Rae Woods (00:03): From Advisory Board, we are bringing you a radio advisory. Your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. It is no secret that the industry is still, still in the midst of a serious workforce crisis. And I know that organizations have been trying a lot, but if I'm honest, we keep going back to the same legacy strategies. We keep focusing on short-term solutions. Today, I want to talk about a non-negotiable tactic to actually address the root causes of clinician burnout and workforce shortages, and that's technology. (00:45): To talk about technology and its role in enabling the workforce, I've invited two Advisory Board experts, nursing expert, Allyson Paiewonski, and technology expert, Jordan Peterson. Hey, Allyson. Hey, Jordan. Welcome back to Radio Advisory. Jordan Peterson (01:02): Thanks for having us. Allyson Paiewonsky (01:02): Thanks for having us. Rae Woods (01:04): Jordan, it's been about a year since you've been on. Allyson, a little longer? Allyson Paiewonsky (01:09): Yeah, I think last October I was on. Or maybe last- Rae Woods (01:13): And, Jordan, I think it was last fall, as well. Jordan Peterson (01:15): Yes. Rae Woods (01:17): We talked about technology last time with you, Jordan. Did we talk to you before ChatGPT launched? Jordan Peterson (01:25): We did. Rae Woods (01:25): Or did that happen after? Jordan Peterson (01:27): No, we talked before, and it's actually funny because, last time I was on, we talked about Digital Consumer experience, so very much focused on the patient. And then, today, it's the other end, talking about clinicians. Rae Woods (01:40): And so much has changed in a year. True dramatic changes have happened in technology. Allyson, we talked about nursing and the workforce the last time that you're on. That's one where I think things, unfortunately- Allyson Paiewonsky (01:53): In some ways similar. Rae Woods (01:54): ... are pretty similar- Allyson Paiewonsky (01:55): Yes. Rae Woods (01:55): ... to how they were last year. Allyson Paiewonsky (01:57): Yeah. Rae Woods (02:04): So, we are going to have this conversation about technology. And I'm going to be honest from the start, I think it is really, really easy to get wrapped up in some buzzwords, some terms that don't make sense. I'm, of course, talking about AI. Everyone wants to talk about AI, and that's a piece of it, which we'll get to in this conversation. But when we say technology, when we're talking about health technology, particularly technology that can help the workforce crisis, what the heck are we actually talking about? Jordan Peterson (02:33): So, or team has done a lot of thinking about this and have had a lot of discussions as we've been embarking on this clinical workforce technology research. Because, like you said, technology is so broad, it can mean so many different things, especially when we're talking about clinical workforce technology because, if you think about it, technology is in every part of our lives and every part of clinician's work. So, we will talk about a lot of different kinds today, but how we've been thinking about narrowing it down is focusing on the technology that helps clinicians do their job better and was implemented for the purposes of supporting clinicians. Rae Woods (03:16): Yeah. And I really want to make sure we're grounding ourselves in that piece, which is supporting clinicians. That's why you're here, Allyson, and why you were here more than a year ago- Allyson Paiewonsky (03:25): Right. Rae Woods (03:26): ... when we talked about this conversation last. And, I'll be honest, in 2023, I'm still seeing a lot of organizations put time and effort into things like recruitment and retention. Not saying that's bad. They're putting a lot of effort there. A lot of folks are still hiring contract labor. A lot of folks are still focused on overtime pay. I want to be clear. Every single one of those strategies is short term. It's all about how do I get bodies in the door? None of them actually address the drivers, the root causes, of burnout. Things like administrative burden, repetitive tasks, below licensed tasks. My question is why Allyson? Why still are organizations so hesitant to run at those root causes? Allyson Paiewonsky (04:11): Yeah, I think a lot of it has to do with these are the strategies that we've relied on in the past. We've done all of these recruitment retention practices in the past, and it helped us then, so you're almost stuck in this mindset of, "If I just keep doing it, if I keep throwing pasta at the wall, it's going to stick. It's going to work. It's going to be enough." But I think, this time around, it's not enough anymore, and I think we need to really be thinking about how are we investing in technology and really using it to help the workforce, like Jordan mentioned, upfront. But I think it's really just being stuck in this mindset and being scared to make a riskier investment or riskier change. Rae Woods (04:51): Jordan, what are you hearing? Why have organizations been so hesitant to either run at these root causes or think about technology as a solution to those root causes? Jordan Peterson (05:01): So, when we talk to leaders, but especially leaders from provider organizations, one of the things that's so hard about getting buy-in for these technologies or buy-in to invest in these technologies is the ROI associated with them. And what I mean by that is a lot of times in healthcare, there's a lot more focus on the I than the R. Som a lot