1 00:00:05,155 --> 00:00:07,205 - This is the Becker's Healthcare Podcast, created 2 00:00:07,205 --> 00:00:08,365 by the team of Becker's Healthcare, 3 00:00:08,485 --> 00:00:10,245 a multimedia company devoted to the people 4 00:00:10,265 --> 00:00:11,565 who power us healthcare. 5 00:00:11,835 --> 00:00:14,645 Four new 15 minute episodes are released daily containing 6 00:00:14,845 --> 00:00:17,205 industry news analysis and thought leadership from powerful 7 00:00:17,205 --> 00:00:19,485 healthcare decision makers Support our show 8 00:00:19,625 --> 00:00:22,445 by leaving it a five star rating and review on Apple Podcast 9 00:00:22,665 --> 00:00:23,925 or other platforms you use. 10 00:00:24,075 --> 00:00:25,925 It's a chance to tell us what you like about the show 11 00:00:25,945 --> 00:00:27,165 and act on your feedback. 12 00:00:27,165 --> 00:00:29,125 Thanks for listening. Now here's the episode. 13 00:00:30,635 --> 00:00:33,005 - This is Laura Dedo with the Becker's Healthcare Podcast. 14 00:00:33,545 --> 00:00:34,845 I'm thrilled today to be joined by Dr. 15 00:00:34,845 --> 00:00:36,485 Heidi Wald, chief Quality 16 00:00:36,545 --> 00:00:38,525 and Safety Officer at Intermountain Health. 17 00:00:38,865 --> 00:00:41,045 Dr. Wal, it's a pleasure to have you on the podcast today. 18 00:00:41,915 --> 00:00:43,585 - Great. Good morning. Nice to be here. 19 00:00:44,335 --> 00:00:46,115 - Now I'm really looking forward to our discussion. 20 00:00:46,115 --> 00:00:48,435 We'll be talking a lot about quality improvement, 21 00:00:48,435 --> 00:00:50,835 especially thinking about the OR and ICU. 22 00:00:50,895 --> 00:00:52,595 But before we dive into that discussion, 23 00:00:52,895 --> 00:00:53,875 can you tell us a little bit more 24 00:00:53,875 --> 00:00:55,115 about yourself and your background? 25 00:00:56,455 --> 00:00:59,465 - Sure. I am an internal medicine doc. 26 00:00:59,645 --> 00:01:04,025 Um, I am, uh, I have a subspecialty in geriatric medicine 27 00:01:04,405 --> 00:01:06,785 and a background in health services research 28 00:01:07,005 --> 00:01:08,465 and also health policy. 29 00:01:09,665 --> 00:01:14,625 I, uh, spent much of my career in academics until about, uh, 30 00:01:14,625 --> 00:01:15,745 five and a half years ago. 31 00:01:16,645 --> 00:01:20,545 Um, and that academic career was always actually focused on 32 00:01:20,545 --> 00:01:23,185 quality and safety as my area of interest. 33 00:01:24,125 --> 00:01:28,265 Uh, I helped run, uh, co-lead for my clinical work, um, 34 00:01:28,565 --> 00:01:31,105 and acute care for the elderly inpatient service, 35 00:01:31,555 --> 00:01:33,705 where a lot of what we did was focus on 36 00:01:34,555 --> 00:01:38,025 mitigating the risks associated with hospitalization 37 00:01:38,025 --> 00:01:40,225 and illness in the frail elderly. 38 00:01:40,725 --> 00:01:42,865 And that just was a, obviously a natural, 39 00:01:42,965 --> 00:01:46,265 my clinical work was a natural connection to patient safety 40 00:01:46,325 --> 00:01:47,785 and quality, um, 41 00:01:47,845 --> 00:01:51,505 and started to really move, um, through, uh, 42 00:01:51,835 --> 00:01:55,345 pilot projects into implementation, science types 43 00:01:55,485 --> 00:01:59,825 of research, and then ultimately also into leadership roles 44 00:02:00,045 --> 00:02:03,785 in the Department of Medicine where I was at, um, university 45 00:02:03,785 --> 00:02:07,025 of Colorado about five years ago, uh, 46 00:02:07,025 --> 00:02:08,385 five or five, six years ago. 47 00:02:08,585 --> 00:02:10,225 I left there 48 00:02:10,685 --> 00:02:12,345 and, uh, took a role, 49 00:02:12,355 --> 00:02:14,785 which ultimately ended up being a chief quality 50 00:02:14,785 --> 00:02:16,865 and safety officer role at SEL Health. 51 00:02:17,355 --> 00:02:20,025 About a year and a half ago, SEL Health merged 52 00:02:20,135 --> 00:02:21,145 with Intermountain, 53 00:02:21,765 --> 00:02:26,585 and I was honored to take on the lead role, uh, same title, 54 00:02:26,885 --> 00:02:29,185 uh, with the much larger organization. 