Annette M. Walker, President of City of Hope Orange County
I have a lot of conversations with leaders from large organizations who are afraid to make any big moves, afraid to risk their own career trajectory, afraid to suggest a new idea for fear of being held accountable. They don’t want to be the only one who doesn’t do things the way everyone else does, because that would put them too far out on a limb.
Either there is no room to fail at their organizations, or they are just too timid to find out.
They keep plodding along with how things have always been done, and I hear firsthand from people who report to them how frustrating and stifling it is to work for someone like that.
So it was refreshing to have a conversation with Annette Walker, president of City of Hope Orange County. She is celebrating the opening of the new City of Hope Orange County Lennar Foundation Cancer Center – the most advanced comprehensive cancer center in Orange County, Calif.
City of Hope Orange County Lennar Foundation Cancer Center, now open and hospital (opening in 2025) is the only provider in Orange County solely dedicated to cancer. Patients will receive fully integrated, multidisciplinary cancer care — from prevention through survivorship — in one convenient location where every physician and staff member is solely focused on treating and curing cancer.
This was a big move for City of Hope, headquartered in Duarte, Calif just outside of downtown Los Angeles. It wasn’t an expansion of an existing location. It wasn’t about opening smaller, less comprehensive community centers. Rather, it was about entering a new market with something newer and bigger.
This is significant for several reasons.
First, it will let people in treatment stay closer to home. It brings treatment, research, clinical trials and cures to the nation’s sixth-largest county. City of Hope officials said nearly 20% of residents with cancer have left the area for advanced care, with many heading to City of Hope’s main campus in Duarte — an up to two-hour commute each way.
This proximity meets a crucial need: the cancer incidence rate in the county is projected to increase by 18% over the next decade, largely because cancer risk increases with age and Orange County has a higher percentage of seniors than the U.S. average.
“When you go through treatment, the travel is so burdensome to the patient and the family,” said Walker. “And almost no patient comes alone. They all come with somebody. To endure travel, it's not only a financial issue, it's a physical issue. It's a work-life issue. It's a childcare issue. It's been one of the greatest privileges of my career to now make this available to people in a more convenient manner that makes it feasible for more people to [access this level of care].”
Here's the second reason the opening of this cancer center is significant: it’s an example of having vision and seeing it through – of not shying away from reaching higher and further than you’re known for as an organization. That’s a risk few leaders are willing to take. So I wanted to hear from Walker why it was possible in this case and how they made it happen.
I’ve been watching City of Hope’s plan unfold for nearly a decade and I’ve interviewed the leaders involved in the past about their vision and their approach. (Here’s a piece about the $50 million gift from the Lennar Foundation, including interviews with the top leaders from City of Hope and the Lennar Corporation.)
Walker would never say this about herself, but she is a big reason City of Hope has been able to successfully enter a market that is simultaneously a crowded field for healthcare but also previously lacking this important major feature: a comprehensive cancer center.
The Orange County region has been her home for 40 years. Before coming to City of Hope, she was president of strategy for Providence St. Joseph Health System, the nation’s third-largest health system. Walker was named one of the 100 most influential people and one of the 25 most influential women leaders in U.S. healthcare, by Modern Healthcare magazine.
With her strong reputation and deep history in the region, she knew how to activate the community. This is a crucial skill. So while the groundbreaking was an important milestone in City of Hope’s plan to democratize cancer care, I’m equally interested in what other leaders can learn from Walker and City of Hope about transformation.
Defining a Vision and Sticking to It
When I asked her how they could accomplish this, Walker immediately points away from herself. She credits the vision of Robert Stone, president and CEO of City of Hope – a vision that she said many people couldn’t see. But that didn’t stop him or her from fully committing to it.
“Robert fulfilled everything he said he would,” said Walker. “He backed me up. He let me do what I needed to do. And that's not very common. It's very unusual. It has been one of the more satisfying aspects of the experience for me. He kept his word on everything.”
Here’s what I get from that: Stone is not threatened by risk or by change. Stone is not like the leaders I mentioned in the opening of this article.
You can stick to a bold vision when you know it’s based on meeting an actual community need that aligns with your mission. And for City of Hope, their mission is clear:
Transforming the future of health. Every day we turn science into practical benefit. We turn hope into reality. We accomplish this through exquisite care, innovative research and vital education focused on eliminating cancer and diabetes.
