4
FIX WHAT ISN’T BROKEN . . . YET
Don’t shrink from fundamentally reimagining your organization just because your business seems to be doing fine right now.
Large, successful organizations that welcome innovators can be something of a rarity. Even though they’re at risk for disruption, these organizations tend to discourage people from fundamentally reimagining how work gets done, penalizing them or shutting them out if they go too far.
So imagine how Dr. Cara Camiolo Reddy, then a staff rehabilitation physician at Intermountain, felt one day in the fall of 2018 when she and a colleague, Dr. Rusty Moore, sat down for a meeting with one of our senior administrators. As Camiolo recalls, the administrator, Nannette Berensen, informed her that their agenda was nothing less than reorganizing from top to bottom how Intermountain rehabilitated patients after surgeries, strokes, and other major health episodes. “OK, let’s go,” Berensen said, a blank legal pad in her hands and a pen at the ready. “Tell me everything you know about rehabilitative care and how we build this.”1 Music to an innovator’s ears.
For the next several hours, Camiolo, Moore, and Berensen brainstormed organizational changes that might allow our rehabilitation teams to communicate better and work more smoothly together across our network of facilities. These changes would standardize care, helping our specialists operate more efficiently and ensuring that patients received uniformly great care. Particularly important to Camiolo, Moore, and Berensen was making the experience of receiving care easier and more convenient for patients. If you suffered a stroke or had a traumatic injury and faced a long recovery, Camiolo, Moore, and Berensen wanted you to be able to move seamlessly from the emergency room to an inpatient floor or from the hospital to your home, receiving precisely the care you need at each stage and avoiding bureaucratic delays and red tape.
Camiolo, Moore, and Berensen’s thinking was high level, the beginning of a broader change process that would convene rehabilitative caregivers and administrators across Intermountain. Over the next several months, teams of specialists fleshed out specific procedures and collaborative arrangements, forging new links across our facilities and departments. As Camiolo notes, some caregivers initially resisted efforts to standardize care. For decades, rehabilitative medicine at Intermountain had been fragmented, with teams at local facilities enjoying autonomy. Skeptics feared that they would no longer have enough of a voice in how they operated. And as they pointed out, rehabilitative care at Intermountain wasn’t by any means broken. We already provided very high-quality care. Why mess with a good thing?
Camiolo, Moore, Berensen, and like-minded colleagues agreed that our care wasn’t broken. In fact, Camiolo had come to Intermountain from the University of Pittsburgh, taking on a less senior role in the process, precisely because she’d been impressed by our caregivers’ spirit and expertise. But she, Moore, and Berensen noted that opportunities for improvement still existed. A lack of coordination on our part meant we often weren’t channeling patients to the care they needed at various stages of their recovery. Patients had trouble accessing this care, even though some of our rehabilitation facilities were only half full, so they went to our competitors. We could serve patients better and see improved business results if we coordinated our efforts in new ways. Wouldn’t it be great if our patients could focus more on healing rather than on navigating our bureaucracy?
As the work of redesigning processes and procedures picked up, most of the skeptics became champions of change—they realized the positive difference these changes would make for patients. “I’ve had rehabilitation caregivers come up to me and say, ‘I’ve worked here for 30 years. This is the best thing that’s ever happened to caregivers and their patients,’” Camiolo says. The data suggests they were on to something. Within just one year of standardizing our efforts, over 20 percent more patients were receiving rehabilitative care from us rather than jumping to our competitors—a huge leap forward.
Driving progress usually requires that we reinvent organizations so that they can execute in new ways. How do we do that even before many or even most people appreciate the necessity of change? And how do we stay strong as innovators, even when we know we’re stirring up conflict?
These are vital questions in our volatile age. Somehow, leaders must find it in themselves to lean decisively into the task of future-proofing our organizations, with all the struggle and angst that this might entail. As I’ve learned at Intermountain, a little old-fashioned courage and determination goes a long way. As unpleasant as conflict is, it may be OK to rile people up if we’re doing it for the right reason, and if we’re also doing what we can to make change as palatable as possible for those affected. As my friend, former Utah governor and current Intermountain board chair Mike Leavitt, likes to say, if you’ve got 60 percent approval ratings as a leader, that’s likely too high and you’re probably not trying hard enough.
