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Submitted: 8 June 2017
Three sessions: 21 September 2016, 3 November 2016; 27 February 2017
Total approximate duration: 4 hours 30 minutes
Interviewer: Tacey A. Rosolowski, PhD
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, email@example.com
About the Interview Subject:
Wenonah B. Ecung (b. July 10; Washington, DC) came to MD Anderson in 1977 in the role of Nurse Clinician II in Medical Oncology. When she retired in 2016, she was serving as Vice President of Clinical Administration reporting to the Executive Vice President and Physician in Chief.
During her long career with the institution, Dr. Ecung had an impact on the organization of nursing care and the transformation of the role of nurses in partnering with physicians in patient care. She contributed to the evolution of multidisciplinary care at MD Anderson, and participated in organizing the institution’s formal shift to the multidisciplinary care model.
 Pronounced “ee-sung”.
Major Topics Covered:
Personal background and education
Perspectives on the role of nurses, oncology nursing, and nursing leadership
Views on racial bias
The Department of Developmental Therapeutics; organization of Station 16, Station 55, Station 65
Leadership, mentoring, career decision-making processes
Evolution of multidisciplinary care
Views on executive leadership; institutional change with shifting leadership
Electronic medical records
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it to written standards).
The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].
In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 21 September 2016
Memories and Details about Family
Chapter 01 / Personal Background
Finding the Way to Nursing
Chapter 02 / Educational Path
An Education that Stressed Nursing Leadership; Experiences of Bias
Chapter 03 / Educational Path
Making a Commitment to Oncology Nursing
Chapter 04 / Professional Path
Nursing in the Department of Developmental Therapeutics
Chapter 05 / Building the Institution
Developing Nursing Care in the New Clark Clinic
Chapter 06 / Building the Institution
Interview Session Two: 3 November 2016
Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care
Chapter 07 / Building the Institution
A New Role as Clinical Administrative Director: Instituting Multi-Disciplinary Care
Chapter 08 / Building the Institution
A Period of Transition for a Leader
Chapter 09 / The Administrator
Professional and Personal Values and Changes in Institution Culture
Chapter 10 / Institutional Change
Interview Session Three: 27 February 2017
The Decision to Retire and Reflections on Working Under Two Physicians in Chief
Chapter 11 / Institutional Change
Associate Vice President of Clinical Operations, an Evolving Role
Chapter 12 / Building the Institution
Chapter 13 / Overview
Vice President of Clinical Operations, a New Working Environment
Chapter 14 / The Administrator
Instituting Multi-disciplinary Care and Electronic Medical Records
Chapter 15 / Institutional Change
A PhD and Teaching Leadership Theory and Policy after Retirement
Chapter 16 / Post-Retirement Activities
Interview Session One: September 2016 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
Memories and Details about Family (listen/read)
In this chapter, Dr. Ecung sketches her early family experiences. She notes that she was from an “Air Force family” and lived overseas for a time, arriving eventually in San Antonio, where both her father and mother worked on planes at the Lackland Air Force Base. She shares memories of her father, who committed suicide when she was ten years old. She notes that her father named her “Wenonah” for her Shawnee grandmother and because the name means “morning star”, alluding to the fact that she was her father’s first born.
Chapter 02 (Educational Path)
Finding the Way to Nursing (listen/read)
Dr. Ecung begins this chapter by noting that when she began college (San Antonio College, transferring to Texas Woman’s University, BS in Nursing conferred in 1977) she believed she would focus on business. She talks about how ambitiously she approached her first jobs in high school and her success as a young employee. She then explains how a guidance counselor limited her sights for study in college to teaching and nursing because of her gender, though she notes that “he didn’t know he was doing me a favor.”
Next she discusses her sense of independence, tempered by a close relationship with her mother, and the stresses of leaving San Antonio when she transferred to Texas Women’s University in Houston.
Chapter 03 (Educational Path)
An Education that Stressed Nursing Leadership; Experiences of Bias (listen/read)
Dr. Ecung talks about her nursing education at Texas Women’s University in this chapter. She talks about the value of the Socratic method employed and shares anecdotes about racial bias she observed and experienced.
