When Rob Allen, CEO of Salt Lake City-based Intermountain Health, thinks about navigating an environment of relentless change, he returns to a story from his childhood on a Wyoming dairy farm and a near-disaster with cattle in 60-below-zero cold.
Calves were dying, and the instinct was to blame the temperature. A visiting veterinarian saw something else entirely. The animals were dying of dehydration. Water troughs were freezing over and the cows were too cold to get up and drink. The fix wasn’t heat, but instead they needed to break the ice several times a day and herding the cattle to the water.
“It makes me, in my leadership today, stop and think many times: are we solving the right problem?” Mr. Allen said during a keynote interview at the Becker’s 16th Annual Meeting. “Oftentimes in healthcare, we see something, we jump to it, we want to solve it. But is that the problem we should be solving?”
That discipline — pausing to define the actual problem before deploying a solution — shapes how the 34-hospital, 400-plus clinic system approaches everything from AI adoption to drug pricing reform to its Epic implementation last fall. Intermountain operates across six states with a health plan and a growing suite of strategic partnerships, and Mr. Allen has spent the years since the system’s 2022 merger with SCL Health focused not just on integration but on building a model capable of sustaining itself through compounding disruption.
That discipline shows up in the health system’s recent focus on nurse bedside time. The conventional debate in healthcare circles focuses on staffing ratios. Mr. Allen argued that’s a proxy argument — the real question is how much of a nurse’s shift is actually spent in direct contact with patients. Nationally, studies put that figure at roughly 30%.
“I don’t know any nurse who got into healthcare to only spend 30% of their shift time with patients,” Mr. Allen said. “That’s the national study in hospitals. We’re undertaking a journey to actually increase that. Our target is 42% at the bedside.”
Intermountain has been piloting AI-assisted tools in select units and has found reductions in charting time of up to 40%. The system was among the first large health systems in the country to launch ambient dictation for physicians and has since been expanding that capability into nursing workflows.
“The nurses and the doctors are spending time face-to-face with patients instead of talking to them while they’re facing a computer typing,” Mr. Allen said. “It makes a difference.”
The goal is to improve the patient experience and restore the professional satisfaction that draws clinicians to healthcare in the first place.
“It brings more of the joy back to our clinicians,” he said. “Why did they get into healthcare? Let’s help them realize that in our journey.”
Technology adoption at scale requires more than tools — it requires a workforce that trusts leadership and feels invested in change. Intermountain has spent eight years cultivating a specific mechanism for that. The system runs a daily huddle structure that, by mid-morning each day, produces a consolidated report drawn from more than 3,000 huddles held across the organization. Those huddles surface operational crisis points and deploy resources in real time. But they also function as a two-way channel for improvement.
“We have over 500,000 ideas in the last eight years that have been generated and implemented by our caregivers, improving processes,” Mr. Allen said. “Allow your people to help you find ways to improve.”
The system’s core values are designed to reinforce the same principle, giving frontline staff a clear frame for autonomous decision-making. The most-invoked: “We do the right thing.”
“When you’re faced with a crisis and you need to make a decision, do the right thing, and we’re behind you,” Mr. Allen said. “We need to enable our people to actually live the mission every day, live their purpose, and have confidence that if they make the choice they think is the right thing, somebody’s got their back.”
Even with that foundation, sustaining momentum through change is its own challenge. At open forums with caregivers, Mr. Allen hears consistent feedback about the exhausting pace of change. He doesn’t dispute it, and he doesn’t promise to slow down. His response is to reframe the change as a continuous journey rather than a sequence of isolated disruptions and draws on the experience of climbing the Grand Teton, a 17-hour slog through waterfalls, boulder fields, and rope-assisted ledges. He was able to finish the climb because he never lost sight of the summit.
“We only give them one piece at a time, and we don’t do a good job of always helping them see the big picture,” he said. “I think one of the most important things in leadership, with all the change, to manage change fatigue — and we’re not going to stop the change — is let’s be clear on where we’re trying to go.”