55 00:02:31,145 --> 00:02:32,245 - That's amazing to hear. 56 00:02:32,265 --> 00:02:34,645 And what a great career journey I could imagine, you know, 57 00:02:34,645 --> 00:02:37,805 especially going from, as you were talking about, um, 58 00:02:37,805 --> 00:02:39,205 just really some of the projects 59 00:02:39,225 --> 00:02:40,925 and initiatives you were doing with the, 60 00:02:41,265 --> 00:02:42,565 the elderly population 61 00:02:42,565 --> 00:02:44,045 and then into, you know, working 62 00:02:44,045 --> 00:02:45,605 with SDL Health and now Intermountain. 63 00:02:45,905 --> 00:02:48,765 How has that transition been since merging in 64 00:02:48,765 --> 00:02:50,725 with Intermountain and really, um, 65 00:02:50,785 --> 00:02:53,365 now having accountabilities over a, a very broad, 66 00:02:53,465 --> 00:02:54,925 uh, health system? 67 00:02:56,265 --> 00:02:58,515 - Yeah, well, it, it certainly has been a journey. 68 00:02:58,565 --> 00:03:03,005 First was the journey from academics, um, into, you know, 69 00:03:03,005 --> 00:03:04,685 more operations, um, 70 00:03:04,945 --> 00:03:08,285 and then the journey from a, you know, 71 00:03:08,395 --> 00:03:12,885 smaller health system, um, to a much larger organization. 72 00:03:13,265 --> 00:03:16,925 Uh, so the, you know, what was interesting about 73 00:03:17,705 --> 00:03:20,965 the kind of alignment with SEL Health 74 00:03:21,585 --> 00:03:24,405 as it integrated inter into Intermountain is in 75 00:03:24,405 --> 00:03:25,565 the quality space. 76 00:03:26,185 --> 00:03:30,485 We had been on, uh, similar journeys over the past five 77 00:03:30,485 --> 00:03:32,365 or six years, I would say. 78 00:03:32,365 --> 00:03:36,405 We were taking different approaches, uh, to those journeys. 79 00:03:36,505 --> 00:03:38,645 And so a lot of the work of integration 80 00:03:39,345 --> 00:03:41,925 has been figuring out how to merge the 81 00:03:42,585 --> 00:03:43,885 way we approach things. 82 00:03:43,945 --> 00:03:45,925 And that's, you know, that's not easy work, 83 00:03:46,585 --> 00:03:49,375 and we feel that, you know, we need 84 00:03:49,375 --> 00:03:50,615 to have a one Intermountain approach. 85 00:03:50,955 --> 00:03:53,535 It, it's more efficient, more effective, more able 86 00:03:53,535 --> 00:03:55,415 to move the needle quickly, 87 00:03:56,195 --> 00:03:59,415 and when we need to adjust to improve quality, uh, 88 00:03:59,915 --> 00:04:02,495 and, um, improve safety for our patients. 89 00:04:03,865 --> 00:04:05,875 - Well, that's great to hear. And can you tell us a little 90 00:04:05,875 --> 00:04:07,715 bit about your quality improvement programs? 91 00:04:07,735 --> 00:04:09,275 How are you optimizing patient care? 92 00:04:10,495 --> 00:04:13,165 - Right, so that is a short question, 93 00:04:13,385 --> 00:04:16,285 and there's really not a short answer to it, . 94 00:04:16,705 --> 00:04:19,805 So I'd say, you know, we're, it's a pleasure 95 00:04:20,025 --> 00:04:23,645 to be in an organization that so 96 00:04:24,155 --> 00:04:27,925 prioritizes quality, safety, actually safety, uh, 97 00:04:27,945 --> 00:04:30,205 if we think about our fundamentals of care 98 00:04:30,205 --> 00:04:33,805 that we focus on at Intermountain, safety, quality, 99 00:04:34,035 --> 00:04:37,725 patient experience and equity, and from, you know, uh, 100 00:04:37,745 --> 00:04:39,645 and then there are four additional ones, 101 00:04:39,645 --> 00:04:41,205 but the ones in the space 102 00:04:41,205 --> 00:04:43,365 that I focus on are the first four. 103 00:04:43,785 --> 00:04:47,965 Um, and so it's such a, you know, a pleasure, um, to know 104 00:04:48,795 --> 00:04:50,725 that our leadership 105 00:04:51,685 --> 00:04:55,565 and our, all of our caregivers really prioritize safety 106 00:04:55,865 --> 00:04:58,125 and quality and patient experience above all else. 107 00:04:58,665 --> 00:05:02,285 Um, uh, not that there aren't other important priorities, 108 00:05:02,285 --> 00:05:05,085 and I'll, I'll, I'll loop in their caregiver experience 109 00:05:05,265 --> 00:05:08,365 as well, caregiver and a physician and APP experience. 