intermountain health

Performance Improvement

Intermountain Healthcare Embraces Transformation

By Patrick T. Ryan and James Merlino, M.D.

Utah-based Intermountain Healthcare continues to transform itself to best adapt to the demands of the changing health care environment. As part of the current transformation, the health system has organized its leadership to optimize the interdependencies of safety, quality, patient experience and workforce engagement. Under this construct, the system streamlines decision making, minimizes waste and redundancy, and positions the organization to deliver exceptional patient-centered care.

“Even though we are a model health system — clinically strong, economically strong and culturally strong — we made the decision to transform the organization from the inside out to get ready for the changes the future will bring,” according to Intermountain president and CEO Marc Harrison, M.D. “We’ve reorganized our operations to be fully aligned with what is most important: helping people live the healthiest lives possible.”

Communication and transparency within and across operational units are hallmarks of the reorganization, Dr. Harrison noted. One way this is achieved is through “tiered escalation huddles.” These 15-minute huddles occur daily and begin with frontline managers and continue up through successive management levels, ending with the executive leadership team.

Organized around whiteboards that display dashboard metrics, charts, new ideas and other information, the huddles provide an opportunity for each tier to review key performance indicators, consider the resources needed to meet performance goals and discuss new ideas. The relevant performance metrics and issues are reported up through each tier based on pre-established escalation protocols.

“Every day, in 15 minutes, we hear about every major safety, quality and experience problem; every major down time; every caregiver injury, and every patient injury. We are able to actually see things across an entire enterprise that you could never see before. In just 15 minutes each day, leaders can communicate and align the organization to what is most important.”

Since implementing the escalation huddles, Intermountain has seen a major reduction in safety events as well as dramatic changes in the star ratings of its hospitals. Also, Dr. Harrison reported, “we met 90 percent of our very difficult quality goals last year.”

The value of huddles such as these extends to the board level as well. “Our board periodically attends our Tier 6 [executive] daily huddle to experience first hand how our organization escalates key information every day,” Dr. Harrison explained. Further, integrated performance dashboards provide board members with a comprehensive picture of the quality and safety issues the organization is facing, how these issues are being addressed and where the greatest opportunities exist to enhance the organization’s quality and safety action plans and outcomes.

Patrick T. Ryan is CEO and James Merlino, M.D., is chief transformation officer at Press Ganey.