Relentless Drive: Hoag’s Leadership on Bringing Its New Campus to Life

Robert T. Braithwaite, Marcy Brown and Sanford Smith on innovation, collaboration, and the vision they realized for the Sun Family Campus Expansion at Hoag Irvine.

Today marks the grand opening of the Sun Family Campus Expansion at Hoag Irvine, which reimagines the traditional hospital tower as a robust wellness village made up of a series of specialty institutes linked by biophilic landscape architecture. It’s an idea that pays homage to the existing midcentury design language of Irvine, which was master-planned as a series of low-scale villages connected by parks.

But design is only one part of the equation. What you don’t see in the finished outcome are the years of behind-the-scenes work that underpin it within Hoag — and the collaborative, forward-thinking leaders who championed the work and kept it moving every step of the way.

It takes innovative leaders to drive innovative results. And at Hoag, three of those leaders are President and CEO Robert T. Braithwaite, Senior Vice President and COO Marcy Brown, and the project’s longtime advocate, Sanford Smith, FAIA, Hoag Real Estate, Facilities, Construction and Operations Advisor.

In this roundtable, the trio details the origins of the campus expansion, what innovation means to Hoag, and the internal culture that made the entire endeavor possible in the first place.

Marcy Brown: When Robert and the team originally opened the Irvine campus back in 2010, I knew we believed there was an opportunity for growth, but until we could prove that our presence in the community was going to be embraced — that the community was going to really see Hoag Irvine as their Hoag — we weren't going to double down. When we filled up the Hoag Health Center Irvine Sand Canyon in 2016 across the street from the main campus, that was truly a pivotal moment where we realized the community really wanted to seek Hoag-branded care.

Sanford L. “Sandy” Smith: It was right around that time that we went to the board for the first time and really sat down and shared with them the growth and the expectations. And again, the Health Center was so widely received. It became an overnight realization of, Oh, we can stay in our own community and have these medical services done. And that really resonated.

I moved to Irvine when I was in my 20s and, unfortunately, I'm no longer in my 20s. While the community has this amazingly well-conceived master plan, healthcare was the one piece that was really not part of it. It has lots of schools and parks and amazing infrastructure. But what it was really lacking were the support services that people who are getting older need.

The other dynamic in Irvine is that because it's such a great community and it's so safe, instead of moving and downsizing, a lot of us are staying put.

Smith: I think when we did our original assessment, we knew we needed growth, and we set out to explore how we could address that. And at that time we hadn't acquired the adjacent parcel of land. So we were thinking tower-centric. But it was sort of like, Yeah, that isn't Irvine. It could be totally appropriate in some other community, but it's not addressing the underlying fabric of the way the city of Irvine was developed. And that sort of sent us back to the drawing board — which initiated the design competition that LPA won.

Robert T. Braithwaite: [A tower] was just too generic.

Brown: When you saw the big, sort of monolithic tower, not only did it not feel like Irvine, but it didn't resonate with us around how patients wanted to receive care. And we made a decision to design a campus around how patients would access and receive care. That was very different than anything else we'd really ever thought about. It just so happened [to coincide with] the timing of Hoag investing in privademics and specialty clinics. Everything came together and just helped to backstop the decision and the direction we were headed in.

Braithwaite: Marcy hit something that was really important. She talked about how [the traditional approach is] not what the community wanted, but I would also say we discovered through the process that it's not what the outstanding physicians wanted, either. They did not want generality. They did not want a general hospital. They wanted something that was hyper-focused on their specialty, where they could create excellence. And so it was community-driven. And then later on we realized, Oh my, if we're going to get best in breed from a physician perspective, this is what they want, too.

Brown: To recruit that talent from across the nation to deliver the Hoag-branded services in the specialties we were investing in, that was critical. Absolutely critical.

Braithwaite: I also think that from the very beginning, before Hoag even took the [Irvine] property back in 2008, one of the tenets was that we were going to think very differently about healthcare there. We call it the incubator for Newport. So anything that was going to be new in the Hoag ecosystem was going to be piloted there. It had a “let's go try it out there” type of a mindset and culture, which I think kind of laid the groundwork for something different to get expressed in the facility plan.

