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

Anne Pendo: 00:07Welcome and thank you for joining us today. I am Anne Pendo. I am an internist by training and a medical director with the responsibility for patient experience, and physician and APP experience, at Intermountain Healthcare. I am lucky and excited today to have a conversation with two of our physician and APP leaders, Allison Showalter, who is the APP director for Neonatology. And her partner in Neonatology, Liz O'Brien, who's the Senior Medical Director for OB and Neonatal Operations at Intermountain Healthcare. With this being Women in Medicine Month, I thought it might be nice for us to start with a little bit of your story of how you got into medicine and what drew you to your specialty.

Liz O'Brien: 01:06I vividly recall, when I was six years old, telling my mother I was going to be a pediatrician. I'd come home from my physician's appointment and was convinced. And I said, "I'm going to take care of small patients." And I remember her patting me on the head saying, "It's okay. You will see. Let's give it time." Well, as time went on, the dream just continued. And I ended up pursuing medicine. And still, now, I'm taking care of the smallest patients. I'm a neonatologist. I developed a love for physiology and the NICU world is very much physiology in action. Transitioning from the intrauterine to extrauterine life is a pretty impressive time. So, here I am. Never thought I would be a neonatologist, actually. Thought oncology initially, in medical school, and came back to my first love of small patients.

Anne Pendo: 02:01Small patients, I love that. How about you, Alison?

Allison S. :02:07From the time I was five, I got for Christmas that Fisher-Pricer medical kit. So, since I was like five years old, I knew I wanted to be in the medical field. When I was a late teenager, I shifted to wanting to be a nurse practitioner. I had an experience where I was being seen by a nurse practitioner, just with my primary care physician. He had one. So, I kind of got introduced to that. And from there, knew that's where I wanted to go.

I didn't know what kind or how I would specialize, but went to Ricks College and got my associates. And then right after graduating, I went down to BYU and got into their associates to bachelors program. and that's where I started working in the newborn ICU at Utah Valley. Right from a new graduate from Ricks College. And amazingly enough, got a job in the newborn ICU as a new graduate, which was, I thought, amazing.

And boy, once I got into NICU, I never wanted to leave. So, when I got done with BYU, I went up to the University of Utah to their nurse practitioner school for neonatology. And yeah, I was pretty young, but I was able to continue working in the same unit as a nurse practitioner. And then I was there for 18 years until just this July when I have, now in this new position.

Anne Pendo: 03:30That's so great. I think it's so great that you both entered or started your love of medicine following an appointment or an interaction with your own physician and nurse practitioner.

Allison S. :03:45Yeah.

Anne Pendo: 03:46That's great. And you've both just recently stepped into leadership roles. Let's switch to why leadership and then we'll talk about the two of you together.

Liz O'Brien: 04:00I initially, I'm going to be completely transparent, started with an academic career doing bench research as well as clinical medicine, doing developmental lung biology, which I loved. But soon realized that I loved being in the unit and I liked leading a team in the unit. So, I started with that clinically and then became a medical director. And progressively took on more leadership positions through the university and Intermountain, in a regional capacity, and started to take a look at the system and "What works in one unit? How can I use that to help in another unit?" And found myself integrating myself into meetings to help facilitate change. Never really thought I would take the next step until Dr. [inaudible 00:04:58] actually tapped me on the shoulder and asked me to just talk to him a little bit about what my vision was and he started me thinking. And here I am.

Anne Pendo: 05:08And here you are.

Liz O'Brien: 05:09And here I am.

Anne Pendo: 05:09And here you are. So, how do you think about... When you think, so it sounds like it was kind of a natural progression from a small group, and then broader, and more broad. As we think about systemness, that's a word that Chris Hyer, our APP leader, uses a lot. What or how did systemness not scare you?

Liz O'Brien: 05:47I think one of the reasons it didn't scare me is... As I progressed and became more involved from a regional perspective, I started to see connections not only within my unit with teams, but between service lines where I saw opportunities. And that I saw improvements in care when I started to bridge those gaps and build those relationships. Neonatology is uniquely positioned in that we have a ultimate pass off, when you cut life support, when you deliver a baby, cut the cord. And I started partnering with other services and thinking about it from a more broad perspective. It made me realize that the system work, while it might be intimidating, could yield pretty impressive results. So, I think I saw it more of a challenge as opposed to scary.

Anne Pendo: 06:44That's great.

Liz O'Brien: 06:45It makes sense.

Anne Pendo: 06:46Yeah, it does. It does. And I love, I'm noticing that the words that you used are connection, relationship, closing the gaps, bridging the gaps, that broad perspective which I think is something that becoming more of, thinking about how we provide care across the system has been really ... Those are probably components that have led to successes in thinking about this work as a system. So, how about you Alison? What about leadership was exciting to you or how did you step into that space?