Next, she explains that nursing education at TWU was geared toward graduating nursing leaders.
Chapter 04 (Professional Path)
Making a Commitment to Oncology Nursing (listen/read)
In this chapter, Dr. Ecung explains how she decided to focus her career on oncology nursing despite her first reservations. She explains how she first took a job (after graduating in 1977) as a floor nurse at MD Anderson, caring for patients with testicular and breast cancer. She shares stories of working with patients and describes why she found it so difficult that she left after a year and a half.
Dr. Ecung then talks about how working for several months in the emergency service at Hermann Hospital made her change her mind and returned to MD Anderson in 1978, working with outpatients in the Department of Developmental Therapeutics.
Chapter 05 (Building the Institution)
Nursing in the Department of Developmental Therapeutics (listen/read)
In this chapter, Dr. Ecung provides a portrait of her work in the Department of Developmental Therapeutics when she returned to MD Anderson in 1978. She explains the physical organization of the clinic (Station 16). She discusses how she reorganized patients by disease type and assigned specific nurses to each disease type to deepen their knowledge so they might be more effective working with faculty and teaching patients about their diseases. She talks about the impact –notably in the retention of nurses. Next, Dr. Ecung talks about the working relationships between research nurses and clinical nurses in Developmental Therapeutics.
Dr. Ecung speaks in general about the culture of nursing at MD Anderson and how it was based on care and a relationship of trust with both patients and faculty. She notes the philosophy of nursing in Developmental Therapeutics at the time: that a nurse could become a protégé of a physician. She explains that nurses developed good relationships of trust with physicians through expertise, their understanding of drugs and their ability to calculate accurate dosages. She explains that their clinic was one of the few where nurses calculated dosages. She talks about communications challenges working with physicians about dosages. She compares the “nurse as protégé” model with the assumption that nurses are physicians’ handmaidens.
Dr. Ecung notes that she became a role model in Station 16. She discusses other projects she undertook to develop nursing in the clinic and department. She speaks about her promotion to head nurse and lists her accomplishments, also noting that she started her family during this period. Finally, she comments on the “big egos” in Developmental Therapeutics, the challenges of working with some of those individuals, and her reputation for refusing to allow faculty to mistreat her nursing staff.
Chapter 06 (Building the Institution)
Developing Nursing Care in the New Clark Clinic (listen/read)
In this chapter, Dr. Ecung talks about her shift to a new position as Nurse Manager of Station 55 (in 1987), which was moved to the newly constructed Clark Clinic. She talks about the physical organization of the new clinic space and how it functioned more effectively. She outlines changes that she helped make to nursing care between 1987 and 1993, including combining the roles of research nurses and clinical nurses into the Primary Attending Nurse designation. She talks about the challenges of effecting this change and the increase in patient satisfaction it created. She notes that she “had a list of nurses waiting to get into Station 55,” and she was extremely careful to bring in new nurses who fit with the culture of the group. She also recalls that other clinics were asking for information on how Station 55 had been so well reorganized.
3 November 2016 (listen/read)
Interview Identifier (listen/read)
Chapter 07 (Building the Institution)
Reorganizing Station 65 [now the Breast Center], the Preceptorship Program, and Multi-Disciplinary Care (listen/read)
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.
Dr. Ecung gives examples of the expanded role for nurses her turnaround involved and notes that the changes resulted in increased patient confidence.
Next, Dr. Ecung comments briefly on the evolution of multi-disciplinary care at MD Anderson. She also explains that on her own initiative she negotiated an increased salary when she took on the reorganization of Station 65.
Dr. Ecung next talks about the Preceptorship Program, which was designed to instruct representatives from pharmaceutical companies in how their drugs were used in MD Anderson procedures.
