Dr. Marc Harrison: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Annie Luke, nurse manager of the Post-Anesthesia Care Unit and Same Day Surgery at Intermountain Medical Center. Annie, please tell us a little bit about yourself and then let's talk about leadership.

Annie Luke: So I've been a nurse for almost 10 years. I started in the Thoracic ICU, and then from there moved on to… I did some marketing and outreach at the Heart Institute at Intermountain Medical Center, and then I've been the PACU/Same-Day manager for just over three years.

Dr. Marc Harrison: Why did you choose Intermountain?

Annie Luke: The entire reason I actually became a nurse is I have an almost 12-year-old, and he was a 31-weeker, spent almost three months in the NICU. Was very, very, very sick, so-

Dr. Marc Harrison: Which NICU was he in, Annie?

Annie Luke: So he was born at Utah Valley and they were absolutely incredible. But really just the outcome is remarkable. He's healthy, strong, really, really incredible. And so I kind of decided-

Dr. Marc Harrison: Really glad for you.

Annie Luke: ... yeah, it was amazing. I owe so much to that team. And I decided kind of early on that if I needed to spend the rest of my life giving back for what I received, that it felt like a pretty life well-spent. Intermountain was the obvious choice. I spent just a couple months with a different company and was really, really excited when I got the job in the Thoracic ICU.

Dr. Marc Harrison: Well, we're really glad you're on board. I had a chance to listen to you at the managers' meetings that we were holding. I think you made some really interesting commentary around leadership, and your philosophy, and how you identify and grow talent. And conversely, what do you do with folks who really just can't get on board? And I wonder if you might share with me and with our audience some of your thoughts.

Annie Luke: Right. So specifically over the last six to nine months, I have been able to kind of change a little bit about how I led my unit. And a big, big thing was, first of all, being very forthcoming that yeah, we're going to work hard, but when we work hard we're going to do it together.

So just really having that expectation that sometimes… Change is hard and change can be scary, and so it's easy sometimes for people to say, "Well this is how it's always been done," because that's kind of in that comfort area. We joke that that phrase drives me nuts in our unit. And so you got to put things in a box and kind of shake it up and turn it upside down. And when you have a team of really engaged, excellent individuals, then accommodating that change is a lot easier. And so you kind of have to stop, take, take a break, set new expectations. But then the real big key part of that is holding people accountable to those expectations.

Dr. Marc Harrison: Let's talk about that for a second. I think you'd be the kind of nurse I'd either really want to work for or with. Not everybody likes to take on new challenges and change. So what do you do when you run into a person who's a good person and you think they're skillful, you like them, but they just can't get with the program?

Annie Luke: I think that it's really difficult sometimes for people to understand that holding people accountable, especially if they're within leadership positions within your unit, it's not saying, "I think you're a stinky person, I don't enjoy being around you." But it's just saying, "Hey, we've got this level. We are wanting to provide the best care to all of our patients regardless of the circumstances. But we also want to do it in a way that you enjoy coming to work."

And I found I've had some turnover of individuals that maybe some of the things that I was asking… and I'm very forthcoming with saying, "Hey, this is a big ask. I'm asking you to do a lot, but you need to understand that I'm right there with you. I'm going to be working just as hard. And maybe it's not at the frontline, at bedside, but sometimes it is."

Dr. Marc Harrison: What have you seen in your unit? So this is, you're leading change, you're making substantive demands of your team — as you're supposed to. You're holding them accountable because you're supposed to, you can do a lot of that kind of stuff and more when there are meaningful outcomes for patients. So talk a little bit about what your approach to leadership has done in terms of results in your unit.

Annie Luke: Okay. So there's kind of two pieces of it. One piece is, as we made it very clear, here's the level of the expectation and the accountability, I've been able to also focus on the high performers in my unit. And I kind of equate it sometimes when you've got a family that, little Susie is getting straight A's, but Johnny is stealing stuff from the gas station, and mom and dad are always paying attention to Johnny and Susie is like, "Sweet. I'm working so hard." So I've basically said, "Here's the deal, Johnny. There's room at our table. We'd love to have you. But you know who I'm going to focus on is Susie." And so as the Susies, as I've been able to focus and reward their hard work, the level of engagement has been incredible.

