Chapter 13: Roles as New Director of Nursing: Working with Growth in a Matrixed Organization
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Description
Dr. Summers begins with an overview of what she learned about leadership in her new role as Director of Nursing as she adjusted to the peculiarities of the institutional structure.
She talks about the institution’s organization in matrices, compares it to other institutions, nad notes that at MD Anderson “a lot of what we do seems to happen by magic.” She describes the challenges that arise from this structure at MD Anderson.
Dr. Summers next talks about the projects she worked on as the new Director of Nursing including the Mays Clinic and Alkek Hospital addition. She offers an example of how a MD Anderson decision-making proceeds and shares her leadership lessons.
She talks about the financial clarity that Dr. Leon Leach brought to the institution as the new Chief Financial Officer.
Dr. Summers also sketches how she developed a Professional Nursing Practice initiative. Dr. Summers says that she saw her role as providing the environment where nurses could excel.
Identifier
SummersB_02_20140401_C13
Publication Date
4-1-2014
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Barbara Summers, PhD, Oral History Interview, April 01, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionUnderstanding the Institution MD Anderson Snapshot MD Anderson Culture The Institution and Finances The Administrator Growth and/or Change Women and Diverse Populations in Healthcare and Institutions
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Barbara Summers, PhD:
So I started on that adventure, and I learned so much about aspects of leadership that while I had been exposed to them conceptually in my formal education and I had had experience with things like communication on a practical basis, never to the extent that they were absolutely mandatory here.
Tacey Ann Rosolowski, PhD:
Tell me about that.
Barbara Summers, PhD:
Well, I came here and I learned quickly that at this organization, which is a magical organization, a lot of what we do seems to happen by magic, in that we don’t have here the very typical structures and processes associated with running an enterprise the size of MD Anderson that you see in other organizations. And specifically in every other organization where I have practiced, there is a hierarchical—not bureaucratic, but a hierarchical structure where the senior-most executives would meet, and in that meeting they would discuss business operation strategy at their level and they would determine what pieces of communication then needed to be cascaded down to the next level, and what pieces of information did they need to have brought back up to them for decision-making, and so that most senior executive group would then break out and they would have meetings with their direct reports, and they would cascade the information down and also ask for specific information. And that group would then cascade to the next group and to the next group. And that’s also the process by which decisions were determined and communicated. And that did not happen there, and it does not happen now. There are no such channels.
Tacey Ann Rosolowski, PhD:
How does it work here?
Barbara Summers, PhD:
It’s all by matrix and relationships, so that’s what I learned. I spent my first six months believing that whatever competence I thought I had, I had deluded myself. I was reminded of a paper that I had read a number of years before about the imposter syndrome. I was certain that one day that MD Anderson was going to wake up and realize that I was an imposter and not capable of doing my job, because I would attend meetings and there would be no background information for me, and I would listen intently and not have any idea what was being discussed. But I’m a smart woman, so it wasn’t a lack of intellect. It was just that I had no frame of reference for how work was accomplished here. But I learned quickly it’s accomplished through developing relationships and networks, and that if you have something that you need to accomplish and you don’t know how to do it, the best thing that you can do is call someone, and then from that individual, although they may not have the answer for you, they will be able to tell you some other people that you may call and talk to about it. So after six months, I had developed enough of a network and I had developed a pretty broad array of relationships, and I began to have big chunks of information fall in place, and I began to understand how to get progress and make things happen here.
Tacey Ann Rosolowski, PhD:
What were some of the first projects you were trying to work on when you were developing this knowledge about the matrix-versus-hierarchical systems that you’d been accustomed to?
Barbara Summers, PhD:
Well, in the ambulatory care areas, my first week of employment I was thrown into a facilities planning meeting for the expansion of the clinic space, and it was at that meeting that I met an individual who’s still a very close colleague, John Wright [phonetic], in the Facilities Division. John is a planner. And he and I both came into a meeting with one of the hematology department chairmen with a set of blueprints that had been signed off by this chairman and all the other chairmen, and we were under the impression, because we came from organizations where there was a very logical flow of information in decision-making, we believed that this was what was going to be happening, and we were just kind of reviewing it, only to have the department chairman very vocally express his displeasure with the plan and express his desire to have accommodations made that were totally asynchronous with the plan that was in front of us. And I remember John and I looked at each across the table, and our eyes both got big, and I know at the same time we were thinking, “What have we gotten ourselves into in this place?” (laughs) So we were able to very quickly kind of pull ourselves together and engage more senior leaders in the Division of Cancer Medicine and get some background and poll all the players at the table and start moving forward and gaining consensus, and really gained an appreciation for the fact that you have to over-communicate here to ensure that people are adequately informed and feel that they have an investment in an initiative and that their investment is honored and appreciated. Because the pace of activity is so high, and people become so busy, that one day blends into another, and it’s not at all difficult for individuals to completely forget about plans that have been made, and then when they’re presented with information, it’s as if they had never been involved in the first place. So that just speaks to the need for just very clear communication.
Tacey Ann Rosolowski, PhD:
I just want to say I’m really glad you’re talking about this, because you’re being really clear about the operation of the institution, and that’s actually a very special piece that this interview is bringing to the collection.
Barbara Summers, PhD:
Okay. Well, good, good.
Tacey Ann Rosolowski, PhD:
So I’m delighted that we’re doing this, the “how it works” part.
