Smart from the Start_Marty Bonick: 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 Marty Bonik, president and Chief Executive Officer of Ardent Health Service. Over the past 25 years, Marty has held senior management roles in large, tertiary, and academic medical centers, multi-site systems of inpatient hospital and outpatient facilities, and physician services organizations, including a CEO of PhyMed Healthcare group, division president at Community Health Systems, CEO of Jewish Hospital, and Senior Vice President of Operations for Jewish Hospital and Saint Mary's Healthcare in Louisville, Kentucky. Fellow in the American College of Healthcare Executives, he also serves as chairman of the board of the Federation of American Hospitals. Welcome, Marty!
Marty Bonick:
Thank you, Steve. Great to be here.
Steve Lieber:
Well, I'm really looking forward to this conversation. We have a number of issues we want to cover today, and getting the perspective from a CEO really helps all of us understand strategy setting and then the resulting implementation. But let's start out talking about workforce challenges. So we had the pandemic, we've got post-pandemic reassessment of work-life balance, we've got employees driven by a desire to work more remotely, scarcity of employees, wage inflation, you name it, you've dealt with it over the past few years. So give us a little insight as to how you view where we are today. And the follow-up question is going to be, okay, where are we headed in terms of workforce issues in healthcare?
Marty Bonick:
Yeah, Steve, I mean, you hit the challenges right on the head, and we're experiencing our fair share of that, as is the industry. What I would probably add to what you said is I've used this analogy a number of times. We think about hurricanes, and when it's hurricane season across the US, the world gets all cued up about that, the media is focused upon where is it going to hit, how long is it going to hit, what kind of damage is it going to do. And the hurricane inevitably hits, it does what it's going to do, it moves on, and as does the media. And for the people that lived in that area, though, that's when the real work starts, the cleanup work. And as I think about the last several years, it'll be about three years for me next month, in August, that I've been at Ardent. I came in really sort of as the pandemic was ramping up, and so, to your point, we've seen it come down, but we're really in that cleanup phase now. The media has moved on, the world's moved on, you know, we've kind of moved past COVID, ... fatigued or what have you. Clinically, things have improved a lot, but we've learned how to manage it inside the hospitals; it's not completely gone away. But the damage that was done, the workforce burnout, the number of nurses, clinicians that have left the field or found other opportunities to work outside of traditional healthcare environments has been magnified, and we're not graduating enough new people coming in to replace the damage that was done. And so we're working shorter, and the demand for services has come back, and it's rebounded largely, and so we've got to find new ways to take care of our people, and one, prevent further attrition, further burnout, and find different ways of caring for people than we've done before. And I think the silver lining to the pandemic, if you want to look at that side of it, is that a number of companies popped up, a number of services, ideas, technologies, that showed that we can care for patients in a different way. Telehealth is a good example of that and how that's proliferated in a number of different directions, not just direct to consumer, but how it's helping people inside of the traditional care environments do and provide care differently. But we have to embrace technology if we're going to get through this workforce shortage, because it's not going to get solved by just hiring more people. The people aren't there anymore, and so we're going to have to find new solutions.
Steve Lieber:
You're right, in terms of people aren't there, and so, what are the, and it's not instead of, it's oftentimes in conjunction with so they work smarter and such. And so, let's kind of pick apart this thought about technology and how the environment has driven you to utilize technology. Now, a lot of the stuff I read during the pandemic, health systems really ramped up telehealth. And then as we came out of it, I'm reading it's dropping back down not to pre-pandemic levels, but dropping off. Give us a little insight about that wave and where are we now, and are you perhaps moving into some different directions other than remote care or distant care? Yeah, great new definition for telehealth in a sense.
