Speaker 1 :00:01 You're listening to Intermountain Healthcare's podcast channel.

Anne Pendo: 00:07 Welcome to Intermountain podcasts and I am Dr. Anne Pendo, the senior medical director for experience of caring, which means that I have responsibility for physician and APP experience, as well as patient experience. We know that those are closely linked and today my guest is Dr. Tamra Moores Todd, who has dual roles at Intermountain Healthcare in Care Transformation and as an emergency department physician. I am excited today to talk to her more about how she stepped into her career in medicine and into her leadership roles at Intermountain's. Welcome.

Tamara Moores: 00:49 Thank you. Very excited to be here yet.

Anne Pendo: 00:51 We're happy that you're here. Maybe you could tell us a little bit. You're a California native. Tell us how you got to Utah and then to Intermountain.

Tamara Moores: 01:01 Well, California born and bred. Did my most of my undergrad and medical school there at Loma Linda University. Then matched to the University of Utah, drawn here by the phenomenal emergency medicine residency program and the leadership there. Didn't really have any friends or family here, just kind of thought I'll try you talk for a few years. I came here and it blew my mind. The passion and community within the emergency medicine community here is really inspiring. I felt very well supported during my residency, and I ended up staying and doing a fellowship, actually, in clinical informatics. At that point I just thought it was too good to leave. We stayed and I was lucky enough to get a job with Utah Emergency Physicians and started working at the Intermountain hospitals here in the salt Lake Valley.

Anne Pendo: 01:55 Great. You have also a role in Care Transformation, am I correct?

Tamara Moores: 02:01 Yes.

Anne Pendo: 02:02 Tell us a little bit about what you do in that role.

Tamara Moores: 02:05 Currently, I am a medical director for Care Transformation, mostly working over emergency medicine, starting to expand into trauma and into urgent care as well. That involves basically doing our absolute best to make everything that you click a little bit better from both a clinician and any role perspective. It's a fantastic team.

I was brought in initially as a consultant role by a Dr. Todd Allen when I first started about three years ago. As I grew and expanded in that role, it became very obvious that it was fun for me and it was fun for others, and eventually was appointed as a medical director a year ago.

Anne Pendo: 02:47 Great. Well congratulations.

Tamara Moores: 02:49 Thank you.

Anne Pendo: 02:52 How did you decide that I'm adding the informatics piece was something that you wanted to pursue?

Tamara Moores: 03:06 I think I had a lucky confluence of being at the right place at the right time, seeing success of some of my early ideas, and then really feeling that satisfaction when I'm at work and I see something that I built that makes it easier to care for my patient. That lit a fire in me that has continued. As I've continued through what has become more complicated than my initial forays in residency, what I've tried to keep in mind is my overall goals. My main goal is to, as much as you can, continue the joy in medicine that I have. For me, that joy comes from sitting down with a patient and talking to them and having that face to face interaction, having that connection of empathy. And so, whatever technical tools I can give myself to give myself more time at the bedside and by extension my colleagues more time at the bedside, I find invigorating. Then of course, any tools that can make my patient get better care also is really exciting to me.

Anne Pendo: 04:14 I love that. I love that. Some of the things like REHR that we were told was going to make it better, hasn't really done that as we had hoped. Having someone who's interested in helping it be better for us and our patients is really great. One of the things that I'm struck by, and those of you on the podcast can't see the bright smiling face of Tamera as she talks about this work. Just the excitement and engagement is really great.

Tamara Moores: 05:06 Thank you. I still really like it.

Anne Pendo: 05:08 Yeah. I just think that's so wonderful. I guess then as I think about what we've heard nationally about how the EHR is making it harder to do our work, and locally in our health system, that seems to be something that really gets in people's way. How do you keep that joy and enthusiasm for your work in a space where people have a lot of emotion, a lot of negative emotion around it? How do you do that?

Tamara Moores: 05:49 Absolutely. I think I try, number one, keep myself focused on the goals that I laid out. Number two, understanding that it's not necessarily getting from point a to point B, but small incremental steps that can eventually make a big difference. I'm very lucky in that the team that I work with in Care Transformation is phenomenal and full of very empowered individuals. Sometimes perhaps it's hard to see that at the front line. I think one of our challenges from Care Transformation is being more transparent about the work we've done and so people can see work is moving forward.

