Episode 5 : Breaking Paradigms to Reimagine Care Models

Smart from the Start_Stephen J. Motew: Audio automatically transcribed by Sonix

Smart from the Start_Stephen J. Motew: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Smart from the Start Intro/Outro:
Welcome to Smart from the Start! Presented by Care.ai, the Smart Care Facility platform company and leader in AI and ambient intelligence for healthcare. Join Steve Lieber, former CEO of HIMSS, as he interviews the brightest minds in the health provider space on truly transformative technologies that are modernizing healthcare.

Steve Lieber:
Hello, and welcome to Smart from the Start. I'm your host, Steve Lieber, and it is my pleasure to bring to you a series of conversations with some of the sharpest minds in health information technology. We'll discuss the smart directions healthcare companies and providers are pursuing to create smart care teams. Today, I'm joined by Dr. Stephen Motew. Dr. Motew currently serves as the Executive Vice President and Chief Clinical Enterprise at Inova Health System. In this role, he oversees all clinical service operations and focuses on delivering optimal outcomes for patients through innovative transformational change, patient care redesign, high reliability, business stewardship, and team building. Before joining Inova, he held the position of Senior Vice President for Novant Health, leading the Winston-Salem market and multiple system service lines. With over 20 years of experience. Steve is also a vascular surgeon. Welcome, Steve.

Stephen J. Motew:
Hey, Steve. Thanks so much. I really appreciate you having me and excited to share some of the really exciting things that we're doing here at Inova and in healthcare broadly.

Steve Lieber:
Excellent. That's exactly where we want to go to start with is understanding a couple of things about what you're doing. And certainly, we're interested in hearing the projects and the things that are front of mind in terms of innovation and what you're bringing in the area of digital health to the system, but we also want to explore how you get there. And so let's start there, of, okay, you've got, I'm sure, dozens, hundreds of people pushing on you with priorities and directions they want to go. How do you make a decision on what to do first?

Stephen J. Motew:
Steve, I think that there's a couple of particular really foundational things that I've learned and that we've stayed focused on here at Inova that apply broadly. We've been undergoing for the last four and a half, almost five years since Dr. Stephen Jones came here and took over as CEO, a pretty remarkable reimagining of Inova Healthcare System. And through that, our ability to establish priorities has been incredibly helpful, and I'll give you a few examples. First is we stay rigidly committed to our core mission and a focus on what is our core business. So you might notice that my title, which is really unique, is called the Chief of the Clinical Enterprise, and our core business is clinical excellence. It's providing high-quality care, what we really would term an aspirational vision of world-class and nation-leading. And both myself, other executives at Inova, and Dr. Jones have really stayed focused on saying, let's be the best we can be at our core business and avoid distractions. So I would say, first and foremost, that's how we begin to set our priorities. Right now, that means establishing an operating model, a change management system unique for Inova, but really focused on our core markets, which is in Northern Virginia and the surrounding DMV areas. I would say the second, where do we start, is paying attention to the fundamentals that are necessary to succeed in any endeavor in a people business. There's, I would argue, almost no more human of an endeavor than healthcare when we look at the challenges that we've had, not only in taking care of our patients and communities, but really our own people, as we know over the last several years and incredible stress. And we have been intentional in assuring that as an organization we are agile and embed a change management focus so that way we can be ready for whatever happens and this changes daily. And then I think the real last thing, which is for me the most exciting now that we've got these two fundamental things, right? Let's focus on our core business and be rigidly disciplined about that. Let's prepare the organization in for change and the comfort needed to do that in a traditionally really change-resistant industry, as I know you're very familiar with. And then the last and the exciting thing is reimagining the models of care. And to me, that is, we're really stuck in this in healthcare, particularly as a physician and provider myself, to models of care that were established in some cases over 100 years ago. And our ability to be flexible and change and rethink that is hard to do. We don't want to hurt people, safety is first, what we're doing, we think is working really well. And so, reimagining the care model really requires us to break paradigms, and that is why if you go back to what do we want to be good at and how are we going to change becomes so important. And I think that can really lead a lot into where does innovation and automation, the concepts of digital and even just improving the day-to-day care at the bedside, come into play.

