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

Dr. Anne Pendo: Welcome. My name's Dr. Anne Pendo and I am the Senior Medical Director for Experience of Caring at Intermountain Healthcare, which means that I have responsibility for patient experience and physician and app experience with the belief that we are not our best at taking care of patients if our we're not cared for ourselves and that's linked with safety and quality. And I'm excited today to speak to my partner in the office of patient experience, Dr. Mike Woodruff. And he is the Senior Medical Director for the Office of Patient Experience. And what we're hoping to do today is really have a conversation about what his leadership journey has been and the things that you've learned in this role in the last little bit. So I always like to start with how did you get into medicine? What was it about medicine that was appealing to you? And then why did you step into your current leadership role? What were the decisions around that?

Dr. Mike W.: Well, Hi Anne. Thank you.

Dr. Anne Pendo: You're welcome.

Dr. Mike W.: It's great to be here with you. How did I get into medicine? I was very interested in biology growing up and loved to catch turtles and frogs and all manner of insects and creatures. And I just, I was in love with the natural world and as I got older I had a mentor who really pushed me. He was a general surgeon and he pushed me to really think about being a doctor. And when I finished college, I didn't know that I was ready to be a doctor and had this crazy idea that I could go to Spain and find a job.

Dr. Anne Pendo: Okay.

Dr. Mike W.: And so I did. Found a job on a farm in the Basque country. And in that journey, I spent about a year alone and it was kind of a lonely life. I was working hard and I was speaking only Spanish and couldn't contact my family very often. And I really, it forced me to look at what was important to me. At that time, there was a terrorist organization active in Spain called ETA, which previously had been fighting for kind of independence against Franco who had really severely oppressed the Basques. And on the TV when I was there, there were a lot of bombings and it's not like American TV. They show sort of all the, they don't pull any punches, they show all the details. And I'll never forget seeing this woman who had been injured by a bomb blast in the middle of the street and she was just had this bewildered look on her face and her legs had been severed. And that was a moment when I thought to myself that I could find meaning in life if I could help people like that. And at that time, since I was in a reflective mode and I was, I had time to think about my life. It made a lot of sense to me that one could dedicate one's life to a purpose. And that stuck with me ever since that. So I went back to America and I did my remaining, I did organic chemistry, my remaining prerequisites. Took the MCAT, and then after a couple of years went to med school.

Dr. Anne Pendo: Very good.

Dr. Mike W.: So if I had to sum it up, I'd say I really went into medicine intentionally to help people because I felt that that would give me a sustaining purpose in life.

Dr. Anne Pendo: Yeah. One of the things that I believe is that we need that time and space to create the opportunity to think about what matters. And I'm guessing you were how old, in your early twenties then?

Dr. Mike W.: Boy no, I was, I think I just turned 19 or so. I went, I was young for my class, so I was not 21 for sure.

Dr. Anne Pendo: So how did you know to think about those things? I mean as a mother who's raised boys through those years, I'm not quite sure that given time and space they would have done that deep thinking. So how'd that come about for you?

Dr. Mike W.: Wow, that's a hard question to answer. I think I've always been maybe overly reflective even, but quite reflective, enjoyed reading and writing. And when you put yourself into a situation where you have that much time and space, then it's sort of natural, I think. At least it was for me.

Dr. Anne Pendo: And you didn't have distractions.

Dr. Mike W.: There were no distractions. I had a very fairly simple job. I learned a lot of new skills such as how not to let an angry bull out of the barn and how to coax a hoard of sheep to go in one direction instead of the other. How to find our lost sheep when they got caught in the brambles, the Blackberry brambles. But I just, I had a lot of time to myself to think. And I think that's one thing that it's hard to get these days for me. And I think for a lot of people that I know is we're so kind of pulled here and there by all our commitments and all the onslaught of text messages and emails and the options for entertainment that when do we really have time to sit, go for a walk by ourselves.

Dr. Anne Pendo: Right.

Dr. Mike W.: And just think about our life. It's really not very common.

Dr. Anne Pendo: Yeah. That's very true. And then what about your stepping into leadership? Tell me how that came to be for you.

Dr. Mike W.: Well, I've always just really wanted to help make things better for my colleagues and for my patients. And I think I was blessed with some really good mentors in all of my education. But one in particular really stands out to me that really got me interested in committing myself to teaching, which I think is very close to leadership. It was the doctor who was running the GI clinic that I rotated through when I think I was a second year medical student, or maybe a third year. But he came up to me and said, "Hey, I need you to come give me a shot." And I was terrified.

Dr. Anne Pendo: I'll bet.