I'm also lucky in that I get to work with a large group of emergency physicians very closely, about 115. Being able to talk to them directly has been quite helpful, and as I establish more connections with the system at large, that's been really exciting to see people come with good ideas, having us be able to implement them, and then seeing their joy in very small fixes. For example, we got a wonderful review from the emergency team at Logan by making some very small changes I thought on an M page for recorders. It really showed them that we are listening and so that helps I think. And also understanding that while it's not perfect, it can only get better hopefully. That continues to inspire our work.

Anne Pendo: 07:15 That's great. You talked about goals. How do you set goals for yourself or for your projects? Tell us a little bit about that process for you.

Tamara Moores: 07:25 For my projects in Care transformation?

Anne Pendo: 07:28 I'm kind of thinking broadly. You commented that a key part of your ability to keep your joy and enthusiasm is setting your goals. How do you do that?

Tamara Moores: 07:44 Well, this is a conversation that I have a lot with my family and my husband as we try to make sure we sustain ourselves and then so that we can sustain our work. The first thing I evaluate is make sure I'm keeping myself healthy and happy and whole, and so my goals involve both sleep and personal time and exercise. Then from there I'm able to add on my work goals, as well. I try to make sure for Care Transformation that it's achievable, that it's quantifiable in data, that I think we're going to have a reasonable result and utilization of our resources. I think we're still learning.

I've been in the medical director role for the past year, I've discovered to perhaps and refine my ways of choosing projects and things that we can achieve versus we can't. At this point, our overall goals focus on improving overall usability and patient care and interface in the setting of return to green. But then beyond that, we look at projects that have frontline impact, products that are data driven, projects that we can have reasonable allocation to resources and a result within a reasonable timeframe. That's been fun and tricky and I've spent a lot of time on the care process models as a part of the technical implementation team that relate to the emergency department for the past two years. I've learned a lot from that.

Anne Pendo: 09:16 That's great. As I think about one of the things that leads us to be successful in our careers is kind of knowing ourselves and knowing what we need, and sounds like you've spent time doing that. How did you even know to do that?

Tamara Moores: 09:38 I'm blessed with a wonderful partner, and we talk a lot about how to sustain ourselves. I am blessed and cursed with a aggressive work ethic, and learned throughout this path that if I am only work, I am no longer as good as I could be.

Anne Pendo: 09:58 That's great. That's great. I think that's a good lesson for all of us. I think our training sometimes leads us to believe that it is all about work. Yes. That's really not sustainable. I'm happy to hear that you are able to have taken the time to think about what matters to you.

Tamara Moores: 10:20 It's certainly never perfectly balanced and I constantly have to remind myself of how important it is to take care of myself as well.

Anne Pendo: 10:27 Yes, yes. I think that's a myth about the balance piece and in my career, realizing eventually after thinking it was supposed to be balanced, realizing that the more I can be present and all in in whatever moment I'm in, that's what works really well. Knowing that I'm never going to achieve balance between two things. Sometimes I need to be more focused on one piece of my life than another.

Tamara Moores: 11:02 [crosstalk 00:11:06].

Anne Pendo: 11:03 Knowing that has made it a lot less stressful, because I was trying to achieve something that I think is not ever achievable.

Tamara Moores: 11:18 Yeah.

Anne Pendo: 11:21 It's been a good life lesson I think for me as well and my family. As you were talking, I was thinking as well that in your career choices, you've had to say no to some things. My guess is that you are an individual that people gravitate to. Let's have Tamera fix this or she would be great with this. How do you decide what to say no to?

Tamara Moores: 11:57 Wonderful question. I am learning still what we can and cannot do, and what's perhaps unknown now versus this is known now but not necessarily in the future. I get a lot of guidance from the other CTIS medical directors, Diego as well. Our overall goal, it seemed in this past year, has been to have more transparency, and not say yes but never do it, but be clear on the things we can and cannot do.

I'm still learning. I will ask my team, is this possible? Does this work? And if it doesn't, the goal is to still go back to that empowered clinician or whoever came up with the idea, and have a frank discussion saying we love your feedback. Please keep it up. I want to hear more. We can't do that right now and here's why. By doing those things, it seems to have a better overall understanding and reception and hopefully engender more feedback, because that's what we want.

Anne Pendo: 13:01 Yeah, absolutely. I love the known now concept, because I think it's leads to possibilities in the future.

