Mark Briesacher, MD: 00:06 I'm Dr. Mark Briesacher, the Chief Physician Executive at Intermountain Healthcare. Today we have a guest host, Dr. Anne Pendo, who is interviewing one of Utah's healthcare heroes.

Anne Pendo, MD: 00:18 Well, welcome. I am Dr. Anne Pendo, Medical Director for Experience of Care and Internal Medicine with Intermountain Healthcare. And today I am here with Diane Salisbury and Kelly Imlay. Diane is a medical assistant at the Bountiful Clinic in Salt Lake City. And Kelly is our nurse administrator for the Intermountain Medical Group. And I'm really excited to speak with both of you today about some great changes that are happening within Intermountain and our Medical Group around medical assistants and their role. And I was hoping, Diane, that you might start us off with a story that is meaningful to you about a patient that you've taken care of.

Diane Salisbury: 01:07 I spent the majority of my career working in the urgent care setting in the Bountiful InstaCare. And one day we had a patient come in and check in for cold type symptoms with congestion and cough and things. And when I brought her back to the triage area to do her vital signs, our stand there in the InstaCare is to do a full set of vital signs on every patient. And as I was checking her blood pressure and the heart rate on the oximeter, I noticed that the oximeter was not picking up an accurate heart rate. It was bouncing all over. And so I did a manual heart rate on her wrist, and noticed that it was irregular.

And so I then checked her pulse with the stethoscope, listened to her heart rate for one minute and noticed that it was very irregular. And so anyway, I brought her back to our cardiac room and alerted the nurse and the doctor. We did an EKG, and she had new onset A-fibrillation when she was initially checking in for cold symptoms. And so we were able to get her sent to the hospital where she could receive care. She had the cardioversion there and was discharged a couple days later. A few weeks after that, she came back to the InstaCare looking for me to thank me for paying attention and catching that because as a medical assistant, we are one of the first points of contact for a patient.

Anne Pendo, MD: 02:38 I bet she so appreciated that.

Diane Salisbury: 02:40 Yeah. We were able to get her where she needed to be for that appropriate medical treatment, and she did well.

Anne Pendo, MD: 02:46 That's a lovely story.

Diane Salisbury: 02:47 Thank you.

Anne Pendo, MD: 02:47 Thank you.

Diane Salisbury: 02:48 It's very gratifying.

Anne Pendo, MD: 02:49 Yes, and so nice that she took the time to come back and say thank you.

Diane Salisbury: 02:53 Yes, very much so. We have some very good patients, but you don't have those experiences very often where they come back to tell you things.

Anne Pendo, MD: 03:00 That's great. Well, as we were talking today about being a medical assistant, maybe you could tell us or share with us what made you consider this field or work and what you like about it.

Diane Salisbury: 03:14 Okay. I've always been interested in the medical field. I think it's very exciting. It's always changing and you can always learn something every day. And so I went to a medical assisting program because I thought it would be a good beginning to healthcare. And the goal was eventually go on to nursing, but with my family and being a mom, and kids, returning back to school is very difficult. So I've been a medical assistant now for 14 years. And I've really loved it. I love my patient interaction. I love being able to greet people with a smile, and hopefully make them have a better day. They're not usually at the doctor's office because that's really what they want to do that day.

Anne Pendo, MD: 04:00 That's a good point. It gets to be a part of our day to day work that we often forget about that, I think.

Diane Salisbury: 04:07 Yeah. They're there because they have to be. And so I think it's very important that we be as positive and make it as positive as an experience as we can because they need to be there.

Anne Pendo, MD: 04:22 As we think about how we practice medicine, and we think more about practicing really working as a team, our medical assistants are critically important. I think you mentioned it or said it really well that you're one of the first people that interact with our patients. And one of the things that we've been discussing, and I'm going to be interested to hear from both you and Kelly about some discussion and conversations around standardizing the type of work, the reason for thinking about that, and what you've discovered.

Kelly Imlay: 05:04 Thanks, Anne. We actually decided to pull a group together, frontline medical assistants and our continuous improvement director and myself to really look at medical assistant standard work. And part of the goal is that we want to ensure that first, the staff knows exactly what they're supposed to be doing, but also to start to reduce variation and allow the ability for staff to help each other out when they get busy, and be able to float to different clinics if there's a sick call or someone gets busy.