GO BIG OR GO HOME
Since my arrival as CEO, my team and I have spent quite a bit of time fixing what didn’t seem to be broken. We haven’t just reimagined a narrow slice of Intermountain—we’ve brought sweeping change to the entire organization. That’s another important lesson I’ve learned: go big or go home. We can’t be afraid to do the big things within our scope of control just because they’re scary or we haven’t done them before.
I’d had experience steering a startup prior to coming to Intermountain, but I’d never led a full-blown reorganization. That said, I was now ready to. I first came to see the need for fundamental change during my first months as CEO as I familiarized myself with the organization. On one occasion, I met with leaders at one of our hospitals to learn about clinical innovations they were implementing. The work these leaders were doing was amazing, but a part of their presentation caught my eye. In describing their success, these leaders proudly reported that they had grown their business by attracting customers from other Intermountain facilities. That struck me as odd. Although I admired their passion and their drive to succeed, I wondered why teams and facilities at Intermountain were competing with one another. Wouldn’t our organization operate more successfully if we thought of ourselves as a single, unified whole, coordinated our efforts, and competed with other systems?
I saw signs that other teams in our organization were competing with one another rather than collaborating and that they didn’t always borrow or share best practices. At the time, Intermountain comprised four regions that ran independently of one another. In our northern region, Tim Pehrson, currently CEO of the INTEGRIS health system, had spearheaded a truly impressive continuous improvement process. But the other three regions had decided not to adopt it. As a result, those regions hadn’t embedded continuous improvement as fully or effectively as their counterparts in the north had done.
Such fragmentation and a siloed mentality seemed to account for some of the gaps in quality that the initial assessment of the organization revealed. As I’ve mentioned, we were famous for developing best-in-class clinical protocols to standardize care, but we didn’t apply those consistently across our network of facilities—by some estimates, it happened only 40 percent of the time.2 With our facilities sometimes located hundreds of miles apart, and with clinical programs lacking the authority to mandate that everyone in the system adopted best practices, individual teams often went their own way. Patients received different care—and had different outcomes— depending on where in our system they were seen. Experience at our facilities also varied, thanks to differences in processes and work-flows. Many patients didn’t even know they were interfacing with Intermountain. Rather, they saw themselves as customers of specific hospitals or clinics.
A lack of coordination wasn’t new at Intermountain, nor was it inherently a mark of dysfunction. Our system was created in 1975 when the Church of Jesus Christ of Latter-day Saints donated its 15 hospitals to the community. A secular, nonprofit organization—Intermountain Healthcare—was created to receive the hospitals and charged with establishing a model health system. Although Intermountain’s early leaders began to link these hospitals together, the system still operated very much as a federation of autonomous hospitals. As we added more hospitals and eventually a medical group of physicians and clinics, we formed ourselves into regions that remained a loose federation. We made tremendous gains in safety and quality under our regional structure, distinguished ourselves as innovators in patient care, and improved access to healthcare in the communities we served.
Individually, the regions were well led, economically savvy, and focused on the community. Yet new challenges that had appeared on the horizon worried me. The cost of care was rising, those who paid for it—employers, government, and patients—were becoming increasingly burdened, and traditional health organizations were struggling. Although Intermountain was financially healthy, our costs had risen by 22 percent from 2012 to 2017.3 In 2017 alone, usage of our hospitals had fallen slightly while the number of employees on our team had increased.4 Customers in Utah were becoming more price conscious, as many of them participated in health plans with high deductibles. Competitors, including Amazon, Walgreens, CVS, Google, and others, were poised to steal market share, introducing offerings that cost less and were more convenient.
