Marc Harrison: Today I'm with Marshall Wallace, a critical care tech at Primary Children's Hospital. Marshall, could you tell us a little bit about yourself and what you do, and then I'm looking forward to hearing what's on your mind today.

Marshall W.: Sure, I'd be happy to. First off, thanks for having me today.

Marc Harrison: It's a pleasure.

Marshall W.: As you mentioned, I work as a critical care technician in the pediatric and cardiac ICUs at Primary Children's, a place you know very well.

Marc Harrison: I know really well, yes. A wonderful place, by the way.

Marshall W.: Certainly, certainly. I've been there for about a year now and I've had nothing but a great experience so far. A bit about where I'm kind of going right now is I'm currently applying to medical school.

Marc Harrison: Great.

Marshall W.: I'm kind of in the middle of the interview process. I've done one and have a few coming up and I'm hoping to this time next year be starting medical school somewhere. Prior to this, I worked on an ambulance for four years and then worked in the emergency department, and I've kind of been following that care progression to now being in the ICU at Primary.

Marc Harrison: How is that for you?

Marshall W.: It's been awesome. I think it kind of developed from my kind of questioning nature. I cared for patients on the ambulance. I wanted to know what happened next. Brought me to the emergency department, and I wanted to know what happened next. And when I was looking for a job after that, I basically said I wanted to work in an ICU, and kind of fell into the job at Primary and I've really enjoyed it.

Marc Harrison: Do you have any questions for me?

Marshall W.: Sure. As I'm working through this process of hopefully becoming a physician, I've been exploring different career paths, and as I was talking to some of my colleagues at Primary, I heard that you used to be a resident and a fellow at Primary, and then now you've made your way to leading Intermountain. And, basically, I want to ask how that path unfolded, how you went from training for a clinical subspecialty to now leading a healthcare organization, and I assume having no clinical responsibilities.

Marc Harrison: Yeah, I do not have any clinical responsibilities at this point in time. I did practice pediatric critical care for just over 20 years, and I guess the evolution into leadership was a fairly ... initially it was sort of accidental. I was a young pediatric ICU attending at the Cleveland Clinic, and we had some business challenges in our unit that led to us not being able to afford to add additional doctors and nurse practitioners.

We had a barely adequate number of folks, and we covered the unit 24/7, which I know you guys do now, but we were amongst the first units in the country to do that. And, I was able to solve some of the financial problems by sort of just digging in and understanding the process a little bit more, and we were able to hire two more ICU attendings and a couple more nurse practitioners as well, and all of a sudden life was pretty good.

And, I sort of woke up one day and was department chairman, and I was only 39 years old at the time. And then from there, I continued sort of my academic career writing papers and giving talks, as well as taking care of patients. But I started to become discouraged, to be honest, about the impact that my academic work was actually making in real life for people.

I found that I'd write these good papers, but as far as I could tell it wasn't actually changing lives. And I became more and more interested in how could I make differences in patients' lives through understanding the operations of a health system.

At that point I started a pediatric critical care transport program, that morphed into an adult critical care transport program. The chief of staff, that's the head doctor for the Cleveland Clinic, asked me to be his associate chief, I think I was like maybe 41, 40 at the time? And it kind of went from there.

It was not a very intentional process, but I had to go through a period of time then where I thought that the mark of being a good leader was just getting stuff done, as opposed to how you get it done and for what reasons you get it done, and there were some real learning that I went through in my mid- to late forties as I began to understand it's important to work within a culture and to build people up while you are making change.

From there I got asked to go over to Abu Dhabi, and be the Chief Executive for Cleveland Clinic, build the hospital, which I had never even added an extra bathroom on our cottage, so we built a 3 million square-foot-hospital, and staffed it up with people from 70 different countries around the world, and got that up and running and running well. And then this opportunity to be at Intermountain came up.

So it all started with a bit of an accident, but I've believed for my whole life that if a door presents itself, you've got to have a good reason not to open that door. So I guess I've opened a lot of doors.

Marshall W.: Sure.

Marc Harrison: Does that make sense?

Marshall W.: It does, yeah. Now that you've kind of fully transitioned away from clinical care, do you miss it at any point?

Marc Harrison: I do.

Marshall W.: Are you happy with the changes you've made in your career?