110 00:05:08,865 --> 00:05:12,365 But the, um, I, as I was thinking about how to answer 111 00:05:12,365 --> 00:05:16,045 that question, I think there are maybe three, um, 112 00:05:16,455 --> 00:05:18,045 major points that I wanna make. 113 00:05:19,065 --> 00:05:22,425 One is, how do we make big changes 114 00:05:23,085 --> 00:05:26,465 and alignment as to, to make sure we're aligned 115 00:05:26,465 --> 00:05:28,185 with evidence-based practice, especially 116 00:05:28,185 --> 00:05:30,545 as evidence-based practice evolves over time. 117 00:05:31,165 --> 00:05:33,065 Um, so that's kind of a macro view. 118 00:05:33,165 --> 00:05:36,425 How do you make sure that, you know, you are 119 00:05:37,175 --> 00:05:41,505 executing on the best evidence, um, in a way 120 00:05:41,505 --> 00:05:43,545 that's consistent across the whole organization. 121 00:05:43,925 --> 00:05:46,785 And that's really what Intermountain is known for. 122 00:05:46,925 --> 00:05:50,425 That's what, um, Brent James kind of put us on the map for, 123 00:05:50,885 --> 00:05:54,945 um, in terms of, you know, establishing 124 00:05:55,585 --> 00:05:59,565 clinical leadership that identifies best practice, 125 00:06:00,675 --> 00:06:02,315 identifying how to measure that, right? 126 00:06:02,375 --> 00:06:06,675 And then looking to make sure that we are doing 127 00:06:06,675 --> 00:06:08,315 what we say we're gonna do in terms 128 00:06:08,315 --> 00:06:10,875 of meeting those process measures and outcomes 129 00:06:11,415 --> 00:06:12,835 and making sure that we're structured, 130 00:06:13,015 --> 00:06:14,075 uh, to do that the right way. 131 00:06:14,455 --> 00:06:19,155 So that's the, the macro. Um, and we still do that. 132 00:06:19,175 --> 00:06:21,315 The way we do that has evolved over time. 133 00:06:21,935 --> 00:06:26,435 Um, but the, and I could take, you know, an hour 134 00:06:26,735 --> 00:06:28,475 and describe work of many colleagues. 135 00:06:28,655 --> 00:06:30,395 Um, uh, but I'll, I'll stop there, 136 00:06:30,415 --> 00:06:32,915 but kind of macro, how do we, um, stay aligned 137 00:06:32,935 --> 00:06:36,075 as a big organization and move, uh, the needle? 138 00:06:36,455 --> 00:06:40,555 The other is, I would say micro Intermountain also is known 139 00:06:40,615 --> 00:06:42,995 for being really a strong operating model 140 00:06:43,255 --> 00:06:46,595 and baked into the Intermountain operating model is, 141 00:06:46,695 --> 00:06:48,755 are the concepts of high reliability, right? 142 00:06:48,935 --> 00:06:52,035 How is it that we get the goals of what we're trying 143 00:06:52,035 --> 00:06:53,835 to do all the way down to the frontline? 144 00:06:54,335 --> 00:06:57,315 Um, how do we have situ situational awareness across the 145 00:06:57,315 --> 00:06:59,035 organization on a day-to-day basis? 146 00:06:59,935 --> 00:07:02,795 And then how do we improve, right? 147 00:07:02,895 --> 00:07:04,155 How do we, if, 148 00:07:04,175 --> 00:07:06,035 if the people at the frontline know the goals, 149 00:07:06,105 --> 00:07:08,515 they also have to know how those goals relate to them 150 00:07:09,135 --> 00:07:11,195 and know, you know, how we're trying 151 00:07:11,195 --> 00:07:14,315 to move the needle in their particular area of practice. 152 00:07:15,095 --> 00:07:17,075 So, um, and that's the micro, right? 