9

GO UPSTREAM

To truly change the world, try to tackle the underlying problems that cause people to need quality products and services.
Don’t focus solely on production, delivery, and profits.

One night during the late 1990s, when I was working at a pediatric intensive care unit (ICU) in Syracuse, New York, ambulances brought in four young victims of a house fire. As the ICU physician on call, I ran down to the emergency room to help. I arrived to find an absolutely horrific scene, one that haunts me to this day. Four young girls—all sisters—lay on gurneys in the trauma room, badly burned and either dead or dying. Members of our team tended to them, doing everything possible to save them.

For the next 30 or 40 minutes, I worked frantically to save those girls. It was futile. None of them survived. An entire family of siblings—gone. As you can imagine, the parents were devastated. I’ll never forget the sound of their wailing as they learned of their daughters’ deaths, nor will I forget the distant, dazed looks in their eyes or the smell of smoke, which suffused everything in the room. I regularly encountered death and dying as a doctor, but this episode hit me especially hard. My own family was everything to me (my wife, Mary Carole, calls me “Dr. What’s Next,” but she knows that our family always comes first). I had two young kids at home, my sons Alex and Martin, and my wife was pregnant with our third, my daughter Settie. I saw myself in those parents. Their kids easily could have been mine.

In one respect, though, I knew they couldn’t have. Like many patients in this hospital, this family was low-income, while mine was privileged to be middle class. I wondered whether these four girls had fire alarms installed in their home—so many of our patients’ families didn’t. If the girls did have fire alarms, I wondered whether their parents had the $10 or $20 it might have cost to replace old batteries in those alarms so that they worked. I wondered whether these girls lived in adequate housing, with electrical wiring that was up to code. I wondered whether they could afford heat, or whether their parents were forced to use their oven to keep warm. I wondered whether their neighborhood was safe, or whether someone in the building had been abusing drugs or alcohol and perhaps had gotten careless with a lit cigarette.

Many presume that genes play the greatest role in determining whether we’ll live to a ripe old age and enjoy good health. Others think patients’ ability to access quality care is decisive. In truth, our zip codes—whether we live in an area that is relatively prosperous, stable, and environmentally safe—influence our health even more powerfully. As research shows, social and environmental factors like access to healthy food, adequate housing, education, good jobs, safety, and a supportive family coupled with our health behaviors (whether we smoke, exercise, eat well, and so on) account for up to 60 percent of our health outcomes.¹

For caregivers like myself, the health challenges faced by people low on the socioeconomic ladder are glaring. Earlier, I recounted my shock at discovering the adversity that caused one of my patients, a single mom with inadequate housing, to arrive late at our clinic. During the years that followed, I encountered many tragedies in which life circumstances—what we in healthcare call the “social determinants of health”—played an important role. There was the teenage girl who, after being shamed and punished for being gay, took a fatal overdose of aspirin. The desperately sick kid in the emergency room whose asthma owed to chronic exposure to dust mites in his house. The child who was fatally injured while playing in his parents’ restaurant, probably because they couldn’t afford good childcare.

You might wonder why we don’t do something about these horrible socioeconomic disparities. More health systems today are talking about it, but only a few have taken meaningful action. It’s not that most caregivers don’t care—of course they do. But medical schools don’t focus on teaching young doctors about social circumstances and the complex ways they affect health. They don’t train them to screen for social needs and help patients address them. More fundamentally, if you get paid to care for people once they’re already sick, as most caregivers do, you’re not going to spend much time thinking about the environmental factors that cause patients to become sick in the first place, and you won’t proactively address those factors. You’ll be less curious about patients and their complex lives, and you won’t see it as your role to make their lives less complex. You’ll do your best to fix what’s wrong and leave it at that, resigning yourself to seeing disadvantaged patients back in your emergency room again and again.