Brown: I think it needs to drive everything you do. Setting up an innovative platform allows for flexibility, and I've learned over the course of my tenure at Hoag that flexibility wins all day long. Whether it's a patient room, whether it's a service line you never imagined we would develop and launch, flexibility. And the facilities really enable our organization to be flexible. So when we're designing spaces, you think about how this is the use today, but you can't even begin to imagine what the use might be in 10, 15, 20 years. And luckily LPA, our partners, the Hoag team and Sandy's division always allow us to think differently when we're designing spaces.

Braithwaite: It was pretty out there and inspirational, especially when we saw the work of so many different firms. Just the novel approach and thinking that was expressed in the design — I think it kind of resonated at a pretty intrinsic level.

Smith: Yeah. I would say it was the one scheme that really represented Irvine. And I think it was because LPA was our Irvine-based firm and grew up building out the ranch, so they really understood what the urban fabric for Irvine was meant to be.

Brown: For me, it was when I saw how they integrated nature. Where else do you have these gorgeous garden views from every patient room? Not only that, but for the outpatient spaces where you might be waiting for a loved one having a procedure in the DHI hospital, you can go out on the deck and listen to the birds and overlook the water features in the garden. It’s mind-blowing. Mind-blowing.

Smith: I think the biggest was when we really got into starting the detailed design. After we'd made the business case, COVID broke out. We were in the beginning of the design process and doing a lot of the sessions remotely, trying to get consensus around it. It was all hands on deck here at the hospital because we were overrun by patients. And so everything from getting access into the hospital to do field measurements, to the design process, trying to bring all the consultants together … it was really unprecedented. And then there was a rapid change in the pricing structure because the supply chain had been so significantly impacted.

Brown: For me, the motivation was delivering this campus to the community, and to the physicians that have been recruited. We get to expand their services, whether it's cancer services or digestive health and mother-baby. I mean, my word. Look at all the Irvine moms who have delivered at [Hoag] Newport Beach — now they get to deliver in their own community. That's amazing.

Braithwaite: We had an executive who came from the Irvine Company years ago, who after experiencing the Hoag culture, labeled it “the culture of relentless.” And I thought that was the first word that kind of captured the nature of Hoag. It is a relentless culture, meaning relentless drive. We're never satisfied with the B grade. Never satisfied with “almost got it done.” It's always across the finish line. And I love that. Was it ever in question that it was going to get done? No, it was never in question. It was hard, but it was never in question.

Smith: The one thing I was going to add that really speaks to Hoag and the incredible support we have from the community, is the board was unwavering in their support. I can't tell you how many times I had to go back to the board and say, "Yeah, we need more money."

The board is informed and educated and passionate about serving the community. And they were aware of what was happening in the world. But rather than sort of saying, "OK, then scale it back," they said, "We're going to execute this." And they gave us the support, which gave us as the design and construction team the resources to make sure that we executed.

Braithwaite: Sandy, that is a great point, because despite the expertise of LPA and the relentless drive of the executives, the tall redwoods in this were the board of directors, because we did go back to them. And they just kept supporting the mission, and kept supporting the community.

Brown: Trusting us.

Smith: Yeah. And I think so many other health systems would have seen the rug pulled out from under them, and then you would have had everything stripped out of the design.

Brown: And I think too, as they walk through this campus, they feel that it's their legacy to the community. And something they feel very, very proud of.

Brown: It's a game-changer. It's an absolute game-changer. I have to say, without the culture and without making sure that every single person we hire to deliver the care at the bedside in these buildings meets our standards and our Hoag culture, we just have beautiful buildings, right? It's with intentionality that every single person that's recruited to be at the bedside and be in the support infrastructure to work in these buildings meets our culture. We don't hire warm bodies at Hoag. We make sure that once they meet the standards, then we take them on the tour. If it's a physician, we have an interview, there's a vetting process, and then we take them through the campus. And then it's like, wow. It would be a privilege to work with Hoag.

Brown: I think so. When we built the comprehensive breast center, we designed it so that a woman would feel like she was doing something very special for herself when she goes for her annual mammogram. It feels like a trip to the spa, from the moment you step into the waiting room and how you're greeted. The lounge spaces are absolutely stunning. And it's very, very different from anything out there.