Allison S. :07:26I never really thought of, I don't think I was, "Oh, I want to be a leader." It didn't quite happen that way for me. I just found that I could be helpful and I would be asked to do things that I had fun doing. And so it just kind of progressed and snowballed, I think really. And then when our group got big enough and they decided they wanted a team leader, then I did apply for that because I felt like, "I could do that. I could help more in a official capacity." And then it just, again, advanced to another degree, of then becoming the APP coordinator for the group. And again, the group just continued to grow and grow and grow. And then when this position opened up I thought, "Oh, I could help there. I could help. I can see things."

And I felt like I had a relationship with many of the APPs through the corporation because I'd helped a lot with iCentra rollout. So, I'd had an opportunity to go to all of the NICUs during that time, and I'd met them and just enjoyed being with them. And so I thought, "Oh, I feel like I could." It wouldn't be so foreign to them because they kind of knew me, and I don't know, I just thought, "I could help. I think I could help."

Liz O'Brien: 08:45She did that with a lot of committees that we'd ask her to join.

Anne Pendo: 08:48Ah.

Liz O'Brien: 08:48Before I was even in this position and was always a go-to.

Anne Pendo: 08:54So, you knew of each other and had worked together before you worked together in this more official capacity?

Allison S. :09:02Yeah. As my role expanded down south at Utah Valley, I would be asked to go to corporate meetings where Liz was there, and we would work together on a couple of committees we had. Yeah, the feeding committee was a big one that we had teamed together with.

Liz O'Brien: 09:19iCentra.

Allison S. :09:19... and iCentra and yeah.

Anne Pendo: 09:23That's great.

Liz O'Brien: 09:24Yeah.

Anne Pendo: 09:24That's great. When Liz was, you were in your position first and then Allison, you became, stepped into that APP director role just recently.

Allison S. :09:40Yeah, July.

Anne Pendo: 09:41In July.

Allison S. :09:44Yeah.

Anne Pendo: 09:44Share with us, what was your first meeting together like? How did you get to know each other and what were you thinking?

Allison S. :09:52Boy, it's such a blur already. What?

Liz O'Brien: 09:55It is.

Allison S. :09:56Do you remember really well? I just remember sitting there going-

Liz O'Brien: 09:59We sat down and we actually, right before-

Allison S. :09:59Help me. What do you need?

Liz O'Brien: 10:03... when Alison first started, we actually had a kind of a crisis situation going on, and we sat down together, and I got out some markers, and we got on my whiteboard. We started mapping things out together and just talking about solving a problem. And it was how can we do it? And we actually had a, it was fun actually.

Allison S. :10:24Mm-hmm (affirmative). It was fun.

Liz O'Brien: 10:26We had a great time and I think we've come to a resolution with that particular problem. But then we realized we worked well when we were together, teaming, and set up regular meetings for one-on-ones, and talking about goals for the week. But the weekly meetings, actually it's kind of funny, because we talk to each other everyday or see each other. And I actually moved a desk into my office for her until we moved to the Transformation Center. So we're connected.

Allison S. :10:55Joined at the hip.

Liz O'Brien: 10:55Regularly.

Allison S. :10:56It seems like.

Liz O'Brien: 10:57Yes.

Allison S. :10:58We go through a little bit of withdrawal when we don't see each other.

Liz O'Brien: 11:00I know.

Allison S. :11:00And it's like, "Oh my goodness, how are you?"

Liz O'Brien: 11:02"You okay?"

Allison S. :11:04"How's the day going for you? I haven't seen you today." So yeah.

Liz O'Brien: 11:07So yeah. It's a very enjoyable relationship and partnership.

Anne Pendo: 11:15I think it's, I just love that. So when I think about you, I think of, I'm pointing to Liz. When I think of Liz, I think of Allison, and when I'm thinking of Alison, I think of Liz. So I really think of you as a unit. And we have this great opportunity at Intermountain to create more of those close effective partnerships between our physicians and advanced practice providers. And as you think about your experience broadly, and then coming together as leaders working in partnership, what advice would you share to our audience about what and how you created success?

Liz O'Brien: 12:14I think one of the things that has facilitated the relationship is the fact that, at least in our clinical world, in neonatology, the physicians and APPs work in partnership in a team approach. And we've done that for a long time.

Allison S. :12:30As long as I can remember. Yeah. I mean-

Liz O'Brien: 12:32And I think partnering and welcoming each other to the table, and realizing we may bring a different perspective, but they're both critically important, and being open to that, has made us at least, I think, have a closer bond and be able to find resolutions to some pretty challenging problems.

Allison S. :12:54I would agree with that. Yeah. I think when you have physicians who do treat you like their colleagues and their partners, it makes that relationship work in a way that is very open. You don't feel intimidated that you can't give an opinion and that you can't say, "Well what about this?" Or "What about that?" And truly our goals align so well. It's not like we are butting heads on goals. We want the same thing for patients. But I think, like Liz said, we have sometimes different perspectives, and those are valuable to listen to and hear. So yeah, it's always just been, even clinically has been a great relationship within the neonatology sphere.