To meet these impending challenges, we would have to move more quickly toward the newer business models of value-based care and population health. That in turn would require us to streamline the organization and find new ways to work better together. We could wait to make profound changes until we were on the verge of failure, as the Kodaks and Blockbuster Videos of this world have done. Or we could evolve proactively, restructuring and transforming ourselves to get ahead of the disruption. To me, the answer was clear. Great organizations embark on change when the need for it becomes clear. They don’t wait for the situation to become dire.5
Of course, preempting disruption through a reorganization would be easier said than done. Research shows that many reorganizations fail and that they also prove stressful for employees.6 Moreover, we’d be asking people to change at a time when we weren’t yet broken. Virtually everything about our organization would be in play, from reporting structures to processes to compensation structures to the way we organized daily work. Looking around the industry and beyond, I saw examples of leaders who had tried reorganizations and transformations only to spark devastating internal conflicts. If we didn’t get restructuring right, an initiative intended to bring us together and launch us into the future could tear us apart, leaving us even more vulnerable.
Despite the risks, we moved decisively in 2017 and 2018 to unify the organization, so that all of Intermountain moved in sync. With the strong and courageous support of our board, we did away with our regions, forged new links across our local facilities, and restructured ourselves as “One Intermountain” under an aligned reporting structure. We also instituted common ways of working that would keep everybody working together and accountable for achieving results. With these changes in place, we’d be able to spread best practices far more readily across the organization, deploy strategies in a coordinated way, solve problems more quickly, and much more.7
In the course of adopting a more unified structure, we created two groups within Intermountain: one dedicated to keeping people well and managing their health, and the other to caring for people once they are seriously ill or injured. This was quite a radical change, one that would help us to move more rapidly toward value-based care and population health. In the group dedicated to keeping people well, we would reward practitioners for finding new ways to manage people’s health risks so that they wouldn’t need more extensive emergency or hospital care. In the group dedicated to caring for patients once they’re sick, we would continue to incent practitioners to deliver high quality care at a more affordable cost. The imperatives underlying this dual structure are complex, but in essence we realized that keeping people well and caring for them when they’re sick are very different. We needed to operate these two parts of our business in somewhat disparate ways to drive high performance in each, keep costs low, and make our entire network of facilities work better.
Our restructuring remains very much a work in progress, and it’s premature to issue a final verdict on its success. But I’m optimistic. Our restructuring has unleashed a rush of innovation that is reducing costs while improving quality and patient experience. By reimagining manifold facets of the care we provide as well as how we conceive of a healthcare system’s role and function, we’re not just becoming less vulnerable to disruption than we’ve been in the past. We’re leading disruption in ways that would have been unthinkable just a few years ago. We’re helping to revolutionize America’s broken healthcare system.
TIE IT BACK TO THE MISSION
Between 2003 and 2008, US Army General Stanley McChrystal led an ambitious transformation of the Joint Special Operations Command (JSOC), a force of elite special operations units from across the country’s military. He also led a force under JSOC control, the Joint Special Operations Task Force (“Task Force”) in Iraq. As McChrystal notes, when he took over its command, the JSOC was at the top of its game: it was “the most elite part of the US military, well-funded, staffed by specially selected people with incredible levels of maturity. Since its founding in 1981, it had gotten better and better,” and it had also developed great confidence and pride in its abilities.8
By 2003, however, in its battle against Al-Qaeda in Iraq (AQI), the JSOC and its Task Force faced battlefield conditions that were more fluid and unpredictable than anything it had previously encountered. “We had been purposely built to do a certain kind of counter-terrorism, hostage rescue, counter-hijacking, that sort of thing, and do very elegant missions, but not do them very often. So, we could do detailed planning, rehearsals, and execution. Now, suddenly, we were in an environment where we had to operate really fast and constantly adapt, and that wasn’t in our habit or psyche.”
Like Intermountain, the Task Force would need to fundamentally change if it was going to continue to compete and win. In particular, the Task Force would have to overcome a siloed mindset and learn to cooperate better with parts of the US government that it had previously regarded as competitors, including the Central Intelligence Agency and the State Department.
Initially, some of the JSOC’s leaders didn’t want to acknowledge the need for change. The reigning mindset was, “We were really good, so why can’t the war be how we want it to be?” As reality sank in, members of the Task Force continued to resist the move toward more collaboration and sharing of information, concerned that it would erode the Task Force’s operational capacity. “There was a fear that if we change from what we were, where our confidence and our stature was well-established and we had proven excellence in how we operated, we’d be in uncharted territory,” McChrystal says. “If we were a football team and started playing basketball, maybe we wouldn’t be good basketball players.”