153 00:07:17,075 --> 00:07:20,235 There's day-to-day improvement work that just has to happen, 154 00:07:21,015 --> 00:07:23,875 um, that, um, comes up in daily work. 155 00:07:24,655 --> 00:07:28,475 And then finally, so a macro approach, a micro approach, 156 00:07:28,655 --> 00:07:33,395 and then I would say a, um, a commitment to build capacity 157 00:07:33,975 --> 00:07:37,675 so that, um, wherever you are in the organization, 158 00:07:38,015 --> 00:07:42,835 you have some skills, uh, to identify, you know, 159 00:07:42,985 --> 00:07:44,155 when there's an opportunity 160 00:07:45,255 --> 00:07:48,875 and how, what is the best way to approach it. 161 00:07:49,015 --> 00:07:52,315 And either, you know, doing a small project in the space 162 00:07:52,315 --> 00:07:57,205 where you work or kicking it up to, you know, uh, you know, 163 00:07:57,285 --> 00:08:00,165 a system level where we need to make a systematic change. 164 00:08:00,385 --> 00:08:02,845 So I guess I'd say three main strategies. 165 00:08:03,465 --> 00:08:05,725 Um, and there are, 166 00:08:06,105 --> 00:08:09,925 and I would be remiss if I didn't add in, um, 167 00:08:10,405 --> 00:08:12,685 learning from all of our data. 168 00:08:12,855 --> 00:08:14,645 We're just so awash in data 169 00:08:15,105 --> 00:08:18,125 and we don't always use it to our best, 170 00:08:18,465 --> 00:08:20,045 um, to the best effect. 171 00:08:20,265 --> 00:08:24,245 And so we get data from, uh, event reporting, right? 172 00:08:24,305 --> 00:08:25,845 We get data from complaints 173 00:08:25,965 --> 00:08:28,765 and grievances, patient feedback, um, 174 00:08:28,985 --> 00:08:33,405 and figuring out ways to use all of the rich data 175 00:08:33,405 --> 00:08:36,085 that we have to, um, 176 00:08:36,755 --> 00:08:38,525 gain insights and act on them. 177 00:08:39,645 --> 00:08:41,705 - That's amazing to hear. And certainly, you know, 178 00:08:41,935 --> 00:08:44,825 it's been impressive to see how the data 179 00:08:44,965 --> 00:08:48,265 and technology can really weave into the clinical care. 180 00:08:48,445 --> 00:08:51,225 And as you mentioned, um, having a strong culture 181 00:08:51,685 --> 00:08:53,865 and approach to doing that, um, 182 00:08:53,865 --> 00:08:55,105 certainly makes a difference. 183 00:08:55,665 --> 00:08:57,885 I'm wondering from your perspective, what are the strategies 184 00:08:57,885 --> 00:08:59,605 that have been most successful in particular 185 00:08:59,875 --> 00:09:02,685 with improving patient care in the OR and ICU? 186 00:09:04,175 --> 00:09:08,545 - Yeah, so I would say, um, the, uh, 187 00:09:08,785 --> 00:09:09,785 ICU, uh, 188 00:09:09,885 --> 00:09:13,225 and we've, we've seen some really impressive work out of our 189 00:09:13,785 --> 00:09:14,865 critical care units. 190 00:09:16,085 --> 00:09:18,205 The one is, 191 00:09:18,225 --> 00:09:21,485 the ICU work is incredibly multidisciplinary , right? 192 00:09:21,675 --> 00:09:24,245 It's, um, about a team coming together, right? 193 00:09:24,625 --> 00:09:28,405 So, um, two, it's about bundles 194 00:09:28,465 --> 00:09:30,285 of evidence-based practices, right? 195 00:09:30,315 --> 00:09:33,885 What, what do we need to be doing reliably for each patient? 196 00:09:35,025 --> 00:09:39,875 And the third thing I, as I was thinking about this, 197 00:09:39,935 --> 00:09:43,035 is really how do we use data in our workflow? 198 00:09:43,495 --> 00:09:48,195 So a really strong example has been, um, the spread of the 199 00:09:48,795 --> 00:09:51,555 practice of low tidal volume ventilation 200 00:09:52,335 --> 00:09:53,875 in our intubated patients. 201 00:09:54,015 --> 00:09:57,555 And we've, um, with some, um, great clinical leadership 202 00:09:58,745 --> 00:10:00,915 have really, you know, 203 00:10:01,355 --> 00:10:05,275 provided data in the workflow of the team members, right? 204 00:10:05,335 --> 00:10:07,755 And, and that involves respiratory, involves nursing 205 00:10:07,935 --> 00:10:11,995 and involves the critical care doc, um, et cetera. 206 00:10:12,295 --> 00:10:14,915 You know, how do we use that data, bring it to the bedside 207 00:10:15,295 --> 00:10:18,635 so that they, um, can execute on a protocol. 