Barbara Summers, PhD:
Yeah. I mean, there was just a lot of imprecision in how things worked. I was in my position in the first month, and I was communicating with the business manager for the Center, and I said, “I’d like to sit down with you and take a look at our financials and see how things are going.” So we sat down and we looked at the clinical activity and the clinical revenue and the expenses, and I remember asking, “Well, what are the payer sources for the revenue?” And we didn’t have that information. I said, “Well, let’s talk a little bit more about the revenue side.” And at that point in time, there was no detail behind the revenue. It was just amount of dollars that were posted to your company centers. And I remember just furrowing my brow, and as this business manager would say, and raising one of my eyebrows, and just saying, “Well, do you ever get worried that because you don’t know where the revenue’s coming from, it could go away and you wouldn’t know it or you wouldn’t know why?” And, yes, of course, it had occurred to her, but there were no systems to address that. So that was very, very interesting. And right around the time that I started working at Anderson, that was also the time that Leon Leach [Oral History Interview] was recruited and started working here. And Leon, I think probably maybe a year into it, a year and a half maybe into it, brought in Ben Melson [phonetic], who was the CFO. And Leon and Ben brought some rationality to the budgeting and finance piece of it so that things were transparent and there was much better understanding of what was going on. Other challenges that I encountered were like the big challenge of how were we going to activate and operationalize this hospital. We were going to open up twelve floors of a new hospital building, and the facility itself had been designed down to the selection of paint colors by the former president, Mickey LeMaistre [Oral History Interview], who was a lovely man, but he had made all these little minute decisions about design with a few other people, and so the folks who were actually going to have to practice in the built environment had had no input into it at all. So we had to get our clinical teams in that facility as quickly as possible so we could start thinking about how care was going to be provided, because it was a different footprint than the existing hospital building. So that was a huge challenge. And then, of course, there were, understandably, upsets because people were finding that there were built-environment decisions that were made that would have a profound impact on the way that care was delivered, but the people who delivered the care hadn’t been consulted.
Tacey Ann Rosolowski, PhD:
You’re talking still in the Alkek Hospital?
Barbara Summers, PhD:
In the Alkek Hospital, yeah.
Tacey Ann Rosolowski, PhD:
Okay. I was just curious if there were issues in other places in the institution.
Barbara Summers, PhD:
No, no, but that experience, plus the construction experience in the clinic, really just hammered home for me the importance of casting a wide net and identifying stakeholders and always erring on the side of bringing more people to the table than fewer people to the table, because you have nothing to lose by getting more input. So we kind of slogged through all of that, and then I discovered other challenges, such as we were actually going to be adding an additional large number of beds, and there had been no plan or provision put in place to hire additional staff to take care of the patients in the beds. So that was a big scramble. So I actually reached out to a leader back in Virginia who I had worked with many, many years previously, before I went to NIH, and I knew that she had progressed. She had completed her master’s degree, and she was now in a much more senior leadership position. So I recruited her down to become the director of the Bone Marrow Transplant, Stem Cell Transplant Unit.
Tacey Ann Rosolowski, PhD:
And her name?
Barbara Summers, PhD:
Her name is Patty Johnston [phonetic], Dr. Patty Johnston. And that is one of the smartest things that I’ve done in the time that I’ve been here, because she’s an outstanding leader and, golly knows, she was brave and took on the challenge and did a great job. So, you know, just dealing with, again, the consequences of no infrastructure to guide you, I’m new to the organization, I’m trying to take the assignment I was given by one of my bosses—because I had multiple bosses—one of my bosses, to take care of the Alkek activation, and it was just a lot of learning in a short time.
Tacey Ann Rosolowski, PhD:
Who were your bosses?
Barbara Summers, PhD:
Oh, my gosh, I had many. I had John Crosley [phonetic]. Dr. Crosley was the former chief nursing officer. Wendy Austin [phonetic], who was the division administrator. Then, of course, the physicians all thought they were my bosses, so I had multiple people who were providing me with direction. But that’s okay. I mean, you have to be able to work in a matrix organization successfully if you’re going to be successful in this place. So, you know, the other thing that I worked on at that time was professional nursing practice development, and I was fortunate to come into an organization where nurses and nursing practice were highly valued and very well respected, and that goes back to the legacy of Renilda Hilkemeyer [Oral History Interview], who was the very first chief nursing officer in the organization and a force to be reckoned with. Renilda really was one of the founders of oncology nursing as a specialty practice, and she set the tone way back when MD Anderson first started, of excellence in practice. So I was really fortunate to be able to come into a place where nurses held themselves to extremely high standards of practice, and I viewed my role as not just an administrative director for the Hematology Center, but also director of clinical nursing. My role really was one of providing the environment so that nurses could excel in their practice, and that includes attending to their professional development needs, ensuring that the staffing plans were adequate to meet the needs of patients for nursing care, and also developing the nursing leaders who were managing these teams of nurses, both in the ambulatory areas and in the inpatient setting.
Recommended Citation
Summers, Barbara PhD and Rosolowski, Tacey A. PhD, "Chapter 13: Roles as New Director of Nursing: Working with Growth in a Matrixed Organization" (2014). Interview Chapters. 1250.
https://openworks.mdanderson.org/mchv_interviewchapters/1250
Conditions Governing Access
Open
