'It really changes who we are': UCI Health's COO on transformation, systemness and a $1.3B complex

UCI Health broke ground on its new $1.3 billion medical campus in 2021 to spark more accessible care for patients systemwide.


The medical complex includes outpatient care, primary care and a center for children's health. But it also represents so much more. The 13.5-acre complex could bring thousands of jobs to Irvine and be the nation's first all-electric hospital with solar panels to fuel the buildings. It will also bring together the University of California system.

Nathan Shinagawa, chief operating officer of UCI Health, joined the Becker's Healthcare Podcast to talk about the project and leadership pivots amid the push for systemness.

Note: This conversation was lightly edited for clarity.

Question: What opportunities do you see as being key to your continued success and what headwinds do you have your eye on right now?

Nathan Shinagawa: The opportunity is that we're becoming a system. We've got 17 ambulatory sites, but we are anchored now by a 459-bed academic medical setting. It's our only acute care setting and the only academic hospital in all of Orange County, which has 4 million residents. But it's the anchor, and we are spending $1.3 billion to open up a brand new campus at the University of California Irvine. That will be a 144-bed hospital as well as an ambulatory care center, cancer care center and center for advanced care.

When we become a system, it really changes who we are. We have to think about how we go from being more local to having systemness.

While we do that, how do we remain agile? How do we keep our leadership structure still flat enough to drive the decision-making in action while being manageable? Especially when we've got tremendous scale that we're investing in, how do we ensure local accountability while also acting like a system? How do you make sure that local leaders are empowered to make decisions without having to go through the bureaucracy of a system? How do we create the best educational experience for our students, residents and fellows, and how do we make that consistent across all these settings?

This is one of those things where there are so many potential challenges, but with those challenges comes all this great opportunity, and that's what we're most excited about. If we are able to execute this right over the next three to five years, UCI is going to be even further poised to really transform the healthcare landscape, especially here in California and Orange County.

Q: You are growing quickly and I know that's not always easy to manage and make sure the culture is strong. How do you make sure you're maintaining a strong culture and adding value to the overall organization amid rapid growth and broadening services?

NS: Whenever you're going through a transformation, you have to be anchored by your identity. Our identity is that we want to be the friendliest, most accessible academic healthcare system in the country. That is firmly our identity, but we also have our values of: discover, teach and heal. How are we supporting our discovery mission? How do we support research, clinical trials and the teaching mission? How do we make it so that our medical students, residents and fellows are getting the best experience possible, and then healing? How can we continue to improve access and provide high quality care?

We constantly go back to those values and we think to ourselves, how do we ensure that we're meeting them as we embark [on a new] future? As long as one's grounded, it's possible to be able to take on all of this tremendous growth because a transformation without the foundational values is aimless; but transformation with values has the potential to take you to a whole new level.

Q: I love that. It's such an easy and simple way to think through transformation with values and what that means for the organization and community. How do you make sure that culture funnels through everyone in the organization and really becomes a part of what they're living and breathing every single day?

NS: I'm a firm believer that nothing gets done without the frontline staff's engagement and buy-in. The way we do that actually comes from Peter Fine, the CEO of Banner Health, where I was before [joining UCI Health]. Peter is a great healthcare leader who I learned a lot from over the years and he said that visibility equals credibility, and credibility equals trust. I think about that so much. We model that all the time.

We do rounding, I have two rounding sessions scheduled to be out with the frontline, and I'm just talking to them about throughput, because we made a major change with throughput where we created daily visual management dashboards.

We're now huddling several times a day to manage throughput, and in a two month period, we saw the number of discharges coming out of the hospital go up 10 percent. We're going out there, rounding, and talking to the frontline teams, and we're thanking them.

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