How Technology Can Prepare the Health Care Workforce and Transform Care

00;00;00;26 - 00;00;06;24
Tom Haederle
The gap between supply and demand for health care continues to grow at an unprecedented rate. In this time

00;00;06;24 - 00;00;07;24
Tom Haederle
of rapid change, 

00;00;07;26 - 00;00;09;17
Tom Haederle
reinventing and transforming the

00;00;09;17 - 00;00;10;07
Tom Haederle
nature of care

00;00;10;07 - 00;00;13;20
Tom Haederle
delivery is essential for hospitals and health systems to

00;00;13;20 - 00;00;14;26
Tom Haederle
achieve quality patient

00;00;14;26 - 00;00;30;06
Tom Haederle
outcomes.

00;00;30;08 - 00;00;30;28
Tom Haederle
Welcome to

00;00;30;28 - 00;00;32;00
Tom Haederle
Advancing Health, a

00;00;32;00 - 00;00;33;17
Tom Haederle
podcast brought to you by the American

00;00;33;17 - 00;00;42;10
Tom Haederle
Hospital Association. I'm Tom Haederle with AHA Communications. Please join us for this discussion of how Northwestern Medicine is using digital

00;00;42;10 - 00;00;43;16
Tom Haederle
technology to better

00;00;43;16 - 00;00;45;04
Tom Haederle
prepare teams to work in

00;00;45;04 - 00;00;46;15
Tom Haederle
the new world of health care,

00;00;46;20 - 00;00;55;03
Tom Haederle
and how technology and digital mindset are vital to care transformation. Today's podcast is brought to you by Accenture.

00;00;55;06 - 00;01;25;29
Michelle Hood
Hello, everyone. I am Michelle Hood. I'm the executive vice president and chief operating officer of the American Hospital Association. And I'm joined today with two guests, Daniel Derman, who is the chief innovation officer and senior vice president for Northwestern Medicine out of Chicago. And Kaveh Safavi, the senior managing director for Accenture. As we all know, the gap between supply and demand for care is growing too fast, and health systems must reinvent the nature of care delivery.

00;01;26;01 - 00;01;51;14
Michelle Hood
A combination of human plus machine can help increase efficiency for physicians, nurses and the non-clinical workforce so that they might meet the rising demand for care. We're together here at the Leadership Summit, where a number of our sessions are focused on workforce, with examples of rethinking workflows, adopting new operational models or teaming in ways we've not done before.

00;01;51;16 - 00;02;04;16
Michelle Hood
I'm interested to hear how both of you are thinking about how to better prepare teams to work in this environment and how important or central is technology and a digital mindset to this discussion. So Kaveh, maybe we'll start with you.

00;02;04;18 - 00;02;25;07
Kaveh Safavi
Well, if you look at all the developed countries in the world right now, they're all facing the same problem that's becoming a crisis. We saw it coming. COVID accelerated it. But the reality is that the number of people who are aging out of the workforce and need health care is growing at a tremendous rate. And the number of people who work to take care of them is actually shrinking.

00;02;25;07 - 00;02;46;05
Kaveh Safavi
So like in the U.S. specifically, between now and 2030, the number of people over who will age into the 60 and older group will grow by 48%, and they consume 3 to 5 times as much resources as people under the age of 60. The number of people working to support people over the age of 60 goes down by 17%

00;02;46;05 - 00;03;20;01
Kaveh Safavi
at the same time. So that kind of mismatch between supply and demand is leading to waiting times already in many areas, two or three months for any kind of elective procedure. And we really fear that we're going to see the same kind of waiting times that people see in Europe now, where, for example, in a country like England for an elective procedure in the NHS, you wait around 18 months. And we will never solve that problem by hiring enough people to do the work because there aren't enough people in the workforce, period, doing any kind of work.

00;03;20;03 - 00;03;44;03
Kaveh Safavi
So we have to rethink the approach. And that's why we talk about moving from thinking about this as a workforce problem to a work problem. You take a job and you break it into tasks and then you ask the question, where's the best place to do this task? Some of them can be done by technology. Some of the technology exists, some is coming and some, most, will be done by people.

