Hoag Orthopedic Institute CEO on Communicating the 'Why'

Kim Mikes, MBA, BSN, RN, CNOR, CEO of Hoag Orthopedic Institute, shares the history of the organization, the benefits of physician-owned models, how her background has helped her become a fluid leader, and offers advice for future leaders.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Women in Healthcare Leadership Podcast. Audio of the full interview can be found here.

Kim Mikes, MBA, BSN, RN, CNOR, serves as the CEO of Hoag Orthopedic Institute (HOI), an orthopedic specialty hospital in Irvine, California, with a deep focus on orthopedic and spine patients.

Prior to advancing into her role in 2021 to become the third consecutive woman to lead the organization, Mikes served as COO and CNO for the organization beginning in 2016. Mikes' career journey has gone full circle, as she started in the operating room as a nurse for spine and orthopedic procedures.

In the latest Women in Healthcare Leadership Podcast episode, Mikes shares the history of HOI, the benefits of physician-owned models, how her background has helped her become a fluid leader, and advice for future leaders.

This transcript has been edited for clarity and brevity.

HealthLeaders: Would you mind sharing a little bit about your healthcare background and how you became CEO of Hoag Orthopedic Institute?

Kim Mikes: I am an OR nurse at heart and started my career in the operating room. Now being the CEO of an orthopedic and spine specialty surgical hospital is extremely beneficial. I understand the business to its core. I know everything that goes on in this organization, clear down to the sterile processing.

I started my career in the operating room, doing primarily spine and orthopedic procedures at a level two trauma center. I later went on to a couple of other positions where I was the OR director, overseeing the entire perioperative phase of care for patients including the pre-op and recovery phases. Within a year of my becoming an OR nurse, I started overseeing the neuro service and the orthopedic service at the hospital I was at.

After that, I also worked for the largest neuro surgical and neuro clinic physician group in the country for just a year. That also helps me in my current position, because I'm in a physician-owned facility, to understand what happens in the clinic as well.

After coming to Hoag Hospital in 2008, I oversaw departments like the same-day surgery department, GI lab, and then for five years in women's health. I was the executive director for Women's Health for Hoag Hospital prior to coming to HOI. That role actually rounded out my career because women's health is almost like its own small hospital at Hoag Hospital. You have an emergency department and critical care, and procedural things, as well as inpatient units.

In 2016, I came to HOI as the CNO and COO. Then when our prior CEO elected to leave last year, I was moved into that role. I feel like in many ways that my career has been tailored to be right where I am right now, and I couldn't feel more fortunate [and prepared] to be in this role.

HL: HOI was developed in 2010 through a joint venture between Hoag Memorial Hospital Presbyterian and a group of orthopedic and spine doctors in Orange County. Could you talk about how HOI came to be and how it operates under this joint venture?

Mikes: We had two large orthopedic groups here in Orange County, both of whom had already ventured into the ambulatory surgery center arena. They both had successful surgery centers that they were operating independently. One was associated with St. Joseph Hospital, part of the Providence system, and one was with Hoag Hospital. These physician leaders —they were competitors at the time—came together because they believed in this specialty model, because they saw the outcomes, the efficiencies, and the value.

They went to the CEO of Hoag Hospital at the time, Richard Afable, MD, MPHA, and proposed this joint venture. He was enough of a visionary to realize that this made sense for all of the reasons that the surgeons brought to them. He was willing to embark on that journey with them.

The way that it works is we have an independent board, but we are a separately licensed orthopedic and spine specialty hospital. That is one of the things that I'm so passionate about here because the advantages and benefits to patients in coming to a specialty hospital are amass. Every single individual who works here is an expert because they focus exclusively on orthopedics and spine.

We're the only hospital in the region that can make the statement that we are solely focused on orthopedics and spine. We have specialized protocols for different procedures, we have navigators who take people through the process, we have not only a hospital with 70 beds and nine operating rooms, but we also have four ambulatory surgery centers, three of them in Orange County and one in LA County.

The other thing is that it has allowed us to develop what we call our signature experience. For us, the patient is always at the center of our care. Our mantra is, "we get you back to you." No one goes to have their hip replaced, or their knee replaced, or their back worked on, unless the pain that they have is impeding what they love to do, and what they want to do in their personal lives.

We also have our Hoag Orthopedics Education Research Institute. Everything that we do is data-driven. When we make changes to clinical protocols, it's based on data that we've collected.

Even though we're only 10 years old, we have a wonderful reputation in the orthopedic world. We do more total joint procedures than any other organization west of the Mississippi. We do more spine procedures than anyone in Orange County. And our spine patient base is growing.

We are currently working on adding capabilities to take care of higher acuity patients. It used to be that our criteria were somewhat limited because we don't have an ICU, but we're putting protocols in place to make sure that we can take care of virtually any spine or orthopedic patient.

HL: What are the benefits of physician-owned models when it comes to ambulatory surgery centers and specialty hospitals, and how has this model worked in favor for HOI?

Mikes: I am a firm believer in the specialty part of the hospital where patients get expertise across the board. The physician-owned part adds another level of quality, because when physicians are owners, like any small business owner, they are invested in the highest possible quality and value that they can provide. When decisions are made here at this hospital, they are multidisciplinary in nature. The physicians participate in all our committees. Anytime major decisions are made, they are part of the process. And quality and value are always first and foremost; the patient is at the center of every single decision we make.

Some people think that perhaps a physician-owned facility lends itself to decisions being made only about money. That has not been my experience having worked in two of these facilities, because of the physicians who enter into these sorts of arrangements understand that if you provide high quality patient care and value to the payers and the patients, you will always come out on top. It always is about what's the best thing for the patient, how are they going to have the best outcomes. That's the way we do things and that's the way decisions are made. And when you have a physician-owned facility, you also have the ability to make changes quickly and to get everyone on board quickly. Not every physician who works at HOI is an owner, but the pure accountability among the physicians is phenomenal.

The other thing that is extraordinary about HOI is the great respect that the physicians have for the entire team. They value and respect every single team member. We have a flat organizational structure and everyone on the team has a say and feels empowered to speak up when they see opportunities for improvement. And their opinion matters.

HL: How would you describe your leadership style? How does your background as an OR nurse, a COO, and CNO help define it?

Mikes: I did neglect to mention one thing about my background that I think is an important piece of it. Seven years ago, I went back to UCI to get my MBA. I think there's value in being able to look at a situation or an issue from both a clinical standpoint as well as a financial standpoint; there's great benefit in having both of those perspectives when you're making decisions. Quality always comes first, but you have to make sure that value is part of the equation.

I would say that the nursing part of me always keeps the patient at the focus of every single decision that we're making. From a leadership perspective, we always ask, what's best for the patient? What do we need to do for the patient?

As far as leadership style goes, I tend to try to involve the leaders and the staff in the decisions, primarily by making sure they understand where we're going. I change my leadership style based on the situation and the individuals that I'm dealing with. But primarily, I would say it might be transformational in that I try to talk about where we're going and then open it up to how are we going to get there.

HL: What advice do you have for women and others who want to serve in leadership roles in the healthcare sector?

Mikes: Many women who end up in a leadership position in the healthcare sector came up through the clinical path. It was an important step for me to get that business background and add the business to my background to be able to look at things in a more holistic way. I believe that it helps you to get credibility from the CFOs in the world, and the other people who sometimes don't want to listen to the clinical people, because they think they may know better. If you can talk about things from both sides of the table, the financial as well as the clinical, then you get credibility on both sides.

It's important to try to round out your background. It is important to understand that it's hard work. If you're going to get to a position of high accountability, you have to be accountable for everything that happens under your direction.