Since joining Intermountain Healthcare as CEO in October 2016, A. Marc Harrison, MD, has rolled out a daily, systemwide routine that has led to improvements in patient safety, patient access and gains in employee satisfaction. This has allowed the system to function more as a team and enterprise versus a collection of 22 hospitals.
Prior to joining Intermountain, Dr. Harrison served in leadership positions at Cleveland Clinic, including Chief of International Business Development and CEO of Cleveland Clinic Abu Dhabi.
Here, Dr. Harrison discusses an idea he implemented across Intermountain Healthcare that has been wildly successful at reducing patient safety concerns and giving employees a voice.
He invites you to steal his idea.
"We don’t believe there is any secret sauce in healthcare. It is all in how you execute, your intent and your commitment to mission. We welcome people who want to learn from what we are doing — I would love to share all the specifics of what we do."
Note: The following responses were lightly edited for length and clarity.
Question: What is one pioneering idea you've implemented at your health system?
Dr. Marc Harrison: One idea I implemented across Intermountain Healthcare is daily tiered escalation huddles, which last a maximum of 15 minutes, as a part of our continuous improvement initiative.
At 7 a.m. every day, the front lines at each Intermountain facility have a huddle to discuss concerns or problems. At 10 a.m., the executive team has a tier six huddle, which means there have been five huddles from the front lines on every unit in the system up through local management, regional leadership to us on the executive team. The tier six team huddle has 14 mandatory attendees from the executive team, two optional attendees and nine reporters.
At 10 a.m. each day, I found out about serious safety events, hospital acquired infections, downtime on major equipment of IT systems, caregiver injuries, power outages, capacity constraints and pharmacy shortages. By 10:15 a.m., the executive team has a snapshot of the entire system. We are able to understand what is happening thematically across the system to put appropriate emphasis on the things we care about. We are able to provide focus, stop adverse events from happening and give our employees a voice. It is a total team effort and the power comes from the front lines.
Q: How have tiered escalation huddles impacted your organization?
MH: We’ve been doing this since April 2017, and the results are stunning in terms of a reduction in safety events and patient access. In particular, 13 safety alerts were sent out systemwide as a result of the huddle process. In addition, prolonged imaging downtime reported during the daily huddles resulted in a policy change for various imaging manufacturers to ensure the parts are delivered to our health system in a shorter period of time. Patient access for Intermountain's clinics, with appointment availability weekdays from 8 a.m. to 5 p.m., improved from 53 percent to 86 percent as a result of implementing this systemwide routine.
Not only have we seen improvements in safety, quality and access measurements, but these huddles also reinforced to the front lines that their voice counts. Since executing these huddles, more than 1,000 ideas from the front lines have been implemented.
These ideas come from all over the system, including our nurses, physicians, environmental service workers and finance representatives. These huddles aren't made to fix and guide but rather build awareness and provide focus for the health system, and I think that's new.
Q: What is an example of an idea implemented thanks to these tiered escalation huddles?
MH: One of the improvements I like best is how we changed to manage capacity. If one hospital gets jammed up from excess ER visits or extra trauma cases, the hospital can go on diversion and you may not be able to serve patients promptly. By using a team approach to raise concerns through tiers of management, we can place patients with the right condition in the right place, in the right time.
Since implementing these huddles, we think less about hospitals and regions and instead as an enterprise and team. We don’t want patients to receive discontinuous care, so implementing a change like this has led to improvements in patient care since we can direct them to the proper facilities in a timely manner.
Q: What inspired this idea?
MH: Actually, this practice is used in the nuclear power industry. Systems of nuclear power plants have safety huddles on a daily basis with management and, because of it, they run an incredibly safe industry. I figured there was something to learn in healthcare from how a whole group of nuclear power plants could be reviewed in 15 minutes on a daily basis to ensure safety. I was also inspired when I organized a similar huddle every day at a hospital I started at Cleveland Clinic Abu Dhabi. The huddle had dramatic impacts on safety and quality at the hospital. Since then, I've always wanted to do this across a whole system.
Q: What were some of the challenges while implementing this strategy?
MH: A big challenge when I arrived here was that continuous improvement wasn’t evenly spread across the health system. People opted in and opted out. I had to make it very clear that this was a standard we would abide by. We would all play by the same metrics and initiatives. It was a bit challenging for some folks, but once they realized the huddles were not to be used punitively — but rather only in a positive way — people got on board really quickly. I also have to acknowledge our COO Rob Allen, who has done a great job providing the necessary discipline to execute these huddles.