Marc Harrison, MD: Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. I'm here today with two caregivers from the Memorial Clinic, Devin Reid, practice administrator, and Brandy Siniscal, practice director for Memorial Internal Medicine and Pediatrics. Thank you both for being here. First, can you please introduce yourselves and tell us a little bit about what you do? Devin, you want to lead off?

Devin Reid: Yeah, so my name is Devin Reid. I'm the practice administrator at Memorial Clinic. I've been with Intermountain now for about four years. Really enjoy it. I've been at Memorial Clinic for just a little over a two and a half years, and we have a fun good group there at Memorial Clinic, as you saw a few months ago.

Marc Harrison, MD: How about you, Brandy?

Brandy Siniscal: So I've been with Intermountain for four years, as well. I've been lucky enough to work in my career in a few different hospitals. I worked as a travel nurse for a while, which is what brought me from my origins in Florida out west to California. And I worked in the Bay Area for a little while and then came here. And when I came here, I was actually working part-time between Intermountain and another hospital organization in Utah, and it gave me a really unique opportunity to kind of compare. And I really found that what Intermountain offered really aligned with some of my favorite things about other facilities I had worked at in my past experience as a travel nurse. And a lot of that is really based on continuous improvement opportunities and patient experience focus that really felt like something I could get behind. And so that's what made me to kind of transition more full-time with Intermountain.

And then when I came to Intermountain, started in the InstaCare at Memorial Clinic, and when an opportunity came up for me to take a more leadership position over pediatrics, I stepped up and have been doing this ever since.

Marc Harrison, MD: Well, I got to tell you, when I visited Memorial, I was very impressed by the level of excitement amongst the clinical staff, the administrative staff. Everybody who walked in seemed switched on and it felt like they really had an investment in the success of the clinic. Talk about how you've built such a culture of accountability there and how you got everybody involved in submitting ideas and then executing against them, because it was very impressive. I really enjoyed my afternoon there.

Devin Reid: Well, that's good to hear. Yeah, I would say kind of the stem of all of that, our caregivers, our providers, the leaders at Memorial all have the same mission. We're striving to do the best we can for patients, to help patients out the best we can. And I think that in itself, as we're sharing ideas or as we're helping each other out, we can always go back to that same root, that we're trying to do what's best for patient care.

At Memorial, we kind of have a focus on daily rounding, our daily huddles, engaging our providers and our caregivers every day to come up with different ideas to improve care, to close those gaps of care that may be that they're seeing, that we're not seeing as leaders or vice versa. And so I think from that, from the daily rounding, the daily huddles, them seeing us as leaders as well as providers, being able to answer questions and follow up on a timely manner have helped them be more engaged, which then kind of gets that...

Marc Harrison, MD: One thing I did hear there, Devin, is that you're always rounding, which I think the providers really appreciate. Brandy, can you talk a little bit about maybe one or two ideas that you've seen implemented that have made a difference for our caregivers, and maybe most importantly, for our patients?

Brandy Siniscal: The one that sticks out in my mind that somebody came up with most recently was in our pediatric department. One of our caregivers had a personal experience where she had made a call to one of her providers and was placed on hold and was then able to listen to some recordings that her provider and that provider's partners were providing messages to patients while they're on hold as opposed to just listening to hold music. And she thought that that might be a good opportunity in pediatrics for us to provide information to our patients that maybe they don't hear often enough or it's just not in their-

Marc Harrison, MD: So maybe about immunization-

Brandy Siniscal: Exactly.

Marc Harrison, MD: ... or breastfeeding or-

Devin Reid: Some of the daily questions that we hear come in and stuff.

Brandy Siniscal: Right.

Marc Harrison, MD: What a good use of time.

Brandy Siniscal: Yeah, it was a great idea. And so they kind of formed a little committee and came up with what the messaging system or what the messages would sound like, and then they proposed it to the providers and said, "Hey, what do you guys think? Would you be interested in recording these? Because we think that the patients would be more likely to listen to the messages if they know that it's backed by you." And they jumped at the opportunity. They were very engaged and were really happy to do it.

And so we set up these messages so that they're seasonally appropriate, and we've gotten really great feedback. Dan Malombe with Telecom took the recordings and even put them to some nice ukulele music, and it's perfect for the pediatric department and it sounds great. And I think in addition to it being really beneficial to providing information to the patients, I think the best win is just that this was a caregiver idea. A medical assistant came up with it.