The deliberate, problem-first orientation extends to how Intermountain approaches innovation. Mr. Allen compared innovation to two different streams. The first flows inward: the 500,000-idea pipeline that continuously polishes the existing system. For more disruptive innovation, Intermountain has a venture arm that evaluates hundreds of companies each year, identifying the small number with real working solutions rather than promising pitches. Executives looking to solve specific problems can tap that team and receive a short list of vetted candidates instead of navigating the market themselves.
The second stream flows outward and is more ambitious. Eighteen months ago, Intermountain launched the Mindshare Institute, designed to incubate solutions to problems that venture capital has little incentive to touch. The model is inspired by Civica Rx, a healthcare utility co-founded by Intermountain Chief Strategy Officer Dan Liljenquist that brought together health systems and philanthropies to produce generic drugs at cost. Civica’s announcement that it would manufacture insulin drove the market price from roughly $350 down toward $100.
In another case, a medication that cures hepatitis C costs $94,000 in the United States. Cost of production is between $150 and $200. The same drug sells for $300 to $350 worldwide.
“How do we use a utility where you come together and say, we’re going to solve the problem?” Mr. Allen said. “Not from our traditional economic model where you’re going to bring investment capital. But actually we can solve the problem in a real way that stops the harm that’s happening to patients in our communities.”
Mindshare, led by Carter Dredge — who holds a doctorate from Cambridge focused on exactly this model of collaborative problem-solving — has launched one company and is preparing a second.
On the growth side, Intermountain’s 2022 merger with SCL Health has yielded $1.2 billion in cost savings to date, evidence that scale can generate real operational value. The system’s growth strategy runs along four tracks:
• Organic expansion to serve the seven of the 20 fastest-growing communities in the country within Intermountain’s footprint;
• Building out the network for proactive care;
• Tuck-in acquisitions that add capability or geographic reach;
• Being selective about M&A.
The health system will stay focused on proving the value of care as well. Mr. Allen said a recent study found that 79% of healthcare executives define value-based care solely as a payment mechanism, missing the underlying foundation.
“Value-based care was a promise of improved quality, increased access, lower cost,” he said. “The payment mechanism is just something to hopefully facilitate that. But if we’re caught on just the payment side, we’ve missed the boat.”
On large mergers and acqusitions, he’s equally direct about the high bar for growth.
“We don’t have a drive to [do more M&A],” he said. “If it’s the right thing, we’ll do it. If we think it’s accretive to our mission and our ability to bless more lives, then we’ll consider it.”
The same problem-first rigor shaped Intermountain’s Epic implementation last September, at the time, the largest single-instance Epic launch in the vendor’s history. Mr. Allen was initially skeptical of the all-at-once approach.
The team made the case that a phased rollout would generate more sustained disruption than a single well-prepared transition, provided it was backed by 18 to 24 months of planning, genuine caregiver involvement in design, and intensive training.
“When people are part of it, they tend to embrace it more,” Mr. Allen said. “If it’s thrust on them and one day they show up and now it’s new, I think that’s just hugely frustrating for them.”
The launch went well. But Mr. Allen was clear the work wasn’t finished.
“People go, ‘Oh, great, it was fantastic.’ Now we’re 60 days in. This isn’t really smooth yet.” The Epic platform was chosen in part because it brought expanded AI capabilities and a development roadmap the previous EHR wasn’t offering, giving staff a clear rationale for the disruption.
Moving forward, Mr. Allen advised leaders to gain clarity on their personal “why” and define precisely what they’re trying to accomplish. Then they need to make sure you have the right people in place.
“A servant leader is able to inspire ordinary people to do extraordinary things,” Mr. Allen said. “Sometimes as a leader, you just got to get out of the way and let people do their thing. You got to know when that time is and step over and let them run, because they’ll run and they’ll do fantastic things.”
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