Marc Harrison:
Hi, I'm Dr. Marc Harrison, CEO of Intermountain Healthcare. Today I'm with Kalleen Campbell, a patient safety consultant based in St. George. Thanks Kalleen for leaving the sunshine to come up to Salt Lake and join me today. Can you tell me a little bit about yourself and what you do?

Kalleen Campbell: Yeah. So I actually ended up in healthcare because I was the roughest of my seven siblings and I was in the hospital all the time and decided this is a really cool place.

Marc Harrison: Okay.

Kalleen Campbell: My poor mom.

Marc Harrison: Yeah.

Kalleen Campbell: And I started working as a candy striper at 14 and I don't know how I ended up in patient safety. I guess I just kept saying, "Why do we do that? Why don't we change that?" And the job evolved and Zero Harm came around and it was the perfect thing. I am absolutely in the right place.

Marc Harrison: Isn't that great?

Kalleen Campbell: Yeah.

Marc Harrison: So you did something very kind, you reached out after I did a video that talked about my myeloma diagnosis and that I was going to have a bone marrow transplant. Thank you.

Kalleen Campbell: You're welcome.

Marc Harrison: Those sentiments meant an awful lot to me and to Mary Carole and it really made me excited to get better and come back to work as soon as possible. I think you've actually had some experience on a bone marrow transplant unit yourself. Is that true?

Kalleen Campbell: Yeah. Not as a patient.

Marc Harrison: Lucky you, by the way.

Kalleen Campbell: Lucky me by the way. Yes, absolutely. I actually just came from Huntsman [Cancer Institute] this morning. My nephew is going to receive a bone marrow transplant. Years ago I worked at the University of Utah…

Marc Harrison: Before you go on, I really wish him the best. I think this idea that cancer is a blessing is baloney, personally.

Kalleen Campbell: Right.

Marc Harrison: But you can make good things come out of bad things and I think that the ability to appreciate the opportunity presented every day and really try and live in that moment and make meaning and have fun and be good to the people who you're meant to be good to, that's good. Those are the good things that come out of the challenge associated with something as stark as cancer or a bone marrow transplant.

Kalleen Campbell: Yeah. Yeah.

Marc Harrison: I'm sorry, I interrupted you.

Kalleen Campbell: I think everybody probably wanted to hear some of that. We all care about you.

Marc Harrison: Thank you, and that means the world to me. So talk to me a little bit about Zero Harm and your passion for that and how you see that impacting our culture and our patients on a day to day basis.

Kalleen Campbell: I think the real strength of what we did with Zero Harm was challenging the culture, challenging who we are. We were already doing good things, we were good people. We wanted to come to work and bring our best and yet things were happening that we didn't want to be involved in and that's very emotional. When I first started doing root cause analysis and interviewing people and seeing the harm to them as a second victim, it really needed to be challenged. We were already doing that work, but Zero Harm changed the way that we look at it.

One of the greatest things, and I said in the email that you were my ally in my work and you really have been, and one of those great moments came when we were on a call with a bunch of people talking about an event and they were trying to decide if we caused it, "Did we cause this harm?" And you interrupted and said, "If we didn't prevent this harm, we allowed it to happen."

Marc Harrison: That's right.

Kalleen Campbell: And that really changed all of the work. We look at the events differently now. It's not about, "Did I do it? Did you do it? Who's going to be to blame?"

Marc Harrison: It's a ‘we.’

Kalleen Campbell: Yeah, it's definitely a ‘we.’

Marc Harrison: I hope you know that I have immense respect for our caregivers. I believe that all 41,000 of us show up every day trying to do the right thing. It's very unusual to run into a person who doesn't give their all.

Kalleen Campbell: Right.

Marc Harrison: And when that's the case, and we still have bad things happening, you have to ask yourself, "What are the aspects of our culture that these really good people live and work within that still allows us to make mistakes that can harm another human being?"

Kalleen Campbell: Right.

Marc Harrison: Can you talk a little bit about what you think some of our cultural strengths are with regard to taking on Zero Harm and then what you think some of our cultural opportunities are in terms of getting better and eradicating harm?

Kalleen Campbell: I think our strengths really come from one opening up the dialogue and being very clear about what the culture needs to be, challenging that culture and saying, "This is not healthy, this has to change." Identifying what needed to change and being very specific about that.

Kalleen Campbell: When we first began this journey, I had some concern that we're going to do all this work and then, in my sixth and seventh decade, I'm really going to need healthcare and I'm not going to be working in healthcare anymore, and then all the work we did is going to fall apart. I've been concerned about that. How do we build something that is going to be there when my children are older?

Marc Harrison: Sure.

Kalleen Campbell: Or how do we build something lasting? But I really think the great work that we did here to transform what we look like structurally, to rebuild ourselves in a way that the culture can be lasting, and that we can really reach across boundaries that were stopping us before.

Marc Harrison: I recognize that making that structural change was tough for some people.

Kalleen Campbell: It was hard.

Marc Harrison: No doubt about it. We stubbed our toes a couple of times and we didn't get the structure just right at first, and I'm sure there's additional refinement that will continue to happen over time, which is normal and healthy.

Kalleen Campbell: Mm-hmm (affirmative).

Marc Harrison: The thing that bugged me to no end is that we would have best practices and not generalize them to the whole organization.

Kalleen Campbell: Yeah.

Marc Harrison: And that we would have inconsistent expectations from a safety and quality standpoint, depending on where we were.

Kalleen Campbell: Right.

Marc Harrison: And I think that's largely gone away, and I think the benefit of playing as a very large team probably outweighs some of the individual autonomy that people enjoyed before. That said, I actually have a firm belief that, if people use the huddle system properly, that there's a lot of room for asking questions, for sharing, and for continuous improvement that should give immense amounts of self-determination to different parts of the organization. But it's not easy.