Liz O'Brien: 13:38Being open and actually willing to listen to each other, and mutual respect, I think, is a common denominator. Right?

Allison S. :13:46Yeah, I would agree.

Anne Pendo: 13:48So as I think about what you've both just shared, one of the key points around having those common goals, that may be a place for folks that are just stepping into these relationships, as a really good place to start, recognizing that the goals, setting those common goals, recognizing what what you have more in common, and then creating that environment to be open and willing to listen. And so the question that I have for both of you is how do you do that? How do you show up? How do you create an environment that allows for open discussion and really honest listening?

Allison S. :14:42I think truthfully, I'm going to say this about Liz. I think it comes naturally to Liz, in her personality of wanting to get that insight and have participation. I think that's just a natural strength that she has. So from a leadership perspective, it hasn't felt like it's really had to be thought about. I think it's just been a natural relationship that hasn't taken a lot of work. And I think it's just due to her having that natural ability to be inclusive. As far as discussions go, she's always including me and asking my opinion. I always feel like I can express, if there is an issue, that, "Hey, I don't know if you're aware of this, but this is what's going on." "I think I need to have your input on this." And she's always willing to talk about anything. So I think that really adds a lot to having a strong relationship that feels like you can be having that openness.

Anne Pendo: 15:47So you feel safe.

Allison S. :15:48Yeah. You feel safe. Yes.

Anne Pendo: 15:51So now I'm curious to know, so Alison thinks it's innate to you, but I'm going to suggest that there's probably things that you've learned in your career to create that environment.

Liz O'Brien: 16:10I guess, and thinking about it, a lot of multiple experiences have probably helped me progress to, I think, being a listener. I was a Associate Fellowship Director for the Neonatology Fellowship Program at the University of Utah. And in dealing with trainees, one of the lessons I learned was really to take a step back and listen to what their needs were, and try and identify where their challenges were, to help them try and solve a problem. And if I didn't listen, it created more challenges.

Anne Pendo: 16:44Okay.

Liz O'Brien: 16:46So I think that was probably one. I learned that if I had an open door policy and people felt welcome, that I could identify problems earlier. And they might be easier to resolve rather than waiting until you have a crisis. So I've tried to be as welcoming and respectful. I want to treat people the way I would like to be treated. And we all bring something to the table, whether you are someone cleaning the unit and stocking a shelf, or if you're working at a bedside as a nurse or an RT, whatever your position, you have a valuable perspective.

Anne Pendo: 17:30Yeah. I think that's so, so the takeaway, from me listening to you, is thinking that in your experiences, recognizing that listening and open door policy allowed you to be more effective, and to address and solve problems more in real time, rather than when they became larger.

Liz O'Brien: 17:59Correct.

Anne Pendo: 18:00Okay. That's a good lesson. I'm writing, I'm taking notes.

Liz O'Brien: 18:04It's a really important lesson and every once in a while I need reminders.

Anne Pendo: 18:08Yeah. Yeah. Luckily life has a way of doing this.

Liz O'Brien: 18:10Yes. It does. If I can remember that as a parent it would be great.

Anne Pendo: 18:15Yes. I was thinking the same thing, thinking the very same thing. So when you both came together, you talked about you had common goals. Is there something that you've done in these first months working together that you're particularly proud of, that you've accomplished together?

Allison S. :18:39Well, that one particular issue that we had initially, which ended up being successful with a successful resolution, I think was a huge success. Because it was a huge priority and now I-

Liz O'Brien: 18:56I think we did a joint staff meeting with one of the groups-

Allison S. :18:59Yeah. I was just going to say that.

Liz O'Brien: 18:59... Neonatal APPs. And it was actually, it was really wonderful to watch Alison, in her new role, leading the meeting and fielding hard questions from people who are scared about all the change. And Alison invited me to be there, and we both participated in the meeting, and shared our joint vision, and what our plans are moving forward, and it was probably one of my favorite experiences in the last month.

Allison S. :19:31Yeah, it was good.

Liz O'Brien: 19:31It was great.

Allison S. :19:32We're going to be doing it again, with some other in our group, because obviously geographically we're spread out. So this was just one of these, in the immediate Salt Lake area, that we were having that meeting with. But-

Liz O'Brien: 19:43We're taking this on the road.

Allison S. :19:45We're taking it on the road.

Anne Pendo: 19:46Hey. I love that.

Allison S. :19:48Yeah, I mean it was a great meeting. Yeah, I'm optimistic about everything. It's nothing that we can't figure out. I really do believe that.

Anne Pendo: 20:00Do you have some guiding principles, for you, that you've created together as a team? Like for your leadership?

