Q&A: Hoag CEO Robert T. Braithwaite on the Future of Healthcare

The healthcare industry is undergoing a fundamental shift in how and where healthcare is delivered. Hoag President and CEO Robert T. Braithwaite on the evolution of the patient experience, specialty care and a new model for distributed healthcare.

As president and CEO of Hoag, Robert T. Braithwaite oversees a regional healthcare system focused on delivering comprehensive, personalized care. The Orange County, California–based nonprofit is on the leading edge of developing facilities to support a team-based approach to whole-person patient care, moving beyond the traditional hospital concept.

LPA is working with Hoag on a new facility in Irvine, California, that changes the dynamic for a modern healthcare facility, with a focus on specialized care and connections to nature. In an interview with Catalyst, Mr. Braithwaite discusses the design of the new facility and the opportunities to improve the continuum of care.

How is Hoag’s healthcare approach different in the new facility?

We’ve realized that the market is hungry and very warm to this notion of specialty facilities. We’re moving away from the traditional historic American model, which has different specialty floors embedded within a general hospital. That was where we started. We knew that we wanted to go with a specialty angle to it. That was the basis for the design.

We put that out to 10 architectural firms and had a design competition. The LPA design really honored that notion of specialty facilities that had the right adjacencies to make sure that the continuum of care wasn’t sacrificed, and it was clearly the one that met all the objectives.

A new type of medical facility for Hoag changes the dynamic of modern healthcare delivery with a focus on specialized care and connections to nature.

How do you define “the right adjacencies”?
It’s core services like women’s services contained within that facility, both inpatient and then outpatient. It’s making it easily accessible for patients to flow between the two points of care, with a heavy emphasis on the outpatient, since that’s where so much of healthcare is delivered.

We want to make it easy on the patients if they have to make that transition. We also want to make it easy on the clinicians so they can easily flow from one space to another without having to navigate in a vehicle between those two points.

How did the pandemic recalibrate your approach?
Outdoor spaces became sanctuaries for staff as well as patients. They were a place where they could go and recharge their battery. It was really hard on the healthcare staff during the last three years. The other impact was just the need for safer environments, generally speaking.

From an infectious disease perspective, how many rooms do you have available to deal with things like patient isolation due to a contagion at the scale we saw? We were able to design into the Irvine facility something that was scalable to better meet the needs of the community should a pandemic occur again.

Outdoor spaces are integrated throughout the campus, providing sanctuary for staff and patients to recharge.

How do you feel that patient experience at a Hoag facility will be different going forward?
Irvine happens to be our incubator site on many things. We really got in deep with the community. Typically, when you do focus groups, you’re largely focused on the community that’s going to be the likely recipients of care, which for most facilities happens to be on the more senior side of the age spectrum. But when we were doing some of the design work for Irvine, we expanded that focus group spectrum and got a lot of input from younger patients, knowing that this was going to be their hospital for the next 20, 30, 40 years.

We spoke to 300 millennials in the process, young adults, and said what do you see? Their perspective was really cool. Incorporating design principles from a younger generation was really essential and different than the traditional design approach for most healthcare institutions.

What input from that younger audience affected the final design?
One thing that they really wanted was wellness incorporated into everything that we do in the care model. To achieve that, on some of our facilities we’re cobranding with wellness brands — Campo for aromatherapy; the Los Angeles Chargers to get sports and active motion into rehab-type work; Lululemon for wellness and yoga. All these retail partners are in that wellness space, but they’re starting to make their way into the overall healthcare ecosystem. Our patients love it. They love knowing that those things are considered and are options for them as they receive their care at Hoag.

How can facility design affect outcomes?

It’s not the best day of their life when they’re in the hospital. Usually that first day or two is really their diagnostic workup and the time when you’re getting definitive answers and treatment plans. Once that starts to happen, you’re in the recovery process, and all of the elements we’ve been talking about are designed to help with that. If you talk to the patient, that’s where they want to be, and they want wind at their back. When you can show them it’s all designed to help them get an advantage in that recovery process, the response is really great.

We spoke to 300 millennials in the process, young adults, and said what do you see? Their perspective was really cool. Incorporating design principles from a younger generation was really essential and different than the traditional design approach for most healthcare institutions.

Biophilia played an important role in the design, recognizing the positive effect of connections to nature on health and wellness outcomes.

What did you enjoy about the design process?
Historically, when you go to design a facility, it’s usually the senior leaders and some of your senior physicians. You bring a lot of tradition into that. By doing it this way and including the consumer, the patient population and a lot of these partners — they began to open up opportunities and concepts that we had not historically thought of. It was really fun to collaborate with them and let them infuse retail and wellness into the overall design.

What are your favorite elements of the design concept?
From my perspective I love the openness. I love the grander spaces that are in the common areas. I think that’s going to play very well for the patient population. I also love the partnerships that we’re starting to establish and infuse into the overall delivery of care and continuum of care. Candidly, it’s been a major recruitment tool for us. Specialists that look at this and say gosh, I’m not in a — I’m going to do air quotes — in a general hospital. This is a facility that’s been specifically designed for the specialty and my patients. We didn’t realize what a benefit that was going to be. We also saw very positive philanthropic reaction to it as well.

What about this project prepares you for the future?

I think the architects and designers have been very thoughtful about the change in environments. Some of the spaces that they have designed work for healthcare as we know it today and as it’s delivered today. But they were very thoughtful in saying okay, if we move to this or if it moves to more technology or more artificial intelligence, we can adapt these spaces to accommodate those changes. In the life of a healthcare institution or a building, it’s going to be 50 years in service. That adaptability is really important.