more attention is paid to the upfront investment of these technologies rather than the long-term return that you would get from investing in them. Rae Woods (05:34): Practically speaking, what you're saying is that people are going, "This is too much money." Jordan Peterson (05:38): Yes. Rae Woods (05:38): "I can't afford to do this now, even though the long-term return, the R, could be quite positive." Jordan Peterson (05:45): Yes. And that is especially true with technology because, especially in cases where it's newer use cases, maybe the results aren't as proven. It's hard to make that large upfront investment when the long-term return is a little bit unclear. Rae Woods (06:02): Yeah, that's another thing that I'm hearing is the, "Yeah, we believe it, but we don't want to go first. We want to wait and see." And I have to be honest. I think that this perspective, or differing perspectives, may actually exist within the same organization. Right? My guess is that, say, a Chief Technology Officer or a Chief Information Officer at a health system may have very different views than a Chief Nursing Executive or the head of the HR Department. And I'm guessing that if those leaders butt heads, that can also stall progress. Does that kind of thing come up in conversations that you two are having? Jordan Peterson (06:42): That definitely resonates with what we're hearing. I think what we're seeing across all leaders is this reckoning that they need technology to support clinicians. The problems are just becoming too expensive to not try something new, like Allyson was talking about earlier. I would say the difference between leaders is more in what they think technology can do to support those clinicians. Rae Woods (07:12): What do you mean? Jordan Peterson (07:13): So, for example, we posted a few different round tables with leaders where we talk about what they want technology to do, what they think technology can do to support clinicians, and the things that they think are completely off the table. Technology either won't support clinicians in that way because the technical capabilities aren't there, or technology won't support clinicians in that way because it shouldn't do that. Technology shouldn't play a role in supporting clinicians in that way. So, to make that a little bit more real with an example, we talked about whether or not technology can support this human connection that is in care delivery, the human touch. And what we saw was a little bit surprising to us in that, when we talked to clinical leaders or HR leaders, they were more on the side that technology can play a role in adding empathy and adding that human touch to the care experience. Rae Woods (08:18): Interesting. Not something that we necessarily think of when we think of tech. Jordan Peterson (08:21): And, I mean, there was a study done where ChatGPT responded to patient messages and was graded as more empathetic than the human clinicians. Rae Woods (08:32): Wow. Jordan Peterson (08:32): They had seen studies like that and saw the potential for technology to help in that way. And then, when we've had the same conversations with digital health leaders, they've been a lot more skeptical about the way technology can support clinicians in that way. Rae Woods (08:47): Which perspective is right? Or maybe there's not a right or wrong, and the more important question I'm asking is how optimistic or pessimistic should health leaders be when it comes to technology and supporting the workforce, supporting a crisis that has not gone away over the last three and a half years, and obviously existed before we ever had COVID-19? Allyson Paiewonsky (09:12): I think there's a lot of room for optimism. But I think you also have to recognize that technology, it's not this silver bullet. It's not going to solve all of your workforce problems. So, it's about how can you combine these new technology solutions that are out there with some of those standard best practices in recruitment and retention to really solve the workforce challenge that is unique to your organization. So, I think we have space to be cautiously optimistic here. Rae Woods (09:40): But I really like what you just said, Allyson, which is that it's not magic. Allyson Paiewonsky (09:44): Yeah. Rae Woods (09:45): It's not a silver bullet. Technology alone isn't going to magically solve all of our problems, in part, because it is part of a larger system. And I also want to channel the voice of clinicians who have been burned many times before with technology that either wasn't designed for them in the first place, or that actually just made their work harder, right? So, I guess my question is if that's the reality for most clinicians, how do we incorporate technology in a way that actually supports them, and not just optimizes their workflow, but actually makes their work better, easier, more joyful, all those terms that we talk about when we talk about administrative burden and burnout? Allyson Paiewonsky (10:30): Yeah, I think we have opportunities here to really look at technology that can extend clinician reach or improve their work environment. So, these are two ways that I think you're really going to be able to combat some of those workforce shortages that we're experiencing. And by alleviating some of that administrative burden and improving the work environment, you're helping patients get back to providing care to, or excuse me, providers providing care to patients. S, I think getting them back to that sense