I Don't Care

Low-performing hospitals often falter, but some pull through and grow stronger with the right vision. I Don’t Care brings you the story of The University of Kansan Health System and its transformation with executives Bob Page and Tammy Peterman. They chronicled their journey in the book Proud But Never Satisfied. Host Kevin Stevenson spoke with them about how it started and how it’s going.

Page began the conversation with where the system was in the mid-1990s. “We had the worst patient satisfaction. Turnover was one-third, and we had no money.”

At the time, it was a state-run organization, and every dollar went back to the university. Consultants came in to assess and left them with the advice to sell or close. There was a third option: to become a public authority, which they did, starting with seed money and a vision. 

They also began looking at the data, which was challenging because they were data-poor. “We found that the biggest correlation to patient satisfaction was nursing, so we said nursing owns this,” Page said.

Peterman also shared that nurses were key to many other areas, especially physician engagement. In changing the culture, Page noted, “We didn’t star with the doctors. We started with the nurses, and what we were doing attracted physicians to get engaged.”

To solve turnover, they empowered employees in big and little ways. The first was making sure they had the resources when they didn’t have a materials department.

“We started a solutions line staffed by leaders. We told employees to make one call to get what you need, and if you don’t, call the solution line. We learned a lot about the problems and process,” Peterman explained.

The well-established culture and focus on patient satisfaction, and employee engagement have created an impressive health system that’s now at the top of the field. It also helped when COVID hit.

“We work as a team. Great things can happen because of a team. We had telehealth ready in two weeks and other improvements. It was the expertise of all the people at the table,” Peterman added.

For an organization to find long-term success, it requires a commitment from all parties. Employers have to commit to employees and vice-versa. But how can organizations get it right in a world of overworked and stressed-out staff members?

Joining I Don’t Care to talk about this is employee wellness and engagement guru Lorna Borenstein, CEO and founder of Grokker. She had the vision to start the employee wellbeing company after working for big tech companies like eBay and Yahoo and realizing the employee-employer dynamic needed to shift.

Borenstein explained the transformation. “The agreement used to be that a company would pay you well, and you wouldn’t bring your problems to work. Now, younger generations aren’t making money like their parents, and they were raised by people who gave them a voice. They have no blind loyalty and expect more.”

Grokker recently released its 2021 Working Americans’ State of Stress Report finding that 80% of workers are stressed out. Younger generations have the highest levels. This stress impacts their lives at work and home.

Borenstein said that for employees to be engaged requires a sense of purpose, belonging, and balance. Most companies do well on the first two, but the balance is harder. The pandemic, in some ways, had made balance more possible. “The good news is that companies woke up and realized their people are their business,” she said.

That awakening led to the Human Connection Movement, a philosophy that Borenstein writes about in her book, It’s Personal: The Business Case for Caring. “Employees are saying you need to care about me.”

Borenstein also discussed examples of the changing paradigm with clients like CVS Health. She noted, “Now 85% of employers consider employee wellbeing to be part of their business strategy; so, it’s culture as strategy.”

Host Kevin Stevenson welcomed Clive Smith, founder and CEO of Thinklabs to talk about his company’s digital stethoscope.

Smith has an electrical engineering background and was researching medical devices. He learned the stethoscope still worked and sounded the way it did when invented in 1816. He spent years researching how to digitize the instrument and bring exceptional sound quality. The first product hit the market in the early 2000s and would find its place in the world of infectious disease outbreaks.

“We worked with units treating Ebola patients in 2014, allowing them to listen to patients while staying protected in their PPE,” Smith said.

So how exactly does the digital stethoscope work? Smith explained, “It’s a round puck that sits on the patient’s twist and can be connected to any type of headphone.”

The “puck” is small, fitting in a hand, but powerful. It would become a highly sought-after medical device during COVID-19, with new challenges. “There were new situations with COVID-19. There was drive-thru testing and a shortage of PPE. We were solving problems in real-time,” Smith said.

The company also learned through a study that the device could be bagged and not dilute the sound. “It can be bagged in many layers without diminishing the sound, so healthcare workers can use pass it around, removing bags to keep it clean.”

Smith noted they are continuing to improve their main product but could innovate on other devices in the future. He also shared his perspective on the future of digital health. “Telemedicine is here to stay, and remote monitoring will evolve to support this. COVID-19 was an accelerant to things already there, but now we see widespread adoption.”

For a completely unique take, host Kevin Stevenson welcomed Jessie Naor, COO of GrandView Aviation. GrandView Aviation is a Part 135 certified aircraft operator. They transport organs for transplant and offer private charters. 

Naor described the company’s origins. “We’ve been in the organ transplant transportation business for 12 years, starting with one helicopter. We now have 10 airplanes and serve multiple locations across the U.S.”