Tamara Moores: 13:11 It is. I've seen it in the past three years. It was know that, and now it's, yes. Oh my goodness. Change is happening and I think it's more dynamic than I realized when I wasn't within the team. It's a very aggressive, empowered team.

Anne Pendo: 13:28 Yeah. Yeah. I would say that as I've observed the work more closely with Diego, and you, and Tyler, and Dan Ricks, and Margaret Lister, and Adam Craft, and I'm sure I'm forgetting a whole-

Tamara Moores: 13:28 RJ?

Anne Pendo: 13:43 RJ Bonnel, yes.

Tamara Moores: 13:44 And James Helliwell. Yeah.

Anne Pendo: 13:46 Yeah, and James. Just watching your team come together has been really exciting, almost seeming like you are all kind of stepping into your roles of we can fix this, we can do better, we've got opportunity and we're going to do it.

Tamara Moores: 14:12 It's interesting. Yeah. I think most of our team comes from that cohort of disgruntled physicians who hoped it would be better, and kind of feel like we've infiltrated into a really cool spot and now are getting a chance to make a change for the better.

Anne Pendo: 14:29 Yeah. Yeah. I think that's great. I think that's really great. What would you say is the thing you're most proud of?

Tamara Moores: 14:42 In life? I'm really proud of this kid that I'm going to have, so that would be my number one thing. Then my relationship with my partner.

Anne Pendo: 14:53 I love that. I have a saying that no success at work compensates for failure at home. My kids are grown now and I think that is something that has served me well as I've navigated working and being a parent, and a partner, and spouse, and sister, and colleague, and you know, has really helped kind of shape how I view things. That's been really, really lovely.

Tamara Moores: 15:30 Yeah. If I do something great at work but I don't have someone to share it with, it doesn't mean much to me.

Anne Pendo: 15:35 Yeah. Yeah. What's next on the horizon? Besides the birth of this baby in December?

Tamara Moores: 15:49 What's next that I'm excited about?

Anne Pendo: 15:51 Yeah.

Tamara Moores: 15:52 I'm super excited about where we're going with the clinical physician support and on the spot algorithms to make it easy to do the right thing, and to surface patient flows and information and decision capacities within your workflow, in a way that people don't hate, that people like, make it as easy to use is your Apple phone, is something that I have a big focus on over the next calendar year, especially as we're continuing to refine our peak head head trauma, our stroke algorithms, and then expanding into sepsis and pulmonary embolism for the ED world. It's cool. The team is fantastic. We are pushing the boundaries of what we have built now. Although it's not going to be perfect to go first go round, I cannot wait to see where it goes.

Anne Pendo: 16:47 Let's go back a little bit. One of the things that I'm so impressed with is your optimism about making practice better, and connecting us back to our patients and why we went into healthcare in the first place. When you are visiting with people who have a lot of emotion and feel despair about the work that they're doing, what do you say to them or what are the things that you would share with them to provide support and some guidance for looking forward?

Tamara Moores: 17:34 That's a wonderful question. It encompasses a large majority of the people I talk to on a daily basis. My first most important priority is to make sure they understand that I, and the people I work with, really do care about their feedback. Most people feel disempowered and disregarded within the mass and morass of computer systems, and adherence and goals, and Medicare goals. The first step is to remind them that we do care about them, and by caring about them and their feedback, that creates a sense of more power.

The second thing to emphasize as much as I can is to help them create those connections, so that they understand that feedback from the front line on how it can make our EMR better is the most quantifiable and useful information we can get back. I want that conversation to continue. I might not be the perfect point of contact for every single individual that works at Intermountain Healthcare, I have an area of expertise, but there are other teams that have those areas of expertise that desperately want to make their lives better.

Anne Pendo: 18:55 Great. I'm taking notes as Tamera's speaking. I'm thinking what I heard is I care about you as a human being.

Tamara Moores: 19:08 You too.

Anne Pendo: 19:08 And the relationship that we have is important. Unless we've got those two pieces, we can't do any of the work that we believe is so important, whether it's fixing the EHR, or caring for patients, or caring for each other.

Tamara Moores: 19:29 There has to be trust. Otherwise they won't talk to us and we won't talk to them.

Anne Pendo: 19:34 Yeah, that's great. Well, it's been a pleasure to have you join us today on our Intermountain Podcast, and I'm looking forward to seeing what great things you and your team do in the future, making care better for our patients and for all of us who are providing care, and on your baby.