In recent years, we at Intermountain have made addressing the whole person—including social and environmental factors that influence health—one of our top organizational priorities. We appointed a senior leader—our chief community health officer Mikelle Moore— to oversee efforts in this area and adopted enterprise-level goals related to addressing social needs. We pumped hundreds of millions of dollars back into communities to make progress on social issues impacting health, engaging in an array of innovative programs and partnerships. We redesigned how our caregivers engage with patients, empowering them to address patients’ social, emotional, and economic needs in the course of treating them. We embedded an ethic of treating the whole patient into our culture, encouraging caregivers to take the initiative to redress social and economic disparities that affect health.

As we’ve discovered, leaders can push themselves to grow their core businesses in ways that benefit society. But they can also do much more. Thinking more broadly about their mission, they can “go upstream,” as we call it, addressing the root causes of social problems, including those whose downstream effects their own goods and services help to remedy. Some companies are moving in this direction, but most aren’t. Leaders often don’t see the business advantages to doing so. Somewhat perversely, they might fear that they’d ultimately be reducing demand for their goods and services if they helped to solve customers’ problems at the root.

These fears are unfounded, assuming you deploy the right business model: one that rewards you for doing good. At Intermountain, basic morality inspires us to address social and economic disparities, since we can keep patients healthier and out of our hospitals. But it’s also good for our business. Remember, under the value-based care/population health model, we get paid for keeping people well. That means anything we can do to keep people out of our clinics and hospitals allows us to cut costs, improve our financial position, and channel more value back to improving health and services for people in our communities, since they are our only shareholders. Tackling social and economic disparities is a powerful approach for keeping people well that complements others we’ve discussed, like telemedicine or digital innovation. Applied across American health systems, it could greatly improve health and reduce the burden of healthcare on society.

Imagine how much impact your company could have if you thought more broadly about your company’s mission, looking upstream instead of construing your customers’ needs more narrowly. Imagine how energized your workforce would be, knowing that they’re not just helping customers in superficial ways but fundamentally transforming their lives. You might think you can’t make headway on the deeper, systemic problems, but by applying some curiosity, an experimental mindset, a bit of elbow grease, and the right business model, you absolutely can.

GO BEYOND CHARITY WORK

Not long after becoming Intermountain’s CEO, I traveled to Chicago to attend a conference of American healthcare leaders. While waiting at the baggage claim at O’Hare airport, I happened to spot former Utah governor and secretary of health and human services Mike Leavitt, who planned to attend the conference as well. I had met Governor Leavitt before and admired his work, but I didn’t know him well. Striking up a conversation, I asked if he would like to share my car into the city.

We piled into our ride and began to chat. After getting acquainted, I took the liberty of explaining my hopes for Intermountain, and specifically, my desire to demonstrate that keeping people healthy rather than caring for them once they’re sick was a better model not just for Utah but for American healthcare. Intermountain had begun focusing on population health back in 2011, and I wanted to build on that foundation and scale it up. I put a question to the governor, who I knew was not only smart and politically astute but also had decades of experience in healthcare. If he were in my shoes, what would he do? How would he mobilize Intermountain’s resources to do the greatest social good?

Thinking for a moment, Governor Leavitt replied that he was interested in how social and economic circumstances shape both a person’s life span and health. He was chagrined at the disparities that afflict marginalized groups, not merely in inner cities but also in rural areas, and he wondered what innovative steps we might take to address them. His response led to some brainstorming that I now regard as among the most important, exciting, and meaningful of my career.

By the end of our trip, which was prolonged thanks to heavy traffic, we had mapped out an idea for a novel project that would explore what happens in a local community when we care for the whole patient, addressing the many elements of their life circumstances that affect health. We would pick one or more specific places in our footprint whose populations were low on the socioeconomic ladder. Rather than attempt to address just one or two pressing needs that were impacting the health of people in these communities, we would bring to bear a wide range of resources alongside the medical care we were providing, tracking changes in people’s health.

