A motivated and devoted team is the best arsenal for managing and conquering a crisis.
As the chief operating officer at Rady Children’s Hospital, Dr. Nicholas Holmes manages the organization’s operations with a people-centric approach for collective success.
Dr. Nicholas is the guest in this episode of the Process Breakdown Podcast. He speaks with host Chad Franzen about leading an organization through a crisis with effective team engagement and motivation.
[1:22] Chad Franzen introduces the guest, Dr. Nicholas Holmes.
[2:04] Dr. Nicholas gives an overview of what Rady Children’s Hospital does.
[3:02] What has been key to the organization’s success in being recognized nationally?
[3:28] Dr. Nicholas talks about his day-to-day role as COO at Rady Children’s Hospital.
[5:45] Dr. Nicholas explains how the organization handled the situation of its staff contracting COVID-19.
[7:11] What steps did the team at Rady Children’s Hospital take to fill in last-minute lapses created by COVID-19?
[9:15] Dr. Nicholas discusses how COVID-19 has enhanced the operations at Rady Children’s Hospital.
[10:20] Dr. Nicholas recalls a similar experience where he had to operate in a flexible and nimble environment before COVID-19.
[11:41] Dr. Nicholas talks about the best piece of advice he has gotten from his mentors.
Dr. Nicholas was recently recognized as one of the top 50 Black leaders of influence by the San Diego Business Journal.
Speaker 1: Welcome to the Process Breakdown Podcast, where we talk about streamlining and scaling operations at your company, getting rid of bottlenecks, and giving your employees all the information they need to be successful at their jobs. Now let’s get started with the show.
Chad Franzen: Chad Franzen here, cohost of the Process Breakdown Podcast, where we talk about streamlining and scaling operations at your company, getting rid of bottlenecks, and giving your staff everything they need to be successful at their jobs. Past guests include David Allen of Getting Things Done and Michael Gerber of The E-Myth, and many more. This episode is brought to you by SweetProcess. Have you had team members ask you the same questions over and over again, and this is the tenth time you’ve spent explaining it? There’s a better way and a solution. SweetProcess is a software that makes it drop dead easy to train and onboard new staff, and save time with existing staff. Not only do universities, banks, hospitals, and software companies use them, but first responder government agencies use them in life or death situations to run their operations. Use SweetProcess to document all the repetitive tasks that eat up your precious time so you can focus on growing your team and empowering them to do their best work. Sign up for a free 14 day trial, no credit card required. Go to sweetprocess.com, sweet like candy, S-W-E-E-T, process.com.
Chad Franzen: Dr. Nicholas Holmes is senior vice president and COO at Rady Children’s Hospital in San Diego. Dr. Holmes is dedicated to creating a high quality and innovative healthcare delivery system for pediatric patients and their families. During a 15 year career in the navy, he was the head urologist at the navy, assisted in shaping urology healthcare policy, and served as the chairman of the Department of Urology at the Navy Medical Center. He was recently recognized as one of the top 50 black leaders of influence by the San Diego Business Journal. Dr. Holmes, thank you so much for joining me today. How are you?
Dr. Nicholas Holmes: I’m doing great, thank you for having me.
Chad Franzen: Hey, tell me a little bit more about Rady Children’s Hospital, kind of maybe describe the atmosphere for me and why would people go there?
Dr. Nicholas Holmes: Yeah, so Rady Children’s Hospital, we’ve been in existence for almost 70 years. We started as a community hospital out of the polio pandemic that happened in the mid ’50s. And so the community came together, because they realized these children who had polio needed to convalesce, and they needed to be in a separate kind of facility than adults, and so they raised money to create it. Fast forward now to 2022, we are a pediatric academic medical center that’s ranked in all 10 specialties by US News and World Report, and so we are a level one trauma center and dedicated to the care of pediatric patients who may have sustained some type of injuries throughout San Diego County, and we’re not only just in San Diego County but we extend to southern Riverside and out to Imperial County. And we’re one of the largest children’s hospitals west of the Mississippi.
Chad Franzen: What do you think has been some of, maybe a key or some of the keys to your success, where you’ve been recognized nationally?
Dr. Nicholas Holmes: I think our greatest asset is our people. And so as a COO, I have to remember that each and every day, and everything that I do is striving to make sure that our team members have all the right things to be able to create an excellent quality care environment for our patients.
Chad Franzen: What is involved in your day-to-day role, kind of as chief operating officer?
Dr. Nicholas Holmes: I liken it to or tell my kids that I make sure that the trains arrive on time, and that the doors are open, and that the things are moving smoothly. So a lot of my time is spent checking in with my 12 direct reports from one of the various operations within the organization, so I have, oversee not only just the clinical operations but some of the support operations like the pharmacy, radiology, security, our environmental service staff. So a lot of my time spends again, just checking in with our teams and making sure that they’re doing okay, reviewing data and quality metrics to make sure that we’re heading in the right direction. Then probably a small proportion is really focused on kind of strategic initiatives or imperatives that we have going on right now.
Chad Franzen: Over the past couple years, obviously COVID has been huge in the news, and especially with relation to hospitals. How has it affected Rady Children’s Hospital? You hear about adults going in and rooms being overcrowded. How would you say it’s affected Rady Children’s Hospital?
Dr. Nicholas Holmes: So COVID for kids has been different from adults, so predominantly the vast majority of COVID cases worldwide are adults, and there’s been fewer with pediatrics. Although this last surge with Omicron, there was a bigger number of pediatric patients. So one of the things is, many of the children’s hospitals in the country, especially ours here in San Diego, we’re the sole children’s hospital here in San Diego for acute care, so if you’re sick and a child you’re going to have to come here. So one of the biggest challenges was staffing. So it wasn’t that we were getting overfilled with COVID patients, it’s just our staff, because they were out in the general community, were contracting COVID. And so for the past almost two and a half years, we’ve had to really be flexible, nimble, and resilient in terms of how we dealt with the changes to the staffing, and to respond to our patient needs.