To convince the organization to embrace the transformation, McChrystal made a simple but powerful argument: What mattered was that the United States won the war in Iraq. That outcome was the Task Force’s ultimate purpose, and it wouldn’t happen unless the Task Force adapted to new battlefield conditions quickly and decisively. “The argument I made to the organization was, ‘We’re going to do whatever it takes to win. If it’s stupid and it works, it isn’t stupid. And so, we’re going to adapt until we figure out what works and we’re going to then do more of that.’”
Reverting back to the purpose ultimately proved an unassailable argument. As McChrystal asks, “Who can be against, ‘Hey, we’re going to do whatever it takes to win?’” The organization came to support the transformation, especially as it began to yield results. In the end, the Task Force saw tremendous operational improvements, notably in the key output metric of the number of raids undertaken. In 2003, the Task Force mounted one raid against the enemy per week. Two years later, it mounted roughly 10 per night—an exponential improvement without increasing the size of the force or significantly enhancing its technological resources.
When attempting to galvanize a large, successful organization around momentous change, especially when the need for it doesn’t yet seem dire, tying that change back to the organization’s core mission or purpose is essential. It allows us to walk a delicate line, affirming the organization’s heritage and tradition while at the same time making a compelling case for undertaking fundamental, proactive change. It also allows us to convince people that they are not compromising the very strengths that made the organization successful but rather drawing on these strengths and safeguarding them for the future.
In presenting our restructuring plans, my leadership team and I linked them to our initial charge of building a model health system and our core mission of helping people live the healthiest lives possible. We did our best to evoke a sense of continuity, explaining how our restructuring, while challenging in the short term, would allow our organization to survive the dramatic changes taking place in our industry, enabling us to continue to deliver on our historic charge. Yes, we were functioning as a model healthcare system now and had every right to feel proud of that. But we needed to ensure that Intermountain could continue to do so in the future.9
We further pointed out that Intermountain had long innovated to improve the care we provided and lower its cost. The changes associated with and enabled by our restructuring were simply the latest in a series of measures designed to keep us on the cutting edge.10 This argument was key. Yes, we were making bold changes. But a capacity and willingness to change has always defined our organization. Rather than taking us off track, change would keep us moored even more tightly to our roots.
Our messaging didn’t win everyone over right away. Just as Dr. Camiolo and her colleagues encountered resistance in reorganizing our rehabilitative care efforts, so my own team and I ruffled a few feathers by introducing One Intermountain. Or perhaps more than a few. As Rob Allen, our chief operating officer, remembers, “There were people who were very concerned that the history of Intermountain— the legacy of who Intermountain was—was being thrown out. People had great pride in working for Intermountain Healthcare, and there was this fear that these things that we’ve held to are gone.”11
In retrospect, I underestimated the pushback that One Intermountain generated—a testament to my own naivete about the difficulty of change. One employee on Glassdoor described One Intermountain as a “Wack-A-Doo Reorganization Without Adequate Direction.”12 Another told a local newspaper, “I think they’ve taken a big hit with . . . just how employees feel. There really (are) morale issues across the board.”13 A few of our senior leaders left, with one grumbling that we had destroyed what had been “a high level of trust and mutual respect amongst employees and management.”14
This response was understandable—some of the changes we made were extremely unpleasant and anxiety-producing. In doing away with our regions, we eliminated hundreds of primarily managerial roles, and at the same time we also outsourced about 100 IT and 2,300 office jobs.15 More broadly, we were asking people in an organization that had long been stable and highly predictable to accept dramatic changes to roles, our reporting structure, and our ways of working. At one point, 1,000 of our leaders had transitioned into new jobs over a three-month period. Bear in mind, too, caregivers often choose careers in healthcare precisely because they’re seeking stability, and the professional training they receive tends to emphasize predictability, order, and regularity.