For the first time ever, a woman who’s diagnosed with breast cancer can go from a screening mammogram to a diagnosis of breast cancer, her surgical intervention, her radiation, her chemo, all in that one village. And never before could we do that in Irvine. For reconstructions, for mastectomies — for all of it, you had to come to the Newport campus. And now, not only can it be achieved on the Irvine campus, but one thing that I'm so excited about is if you have a wire localization, a stereotactic biopsy, you will never see the public. Usually, you're in your gown, hoping you don't see a neighbor. But when you're in Irvine, you'll go down the private elevator to the tunnel, to the surgical pavilion, which is brilliant. And that journey is such an opportunity to connect with your surgeon and your team and your caregivers.

Braithwaite: I'm going to put an exclamation point on Marcy's comment. Marcy talked about the clinical excellence and the clinical efficiency and the clinical brilliance. I have never, ever, seen a healthcare facility more beautiful than what is happening in the women's center.

Brown: Surreal, but it's an incredible responsibility. We cut the ribbon, and then a whole other line of work begins. We have to activate the buildings, every single square inch, with intentionality. And Robert and Sandy always talk about big pants. We've got really big pants to fill right now. We don't need to fill all of the space. We built this campus for the next 50 years. And so it's going to take restraint to not fill up every hospital room and every floor and every department. So now there's a lot of work that goes on behind the scenes to make sure that we activate it with just as much intention as we did when we built it.

And already I'm policing the areas because when you walk in and you get that wow moment — whether you're in the women's receiving area, the lobby, cancer and digestive health — I want it to have that same response 10, 15, 20 years from now. And that takes a lot of work, managing every patient room to make sure that the brand standards meet our community's expectations. And we owe it to our donors to make sure that the facility stays that way.

Smith: We're really here to create the infrastructure for the healthcare to be delivered. And I think it's the promise of the ability for the community to expand and get the services it needs that is so fulfilling.

Braithwaite: You know, Sandy, my father was a history teacher. He always used to tell us about these great people in history. One of my favorite stories was about George Washington. They had to beg him to come lead the army to fight the British. He finishes the war, but rather than spiking the football … he just went back to Mount Vernon and became a farmer. And so I loved your comment. It's kind of like, hey, at the end of this thing, together with LPA, we will go back and do what we have been called to do, which is to make sure this community has the best healthcare. There'll be no spiking of the ball. We will all go back and do what we were called to do to care for this community.

Smith: Transparency in the communication. We met with the senior leadership team weekly, going through the design process to talk about everything from color of the material to macro-level things. And I think the ability to be direct and honest — "I like that,” “I hate that,” “Why would we do that?" — is critical. And once we got consensus about the things that we were doing, everybody was locked in. Everybody was executing. And I think that's the sign of a really healthy organization, to be able to have that kind of legitimate debate about what our priorities are. It really helped to keep the project on track and remain pretty true to the original vision.

Brown: For me, when we would meet with the physicians, the nurses, all the caregivers that are going to be working in these buildings, my goal was that when we cut the ribbon, they all say “this is my hospital.” That their DNA is in this design. We had design sessions with Sandy, LPA and the team where surgeons would come in and nurses would come in. We built mock-up rooms where the OB physicians could put their Post-it notes all over — "don't put that here, put that there, put the boom here." Because they are the ones in those rooms every day, every night, the middle of the night, on weekends, delivering those babies and working in the spaces. And I think we accomplished that, without a doubt. They feel like this is their project, not ours. Not the three of us, but theirs.

Smith: Well, I think the project will certainly be studied by lots of health systems and architectural firms in terms of the physical experience. Whether it becomes the future for healthcare, I don't know because, again, I think it expresses our culture very uniquely, and I think it'd be very difficult for a lot of the other health systems to recreate this and be able to support it, because they don't have the cultural pieces that are so embedded in Hoag.

Braithwaite: I do think the architecture plus the culture of Hoag is more consumer-centric than what most healthcare in this country is. And so I think that that's going to be a problem for competitors. They're going to realize, Uh-oh, how do we overcome that differentiated hurdle?

Braithwaite: We're not stopping. We're going to get back to relentless. I just think it's part of how we roll. It's constantly figuring out how to better care for the existing communities that we're responsible for, but also serving new communities, which is equal in its importance. Orange County is, unfortunately, a microcosm of what's happening nationally; the fragility of healthcare in our country is far greater than anyone fully appreciates or acknowledges. And so future-proofing — making sure that Hoag can not only survive, but excel in that kind of environment — is important work that we take extremely seriously. And that'll be manifested in new facilities and new physicians, new care teams, new technology tools.

There's no time or luxury to take a step back and spike the ball.