Allison S. :20:09Guiding principles? I would say probably a lot of what we've been talking about is that we have an open door policy. When I talk to the APPs, I basically say, "You can talk to me about anything. It doesn't matter what it is. It doesn't matter your frustration." I mean, obviously, I want it to be a mutual, appropriate conversation, but I can talk about anything with what they have a concern about or an issue or an idea. I think that's important, that your team feels like they can come to you at any time, and feel like they're going to be heard. I think it's huge for a team dynamics, to really be able to function the way that it needs, to accomplish the high quality care that we want to provide.

Anne Pendo: 20:53Yeah.

Liz O'Brien: 20:54I think putting the patient in the center when we have a challenge always helps us stay grounded. What is the best for the patient, for the family? And then how do we make that work as a team.

Anne Pendo: 21:05Yeah.

Liz O'Brien: 21:06I think it's the other guiding principle.

Allison S. :21:07Mm-hmm (affirmative). Always assuming good intent. That's really what everybody on the team really does want to do. I really do believe that.

Anne Pendo: 21:15Yeah.

Allison S. :21:16They worked hard to be where they are. Their goal is to do what's right for the patient.

Anne Pendo: 21:16I love that. I love that.

Allison S. :21:23I think assuming good intent is something all of us need to remind ourselves of. And I think we need to gently remind some of our team members about that. And I think it really helps bring you back to a better place where you can be effective.

Anne Pendo: 21:37Yeah. I think that you are stepping into managing change, for many of your team members, and I think that one of my lessons, as well, has been the assume good intent. And recognizing that sometimes things come, or show up, are anxiety or fear, and how we as leaders respond can either inflame or reduce the stress and anxiety that our colleagues are feeling.

Allison S. :22:17Yeah, I'd agree.

Liz O'Brien: 22:18I also think being able to show when you're feeling those things, and acknowledging it for yourself, and being able to be vulnerable with the people that you're leading is also, I think-

Allison S. :22:28Yup. I would agree with that as well.

Liz O'Brien: 22:30... an important thing to remember.

Anne Pendo: 22:33Yeah. I think that's a very good takeaway and very good lesson. That is a good reminder. Often.

Allison S. :22:43Yeah. I think it's important as a leader, we don't have all the answers. We're not expected to be the ones that come up with all the answers. We need help from our team. So being able to say, "I don't think I have an answer for this one. Help." is valuable.

Liz O'Brien: 22:58Happens on a regular basis. "Well, what do you think?"

Anne Pendo: 22:58Well, yeah. "What do you think?"

Liz O'Brien: 23:01"Are you willing to partner with us and work to help solve that problem?"

Anne Pendo: 23:04Yeah, yeah.

Liz O'Brien: 23:05And they sometimes will look at me with a, like, "Really. Yeah, I'd love for you to join." And all of a sudden I have a lot of people willing to step up and do things that maybe is outside of their comfort zone. It's kind of fun to watch.

Anne Pendo: 23:18Yeah. I like that. So I'm excited for the future. I'm excited to see what the-

Allison S. :23:25So am I.

Anne Pendo: 23:26... two of you do together. As we finish our time today is there something, Liz, that you would like to say to Alison about your thoughts about you're working together in the future?

Liz O'Brien: 23:40I'm just, I am very grateful that Alison has been willing to take on this challenge, and to partner with me, and to be available. Available for questions, available for support, and willing to partner. Thank you.

Allison S. :24:05You're welcome. I couldn't ask for a better partner.

Anne Pendo: 24:08Okay. I'm going to ask the same question. I can tell. I can tell by the way the two of you look at each other and just kind of the flow back and forth.

Allison S. :24:22Yeah.

Anne Pendo: 24:22So I'm going to ask you the same question I asked Liz.

Allison S. :24:26Yeah. All I can say is how grateful I am to have Liz as a leader and to have that partnership. Being able to talk openly, it makes me excited for the future, it makes me optimistic and excited for where neonatology is going to go in the future. Especially under the banner of one Intermountain, and making Intermountain the place of choice for not only patients and families but also employees, APPs, doctors, nurses, respiratory therapists, everybody. It makes me excited.

Anne Pendo: 25:02Excited and grateful.

Allison S. :25:03Yep.

Liz O'Brien: 25:03Yep.

Anne Pendo: 25:04I love that. I think that's a great way for us to think about the future. To think really about how we work together in new teams, to take care of our patients and take care of each other. So thank you, Alison. Thank you, Liz, for joining us today.

Allison S. :25:20Thank you.

Liz O'Brien: 25:20Thank you.

Anne Pendo: 25:21It's been a great conversation and I am looking forward to hearing about the wonderful things that you both do next. Thanks.

Liz O'Brien: 25:31Thank you.

Allison S. :25:31Thank you.