00;03;44;05 - 00;04;10;22
Kaveh Safavi
But in order to get the work done, you have to reorganize and reconnect the people and technology together to actually do the job. Because you're not taking a person's job whole cloth and shifting it to technology. So the orchestration or harmonization of the human and the machine together is just as critical as the technology itself. And that's where we start talking about how the nature of work and the meaning of work are changing.

00;04;10;24 - 00;04;32;21
Michelle Hood
So this is a complicated problem. There is no formula to follow. We're going to be learning as we go, but it is becoming the problem that replaces all other problems because without it, there's no access. And with no access, we have a political issue. We have an economic issue. It will be more important than the cost of care

00;04;32;21 - 00;04;33;23
Kaveh Safavi
at some point.

00;04;33;23 - 00;04;39;03
Michelle Hood
Yeah the declining health of the country comes along pretty quickly thereafter. Right? So, yeah, yeah.

00;04;39;05 - 00;04;41;20
Kaveh Safavi
There's no such thing as a quality of care if you get no care at all.

00;04;41;20 - 00;04;45;25
Michelle Hood
Yeah, exactly. So what does an innovation officer think about this?

00;04;45;28 - 00;05;09;27
Daniel Derman
So let me highlight a little bit and augment what Kaveh was talking about and do it from the unique lens of health care versus just that workforce in general that goes beyond health care. And there's a unique piece, I believe, to health care that was really highlighted from the pandemic and challenges we had then. And at first everyone thought, oh, this is the pandemic once we get over it.

00;05;09;27 - 00;05;34;20
Daniel Derman
But what it really did was put a spotlight on what was a impending crisis anyways. And the thing that I'd like to add or kind of take away from what Kaveh was talking about is the joy in the nature of work and why the clinicians went into health care, and put pejoratively they didn't go into health care to spend half their shift documenting and the electronic medical record.

00;05;34;23 - 00;06;12;13
Daniel Derman
Most health care staff would tell you that they went into it being somewhat mission driven and wanted that direct patient care. And there has been a number of barriers. Electronical record being one of them as an example, that took people away from that direct patient care. So I think there's an imperative here in the background which addresses some of this concept of the reduced workforce by trying to bring joy back to the patient experience and put more direct contact there and a benefit. A side benefit of the technology

00;06;12;13 - 00;06;37;26
Daniel Derman
besides just getting enough bodies would be to change the nature of the work so that people have more direct care. I gave the example of the electronic medical record, but there's numerous other examples that would highlight that as well, and I think that's really the opportunity we have here, because let's face it, there's not enough health care. So I've been to places where they talk about replacing the radiologist.

00;06;38;03 - 00;06;51;05
Daniel Derman
No one's going to replace anybody because there's not enough staff there. So this crisis that's upon us now, it's all about managing it and at the same time trying to bring the joy back to the practice of medicine.

00;06;51;05 - 00;07;13;05
Kaveh Safavi
And that's a fantastic point because a lot of people don't fully appreciate the fact that health care is a sector that the technology will only take over part of the tasks. Best case, probably a third of the tasks. This is still predominantly a human-performed service and we need more than our fair share of people in the workforce to enter health care.

00;07;13;05 - 00;07;22;26
Kaveh Safavi
And to Dan's point, the motivations are actually declining. The number of people who want to go into the profession are declining. That's a really bad place for us to be.

00;07;22;28 - 00;07;39;26
Michelle Hood
Right. So if we take both of those concepts, the, you know, bringing purpose and joy back to work and redesigning the work and allowing our workforce to do what it is that they trained to do, what are each of your organizations doing to try to accelerate that? Because we don't have a lot of time.

00;07;39;29 - 00;07;58;16
Kaveh Safavi
Well, we already know that people go to work for reasons that are different now than they were a decade ago. So this is not even in health care. It is across all sectors. If you actually look at why people work, we have done some research and pre-pandemic we're able to document that people go to work for more than pay and professional development.

00;07;58;16 - 00;08;30;07
Kaveh Safavi
They go to work for companies that they think resonate with them, everything from their values all the way to to worrying about their safety, their security. We call that net better off. So I work for a company that leaves me feeling net better off. And when we took those scores and we looked across the United States, across seven industries, sadly the health care sector was the worst performing of all of those industries, which tells us that we are failing even more than other options to make people feel net better off in health care.

