'[I worked] 90 days straight': How 1 COO overcame her darkest moment

In June, Los Angeles-based City of Hope appointed Angelique Richard, PhD, RN, to be COO of its California locations. 

She comes to her new position from Chicago-based Rush University Medical Center, where she most recently served as senior vice president of hospital operations and chief nursing officer at Rush University System for Health. As City of Hope's COO, Dr. Richard oversees alignment and innovation across operations at City of Hope National Medical Center, City of Hope Los Angeles, City of Hope Orange County and the cancer center's clinical network in Southern California.

Here, Dr. Richard talks about her priorities and darkest moments as a leader.

Question: Why did you choose leadership?

Dr. Angelique Richard: I think my first day of nursing school, Dr. Luther Christman, a true pioneer in advancing the nursing profession and healthcare as a whole, came in. He was the dean and vice president of nursing at Rush, where I went to undergrad. He talked about nurses with PhDs at the bedside and the importance of education and how that would advance not only the nursing profession but also healthcare and patient outcomes. He planted the seed about our responsibility in this field to lead and prepare ourselves for leadership. 

I often talk about how leadership found me, rather than me choosing it. Through my various roles as a student, staff nurse and through my overall commitment to making things better, being a leader gave me the opportunity to impact patient care. Later in my career, it also allowed me to impact the staff, helping them develop and achieve their goals and impact healthcare overall.

Q: What do you think is the greatest operational challenge that hospitals and systems are facing right now?

AR: There are many challenges for all systems, including financial pressures, national workforce shortage and health disparities. Integration within health systems is another significant challenge. Systems are often formed to create scale, but creating a unified culture within these organizations is tough. City of Hope has been around for over a hundred years but its transformation into a cancer care and research system is new, and while it's challenging, it's also exciting. Our mission of bringing hope to those facing cancer or diabetes unites us.

Q: What was one of your darkest moments on the job and how did you move forward?

AR: One of the toughest times to lead through was the pandemic when I was at Rush University Medical Center as its COO/CNO. I remember working 90 days straight, trying to keep our patients safe and meet their needs. We had to create capacity, work with Chicago and Illinois officials, ensure staff safety and educate communities. There was great fear, uncertainty and constantly changing messages. I was responsible for our incident command center and led efforts to navigate these challenges. 

One of the darkest moments was seeing the health disparities highlighted during the pandemic. At one point, we converted a critical care pediatric unit into a critical care unit for adults, and I remember seeing every room filled with a person of color on a ventilator. That image is ingrained into my head. We got through that by being honest, transparent and engaging our staff. We made a leap of faith to prioritize care over cost, and I'm very proud of how we led through that difficult time.

Q: If you could change one thing about the healthcare field, what would it be?

AR: I would address access to healthcare. The pandemic made these disparities so evident. This is a responsibility for all of us in healthcare, especially those in leadership roles. We need to provide access to care and understand and address these disparities. City of Hope is making an impact in this area; we've expanded our clinical network to make leading-edge research and treatment accessible to more patients, families and communities. We're impacting legislation with the California Cancer Care Equity Act. We're taking mobile screening units into underserved communities and we're helping to create career paths to change the economics of those communities.

Q: What's the best leadership advice you've received?

AR: Seek first to understand. When starting at a new organization, it's crucial to understand the history, people and problems we're trying to solve before jumping in. Engagement is also key. Engaging others in finding solutions results in better outcomes and their commitment to the process.

Q: What new hospital program or initiative are you working on in your new role?

AR: I'm responsible for our Southern California region, including the National Medical Center, which is the home to our NCI-designated comprehensive cancer center and research hub, 30-plus network sites, and a new specialty cancer hospital in Orange County set to open in 2025. We launched a mobile cancer prevention and detection unit this year, one of the most comprehensive in the country, aimed at getting care into communities that don't typically have access to this level of cancer screening.  Additionally, We're also opening the largest ambulatory care facility on our Los Angeles campus, in February, which will provide comprehensive, state-of-the-art outpatient care in one location.

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