Steve Lieber:
Those three core principles are really great in terms of organizing your strategic thinking. I want to pick on the last two because all of them are obviously related and interrelated, but change management and reimagining models. So this takes me to the question of incremental change versus transformative change. And so we can't, I don't think, always be in just a dramatic transformational mode. At times, we have to do a step-wise approach as well. Talk a little bit about how you kind of balance those two things of I really want to make some major change here versus I need to take people through a process, and maybe there are steps to transformation.

Stephen J. Motew:
Yeah, the, I like to say that all transformation and change is incremental, but that doesn't mean that it's slow, inefficient, and without a sense of urgency. The question is, how do you take each of those steps at the right pace? And to that point where we've really seen the fruits of our labors manifest itself is to be very intentional and disciplined on the change management paradigm, and that then allows us on the transformation to then move with a sense of really established urgency. I believe, and what we're experiencing is that, you can't do transformational change without having that foundation. And that's where we've all seen many organizations, large, small, international, healthcare, and others, really challenged, be challenged. If you try to move without understanding the implications of that change, then you're going to be stuck trying to transform things, as you said, all of a sudden, and then you look back and say, why didn't everybody come along with me? So I'll give you an example, and really, that's been really core to the transformation, I would say reimagining of Inova over the last three, 4 or 5 years. First, you have to be patient on that part. We have almost 22,000 team members as, particularly I'll pick on myself a little bit, physicians are very hard to change. And the amount of effort put in, we, you pick a change model, we modeled our change paradigm on Kotter, you can pick any, there's many of them. Put in place a intentional change management infrastructure, engage the stakeholders, and stay at it. And really, going back to your question about incremental, while that is incremental, we have seen the change happen very organically as we've moved incrementally through that change management paradigm. For example, we want to define ourselves as an organization that says yes to everything. It's yes to patients who want to come in, yes to the right and new technology. The mindset of our team is to be okay with not getting it perfectly right the first time and learning your lessons, being rigidly transparent, psychological safety, all of those things which are embedded in our care model, then allow somebody in the room to raise their hand in an innovation platform and say, Hey, I've got a great idea, and that's okay. And so from that, then I think we have the ability, and we're really just getting going at that stage now to have this wholesale transformation. But I won't pretend that it's easy and it never goes as quickly as you want it to go.

Steve Lieber:
And as you pointed out, with 22,000 team members, you can't always expect everybody to be at the same place at the same time, and so working through all that is a significant challenge. What are a couple of the projects that you'd like to point to that are really on the forefront of significant change to care outcomes the way clinicians are working? You choose, but give us a couple of examples.