In retrospect, we also didn’t socialize One Intermountain with caregivers and leaders across the organization as well as we should have. What we should have done was involve leaders early in the process, soliciting feedback from them, giving them tools to use in communicating the change to their teams, and trusting them to serve as spokespeople. Instead, we kept an excessively tight lid on information about our restructuring. Our organization only learned key details when we announced them at a public meeting, leaving some within the organization feeling angry and betrayed because we hadn’t first confided in them. Since this meeting happened to occur while I was attending the World Economic Forum in Davos, I came across as especially distant and aloof—an uncaring member of the global elite. It was a bungled launch all around, one that made an inherently diffi-cult situation that much worse.
I went on to exacerbate the internal tumult by sometimes failing to communicate the change as adeptly as I might have. On one occasion, I likened our existing model to a Model T and proclaimed that I wanted us to become the Tesla of healthcare. Although that analogy is instructive, it understandably led some to take offense, especially given all the innovation that occurred at Intermountain prior to my arrival. Intermountain has been a leader in innovation and clinical care for decades, and I deeply revere its heritage. The last thing I wanted to do was disparage it. With this analogy, I probably made the case for change too sharply, and the comments became a lightning rod for those opposed to our restructuring.
At the same time, I think many in the organization could tell how intensely I felt about value-based care (which Intermountain was already committed to pursuing), the organizational changes I was advocating, and Intermountain’s mission. That’s important. As Frans van Houten, CEO of the Dutch multinational Philips, observes, leaders can’t simply make rational arguments when communicating big organizational shifts and expect to generate followership. They must feel genuinely passionate about their underlying strategy and convey that energy. In reorienting Philips toward its healthcare markets and driving organizational change to support the strategy, van Houten drew upon a longstanding passion he had for healthcare (his mother was a physician, and in his youth, he had hoped to attend medical school).16
Likewise, General McChrystal relates how he became “fanatical” about JSOC’s mission of winning in part because competitiveness and an intense desire to win is an important part of his personality. As he says, “I don’t think I suddenly became a hugely courageous leader or a brilliant leader. But I did become a leader who was very committed to winning, and I used to talk that way to the organization. It was very, very helpful.”17
At Intermountain, resistance subsided as our reorganization started to bear fruit, leading to improvements in quality, safety, and patient experience, and as our caregivers began to exercise a voice in continuous improvement under our new operating model (more on this in Chapter 5). The introduction of big change unleashed in our case a fairly big storm, but by staying close to our purpose and sticking to our message, we managed to weather the turbulence and emerge even stronger and more unified—an organization that truly was One Intermountain.
LEAVE SPACE FOR INNOVATION
Once you’ve begun to generate support for fundamental change to preempt disruption, how do you deepen that support and ensure that it lasts? As we learned, it’s vital to give people a meaningful role in reimagining the organization. By their very nature, organizational shifts can create new spaces for innovation by suspending old rules and ways of operating. People at all levels who are interested in advancing progress sense that an opening for progress exists, and they step up. Leaders can open these spaces wider, further galvanizing people to embrace and pursue innovation, by giving teams and individuals autonomy in changing the system.
In transforming the Task Force in Iraq, General McChrystal devolved decision-making authority downward and to the periphery in his organization, a decision he credits with unleashing tremendous performance gains. It was tempting to continue a traditional command-and-control approach, funneling all information from the periphery of the organization to the center. In a global operation such as his (the JSOC operated in dozens of countries), information technology gave leaders unprecedented abilities to track and direct operations. But in a fast-changing, chaotic environment, leaders achieve better results when they cede control to local teams, speed up the flow of information across the organization, and focus more on providing general guidance to shape action. “You have to give more junior, less experienced people general guidance and let them figure things out, because you can’t tell them in advance exactly what conditions they’ll be facing.”
In reorganizing Intermountain, our senior leadership team didn’t dictate the details. We left it to several dozen clinical and nonclinical working groups to redesign how we worked across our system with an eye toward efficiency and cost savings.18 Our goal, as we publicly described it, was to “operate as a system, with local flexibility.” This would afford us “scale and consistency, while enabling local leaders the flexibility to meet local needs.”19
In the short term, the decision to leave the operational details of the restructuring to local groups aroused anxiety in the workforce, as it made for more uncertainty. We often feel more comfortable in times of transition when people in charge tell us what to do. Over the long term, empowering local groups unleashed talent throughout the enterprise, galvanizing frontline caregivers to participate in and lead change. As our restructuring became established and as we launched a range of other initiatives, we saw extraordinary enthusiasm and efforts from literally thousands of people across our system who pulled together in new ways to advance value-based care and our mission.