Our goal was twofold. We wanted to demonstrate the positive impact of addressing the entirety of patients’ needs. If we did that, we thought we’d be able to spur change in healthcare nationally. We also wanted to uncover specific practices we could spread to help our health system and others around the country address underlying social and economic disparities in ways that affected health.

Let me say more about this second goal. When companies think about social responsibility, they often approach it as charity work. They find a social need—often one that relates to their mission—and write a check in hopes of doing some good. That’s fantastic and worth celebrating. But what many companies don’t do is attempt to reengineer their core business to have social impact. In launching this demonstration project, that was exactly our goal. We didn’t simply want to change life in one or more of our local areas. We wanted to change ourselves, so that over the long term we could make more of a difference in all the communities we served.

After my return from Chicago, we formed an organization called the Utah Alliance for the Determinants of Health, providing it with $12 million from Intermountain. We launched pilot programs in Utah’s Weber and Washington Counties, two zip codes where Intermountain already cared for patients and whose populations faced social and economic challenges. In each of these places, we took a 360-degree approach, helping people to access the full range of resources—housing, food, prenatal care, and more—they would need to stay healthy. We chose these two counties because their populations varied considerably. Weber County was more urban. People who lived there tended to be younger and were more liberal politically. Washington County was more rural, older, and more conservative. Confident that our comprehensive efforts to address social needs would work, we wanted to anticipate skeptics who would say, “Oh, that approach only works with a specific population—it won’t work elsewhere.” We hoped to show that caring for the whole person and taking into account their life circumstance is always a good idea.

In these two communities, the problem wasn’t so much that resources for low-income patients didn’t exist. It was that patients often couldn’t access resources they needed because providers weren’t working systematically to spot these needs and help patients fill them. To remedy that problem, we convened a large network of local partners that provided services—homeless shelters, local educators, food pantries, low-income health clinics, mental health providers, and the like. We provided questionnaires that frontline staff at these organizations and at our own hospitals and clinics could use to screen people they encountered for the full range of social needs. Had they gone without food in the past 30 days? Had they had trouble paying rent? Were they having issues getting rides to their medical appointments?

When people in these communities had only one or two unmet needs impacting their health, frontline providers could connect them with resources provided by organizations in our network. Quite often, though, patients had multiple, intersecting needs that were both profound and complicated to address. To help in these situations, we hired a corps of community health workers in each zip code who would work with patients over time to obtain the help they needed to get back on their feet.

Critically, these workers would interact with patients in their native language, which was often Spanish. We also provided these workers with a budget to cover small, incidental costs that prevent people in need from obtaining help. A person eligible for government housing assistance might not be able to obtain it because they don’t have $15 to cover the application fee. Someone else applying for a job as a construction worker might not have money for steel-toed boots, which were required. Such gaps might seem small, but to people in need, they are enormous and often insurmountable. With funds at their disposal, community health workers could help patients bridge these gaps and get people what they needed. That, in turn, would help keep them healthy and out of the hospital.

As this work got underway, the profound impact it was having on individuals and their health soon became evident. Consider the story of “Randy,” a 52-year-old resident of Washington County. For years, he’d suffered from a slew of chronic ailments, including heart disease and rheumatoid arthritis. Unemployed and struggling with substance abuse and violent behavior, he had a hard time taking care of his health and made numerous trips to our emergency rooms to treat his chronic conditions.

Community health workers and providers in our network assigned to Randy’s case arranged for him to receive temporary housing at a homeless shelter. They got him a cell phone and a primary care provider, helped him to apply for disability insurance, and arranged for him to meet with mental health counselors to help with his substance abuse. Over time, Randy was able to afford a car of his own, which allowed him to get to his medical appointments, and he moved into a home of his own. Randy had setbacks, but he continues the process of getting back on his feet. Since he can access the preventive care he needs, he can better manage his chronic conditions without frequent emergency room visits, removing cost from our system while lowering his out-of-pocket expenses.

