Chapter 11: Center Administrative Director: Philosophy of Leadership

Chapter 11: Center Administrative Director: Philosophy of Leadership



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In this chapter, Mr. Brewer addresses the period in which he served as Center Admin Director for the Ambulatory Treatment Center, the Clinical Translational Research Center, and the Emergency Center (1996 – 2004). He talks about the growth of these areas as the institution grew and his own philosophy of management. He talks about the complexity of the workflows in these centers and the need to give employees autonomy to make decisions and problem solve.



Publication Date



Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Professional Practice; The Professional at Work; Leadership; On Leadership; MD Anderson Culture; Working Environment

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.


History of Science, Technology, and Medicine | Oncology | Oral History


Tacey Ann Rosolowski, Ph.D. Well, I wanted to go back to some questions about the CAD experience that—which obviously was a lot of years in your mid-career, which is very cool. And I wanted to ask you a couple things about that period from 1996 to 2004 when you were the center administrative director for the Ambulatory Treatment Center, Clinical and Translational Research Center, and the emergency center, that kind of big, big job. And the one that I was—well, they were all big jobs, but that was (laughs) sort of the first big step into a huge administrative role, which is really, really cool. And I saw an interesting thing going on here, which was that during this period, of course, the institution was growing enormously and the patient volume was increasing incredibly. And at the same time, you have a note on your CV that you were championing this strong, self-directed work teams and this management by walking around. And I was wondering if you could talk about the connection between those two things, the importance of providing autonomy and leadership potential at the granular level and how important that was at the time that the institution was growing so rapidly? Am I on point with that? I mean—

Cecil C. Brewer, RN, BSN, MS:

I think you’re very much on point with talking about how I was able to—my philosophy, I developed my own internal philosophy that I tried to practice what I teach. And throughout my career, I had worked with very dynamic immediate supervisors, and I try to mold my work patterns after some of the best practices that I had been exposed to. One was how to engage staff and allow staff to work autonomously but safely and encourage them to utilize all the tools at their disposal in a very safe way in taking care of the patients and not to be micromanaging and also encouraging staff to do better, to improve, so self-improvement. And so that’s where—in the mid-’90s as I was transitioning from a more primary inpatient director role where the structure was quite different on inpatient as far as management as concerned, you have a 24-hour-a-day nursing units to operate, and you have nurse managers who are responsible for this unit and then to assist the nurse mangers, you have assistant nurse managers who are assigned to different shifts such as the day shift or the evening shift or the night shift. At that particular time, we had three different shifts, but nurses have shifted into the contemporary world to 12-hour shifts but they still have managers who are around the clock. And those individuals were providing supervision. There was different types of approaches for how we manage the floors, team nursing or functional nursing, etc. So the staff were kind of in a bubble if you will, in their—kind of in a little controlled environment. And I often wanted to see how I could make staff more autonomous., and also, the literature at that time was supporting more autonomy in nursing. And I had this opportunity— Tacey Ann Rosolowski, Ph.D. I going to interrupt you, I’m sorry, but I’m just dying to ask this question. Where did you get the ability to trust people below you to know what to do?

Cecil C. Brewer, RN, BSN, MS:

Wow, that’s a tough question. Where did I get the ability to trust people below me? Tacey Ann Rosolowski, Ph.D. [00:30:2] Because that’s really what—

Cecil C. Brewer, RN, BSN, MS:

Trust. Tacey Ann Rosolowski, Ph.D. —inspires micromanagement is not trusting people, right?