Hospitals mostly use the flights for organs with the shortest cold-time, including hearts, livers, and lungs. A typical procurement involves two pilots and two healthcare workers. They start at the home hospital, fly to the donor, retrieve the organ post-surgery, and return to their base. 

Naor then discussed the importance of the FAA (Federal Aviation Administration) Part 135. Part 135 is different from Part 125, used by commercial airlines. It corresponds with private commercial, non-scheduled aircraft operations, requiring specific safety and operational protocols. Until the last few years, many organ transplant operations didn’t fly under Part 135. 

“They were just flying private with few regulations. Now, it’s changed because of medivac accidents. There’s always risk, and you can never mitigate it 100 percent, but you should always ask operators how they’re doing it,” Naor shared.

Naor and GrandView have a mission to educate the healthcare industry and beyond about best practices and safety. Naor is currently on an FAA committee making suggestions to handle crew safety and organ transplant.

When asked what’s next for organ transplant, Naor said, “We don’t yet have drones, but people in the industry are trying to figure it out. I could see as being helpful within large cities.”

Host Kevin Stevenson spoke with Mike Joyce, Client Strategist and Engagement Partner, at Theorem. Theorem is an innovation and engineering firm that solves complex challenges for the world’s most admired organizations. The organization built a mHealth Platform for AT&T to share clinical data in a compliant and secure manner. 

Verifying vaccinations is both a complex and simple problem. “Transmitting verifiable information through secure tunnels and layers of trust isn’t new. Implementing is the real problem,” Joyce said.

The challenge stems from multiple stakeholders and a fragmented healthcare system. 

“With a digital certificate, the issue is we don’t know where it’s going to be used. Investment in a system designed to accommodate flexibility will be key,” Joyce added.

In breaking down the parties involved, there are the holders (consumers), the central authority (issuer), and the verifying party. The move to require vaccines for certain activities is likely coming. The verifiable platform will also need to be global. 

The technology is already there. Microsoft, Salesforce, and Oracle are developing a digital solution to access COVID-19 vaccination records, but that’s just the first part. “Technology is great in developing the scaffold. Regulators need to take the next step for consistency in the process,” Joyce shared. 

Privacy and security are another issue, but Joyce noted that the cryptographic protocols already exist for protecting sensitive data. The looming constraint is infrastructure. “someone has to write the software to integrate with healthcare records and appointment platforms. It will require more investment than a paper-based method. There’s a systemic issue in healthcare with sharing data,” he said.

Access to specialty medical care is difficult in such parts of the country. Urologists are even harder to find. He explained, “By 2025, we’ll have a shortage of 7000-9000 urologists. We’re only training about 300 a year and don’t have the supply to meet the demand because of fewer slots in residency programs. Telemedicine is a way to bridge that gap.”

Many might think urology wouldn’t work in a virtual care environment. Pazona disagrees. “There are very few times I need to touch the patient physically. A urologist’s greatest asset is their wisdom in an area of medicine where many lack proper education.”

Realizing that consumers are battling a broken system with confusion in referrals, insurance, and other barriers, Pazona started VirtuCare. No referral or insurance is required to have a telemedicine visit with a physician.

“The platform is consumer-based and has cost transparency. I take patients as far as telemed will go. If they need hands-on, I refer them to a urologist in their area,” Pazona said.

As for the future, Pazona believes that telemedicine should continue to be a solution beyond the pandemic. “There is a silver lining because it sparked innovation and forces people to take control of their healthcare decisions,” he added.

Pazona now practices in Nashville, but before that, he was in rural areas in Washington and Alabama, seeing many challenges. “These were lovely places, but it was difficult to practice cutting-edge medicine in a community that struggles to attract growth and new industries because that has a downstream effect on hospitals,” he said.

Access to specialty medical care is difficult in such parts of the country. Urologists are even harder to find. He explained, “By 2025, we’ll have a shortage of 7000-9000 urologists. We’re only training about 300 a year and don’t have the supply to meet the demand because of fewer slots in residency programs. Telemedicine is a way to bridge that gap.”

Many might think urology wouldn’t work in a virtual care environment. Pazona disagrees. “There are very few times I need to touch the patient physically. A urologist’s greatest asset is their wisdom in an area of medicine where many lack proper education.”

Realizing that consumers are battling a broken system with confusion in referrals, insurance, and other barriers, Pazona started VirtuCare. No referral or insurance is required to have a telemedicine visit with a physician.

“The platform is consumer-based and has cost transparency. I take patients as far as telemed will go. If they need hands-on, I refer them to a urologist in their area,” Pazona said.