Chapter 08 (Building the Institution)
A New Role as Clinical Administrative Director: Instituting Multi-Disciplinary Care (listen/read)
In this chapter, Dr. Ecung tells the story of taking on the role of Clinical Administrative Director (in 1996). She begins by talking about the interview process, which took place during a difficult period of her life. She then talks about her responsibility to build multi-disciplinary care teams as the institution went to a “one stop shopping” model. She also talks about the effects of this “huge change” on faculty, nurses, and on patients. She also notes that at the time other cancer centers were discussing this change, but MD Anderson took the step of instituting it and “became the way” of organizing care.
Next she notes that she has always had “great nurses” who wanted to “do more than put a patient in a room.” She talks about the interview process she used to select nurses. She also recalls her Master’s program, where she began to understand her administrative philosophy.
Chapter 09 (The Administrator)
A Period of Transition for a Leader (listen/read)
In this chapter, Dr. Ecung talks about a period of transition she went through in her focus on leadership. She begins talking about an MD Anderson-sponsored leadership development program she attended, then shifts gears and explains how Dr. Charles LeMaistre invited her to chair a group of classified employees tasked with interviewing candidates for the new presidency of the institution. She notes that this role gave her visibility among staff outside of medicine; she also recalls lessons learned, illustrating with an anecdote about how she had to handle an awkward moment during an interview with Dr. John Mendelsohn. She notes that these experiences prepared her for leading larger interdisciplinary teams.
Dr. Ecung then returns to her original story about her leadership training, telling a story about how she intervened as a bridge builder when Dr. Mendelsohn and Dr. Todd Pritchard got into an argument about mentoring.
This set the stage in which Dr. David Callendar asked her to interview for the role of Associate Vice President for Clinical Programs. She explains that Dr. Barbara Summers (oral history interview) was chosen for the position. She tells a story of how she demonstrated her support for Dr. Summers in her new role: Dr. Summers eventually asked her to lead the Clark Clinic Renovation project, her second major opportunity for exposure to executive leadership. [Dr. Ecung’s husband, Ramon, comes in briefly at the end of this chapter.]
Chapter 10 (Institutional Change)
Professional and Personal Values and Changes in Institution Culture (listen/read)
Dr. Ecung begins this chapter with some brief comments about mentoring: she notes that “I am a product of mentoring” and talks about her own strategies of mentoring. She tells an anecdote about mentoring staffmembers who are already fairly highly placed but looking to rise higher in the institution. She notes that by virtue of her mentoring, she began to serve as “the doorway” to the Physician in Chief’s office. She explains that honest and integrity are key concepts in her personal and professional philosophy and these values served as motives for her decision to retire.
Next Dr. Ecung offers her observations on changes that she has seen in MD Anderson’s culture over the past five years, noting that the institution does not feel “as wholesome” as it did during her years of service and that the place is “reshaping” in ways that do not match who she is. As an example, she explains that for 37 of her 39 years at the institution she never felt that she was looked at as black, but now feels invisible in meeting with the president [Dr. Ronald DePinho; oral history interview]. She also explains that she has observed Dr. DePinho’s wife, Dr. Lynda Chin, behave in ways that were damaging to moral.
She notes that in the past, she observed situations arise where the faculty might not like an institutional policy or decision, but nevertheless supported the president. Today, she explains, the faculty does not feel heard and this support is not as strongly expressed.
She also notes changes in the Physician in Chief’s office. The atmosphere was very close and trusting in the past, but now sees a kind of class system in place.
27 February 2017 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (Institutional Change)
The Decision to Retire and Reflections on Working Under Two Physicians in Chief (listen/read)
In this chapter, Dr. Ecung explains the factors that led her to retire at the end of 2016, setting her decision in the context of her work with two physicians in chief, Thomas A. Burke, MD [oral history interview] and Robert Brigham.
She begins by noting that she was serving as Associate Vice President of Clinical Operations when Dr. Burke came in as physician in chief, and he made the conscious decision to keep her in that role. This gave her to opportunity to observe the process by which he was removed from that position and notes that she felt it was “not done with integrity.” She talks about Dr. Burke’s accomplishments in his role and explains that he had the habit of “speaking truth to power” while also being a “citizen of power.” She explains the process of removing him (2013) and why integrity is so important in executive levels of an institution.
