Using technology to reduce healthcare drudgery
Healthcare caregivers are burning out under the burden of common tasks and rising patient loads. It’s time to think creative about how tools can relieve the monotony.
Picture a patient who develops low blood pressure from a medication received while hospitalized. As a result, she falls while going to the bathroom.
Because her hospital unit is short staffed, she is on the floor for hours with no one checking on her. She becomes dehydrated, goes into renal failure and develops multiple pressure ulcers that become infected. She becomes septic and is transferred to the ICU. She fights for her life but eventually dies.
This was an entirely preventable event. Unfortunately, if you spoke to clinical staff currently on the front lines, this story will sound disturbingly familiar.
Who’s to blame
At first blush, one may want to cast blame on the staff. Wrong. The blame should be on the system. We are at a crisis point in clinical staffing, with fewer nurses and physicians taking care of more and sicker patients. It is an untenable situation.
The issue of clinical staffing has been an ongoing concern in the national healthcare system. Since the beginning of the pandemic, according to one report, 18 percent of healthcare workers have quit their jobs. Another 12 percent have been laid off. On top of that, of the remaining workers, 31 percent have considered leaving.
How are we trying to stop this bleeding? Our healthcare organizational leadership has a habit of falling back on tools that have worked in preceding decades. There is often a focus on pay. This makes logical sense. Our staff are more stressed out and want to be paid more. However, the result of this is that the increased labor costs are passed on to payers and employers.
The reality is that this is not sustainable. More importantly, it takes the focus off what is the bigger opportunity. There is a more fundamental solution – we can't afford to keep hammering away with the same strategies that have dug the hole in which we find ourselves. The strategies may have worked in the past, but there is a different reality now.
We have an opportunity to make things different...and better. We cannot re-engage our burned-out workforce without transforming the way our workforce works using technology.
The medical profession is deeply mission driven. Unfortunately, the pressures of COVID 19, clunky electronic workflows and regulatory demands have sucked much of the true mission out of our daily work. Instead, the work we do makes us feel like automatons and factory workers creating coding and regulatory widgets.
A complex answer
Many will advocate that we need to pay our staff better. However, I believe that the complete answer is far more complex.
Certainly, we need to pay our staff fairly, but the missing piece isn't more pay. I am a devotee of intrinsic motivators in professions like medicine that (ideally) involve more than assembling widgets. How can we escape the coding and regulatory widget factory hell? We can use modern technologies to bring the joy back into our work.
As a metaphor, think about the conflict in Ukraine. The reality is that Ukraine needs more soldiers. However, they are not going to get them. In opposition, they have a Russian adversary that has far greater resources, even if the soldiers it sends to the front are "cannon-fodder." The Ukrainians cannot win by matching Russian human waves. Instead, they will need to rely on technology to give them the edge. They will need to rely on technology to be a force multiplier.
Like the Ukrainians, we in healthcare will be fighting a battle that appears to have no end, with ever increasing volumes and other challenges. It is a fool's errand to rely on increasing our workforce numbers or increasing pay. The additional help isn't coming, and extrinsic motivators like higher wages will be temporary Band-Aids at best.
If we don't address how our workforce performs work, we will be as doomed as the Ukrainians without advanced Western weapons.
How can we rethink the approach to the clinical work we do? As a relatively simple example, consider the many clinical scoring tools used in clinical practice. Many of my colleagues pull up a web browser and use MDCalc.com, do the calculation and transcribe the result into an EMR. In fact, once you perform the score, there is even a handy "copy results" link that facilitates this exact workflow.
As handy as this is and certainly better than manually looking up the scoring system in the trusty old spiral bound "Washington Manual" I used in residency, more often than not, when I comment that we can embed these tools directly within EMR, the frequent response is, "You can do that?" We need to search out and deliver on these sorts of opportunities.
Using automation as a support
The daily work of a nurse is typically filled with many tasks and reminders. Individually, many are fairly simple but they add up and can erode a nurse's sense of purpose, especially when they take them away from doing more satisfying work.
Technology now can offload much of that drudgery and even fully complete such tasks. For instance, tele-sitting has become a common strategy to offer oversight to care with fewer staff. Typically, the systems enable a single person to watch six to eight patients at risk of falling or otherwise harming themselves.
However, there is now technology available that can use computer vision to highlight the one person that needs attention. The sitter does not have to have eyes on all screens; it enables a sitter to monitor dozens of patients at a time.
Moreover, the same sort of technology can be repurposed to track and document workflows in high volume/high turnover areas like the emergency and operating departments. We currently rely on brute force manual documentation, which is both a significant staff dissatisfier and produces bad data.
Certainly, these examples are not an exhaustive list of all the potential solutions, but they are a sample of the ways we can rethink how we can think of our technology shops as true strategic resources.
If we are successful, we can reduce the drudgery for our clinical staff. They will be able to do the things that actually give them satisfaction – interacting and educating with the patients, doing shared decision making and other higher value-added activities. Let's remove the widget making aspect of healthcare and unshackle ourselves from our old mental anchors. We can not only transform care, but we can also transform and regain our joy of taking care of patients.
John Lee, MD, has been a clinical informaticist since 2006 and has been Chief Medical Information officer at two health systems. In 2019, he was honored with the prestigious HIMSS Physician Executive of the Year award. He is a firm believer that the key to solving the myriad problems we experience in our healthcare system is efficient and transparent delivery of information.