Marc Harrison, MD: Must make her or him feel very special.

Brandy Siniscal: Yeah. And really, that's what I think is special about Memorial Clinic, and Devin Reid does a great job of leading it, but we have just this kind of synergy between Devin Reid and some providers who kind of follow his lead of getting excited about things like that. And so when it comes from the caregiver and we get excited about it, then they get excited about it and it just kind of snowballs. So I think that's really what you saw when you were visiting.

Marc Harrison, MD: Yeah, I could feel the optimism. And when things aren't going well, you can sort of sense that people are taking on a victim role. "Oh, those people are making me do X, Y, or Z." What I felt at Memorial was you all understood why we're doing what we're doing. Highest quality, lowest cost, affordability, access to great care, keeping people, well. You guys totally get that. And then I could see people generating ideas and being excited to execute within those guardrails. And so I felt like as opposed to being victims, your clinic are leaders. Everyone's in there acting like a leader. And I really think that may be a secret to some of your success. What do you think?

Devin Reid: Yeah, I would agree. I think that we've had some big wins at Memorial Clinic, some fun ideas shared, similar to the ukulele experience. We've also had ideas focused around safety or quality that have been shared, and then also shared across other like clinics in our area. We have a group of providers that from this have been very engaged and want to do more and be leaders. You met Dr. Josh Romney and Dr. Danes.

Marc Harrison, MD: Oh my gosh. Those guys, I wish I could bottle their energy. They're incredible.

Devin Reid: But it becomes contagious and other providers across different departments even at Memorial are doing the same things. Dr. Hansen in mole surgery, him and his practice are very engaged.

Marc Harrison, MD: His team, I wouldn't want to get between them and anything they wanted to get done. They're going to go right through you to get it done. They're very, very passionate about what they do.

Devin Reid: And then I think one of the key successes we have as leaders is we try to recognize caregivers and providers as they have ideas. So we don't want them to feel like their ideas are bad or anything. We want them to share their ideas, and then as ideas are implemented and they are successful, we recognize them and we recognize them. In this case, the MA with the ukulele, we recognized her. It was her idea. So we want her to get the credit for it and be noticed for it.

Marc Harrison, MD: So before we wrap up, Brandy, Devin, any questions for me?

Devin Reid: In the mindset of continuous improvement and engagement, clearly you spent time at Memorial, but I'm curious, some of the other maybe facilities that you've rounded on and you've spent time with, what are some of the other strategies that maybe teams are using to win when it comes to continuous improvement or engagement?

Marc Harrison, MD: So first of all, you guys do a great job with your huddle boards and I know you are sort of idea monsters at Memorial, but taken as a whole, last year I think we implemented almost 50,000 ideas across the system, more than one per caregiver. And so the ideas are as varied as the places where people work, so an idea in supply chain may be different from an idea in finance, may be different from an idea in an operating room.

I think the commonality is really that there are good ideas all around us and the winning strategies are actually already resident in the heads and hearts of the people who are working with us. And it's a matter of making it safe and fun for them to share those ideas and then as leaders to clear the way for them so those ideas can get implemented. One of my hopes for this coming year is that we will do better and better at actually propagating some of those ideas all the way across the enterprise, because why reinvent the wheel at 150 different clinics, right?

Devin Reid: I agree. I think this past year just ... I mean, Dave Hendrickson being our operations leader in north Salt Lake and being over in trauma medicine, we've seen that. He shared it across other Intermountain clinics.

Marc Harrison, MD: He's done actually an extremely good job of that. And I think it'd be remiss if we finish this podcast before mentioning how thrilled I am that you're implementing re-imagined primary care at Memorial. I think that really appears to be the key to the future for providing great primary care. And as you probably already know, the early results are pretty astounding. So a 60 percent decrease in hospital admissions, roughly a 30 percent decrease in emergency department visits, about a 10 to 20 percent decrease in per member per month cost, but better than all of that is improved safety, improved access, and improved satisfaction. And the providers seem to love it, too. So thank you for being leaders on that front. I think you're really paving the way for the rest of the system.

Devin Reid: Thank you.

Marc Harrison, MD: Yeah. So thanks.