember with Burke, as he was EVP, and I don't remember which one it was, I think it was Hurricane Katrina, it was one of the hurricanes coming through where business as usual stopped. And this is what was dissimilar to the role, alsoit was similar but dissimilarit was similar with Buchholz in the role, and became dissimilar when Brigham came on board. But we would have a war room, and all leadership would report and receive their direction on what needed to be done. And I recall vividly, and I think it was either Hurricane Katrina or Hurricane Rita, [ ] a lot of the people evacuated the city. Facilities didn't have enough people on board, and we were asked to help out. And I can remember going and after collaborating with my Facilities colleague on what I needed to do, I can remember going to patient rooms and checking for air coming through the structurenot something that would have been on a piece of paper, unless it was under "Other Duties" as assigned. So that would have been unusual. I can remember us putting our teams in place, staying overnight, ensuring that our patients were safe, the facility was safe. So that was not business as usual. But the business of taking care of our patients had to go on. I can remember vividly participating in our joint commission surveys. Burke actually assigned me our ACOS survey. I was the point person for the American College of Surgeons survey. My office coordinated that completely, and if the institution passed with commendations, it was because of the work of the team within the office, and those that were a part of that survey. And if it didn't, it was the work of me at that point. But his trust, David and Burke's trust in me in terms of my abilities and what I could do was huge. And then once Brigham came on, if we were being pulled together because of impending flood, not hurricane, but impending flood, he saw no need for the role to be in the room. So that was extremely foreign to me. So I don't know if that answers your question; gives you a picture of business as usual versus the unusual taking over?

Tacey Ann Rosolowski, PhD :

Sure. Sure. Now whathow did your comfort level, or how did the position evolve over time? You were in the role for 11 years. What were some of the high points from whatever perspective?

Wenonah Ecung, PhD:

Well, I guess the position evolved, and the high points were the fact that after that initial two years, probably five years into the role, I really felt like I knew what I was doing. And that was kind of a sweet spot to be in. But I have to admit, towards the end of that 11 years, it became, probably like any position would be after being in it for that period of time, somewhat mundane. And it was at thatso it wasn't changing. The role was what it was, right? It wasn't changing, so I knew I needed it to change, or I needed to do something to enhance myself. And at that point is when I decided to go back to school. So that was in 2010, and work on a PhD. And then I graduated in 2014. I was able to do that becauseI wouldn't have been able to do that initially, because nothing about the role was recognizable to me. After being in it, I was able to do it, because I had come to shape some of what was happening within the role. I knew how to look at the contracts that were coming through. I knew how to evaluate the faculty salaries, and what to bring to Burke or Buchholz' attention. So what previously took me hours didn't take me hours anymore.

Tacey Ann Rosolowski, PhD :

How did you shape some of these things that were going on?

Wenonah Ecung, PhD:

Well, I don't know if the pattern that I put in place is followed now. But, for example, like the faculty salaries, I don"™t think Barbara ever went through the faculty salaries. So that was assigned to me. I went through them. I looked for equity. I looked for gender equity. I looked for tenure. So with everything I did kind of, pretty much, I would list out the variables that I'd want to take a look at, and see how things were playing out in that regard. And then in the meetings, it was the way it should be. If you were the Physician In Chief, he would speak, but I would have my notes, my bubbled notes where you put in your comments. And he would use those comments to guide the meeting. So it looked very much like he had spent hours going through the data. What pleased me was, he didn't have to spend hours going through the data. I did that, and he trusted me enough to just use whatever bubbled comments that I had given to him. That was with the faculty salaries. That was withthe holiday letter program, as I mentioned, was just a program where we decide how much money different leaders, like managers, directors, faculty, can apply for funding their program. I would read through all their programs and I would decide which programs were viable, and should be funded, and which shouldn't. Now, that faculty member would never say, "Wenonah made the decision." He would say Burke or Buchholz made the decision. But again, I would develop a rubric, and then I'd use it to make my decisions, and then I'd go sit with Burke or Buchholz, and I'd say, "Now, look at what I did so that you kind of have some idea. And here's how I arrived at these 15 should receive funding. We don't have enough funds to do all 15, so I'm going to fund this partially. But I'm going to take the rest of the funds for that one, because I believe it should be funded from this other pot of money that we have." And of course if they said no, I wouldn't have moved forward. But they alwaysthey trusted me to do it. The contracts, the Advisory Board contract for the entire institution, it started out for Clinical Ops. I was the person so thatwhat we found was, the Advisory Board would go to you, and they get an agreement put in place. They"™d go to another Director, get an agreement put in place, only for us to find out there's so much overlap, and why are we paying twice? So I became the point person for Clinical Operations. Well, somehow, Business Development and [ ] and HR, [ ] and others outside of Clinical Op, somehow it became, oh, Wenonah's the point person for the Advisory Board contract. And that was fine, because what was needed was one central body or individual that could look out across the institution to make sure we didn't have duplication going on. Again, I don't know what has happened with these different programs. I used to oversee the Arsenio Award, nursing award. And as I mentioned, ACOS, the American College of Surgeons.

Tacey Ann Rosolowski, PhD :

How were these decisions made prior to you coming into the role?

Wenonah Ecung, PhD:

Interesting, because Barbara didn't do a whole lot of those things. So Barbara's role was, I had heard a little in the hallways prior to taking the role of how she was viewed as an impediment to being able to access David Callender. It was always you had to go through her in order to get access. And faculty were not pleased with that. And they actuallyI had good relations with the faculty of Anderson, because I grew up with many of them. Many, many of them. And they wouldwhen they knew I was interviewing, they would say, "I hope you're not going to do such-and-such-and-such." And I actually made a point to say, "I'm going to operationalize this role different." I wasn't going to be the gatekeeper to the Physician In Chief. I would know what was going on, but I wouldn't be the one blocking the way to that person, and [have things] only interpreted through my voice. And I think that was appreciated. But that was kind of Barbara's main role. One of the reasons I think she turned to me was, we had this huge project that I think would have landed on her desk to do, which was the Clark Clinic renovation. But Barbara knew, and she would admit, she was a big-picture person, she was not detail-oriented. And it needed somebody that was detail-oriented. And I am detail-oriented. I can step back and first take a look at the big picture, and then decide, how we get there? Well, she could look at the big picture and look far into the future in terms of the impact of the big picture, which I had less of that. But where she didn't have the detail, I did. So she asked me to take this project on. And I reported to her. And it was the first multidisciplinary, interdisciplinary committee of over 40 individuals from different sectors of the institution, whether it was Facilities, the police, nutrition, social service, nursing that came together. And for two plus years, I led that committee, and we redesigned and renovated the Clark Clinic. So if you get anything, it would be that this isn't, or wasn't certainly then, a packaged role, like as the Director of the Sarcoma Center, each Director is responsible for X, Y and Z. This wasn't a pre-packaged role at all. It was what is the need of the institution in this day at this point in time. And we've got to be responsive to it. And that's what the role would take on.

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Chapter 12: Associate Vice President of Clinical Operations, an Evolving Role

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