Happily, stories like Randy’s abound. By the end of the Alliance’s three-year pilot project, a total of 320 organizations had joined our network of providers in Weber and Washington counties, serving over 1,800 people. Frontline providers began to rigorously screen people they encountered for social needs—our data showed they did it 96 percent of the time. Although it will be years before we’ll be able to gauge the full health impact of providing for people’s social needs in these two communities, early signs suggest that this impact is profound. During the pilot, we tracked how often people were going to an emergency room to handle chronic health needs rather than true health emergencies. If we saw fewer people using the ER in this way, it would mean that they were better able to navigate the healthcare system and were likely also staying healthier. We had hoped to see 8 percent fewer ER visits that weren’t true emergencies. Instead, these visits dropped by over 34 percent. Weber and Washington counties are continuing the Alliance’s work, and we’re expanding the program to other counties in our service area.²

After the project’s first year, Intermountain took what we learned and began using it to change how we deliver care. Remember those questionnaires we developed that allow frontline providers to screen for social needs? We’ve incorporated such screening across our emergency rooms and are rolling it out to primary care facilities in our system. When was the last time you went to the doctor and someone bothered to ask you whether you had appropriate housing or enough to eat? When was the last time someone bothered to ask you whether you were feeling depressed or anxious or whether you were abusing alcohol or drugs? At Intermountain, we increasingly do, and we can also connect you with services to provide for the specific needs you might have.

To help with more complex cases, our primary care teams include caregivers who function like community health workers, helping patients to navigate social services and address many needs at once. We’re also rolling out screening procedures among our medical specialists. Obstetricians, for instance, are asking patients whether they can take care of their basic needs during their pregnancies and whether they have access to services that might help with postpartum depression. Our kidney care specialists are asking patients whether they have access to the nutrition, medications, and transportation to and from medical appointments they need to manage their conditions and to avoid costly, painful, and debilitating dialysis treatment.³

Changing our own ways of working with patients hasn’t been easy. Our caregivers already do a lot, and now we’re asking them to change familiar work patterns and do even more. But after some initial resistance, most caregivers and administrators in our system are welcoming the changes. Rather than complaining about having to screen patients, they’re now pushing for even more resources to provide to patients facing social and economic disparities. Our caregivers understand how important it is to keep people healthy. Many of them have seen firsthand how devastating social and economic disparities can be to patients’ health. For them, it’s exhilarating to finally address the basic problems that cause people to become sick rather than see them in the emergency room again and again.

Think about the customers you serve and the underlying needs that prompt them to use your goods and services. Are there innovative ways you might address these needs in the course of operating your business? If your business model doesn’t incentivize you to do this, how might you change that to render your efforts to go upstream financially sustainable?

In addressing underlying social issues, we at Intermountain regard it not as a charitable contribution, but as a core part of how we operate. Consider another patient—I’ll call him Greg—who lived in one of the two geographic areas served by the Alliance. For years, Greg’s battles with diabetes and opioid addiction sent him repeatedly to our emergency room. As part of the Alliance’s work, a case worker met with him and discovered that because of his diabetes, his feet no longer fit properly into his shoes, and he suffered severe pain that made it impossible for him to hold down a job. The caseworker arranged for him to receive a modestly priced pair of shoes, which led to a reduction in his pain. He also agreed to receive counseling to help with his drug addiction. As his physical condition improved, his caseworker arranged for him to see a primary care physician, who could help keep track of his health and take preemptive steps to prevent it from worsening.

Thanks to these measures, Greg has held onto a steady job, and his visits to the emergency room have declined. Greg wins because he enjoys better health and can attend to his financial needs. Society wins because of the cost savings that accrue, thanks to the reduction in emergency room visits and because we’re helping social service agencies to better collaborate and integrate their services. But Intermountain also wins because it costs us much less to care for Greg over a period of time. In addition, we earn a small return on the care we do provide for him, and our efforts to drive improvements in community health enhance our reputation locally. All these gains became possible because we challenged ourselves to address the wider needs our customers have, and because we’ve transformed how we get paid to incentivize us to go upstream.