Stephen J. Motew:
Yeah, we've been intentional in establishing an infrastructure that supports what we call care transformation. So it's really an engine that can take a clinical problem. So I'll start there, and then I'll get really into some of the operational challenges and solutions that we're thinking of. And in order to prime the pump to be able to say, I want to take care of this condition better for our communities, we've had a few really remarkable quick wins in this transformation. One example of this is, we recognize coming off of the tails of COVID, our volumes and our emergency departments and hospitals have been at an all-time high, and I think in some ways we're fortunate that we're busy. In other ways, we're really seeing, for example, in this example, mental illness be a humongous burden to our communities, more so than we've ever seen throughout all generations, and particularly in adolescence and youth. And recognizing that this drives, whether you're doing surgery or heart disease, we made an intentional care transformation decision to focus on establishing a model for depression. We started that over a year ago, and one small component of that is we made the declaration that every person who comes to seek care here or is a team member here, we are going to screen them and provide treatment for depression. So now we've got orthopedic surgeons and vascular surgeons like myself engaged in screening hundreds of thousands in the last several months. It's truly saving lives. So that would be an example of sort of where does transformation, you know, we put a rigid focus on one problem, we use that to test a transformation engine so all the support, the data and analytics, the operations, how do you actually ask somebody this, how do we allow them to use a digital front door to be screened for depression so it doesn't add burden. So that would be one example. The other example really is in rethinking, reimagining how care at the bedside in our acute facilities is managed. We'd say we're earlier in that process, so we're obviously looking at the ambient technology, the use of remote monitoring. I think that those are necessary, but they're not sufficient. The real challenge in the change management is to say, how do we rethink the team that takes care of a patient? So we're stuck in these concepts of ratios of team members, nurses come to mind, or there must be a doctor at the head of whatever you're doing. And the transformation that we're engaging on right now is questioning every one of those things. What does it look like to reimagine a care team that doesn't rely on an overburdened, overstressed workforce of doctors and nurses having to have a certain number that has to be there and still provide safe care and still provide an opportunity for our team members to enjoy the work that they're doing? And so that would be that next level of true transformation. And then the last thing I'll say, and I think that there is a lot of integration into newer technologies, we're looking at artificial intelligence and all the models associated with that, is the unburdening that one of the largest, if not the largest challenge in healthcare across the board is the level of workload that is now imposed on everybody, not just our clinical team members. We're busy, we're, we have pockets of inefficiency that we all know we're slightly outdated as some of the things that I just said. So I believe, and we are, we have implemented an internal innovation mindset, and we're calling it really frontline or innovation, already accessible AI, large language models to rethink how you write your emails so you never have to do that again. The amount of time that people take to do simple tasks. I truly believe that, at least in the first run to the newest and most exciting really industry transformation technology thing, getting that into the hands of individuals and empowering them to make their lives easier is the first step in unburdening. We're already beginning to see that with less meetings, a little bit less hunting and gathering on the floors. But once again, I think we're early, but I do not want to discount the simple stuff. It doesn't all have to be our new large language models and machine learning tackling the hardest clinical problems in research right now.

Steve Lieber:
Yeah, a lot there to unpack, and I really have 2 or 3 paths I want to go down, one on the screening for depression. I'm impressed with what sounds like a comprehensive sort of system-wide approach, not a one-off. This wasn't a behavioral health activity. It went throughout the organization, and everybody was brought into it, because it is a systemic sort of problem that doesn't manifest itself, only when somebody presents with the issue at hand, depression. They could be there for another reason. So really impressed with the way you described that and involving other disciplines and other parts of the organization around what probably falls in that category of core business. It's what we do, strategic priority. And then around ambient monitoring and artificial intelligence. Obviously, everybody's talking about these things now. We went through, what, probably 15, 20 years of data collection when we adopted EMRs. Now we're starting to do stuff with it. Now we started out with data analytics and that sort of stuff, but now we're getting into that point of actually doing something with it. We're not just analyzing it, but it's driving things. You mentioned Unburdening as an example, but you also mentioned clinical implications as well, which can also be part of the unburdening by helping people operate at the highest level of their license, so to speak, and all. So how are you able to sift through? Because it is early, you're right. You guys are at an early stage. We all are at an early stage here, and there's a lot of noise as well as a lot of value. How are you sifting through that as it relates to AI?