Cecil C. Brewer, RN, BSN, MS:

Yeah, trusting peo—well, one is talking to people. One, you have to know. How do you know a person? Well, I think it’s simple. You talk with them, you understand their resume, you find out a little about their character. Not only what they do at work but what they do after work, you know. One of the things—the characteristics that we were taught in our executive development is that you have—if you only believe in your staff and get to know what their activities are outside of work, many of the lower level—I mean many of the staff that are trying to progress are probably the deacon in their church or the treasurer in their local society, a local organization, but at work, they maybe just—you say they’re not—their job is to be an aide or a clerk, and this is what you do, this little box right here, but they have much more ability to do, but how do you know that? You wouldn’t know it because they probably are not going to talk about it because it’s not appropriate for their workplace. But you find out that, oh, this person who is doing this job here, in this box, well she’s in charge of 20 people in our organization or she’s in charge in of the entire budget for her church. She’d take kids on camping trips, and she’s the leader. Well, why can’t she be a leader here? If we only allow them to be with those. And how do we do that, how do you manage that? So one of the things that I’ve learned was early on— Tacey Ann Rosolowski, Ph.D. I’m glad I asked you that question.

Cecil C. Brewer, RN, BSN, MS:

—was to kind of get into people’s mind and understand them and then the trust comes. You start building trust, I’ll put it that—you start building that trust. If I trust them, they trust me. Then, to encourage and to expose and try to find avenues for self-development and progression. And that’s always been my MO, if you will, throughout my career. As I grew and other folks helped me, I want to give back. And so in the mid-’90s, I saw a different opportunity where I probably could to this more. I was offered the opportunity to move from the inpatient director of nursing to outpatient Ambulatory Treatment Center as a director, and obviously, I was brought there because there were problems to be solved. Tacey Ann Rosolowski, Ph.D. Right. You talked about some of those last time, yeah.

Cecil C. Brewer, RN, BSN, MS:

I had become known as a problem solver in my career. I was given various ta—various challenges such as back to the patient unit they said—they came to Cecil—“We’ve got a problem in the ICU, intensive care units, has some leadership issues. The staff are very discontent, the physicians are discontent with what’s going on. There’s a tremendous amount of turnover among nursing staff. We want you to use your skills and go in and see you could help resolve some of these issues.” So I always say, “Okay, start from simple to complex.” You go in, you sit down, you talk with the staff, “What are your problems? What are your concerns? I’m here to help. We won’t solve it overnight, but together, we can work this out.” Then, they start telling you all the issues and then you start (inaudible), “How do you participate or how can we do—how can we work this out?” So with that, we were able to develop a plan, and from that plan, we started working the plan. Tacey Ann Rosolowski, Ph.D. You talked about the fishbone approach and all that, and I’m wondering, what were specific issues that were emerging because of this increase in patient volume? I mean was it difficult to ma—was that the key problem?

Cecil C. Brewer, RN, BSN, MS:

I think we identified about—there’s a tremendous amount of problems, issues, volume increases, you’ve got staffing issues, you’ve got pro—you’ve got patient flow issues. You have issues with medications, you got errors, you have people who have been overworked, overtaxed in their work, you have competence issues among staff. A so when you outline all these different issues, I think we identified, I don’t know, maybe over a hundred issues. Then, you start putting those into categories, and you could start eating this elephant. I got a picture of elephant and I said, “How do we eat this elephant?” One piece at a time. But the key to all of that is find the simplest thing on the chart and show a quick win. Tacey Ann Rosolowski, Ph.D. Yeah, it inspires people.

Cecil C. Brewer, RN, BSN, MS:

Get the quick wins and then you pound it, look what we have to accomplish. It was the simplest thing wrapped under their eyes that all it needs is someone to pay attention to it, and they thought that was the greatest thing in the world, so now you got your trust. You’re on your way now. You’re on your way now. Tacey Ann Rosolowski, Ph.D. And people feel like a team too.

Cecil C. Brewer, RN, BSN, MS:

You’re on the team. Tacey Ann Rosolowski, Ph.D. It’s like, yeah. We did it together.

Cecil C. Brewer, RN, BSN, MS:

You’re on your team, the medical staff comes on board, the administration comes on board, the staff taff becomes more productive, things start to happen.

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Chapter 11: Center Administrative Director: Philosophy of Leadership