Physicians Leading | Leading Physicians

Coming from the Outside and Driving Change

Interview · September 15, 2017

Marc Harrison and Tom Lee_150

Tom Lee interviews Marc Harrison, MD, President and Chief Executive Officer for Intermountain Healthcare.


Tom Lee: This is Tom Lee from NEJM Catalyst, and we’re talking today with Marc Harrison, the new CEO for Intermountain Healthcare, after a terrific career at the Cleveland Clinic. Marc, you said at the last NEJM Catalyst meeting on leadership that you felt like you were moving into the best job in health care. Can you tell us why you feel that way?

Marc Harrison: Thanks, Tom, and it’s great to talk to you today. You know, good jobs are made by opportunities to have impact, and the ability to have impact is facilitated by an organization’s commitment, mission, and vision. And thanks to Charles Sorenson, who was my predecessor here, and our governance and the great leadership, Intermountain is laser-focused on population health and value. When I look at my peers around the country, a lot of them are spending time thinking about, how do I pivot from a traditional volume-based system or traditional academic system, to really serving populations and serving communities? And we are oriented in that direction. A lot of that is credit to the history of Intermountain.

When we were formed in 1975, the mandate was to be a model system, and that’s remained our sort of our guide star ever since. And Charles took the organization through the arc of orientation toward value and making sure we take care of populations long before I got here. So, with our history, with our innovative spirit, with the great workforce that we have, man, I think we’re poised to do the right thing for people, and that’s what it’s all about.

Lee: It does sound like a great job, but the fact is — one of the reasons I was so anxious to do this interview — that you are an outsider, and you’re coming to a place that is more than good. It’s considered great. And you know, these great places, including the Cleveland Clinic, where you came from, they tend to hire and promote from within. Now, Intermountain has hired someone from the outside because the board must have felt that change would be good for the organization. So, what’s it like to be a change agent in a place that’s already pretty darn great and probably knows it?

Harrison: Intermountain is great, and there are a lot of people who do know it. I’m sort of an inside-outsider, or an outside-insider. My history is that my wife and I moved to Utah the day after we got married, and the day after that we started residencies at Primary Children’s. She was a second-year resident and I was an intern, and then I did my critical care training here as well. And we have lots of friends still here in Salt Lake. I will tell you that the Intermountain way around reduction and variability, improving quality, playing as a team, commitment to the community, that kind of got into my DNA, and I’ve carried that around with me ever since.

That said, I am a change agent, but I’m a change agent within the context of our mission, vision, and values. So, the mission of helping people live the healthiest life possible is as relevant today as it’s ever been. And I think that the vision of being a model system, having care be extraordinary, affordable, and accessible to all people, again, it’s just the right time and right place. It’s been interesting trying to inject some different ways of thinking about things. Probably the biggest is we have not been interested in growth here in Intermountain for a while, and probably for very good reasons. The necessity to solidify our approach to population health, that took a primary role. Now it’s time to grow, but we have to grow in ways that are consistent with our values. And you know, as an outsider, or an inside-outsider coming in, one of the toughest things I had to do was convince people that all growth wasn’t associated with perverse incentives. I think we’ve gotten there now. I feel real momentum in the organization. It’s good to be home here in Salt Lake after a 20-some-year gap, and off we go.

Lee: This isn’t the first time that you’ve been in that role of coming from the outside and trying to drive change. And even though you feel like you’re an insider, I’m sure a lot of your new colleagues are very aware that you haven’t been in the system over the last couple decades. Are there similarities to what you’re going through now, to when you took on the leadership role for the Cleveland Clinic, United Arab Emirates venture? I mean, there you were a real outsider. Are there similar tactics involved?

Harrison: Tactics makes it sound like almost scheming, but it really isn’t. It’s about connecting with what communities believe in, Tom. So, the only thing I will say is that I’ve gained less weight here than I had in Abu Dhabi, but a lot of what I did was I went out to dinner with people, and here I have lunches and breakfasts and have gone to people’s offices and talked to Rotary Clubs.

It’s really about understanding what makes a community tick, what they believe in, and then making sure we serve them. I guess that is probably more important as an outsider than it is as somebody who’s grown up in a community, but it’s establishing the commonalities of purpose. Why am I here? What do people want? Where are the overlaps? And then, how do we work together for the betterment of the people we’re meant to serve? And, you know, it seems to work okay.

Lee: What’s the big goal that you’re bringing to this next phase? If you look ahead to when the press release is written about your era, what are you hoping that your tenure will be about?

Harrison: I think if somebody said Intermountain was the first fully integrated, digitally enabled, consumer-centered health system and boy, that’s a replicable model, and it’s really served people well and helped keep care affordable, I would be the happiest guy around. Because that really is what it’s all about. How do we empower people to take really good care of themselves, and how do we move the needle in the communities around elevating the healthiness of those communities so that we keep trying to put ourselves out of business? The closer I can get to that, the happier I’ll be.

Lee: That’s a pretty good long-term goal, but some specific steps you’re taking to pursue it, like the highest priorities as you try to work toward that long-term goal?

Harrison: I think the highest priority is recognizing that the game has just changed and that consumerism is here, it’s here in a big way, and that’s a good thing, and that we need to switch from a provider-centric approach to things to a consumer-centric approach, and that talking about consumers does not in any way impugn the sacred relationship that doctors and nurses have with their patients. That people can still be a patient and act like a consumer. I think that’s a rabbit hole that people try to go down all the time, and I think that’s fallacious reasoning. So, it’s that people are acting like consumers, their health care is just too expensive, and consumers are complaining, rightfully, and they’re starting to shop, and they’re starting to demand real service and real quality, and we have to respond to that. That’s happening all around us in the very short run, and I think lots of legacy players are going to be in big trouble really fast.

Lee: So, for doctors in the office at Intermountain and your other nurses and other clinicians, how might life feel different as you picture it?

Harrison: I think that it’s going to feel really different. I’m hoping that they’re going to actually help shape what that looks like. You know, Tom, that one of the things that I worry about is that people, they say they’re protecting doctors because they’re so busy and they’ve had “so much change.” I actually think they’re pandering to them and treating them in a paternalistic fashion. What we’re trying to do is bring our clinicians in.

I met with our medical group board yesterday, and what did we talk about? We talked about industry forces that are going on. We talked about what our strategy is. We talked about what consumers are expecting. We talked about disruptors. And I can’t tell you how pleased I was by their engagement in being part of the solution. Because they went into this to serve other people, and I think the assumption that clinicians can’t morph and change in pursuit of their overall mission is actually an underestimation of their capabilities. So, it’s going to be different, but I think they’re going to help shape [it]. It’s going to be different hours. It’s going to be digitally enabled. There’s going to be a lot of distance. We’re going to use different kinds of providers to serve people, but I really think that the clinicians are going to be at the heart of the solution.

Lee: We’re rooting for your success and, frankly, hoping to take the progress that you’re able to achieve and spread the best practices, and create pressure on the rest of the health care system to catch up or even do better. I hope you don’t mind if we’re going to check in with you from time to time in the years ahead and see how it’s going.

Harrison: You know what, I’d love that Tom, and I value your counsel as well. This is a team sport, and I believe there is no secret sauce. We’ll share everything that we learn and in the hopes that we engage in, from a community standpoint, a dialogue that makes it better for all the patients.

Lee: Great. Well, we’ll have plenty of you, and plenty of Intermountain, and NEJM Catalyst for years to come I hope and expect. Thanks very much for your time today, and for sharing your comments with our audience, and for the terrific work you guys are doing.

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