Marty Bonick:
Yeah, absolutely. Great topic, and a lot to unpack there. So I'll start with the first part of the question, which is, what was the demand? So I'll talk for Ardent. So pre-pandemic, Ardent was doing telehealth, quote-unquote, and we were seeing maybe a thousand patients or just shy of a thousand patients a month across eight markets in six states. So really, we were dabbling in telehealth, and it was something we, you know, it was a novelty. There were certain physicians that had an interest. We were sort of trying it out, but there was really no concerted strategy. So we'll call it a thousand visits a month. In April of 2020, as COVID was starting to ramp up, we went from a thousand visits a month to 60,000 visits a month, so 0 to 60, like healthcare doesn't move that fast. In two months' time, we had a 60x growth, which in our experience, I think was indicative to what most of the industry was seeing, just this phenomenal growth, this phenomenal energy. Well, if you go back, I go back in my career, the first time I was with Ardent back in Oklahoma as a CEO, at our teaching hospital there we were doing telehealth back then, back 15-plus years ago, but it was more inside the hospital, it wasn't consumer-facing. And so, you know, the world has changed, but the technology existed. COVID gave us the practical reason to have to use the technology, and the good news is the industry did, people did. Now, what's happened, you know, COVID has leveled off, we've learned how to control it, we got masks going. You know, we found a way to get back in person. Why? One, we had offices and people that were used to doing that were paying for these real estate spaces to take care of patients, and that's how people traditionally are accustomed to doing their work, and so we started to see that curve come back down. So now, in a post-pandemic world, quote-unquote, we're doing somewhere between 11,000 and 13,000 visits a month. So, yes, way, way far short of where that peak was. But if we go back to traditional business terms, where can you say you've had 12x or 13x growth in a couple-year period and sustaining that, that's pretty impressive. I'll take those statistics on most of my investments, you know, so that's, but you know, I think if you just follow the Wall Street headlines, you've seen Teladoc and Amwell and some of these big companies that soared and then plummeted. It's not that the technology is not working, it's not that people don't want to, it's our inertia as an industry trying to go back to the status quo and not really embracing it. So at Ardent, we're really looking at this as a new business opportunity to connect with our patients. How do people want to be connected with, and I got to use telehealth during the pandemic for my own personal needs, and after having done that, it's not the panacea. It can't solve every process or every problem, but once you've tasted that, I don't want to go back to the way it was before. And so I've challenged our organization to think the same way. And how do we think about this as an actual business line? And you didn't ask about disruptors or, you know, sort of nontraditional, I'm sure we'll get there, but, you know, it's just, while we're on the topic, Amazon bought OneMedical group, and they have a telehealth offering. And so this past Prime Day, a couple of weeks ago, they blanketed the world with these email solicitations. Join Amazon's OneMedical Prime Healthcare group, and you have access to 24/7 telehealth for $169 a year or whatever it was. My wife sent me that email that she got, and she's like, Oh, look, Amazon cares about me. And, you know, and I said, Gosh, I live in Nashville, and I'm pretty sure that all the big systems here are doing telehealth also, but I didn't get a solicitation from them. And then I said, okay, we do telehealth at Ardent, and all of our clinics, we have same-day or on-demand video visits. You can come and do it, it's on our home page. Did we blanket our customers with joining Ardent Medical Group and Ardent telehealth platform? Not yet, but we are, we will be, and we have to think about it, because if you think about it, consumer mindset, we want ease of access, we want on-demand, we want what we want when we want it, and healthcare traditionally hasn't been that way. So I think this is the opportunity we have as an industry to really seize the moment, because it's not that it's not working or people don't like it; we have tried to force people back to the way it used to be because that's what's comfortable for us. We've got to get comfortable being uncomfortable, otherwise, these quote, disruptors are going to come in and try to disrupt us, but I think it's ours to lose. And for Ardent's sake, we're trying to seize that moment and capitalize on that because we don't have some of these bigger, bigger competitors, at least national competitors, coming into our markets. They're starting to, but if we can do a good job of doing what they're trying to do and do it ourselves, then there's not room for them to come in.
Steve Lieber:
Yeah, you know, we've all talked about it for years, about the patient being at the center of what we do, and we have to be honest and say that really wasn't the case, but we do. We all expect a degree of convenience, and I wanted in healthcare, and I just moved, and I needed something from Home Depot. Well, I'm not getting in my car because it's 97 degrees today in Washington, and so I went on Amazon, and it's going to be here tomorrow morning, and it's like, I wouldn't have gotten out any faster, so we have we've come very demanding in that respect. The other side of it is, back to the workforce, there are drivers for, doing this for the patient and for the convenience and the expectations that we all have, but also on your workforce, back to your shortages, the scarcity of talent, and such. So, in settings such as ambient monitoring and listening and things like that, what are you looking at in terms of how you're using technology to address the workforce issue?
