Chapter 13: Key Projects

Chapter 13: Key Projects

Loading...

Media is loading
 

Description

Dr. Ecung begins this chapter by identifying her role as Chair of the Clark Clinic Renovations Project Team as one of her most significant (2005 – 2008). She ran the first interdisciplinary committee comprised of forty-three individuals from all over the institution to have input. She notes that it was extremely successful. She talks about the impact of her decision to have committee members present to the Dr. Buchholz, rather than presenting their conclusions herself.

Next she talks about addressing long wait times (sometimes twelve hours) in the Emergency Center (though the recommendations were not implemented). She speaks on more detail about the survey conducted to gather information for the American College of Surgeons’ accreditation process, noting that MD Anderson most often received a “commendation” level evaluation.

Identifier

EcungWB_C13

Publication Date

2-27-2017

City

Houston, Texas

Topics Covered

The Interview Subject's Story - Overview; Overview; Definitions, Explanations, Translations; Building the Institution

Transcript

.

Tacey Ann Rosolowski, PhD :

So you've mentioned the Clark Clinic. You've mentioned creating these systems of variables for doing this evaluation. What were some of the roles that you consider of projects that you took on within this role, that you'd consider the high and low points? The biggest successes, and maybe one that you say, wow, if I had the chance to do a do-over, this is how I'd approach it differently?

Wenonah Ecung, PhD:

Well, I'll start with the Clark Clinic. That turned out to be an extremely successful project. And I don't know how I knew, but I knew there was [a knowing?]. To this day, I don't know where it came from. But I remember at the beginningfirst thing I remember about it is panic, where I panicked at home because it had nothing to do with nursing. Yes, it had somewhat to do with Clinical Operations, patients coming through. But it was really a Facilities project. And why was I heading a Facilities project? And why would these people feel a need to be responsive to me? And

Tacey Ann Rosolowski, PhD :

What year was this, by the way? When did it start?

Wenonah Ecung, PhD:

Clark Clinic, maybe I can go look at my construction hat that they all signed, (laughter) because I don't have my resume in front of me. It's in the resume.

Tacey Ann Rosolowski, PhD :

It's in your resume, okay.

Wenonah Ecung, PhD:

Yeah, it's in the CV.

Tacey Ann Rosolowski, PhD :

I will have a look.

Wenonah Ecung, PhD:

Yeah, it's in the CV. Probably 2005 to '07 or '08, something like that. It's in the CV.

Tacey Ann Rosolowski, PhD :

Okay, thanks. So you're saying it wasyou had no idea why these people would be responsive to you?

Wenonah Ecung, PhD:

Right. So I remember setting it up to where we had multiple meetings. And the first meeting started out with, we're going to clarify what our mission, what our vision is going to be here. And identifywe can't do this alone, all the different stakeholders that we're going to need to get involved. But one of the things that I did was, they had to sign in. When you signed in, the very first meeting you attendedand this will date me somebut when you signed in, you had to also indicate who your favoritewhat your favorite music or singer, or just in that genre. And at the very end when we wrapped up our project, I remember my youngest daughter going with me to Best Buy where we boughtthere was 40-some CDs, and that dates me, because you probably don't get music on a CD nowwe bought 40-some CDs, and we took the list, and it would have, like, Tacey and what you liked, and the next person and what they liked. And I remember her saying, "Gee, mommy, if you're doing all this, I wouldn't mind working for you!" And I was personally funding it. And so, in their very last meetingwell, there were two things, but along those lines, in their very last meeting, their departing gift at each desk, I had their favorite whatever it was. It was a piece of music, or singer. And I think that wasthey were just overwhelmed by that. The other thing was, at the end, we had to present to David Callender on what our findings were and what our recommendations were. And I could have easily gotten up there and presented all of their work. And I chose not to present any of it, other than to do the introduction, but to give full credit to the teams of individuals that had done the work, that had been meeting consistently. And that not only gave them an opportunityit gave them visibility with the Physician In Chief, but I think they developed a different level of appreciation for me in that they knew I couldn't do this without them. And for them, it was, she didn't do it without us. She let our work be our work. So that, for the Clark Clinic, I think were the valuable lessons that I gained from that, and what I did right.

