Marc Harrison, MD: 00:22 Today I'm at Park City Hospital with Brenda Puchalski, who is a nurse and Surgical Services Director here. Thank you for joining me today, Brenda. Would you mind telling us a little bit about yourself and what you do here, and then I'm excited to hear your question.

Brenda Puchalski, RN: 00:34 Yes. I've worked for Intermountain actually for about 17 years. I started off in Pediatrics at Primary, moved around in there, went to the ED, and then I moved up to Park City, got married, and when my kids were born, I didn't like being that far away from them, so I worked at the surgical center that was currently in Park City, and then the hospital was built and I came to the hospital. I’ve worked in surgery ever since.

Marc Harrison, MD: 00:58 So, you have had some interesting experiences. You know I did my training at Primary Children's, because-

Brenda Puchalski, RN: 01:03 I know people that know you-

Marc Harrison, MD: 01:05 Uh oh.

Brenda Puchalski, RN: 01:05 During that time.

Marc Harrison, MD: 01:06 Yeah. There're some good stories, aren't there?

Brenda Puchalski, RN: 01:08 There are some good stories.

Marc Harrison, MD: 01:11 I would say that I was moderately well behaved and not boring to be around.

Brenda Puchalski, RN: 01:15 I think that would be exactly what they said on my river trip.

Marc Harrison, MD: 01:20 Tell me what's on your mind today. What can we talk about?

Brenda Puchalski, RN: 01:22 Okay. First, I have really appreciated your access. Working for Intermountain for 17 years, I've seen a few administrators go through, and I’ve met you now in one year three different times. I just have to say thank you for that access. I wonder if you ever stop moving, but that access means a lot. It means that you actually really are trying to make changes in a positive manner, so I just want to say thank you for that.

Marc Harrison, MD: 01:50 Thanks. That means a lot. No, I don't stop moving, but I'm happy doing what I do. Hopefully when you've seen me, I don't seem unhappy or grumpy. I love Intermountain. I love the people who work here, and I really just want us to have the best health system anywhere. I want us to be that model for real, not just talking about it, for real, and I want our patients to get the best, safest, highest quality, best patient experience, most affordable care anywhere in the country. That's what I'm going to keep hammering away at. I don't think we'll ever get there, but we're sure going to try.

Brenda Puchalski, RN: 02:26 I actually feel that, and that's not, like I said, although I'd love to stay on the good side of people who have power, I'm not saying that lightly.

Marc Harrison, MD: 02:34 That's how I feel about my wife. I'm still working on it. Yeah. What's your question?

Brenda Puchalski, RN: 02:40 I have a couple that may shoot around, but the first one I want to ask is what do you feel your definition of success with the realignment is?

Marc Harrison, MD: 02:50 My definition of success is less around the realignment but what it's meant to do. I want us to have the quantitatively healthiest communities in the United States at the lowest per capita healthcare cost in the U.S. The reorganization of Intermountain has been designed to try and get us along the path to those goals. For instance, recognizing that it's a different business in keeping people well than taking care of them when they're sick, that's a big part of having these healthiest communities. Having healthcare be affordable means that it doesn't just happen by accident, it means you actually have to change the cost of what it takes to provide care. I know it's been difficult for people, but to get rid of four redundant leadership teams with competing strategies, all of whom inadvertently increased the cost of what we do, that's not good for people. And so I know it's been very difficult for some of the excellent people whose roles have changed, and for that I'm sorry. But I'm not the least bit sorry that we're taking the money that we're saving and doing things to make healthcare more affordable. And when we get there, we'll be done, but we're never going to get all the way there.

Brenda Puchalski, RN: 04:18 And I know that frontline staff were not really affected as far as job role changes, but because more jobs are rolling up into one person's job, do you see frontline staff's roles changing when you have those moments of looking back and say what's working well, what's not working well? I know they worry about it.

Marc Harrison, MD: 04:41 What I want our frontline staff to know is that they're valued, they're necessary, and that I need them to bring their brains and their creativity and their energy to help keeping people well, or getting them back to normal as soon as they can after they're sick. Is everything always going to look the same? No. We talked a little bit about TeleHealth. Didn't exist five years ago. Have we adapted well? Yeah. We've adapted really well. When we started that, did everyone think it was a good idea? Absolutely not. People thought it was crazy. But it's not. When we started Connect Care, there were a bunch of primary care physicians who were really worried that it was going to be an antibiotic factory and we're going to miss people with meningitis, and etc. None of that has happened. Change is hard, and I don’t discount that in any way, but Ben Franklin said, "When you're done changing, you're done." And our industry is changing incredibly fast. Intermountain is as well positioned as anyone to be successful in serving our mission, but we have to keep moving in order to do that. But, that shouldn't scare our frontline staff. They're as valuable as ever. What I really need them to do is to participate in their huddles and share their best ideas, and continuously improve along with the rest of us.

Brenda Puchalski, RN: 06:01 I do think the huddles actually have helped. I do think that both hospital and locally in your department I find that employees are more informed, better informed, well informed, and I think that sets them up for success daily. Everyone was a bit skeptical about huddles and felt, "We're doing this now." But we really weren't.

Marc Harrison, MD: 06:23 You know I've been to a lot of huddles. One of the things I find incredibly gratifying is when I can watch a frontline caregiver who hasn’t been prepped speak with authority about the projects that are happening on his or her unit. That's success. Because that's alignment. But boy none of this is easy, and it really ... The strategy around One Intermountain is to push authority out as far as you can, so that people use their huddle boards to improve their local environment but stay aligned with the overall mission and vision of the organization. I think it's working okay, but I know it has a long way to go. I also know if we hadn't gotten started, we'd be right back where we were. I guess I'm big on quotes today. Wayne Gretzky said, "You miss every shot you don't take." Let's take some shots. We'll put some in the net.

Brenda Puchalski, RN: 07:17 Perfect. Those are the questions I had.

Marc Harrison, MD: 07:21 Thanks. Advice for me?

Brenda Puchalski, RN: 07:22 No, just keep doing what you're doing.

Marc Harrison, MD: 07:24 No worries there. Relentless forward progress is my watch word.

Brenda Puchalski, RN: 07:29 You know, live healthy as well. Take some times to yourself if you don't stop.

Marc Harrison, MD: 07:33 I play as hard as I work.

Brenda Puchalski, RN: 07:35 Work.

Marc Harrison, MD: 07:35 Yeah. So there's no worries there. You probably heard that as well.

Brenda Puchalski, RN: 07:39 Like I said, a river trip is a great place to get information. But what goes on the river, stays on the river. We're good.

Marc Harrison, MD: 07:47 Okay. I will share a story with you. When our third year of residency was coming up at Primary Children's, my residency class thought it would be really fun to all get together and sort of do this lottery, and organize our schedules together so we were mutually supportive of one another, so we could get what we wanted. And I had the really brilliant idea that it would be great to bring a couple of cases of beer into Primary Children's Hospital. And we proceeded to, as a residency group, we were playing music, and we were drinking beer, and we were choosing our schedule when Dr. Simmons who was the head of the hospital at that time and the chairman of Pediatrics came in, and he was not happy — as you might imagine. I don't blame him in retrospect. And he said, "Whose idea was this." And everyone kind of pointed at me. That was not the best day of my life. Let's put it that way. That was maybe some of the work hard, play hard kind of stuff you heard.

Brenda Puchalski, RN: 08:47 Keeping it real.

Marc Harrison, MD: 08:48 Keeping it real. Well, thank you.

Brenda Puchalski, RN: 08:48 Thanks.

Marc Harrison, MD: 08:51 It's a pleasure.