of purpose and showing them that technology actually makes their lives easier and allows them more time with patients doing what they got into healthcare to do, I think that's how you can really get clinicians on board and making sure that these type of technologies are something they'll accept and something that is fitting into their workflow. Rae Woods (11:15): And maybe that also helps our listeners prioritize the right kinds of solutions. Right? Jordan started off by saying there's tons of technologies that we could be talking about here. We had to define it ourselves in the beginning of this research of what's in scope. But if we focus on those two things you just said, Allyson, which is extend clinician reach and make work better, that should, at least in theory, narrow down some of the options and make decision making easier on health leaders. Allyson Paiewonsky (11:38): Right. And I think if you're also trying to optimize clinician workflow, you have to make sure you're bringing in clinician voices. I think something we touched on earlier was that misalignment among leaders at organizations on what technology should or shouldn't do, but I think there's also misalignment between clinicians and leaders of organizations. So, a lot of times, clinicians feel, like you mentioned, Rae, that, "This technology actually isn't put in place to help me or solve my problems. It's only making life harder for me." So, if you can pull clinicians into those conversations and those investment decisions, that's really going to help make sure that technology is fitting into the workflow and not just adding more on top of the work that our clinicians already have to do. Jordan Peterson (12:20): And then, I would add a third thing to prioritize in addition to extending clinician reach and improving the work environment, and that's to also prioritize nurses when you're thinking about how technology can support your clinical workforce. Because- Rae Woods (12:36): Yeah. Jordan Peterson (12:38): ... what we found when we were talking to leaders is that a lot of the examples they were giving us about the ways they use technology and who they've set that technology up for were physicians. But we know-, Rae Woods (12:52): Can we explicitly name why that is? Because that's exactly right. I mean, I've been doing physician research for a long time, and I had been talking about reducing administrative burden and bringing joy back to medicine for the context of physician burnout, specifically. But we've been having this conversation talking about clinicians. Why have we only, as an industry, focused our efforts, or mostly focused our efforts, on doctors alone? Jordan Peterson (13:19): I think there are two main reasons. One, the financial incentives of healthcare makes it easier for leaders to prioritize physician workflows because if you make your physicians more efficient, they'll see more patients. That's more revenue for your bottom line. But then, there's also the second element, which is more of the cultural perception of physicians and nurses. We typically see physicians as partners to the organization, so their needs are met, their wants are prioritized. Rae Woods (13:53): Yeah. Jordan Peterson (13:54): Whereas, nurses are seen as employees of the organization. And so- Rae Woods (13:59): Yeah, this is a cost center. Jordan Peterson (14:00): Yeah, exactly. Rae Woods (14:02): And this has to be frustrating for our listeners. Allyson, this has to be frustrating for you to hear as a researcher who has focused on nursing for the majority of her career. And I also want to name the fact that, when we talk about the workforce crisis, isn't the biggest strain still today in nursing, and in bedside nursing specifically? Allyson Paiewonsky (14:25): Yeah, it's definitely it's bedside nursing. They're the largest part of the workforce and probably the least invested in terms of tech. And I think there's really an opportunity here to look at why is it hard to retain our nurses, and a lot of it has to do with turnover. And we know that drivers of turnover are burnout and nurses not being able to practice at top of license. So, if we're able to alleviate that burnout and make their work more enjoyable through technology, there's definitely possibility there to retain your nurses in the face of a workforce shortage. So, when you're looking at retention recruitment best practices, I think it's crucial that you're considering technology today. I think this is one of the major tools that you have in your pocket to be thinking about. And if you don't, it's going to be harder and harder to retain your nurses as more and more organizations are thinking about these things. Rae Woods (16:26): I think there are some direct parallels in the workforce crisis when it comes to nurses and when it comes to physicians, at least when it comes to using technology. I'm thinking about ambient listening. I am thinking about things that can help reduce, again, this administrative burden of medicine, note-taking, dictation, things like that. But when it comes to clinical work, being a physician, particularly being a physician in the ambulatory space, looks very different than being a bedside nurse. So, what specifically can we do to use technology to alleviate this burden among nurses, especially if that's an area where we're still seeing really high rates of turnover, really long time to fill, and really, really high costs that are still earning the attention of the C-suite at hospitals and