208 00:10:19,895 --> 00:10:23,835 Um, another example we're, um, we're having, you know, 209 00:10:23,835 --> 00:10:28,435 some great successes, the awake and walking ICU concepts. 210 00:10:28,615 --> 00:10:32,955 Um, one of our hospitals, uh, LDS hospital really, um, 211 00:10:33,095 --> 00:10:34,795 was a pioneer in this space 212 00:10:35,145 --> 00:10:37,075 that is incredibly complex, right? 213 00:10:37,295 --> 00:10:39,755 The, you need physical therapy, you need nursing, 214 00:10:39,815 --> 00:10:44,315 you need respiratory therapy, um, to, uh, get up, you know, 215 00:10:44,315 --> 00:10:48,075 get a patient out of bed, um, uh, lift, lift their sedation, 216 00:10:48,075 --> 00:10:52,515 get them out of bed, um, and allow them to be upright, um, 217 00:10:52,935 --> 00:10:55,635 and, um, sometimes even take a shower, right? 218 00:10:55,915 --> 00:10:58,955 . So, but to do that, right, again, 219 00:10:59,255 --> 00:11:01,755 multidisciplinary, um, really 220 00:11:01,825 --> 00:11:04,235 what are the evidence-based practices we need 221 00:11:04,375 --> 00:11:05,555 to bring to bear? 222 00:11:05,855 --> 00:11:10,645 And then how do we support that with the right data, um, 223 00:11:10,705 --> 00:11:12,125 to, to help with improvement. 224 00:11:12,465 --> 00:11:15,565 And I'd say final area is really making sure 225 00:11:15,635 --> 00:11:19,045 that we're leveraging, um, end of life care, um, 226 00:11:19,045 --> 00:11:22,965 appropriately in, in patients who are dying, um, 227 00:11:23,305 --> 00:11:28,085 and that we are, um, valuing, you know, providing them 228 00:11:28,395 --> 00:11:31,485 with, you know, the most effective medical care while 229 00:11:31,485 --> 00:11:33,885 they're dying, and that may involve palliative care 230 00:11:34,145 --> 00:11:36,125 and may involve referral to hospice. 231 00:11:36,305 --> 00:11:39,925 So another space in which we are spending a lot 232 00:11:39,925 --> 00:11:43,165 of time thinking about how to improve those connections. 233 00:11:44,165 --> 00:11:48,505 Um, in the, or I would say it's really about, 234 00:11:49,675 --> 00:11:51,175 um, culture there. 235 00:11:51,415 --> 00:11:55,005 A lot of our work in ORs is about culture of safety, right? 236 00:11:55,545 --> 00:11:59,285 How do we make sure that the timeout is effective, 237 00:11:59,385 --> 00:12:02,165 the briefs and debriefs that, um, 238 00:12:02,625 --> 00:12:04,285 the protocols are, are followed. 239 00:12:04,385 --> 00:12:08,205 And if, if they are not followed, then anybody in the 240 00:12:08,505 --> 00:12:12,445 or, um, is able to stop the line, right? 241 00:12:12,785 --> 00:12:15,725 Um, and speak up. And that is hard work, right? 242 00:12:15,745 --> 00:12:17,405 You have to talk about safety, 243 00:12:17,465 --> 00:12:20,445 safety culture every si single day, day in 244 00:12:20,445 --> 00:12:25,325 and day out, um, to really, uh, make sure that 245 00:12:25,325 --> 00:12:28,645 that is, that, that folks have that mindfulness that, 246 00:12:28,785 --> 00:12:32,165 you know, emerges out of a high reliability organization. 247 00:12:33,785 --> 00:12:35,705 - I love that. And I think, as you mentioned, it seems 248 00:12:35,765 --> 00:12:39,385 so critical to be able to have, um, that culture in place 249 00:12:39,565 --> 00:12:41,625 and, you know, making that change or, 250 00:12:41,625 --> 00:12:44,225 or really getting into a space where, um, you know, 251 00:12:44,225 --> 00:12:45,945 that all the, um, providers 252 00:12:45,945 --> 00:12:47,425 and everybody that you're working with really 253 00:12:47,565 --> 00:12:49,145 has, um, that in mind. 254 00:12:49,265 --> 00:12:50,625 I can imagine, as you said, it's, 255 00:12:50,625 --> 00:12:51,905 it's easier said than done. 256 00:12:52,365 --> 00:12:54,745 Um, when you look at having that culture, 257 00:12:54,745 --> 00:12:57,065 you've talked a couple of different times about having 258 00:12:57,065 --> 00:12:59,945 that information, um, flow down into the front lines and, 259 00:12:59,945 --> 00:13:03,625 and really, um, having trust that things are, are, um, 260 00:13:03,645 --> 00:13:04,825 the way they're supposed to be. 261 00:13:05,565 --> 00:13:07,265 How do you really build that? 262 00:13:07,405 --> 00:13:10,385 Um, especially after bringing together two organizations, 263 00:13:10,725 --> 00:13:12,225 and for some, you know, 264 00:13:12,225 --> 00:13:13,825 there's gonna be some significant changes. 