One of these individuals was Dr. Chad Spain, a primary care physician at one of our Utah clinics. Practicing under the traditional fee-for-service model, he felt constant pressure to cram more patients into his schedule, to the point where he was spending only about 15 to 20 minutes with each one. This bothered Spain: he had gone into medicine to help people, and he felt that he didn’t have the time he needed to forge relationships and understand patients’ complex medical conditions. “I was very frustrated,” he remembers. “Burnout is real, it was there, and it had me questioning my career choice.”20
In 2017, Spain jumped at a chance to participate in a small pilot initiative we launched called Reimagined Primary Care. As part of the program, doctors would reduce their loads from 1,500–2,000 patients to about 750. Instead of having his compensation pegged to patient volume, Spain would receive a fixed salary. In keeping with a population-health, value-based care model, insurance companies would pay Intermountain a fixed price for his patients’ care. If Spain could keep patients healthier and out of the hospital, our costs would go down and the new model would prove economically viable. Patients would benefit, and Spain’s own work would be more fulfilling.
We launched this pilot as a prelude to what we hoped would be a broader shift of our primary care physicians to the population health model. To that end, we enlisted participating physicians to help us define and fine-tune the new model of primary care. Every week, Spain and a handful of other doctors met with administrators to discuss issues such as how best to reduce their patient load, how to communicate the changes to their patients, what support staff they needed to improve preventive care for patients, and so on. Although these meetings took time out of Dr. Spain’s day, they were “very rewarding because for what seemed like the first time, we as providers were being heard. We’d say, ‘Hey, here’s what we see are issues in delivering good healthcare,’ and administration was taking that back and saying, ‘OK, let’s see if we can build this system around you.’”
The new model transformed Spain’s practice of medicine. At the start of each day, he and other providers in his clinic would meet with a designated caregiver who monitored patient progress, such as whether they were meeting their blood sugar goals or receiving appropriate cancer screening, or how they fared after a recent emergency room visit. Having this caregiver on the team helped to prevent patients from falling through the cracks, as sometimes happened under the fee-for-service model, given the overwhelming patient loads.
During the morning huddle, Spain and his colleagues received an update on patients, allowing them to plan for their care. After the huddle, Spain spent most of his day meeting with patients, taking 30 to 60 minutes with each one instead of 15. “You can imagine the benefit that comes from that,” he says. “The more time you spend, the better you get to know them, and the better you can take care of their chronic illness.” Dr. Spain also had time blocked off in his day to see patients with acute but non-life-threatening conditions—a flu, perhaps, or a worrisome rash—that would have previously led them to visit an emergency room or urgent care facility. Seeing such patients in a primary care setting is less costly, and we pass the savings along to patients or use it to improve the quality of their care.
Thanks to Spain’s efforts and those of other participating caregivers, the Reimagined Primary Care pilot was a breakout success. A year after the pilot’s launch, we saw a 60 percent drop in hospital admissions among these patients. The cost to care for an individual patient over a single month dropped 20 percent. Patient experience improved, as did physician satisfaction.21 We’ve since moved all primary care providers at Intermountain to some form of value-based care or hybrid model. Although we’re by no means done ironing out kinks in the model, the impact has been profound. Spain is eager to see further changes, but he reports that he has grown much happier in his practice of medicine. “I have more time to spend with patients. I can make visits to their homes. Patients feel that if they need me, they have access. And our data proved that we were providing better healthcare and we had a great team to do it.”