Stephen J. Motew:
As you, very much. You can always tell the buzzword excitement of the day by the sales pitch emails you get and how many people put those words in their signatures. So right now, I would say 99% of the pitch emails say powered by AI. I will say, as you very well know, having looked at all the technologic transformations that have occurred over our lives, which many, if not most, have been wonderful, not without their own challenges, this seems different, and I think with the explosion of sort of the socialization and the Rubicon that was crossed in November, December, when the large language models became more cognizant, for lack of a better word, and then socialized. I think that the excitement is real, and to what you're saying, we are early on. So there's a couple of things to answer your question that we think about balancing here. As always, risk is something that is at the top of mind, particularly in healthcare. When I think of risk, I think about hurting people and making sure that we do not do that, and then all of the attendant risks to that. I would also say that we have to be bold by keeping that in mind. So in sifting through this, it makes sense as we put our governance and understand the implications of the new technology in place, to start with, the No Regrets move. And I think that there's plenty of them, and that goes back really to the Unburdening. To use, for example, in the room early generation of ambient listening to capture not only the words in a dictation that somebody is saying, but some sentiment is relatively low risk because there's always a check mechanism right now. Now, I believe at some point, probably sooner than later, that check mechanism is not going to be necessary, but that's almost a no regrets. If I can speak and engage with a patient or a nurse can do that, and we have the ability to translate that check that the, I think clinicians are very used to that. We'll assimilate data from research, from papers, from articles, from colleagues, and we always put our thought process to them. Let me take the bits of pieces that I know are safe out of that. And I think that we should approach artificial intelligence models in a very similar way. I also, as I stated before, necessary almost no risk moves are in the administrative tasks. There is, we can't continue to hope that our staffing is just going to magically get better because we're paying less for contract labor this month. We have to really understand that automation and revenue cycle, insurance, and our emails and meetings. As you're probably well aware of, we're over-meeting and overburdened from that, particularly at the management and administrative level. I look for every minute I can gain back into my day so then I can take the time to be, to think, and to solve problems, and I think that helps sift through it. The last thing I'll say, which is something that we're gaining more traction on, we are very fortunate that we were able to recruit a new Chief Information and Digital Officer, Matt Cull from Cleveland Clinic, who just started a few weeks ago and a real thought leader in digital and information technology. And that was a time for us to really think of platform services. And the answer to your question, how do we sift through this, I think that there, we know that there are some established players that are now emerging because it is just a wild West out there right now, and the core technology that allows us to build on that as opposed to plopping a little, oh, this tool here and there without establishing a core platform service is one way that will help sift through this. So we're in that process right now really of thinking, who's going to be our core cloud partner? Who's going to be the AI infrastructure support? It may be more than one, but we really do think about that as a platform component. Bet on the big players at this point is at least the point of view that we have now.

Steve Lieber:
Yeah, you went exactly to where I was going to wrap this up and talking about platform versus point solutions, because when we, and AI is in that category of a new technology, it's not just a single tool. We do have the risk of adopting little pieces here and there, and suddenly, we find we're trying to knit together a whole lot of point stuff versus what you just described of, start out at the beginning think platform and go from there so that it really will encompass a whole suite of activities that are related to one another.

Stephen J. Motew:
Absolutely. That's, it sounds easier than it is because there will be point solutions that come up that fit a need perfectly, but take the time to really vet that out. As we said, we all have lots of colleagues and friends and collaboratives and initiatives, and I think that they can be enriched sources of information to curate a little bit, given how many solutions and what the investment is right now. It's, like I said, it's in every email pitch that I get, yeah.

Steve Lieber:
Excellent. So let's wrap up here. Our listeners are folks like you, so digital health leaders, information technology executives, what's your one takeaway? What's the thing that Steve has to say to his colleagues that you are doing, you've learned? That key takeaway.

Stephen J. Motew:
Without a doubt it's, do not discount the components of mindset change management that is necessary to be effective. Left up to me and many of us, Steve, I invest and bring in solutions for everything because this is just so cool and fun and transformation. At the end of the day, there's human beings and individuals that have to interact with this. And so, taking that intentional time to prime the pump to establish a mindset of inquiry, exploration, excitement, appropriate risk-taking. That vision of the future, I cannot overemphasize that. We've all seen too many times, even the most simple, whether it's technology or process or medication, fall flat, because we didn't take the intentional time to say, how is this going to impact that individual, and how can we garner that ability to say, come along with us, let's generate some excitement. Know that it's okay if it doesn't work first. Safety's always going to be at the top and allow us to innovate in that space.

Steve Lieber:
Yeah, that's great. We talk about healthcare being a people business, and oftentimes, we're talking about the patient when we say we're in the people business. But again, back to the 22,000 colleagues you work with, it's a people business on the provider side as well, and recognizing their needs and how you bring them along. Great insights. Steve, this has been a fantastic conversation. I really appreciate your time today.

Stephen J. Motew:
Thank you, Steve. I'm always happy to chat.

Steve Lieber:
And to our listeners, thank you for joining us. I hope this series helped you make healthcare smarter and move at the speed of tech. Be well.

Smart from the Start Intro/Outro:
Thanks for listening to Smart from the Start. For best practices in AI, in ambient intelligence, and ways your organization can help lead the era of smart hospitals, visit us at SmartHospital.AI, and for information on the leading Smart Care Facility platform, visit Care.ai.

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