265 00:13:14,325 --> 00:13:16,545 Um, what does that look like when you're just starting off 266 00:13:16,545 --> 00:13:19,785 and then, um, as you mentioned, a continuous reminders 267 00:13:19,785 --> 00:13:21,665 or continuously, um, making sure 268 00:13:21,665 --> 00:13:22,745 that that culture is in place? 269 00:13:24,005 --> 00:13:26,335 - Well, we're right in the middle of it right now, , 270 00:13:26,335 --> 00:13:28,535 so it's a timely question, right? 271 00:13:28,955 --> 00:13:31,935 The, the, when you think about a merger, 272 00:13:32,275 --> 00:13:35,255 and I don't know if, uh, your listeners, you know, have, 273 00:13:35,255 --> 00:13:37,375 if they're in healthcare, there's chances are they, 274 00:13:37,475 --> 00:13:39,295 you know, they might have been involved in a merger, 275 00:13:39,475 --> 00:13:42,375 but, you know, there's the, uh, the official, you know, kind 276 00:13:42,375 --> 00:13:46,695 of merger period is a, a lot about the back. 277 00:13:46,695 --> 00:13:49,855 Well, I, I don't say this in a judgy way, , 278 00:13:49,855 --> 00:13:51,575 but the back office functions, right? 279 00:13:51,845 --> 00:13:55,815 Getting HR aligned, getting finance aligned, um, getting, 280 00:13:56,715 --> 00:13:58,055 you know, those, um, 281 00:13:58,055 --> 00:14:00,335 getting legal aligned and compliance, right? 282 00:14:01,115 --> 00:14:05,495 The, um, actual, it takes a while for 283 00:14:05,525 --> 00:14:08,295 that alignment to come to the clinical space, 284 00:14:08,515 --> 00:14:10,575 and you have to be really committed to it 285 00:14:10,575 --> 00:14:12,215 because it is hard. 286 00:14:12,795 --> 00:14:15,695 Um, so we are in the middle right now of 287 00:14:16,215 --> 00:14:18,495 aligning our safety culture programs, right? 288 00:14:18,595 --> 00:14:23,135 We are in the middle right now of aligning our surgical kind 289 00:14:23,215 --> 00:14:24,815 of periop services leadership. 290 00:14:25,395 --> 00:14:29,375 And so I would say even 18 months in, 291 00:14:29,425 --> 00:14:30,855 we're not finished yet, right? 292 00:14:31,115 --> 00:14:35,335 And so we're, um, working on that diligently right now. 293 00:14:35,355 --> 00:14:39,535 And I think the, the, the reason that we're not done yet is 294 00:14:39,535 --> 00:14:42,055 because we're really committed to doing it, right? 295 00:14:42,215 --> 00:14:45,535 I think there's a lot of mergers where, um, 296 00:14:46,165 --> 00:14:50,335 there's maybe not a commitment to really pushing, um, 297 00:14:50,605 --> 00:14:52,635 that alignment to the same degree, 298 00:14:52,695 --> 00:14:54,995 but we really are committed to one Intermountain. 299 00:14:55,535 --> 00:15:00,195 Um, and so I guess we are for the most part, um, 300 00:15:00,575 --> 00:15:04,235 at the frontline clinical, we're still not operating 301 00:15:05,435 --> 00:15:09,665 entirely the same, but that is our goal, um, going forward. 302 00:15:10,125 --> 00:15:12,545 So anyway, I don't know if that answered your question, 303 00:15:12,595 --> 00:15:15,225 Laura , um, but I hope that's helpful. 304 00:15:16,175 --> 00:15:18,225 - Yeah, absolutely. Extremely helpful. 305 00:15:18,765 --> 00:15:20,985 Um, and definitely great insights to have. 306 00:15:21,245 --> 00:15:22,985 Before we wrap up here, I'm wondering, 307 00:15:22,985 --> 00:15:25,105 what is your experience implementing enhanced surgical 308 00:15:25,545 --> 00:15:27,345 recovery programs and what are the 309 00:15:28,935 --> 00:15:29,935 - Results? 