health systems? Allyson Paiewonsky (17:14): Yeah. I think the automation of administrative tasks, taking documentation off of nurses' plates just like you would for doctors, is something that could make a big difference here. I think there's also opportunities to take some of the more laborious work off of nurses as well, thinking about in the future, there are ways to incorporate robots to take some of that monotonous laborious work away. I mean, that might be further down the line, but it's time to start thinking about those potential solutions. And I think virtual nursing is probably the biggest and most talked about opportunity here, and that's really a way that you can scale nursing expertise across your organization. I think we're seeing more and more nurses are reaching retirement age, and as they leave the workforce, they're taking a lot of their expertise with them. So, finding a way to retain them either through these flexible virtual roles, but then also making sure that they're passing on that expertise and that years of experience that they have to those newer nurses who are in need of that support. Rae Woods (18:14): I'm not sure everyone in our audience knows what virtual nursing is. Allyson Paiewonsky (18:17): Yeah. Rae Woods (18:18): Can you tell me more about what that might look like in practice? Allyson Paiewonsky (18:21): So, one of the most common models we've seen is a virtual expert nurse model where you have this nurse floating from afar. She's virtual, or he is virtual, and they're providing that support or hands-on assistance virtually to newer nurses. So, either monitoring vital signs or providing suggestions to nurses who are delivering care at the bedside physically, but just someone who is overseeing that role. It's also a really good way to facilitate team-based nursing and having those hierarchies of different roles on a team. Rae Woods (18:55): That also strikes me as something that can help with actual workforce shortages right now. Allyson Paiewonsky (19:00): Yeah. Rae Woods (19:00): Right? Allyson Paiewonsky (19:00): Yes. Rae Woods (19:00): That's not just something where I'm thinking about making the practice and the work of nursing better such that the existing nurses will stay, but that sounds like a strategy to actually stave off real shortages. Allyson Paiewonsky (19:13): Right. Yeah, I think it's something we see a lot of our members doing already. It's something that we've also profiled for years and just hasn't been adopted. And I think we're finally at the point where this technology is easy to implement, it's something that we have virtual visits for doctors, we can do virtual nursing for nurses. It is something that we have the technology and should be capable of, but I think there's just been this hesitation to adopt it for a lot of those reasons that Jordan mentioned earlier about that disconnect between investing in physicians versus investing in nurses. Rae Woods (19:47): But you said yourself, Allyson, that now these are non-negotiable investments. Allyson Paiewonsky (19:52): Yeah. Rae Woods (19:52): Right? We cannot hire our way out of the workforce crisis, so we need to be thinking about investing in these technologies now. Is that finally being recognized by the market? Is it possible with, again, I'm thinking about hospitals right now because thinking about bedside nursing. Hospitals are in such a fragile state. They don't have an extra dollar, and that's why they're thinking, "Gosh, can I actually do the I in the ROI and make a big investment now?" Are leaders able to follow your advice, which is say, "The time is now. We've actually got to make this investment." Allyson Paiewonsky (20:29): I would like to think, yes. I think part of the research Jordan and I have been doing, it has really shown that you can no longer afford not to invest in technology. I think it really is the time is now. If you continue to drag your feet here, you just get further behind your competitors, and it gets harder and harder to, I think, remain viable and staff in this type of environment. Jordan Peterson (20:50): I would also add that one thing that makes it, maybe, easier for leaders to start thinking about technology as a tool to support clinicians is that clinicians are more open to technology in their work now. So, on one hand, everyone went through the pandemic. There was a huge increase in telehealth visits. I think that was one way that technology got added into their workflow, and clinicians saw that it could work for them and it could work for their patients. So, that started to change the culture around the way clinicians view technology. Rae Woods (21:29): I also have felt this change. It was not long ago where, if I would bring up this idea of technology, I would get proverbial tomatoes thrown at me. It was like, "Hold on." I will say it was always folks that believed that technology, and AI in particular, was something that would happen. It was a question of when, not if. But my conversations have changed dramatically, to your point, Jordan, where folks are almost demanding this as being part of their daily practice, because that's really what's going to keep them engaged and excited to continue to show up to work. Let alone make their work easier, right? Jordan Peterson (22:07): Yep. And that's been a huge factor behind leaders finally investing in this technology, or at least sensing an urgency to invest in technology. Because not only our clinicians in the workforce weren't comfortable