Tacey Ann Rosolowski, PhD :

What were some of thewhat about the conversations? How did the stakeholders interact? What were some of the key issues that were discussed with the Clark Clinic, in this newyou said it was the first interdisciplinary committee from all over the institution. So

Wenonah Ecung, PhD:

Right. So we had to come to agreement on, because they weren't all from clinicalmost of them weren't from Clinical Operations, their leaders had given themhad agreed that they could sit on the committee, but had also given them a vision of what this committee was to be about, which didn't necessarily [match the real task.] So it didn't always match the amount of time that we were going to have to spend, that they were going to have to spend, really had not been conveyed. The mere fact that we were going to have to look at, how do patients access this institution? How do employees access this institution? What are we going to have to do to change the way traffic accesses this area? What land do weare we able to use any parts of the garage? If Facilities was saying no, or if the police were saying this would be a problem, then I had to understand why that was such a problem for the police workforce. And I had to listen a whole lot. And in that listening, I had to also get out and walk with them, which I can remember one of the lieutenants sharing with me, nobody had ever really tried to understand what they were talking about, and he felt I had, because I got out and walked the area with them. But they were important voices there. So designing the Clark Clinic impacted pretty much all aspects of Anderson. It wasn't just, are we going to put an aquarium in? It was, where do we start the drive? Do we end the drive there? How's valet going to continue during the construction? [ ] How are patients going to be able to access them? So that's what made it so different for me; aspects that I had never had to deal with. And

Tacey Ann Rosolowski, PhD :

Do you think that participating in a committee of this type, which was so important, helped people at MD Anderson understand that a multidisciplinary committee, this could really work and have a positive impact? Did it have a longer impact culturally, maybe?

Wenonah Ecung, PhD:

Well, I think for the leadership that was there during the time, they understood. I don't thinkpart of me working with Buchholz and supporting him, he had neverhe was not aware of me before. So for Burke, he was aware of me, for DavidDavid gave birth to me, if you will. But no, I think that was somewhat lost on Buchholz. Not only that, I don't think Buchholz hadI know he didn't have any idea as to what he was stepping into as Physician in Chief of Clinical Operations and Programs, because he said to me once, "I had no idea of the scope of Clinical Operations and Programs." It is the engine of that institution. And coming from Radiation Oncology, he was from a little subsidy, if you will, within this huge state or country, if you will. He was coming out to lead it. So no, I don't thinkthe private leaders probably weren't surprised, because we had also embarked on multidisciplinary care for the clinics, and designing and rolling that out. So that spirit, that knowledge, that know-how, the knowing that multidisciplinary and interdisciplinary is the way to go, it was there. I think a lot of that has been lost with the new administration.

Tacey Ann Rosolowski, PhD :

Your comment just a moment ago alerted me to the fact that I didn't really ask you to kind of paint a picture of what the scope of Clinical Operations really is. I mean, what does it comprehend?

Wenonah Ecung, PhD:

Well, you have your 10 divisions, your nine disease entity divisions, or eight plus anesthesia, and I always include pharmacy as one of the divisions. Nursing later asserted itself as one of the divisions. But Clinical Operations is everything that touches the patient. I honestly don't knowI get that question, or I used to get that question frequently. Well, what's in Clinical Operations? Well, if you can just stand for a moment in a space and say, when I touch the patient, or I touch the patient when I dispense a drug, or I touch the patient when I'm planning for them to go home and they need durable medical equipment, or I touch the patient when they need physical therapy or occupational therapy, or music therapy, nursing, or sending them to Surgeryit's everything that touches that patient. I don't know any other way to help one understand.

Tacey Ann Rosolowski, PhD :

Yeah. It's kind of amazing. So I can see how stepping into that role, there would always be new things emerging. Always new things popping up. So you gave me this example of the Clark Clinic, which was really successful. Was there another example you were going to talk about?

Wenonah Ecung, PhD:

Well, you asked for one that wasn't successful.

Tacey Ann Rosolowski, PhD :

Yeah, something that was a learning experience, you know.

Wenonah Ecung, PhD:

Well, they were always learning experiences for me.

Tacey Ann Rosolowski, PhD :

From a flipside.

Wenonah Ecung, PhD:

But in terms of maybe not turning out quite the way I thought it would, or wanted it toand this seems somewhat self-serving, but I really can't think of an example.

Tacey Ann Rosolowski, PhD :

Well, that's good! (laughter)

Wenonah Ecung, PhD:

Tacey, I really can't. I would share it with you, if it were there.