Marc Harrison: Look, to be completely honest I'm never 100% satisfied with anything, that's why I like to keep growing. I think all things being equal, I'm having my maximal impact for society, doing what I'm doing. I love clinical medicine and I deeply enjoyed and was honored to take care of patients on an individual basis. Nothing's better than that, that's really important stuff.

But I do think that making impact on sort of a whole society level is very gratifying also, and so I'm happy doing what I'm doing.

Marshall W.: Awesome.

Marc Harrison: So let me ask you a question.

Marshall W.: Sure.

Marc Harrison: Healthcare's changing, doctors' and nurses' roles are changing really fast. Why do you want to be a doctor?

Marshall W.: It actually kind of echoes a lot of what you were saying. I have the type of personality where I'm very interested in opening doors as they become available, and I really enjoy kind of pushing my limits. Basically, I really like constantly learning new things, and making myself a vehicle for helping other people. As cliché as that sounds, I truly enjoy waking up every day, learning something new, and being able to hopefully turn that around to help someone else through a difficult experience, or improve someone else's experience.

Marc Harrison: Well, I'll tell you, Marshall I think that you've got every reason to be optimistic. I so firmly disagree with people who say medicine is just not what it used to be. Well, it's not, but that's a good thing, because medicine is better for patients now than it's ever been, and I think it empowers people who are beyond physicians and nurses to make impacts in ways they haven't been able to make impact in the past. I think the amount of diversity we're seeing enter our profession is really good for patients, because more diverse voices serve more diverse populations, effectively. And I think we're strengthened by welcoming lots of different folks to the profession.

The other thing I'm really optimistic about is people who are millennials and younger are bringing an open-mindedness, and a mission orientation, and an ability to work in teams like I've never seen before. And I think you guys are going to be great, way better than we ever were. So I'm really optimistic for the future and I'm really glad that you decided to go into medicine.

Marshall W.: Thank you. Kind of building off that, do you have any advice for me as someone chasing this kind of career, or trying to move into this ever-changing field of healthcare?

Marc Harrison: I think reminding ... you're going to have hard days, right? So maybe you'll be tired, maybe something really bad will happen with a patient. Nothing's easy all the time. Just keep remembering why you went into this in the first place. Connecting back to your purpose, I think that's really powerful. And this idea that, at least I have an idea, that I'm here to serve other people, they're not here to serve me. And I try and remember that every day, that we're lucky to take care of them, they're not lucky to see us. And I think if you can have those two sort of things, "why did I go into this", and a sense of service and humility, you've got an unbeatable life, right? I mean, it's all good at that point.

Marshall W.: Yeah, that's great advice, thank you.

Marc Harrison: So any advice for me? So you're in the trenches, you're the tip of the spear in the PICU at Primary Children's, so what advice do you have for me?

Marshall W.: Keep doing what you're doing. I would say that I've been in this organization for a year, and if a year ago I thought that I'd be sitting across the table from the CEO of Intermountain and having conversation, I would have thought it was a joke. If I look at previous organizations I have worked for, I really don't think that would be the case. But being, as you mentioned, kind of in the trenches, but then having access to the top of the organization, and being able to have my voice heard or have a conversation with you is really powerful. I think that it shows by doing that you truly care about the organization and the employees within in.

Marc Harrison: I really do. Thank you, those were nice words and I appreciate them. I would say that I learned a lot of this from trying to be the best ICU doctor that I could be. You know from working in the PICU that in order for something complicated clinically to happen, the number of people it takes to practice at the top of their game and in synchrony is enormous. So let's say you're getting a patient intubated, and lined up, right? So you need a respiratory therapist, you need the ventilator, I'm sure you set up the pressure bags for the lines, and all that kind of stuff, get the monitor ready, the nurse is there, the pharmacy's got to get the drugs right — everything has to be just so.

By myself, I was useless, absolutely useless. As a member of a team, I was very good and very useful. And in order for that team to work optimally, each individual, regardless of how high or low up in the organization, (although I hate those terms) they had to be thinking clearly and independently, and using their judgment to the best interests of the patient. I think that's one of the reasons why our ICU at the clinic was so darned good, as we had that culture. I take that with me everywhere I go. So, I actually thank you for taking the time to visit with me, because you've given me insights and inspiration today that you probably have no idea of, so thank you.

Marshall W.: Thank you.