Smart from the Start_Roberta Schwartz: 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. Roberta Schwartz. Roberta is the Executive Vice President and Chief Innovation Officer of Houston Methodist Hospital. She oversees all operations at the 948-bed hospital and is responsible for advancing and expanding Houston Methodist digital innovation platforms, including telemedicine, artificial intelligence, and big data. Prior to joining Houston Methodist, Roberta worked as director of business development for Mount Sinai School of Medicine in New York and as a consultant and project manager for several academic medical centers, companies, and the federal government. Roberta earned her PhD from the University of Texas School of Public Health and was most recently recognized by Modern Healthcare's top 25 women leaders as one of its ten women to watch. Welcome, Roberta.
Roberta Schwartz:
Thank you so much for having me.
Steve Lieber:
Looking forward to this conversation. There are a lot of great things that you're driving down there at Houston Methodist. And so, let's go up a level first, though, and talk broadly about the definition and vision of smart hospitals and smart care teams.
Roberta Schwartz:
Yeah, it's really interesting to recognize that in healthcare, we've been doing things the same way for a very long time. In fact, we were looking at some new vital sign technology bio buttons, and one of the nurses in the room who said, We've been doing vital signs every four hours since doctors smoked in hospitals. When you think about that, there are so many things that we've been doing the same way for a very long time in nursing interactions and other interactions, the way we staff, and the biggest change is really been the electronic medical record, which is that foundational piece that everybody needed, but it's a repository. It's a repository of information that we have about the patients, and we try to layer on some things to make the electronic medical record smarter or work for us rather than us working for the medical record. You hear those phrases all the time.
Steve Lieber:
We do.
Roberta Schwartz:
But there are better ways to make the same widget rather than changing the way that the entire, we look at patients, and then we staff institutions. And I think that's that definition of smart, and that's that definition of innovative; we sometimes call it Small Is, Big Is. Like it's, there are things that like incrementally change, and there are things that you turn around and go, Oh my God, I don't know what, I didn't know, what I didn't have.
Steve Lieber:
Thinking about the EMR as repository and turning it, I hope I'm not being disparaging, turning it into a smart, smarter, not the smart before, but a smarter tool and getting intelligence out of it. I think that's something of a light bulb turning on with all of us as we went through the evolution of first getting people to even recognize the value of multi-encounter digital patient record as, and so our focus was on repository for a long time, but I really liked your definition there of turning that into a smarter tool by getting something out of it. I think that's really insightful. So, at Houston Methodist specifically, how are you doing this? How do you organize teams? How do you organize the approach? What's your thinking on maybe both the little I, incremental, as well as the, oh my Lord, change type of process that you go through and how you accomplish that?
Roberta Schwartz:
So we recognize pretty early on that, or at least I would say we took a shot at this from a very different direction. Most hospitals were going outside. They were going out to hire somebody from Google or hire someone from Amazon; they were hiring somebody from a whole different, Uber, someone who had already transformed, and they would look at these people and see what these people could do to healthcare. What they didn't recognize was how complicated healthcare structures are, how complicated our insurance is, or the most regulated industry. There's not a week that goes by where I don't have at least two surveyors from outside organizations in here to look at some process that's happening within the hospital. It's like a microcosm of the world. You're serving food, you're going to have the food people in serving, you're going to have pet CTs, you're going to have nuclear kind of folks coming in for nuclear safety, you're going to have all kinds of different people that are involved in a hospital, and so when you come in from the outside to really understand all of these million pieces of complexity is really hard. And so when we started really getting interested and invested in innovation in a very different way, we basically brought these marriage operators with IT. What we recognize is we were never going to build this, never going to build anything as fast and as good as innovators that were out in the community. And if we partnered with them, then our job was not to decide which of them was going to be great or not. Our job was to show them to pick companies that can work in a complicated healthcare environment and grow with them. So we would offer that operational expertise. We would offer that how to work with the systems, and we would partner with these companies almost, they had the grill with the steaks already on it. Our job was to say, okay, who was going to eat it? And like, how do we pour gasoline onto the fire? Those were our two jobs. And if we did that, then we'd all partake in this incredible meal. And so we did, so we partnered with some incredible companies who people ask us all the time, Are you owners? The answer is no. Like, we're not trying to own the companies. I'm not trying to profit from the companies. I'm trying to make healthcare for our patients better. So we're very purists. We are trying to bring that to the table. And then we recognize that these companies don't have that expertise that we have. And if we catch them at that right moment in that right time, and they allow us to basically bring that expertise to the table, we can take these companies and help them be great for everybody. That's our, that's been our mission. And our partnerships with some of these industry companies now that have grown far beyond where the beginnings of where we knew them and they're all over the place is really been not only a testament to these great companies we get to work with and many more that we don't get to work with, but also the investment that our people, our operators have in working with these companies to make the operation much better.
