Smarter, Safer Hospitals: How HCA Healthcare Is Using AI to Redefine Patient Safety
Cross-industry insights and new technology are helping HCA Healthcare reduce risk, improve outcomes and lead the future of high-reliability care
For Randy Fagin, M.D., chief quality officer at HCA Healthcare, safety is foundational. “You cannot achieve regulatory compliance without a foundation of safety. Absent safety, your clinical outcomes cannot be what they need to be, ” he said in a recent two-part Advancing Health podcast hosted by Chris DeRienzo, M.D., chief physician executive for the American Hospital Association.
This philosophy positions safety as a linchpin for compliance, financial performance, clinical outcomes and reputation — making it a top priority for hospital boards and C-suites alike.
Learning from High-reliability Industries
In designing its approach to safety under Fagin’s newly created role, HCA Healthcare studied safety practices across industries including aviation, manufacturing and military operations. Cross-functional teams visited GE’s CT manufacturing plant, DuPont Chemical and the U.S. Army’s 160th Special Operations Aviation Regiment to learn scalable, industry-agnostic safety strategies. These learnings are now being incorporated into HCA Healthcare’s clinical operations and care delivery.
AI as a Force Multiplier
Unlike traditional hospital reporting that focuses on downstream events like infections or falls, AI enables the creation of digital markers that can be used for upstream monitoring — identifying near misses and key risk indicators before harm occurs.
Artificial intelligence is central to HCA Healthcare’s safety strategy. “AI becomes not just an enabler, but I believe it is going to accelerate our ability — and likely even create an ability we wouldn’t otherwise have — to advance our safety model using these high-impact, cross-industry, safety practices,” Fagin explained.
Building a Robust AI Governance Framework
Effective AI deployment starts with governance. HCA Healthcare’s model includes a broad group of leaders of operations, finance, marketing, supply chain and clinical teams. “We’ve put into place a robust governance structure that goes beyond just our clinical leaders,” said Fagin. “It’s important, as we look at the use cases for AI, that we’re looking at each use case through all lenses.”
This multidisciplinary approach ensures that AI initiatives are evaluated for clinical impact, operational feasibility, financial viability and patient experience.
Reducing Variance, Not Just Improving Averages
One of AI’s greatest strengths is its ability to maintain consistency in care. By lifting up inconsistencies in clinician decision-making, patient presentation and geographic differences, HCA Healthcare aims to improve its understanding of what drives high-quality clinical outcomes and ultimately improve care delivery across its large national footprint.
“It’s about variance reduction. How can we reduce variance and in doing so improve the consistency with which we deliver the highest level of care to our patients?” Fagin emphasized.
Frontline Engagement and Augmentation
Successful AI initiatives depend on frontline buy-in. HCA Healthcare involves nurses, physicians and support staff early in the design process. “It’s critical that we involve frontline staff early… It validates the problem and ensures both relevance and buy-in,” Fagin said.
Importantly, HCA Healthcare views AI as a tool for augmentation of work: “How do we enhance human decision making, not replace it?” he asked. This principle ensures that technology supports, rather than supplants, clinical judgment.
Real-World Applications
AI-driven Nurse Staffing
HCA Healthcare’s AI-powered staffing models optimize nurse schedules based on preferences, shift patterns and patient acuity. These tools reduce administrative burden and dynamically adjust staffing to meet real-time needs. But, Fagin stressed, “with each AI-powered initiative, it is critical that we get the people closest to the work involved early in the process to help shape that work.”
DeRienzo reflected on the importance of user-centered design and recalled a similar event earlier in his career, developing a “terrific” machine learning model to predict readmissions: “We spent nine months in development… and then we showed it to the people who are going to use it, and they said, ‘What’s this? We don’t need this.’ It took us another nine months to walk through the people side.”
Ambient AI for Documentation
In emergency departments and inpatient units, HCA Healthcare is piloting ambient-listening AI that captures clinician-patient conversations and generates structured notes that physicians review and finalize. “It literally can unburden hours of [administrative] work for a physician,” Fagin said. “And when you think about its ability to help more consistently capture a more accurate, complete picture of the patient in the medical record… it’s just better for patients.”
Fetal Heart Rate Monitoring
In partnership with GE Healthcare, HCA Healthcare is training an AI algorithm to identify key portions of fetal heart rate tracings. “We’ve been training an AI algorithm, that is being submitted for FDA approval, to recognize these key findings to support physicians in making the most informed decisions,” Fagin shared.
DeRienzo added, “There could never be enough human workforce to be able to watch every single one of those strips… That is where AI is making a difference today.”
Key Takeaways for Hospital Leaders
- Safety is non-negotiable. It is the basis for all performance metrics.
- Benchmark beyond health care. Learn from high-reliability industries.
- AI is a strategic enabler. Use it to anticipate risk and reduce variation.
- Start small. Begin with low-risk pilots to build momentum.
- Augment intelligence. Support clinician judgment while enhancing decision-making.
Final Word
HCA Healthcare’s journey shows that combining AI with cross-industry learning and frontline collaboration can help hospitals and health systems improve patient safety. “At the end of the day,” Fagin said, “we’re all caring for our communities, and we need to do this together.”
Want more details on how HCA Healthcare is using AI to boost safety? Listen to the Advancing Health podcasts: Part 1 and Part 2.