Chad Franzen: Can you give me an example of a way that you had to react in the moment to a situation that involved COVID for one of your staff?
Dr. Nicholas Holmes: Yeah. So there were some days where we had 20 or 30 people would have to be taken off because of either COVID exposure in the community, or they actually contracted COVID. So we would have a daily check-in with all of the operational leaders, just to make sure where we’re staffing, what is or was or where it’s needed. So we even had some people that were licensed clinicians, but were doing more administrative stuff, and so we had to bring them back into providing more clinical care. And so many of our clinical leaders that primarily do administrative stuff were actually doing direct patient care. And it goes to really the spirit of this organization.
Dr. Nicholas Holmes: So we say mission first, people always, and that’s the great thing about this place is that people will walk through doors to get things done, and make sure that kids are taken care of. And so staff volunteering, stepping up to the plate, taking additional shifts, covering for people, so really trying to be creative in how we made sure that we had the proper staffing to meet the needs of our patients.
Chad Franzen: What did you do to kind of facilitate maybe at the last minute type of thing, type of reorganization? Say one doctor or care provider got COVID, wasn’t going to be able to make it, how did you kind of reorganize in the moment?
Dr. Nicholas Holmes: So one of the things is that we had had a little bit of headstart than everyone else in the country. So when the COVID pandemic broke out, we were actually prior to the rest of the nation going on lockdown. When they evacuated the expatriates from Wuhan in China, they actually here in San Diego, they went to the Marine Corps Air Station where they isolated them. So we already, even before COVID was going to happen, we had to prepare for that, then the rest of the nation. So we were putting contingency plans just in case of people being sick and staffing, so we had protocols and plans already in place, so it was really seamless for us. We had to just pull them off the shelf and actually execute plans that we had laid out over a year and a half ago.
Dr. Nicholas Holmes: So, but I think one of the key things is constant communication throughout that whole process, and really communicating to our leadership team and to our staff about what we were going to do and what we were up against. So that allowed everyone to kind of even the playing field, so that people didn’t feel like they were not in the know, and they were being burdened by doing some additional work. So, and we do that with our daily huddles that we have for our operational leaders at 8:35 every morning. We have a town hall every Thursday that relates to COVID and how it impacts our staff and impacts their family out in the community. And so we still continue that to this day.
Chad Franzen: Did you have daily testing or something like that for COVID?
Dr. Nicholas Holmes: So we were one of the first institutions that really ramped up testing, so we had an ability to do over 2,000 tests a day. And so that’s just not only for patients, but for our staff. And so we had set up a system where we actually were doing testing, drive up testing, in one of our kind of circles, circular driveways here on campus so that we had that available for patients, for family, and for staff as well and for their loved ones as well.
Chad Franzen: Do you still follow the same process that you did maybe in June of 2020? Do you still follow that now, or how had that changed over the past couple years?
Dr. Nicholas Holmes: So again, the one thing about this whole thing, it’s taught us to be flexible and resilient, nimble and quick, because many times things that we had said at 7:30 in the morning, new news would come out by midday and we would completely change the plan. So probably the foundational elements were there from June 2020, but we’ve changed and evolved based upon what’s actually going on. So, and that really goes to the organization’s ability to pivot very quickly in the midst of the pandemic.
Chad Franzen: And you’ve had a pretty distinguished career so far. In your career, have you seen anything like this where as a leader, you had to be so flexible and nimble almost day-to-day?
Dr. Nicholas Holmes: When I finished my residency and fellowship, I was in San Francisco when I finished my fellowship then I moved back to Washington DC. Then I started working there on September 1st of 2001, so little did I know that 10 days later, September 11th would happen and would change the world. And so one of the things happened is that a lot of the staff left the hospital to be deployed to Iraq and Afghanistan, so we had a skeleton crew that was left. So many of us were doing jobs that weren’t just in our job description. And so that really gave me that kind of foundation that I learned early on in my career as a leader that I needed to be able to pivot quickly based upon what was in front of me. And so I think that’s helped me, all throughout the entirety of my career, that I don’t get locked into just doing something because that’s what the plan is and that’s what we decided, and really being able to respond to the elements that are around you.
Chad Franzen: I have one final question for you, but first, how can people find out more information about Rady Children’s Hospital if they don’t know it already?
Dr. Nicholas Holmes: So you can go to our website, so even though you can certainly Google Rady Children’s Hospital San Diego, it’s www.rchsd, Rady Children’s Hospital San Diego, .org and you can learn about all the wonderful things that we have and do for the community at large.
Chad Franzen: My final question for you, who, at the risk of putting you on the spot, who was a mentor for you or mentors for you, and what’s a best piece of advice that you can think of that you’ve heard from them?
Dr. Nicholas Holmes: Mentors, I’ve been fortunate and had lots of mentors over my career in medicine and my career as a leader, but I will kind of amalgamate three people into one, because again, all of them have been pivotal in my career. And I think one of the key elements was, a key element that one of my mentors said to me is if you put your mind to something and you know it’s the right thing, then do it no matter what. And that’s always been my guiding star, right? Whenever it’s been a really difficult or crucial, critical conversation or critical decision right? So if you know it’s the right thing you should always do it.
Chad Franzen: Great. Sounds good. Hey Dr. Holmes, it’s been great chatting with you today. Thank you so much for your time.
Dr. Nicholas Holmes: Thank you.
Chad Franzen: So long, everybody.
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