Steve Lieber:
Let's talk a little bit about how it works internally and how the workforce is reacting to the change in innovation, referenced it before, of having things done to them. Have we turned a corner, and maybe we're better at what we're bringing forward? Maybe what we're bringing forward is better. What's the sentiment you're seeing on the front lines in terms of the projects that are being brought forward?
Roberta Schwartz:
I think one of the things that I love is that our people really do embrace, like they really are embracing innovation. Now, despite embracing innovation, the minute it, people love something that's an And. Oh, I get to stay the way I am, and I get to add an innovation. The issue and the challenge that you've got, which is why it's so important that operators are integral in every piece of movement that you have. Because honestly, we can't afford a "healthcare and" we need, labor costs are going up, no insurance or government is saying, "What we want to do to hospitals? Pay them a lot more money," which means we make our operations more efficient and we improve the care to reduce the cost, the total cost of care, right? That's what, where our future has to be. And so, internally, the struggle comes with very small teams associated with innovation. Most of our teams are actually like, I run the hospital, I run a major academic center, and I do innovation. Our head of IT and innovation, she runs a lot of our clinical and operational IT, and she runs innovation with six people who are dedicated to the innovation team full-time. It's a very small number of people that are trying to move an organization of 30,000. So we need people from the inside when it's, and I get this, and I get the technology, staff are fantastic. When you start saying, "Now I'm going to replace this, and we're going to do it this way, and you're going to have to change, and we're going to have different types of people, and maybe different numbers of FTEs." Then it's, "What did you just say? What did you just say to me?" And then, you'll start to recognize that the change process, no matter what you do, people say they like change. They do not like change. People like things to be predictable, and innovation makes things unpredictable. And so that's where you'll get this initial really like embracing. Then, you and almost every one of these, you get an a jerk back and then a move forward. So the question is how deep and how difficult is the jerk back and how prepared are we for that and how to address it and then the move forward. And I tell everybody when they do these things, and they come on, and they're a new operator, maybe in a new area, I try to warn them about the jerk. And sometimes they just it happens, and they're like, but they're rebelling. And I'm like, I warned you that the jerk was going to happen.
Steve Lieber:
This was predictable. We knew it was coming.
Roberta Schwartz:
Predictable jerk. When you just got to work through it, you can't give up at that point. The jerk makes people really, a lot of times, stop and give up.
Steve Lieber:
You mentioned something there in terms of dual role that you have that I want to highlight because my takeaway from that is having a foot in operations and a foot in innovation gives you an advantage. You see it that way?
Roberta Schwartz:
Yeah, I think that it's both an advantage and it makes it just sometimes a little bit harder, which is, when you're doing innovation from the outside, you can go, Oh, I'm going to innovate, here's how I'm going to change everything. Now, it's like operations. Here it is, I've given it to you, go change it. And then they always wonder why it doesn't operationally change. Because that's, operations to change, I did my job and introduced them to it. Whatever innovation I bring to the table, I have to live with. So if I'm going to bring a new innovation that's going to bring a phone bot to the main line. And basically, I say that the ROI for doing that is cutting down by 50% of my operators. I have to live with a new budget of 50% of my operators and make people equally as happy on the phone. Like that whole trail is under somebody to bring to work with our innovation team to bring but also someone to live with it with our operators, and I think the answer is I have control of that, so I can do it. And if you don't, if your operations right from the start are not that invested, then you don't get anywhere. You don't get these things implemented. You get great ideas, but you don't get implementation. And that's the beauty of having our operators involved in the innovation activities from HR, from revenue cycle, from all over the place. They have these dual roles, and their dual role is to take and make the Big Is happen because they are passionate about the Big Is, but they also recognize they have to live with the change that comes with the Big Is and get everyone on board and get these things implemented and change the way we do our business. So, it is unique. Like we were, that we knew of, the first that really started in this way, living this way. And what we found is more people are migrating towards our direction because we get things implemented. That's the difference. Not just, we don't have any better ideas or any more ideas we are able to implement more quickly.