Our restructuring has opened the way for Spain and thousands of others at Intermountain to drive change. Spain has taken on leadership roles, serving as board president of the Utah Academy of Family Physicians. “They say change is always hard,” Spain reflects, “but I don’t think in this setting of healthcare that we can be afraid of it. If we want healthcare to change, we need to be willing to make change ourselves.”22
THE THREATS YOU DON’T SEE COMING
In 2020, health systems across America were sent into disarray by the arrival of the Covid-19 pandemic. Enforced lockdowns meant they couldn’t book revenue from noncritical procedures as they had before. Meanwhile, their costs rose: they had to treat more uninsured people who flocked to emergency rooms, and they also had to shoulder the high cost of outfitting caregivers with personal protective equipment. Operational issues such as staffing shortages and a lack of ICU beds made the situation even more difficult. With financial strains mounting, some facilities buckled. By November 2020, over three dozen hospitals had filed for bankruptcy, and more would follow.23
Covid hit our organization hard, but the impact would have been much worse had we not restructured ourselves a few years earlier. Under our old organization, each of our 23 hospitals would have created their own individual plan for handling surges of patients sickened by the virus. Operational functions such as supply chain would have had plans of their own. Some of these arrangements would have responded better than others, and we would have struggled to bring all of the resources available in our system to bear in a coordinated way. Our ability to care for patients in this frightening time would have been greatly impaired.
Under our new organizational structure, we came together to devise and execute one plan for our entire system. As part of our incident command system, teams of leaders huddled regularly to coordinate treatment protocols for patients, infectious disease control, protective equipment, operations, communications, and so on. We were able to collect data systemwide and predictively model Covid volumes at specific locations. We could coordinate patient care across our system, transferring patients between facilities in ways that best served their care. When beds in one local area were full, we could move patients to beds at other facilities.
Critically, we also coordinated our staffing. Instead of local nursing directors making staffing decisions at their locations, our chief nursing executive, Sue Robel, worked with Heather Brace, our chief people officer, to move our 10,000 nurses around to the facilities where we needed them via a central redeployment office. When the virus forced us to shut down elective procedures, we rapidly retrained people and sent them to work in facilities in our system that were seeing a crush of Covid patients.
Like other health systems, we faced severe staffing issues and caregiver burnout. But our staff didn’t lose their jobs or see reductions in their work hours or incomes, and we had the flexibility to respond quickly to hotspots as they arose. As Robel reports, “Without nurses moving between our regions, we wouldn’t have had enough caregivers to take care of our patients. We wouldn’t have been able to open up all of our beds. So, that was a huge, huge benefit for us, to function as One Intermountain.”24
Taking steps to future-proof an organization can prepare us for disruptions we see coming—and critically, those we don’t. Given the increased economic volatility the world is seeing, it really does behoove us all to take a close look at our organizations. Are they really up to the task of preempting disruption? If not, we shouldn’t hesitate to reinvent them, even if doing so will arouse resistance. It’s less about being popular and more about doing what’s right. Restructure the organization to operate better under your present model and to align better with powerful new ones. Build support for restructuring and transformation by tying it back to your heritage and core purpose. And foster more autonomy, giving your people space they need to collaborate with you in driving change.
Driving big, systemic changes in an organization isn’t for every leader. Some of us are inclined temperamentally to pursue incremental improvements—and that’s great. Organizations desperately need these leaders to consolidate gains in times of relative stability. But in less stable times, we as leaders must step up and be capable of driving larger changes for the organization’s greater good.
Which kind of leader are you? Do you have the strength, determination, and sheer stubbornness to yank the organization forward, even if that might anger some people? If so, it’s time to do it. When we see a significant problem in the organization that needs fixing, we can grit our teeth and get the job done.
I opened this chapter with a quote from former Utah governor Mike Leavitt. He has another saying of which I’m fond: “If you’re 5 steps ahead of your organization, you’re a leader; 15 steps, you’re a martyr.” In other words, don’t overdo it.
I agree wholeheartedly. It would be a mistake to create tumult in an organization for its own sake or to conflate the presence of conflict with change-making. Change, in the end, must always be purposeful. We should avoid unnecessary, unproductive, harmful conflict, pursuing healthy conflict that moves our organizations forward and enables people to work better together over the long term. It might be hard to restrain from pushing too hard, especially if, like me, you’re passionate and impatient by nature. But think of it this way: If we try to make our organizations into something they aren’t or can’t be, we’ll certainly fail. If we challenge them to become a better, more successful version of what they already are, we just might succeed.