Speaker 1: 00:01 You are listening to the Intermountain podcast with Dr. Mark Briesacher.

Mark Briesacher: 00:07 Hi, this is Mark Briesacher. I'm the chief physician executive at Intermountain Healthcare, and today I'm going to be sitting down with Dr. Scott Stevens, medical director of our medical specialties clinical program. We featured Scott before on this show, and we did this when we introduced this clinical program and how he was going to bring a group of specialists and take them from being a disperse group of committed caregivers and lead them into one where they are now a high performing group working together, serving others.

Scott's story begins with English literature. That's what he received his bachelor's degree in. Upon graduation from college, he took a job that took him all around the world. Serving others in these moments and in these circumstances began to understand what it was like to serve others. It was in this new role in a traveling clinic in the Southern Philippines that Scott became inspired to pursue a career in medicine, and learn skills to make a more meaningful difference to people in need of healthcare. So Scott, it's really great to have you here again. Can you tell us a little bit about those early days and what that time was like, and then how you then ended up thinking about, "I'm going to go into medicine."

Scott Stevens: 01:21 Well, Mark, first let me thank you for having me back on this podcast. It's a delight to be here, and I was looking at my calendar and realized it was just over a year ago that we were sitting at this table together. It's amazing to think through everything that has happened in so short a period of time. Well, as an English major, of course it was only natural that I would go to medical school. Obviously that hadn't been in my thinking when I was working my way through college.

Shortly after graduating, I had an experience which I think is common to many English majors, and that was an unfinished novel sitting on my desk that was pretty clearly never going to get finished. And so I started looking for other things that might be fulfilling for my path in life. I actually had the great fortune to stumble upon a small non-government organization, and got a job helping organize teams of volunteers to do short term service projects in various places around the world.

As you mentioned, we built some houses and some other structures. We helped with water projects, helped dig a couple of wells. And one really unique experience, we actually helped [inaudible 00:02:39] Apartheid by staying in the same homes as black South Africans who lived in townships back before Apartheid fell.

Mark Briesacher: 02:48 Wow.

Scott Stevens: 02:49 But one of the most meaningful experiences I had over that period of my life was the chance to participate with a traveling medical and dental clinic in the Southern Philippines. We actually went by canoe into villages that had no access to healthcare. And in these incredible marathon, 15 to 20 hour sessions of clinic, we would provide absolutely as much healthcare as we possibly could. Claps for the night, get back into the canoe and paddle on to the next place. I had no skills at the time that I joined. The team, I sort of tagged along because there was an opening in my schedule. Quickly picked up a few skills, like measuring blood pressure and anesthetizing the skin for procedures in an environment where it was all hands on deck to do as much good as you possibly could.

Even having so few skills really made me feel like I was making a difference. And I could see it in the faces of the people we helped, who were so desperate for healthcare and really had no other access to that kind of service. But after some time reflecting on that experience, I realized that if I acquired more skills, I could do a lot more good. And that led me to going back and finishing up a few courses as prerequisites for medical school. And here I am today.

Mark Briesacher: 04:12 Yes. I'm trying to picture the English major diving into organic chemistry for the first time.

Scott Stevens: 04:21 I would tell you that I was really hopeful for any essay question responses on any of my mouth and science tests.

Mark Briesacher: 04:30 Yeah. Obviously you did get enough essay questions on your organic chemistry test to get your pre-reqs done and you went to medical school. And after you finished your internal medicine residency, you ended up at the Fourth Street Clinic, which is a clinic for homeless people here in Salt Lake City. Tell us a little bit about what led you down that path.

Scott Stevens: 05:00 That was just an amazing experience. I spent the first three years after my residency at the Fourth Street Clinic. As you mentioned, this as healthcare for the homeless center in downtown Salt Lake City that serves the homeless population. I had entered the National Health Service Corps during medical school, and that program carries with it a service after finishing residency.

And so that was the location that I was fortunate enough to land in, and actually very grateful to Intermountain Healthcare. Because at the time, the Fourth Street Clinic didn't have enough funds to add an internal medicine physician to the staff, and Intermountain was kind enough to actually underwrite some of my salary and supported the clinic while I was there. The medicine was amazing. The patients were amazing. Being able to know that I was making a difference to the person sitting in front of me with every encounter, and to understand that I wasn't giving that care to that person, maybe nobody else would. It certainly made for the most gratifying experience of my young professional life.