Kalleen Campbell: Right.

Marc Harrison: I think you talk about cultural pieces, I think that we have an element at Intermountain that cuts both ways. One is that I think we are very thoughtful and kind, and I think people are mutually supportive and they want to live and work in a harmonious environment, which I think is great. I think sometimes that gets in the way of us actually having tough conversations around making change. So that desire for harmony can actually get in the way of saying, "I'm really uncomfortable that we hurt this patient and let's really dive in and find out what went wrong." Not who is wrong, but what went wrong. So I think that is probably additional work that needs to happen. Am I way off base, Kalleen?

Kalleen Campbell: No, you're not off base. That absolutely needs to happen. And I think it is happening. The experience of interviewing a caregiver now versus interviewing before, it isn't punitive. They're now bringing the learning in and we can change the conversation to the point that we say, "At this moment we forfeit the opportunity to discipline for the opportunity to learn." And they bring that learning to us and we've changed things that...

Kalleen Campbell: I taught Zero Harm when we first started and we talked about a case that happened with a baby. Three years later, I'm investigating the exact same scenario, which was so frustrating. How do we continue to investigate the exact same event? And it wasn't until we changed the way we talk about the event, we talk about the learning, we really bring something meaningful and powerful to the action plan and change the way we're doing it.

Marc Harrison: That's excellent. Well, I thank you for your optimism around the fact that we can change, and we will. I'm seeing all sorts of good things and our data looks great, but maybe more importantly than that, I really liked the way I hear the vast majority of people talking about safety and quality. Thank you and your colleagues for helping this be a just environment and avoiding punitive tone to our conversations wherever possible.

Marc Harrison: I think it's important for our listeners to know that people really are very safe to raise issues and to engage in this continuous improvement work. I think the only time people are at risk is if they are willfully negligent around adhering to Best Practice. That's not okay.

Kalleen Campbell: No.

Marc Harrison: And never has been.

Kalleen Campbell: And they stand out more.

Marc Harrison: I think it's very rare. And so, for the vast majority of us who make honest mistakes, I think they're going to be treated really well and valued for their forthcoming approach to mistakes and problems.

Kalleen Campbell: Right.

Marc Harrison: So do you have any questions for me? Anything I can help you with?

Kalleen Campbell: Well, I have a couple of questions.

Marc Harrison: Please.

Kalleen Campbell: Are you going to do another Ironman?

Marc Harrison: I'm signed up for Ironman Arizona in November, but I may actually try and get a charity slot at Kona, [Hawaii,] the World Championship, and raise some money for the bone marrow transplant unit. One way or the other, my next Ironman will be really focused around fundraising for other people who get to go through this adventure.

Kalleen Campbell: Yeah, that's awesome.

Marc Harrison: Yeah.

Kalleen Campbell: That's inspiring.

Marc Harrison: Well, some days are easier than others, that's for sure.

Kalleen Campbell: Okay, I have to make sure I ask a couple of questions from safety coaches, because I told them that I'm going to meet with you.

Marc Harrison: Okay.

Kalleen Campbell: So, let's see. Okay, this was the big question that I loved. What's your vision going forward and are we on track with your vision right now?

Marc Harrison: So we are completely on track. Intermountain has always been a model healthcare system and, as we make this pivot towards keeping people well, I can't think of any other large system that is ahead of us in terms of being able to do that for a really very diverse population. There are other folks who take care of very much a middle class or commercial population, but we take care of everybody. And half of our work now is around people who we've been paid a sum of money to keep them well over the course of a year, and we're doing a really good job of that. I'm so proud of the work that we're all doing on helping to make sure that our neighbors can afford their healthcare. It will never be as inexpensive as people want but we're going to keep chiseling away at this.

But I couldn't be more proud of the people who work at Intermountain. We'll face challenges and we will overcome them. But we're going to be more than okay, we're going to be the leader.

Kalleen Campbell: Yeah, we've done some hard things and I know we will get through hard things.

Marc Harrison: Hard things for the right reasons.

Kalleen Campbell: Absolutely.

Marc Harrison: You don't do them just to do them, but we, like everyone in healthcare, recognizes that safety and quality can be better, care can be more affordable, access can be better. We can create a better environment for the people who work with us. None of those are near fixed and they never have been, but we'll keep working at them.

Kalleen Campbell: Right.

Marc Harrison: Yeah. Any other questions?

Kalleen Campbell: Well, I have a gift for you.

Marc Harrison: Okay.

Kalleen Campbell: So this is a book that I was reading called Expect To Win, when we started going through our transition, and I hit this section of the book.

Marc Harrison: Okay.

Kalleen Campbell: Page 16 is The Default. If you don't make your changes, and you're not relentless, you're going to default and you're going to go back. And so, if you go back, you lack vision, your fear increases, your distraction increases. So this is the book that helped me at the point when we were going through...

Marc Harrison: Great, thank you. I will read this with great interest.

Kalleen Campbell: I met this guy, and he signed that book for you.

Marc Harrison: Oh, thank you. I heard a quote that I really like and it goes something like, "If you don't like change, you're going to like irrelevance even less."

Kalleen Campbell: Right.

Marc Harrison: The world is going through all sorts of transformation and evolution, and we are no different, and we can stick our heads in the sand, but that doesn't really help any, does it?

Kalleen Campbell: No.

Marc Harrison: Yeah.

Kalleen Campbell: No, it's going to change anyway.

Marc Harrison: Yeah. I'd rather be ahead than behind. Look, Kalleen, when we all work together, which we are doing, the best is yet to come.

Kalleen Campbell: Yeah.

Marc Harrison: Thank you.

Kalleen Campbell: Thank you.