Dr. Mike W.: I had never done that to anyone. And it was just a PPD that he wanted placed and he took me into the medication room and walked me through it. And I placed this PPD for him and he said, "When I was a medical student, my mentor did this for me and he made me promise that every year that I needed a PPD, I would find a student and teach them on me." And I just thought, man, what a dedication to training people and to helping doctors learn. And I just found it really inspiring. But I wouldn't say that's the only thing, but I really always enjoyed teaching and always enjoyed thinking about the problems of how do we make our work better for ourselves? How do we make it more efficient? How do we tell stories to learn? That's always been a big one for me. I grew up learning how to run M&M's in residency, in emergency medicine and boy what a rich experience of sitting in a room and sharing how things didn't go the way we had hoped or how they did and what can we learn from that. But sitting with the people that are involved and that went through and honestly sharing where we fell short or where we did our best and but all committed at the same time to learning and improving.

Dr. Anne Pendo: And so your current role, which has you with responsibility for safety and quality and experience in the office of patient experience. I think the area that has most been most memorable for me watching you as a leader in this role is your ability to be part of a really difficult conversation with a lot of emotion and processing it and then going back to continue the conversation. I'm not sure that you know that that is what you do.

Dr. Mike W.: I'm doing it now. I think I'm uncomfortable and I'm processing.

Dr. Anne Pendo: And you're, yes. Yes.

Dr. Mike W.: But we'll go back.

Dr. Anne Pendo: But so I think that's been one of the observations of watching your leadership has been your ability to call to process or reach out to someone to process and where it might be easy to say or label someone as they're just difficult or they're not interested. The ability, I think it's the processing that allows you to go back and continue the dialogue. And I'm wondering, is that something that you learned? Are you conscious of that? How did you get to the place where that's what seemed to work for you?

Dr. Mike W.: Well, I'd say that it's something I'm constantly learning over and over again because I'm never perfect at it and I always want to get better at it. And I think it's something that I've learned both by bad example and by good example and my mentors. And I've seen people handle things the wrong way in ways that shut people down and made them feel judged and I've been on the receiving end of that as well. But I always just think that every person I interact with has something to teach me good or bad ways not to do things, ways to do things. And I've been blessed to have some really great mentors in that way. And I think of one in particular who took the time when I started my residency in neurosurgery back when, at the university actually. And I just remember being in the ICU late one night and being with the family of a young man who had been hit by a car going up one of the Cottonwood canyons and he was dying of a terrible brain injury. And my neurosurgery attending, who I really looked up to quite a bit, took the time to just sit with the family and cried with them for probably half an hour.

Dr. Anne Pendo: Wow.

Dr. Mike W.: And it was just this realization that this is all really hard. All our work is really hard and the best thing you can do is just be present and be vulnerable and be willing to be human in those moments. And he did so much for that family by crying with them and sharing their grief and giving them a hug. And I feel like that's when I have those kinds of interactions. It's not that I'm looking for them, but they're necessary. And they're so impactful and they're more impactful than all the x-rays, CAT scans, I've ever ordered or the medications I've prescribed. You can change someone's life in a moment by just being available for them.

Dr. Anne Pendo: Yeah. And so as I think about you as a physician and you as a leader, those two are the ability to be present and not try and fix something has something that's been useful to you. And then I'm wondering as you've thought about your work in risk, share with us how you think about your interactions differently now then maybe you would have a few years ago. What's different now?

Dr. Mike W.: You mean as a doctor or as a leader?

Dr. Anne Pendo: As a leader. Mm-hmm (affirmative).

Dr. Mike W.: Well, I'm going to go to as a doctor first because I think what I've seen in myself is that I am more comfortable with uncertainty than I used to be. And I am comfortable expressing that to my patients. And so I will often make it clear that I don't have an explanation for what's going on. And in the emergency department, that's not uncommon.

Dr. Anne Pendo: Right. Right.

Dr. Mike W.: But what I do do in that is I want to get to what they're worried about. And so I've actually started asking my patients, what did you look up on Google? No, I'm serious. Because they are often ashamed to tell me that they looked something up on Google.

Dr. Anne Pendo: So you normalize, looking up on Google.

Dr. Mike W.: So I normalize the looking up on Google. And I've had so many patients just thank me for opening that door because then they'll tell me and then once they tell me, I can say, well I can't prove that it's not, that your pinky pain is not a heart attack, but we've done some tests that make it pretty darn unlikely and I think you're going to be fine. And just having that concern addressed is for them often all they really came for. They didn't come for a testing, they didn't come for blood work. They often just came to be told you're going to be okay. So I've seen that role much more clearly and I've seen it be very rewarding in the interaction with the patients. And the reason I start with that is because it's often the same in leadership, is that I don't have the answers to tell people what to do. And it's really about uncovering what it is that they want to do and can do. And how do I support that, bring that out, make it more effective. Because I can't be the expert on everything, obviously. Nor should I try to be. But I want to facilitate the work of people who are the experts and get them to do their best, which is what they want to do.