Fourth Street Clinic rarely charges for any of the medical services that they provide. They're most often free, but the payment is returned a hundred fold in the thank you's that I received from almost every patient that I cared for while there. The other great thing that I started to learn at the Fourth Street Clinic was a little bit about medical leadership, as I was privileged to serve in the role of associate medical director during part of my time there. I began to understand that service can be provided directly to patients, but there is also great service that can occur in helping empower others to provide the care that they do to patients.

And that really started my journey as having a role in leadership in my career in medicine. I was at the Fourth Street Clinic in the late 90s, and I'm not sure that at that point I had ever heard the term social determinants of health, even though the clinic staff and patients were living that every day. As I reflect on the medical care that we provided, it was really a sidelight to the services that the clinic provided through their CERT outreach teams and others who actually went out into the homeless community. Connected people with jobs, helped people get set on a path towards stable housing, worked on employment opportunities, found the mentally ill who would not find their own way to a clinic, and brought them in when they needed care.

In fact, I'm not sure I ever heard the term mental health integration when I was down there, but it was happening from at least the early 90s, if not before. So seeing the people in society who often have the least and therefore tend to suffer often the most from diseases, I really became profoundly grateful for those who reach upstream beyond just providing healthcare and try to make a difference in people's lives, to head them down a path towards a healthier and more fulfilling outcome than they would otherwise have.

Mark Briesacher: 08:32 There is no doubt that the care that is provided at places like the Fourth Street Clinic, and really there's clinics like this all across the country. And people who are so committed, like you, have been to supporting our communities in that way. There's just no doubt that the work goes way beyond the healthcare part. And as we all have now come to learn, one's health is so much determined by the social factors in a much more impactful way than the medical diagnosis and the medical treatment, which is also still very important to do.

You moved on after working those years at the Fourth Street Clinic to serve as a residency director at Intermountain Healthcare. So tell us a little bit about what led you to think about that leadership role, and what were the things that were important to you that you wanted to accomplish?

Scott Stevens: 09:33 Yeah. It was really a wonderful opportunity to move back to Intermountain Healthcare, and at the time, LDS Hospital. Part of the path toward that role was actually determined for me to some degree. Because the agreement that I had with Mike Vincent, the department chair of medicine at LDS Hospital, is after a period of service at the Fourth Street Clinic I would come back and work for him. And the role he needed filled was residency director at the time, as it turned out.

It turned out to be an amazing fit for me. I love teaching. I loved seeing the excitement of the interns on their very first day actually practicing as a doctor, seeing the thrill that they have in their new experience and the desire to make a real difference in the lives of the patients that they were seeing just is incredibly energizing. And through that experience, I really began to form the foundation of what I've come to understand is the meaning and importance behind a leadership role in medicine.

In the context of medical education, that really came in watching the transformation of the interns as they went through their first year of training. Seeing really excited, really smart people with absolutely no experience, a little bit terrified, but incredibly enthusiastic to do a great job. And then to see them at the end of the year confident in their abilities, understanding that they really are capable of providing great care to patients. And the thrill for me as a leader is knowing that by helping build that foundation of education, in a tiny way I get to touch the many thousands of patients that each of them will care for over the course of their future career. Talk about an incredibly gratifying role to have. I'm endlessly grateful for the opportunity to have that experience.

Mark Briesacher: 11:34 You've had these different roles in leadership through the years, starting with a small clinic, then leading a residency program, and now serving as a senior medical director across multiple medical specialties. What do you think some of the common challenges are for leaders, irrespective of where they're at in their leadership career?

Scott Stevens: 12:02 I think one of the most important challenges in being a leader is the flip side of the coin of one of the most important characteristics to carry into leadership, and that's to be a continuous learner. I commented a moment ago about watching the enthusiasm, but nervousness of new interns. Their first day on the job felt exactly that way my first day on the job as the new medical specialties medical director. But it's that same curiosity and particularly a passion to serve that, in my opinion, is the most important characteristic that helps one overcome the many challenges that arise in leadership.

Service takes on a little bit different flavor as a leader. I spent some time directly caring for patients, which I value, but of course much of my time is now spent executing my tasks as a leader. But I've learned much as I did through educating residents that the more effectively I'm able to serve those that I lead in the specialties, the more fulfillment I get from understanding that I'm helping again in my own small way to touch the many more patients that all of them care for in their roles.

I think one important challenge in leadership in our current context is leading in the face of uncertainty. There's a lot of change going on in Intermountain. There's a lot of change going on in healthcare and society in general, so times are uncertain. And that can cause a lot of stress for everybody, and certainly stress for those in a leadership position, trying to help navigate that change.