Customers today don’t reward companies that simply donate to good causes. They reward transformative organizations that engineer new ways of doing well even as they do good. Investors increasingly value these organizations, as do employees. If your business model penalizes you for addressing underlying social problems, it’s time to disrupt yourself. Keep an eye out for innovative ways of doing business that allow for both profit-making and long-term benefits to other stakeholders. With the right business model in place, you could be making real progress on fundamental issues plaguing society and inspiring others in your industry to do the same.

BUILD UP LOCAL COMMUNITIES

Nick Fritz isn’t the kind of person health systems have traditionally hired. Originally from Ohio, he studied engineering in college and served as an officer in the Marine Corps. Becoming interested in business, he earned an MBA from the University of Utah and then went to work in impact investing, an approach that aims not just to generate financial returns but to help society or the environment in some way. Most money managers seek to obtain the greatest possible returns for investors. Impact investors want to make money, but they also want to support projects that will do significant good.

In July 2019, we brought Fritz over to Intermountain to start an impact investing practice for us. In our efforts to go upstream, we were thinking big. We didn’t simply want to help individual patients in specific communities, as important as that is. We wanted to enhance the resources available across our entire geographic footprint to remedy health disparities, mobilizing every tool available to us. Fritz’s assignment was to find investment opportunities in our service area that would improve life for underserved populations while generating a small return for Intermountain.

During his first six months on the job, Fritz drove around Utah, talking to community and business leaders about how Intermountain could best make an impact. Two themes kept popping up. First, communities needed more affordable housing for low-income folks. Second, they needed more economic opportunity. So far, most of Fritz’s work has focused on the first area. Research has shown that when people can access safe, stable, reliable housing, they stay healthier. If your home is poorly ventilated and moldy, you’re at higher risk of asthma. If you suffer a foreclosure and have to move, you might be more likely to suffer from a range of mental health conditions. If your cost of housing eats up too much of your monthly budget, you might lack money to buy healthful food or visit the doctor when you need to.⁴ Again, your health might suffer.

Aware of these important connections between housing and health, Fritz in 2020 led investment in a new flagship project called the Utah Housing Preservation Fund. Every year, governments pump money into building affordable housing, but after a period of time, the owners of those properties are allowed to sell them on the open market. When they do, developers buy these homes and kick out the low-income people who are renting them. The developers either knock down the existing homes and build new ones or invest to improve these properties. They then sell them off as high-end properties. Thanks to this dynamic, a certain amount of affordable housing vanishes each year, exacerbating shortages in communities and leaving more families homeless.

The fund we created works as an affordable housing stabilizer. Instead of leaving developers free to buy the properties, the fund buys them at the market rate, upgrades them, and maintains them as affordable homes in perpetuity, charging rents that low-income folks can afford. The fund doesn’t lose money on these deals, but the returns it earns are below the market rate—a small price to pay for families to access the housing they need to stay healthy. “The whole purpose of the fund is to keep people stable in their housing,” Fritz says.⁵ Instead of being evicted and suffering dislocation and perhaps even homelessness, low-income renters in this property can stay and continue to pay affordable rents. Coordinating with social service agencies, the fund also helps to provide people who are currently homeless with affordable units as they become available.

The Utah Housing Preservation Fund is just one of several impact investing projects we’ve helped fund to date. Others include a program that helps those suffering from addiction get jobs and secure housing and programs that assist low- and middle-range income workers with their down payments so they can afford homes.⁶ All told, we’ve committed about $50 million to our impact investing efforts and hope to deploy $180 million within a few years. So far, our projects have led to the construction and preservation of more than 1,000 units of affordable housing.