Tacey Ann Rosolowski, PhD :

Well, how would youso the Clark Clinic kind of actually kind of took place sort of in the earlier third, if you will, of your role as AVP. What were some of the other kind of landmark projects that you worked on?

Wenonah Ecung, PhD:

So we had the Emergency Center. That was supported by Paul Mansfield, and I think Jorge Cortes, although he was the co-chair. He missed most of the meetings. And that's where we were looking atwe had long patient wait times in the Emergency Center. Not to access emergent care, but in being transitioned from the emergency room up to the floors. And some of our patients would wait 12 to 16 to 18 hours.

Tacey Ann Rosolowski, PhD :

Really?

Wenonah Ecung, PhD:

So the goal was to understand what was going on, and to bring that time down to something reasonable, two to four hours. So that was one of the projects I worked on with Paul and the committee that we got together. And that's wherewhoever was, like, the chair, he was chair, would say, "Well, who do you think should be on this?" Because they didn"™t have any idea. Another project, and I worked this with Feeley, Tom Feeley, who I heard just retired. And what did we do? I have to think about what we did.

Tacey Ann Rosolowski, PhD :

While you're thinking with one part of your brain, can I ask you, what were the reasons for the long wait times? What did you discover?

Wenonah Ecung, PhD:

Faculty not responsive to pages that they would receive. There washow do I say thisconflict between faculty in the Emergency Center not beingthey were not oncologists. They were true emergency physicians, Emergency Medicine physicians, feeling one decision should be made, and then the oncologists believing a different decision should be made. And not only a different decision, but I, the oncologist, I am the primary. So if I say you need to wait, or if I don't answer your call, you just simply need to wait. So conflict between faculty. One of the great things that came out of that was, we bought Medicine and Internal Medicine together, of which [Robert] Gagel was the division head at that time, to help barter peace, if you will, between those two groups. Ki Hong was the division head for Medicine at the time. And I think the project thatso we came up with recommendations out of that committee that really weren't put into action. And the reason I was thinking about Feeley was because it just seemed so similar. And it was. It was a continuation when Feeley came on, he becameyears later, that project was kind of shelved. And then years later, Feeley came in, and I think it was under Burke, he was asked to chair it. And we had a whole different group come together. We used the report from the prior group, even though it had been years earlier, but redid the assessment and came out with the same conclusions, but only that time Burke activated. He acted on the recommendations, which didn't bring him favor with some groups. But I admired him for that [ ]. He would take critical steps that he knew he had to take, even though he knew it would create disfavor for him with some.

Tacey Ann Rosolowski, PhD :

What were some other

Wenonah Ecung, PhD:

ACOS was one, the American College of Surgeons. That was a project I worked closely with George Chang. And I think George is still there. He's one of the colorectal surgeons. And I think George would tell you, when I worked with him, he didn't have to do anything but show up at the meetings. I would help guide him in terms of all that he needed to know, and all that he needed to ask. And that project would organize people, patient care-level faculty that could [attend meetings with] the surveyors and actually provide PowerPoint presentations in terms of what we were doing in the area of performance improvement. It would have all division heads represented, and for the many years that I oversaw that, we most often achieved three-year accommodation. Then I think it was, when Bob came in, he felt that shouldn't bewhen things were with me, they were reporting directly to the EVP, right? So that was one of the areas he thought, well, why are you doing this? It should be in a different area. And it was removed. The problem is, people don't realize everything that goes into something when something is just removed. So it went to John Bingham. And I shared with John I would do whatever he needed to make sure he could continue the path of accommodation we had been receiving. And I did, as well as my assistant. But ACOS was one of them, and I really enjoyed that experience. But again, you can see how the role works with different faculty throughout different levels of the institution.

Tacey Ann Rosolowski, PhD :

It gets you a really amazing perspective. I mean, I could see how your strengths as a detail person would be very, very valuable there, having this great internal perspective.

Wenonah Ecung, PhD:

And yet, having some knowledge of what's going on in the outer parts of the world so that I could take from there and say, is this going to impact what we're doing?

Tacey Ann Rosolowski, PhD :

Yeah. Interesting. Well, do you want to talk aboutI mean, unless there are some other perspectives, do you want to

Wenonah Ecung, PhD:

No. No, I'd have to look at the CV.

Conditions Governing Access

Open

Chapter 13: Key Projects

Share

COinS