So going through this standard work really allows the staff and the providers, the whole team, to understand what to expect when the medical assistant is supporting them and their team. It was interesting as we started to go into the discussions. We learned a great deal about exciting things that we have opportunities to look at, from standing up a shared leadership structure that includes the voice of the medical assistant and nurse from the frontline to really guide us on practice decisions and caregiver engagement, to what are some barriers that we could work on to make the medical assistant be more of a career and not a stopping point. I think Diane was instrumental as we went through some of these discussions with her background and the fact that she has been a medical assistant for so long, and really giving us some great ideas and opportunities that we can work on in the near future in the medical group.

Anne Pendo, MD: 06:45 Thanks. I was lucky enough to be present for part of that conversation and work group. And one of the things that struck me is the amount of engagement and conversation amongst the whole group, and also realizing how much variation there was with one caregiver saying, "Oh, we always do it this way," and somebody saying, "Oh, I was told not to ever do that." And it made me realize what a big opportunity we have to create the standardized work. And as we were preparing for this conversation, Diane and I were talking about that standard work, knowing what your work is, what your expectation is, some people view it as a negative. But in our conversation, we talked about it as a positive. And maybe you could share that with our audience today.

Diane Salisbury: 07:49 I think it would make it a lot easier for medical assistants if they knew exactly what was expected every day, no matter where they were working. I work with several floats in the Bountiful Clinic, and it can cause a lot of anxiety knowing today I'll be in family practice with this specific provider, and this is what I need to do for them. And then tomorrow I'm going to be in internal medicine. And what is that going to be like? What do I need to do there, and things? And I think it would really help us feel more confident in our role and help us to feel more successful, going home feeling like I did what I was supposed to do today. I did it well. And be excited to come back tomorrow rather than being worried about it.

Anne Pendo, MD: 08:34 Yeah. And I think from a patient perspective, patients may or may not know if you're the regular medical assistant or if you're filling in, but having that confidence on their side knowing that if I'm seen at an Intermountain Healthcare Clinic, I know that I will receive the care that I should be receiving. I'll have a full set of vitals. I know that things will be done in an orderly way. And that's got to be reassuring for them as well.

Diane Salisbury: 09:05 Definitely.

Anne Pendo, MD: 09:06 Yeah. Do you see, as we think about moving forward, do you think your group, your work group will grow? Or how are you seeing that moving into the next stages?

Kelly Imlay: 09:20 I really see this work group actually being some of the key stakeholders as we start to stand up shared leadership. It was resounding that they want a voice, and we saw that in their engagement. And I really think they can help us roll this out and mentor and model what we're looking for in these groups. As far as that work group goes, we'll probably sunset it because we met our initiatives. But I believe it just opens the door for a much longer and more exciting opportunity for everyone to really have input into what healthcare is going to look like being provided from their view.

Anne Pendo, MD: 10:03 Yeah. Think that'll be great. I know that in my internal medicine career, the medical assistants that I've worked with, I've really felt that we were one, that we were a team. And when we worked well together, there really wasn't anything we couldn't do. And I was confident that the work that was being done by my medical assistant was ... I could trust it. I knew what to expect when I went into the exam room. And that created, for me, less anxiety and more confidence as well. So I think that's a win-win for our patients and for our clinicians and our caregivers as well.

Kelly Imlay: 10:57 You know Anne, I also see as you talk about the patient, having the standard with and this committee allows for the patient to experience the same care in each location. And it really reduces that variation and helps, I believe, us build that trusting relationship. So regardless of where that patient enters into the system, they are going to experience that same level of quality care that we have outlined as we went through the standard work. Would you agree with that, Diane?

Diane Salisbury: 11:31 Oh, yes. Definitely.

Anne Pendo, MD: 11:33 And I think, too, as we look at our safety events, a lot of those are around having variation. And so I'm just going to use the standard set of vitals. As you look at events that occur, a lot of those are related to a temperature wasn't taken, or a pulse wasn't obtained, or an O2 sat wasn't obtained. And have that just be, this is part of what you do, it doesn't matter who you're working with or where you're working, but that's just part of the job, helps with safety as well.

Diane Salisbury: 12:14 It really helps make sure our patients are safe while they're in our care.

Anne Pendo, MD: 12:18 And when I think about our Office of Patient Experience, which encompasses safety, quality, and experience of care, I think about our conversation today really supporting those three pillars, and that's pretty exciting. I really appreciate you both taking the time to be with us today. And I'll be interested to have you both back soon as we've implemented some additional changes. And you can share with us what is going well and what you're looking forward to next. And I think there are some good things to come, so thank you very much. This is Anne Pendo from Intermountain Healthcare signing off for today.