As for the future, Pazona believes that telemedicine should continue to be a solution beyond the pandemic. “There is a silver lining because it sparked innovation and forces people to take control of their healthcare decisions,” he added.

Nurses are an integral part of the healthcare ecosystem. They have been critical to the frontline response to the pandemic, but how is the profession faring? Host Kevin Stevenson invited Kathleen O’Grady Winston, Ph.D., RN, College of Nursing Dean at the University of Phoenix, to the show to discuss what’s happening in nursing, including a new survey her college published.

The first topic Stevenson addressed was the concern of an exodus from the profession because of the stress of COVID-19. Winston shared, “There is good news on this, as 99% of respondents to our study said they are still very satisfied with the profession.”

Winston does, however, have concerns with the pipeline of qualified, eligible candidates. “We have a capacity and pipeline issues exaggerated by the pandemic but existed before,” she said.

While interest in the profession is high, Winston noted that the desire to be a nurse and what’s needed academically and personally are different things.

The curriculum for nursing is also always evolving, and COVID-19 has made its impact. “It’s a dynamic discipline, and we’ve been updating activities and experiences that prepare for the management of infectious diseases,” Winston noted.

Stevenson and Winston then went in-depth on the survey results, picking on two data points that are important to address—nurses not being heard or appreciated. How do these sentiments impact the industry?

“What they are asking for is to be at the table when decisions are made. They have a unique voice, and it's one of advocacy for the patient. For nurses to be appreciated, transparency, sharing information, and closing the loop by communicating back to the nurses on the insight they provided,” Winston said.

Listen to Previous Episodes of MarketScale’s I Don’t Care Right Here!

The digital consumer experience applies to much more than retail. It’s also integral for healthcare patients. As healthcare accelerated its digital channels in the pandemic, what does this mean for the consumer experience? To answer those questions, Astound Commerce, a global digital commerce platform, created the report, Transforming the Global Healthcare Consumer Journey: Now and Beyond Covid-19. Talking about what they learned from this is Tina Wilson, VP of Global Health and Life Sciences.

The survey included 1,000 healthcare consumers all over the world. It asked them about their patient experiences. It looked at access to healthcare and the reception of telehealth. The insights were powerful. Tina said, “What surprised me the most was the significant challenge for women’s health. Only 21% of women felt very confident that they could afford an emergency healthcare situation.”

Along with the inequality of women, the study showed many disparities, supporting the importance of social determinants of health (SDOH) impact on access. “Only 40% of all respondents said they had adequate access to care,” Wilson added.

Different regions of the world also had different perspectives. “Those in South America were very responsive and had positive responses to healthcare. The EU less because of uncertainty around Brexit,” Wilson explained.

So how can providers better engage with patients to ensure better experiences and outcomes? Tina commented, “Patients are consumers. It’s relatively the same experience journey with other brands. And patients are adopting digital channels.”

The study revealed that 41% of respondents had used telehealth, and appointment scheduling online was up 39%. These data points further substantiate the consumerism of healthcare.

Wilson also spoke about the trends emerging in 2021, and it comes down to one word—data. “We’ll see trends toward accurate data, and companies need to process and act on it fast,” she noted.

While there have been many downsides to the unexpected changes we all needed to make in 2020, there were also improvements made to how we work and live. The upsurge in telemedicine is an example of such progress made in the face of adversity. On the latest episode of I Don’t Care, host Kevin Stevenson spoke with Dr. Adam Saltman, Chief Medical Officer, Eko about the integration of telemedicine with digital technology and AI.

Telemedicine can allow for more convenient access to care and can help keep patients and health care providers safe. That being said, there are some crucial missing components that can limit the quality of patient care. For example, physicians cannot listen to their patients’ bodies on their own via video conference. Really listening to the patient's heart, lungs, and bowel sounds through a stethoscope can typically only happen face to face. Eko closes this divide between physicians and patients with their digital stethoscopes, which transmit high fidelity sounds to remote physicians in real time as if they were at the bedside. In addition, Eko AI analysis algorithms help physicians screen for AFib and heart murmurs.

According to Dr. Saltman, if they have the right technology available to them, physicians can overcome the distance based challenges of telemedicine. “When I listened to physicians say things like, ‘Well, I don't think a Zoom call is a really good physical exam,’ they're right. It's not a good physical exam,” Dr. Saltman said. However, he feels that if he can give them an EKG and therefore can give them heart sounds, lung sounds, bowel sounds, and whatever else they want to listen to, they can make telemedicine work. “Combined with that video, now they feel a lot more comfortable. They're getting a real medical evaluation. And the patients too, they feel that, wow my doctor actually listened to me even though I'm far away,” Dr. Saltman explained.

Listen to Previous Episodes of MarketScale’s I Don’t Care Right Here!