Marty Bonick:
Yeah, I think we're at a great moment in time where healthcare, traditionally we have pushed technology on our providers and our clinicians, and our clinicians have largely had to work for the technology. I think we're at a tipping point here where the technology can actually work for our caregivers, and so I'm excited about that. We've got a number of partnerships that we've kicked off across Ardent, and one of them sort of fits the telemedicine theme that we've been on, but doing it and using it inside, and that's what's Care.ai. Care.ai has the ambient listening, the monitoring, the telehealth component, where we have virtual nursing programs and starting virtual attending programs where we can bring the people to the person inside the room and use technology. If I can zoom from room to room to room, that's a lot quicker than me walking from room to room to room or hospitals or big complex spaces. If I need to get from the seventh floor to the third floor back up to the fifth floor, that takes time, but with technology, it's clicks of buttons, and we can get to people where they need it most and where we can triage that help. And so this is an example where I think technology is going to work to help our workforce. And again, there's proponents of this, and there's people that will say, particularly from a union perspective, but I think that that's a shortsighted mindset. We're not using technology to try to replace people, but as we talked about before, when you don't have enough people, we need to do something to help them. And technology, I think, is going to be that leveling factor. We've got the virtual nursing programs that we've started in Albuquerque. We've rolled out to Idaho, we're moving to Texas. These partnerships are helping to be an augmentation and a support system to our floor nurses, and to bring people in that can spend more time with patients and doing some of the necessary but very tedious or intensive background histories, discharge instructions, admissions assessments, medication reconciliation; very important that we have those things done and do them well, but they take people away when they're getting called by the next patient, or a call because somebody needs a pain medication or needs to go to restroom. So now we can divide the work up and make sure it's getting done. And it's not necessarily less people, we haven't really saved any labor as a result of doing this in a meaningful way, but we're helping to support our team to balance out the workforce shortages that we're just all experiencing. And it's just about divvying up the work and doing it smarter versus harder, which is what we've been doing, or just asking people to run faster on the hamster wheel. It's like, no, let's divide the work. Let's be thoughtful about how the work gets done and who needs to do that. It's also been a benefit to extend the workforce in terms of, we had one of our nurses, Elka, Elka works in our New Mexico facility and got relocated due to her husband's job. Well, Elka still works with us now, and she does it remotely, and she's able to zoom in and care for her patients and do it well. Got another nurse, John, who was injured on the job and couldn't be on his feet and spend 12 hours a day at a hospital walking around. Well, now he can still be a nurse and interact with our patients in a way where he's able to fulfill his personal passion of being a nurse and caring for people, but doing it a way that didn't exist before. And so I'm really just excited that we're at the tip of the iceberg in terms of the possibilities of reimagining how we deliver care in our hospitals, how we take care of our patients and be smarter doing it. Another partnership we have with a company called Bio IntelliSense, and they make what's called the bio button. And basically, this is automating the vital sign capture. The number of machines, and wires, and pumps that we're connected to people, now, one little button, this little device that is placed on the patient's chest can monitor all that. And instead of getting vitals 3 or 4 times a day on a med surge unit, which is what the typical standard of care is, we're getting minute-by-minute vitals. So we're essentially getting ICU-level monitoring in the med surge environment, and we can detect if somebody is improving faster than we expected or deteriorating faster than you might not have been picked up if we were doing traditional vital sign capture and literally saved a patient's life the first day we put it on the unit. We just expanded this to one of our hospitals in Tulsa, Oklahoma, and the very first day we put it on, we caught somebody that was becoming septic. And if we didn't have that and the machines' alert watch system was capturing and trending this patient's vitals, we might not have caught that, and that patient might have had a code. That patient might have had to been transferred to an ICU or something else. And so technology is really starting to work for our caregivers to allow them to work at the top of their license and be able to do their job more effectively and provide better outcomes of care for our patients.
Steve Lieber:
Outstanding examples, really is, and your point about, you're augmenting, you're allowing them to operate at the top of their licensure. All of those sorts of things really are the strong arguments. You, also your story kind of indicates to me there's a little more than just collection of data here. There looks like there might be a little artificial intelligence or something going on here to help understand where a patient's headed, what's likely to happen, and queue people up to be ready to react.