00;08;30;07 - 00;08;53;19
Kaveh Safavi
And I think part of it goes to what Daniel describes very critically, which is they don't feel like they're actually doing health care work. They feel like they're doing documentation work. The pandemic had lots of other issues associated with it, everything from the scheduling to feeling like they were not taken care of from a safety perspective. Over time, all of these things conspired to drive people away from health care.

00;08;53;19 - 00;09;18;29
Kaveh Safavi
So what we're seeing now is organizations start to recognize, even before technology shows up, that they have to shift the way they think about this problem and expand the notion of why people come to work to be able to address this issue. One interesting phenomenon, for example, is that the pandemic made everybody in the world realize that some jobs can be done away from a physical location.

00;09;18;29 - 00;09;42;07
Kaveh Safavi
Not all, but that actually plays itself into health care, because in many cases we have individuals that are performing tasks that are both physical and documentation. The same person in a single location. But if you were to rethink the work and you separate them, you don't have to give up the documentation, but you could actually have somebody in a different place and you can start to take advantage of people's motivations for working in a different way and expand the field.

00;09;42;07 - 00;09;48;28
Kaveh Safavi
So we're starting to see people recognize you have to use everything at your disposal to address this issue.

00;09;49;00 - 00;09;58;05
Daniel Derman
This is why I love doing this with Kaveh, because he sets sort of the intellectual basis and the structure for why. And then I fill it in with specific examples.

00;09;58;05 - 00;09;59;00
Michelle Hood
Of practical steps.

00;09;59;00 - 00;10;18;15
Daniel Derman
Exactly. Practically how we do that. So let me put some meat on those bones and give you some examples, okay? In two different arenas. So first of all, we have what we call the pebble in the shoe and it's actually a boulder in the shoe. I wish it was a pebble in the shoe, but it's a boulder in the shoe of what gets in the way with the joy of your practice everyday.

00;10;18;15 - 00;10;42;25
Daniel Derman
So give you an example first from the physician side. So we're doing some early - and others are as well - some early work now with taking and using NLP to create an electronic medical record note so that the doctor can continue to have that interface with the patient and not have to do the documentation. n the other side, let's take the nursing side, for instance.

00;10;43;02 - 00;11;04;01
Daniel Derman
We have a remote nursing project where the nurse can do all the work at the bedside. We have in V one, we have a nurse remotely one of her colleagues or his colleague that is now doing the documentation. So the nurse at the bedside can do that. But v 2.0 as we go up the scale is probably going to have that remote

00;11;04;01 - 00;11;27;14
Daniel Derman
so that replaced with automation rather than a live nurse having to do that. Now, at the end of the day, it sounds high tech, it sounds maybe less personal, but what we've done is a nurse spends about 50% of a shift documenting electronic medical records. If all we do is reduce that by a half, forget about all of it, but we reduce it by half,

00;11;27;17 - 00;11;54;16
Daniel Derman
we probably could take care of 20% of the nursing shortage just by that alone. And the satisfaction goes way up. It's also a workforce retention issue because we see it as a recruitment tool, which makes us more attractive for the limited pool that's there by being able to offer people the possibility to have more time at the bedside rather than this work.

00;11;54;19 - 00;12;11;29
Daniel Derman
Those were clinical examples. I can go on the administrative side and say the same thing. You know, it's a version of working at the top of your license on steroids, now really having the ability to do that, whether it's on the clinical side or on the admin side.

00;12;12;01 - 00;12;41;00
Michelle Hood
So jumping out from that point, let's go back to one of the pieces of the first question, and that was the mindset that needs to change in order for people to think about work tasks and series of work tasks in a different way and think about technology as a complement. So we have an existing workforce, we have leadership from the front line leadership to the boardroom that this is all new, this is all new to them in a large respect and a high percentage.

00;12;41;03 - 00;13;02;27
Michelle Hood
So how do you bring leadership in? When I talk about leadership, everything from the unit manager, the nurse manager on shift AM to the boardroom, how do you bring that mindset quickly to the recognition copy of what you said? We've got to think about it as a different problem. It's work, the redesign of work. How do we reskill these folks?

