Marc Harrison, MD: Today I'm with Trent Gee, a sourcing manager from Supply Chain. Trent, would you mind telling us a little bit about yourself and your job, and why it's so important to Intermountain? And I can't wait to hear your question.

Trent Gee: Thanks for the time. I've been working with Intermountain for 23 years, really enjoyed my time, and all of it's been within Supply Chain.

What we do, at least in our particular role within Supply Chain, is we work very closely with the clinical program directors and the service program directors to make sure that they have the products that they need to perform the care that they give.

Marc Harrison, MD: It sounds great. It must be really interesting. We're making a lot of progress in that area, but I bet there's some challenges as well.

Trent Gee: There still is. I mean healthcare when it comes to Supply Chain and some other things like that is years behind other industries, and so there's a lot of efficiencies that we're still trying to obtain by doing that, and One Intermountain helps us achieve that a lot faster.

Marc Harrison, MD: I'd love to hear your perspective on how the One Intermountain approach is helping us achieve affordability through Supply Chain and through standardization.

Trent Gee: Well, prior to that, the previous structure just would lend itself to more pocket of decision-making and authority, and so you would have different regions that would have different standards. Interesting to note that we had just for a specific product up in the old north region McKay and Logan ED both said that they had the best clinical practice, and it was proven. And so, the product that they had selected were the best products to be used. They weren't the same products. So, it was kind of difficult to-

Marc Harrison, MD: Right in the same region?

Trent Gee: Yeah. It was difficult to say, "Well, who has-"

Marc Harrison, MD: Fantastic.

Trent Gee: "Who has the best product?" And so, aligning has really helped us have the conversation, I think, within the clinical side and helped us lead that and helped them identify that the silos that existed before need to come down. That communication needs to be shared across their old regions across the entire system now through the clinical programs so that we're not missing opportunities to really, really improve products that are out there, but also apply those products to the best clinical practice.

Marc Harrison, MD: Yeah. This is really important to me because I want us to provide the highest quality and most affordable care to people, and I want us to be quantitatively the healthiest communities that delivers care at the lowest per capita cost in the United States. And what worries me is the lack of standardization or when people act with ego and drive up costs, who suffers? Well, it's the patients we're meant to take care of. Do you find, and I expect that our clinicians are very receptive, that when it's put in those terms that they really try very hard to comply?

Trent Gee: Yes.

Marc Harrison, MD: Because I think we work with great people by and large.

Trent Gee: We do. And I believe on in whole that they do, but that brings me to the question.

Marc Harrison, MD: Yeah. Fire away.

Trent Gee: We really try hard to make sure that we do provide the best products at the lowest costs, but we want to make sure that we're not having a specific facility or even a specific physician use only one product. That's the only one they'll use so that if you look through the system that his or her peers are using something entirely different, and so we have these outliers.

So, we're trying to identify and address those, and a lot of times, it's just through education. We're finding that people are very receptive to that, but what would you say? What advice could you give to us as we work with those individuals who are reluctant to change, reluctant to come onboard with the value that standardization leads? Because standardization to me is not a destination. It's a journey, and standardization doesn't mean you only use one product.

Marc Harrison, MD: Well, thanks, and I'll try and answer that question. I will say it sounds like you've been waiting for One Intermountain for a long time.

Trent Gee: Yeah. We have.

Marc Harrison, MD: Okay. If I were to give you some advice about working with those outliers, I'd approach them with an open heart and open ears. I suspect that they have a story, and I would really listen to what their hopes, dreams, fears, concerns are. And really give them an opportunity to share and try and figure out what it is exactly that's preventing them from coming into line. At least in my experience, that process is of giving people voice, allowing them to be heard, trying to understand them, often gets people over the line.

And then, for those that can't, understanding if their concerns are reasonable and trying to accommodate them if they are. Generally, they're not, actually, but trying. And then, in very rare instances for people who absolutely have no ability or desire to comply, then they may need to find someplace else to practice that particular procedure. But I think having that absolutely be a last resort. That process of empathy, understanding, accommodation where appropriate, generally does the trick.

Trent Gee: Thank you.

Marc Harrison, MD: The other thing I'll say is I generally believe these standardization efforts, and this is with no disrespect to our experts in Supply Chain, are much more palatable when they're clinically led.

Trent Gee: Yes.

Marc Harrison, MD: So, it's one peer to another. They can kind of call, "Bologna," in a way that a non-clinician can't and do it in a respectful way, and say, "Look. I made the change. I'm still getting great outcomes, doing it in the same amount of time. And, hey, we're achieving it for a third of the cost," and that cost is ending up in people's pocketbooks because of high-deductible plans. I think they can have that conversation in a way that's much more difficult for a non-clinician.

Trent Gee: Yeah. Fortunately, we've set up all of our committees around that structure where they are clinically led.

Marc Harrison, MD: I think that's fantastic. It also gives those clinicians an opportunity to develop their own leadership skills. We as an enterprise, the more leaders we have who are capable and ready and willing to take on transformation, the more quickly we can go on this journey towards higher quality and greater affordability for the people we're meant to serve. So, I don't think ... I never look at leadership as just a few people. The more people that behave as leaders, the better off we are. Don't you think?

Trent Gee: Yeah. I agree. I agree.

Marc Harrison, MD: So, before we break, anything that you want to add that's off-topic or any advice you want to give me?

Trent Gee: I've just been thoroughly pleased with how on a personal level, but also on a professional level of how things have rolled out the last several years. It's been hard. Change is never easy. But it's been change that's been needed, and we're starting to see some of the components of the puzzle be put together more effectively.

Just even in the last six months, conversations have changed. And the tone of conversation has been knowing that the change has been rough on some people and in some areas, more than others, but nonetheless, people have been very supportive of having that bigger picture vision. So, the only advice I would have is just keep it up, and-

Marc Harrison, MD: Yeah. Trust it.

Trent Gee: ... to try keep those people engaged as much as possible.

Marc Harrison, MD: Well, thank you. Thank you for your leadership and your advice. Some people ask me, "Are we there yet?" And the answer is I think we've made the big structural changes that we need to make, although I'm sure there'll be more opportunities to refine what we do and better understand how to function effectively in this new structure. But the journey's not over, and it probably will never be over. The demands for higher quality and more affordability and how we achieve that for people I think it's going to go on forever, and maybe the core competency for our leaders going forward is people who can lead change and do it in a thoughtful, kind, and positive way. Does that make sense to you?

Trent Gee: Yes. It does because I don't think that if we want to continue to improve ourselves regardless of whatever the external pressures are, that should never stop.

Marc Harrison, MD: Right. It's all about service, right?

Trent Gee: Risk.

Marc Harrison, MD: It's not about us. Well, thanks. It was great to talk to you. I appreciate it.

Trent Gee: Thank you.

Marc Harrison, MD: Yeah. Thank you.