Marty Bonick:
Absolutely. I mean, I think we're at the early signs of progress here, but when you've got clinicians that are saying, okay, this technology can make my job better, easier, more effective, efficient, then you start to get people that ideate around it and go, okay, well if we can capture vital signs minute by minute, and the machines can watch what's happening, there's no physical value in a nurse or an aide or a technician going and taking the vital sign. That benefit is the result of the vital sign. And now the machines are doing it, and the machines are tracking and trending it and doing this in real-time in ways that, again, with 14,140 data points across the day versus 3 or 4, you can detect patterns and trends and is within control limits or without a control limits. And so, yes, as we start to apply, you think about all the inputs that we put into an EMR. We've got tons of things coming in from lab work and radiology results and doctor impression notes, nursing notes, inputs, and outputs. We've got a ton of data going in, but historically, it's been a data capture system, and it takes humans to sort of extract the intelligence out of it. Now, with machine learning, natural language processing, data collection, AI, all of these things are going to help provide insights for the future that are going to actually, I think, drive and improve the outcomes and effectiveness of the care that we can deliver in ways that just humans can't do it when you're seeing multiple patients a day, short visit windows, the machines can be working in the background and again working as a support system to make us better, make us smarter.
Steve Lieber:
You talk about EHRs being data capture, and obviously, have captured a lot. Key is pulling that information out in a way that works, that tells you something. Are you seeing good connectivity and interoperability between what now we're going to call Legacy, which back in, 20 years ago, they were the new kid on the block, the Legacy EHR systems, and these new technologies? How's that looking?
Marty Bonick:
I think it's a work-in-progress process, but I think it's working. You know, we're seeing we use Epic across our entire platform of our hospitals and our clinics all across the country, and Epic's a great partner to work with, and we've had good success with them. They are continuing to innovate around their platform, but they realize that there's partnerships that are needed. So they've got a partnership with Microsoft around AI, and you can imagine the power of those two companies coming together with that will yield, but there's other partners that we've been working with that are integrated into Epic's app, Orchard, and vendor partnership side, that we can interchange the data from the EHR into these newer, more innovative technologies that are coming about, and that's key. We have to have that integration to make this work, and I think all parties understand that there's a necessary coordination and collaboration to make everybody work at the top benefit of what their technology can bring to the table for patients.
Steve Lieber:
Gotcha. And looking at your background, you've got a master's in information management, and you're CEO. I would expect that creates a little different dynamic with your digital leaders, your CIO, your CTO, and others. And, you know, I'm not really asking you, okay, what about those other guys that don't have that background that are CEOs? But talk a little bit about how it works in your shop in terms of how that strategy conversation goes in Ardent with a CEO who knows what he's talking about.
Marty Bonick:
Yeah, yeah, no, that's a funny story because when I came into the organization, our IT leaders and digital leaders, like you said, were kind of excited. It's like, oh, the CEO kind of understands our world and literally was just having this conversation with one of our IT leaders this morning, and they're like, oh, did he kind of knows what he's talking about. And, you know, you can't just, two sides to that coin, you can't give me IT speak, and he's like, Yeah, we don't like that anymore because it's like, you know our world enough that, you know, I always say that I know enough to be dangerous. Like, I'm not the expert, and I realize that, but it does, you know, I grew up, and it's always just been fascinated by computers and technology and kind of have this geeky tech side to me that I've always appreciated, but when you apply that to healthcare, this is our opportunity. And so, working with leaders that understand that potential of technology, with operators that also understand the potential of technology, I think, causes us to think differently, and I want to think about what's possible, not all the roadblocks of why it's not. You know, I think healthcare should be easy. And I've used this example, we all carry these little iPhone or Android devices in our pocket, and I can control my world from this, I can control my car, my thermostat, my bank account, all these different things, but in healthcare, it's kind of been a brick historically. You know, I can call somebody, navigate a phone tree, get put on hold, be frustrated, get disconnected, and like, why is it so hard? I can go online and schedule my haircut and press a couple of buttons. I'm not saying healthcare is as easy as scheduling a haircut, but why can't it be? I mean, why should our insurance system not be a card in my Apple wallet that I just come and tap it at the device instead of having to produce a physical card? Somebody's making a photocopy of that, scanning it, looking up and trying to find out of the hundreds of health plans that we have, which one is yours, what's your co-pay, what's your deductible? The technology exists to make that easy. We just have not embraced that as an industry. And so, you know, with everything that we do, we're really trying to challenge ourselves to think about the consumer's perspective. What is their mindset, what do they want, what do they value? And it's not that hard. Think about your own life. What do you want, what do you value, and how do we start to apply that? And the solutions are out there. Yes, it's a complex industry, and we only control certain parts of it as providers. The insurers have their own rules, the government has its own rules, but if we come together and if we're really trying to solve the triple aim of improving access, quality outcomes, costs, the technology exists. Other industries have figured this out. So I'm excited about that, and having that background allows me to push our organization to say what is possible and how do we get there, versus just hearing all the reasons why we can't and being defenders of the status quo. So that's how I've tried to incorporate that side of me into the organization, and I think we're responding well.
