How to be a continuous improvement whisperer

As a horse trainer, Rusty Moore, DO, tries to put a horse in a position where the right choice is also the easy one. As system medical director of continuous improvement, his job is perhaps not so different: to position the right processes to eliminate waste and improve patient experience.

Continuous improvement is the foundation of the Intermountain Health Operating Model, which aims to provide clarity, alignment, and accountability throughout the system to improve outcomes for patients and caregivers.

Dr. Moore previously served as continuous improvement medical director for our Desert Region. He currently serves as an enterprise leadership development consultant and physical medicine and rehabilitation physician at St. George Regional Hospital in St. George, Utah. He came to the system-level role with a unique set of qualifications.

Here, he reflects on applying continuous improvement practices in the clinical setting and what horse psychology has taught him about leadership.

What’s continuous improvement?

“It’s a structured approach that looks at every process, and everything you do, and asks, Is this making the outcome better? And if you can’t point to a direct line between what you’re doing and the outcome, that’s a waste. Continuous improvement is all about reducing waste to improve flow.

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Can you give an example?

In the Desert Region, leaders were looking at patients who go to the hospital unnecessarily, trying to understand what makes someone go to an emergency department for something that’s not truly an emergency, rather than going to a clinic or an urgent care.

So, the team came up with a list of about 200 patients who were routinely using the emergency department, and then looked at the tools we already had in place. We have a program where a nurse calls and follows up with patients after discharge, but they were basically calling patients at random — any discharged patient might get contacted.

It became clear that if the group could focus on addressing the needs of these patients, they could decrease those visits without increasing resources at all. It’s important to note that continuous improvement didn’t drive this work — we just facilitated the work these teams were already doing.

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What does that kind of facilitation look like?

It’s not so much that I’m going to tell you what you need to do. It’s more about using a method for approaching problems to overcome the barriers to your success. I can also serve as a fresh set of eyes to help you think though and better understand the problem you’re trying to solve. You supply the 'what' and 'why' of what you need to work on through your understanding of your own performance. Together we figure out the formula for 'how' you make things better.

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What do you hope to accomplish in this systemwide role?

We need to make it easier for the average person to understand what continuous improvement is trying to do. We’ve been working on this journey for many years at Intermountain, and we’ve made some strides in the right direction, but for our clinicians, it seems like it’s been harder for them to feel like they’re involved.

I think it’s a language barrier. We went to school and learned the language of healthcare. We got these important jobs taking care of people and using that language to communicate with each other. Now you’re asking us to learn this language of continuous improvement? A lot of the terms aren’t intuitive. We need to find a way to make that easier.

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What do you like to do outside of work?

I’ve always been fascinated with training horses. My family tried to adopt and train a mustang when I was a teenager, which I wasn’t very good at, and since then I’ve always wanted to do it right. Over the last 15 years I’ve worked to make that happen.?

Horse psychology is fascinating. As prey animals, horses want a leader who can protect them from the scary world outside. If you can learn to interact like a more dominant horse would, the horse will naturally want to follow you. I guess, in a way, it’s learning the language of a horse.

It essentially boils down to a game of body language and space. If you can control your position and get a horse to move out of your space, you’re on your way. Sometimes this involves a little equine drama. Depending on the horse there may be some bolting, kicking, snorting, or even some aggression. Most of the time it’s subtle, just a little bit of movement.

If you’re consistent and control the environment, the horse will eventually stop running away, and then something magic happens. Instead of moving away, the horse will begin to ask if they can come back to you. When you invite them back in, a connection is made. You now represent the safety, leadership, and strength of their herd — and they’ll follow you.

Do you think there’s a parallel to continuous improvement there?

I think so. With horse training, the key is to understand what’s going on with them, so you can make it easy for them to make the right choice. It’s just becoming attuned to the horse, how they move and where they are and what they’re feeling. It’s also about setting up the environment that helps them succeed. It’s no different for people. We all want to learn, grow, and get better at what we do. We can set up the right environment, become attuned to what they’re experiencing, and then respond in a way that supports their success. To me there are parallels there.”