310 00:15:29,935 --> 00:15:33,705 Yes. So the experience I'm gonna tell you about is the 311 00:15:33,715 --> 00:15:37,465 experience, um, from our peaks region, which is Colorado 312 00:15:37,565 --> 00:15:39,985 and, uh, eight hospitals in Colorado 313 00:15:40,045 --> 00:15:43,705 and Montana, um, from the legacy SEL Health organization. 314 00:15:44,405 --> 00:15:49,265 Um, and we really, um, started a, um, diving 315 00:15:49,815 --> 00:15:52,425 into the enhanced surgical recovery programs, 316 00:15:52,485 --> 00:15:56,505 and we refer to it as, um, E-E-R-A-S in our organization, 317 00:15:56,805 --> 00:15:59,545 um, enhanced, uh, enhanced recovery 318 00:15:59,545 --> 00:16:02,305 after surgery, um, for, um, 319 00:16:02,335 --> 00:16:06,105 because our anesthesia providers were asking for it. 320 00:16:06,245 --> 00:16:10,665 Um, and so we have been in this work, um, for, 321 00:16:10,925 --> 00:16:12,345 uh, multiple years now. 322 00:16:12,925 --> 00:16:16,345 Um, we have, um, uh, 323 00:16:16,405 --> 00:16:20,345 so we had great physician champions, um, to lead out, 324 00:16:20,845 --> 00:16:24,425 and we, um, we looked at all the protocols, 325 00:16:24,805 --> 00:16:28,265 and I think we might have done something a little bit unique 326 00:16:28,885 --> 00:16:31,945 in that, um, we did start with one 327 00:16:31,945 --> 00:16:33,665 or two types of surgeries. 328 00:16:33,685 --> 00:16:35,825 So let's say we started with colorectal, 329 00:16:36,955 --> 00:16:40,215 but what we started to do is really think 330 00:16:40,805 --> 00:16:45,095 what are the key principles that apply across surgeries? 331 00:16:45,955 --> 00:16:50,495 Um, and I would say things like early mobility, um, uh, 332 00:16:51,745 --> 00:16:53,285 the approach to pain control, right? 333 00:16:53,335 --> 00:16:55,725 Minimizing narcotics when possible, 334 00:16:55,825 --> 00:16:58,805 the using the alternatives to opiates, um, the 335 00:16:59,675 --> 00:17:01,805 nutritional approaches, right? 336 00:17:02,105 --> 00:17:06,725 Um, minimizing the amount of, uh, NPO, um, the, the, 337 00:17:06,905 --> 00:17:10,405 um, approach to carbohydrates, et cetera, pre 338 00:17:10,405 --> 00:17:11,765 and post the surgery, right? 339 00:17:11,785 --> 00:17:13,285 So we found those principles 340 00:17:13,745 --> 00:17:16,565 and we decided that was our evidence-based bundle, 341 00:17:16,625 --> 00:17:18,805 and how could we apply them across 342 00:17:18,905 --> 00:17:21,645 as many surgeries as possible. 343 00:17:21,705 --> 00:17:26,125 And so, over several phases of the work at each of our, 344 00:17:26,505 --> 00:17:29,885 at all of our hospitals, um, we 345 00:17:31,165 --> 00:17:35,325 identified, um, how we could apply those principles, um, 346 00:17:35,475 --> 00:17:37,965 more globally, not just, um, 347 00:17:39,035 --> 00:17:40,525 procedure by procedure. 348 00:17:41,105 --> 00:17:43,125 And my understanding is that 349 00:17:43,145 --> 00:17:44,725 that's maybe a little different than 350 00:17:44,725 --> 00:17:46,085 how some places are doing it. 351 00:17:46,425 --> 00:17:50,965 So at this point, we have 90% of our surgeries, 352 00:17:51,705 --> 00:17:55,925 um, in the region are essentially using, 353 00:17:56,385 --> 00:17:58,045 uh, eras protocols. 354 00:17:58,385 --> 00:18:02,005 The 10% that aren't, are usually urgent or emergent 355 00:18:02,005 --> 00:18:04,885 and are not appropriate, um, for, you know, uh, 356 00:18:04,885 --> 00:18:05,925 some of that management. 357 00:18:06,665 --> 00:18:10,045 Um, in phase one where we were doing just a subset 358 00:18:10,305 --> 00:18:13,085 of surgeries, um, we, um, 359 00:18:13,495 --> 00:18:18,245 noted an 18% shorter risk adjusted length of stay if, um, 360 00:18:18,625 --> 00:18:23,605 the procedure had met the process pass rate, all, all, 361 00:18:23,705 --> 00:18:28,045 you know, kind of five, uh, elements of the bundle were met 362 00:18:28,785 --> 00:18:29,965 in phase two. 363 00:18:30,825 --> 00:18:35,325 Um, another, um, kind of outcome that we had was a, a 16%, 364 00:18:36,105 --> 00:18:39,805 um, morphine equivalent unit reduction. 