Steve Lieber:
You touched on, really sort of the wrap-up question that I wanted to touch on, and that is the risk of the status quo. Healthcare historically has been viewed as slow to adopt and that sort of thing, and I think we all have both legitimate as well as defensive reasons we throw out as to the why. Are you seeing, you've been in the business long enough, is the pace of change happening at a more rapid pace, or is it just a different kind of change, and we're still going to kind of experience the incremental processes we have in the past? Kind of give us a view of what Marty sees over the next five years.
Marty Bonick:
I've got lots of little Martyisms, I guess, but one of them is that most things are evolution, not revolution. I would say I'm not satisfied with the pace of change, but I do think to your point, it is starting to accelerate, you know, from where it's been. It's not going to change overnight. I don't think we're going to be there next year or the year after, but I do see meaningful progress happening, particularly as the world is primed for it, and we've got workforce challenges that are going to demand that we think differently. And consumers have tasted through the pandemic what possible could look like. And right now, it's manifesting itself in a number of point solutions that have come to bear, but most people don't have problems that live in a single-point solution. And so, you know, people with comorbidities and complex medical chronic conditions, those types of things, a point solution will only get you so far. And so I think healthcare systems are in the driver's seat if we seize this opportunity to embrace the change, but we've got to do that. And we can't just sort of half-heartedly do it and say, well, we're really just trying to protect the status quo, but we're going to talk about innovation and-. We really got to do it, and we've even started to try to change our vernacular that we're not talking about innovation. This is about how we need to do business. This is about embracing consumerism. This is embracing what our patients want from us. And yes, we're doing some innovative things to address those concerns, but this needs to be how we do business, not just a novelty, you know? And I think that's where I see a little bit of sort of a foot on the boat and a foot on the dock within the industry as people are talking a lot more about innovation, but it's in a novel sense and not in a sea change way, in which I think it needs to be to truly deliver the care that people want and the service that people want at a price that people can afford. So those are the things that we're going to have to continue to work on. And I think that again, within the organization, we've pushed a lot of change through Ardent over the last few years, and I think people have responded quite well. And my bias around this is that people are not as averse to change as we think they are, it's changed on with you versus changed on to you. And people need to understand why we're doing this change and what do our customers expect. Is it something that you would want? And having my own personal health journey that I've gone through after an accident a couple of years ago or a year and a half ago, and my wife going through one right now with a knee problem that she's having. And when you become a patient and really start to think of it from that perspective, you can see where the inefficiencies are. We've got great people trying to do great things and taking care of people surrounded by challenging processes and systems that weren't designed to work together or work in harmony with each other, but us as leaders, that's our job. We need to break down those barriers. We need to challenge the status quo, and we need to embrace the change that people want from us. So that's how I see the next few years playing out for us, and I hope the rest of the industry will continue in a meaningful way in that direction.
Steve Lieber:
Great. Marty, this has been a real treat to chat with you today. Some great insights about what's going on not only at Ardent, but across healthcare at large. So thank you very much for your time today.
Marty Bonick:
Pleasure to be with you, Steve. Thank you.
Steve Lieber:
You bet. And to our listeners, thank you for joining us. I hope this series helps 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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