Dr. Anne Pendo: Right.

Dr. Mike W.: But again, there are all these barriers often and barriers are, unless you're going to address them, they're not going to go away probably.

Dr. Anne Pendo: Yeah. And is that something that another mentor, because that seems to be a theme here, that you are someone who pays attention and observes, listens and learns from those around you. I'm shaking my head, you're kind of like maybe.

Dr. Mike W.: Well, like I said, I've been so lucky to have so many mentors. When I first came to Intermountain, Todd Allen was my mentor for many, many years and still is. I was just blessed to have to work with people of that caliber and I could name 10, 20, 30 people who've had a positive impact on me and I hope I live up to their legacy. But certainly working with Shannon Phillips is just an incredible privilege and I've learned a lot from her about being present in discussions and putting away my cell phone and really listening. And not being afraid to say what the hard things are because it does everybody a favor. And lately I've been thinking about in particular how giving feedback is kindness in a way.

Dr. Anne Pendo: Yep, that's what Brene Brown says.

Dr. Mike W.: And how the converse, if you withhold your feedback that it's actually unkindness because you don't give the other person the chance to address what could be easily fixed perhaps to let them be more successful. I would also say that I've probably been mentored by patients and families most of all.

Dr. Anne Pendo: Particularly in the emergency department or in your role with clinical risk and safety?

Dr. Mike W.: Both, it's really in my leadership role in risk and safety. It's given me the chance to sit down with patients and families who have been really harmed. And I don't mean just physically harmed but emotionally harmed sometimes just by our system and listen to them and really understand that I don't know what that's like really. And I mean I do know what it's like a little bit because I've been through things with sick family members. But you never really understand until you sit and listen with the person really what it was like to be in that scenario. And I've learned that until we do that and take the time to sit and listen, we won't understand what happened. And so what has happened in the past so often is we look at the chart or the medical record to try and understand what happened to a patient and I've never seen a case where that gives a full picture and tells the patient's side of the story or gives the patient's voice about what was happening. And so it's really taught me that we need to spend that time with patients and their families to really dig into what kind of care we are providing. Because if we don't, we only are going to see a very two dimensional picture of that care. I don't know if that makes sense.

Dr. Anne Pendo: It does. And before we started our podcast, you talked about being comfortable with being uncomfortable and is it sitting with those families that have been the opportunities to get more comfortable in the not having an answer, just being in that, either the pain or the sadness or the discomfort.

Dr. Mike W.: That's been a big contributor because I think to be with a family that's angry and often they are angry because they are confused and they feel like they haven't been heard. They feel like maybe something was done wrong, although often they just are confused and they'd have answers or they have questions and they feel like they haven't been given answers. And so to sit with that degree of emotion, you really just have to clear your own ego out and just sit there and give it time and see where it goes and what happens. And be willing to absorb those words and try and understand them.

Dr. Anne Pendo: How do you prepare for those meetings? Are there things that you do to get yourself in that space?

Dr. Mike W.: I don't have a specific ritual, but just realizing that you're going into a room or a setting with another human being who's a valuable human being, who has a valuable viewpoint. I've just learned so much and I've had, every time I've gone into talking to a family where I thought I knew the answer, I thought I had a label on them. It's turned out that I was the completely, not the opposite, but I just was completely off the mark. And I'd say that the similar situation is being with your colleagues who are angry and upset or hurt and who have complaints about the system and how it works. And just being patient with them and listening and understanding where you can help both clarify their understanding so they can move forward. But also where can you connect them with resources that might be able to help them move forward. It's very similar actually. There's a lot of emotion in our caregivers as well. And it's a hard time in medicine, healthcare because of a lot of demands on everyone.

Dr. Anne Pendo: Yeah.

Dr. Mike W.: People are overburdened with tasks to do and they're going through a very, I'd say globally difficult evolution through the electronic health record. I mean that's universal. That's been hard and people are emotional about that. And so how can we help them get those emotions out in a constructive way. That's what I see sort of our roles are partly that, right?

Dr. Anne Pendo: Yeah.

Dr. Mike W.: How do we encourage people to express themselves and then work productively on making their work environments better?

Dr. Anne Pendo: Yeah. I'm imagining in the emergency department you are faced with angry patients as well. So I'm seeing a thread through all the parts of your work that are connected in how you show up. I know we've had conversations about putting humanity back in our work and we've had some really good conversations I think in talking about that. And so my question for you now is how are you going to know we're doing better? What's going to be the thing that says to you, okay, we made a difference here. What are you going to see?