It’s important to approach going upstream from multiple angles and not just through impact investing. To help remedy economic disparities, we have adjusted how we purchase goods and services from others to prioritize local suppliers. Our goal here is to support the creation of good jobs in our communities, which in turn will help keep these communities healthier. We also mobilize our hiring strategy to benefit local communities, increasing diversity and hiring more workers in rural areas to bring opportunities to underserved segments of the population. We conduct a number of efforts in the area of food security, providing food and connecting patients, caregivers, members of our insurance plan, and members of the community with resources.⁷

At times, going upstream forces us to acknowledge that we, too, can contribute to community health problems. When I became CEO, Utah had one of the worst rates of opioid overdoses in the country. We had partnered on efforts to raise public awareness about the opioid epidemic and to educate our own caregivers about it, with limited effect. To tackle this problem, we couldn’t simply focus on the behavior of users but also on that of suppliers of opioids—in other words, our own doctors. As we found, physicians in Utah were prescribing these medications at among the highest rates in the country.

We pushed physicians to adopt a goal of reducing opioid prescriptions by 40 percent.⁸ As Mikelle Moore, Intermountain’s chief community health officer, remembers, “That took a ton of work, figuring out an education program for every provider, giving physicians real-time data about what they were prescribing relative to their colleagues, surveying patients about how many pills they actually needed or were taking, and sending that feedback to physicians so that they didn’t feel like they were leaving their patients in pain by prescribing less.”⁹

These efforts paid off. As of 2021, we reduced the number of opioids our providers prescribed by 11 million pills, and between 2015 and 2020 Utah saw a decline in opioid deaths of about 3 deaths per 100,000 people in our population.¹⁰ We took other measures to reduce overdoses, such as distributing medication that reverses the effects of opioid overdoses, but in Moore’s view, “probably the most impactful thing is the way our prescribers are behaving differently.”

Tackling underlying social problems at the community level requires humility, and it also requires persistence and determination. This isn’t the kind of work we as leaders can simply do once and then check off our list. We must stick with it, applying constant intellectual curiosity. As Moore observes, “we often make the mistake of patching a program with a charitable contribution or putting work into something at the surface. Before you figure out what to address, you really need to have the rigor in place to ask, ‘Why is this true,’ and, ‘Why is that true,’ and, ‘Why is that true?’”

A long-term view is important, too. When addressing social issues at the community level, investments might require years, even decades to show results. It’s a different way of approaching business, one that’s admittedly easier to sustain if you’re a nonprofit like we are and free from the tyranny of the quarterly earnings report. But I contend that it’s a viable strategy for public companies, too. After all, when entire communities are better educated, better housed, more financially stable, safer, and healthier, the people who reside in them are able to consume more products and services. Going upstream is not only the right thing to do; it helps ensure the long-term health and prosperity of everyone in a community, including business.

EMPOWER PEOPLE TO GO UPSTREAM

In 2021, Shannon Clegg, a neonatal intensive care nurse and member of our strategy team at Intermountain, received a call from her church, asking if she’d help on a volunteer project. The Utah State Correctional System wanted to open a new prison nursery in about a year’s time for incarcerated women who were pregnant or had newborns. The space for the nursery was built, but the program hadn’t yet been organized. Officials were way behind schedule and needed someone who understood maternal care and healthcare management to help them get the program up and running. Among other tasks, they needed this person to staff the nursery with the right people and put policies and procedures in place that would ensure that mothers and babies were well cared for.