00;13;02;29 - 00;13;26;13
Kaveh Safavi
That's probably going to be a harder problem than the technology problem. People tend to think about this as predominantly a technology problem. I think especially if we look at some of the what's generative AI and large language models will do. Their ability to take these documentation tasks over is pretty profound. The problem is, if I walked in with that technology today and I put it in place, I will actually make the workforce less efficient, not more efficient.

00;13;26;16 - 00;13;49;28
Kaveh Safavi
And so we're going to have to create a whole set of skills that allow people to interact with technology to get their work done. So let's think about a couple of examples. And this has been documented in the past in terms of human machine is just getting more amplified. In health care, for example, if I give you a little bit of time back, five or 10% of your time, you have to do something intentional with that time or it's completely wasted.

00;13;49;28 - 00;14;14;15
Kaveh Safavi
Now that time may just be reclaimed by you because you're effectively already running at 110%. And that time can be spent for everything from personal regeneration of energy or more time with an individual patient or something about learning. That's what we call reclaim time. Maybe if you get more time, you actually repurpose the time and you take care of more patients.

00;14;14;17 - 00;14;31;28
Kaveh Safavi
The first units don't always get turned into productivity, but that is an intentional act. It's actually called re-humanizing time. And any time you put a human machine together and you introduce technology for productivity, the human side has to decide what it's going to do with the time back. So we don't right now have a plan for that.

00;14;31;28 - 00;14;55;28
Kaveh Safavi
We have to try to understand what that means. Another example that technology responds to humans in the way that they interact. And every time you interact with a technology, it changes. You actually have to change the way you work to get the technology to work. Dan's example of documentation is a fantastic one. So let's think about nurses. The technology that is going to exist in a short amount of time can listen to a conversation and structure

00;14;55;28 - 00;15;14;16
Kaveh Safavi
a document needs to hear a conversation. If you actually watch what a nurse does, they may or may not be working out loud. They have to be trained now to work or think out loud. Similar to what you might see today, the way a senior doctor trains a junior doctor, everyone's going to have to work that way or you can't take advantage of the technology.

00;15;14;16 - 00;15;38;17
Kaveh Safavi
So that's an example of training. That problem does not belong to the company that brings the technology in. That problem belongs to the organization that has the workforce. So one of the questions that often comes up is who in my organization is responsible for this problem? Because it doesn't actually fit naturally with the way our organization silos are built or our capabilities.

00;15;38;19 - 00;15;49;13
Kaveh Safavi
So a lot of times what you're starting to see is executives who recognize the problem and start walking it back. One of the first questions they ask is, Well, how am I going to give this problem to? Who in my organization is ready for it?

00;15;49;19 - 00;15;57;04
Michelle Hood
Yeah, because it's a combination of change management, but also a different set of skills to make it work. So dig out a little.

00;15;57;06 - 00;16;20;27
Daniel Derman
Typically, if you look at the leadership structure and you look at their age and the arc of where they're at, you end up having people that are the decision makers that invariably are not going to be there. Five...pick your year: three, five, seven years. They're not going to be there to implement it and to live with the consequences of that and to keep tinkering and modifying it as well.

00;16;20;29 - 00;16;51;21
Daniel Derman
Another analogy that I like to use is: think about it like autonomous driving and there are stages. I'll make them. There's five stages of which the first is: it's human with a little bit of augmentation. And the final stage is you're sitting in the backseat reading your paper while you're getting to work. And I would say that one of the lessons we've learned early on is to be very careful and intentional about the staging of it, both for success and for buy-in as you go along.

00;16;51;23 - 00;17;17;02
Daniel Derman
So I don't think anybody has to talk about the machine and the technology taking 80% of somebody's position. It's really just in a graduated way. And that's how we're thinking about it and how we're getting leadership buy-in is to give them a scope and a view of the whole playing field and say, okay, this is what it could look like, this is what it's at some other industries.

00;17;17;04 - 00;17;30;17
Daniel Derman
But we're going to start here and we're going to we're going to great up with it. Now, the pace of it is probably going to be faster than everybody thinks, but we're going to use examples. There'll be models out there that will end up pushing people.

00;17;30;23 - 00;17;33;22
Michelle Hood
Yeah. And defining success at every stage of the way.