Dr. Mike W.: I honestly think we'll probably know it first because we have fewer patient complaints.

Dr. Anne Pendo: Okay.

Dr. Mike W.: Because I really, and we're going to see it in our quality numbers. We're going to see it in our efficiency numbers. I'm not sure people will stand up and tell you Anne I'm so much happier now than I used to be.

Dr. Anne Pendo: Yeah, I'm not thinking we're going to see that, but that would be nice.

Dr. Mike W.: That might have happened once. I mean, we could shoot for that one time. But I think instead you'll see us get better at our jobs because we come to work with joy and not with resentment. And our patients will see that. I know they see that in, they've seen that me. I've come to work in the past on days when I was not showing up with joy. And it makes it harder for everybody. And so that's where I think we'll see it.

Dr. Anne Pendo: I think we'll also see it and I think we're starting to see some of that in the questions that we ask. Instead of who can I blame for this? It's the, okay, how are you doing? Are you doing okay? What do we need to do differently? What are we going to learn from this? Instead of, I can't believe you did that. And you are bad.

Dr. Mike W.: Exactly. And I guess to answer your question then, we're already seeing it. And it's tremendously exciting to me because we, and this isn't just me or you or the office patient experiences, there's a broad effort afoot to try and bring emotion back and human connection back into medicine in a more authentic way, in a way that will help people. And one of the ways is through this idea of when a difficult event occurs, we need to do two things really urgently. And one is to care for each other and care for the patient. So caring. And then the second is we need to learn and we need to learn quickly and we need to learn authentically and deeply so that we can then make sure that we are doing our best to make sure that things go better next time if possible. It's not always possible. There's not always a lot to learn, but what we might learn is how we support each other better. And so there's a lot of groups working on that at Intermountain and it's just fantastic work. And we've heard incredible feedback from that already. And we've more importantly heard people saying after something goes badly, hey, let's pause and let's ask those two questions of first how do we best care for everybody? And then do people need a break? Do they need time off work? Do they just need a big hug and a couple of deep breaths?

Dr. Anne Pendo: Yep.

Dr. Mike W.: They definitely are going to need follow up from somebody who's the peer support. And then secondly, okay, what happened? And so that's actually happening. It's so exciting because it's the opposite of judgment and it's the opposite of a system of blaming and fear. And I think there was a lot of fear out there. And so I think it's going to take us some time to heal that and get back to the way it should be.

Dr. Anne Pendo: Right.

Dr. Mike W.: Where we're caring and learning.

Dr. Anne Pendo: And I think as I think about this, I think of safety, feeling safe. I think about being afraid also to share when something didn't go right or share feelings associated with that and being able to model that. And then have others step in and say, you know what, that was good. We're going to do that next time has been, I agree, has been really exciting to see.

Dr. Mike W.: I think we all have it inside of us and we all want to approach it that way. It's just that like you said, there's a lot of traditionally fear and it hasn't been an emphasis of our training.

Dr. Anne Pendo: No.

Dr. Mike W.: We talked with one physician who said that he'd been practicing for decades and had never had anyone ask him after a difficult patient event, how are you doing? What do you need?

Dr. Anne Pendo: And I'm anticipating that he heard you asking in a way that he was supposed to answer truthfully. Not just say, oh yeah, I'm fine.

Dr. Mike W.: Yeah. Right. Exactly.

Dr. Anne Pendo: Right.

Dr. Mike W.: That's the important part. And to your earlier question, how will we know? I think we might see more tears, healthy tears, right?

Dr. Anne Pendo: Yeah. Not afraid.

Dr. Mike W.: Not afraid to show emotion after these really, really difficult things that we deal with everyday.

Dr. Anne Pendo: Yeah. Well, it's been particularly fun for me getting to work with you in teaching and learning and using our stories to learn from each other. And I love the phrase, everyone has something to teach me. And I think that's a really great place to end as we come to the conclusion of our podcast. Thank you so much for being with me today.

Dr. Mike W.: You're welcome and I would like to say that I've learned so much from you.

Dr. Anne Pendo: Thank you.

Dr. Mike W.: And your willingness to host these conversations in a positive and such, it's always, you're like a ray of sunshine whenever you come...

Dr. Anne Pendo: Thank you.

Dr. Mike W.: Come around.

Dr. Anne Pendo: Thank you.

Dr. Mike W.: So I've learned a ton from you too Anne.

Dr. Anne Pendo: Thank you.

Dr. Mike W.: So I appreciate your mentorship there.

Dr. Anne Pendo: Well, these conversations have been particularly wonderful, so thank you. We will look forward to you on our next podcast and thank you for spending time with us today. Thanks, Mike.

Dr. Mike W.: Thank you.