Next, she talks about her expanded role as Vice President of Clinical Operations under Dr. Thomas Buchholz because another key individual had left the institution and Robert Brigham had come in as new Senior Vice President for Hospital and Clinics, working closely with Dr. Buchholz. She describes the new perspective that Mr. Brigham brought from his years at Mayo Clinic and the changes that he and Dr. Buchholz instituted.
Dr. Ecung explains how her role changed and was ultimately diminished in this new administrative context. She talks about her decision to retire and cut off from all contact with MD Anderson for one year, explaining her reasoning. She also talks about how people who remained in the office of the Executive Vice President felt they had lost an advocate when she left.
Chapter 12 (Building the Institution)
Associate Vice President of Clinical Operations, an Evolving Role (listen/read)
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 repeat 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.
Chapter 13 (Overview)
Key Projects (listen/read)
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. Callendar and Dr. Barbara Summers, 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.
Chapter 14 (The Administrator)
Vice President of Clinical Operations, and a New Working Environment (listen/read)
Dr. Ecung begins this chapter by narrating the story of how she was promoted in 2014 to Vice President of Clinical Operations (along with others in the Office of the Executive Vice President). She notes that her official role didn’t change, as its scope was already “huge” and she was required to have a great deal of agility to take on new projects.
The role did shift, however, along with circumstances over the next two years, she explains, because Dr. Buchholz had taken over as Physician in Chief in 2013. Once Robert Brigham came in as Vice President of Hospital and Clinic, she explains that she was expected to do more, but also serve a more restricted and diminished role.
She notes that projects effectively stopped when Dr. Buchholz came in as he adjusted to the new role.
Chapter 15 (Institutional Change)
Instituting Multi-disciplinary Care and Electronic Medical Records (listen/read)
In this chapter, Dr. Ecung sketches some of the major changes she saw during her years working for the Physician in Chief.
First she talks about the process of adopting electronic medical records. She explains that under David Callender, the institution looked at a variety of vendors and determined that the MD Anderson-developed system, ClinicStation, exceeded what was on the market. In 2014, she explains, leadership decided to adopt the EPIC EMR system. She talks about the pros and cons of ClinicStation and notes that the administration planned on a $250 million loss when instituting EPIC.
Next, she talks about the process of supporting the evolution of multidisciplinary care at MD Anderson, a process that involved helping faculty and staff understand what it was about and then managing the transition of practice to a team approach. She talks about the difference between physically bringing the different specialties together versus creating a culture of collaboration. She talks about some of the strategies used to foster collaboration, including the importance of cross-training nurses and holding planning conferences with faculty across specialities. She talks about the importance of spatial support in design of clinics, developing teams, holding formal conferences, and including multidisciplinary teams in patient visits, the latter resulting in a “show of force for a patient.”
Dr. Ecung talks about working on the Clinical Effectiveness Committee that formalized multidisciplinary approaches in the MD Anderson algorithms of care. She points out that the Sarcoma center did a costing of each algorithm.
Chapter 16 (Post-Retirement Activities)
A PhD and Teaching Leadership Theory and Policy after Retirement (listen/read)
In this chapter, Dr. Ecung first explains her decision (in 2010) to get a PhD and then talks about teaching Leadership Theory after her retirement in 2016.
First she explains how she came to earn a PhD at Our Lady of the Lake University at San Antonio after that institution established a cohort in Houston in 2010. She talks about her husband, Ramon’s support of her work and the challenges of doing a PhD (conferred 2013) while involved in a demanding position. She recalls her graduation.
Dr. Ecung then discusses the impact of her program of study as she served as Associate VP and VP of Clinical Operations.
Next, she explains how she was invited to teach leadership theory and policy after her retirement. She explains that she wants to give back to the University and this is her contribution of community service.
Finally, she notes that her heroine is her mother.