Clegg didn’t hesitate. Like many who work in healthcare, she had dedicated her life to public service. She had participated in volunteer missions around the world, teaching neonatal resuscitation in developing countries. “Anything where I feel like I can have a direct impact in improving the life of a human being brings great meaning to my life,” she says.¹¹

Working on her own time, Clegg reached out to Intermountain and the wider community, assembling a team of specialists who agreed to help on a volunteer basis. An Intermountain neonatologist agreed to serve as the nursery’s medical director. Child development specialists at one of our children’s hospitals helped map out policies specifying how long infants should stay with their mothers in the nursery after they were born and ensuring that the nursery space was developmentally appropriate. Educators from the University of Utah, Intermountain, and several community agencies worked together to oversee the nursery’s offering of parenting classes to new moms. A team of lactation consultants from Intermountain and the local community convened to create protocols for helping new moms breastfeed. Clegg helped identify community partners and governmental agencies that are collaborating to provide supportive care to ensure success as these mothers and babies transition back to society. With the help of Clegg’s church, a volunteer program was designed to augment prison resources in the provision of mentorship and childcare both while moms are in the prison and upon their release.

As Clegg relates, a prison nursery like this is a prime example of an initiative that goes upstream to solve underlying problems. By keeping the mother and infant together, the program enhances bonding between them. It offers babies the opportunity for healthy brain development and secure attachment with their mothers, which improves long-term outcomes and reduces the likelihood of intergenerational incarceration. By teaching new moms to breastfeed successfully, the program improves their health and that of their newborns, helping them to avoid future illnesses. Extensive research has shown that children who receive breastmilk enjoy a lower risk of many health conditions, including infections, obesity, diabetes, and cancer. They are also healthier later in childhood. Meanwhile, mothers who breastfeed have lower risks of conditions like heart disease, cancer, diabetes, and postpartum depression.

But that’s just the beginning. Research shows that pregnant women cared for in prison nurseries don’t commit new crimes as often as those who don’t receive such care. Since these women receive mentorship and training in parenting and job skills, they often can establish more stable family lives after they leave prison, gaining custody of other children they might have. Once launched, the program will also help women transition back into society upon their release, connecting them with resources for healthcare, food assistance, housing, and the like.

In all these ways, the new nursery keeps moms and children healthier, lowering the burden on society. We could certainly opt to do nothing for these moms and newborns and then take care of them after they became ill. We could wait for these new moms to struggle with parenthood, lose their children, commit more crimes, and then just put them back in prison. Going upstream to solve social problems at their root is a much smarter and more humane move, one that benefits us all.

As Clegg’s story suggests, companies need not do all the work of going upstream. If organizations orient themselves toward tackling social problems at their root, altruistic employees will also connect the dots and find their own ways of helping. Clegg notes that not a single person at Intermountain turned her down when she asked for help with the prison project. Some of this response owes to the cultures of Utah and the healthcare industry, both of which emphasize public service. But when organizations move decisively to address root causes, as we have, it also unleashes new energies among the workforce. It’s up to us as leaders to celebrate employees like Clegg who volunteer their time and to support them by making our own resources available.

Great employees like Clegg take the initiative. They do more. They make it personal. Great leaders do the same thing. They make it their business to go home each night, knowing that they and their organizations have helped make the world a better place. It can feel overwhelming at times, but that’s not a reason not to engage. Rather, it’s a reason to push your hardest and then push some more. At Intermountain, we know we always could be doing more, so we’re constantly looking for new ways to buttress our communities. Most recently, we committed $250 million to create an endowment to fund innovation in education across the state of Utah. Does this money directly improve the health of our patients? No. Will it do so indirectly? Absolutely. A more educated population will be more socially and economically stable and will be healthier over time.

It’s true that we as an organization can’t single-handedly solve for every problem people in our footprint have. That’s frustrating for us. But we’ll continue to make progress, working in tandem with partners in our community. I invite you to deepen your own efforts to solve bigger social problems, changing your core business if necessary to make these endeavors sustainable. Take the basic social problem that your company solves as part of its mission, and then think about what you can do to address not just that problem but its root causes.

Humanity is at a crossroads, and so is our country. As is patently obvious, many aspects of how we live and work are unsustainable. With government unable to drive change on its own, leaders and organizations can and must help meet the challenge. Opening your gaze wider allows you to see the greater good, and along with it, a whole new array of business opportunities.