Steve Lieber:
Excellent. You've touched on another aspect here, and that's workflow. When we often talk about innovation, we think the technology, a platform, a solution, or whatever, but there obviously is an underlying workflow associated with the way it was done before and the way it maybe ought to be done in the future. Give us a little riff on that relationship between change, I think, changing workflow and changing technology or innovation.
Roberta Schwartz:
Recently, I had to go back, I was asked to give a lecture at HIMSS, and the lecture was actually on the change management process of doing a virtual ICU. And we started that process probably five years ago now, and we hung our last camera in, it's almost ironic at this point, February of 2020, and we got our first COVID patient. We got our first COVID patient in March of 2020, and the doctors were in the middle of that jerk. It was like that jerk back of, no, we're not going to change the way we staff these ICUs. We're not going to we have doctors here all night. They had four of them at the time, and they were having terrible trouble staffing four of them. In fact, like two of them at any one time could be locums because we couldn't staff it, but they didn't want to change the staffing to the virtual. So we were in the middle of that craziness, and we, of course, COVID and the TVs are there, and we have the virtual ICU in place, and one of the doctors turned around gently and said, Way to take a pile of blank and make it smell like roses. And so right away, you got this buy-in to something yesterday that you didn't have buy-in to because we had the cameras, which was great, this incredible work that was done. And then we were able to look at the quality changes, all the things we were able to do, we now have seen a 20% reduction in our codes that have happened. So now that's happening, a new set of doctors are working on basically algorithms and big data, predictive analytics on top of that, and they're now saying, okay, here's what we could do. So I had to go back through all of the data, like the 4 to 5 years of emails, of the key emails, to remind myself about this process change, about how long a process change takes. And actually, I could feel like every scar reopened. It was like, Oh, I remember that. Oh, that was terrible. Oh, that was-
Steve Lieber:
Reliving.
Roberta Schwartz:
-a moment in time. Oh, I didn't want to remember that. With the, with different how to agree to staffing levels, how to do different things. It was fascinating to recognize this change aspect, and this moving. And what I love to see is that we, that actually happens with every innovation you're going to bring to the table. The great ones, the brilliant ones, the ones that are going to change the world, or even like the smallest ones, they come with this changed management structure. But at the same time, like when you see when you look at that changes, and you look at those quality improvements or the engagement, recognizing that we could text a patient, little bits of information along the way and go from 30% engaged to 90% engagement of patients. It was so simple, and yet it was like, the doctors were like, No one will use that, no one's going to want it. And then we get these patients going. How'd you know I was going to ask whether or not I could drive? That's creepy. And we were like, because 100,000 patients before you called our offices at day six and asked us if you could drive tomorrow. We knew that because everyone asked it. And so we were able to do that now, that goes on a technology called Cure Signs. That, for us, is a noun, it's a verb, it's an adverb, sometimes every once in a while, it's a swear word, but it's the technology. Once the technology actually becomes like a piece of your vocabulary, you know that it's ingrained in the way you do your business.
Steve Lieber:
Excellent. So you talked about ambient monitoring and cameras in the facility, and all this head down this path for a moment as ambient monitoring has in my mind moved to ambient intelligence. There is now that overlay of analyzing trends and patterns and trying to predict directions and that sort of thing. Talk a little bit about your journey. What are some of the key places where you've got solutions in place? What have you learned along the way?