One thing that I'm learning is that the same challenges that arise from change also come with many opportunities. I'm increasingly hopeful that I can help those that I lead find a way to take charge of the change in their own clinics. And rather than waiting for the effects of larger change to come to them, instead step forward, find ways to change what they're doing, look for the better path. And then use the new teams that we've developed to take those great ideas and spread them throughout the system more quickly than we've been able to do in the past.

Mark Briesacher: 14:34 I think this idea of really owning the work that you have is such an important concept, and I think the fact that you as a leader view it with that mindset is a really powerful thing. It shows respect. It recognizes the fact that those solutions are going to be arrived at by the people who are closest to the actual care of patients, and closest to how do they work together as a team.

We just know that a diverse group of people who share a common purpose, who are then empowered to go out and solve for things can really in meaningful ways cocreate and come up with new solutions to address these big challenges that we have. Access to care, creating the experience that all of the members of the team deserve in this work in healthcare. I think that's a pretty powerful lesson for people to think about as they contemplate in their leadership. If you were to say, look, there's three things. So if that's one of the largest things to know, what are some of the other big lessons you think that that you've learned over the years that would help those who are thinking about a career in leadership in medicine?

Scott Stevens: 16:02 I had the privilege of taking the developing trusted leaders course at the Intermountain Healthcare Leadership Institute over the last several months, and that was just a transformative experience. I'm still unpacking, and will be for years the lessons learned. One of the things that struck me most deeply about that course though was the focus on understanding your personal why, your purpose in leading, how you aspire to be the leader that you want to be. And they really encapsuled that in trying to come up with something they described as your personal leadership brand. Brand is a word that strikes me a little bit funny. I've used the word purpose. But after a lot of self-reflection and a lot of discussion with my classmates, I came to the statement that my purpose is to empower fulfilled caregivers, to bring the best possible health to all people.

And the reason that really is why I show up to work every day is it embraces the two things that I feel are most important about a leadership role: which is executing our mission in healthcare, which is I think the noblest mission of all, to help people be as healthy as they possibly can. But then in my role as a leader, to do everything I can to make sure that the satisfaction and professional wellbeing of the caregivers is the best it can possibly be because it's the right thing to do, but also because healthy and fulfilled caregivers give that much better care to our patients.

In the leadership role I have now, I have an opportunity that I've never really had before, and that is to be somebody who is leading other leaders. So we have a group of eight absolutely amazing specialty medical directors in the clinical program, and every day I'm astounded by their passion, their ability, their dedication, their deep commitment to serve the specialists in each of their disciplines. And the more time I spend in this role, the more I realize that that success really doesn't come from me being on stage in the spotlight, but rather from me asking the specialist medical director to be in the spotlight. And then I get to sit in the wings behind stage and cheer them on, which is the best part of any of my days.

Mark Briesacher: 18:45 Scott, these are really important lessons for leaders. The idea of how important it is to inspire and lead through times of uncertainty, knowing your why, knowing what your purpose is, and also understanding your role in developing others in their leadership, much like when you were in practice helping a patient get better and better in self care. And as a pediatrician for me, helping parents and family members learn how to best care for their child is empowering for them. The developing of others just so much increases the impact you can have across time. How many can we serve, how well can we serve them? How long can we do that? If you were sitting with a group of physicians, nurses, pharmacists, and sitting with them today, what do you think the one bit of advice would be that you would leave them with?

Scott Stevens: 19:53 Well, I'm not quite at the end of my leadership career yet, hopefully. But looking forward to that time and thinking about what I would like to be able to say at the conclusion of a career in medical leadership that that was well done would be, "Scott Stevens: he took good care of his patients, and he helped me take good care of mine." One of the other amazing lessons that I took away from the Intermountain Healthcare Leadership Institute course was a few second statement that I think will last with me the rest of my career. And that was, "Think about what you're doing today. Are you trying to add to your CV? Are you trying to add to your epitaph?"

Mark Briesacher: 20:40 So Scott, thank you for being here today. I always enjoy our conversations, even the ones that happen at 6:15 in the morning sometimes. I think you mentioned that you finished college with an unfinished novel on your desk, and it strikes me that you're writing your novel still. It may not be one that's written in the way that is most commonly thought of, but in so many ways, this story of your personal story of leadership and your personal story of service to others, that is very much a compelling and remarkable story.

Scott Stevens: 21:21 Thank you.

Mark Briesacher: 21:22 Well, you may not know how big of a difference you're making, but you're making a really big one. So it's important to say that. I'm grateful for what you have provided for Intermountain in your leadership to date. And I'm very much am looking forward to seeing what else you and the team are going to accomplish going forward.

Scott Stevens: 21:39 Thank you very much for having me, Mark.