365 00:18:40,425 --> 00:18:43,805 And so redu reduction in use of morphine or, or, 366 00:18:43,945 --> 00:18:45,245 or morphine equivalents, 367 00:18:45,465 --> 00:18:47,045 and that is length of stay adjusted, 368 00:18:47,385 --> 00:18:49,125 and that's across all surgeries. 369 00:18:49,745 --> 00:18:53,845 Um, and so, you know, we are, and, and, 370 00:18:53,905 --> 00:18:56,765 and again, a kind of a similar length of stay reduction 371 00:18:56,825 --> 00:18:58,845 as our first phase implementation. 372 00:18:59,145 --> 00:19:02,325 So, you know, we, you know, feel 373 00:19:02,325 --> 00:19:04,765 that we had great outcomes related to that. 374 00:19:04,835 --> 00:19:06,565 It's really just kind of baked in. 375 00:19:06,715 --> 00:19:11,005 It's our standard of care now, um, for, um, certainly 376 00:19:11,025 --> 00:19:14,165 for all, um, elective surgeries where it's appropriate 377 00:19:14,185 --> 00:19:15,405 to apply those principles. 378 00:19:15,825 --> 00:19:19,725 And so the, the, the philosophy that we took was really, um, 379 00:19:20,345 --> 00:19:23,405 that's, uh, eres is our approach to surgery. 380 00:19:24,575 --> 00:19:26,715 We are now working and to the point we, 381 00:19:26,715 --> 00:19:30,435 we made earlier about integration, we're now examining if 382 00:19:30,435 --> 00:19:34,995 that approach would be best spread across the rest 383 00:19:35,015 --> 00:19:36,115 of the organization 384 00:19:36,855 --> 00:19:40,555 and comparing, you know, lining up what work has been done, 385 00:19:41,095 --> 00:19:44,355 um, in, um, the legacy Intermountain organization. 386 00:19:44,375 --> 00:19:45,715 So, so hope that's helpful. 387 00:19:47,165 --> 00:19:48,495 - Yeah, that's so interesting to hear. 388 00:19:48,555 --> 00:19:51,175 And definitely, um, great to know that, you know, 389 00:19:51,235 --> 00:19:54,015 the process is obviously, um, takes a while, 390 00:19:54,035 --> 00:19:56,055 but certainly to get everyone on the same page, 391 00:19:56,055 --> 00:19:57,575 it seems like it makes a big difference. 392 00:19:58,615 --> 00:20:00,115 - Yep, absolutely. 393 00:20:00,415 --> 00:20:02,675 Um, and so, and, and you don't wanna change, 394 00:20:03,095 --> 00:20:05,795 you don't wanna break processes that are in place, um, 395 00:20:06,295 --> 00:20:08,035 you know, just for alignment 396 00:20:08,495 --> 00:20:12,835 and yet, you know, at some point, um, it, it, 397 00:20:13,175 --> 00:20:15,235 it is, I think something you have 398 00:20:15,235 --> 00:20:18,195 to look at if you really wanna operate in the same way, 399 00:20:18,985 --> 00:20:19,985 - Way. 400 00:20:19,985 --> 00:20:20,885 That makes sense. Dr. Wald, thank you so much 401 00:20:20,885 --> 00:20:22,325 for joining us on the podcast today. 402 00:20:22,325 --> 00:20:24,365 This has been such a fun and interesting discussion, 403 00:20:24,365 --> 00:20:26,085 and I look forward to connecting with you again soon. 404 00:20:26,675 --> 00:20:28,485 - Wonderful. So nice to chat with you. 405 00:20:30,675 --> 00:20:33,045 - It's so important for leaders at the top of organizations 406 00:20:33,045 --> 00:20:35,685 to keep learning, stay sharp, grow their networks, 407 00:20:36,075 --> 00:20:38,645 help our audience better do this in a more simplified, 408 00:20:38,645 --> 00:20:40,325 personalized, and meaningful way. 409 00:20:40,885 --> 00:20:43,365 Becker's Healthcare has launched my BHC, 410 00:20:43,835 --> 00:20:45,805 it's your trusted Becker's healthcare experience 411 00:20:45,805 --> 00:20:48,045 and more with content, connections, events, 412 00:20:48,105 --> 00:20:50,885 and learning opportunities, join the community free 413 00:20:50,885 --> 00:20:55,725 of charge@www.my dot becker's hospital review.com 414 00:20:55,825 --> 00:20:56,645 and we'll see you there.