When first stepping into the top executive role at Intermountain Health almost a year ago, President and CEO Rob Allen said that “a lot of folks” advised him to be careful and attentive to what he hears from employees. Many would tell their boss what he expects to hear and not what he needs to know, they cautioned.
With a six-month internal listening tour in the rear view, that advice turned out to be half true: Listening was important, but few of the health system’s clinicians and other employees were inclined to hold back.
“I don’t know if it was my long tenure with the organization,” he said in reference to his 27 years in executive leadership positions across the 33-hospital system, "but what I found was really candid discussions, and it wasn’t always the stuff I wanted to hear. … It’s what I wanted it to be, but didn’t expect, and now we’ve seen the engagement scores with our caregivers performing high [during] this time of challenge. They’re all in, and I love it.”
Allen, who closed a five-year stint as chief operating officer to take over for the departing Marc Harrison, M.D., last November, is credited by Salt Lake City-based Intermountain with leading the development and launch of novel outreach, telehealth and clinical shared service models. Following in the footsteps of his mother, a nurse and later administrator at Wyoming’s Star Valley Hospital, he’s also held CEO roles at hospitals and health systems in his home state as well as in New Jersey and Massachusetts.
When recalling the past year’s transition, Allen said that his and his team’s conversations among the organization’s 64,000 employees frequently centered on their daily workloads and working environments. Coming off the worst of the COVID-19 pandemic, issues of burnout, clinician shortages and a disconnect from hands-on care were front of mind for employees and a priority for leadership.
“As I was rounding, we were able to collect a list of things we were hearing, and got folks in the system responding to them,” he said. “We were able to adjust and make changes and fix, in just my rounding visits, 78 different system problems. That was wonderful.”
Other feedback will take longer to implement than those 78 items, Allen acknowledged.
For instance, Intermountain shared in September that it was shifting from a Cerner electronic health record system in place at several hospitals to Epic’s platform, a decision made “with input from thousands of physicians, advanced practice providers (APPs), nurses and EHR users from across the organization.”
Intermountain aims to bring the organization under a single platform by the end of 2025, which should simplify some administrative tasks and, ideally, address some of the negative EHR comments that “certainly came up in the process for us,” Allen said.
Fierce Healthcare caught up with Allen for more on leadership’s priorities during a transition, addressing burnout and labor shortages with financial sustainability, and how his system is tackling the rising costs of medical supplies and drugs.
Editor’s note: The following Q&A has been edited for length and clarity.
Fierce Healthcare: When seeking out and hearing all these concerns from inside the organization, how does new leadership decide what needs to be tackled? And what have emerged as the priorities?
Rob Allen: That is really, I think, one of the biggest challenges a CEO has: How do you prioritize the use of your time, and how do you prioritize the deployment of system resources around things that you want to accomplish?
We do have a distinct process when those requests come in regarding what to look at and what’s further down the list as far as timing. There are a number of factors with that, and of course, bandwidth is one of the biggest.
The EHR change, that’s one of the important things we’ve looked at. We’ve actually had to look at some other IT demand areas and say, 'Well, that’s going to take a little longer because we’re going to deploy resources into changing this EHR from Cerner to Epic in parts of our organization.'
The process for that prioritization really anchors to mission, safety and quality for patients, and then our focus on simplicity—you know, we think of all these caregivers and how we make their jobs more doable. We’re looking at tools to bring that out.
You know, Nuance DAX is an ambient dictation tool that’s new to the market. We trialed it with a group of doctors: 97% of them liked it and 3% did not, and that was usually the training process … but the doctors report saving up to two hours a day. That’s post-clinic time and charting—they can see their last patient and they can go home, have a life.
We think that’s a burnout factor or retention factor that will be positive over time, and so we’re trying it on the nurse front. We’ve got a pilot in one unit in one of our hospitals where we’re using our telehealth technology in every patient room, the camera, to identify what’s happening in the room, have charting done from that interface and support the nurse.
That’s just a couple of examples of where we really find an opportunity that, as we’ve talked with our staff, they really want to get back in the heart of why they got into medicine, and we’re looking to deploy tools and prioritize that, to simplify.
That issue of burnout and workload issues intersects with a macro level issue that it seems every health system is dealing with. There aren't enough healthcare workers and those who are working feel overwhelmed, which leads to a financial challenge where new hires are demanding higher wages and retention becomes costly as well.
FH: Intermountain’s financials suggest you’ve tackled that at least in part by hiring across much of 2023, but could you talk about addressing these issues in a way that’s financially sustainable?
RA: Yeah, lumping those together is logical, but it’s also logical to separate them out just a little bit. You think about the sustainability side of manpower shortages—you can tackle those by going out and hiring staff and paying higher wages. Yet, the inflationary factors that have hit healthcare are much more dramatic than the general economy—about 37% through COVID periods till now, whereas the general economy has about 25%. We’re not getting raises on the payment side sufficient to cover those, so higher-cost labor in the same labor models is only going to exacerbate that problem.
We want to pay people fairly in the market; we want to pay them appropriately for the jobs that they do. But we have to recognize in healthcare that we’ve got to change the jobs. First off, we can’t hire enough people to have 50% of our cost structure be on the people side, so the tools that we’re talking about have to come in and help us fill the gaps so that the jobs are doable.
Part of the challenge of burnout right now is we’re asking people to do more within their current jobs to fill the gaps. That can only go so long. But if we can change the dynamic so these clinicians are doing the clinical work and not so much of the administrative work, we truly can do it in a cost structure that’s sustainable, as well as while paying people market rates, by using technology to supplement and fill those gaps.
That’s the road map for us to sustainability: really use these tools to streamline the work and get caregivers back to caregiving. And in the process, the model evolves enough that that’s doable.
FH: And those projects you mentioned earlier—EHR transition, ambient dictation, etc.—they’re pushing toward that goal?
RA: Correct, absolutely.
FH: Got it. So still on the topic of financial issues, you mentioned inflation has hit hard. Can you discuss Intermountain’s thinking around tackling the high costs of medical supplies and drugs?
RA: Our supply chain is robust at Intermountain—we’ve been recognized as a master of supply chain for many years now. That’s a good thing and will continue to serve us well.
But now we’re looking for our relationship with vendors to be more than a vending relationship, but really, truly, a partnership to engage with these folks around how we enhance that whole experience. I believe that our suppliers, in the future, are going to have to help us look holistically at the journey, not just the little piece they want to sell. How do we stitch that together so that the whole view of supplies needed addresses some of that affordability we’ve got to be looking at? That’s an area we’re focusing more on as we look ahead.
And then you really have to break pharmaceutical out, and think of pharmaceutical in its own bucket. This is something that we as an industry have to address, but frankly, we as a country—how long can we afford to pay multiple times for medications what other countries pay for those medications? Our society is paying the price and it’s not sustainable. We’ve got million-dollar drugs now; how many patients can you put on that?
Medicare just approved the medication for Alzheimer’s disease, $80,000 per year per patient. That’s nice, frankly, if you’ve got Alzheimer’s or onset of Alzheimer’s. Those are important advances, but can society actually afford to pay $80,000 per person? Those are reality points we’re going to come up against really hard and fast. And that’s a societal question, frankly, as much as it is a healthcare system question.