00;17;33;22 - 00;18;01;24
Kaveh Safavi
So there's actually another interesting corollary to what Dan described, which I think is really critical, and this idea of having a plan and a path and an evolution not only in terms of change management, but this is actually playing itself out vis-a-vis people's trust in technology itself and the users. So we're seeing it play itself out right now with the evolution of generative A.I. and large language models, because the consumer experience for generative AI is answering questions.

00;18;01;26 - 00;18;26;20
Kaveh Safavi
People want to go, well, let's answer a medical question. Our perspective is that's the worst possible use. And in fact, I would discourage people from doing that because the language fluency in the documentation that Dan described doesn't need to have a medical answer. We're taking all the advice out of it. My fear is that people will be tinkering with this stuff and actually use it to do something like answer questions.

00;18;26;20 - 00;18;51;08
Kaveh Safavi
It will inevitably answer it incorrectly. That will result in a lack of trust and regulatory backlash and set us back. So there's a part of this that says that you need to actually know in advance what you're not going to do. And we are actually starting to see academic institutions in particular that are trying to work with generative A.I. put forth policies ahead of any actual use to prevent this from happening.

00;18;51;08 - 00;19;04;14
Michelle Hood
Yeah, and I know at the AHA we're also beginning the discussion around how do we get in front of that potential regulation, whether it be an FDA kind of approach or are some other agency who's going to want to get in to protect the consumer?

00;19;04;18 - 00;19;32;21
Daniel Derman
And it's doubtful that the agencies are going to go in a cognitive kind of straight line making good decisions. Yeah, I think either there'll be a vacuum or there'll be some knee jerk responses that are going to probably be harmful in the progress of it. So I think it is incumbent upon us, the health care system and the providers, to get out there and start to create a pathway or some guideposts, some rails or some help along the way.

00;19;32;29 - 00;19;33;27
Michelle Hood
Great.

00;19;33;29 - 00;19;47;19
Michelle Hood
How do you think people - we've touched upon this a little bit, but I'd like some amplification - about business case and use case in this. And we talked about how to convince leadership and bring skills. But talk about the business case.

00;19;47;19 - 00;20;06;10
Kaveh Safavi
Well, following in the spirit of this, let me give you the general and then Dan can give you a specific. So I think the business case for this follows a path analogous but not identical to electronic health records. If you think about the business case for electronic health records in the early days, people were trying to find a financial business case that would it pay for itself.

00;20;06;10 - 00;20;30;18
Kaveh Safavi
And the answer is it doesn't. But what we recognized pretty quickly was especially when the agenda for safety and error reduction came in, that if we didn't hardwire health care with technology, too many people would die. And we have actually delivered on that. But people stopped worrying about a short term, financially driven business case and looked at a business case that included quality of care as an example. For this kind of technology,

00;20;30;18 - 00;20;56;13
Kaveh Safavi
it's going to be waiting time and access. Now, in the short run, when you're really close in, what happens when you think about the labor problem before the technology is it feels like a cost problem. My labor costs just went up. Oh, big problem. But actually it turns out to be a revenue problem because you actually have essentially buildings with mortgages and no patients in them.

00;20;56;15 - 00;21;17;02
Kaveh Safavi
So you have a revenue shortfall and that's a tax that's put on the smaller base of services that you can give, but it flips into an access problem. And when it's an access problem, it's a political problem. I think that we are actually going to find most business cases built around access and waiting time. That will be the defining business case and everyone will be able to make the case.

00;21;17;04 - 00;21;41;00
Kaveh Safavi
It's also going to be what people are going to use when we start to get into challenges about traditional thinking about how health care should be delivered. So all human versus human machine combination and people may make the argument that the quality of care will suffer. And the answer will be, tell me how long you want to wait before the suffering for waiting is greater than whatever your theoretical suffering is for solving this problem by taking the work and changing it. Right.

00;21;41;03 - 00;21;59;18
Daniel Derman
I think Kaveh said it really well. The only thing I'd add is something that I alluded to before, and that is as a recruitment tool that I believe that those that are doing these type of activities with the job description and what people are doing will be the winners in the marketplace in terms of recruitment.

00;21;59;21 - 00;22;18;09
Michelle Hood
Fantastic. Well, thank you very much, gentlemen, for being with me today. I really enjoyed the conversation. Lots to learn, lots to live through and appreciate your input.

00;22;18;11 - 00;22;19;27
Michelle Hood