with it, but they're increasingly going to expect technology to help them with their daily work. So, I think the example- Rae Woods (22:30): Is it a differentiator for employers, right? We're talking about this context of the workforce crisis, and it's not just that people are leaving healthcare. Sometimes they're just switching jobs, switching employers. Is there a world where technology can actually be a lever to try to say, "Hey, come work for me because I offer a better solution than my competitor or than your existing organization?" Jordan Peterson (22:50): So, I would say today it is a differentiator. I think, soon, some of this technology will be considered table stakes. So, the example there is anything that helps with documentation administrative burden, we know that's a complaint amongst clinicians. It's what takes them away from patient care. We've already seen a lot of solutions that can take some of the burden off their plate. So, things like that will be table stakes. Why would a clinician want to handle that burden and face all of those clinical notes when they could work for an organization that takes care of that for them? Rae Woods (23:30): This conversation is making me really hopeful about an industry that will finally embrace, because they have to, technology as a necessary solution to advance against the clinical workforce crisis. But one of the most important things I heard from you all is that it is not magic. It is not a silver bullet. It is not a standalone perfect solution. And I'm thinking about all the times where clinicians have been burned, not just because the technology itself didn't work for them, but the implementation was actually what fell short. So, what do we need to know about the change management behind implementing some of these solutions such that they actually work for the clinicians that desperately need it? Jordan Peterson (24:14): So, I think the biggest thing there is making sure that you are using technology in a way that clinicians actually want to use it. So, we've mentioned a few times that clinicians have been burned in the past by technology implementations, but I think it's also important to remember that, for a lot of those implementations, the goal was never to help clinicians in the first place. Rae Woods (24:41): Yes. Jordan Peterson (24:42): The EHR is the example that we like to use here- Rae Woods (24:46): Yep. Jordan Peterson (24:46): ... where it didn't put into place to make clinicians' lives easier. It was put into place to make data more accessible- Rae Woods (24:54): Billing easier. Jordan Peterson (24:55): ... billing easier. And so, it accomplished those goals. And then, the other downstream effect was that it did put a burden on clinicians. And we can look at a lot of technology investments that have done similar things. So, I think the first part of change management is making sure that, when you're prioritizing investments, you know what your clinicians want and need from technology. Rae Woods (25:19): So, if the era of a tech enabled workforce is now, what's the one action step you want our listeners to take to start to unlock the potential of technology and actually address the workforce crisis? Jordan Peterson (25:34): I would build off of what we just talked about in that if they do one thing, ask their clinicians where they need help. Allyson Paiewonsky (25:41): Yeah. And I think I would add on to that, once you've asked your clinicians where they need help and you've implemented technology to help there, figure out what you're going to do with that time that your clinicians now have back in their day, and make sure you're not just doing more burdensome tasks that are going to lead to burnout and turnover. Be really intentional about how that time is spent once you've alleviated some of those pressures on your clinicians. Rae Woods (26:05): But you're so right. It's this idea that technology must solve an actual problem, and the problem we need to keep in the center of our minds is the workforce crisis, right? It's shortages, it's burnout, it's turnover. So, if we use technology to just increase the burden on our workforce, even if we've reduced the administrative tasks, we aren't keeping that problem central to our business decision making. Well, Jordan, Allyson, I hope to not wait a year to have you on again, although I'd be interested to see what's going to change in technology at the end of 2024. Hopefully, by then, we can be done talking about the clinical worker crisis. Thank you both so much for coming on Radio Advisory. Allyson Paiewonsky (26:47): Thanks, Rae. Jordan Peterson (26:47): Thank you. Rae Woods (26:55): In this episode, we talked about lots of different kinds of technologies, but we focused on how they can be deployed for a specific problem. Next week, we are going to do the opposite. I am bringing back fan favorite guest, former Head of AI for Microsoft, Tom Lawry. You'll remember, he actually helped this podcast win several awards, and Tom is coming back to talk about artificial intelligence and how it can be used to solve many problems in healthcare. We are going to talk about all of the possibilities, and we're also going to address some of your fears. (27:33): Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson, Kristin Myers, and Atticus Raasch. The episode was edited by Josh Rogers, with technical support by Dan Tayag, Chris Phelps, and Joe Shrum. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. Thanks for listening.