Walker admits they were entering a highly saturated, competitive healthcare market – but they could do that because they were bringing something entirely new.
“We decided to disrupt a healthcare market and enter a mature market. So why in the world would anybody come? They would only come if they're bringing something that's not there. We answered a need of patients.”
Walker said she had never been part of a healthcare expansion that wasn't just an expansion of an organization that already had depth in the market.
“We were like a startup. There was no building next door to go rely on. There was no IT department on the ground that's been here for 50 years. It was a very, very different thing than any other healthcare expansion I've been part of, because we had no local assets on the ground when this was envisioned.”
From Cottage Industry to Big Business
They were embarking on a vision to take their business to another level. Walker shared some of the challenges and lessons learned along the way.
Challenge: Getting people to understand the vision.
Because City of Hope’s prior expansions had been through smaller community sites, one of their first challenges was getting people to grasp the full vision of what they wanted to do.
“A lot of people assumed it was just another big community practice coming to Orange County,” she said.
But they wanted to build something that would allow people to remain in Orange County, which means people need to be able to access super specialists and clinical trials – all of which requires a comprehensive approach.
“If you do not bring those things, the people in Orange County would still have to leave Orange County,” she said. “So those were a must-have. So we had to build something that would support that type of care being brought into this community. That's the real difference. That's what is not done anywhere else in Orange County – the breadth of super specialists, and breadth of clinical trials working as a multidisciplinary team under one roof. There’s nothing like it in the county.”
They had to get people to see that it wouldn’t be a community site. It would be an academic campus.
Challenge: The cultural difference of growing into a system.
Walker came from a system, so she had experience in how a health system works.
“When you have a system and you have multiple entities, you have to learn how to manage authority and decision making to optimize performance,” said Walker. “In 2018, City of Hope was just beginning to learn this. Those were the things we had to work through as we grew into as a system.”
They also had to determine how they would use their medical expertise, now that they’ve built out another academic location.
“We've hired 25 faculty for Orange County who will work closely with the other 575 City of Hope oncology specialists,” she said. “Our expertise is not limited to one location.”
These types of changes can have a big impact on the organizational culture. So it’s great to hear that they recognize that growing into a system requires some thought about how that will affect the way people work.
Lesson: The importance of having a leader who knows and is trusted by the community.
Having a brand that people know and love is a good starting point, but might not be enough when you’re defining a vision that’s bigger than what people know you for.
“The brand of City of Hope is a spectacular brand, but a lot of the community didn't understand how it was different from other providers of cancer care,” said Walker.
If you’ve never needed comprehensive cancer care, you might not have known that it didn’t exist near you. She said people would ask her: Doesn’t that other hospital already offer this?
Walker said they had to continually explain: “No, they don't have 575 cancer specialists and no, they don't have a thousand clinical trials – the leading edge of cancer cures.”
But she was able to do that because she knew the needs of the community.
“Whatever you're providing to the community, and particularly in healthcare, you don't want to provide more of what it already has,” she explained. “You want to find where there are gaps, if you're a new entrant in particular – because that's where you have a chance of success. Why do you want to put more into the community of what's already there? You want to add value.”
Lesson: Reframe your competition.
When you’re bold enough to be the only one – the only provider in a market, or the only leader in your organization going a different way – you can reframe who or what your competition really is.
As Walker puts it, City of Hope is not competing with other hospitals in Orange County: “I'm not competing with you. I'm competing with cancer. Cancer is the competition. I would have an uphill battle if I was just doing the things everyone else already does. That wouldn’t be strategic.”
And because she and City of Hope haven’t limited themselves in that way, the people of Orange County have gained a significant resource in their community.
“It is my hope that this center provides an opportunity for the people of Orange County to have access to the best that we know for cancer prevention, treatment and cures. That they have access to what is the best available in the known world today, that they can access it near their home.”
If you’re someone who is afraid to make big moves, afraid to risk your own career, afraid to suggest a new idea for fear of being held accountable – think of what you’re keeping yourself and others from. You think you’re avoiding risk, but you’re really just choosing a different and worse risk – the risk of not making a difference. The risk of no longer being relevant.
Instead, have the courage to be the only one.
In the weeks ahead, I will dig deeper into City of Hope’s transformation journey (which includes its recent acquisition of Cancer Treatment Centers of America), by sharing my discussions with CEO Robert Stone and Chief Transformation Officer Debra Fields.