Roberta Schwartz:
So it's interesting to look at where we are now and step back and think about where we can be. In so many industries, ambient intelligence is now taking the forefront, the stage, right? Today, I still look at the fact that you can get in a car, and say, park, and it can parallel park itself without a human operator. But in healthcare, everything that we do, really, we have a person at the other end. It's almost video intelligence at this point, not ambient intelligence at the level. To get there, I can have a computer and/or algorithm summarize what is happening and then break it down into information that's meaningful and quick for us to do something about. So let me give you a couple of examples, and I'll give one from the operating room, and I'll give one from the rooms. In the operating room, you have a four-hour operation. You can now go to that computer and say, "Please identify for me ten times that we broke sterile technique," or however many times we broke sterile technique. You can go through the video and then basically now can tell you look at minute 12.5, minute, hour, and two seconds, minute, two hours and 42 seconds. You can basically say, do that. It can then summarize, for somebody who's trying to look at safety and use it for training, you no longer have to watch all four hours of a video or stand in the room to audit that procedure and say, "Oh, here we go, let me train you later." You now have the information at your fingertips within a second to be able to know who needs to be trained and what they need to be trained on, because you got to the right place, watched it, you moved on. So, a person can audit all 20 operating rooms in that phase in a few hours and know exactly what they have to train. Now, go into the room, let's now go into a patient room, and I can basically say, okay, every nurse is wearing a badge that can be identified. How often do they do with their hourly round? How often were they in there, and how long were they in there for? Or if I basically know that we're doing a ambient video of a housekeeper, I can do the same thing. They start their housekeeping, they finish their housekeeping. What's every surface touched, or did they miss a surface? Can I go back in and remind them that they skipped the remote, and remind them right then that is something that needs to be cleaned? Because when you go through a flow, human mind thinks you did something. Please, I think I have my keys every time I walk out to my car. Then it's, Oh, I get out there. And I'm like, "Oh, I changed jackets. Crap," but key's back inside. What if when I passed through the door it said to me, "Your keys are missing from your hand." You think about those things of we all are aiming to do the right thing. Every one of my people, their hearts, and their minds, and their souls are all into the best patient care. We are here for a mission and a passion. We're not here for a job. No one comes to work in a hospital for a job. It is a passion profession. So if they want to know if they didn't hit the remote, they want to know that because that's an infection control. How do we help them to do that? How do we help alert our folks a minute before the patients fall in rather than what we deem a bed alarm today, which is it just lets us know the patient's already on the floor? So that's the ambient intelligence that you want to get to. And that's where that, this field, is evolving to. And it's people like Care.ai, who are doing this with us, you, they don't profess to have this journey done. They don't profess to walk in with products that, oh, you open up the box and magic, you have ambient intelligence all over the place. They're working, as I said, with people like us to say, how do you do this in a great way for our patients?
Steve Lieber:
Excellent, yeah. In doing some research preparing for our conversation, I ran across a slide that you were on. And I don't know if this is a personal quote or if it's a Houston Methodist quote, "The future depends upon what you do today." Is that, tells us a little more about that thought, and/or am I piecing together something that isn't related to you at all? But it sounds like you in terms of what I've learned listening to you in these past few minutes.
Roberta Schwartz:
Yeah, it would not surprise me that was a quote that came out of my mouth. I don't know that it's one I always use, but it's very true, right? If I say to you today, I am working with Care.ai on natural language processing so that functions in the room are identified and started, right, so I'm working on those today. It's not something that's today ready, that say, "This is prime time, all done. It's perfect, here you go." But if we don't, we as hospital folks don't work with companies like this today, tomorrow, we're not going to have it. We know what we want, and it is essential that we move this world and dedicate ourselves to innovating with folks like this so that I get what I want in two years. If we basically just say that, "You develop it and come back to me when it's developed," I won't have what I want. So, that future is dependent on the work that I do today to make the future I want.
Steve Lieber:
Excellent, great. Picking up off that theme, what is something that Roberta says often, our listeners are CIOs, CTOs, CMIO, CNIOs, people that are interested in the things we're talking about here, put your leak behind here for them.
Roberta Schwartz:
I think that innovation is our friend. It's also complicated, and it's not easy, but not easy is not a reason not to do it. It is, oftentimes it's sexy, and it's out there. It's like the Consumer Electronics Show. Oh, look at what that car can do. But the hard work of changing the way we operate is what we need to dedicate ourselves to. The other thing about it is, again, you have to change the way you operate. The And will make it so that people will shy away from it because it's too expensive. The and/or/but, right, stringing all of those things together, along with the hard work of working with operators, is really what we need folks to do. So chief innovation, without that pure operational partner that agrees that they're going to change. I can't even tell you how many times somebody will say to me, what my CNO won't change. And it's, Have you gone out to lunch, sat down with your CNO, talked about the future, talked about where it's going, talked about what you can do together? You need both that to embrace that. And sometimes, we may need to change people to folks who are going to embrace those things. Because I think the one thing I love about this culture is not just me who embraces it. It's our North region executive vice president, it's our south region executive vice president, the head of revenue, I can't think of anybody in this organization who isn't embracing it. I do remember one person on a senior level who was like, "Are you telling me I'm going to be baptized?" And I was like, Maybe. And but, you almost have to take it in good ... because everyone's going to come on this journey at their own speed. So, I think I'd say lots of things, but the one probably overall is, embrace it. It's amazing. It's an amazing journey.
Steve Lieber:
Outstanding. Roberta, this has been a delightful and fascinating conversation. It really is great to be speaking with someone who is there on the front lines, running it, living it, driving it, and so I really do appreciate your time today.
Roberta Schwartz:
Thank you so much for having me.
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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