So they feel so much more committed to making sure that they are providing excellent care. Probably one of the best examples that I have. So our patient engagement scores were a little… they were low, and I felt very confident that it wasn't due to the quality of care that we were providing. It was because there was a communication piece that was missing. I identified some high performers that really are great with communication. They are engaged. And I said, "You know what we're going to do? We're going to try a new thing and it's going to be called a patient liaison."

Essentially they meet with a patient in pre-op, they sat down some of the, "Let's talk about pain, you're having surgery, it's going to hurt." But really identify some of the things that we found were gaps in knowledge. Those side effects of anesthesia. Having them identify their biggest worry. Sometimes it had nothing to do with the surgery that they were about to receive. So meeting with them pre-operatively if there were any concerns related to safety. Maybe it was a security issue, maybe the patient had a history of waking up combative. Then, kind of letting the OR and PACU know so that we can keep our caregivers safe. So then the liaisons would meet with the patient post-operatively and just kind of reaffirm that education. Say, "Do you feel that those biggest concerns that you had when we first met, do you feel that those have been adequately addressed?" We went from the third percentile in the third quarter of last year to, at the end of the year last year, we were in the 67th percentile.

Dr. Marc Harrison: That's outstanding, Annie. I like the fact that you're willing to take some risks in order to, not with patient safety, of course.

Annie Luke: Right, right, right.

Dr. Marc Harrison: But by doing things differently. By and large, has your team gotten comfortable with this idea of leaning forward and trying new things now?

Annie Luke: Absolutely. It's actually so exciting to see. I kind of have a standing appointment with the individual with continuous improvement, Zach Smith, that supports us. He comes about every other week. And so we've got an idea board. And it's funny because just the other day I was working through, you know, what needs to be assigned out? No sooner had I gotten through the things on the new idea board, that the board was completely full again of new ideas. So, I came back from a meeting and there was a group of nurses that were waiting for patients to come out of the operating room, you know, kind of talking. It was a Friday. I was thinking, "Oh, maybe they're talking about their weekend." No, they had identified a process that was frustrating to them and the five of them were sitting around saying, "OK, what are some things that we can do?" They were just talking and getting really, really energized. So it's so fun to see.

Dr. Marc Harrison: Great. So a couple of things. First of all, I mentioned something at that manager meeting. I said I'd been with General Petraeus and what he said in this conversation we had is that, "If you walk past something and don't do anything about it as a leader, you've now established a new standard. Whether that thing you're walking past is good or bad." And it sounds like you've taken a very active approach to noticing things that are both good and things that are bad. What do you think the expectation for other leaders in the organization like you should be?

Annie Luke: See, one thing that it's been really exciting for me to see, even over my nine years with Intermountain, is seeing how the culture has shifted and the culture is changing. And so I think that it's really easy for leaders to kind of see, "Oh, this is more work. I don't know." But really recognizing, "No, we can utilize this momentum and make it work for our benefit, for our patients benefit." I don't feel that there should be any excuse for just letting things stand how they used to always be.

It's exciting to have that change in culture because it allows me to do the things that I'm good at. Sure, I can make sure that the staffing is done for next Tuesday, but if I have an infrastructure in place to ensure that I've got some of my core leaders within the unit helping me with that, then I can free up my energy and brain space to really work on those things that are going to have a huge impact on patients.

Dr. Marc Harrison: Well, I just want to say thank you for your leadership, your autonomy, your optimism, your openness to a leading change. I think with leaders like you, we're going to be in absolutely great shape. Do you have any questions for me?

Annie Luke: I think that looking at kind of where the direction and the transparency of the direction now versus a year ago is really exciting for me. If I can't find a personal why, if I can't find something that is really a driving force behind it, I can't sign on. And so it's really nice, as you've given more, you know, we're kind of seeing the bigger picture emerge of the direction that Intermountain is going. It's exciting for me.

Dr. Marc Harrison: Well, we'll keep pushing it.

Annie Luke: Perfect.

Dr. Marc Harrison: And for those folks who are listening, it really is all about providing health to people, and when they're unwell, providing their healthcare at the highest quality and the lowest possible cost. We believe that value and population health is really the way of the future, and that Intermountain is perfectly, perfectly poised to lead the industry and serve as a shining example to other systems about how to do it very well. Doesn't mean we won't stumble or stub our toes on occasions, but we certainly will never get better if we don't try new things. And it's caregivers like you that are going to make that possible. So thank you, Annie.

Annie Luke: Thank you.

Dr. Marc Harrison: Great.