Episode 19: Looking Toward the Future: Part 1

Today’s healthcare landscape is rife with challenges, many of which threaten the systems as we know them. But what impact will the challenges of today have on the industry going forward, and where can we find glimpses of hope? Join futurist Ian Morrison and host Karen Wolk Feinstein for an eye-opening expedition through the business of health care and the innovations that hold the promise to transform it—for both patients and providers.

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Episode Transcript

[00:00:02] Ian Morrison: Our pace of innovation is much slower than most other industries. To be fair, we’re innovating constantly clinically, which is less perceptible perhaps, but we’re not innovating in terms of business process and models and care delivery platforms as much as we should.

You know, if all we do is pave the cow path of doing telehealth visits, we’ve not done anything. That is basically replacing bus fare. Big deal. What we need to do is fundamentally redesign clinical care processes to be more digital and more consistent, more automated, more standardized across end to end for the benefit of consumers and for clinicians.

[00:00:57] Karen Wolk Feinstein: Welcome to Up Next for Patient Safety. We continue conversations with the most interesting people doing important work toward our common goal of making healthcare safer, but also more reliable and even more satisfying for both patients and practitioners. I’m your host, Karen Feinstein, president and CEO of the Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative, which is a multi-stakeholder quality collaborative located here in my hometown, but with statewide, national, and even global links. We’ve been working to reduce medical error for 25 years, and I will say, we never believed progress would be this slow. I do know that revolutions come from hope and not despair. I’ve found that these conversations inspire me with hope as we hear from safety leaders of distinction.

This episode is part of a three-part series on the future of health care. We’ll be joined by some notable futurists who will share their insights on where health care is heading and how to ensure that patient safety will be part of this future.

Given the challenges facing health care today, many exacerbated by the pandemic, even if longstanding, we wanted to hear where these experts envision the industry moving toward a safer, more trustworthy future. In this episode, I’m joined by Ian Morrison. Ian is an internationally known author, consultant, and futurist specializing in long term forecasting and planning, with a particular emphasis on health care.

He is the founding partner of Strategic Health Perspectives, a forecasting service for clients in the healthcare industry. It’s a joint venture with Harris Interactive and Harvard School of Public Health’s Department of Health Policy and Management. He is President Emeritus of the Institute for the Future.

Ian has also authored numerous books and journal articles examining the healthcare system of the future, including Leading Change in Healthcare, Building a Viable System for Today and Tomorrow, as well as Healthcare in the New Millennium: Vision, Values, and Leadership. So, welcome Ian, let’s get started.

I’m going to mention the triple afflictions, which I touched on, all interconnected, that are facing healthcare now. One which we all hear about, and we know is a reality is the workforce, the issues of burnout, low morale, the many people who are exiting or planning to exit. And related to that is the rise in medical errors.

We are losing a lot of experienced health professionals, but we’re also losing them, so they report, because they are worried about working in an environment that isn’t safe. And then, no surprise, along with this, as this information gets out, is the growth in public mistrust. So, with all of this happening at once, what we call the, the triple crisis, could you give us one or two solutions that you think would make a difference?

[00:04:12] Ian Morrison: Well, first, thank you for having me, Karen. This is an important topic, but I think we’re at a very difficult time, and there aren’t any facile quick fixes to this problem. We had burnout before the pandemic, and then we threw gasoline on it for clinicians, nurses, and doctors.

But really, everybody in the health system, what we saw through the pandemic and particularly in 2022 was the worst financial year for hospitals And the reason for that was 2022 was like 2020 without the CARES Act, and most hospitals were in deep hole and we saw hyperinflation in the labor market where labor costs for most hospitals are up 20 percent over pre-pandemic levels.

And all of that is fueling this, you know, the triple affliction that you point to. The rise in medical errors, I think, is a predictable, you know, outcome of stressing an already stressed system. And as you point out, what’s been happening, if you look at the labor force trends, we’ve been losing experienced nurses and replacing them with new nurses who are somewhat freaked out by the responsibilities, and they’re leaving as well.

If you look at most hospitals I talked to in 2022, they were struggling with making up for lost staff by using travelers at $300 an hour. Now, those rates have come down to about $120 in most markets, but still, most hospitals, including the one I’m involved in, saw this huge spike in the use of temporary clinical labor to make up, because volumes are back up again, and everyone is busy, everybody I talk to is full, and in particular, it’s very difficult to get people into a lower step-down environment because of nursing homes, nursing facilities also being understaffed.

And all of this has fueled the mistrust you talk about, which is, as one CEO put it to me, we have gone from being heroes to zeros, in the space of five years. In terms of solutions, I think, to be honest, a lot of it is about good old-fashioned blocking and tackling and operational excellence and a focus on leadership and management discipline to get the finances and the clinical care systems operating at a safe level going forward.

And that’s hard, slogging work, I think. We can talk, long term, about the potential for technology to be helpful, but I think in the short run, it is really trying to turn the corner in these difficult financial times.

[00:07:03] Karen Wolk Feinstein: Something tells me right now that our health system should be in a crisis mode. There is a real challenge here in providing care that’s safe and effective. But I’m asking this question. I don’t feel (health systems) are in a crisis mode. You know, as a purchaser, a patient, an advocate, what should I be feeling? How would I know that a major health system in my community is in a crisis mode and they’re taking this worker shortage and all the things related to it seriously?

[00:07:42] Ian Morrison: Well, I’ll tell you that the simplest tracer condition of crisis for hospitals is days cash on hand, and in California, we’ve seen a number of hospitals get perilously close to that number being in the, you know, well going asymptotically approaching zero, which is not good. I mean, you want to have about 250 days cash on  hand.

Some big systems are running three, four or 500 percent of 500 days of cash on hand. But that is not a number the public tracks very closely. I think where they’ll see this is in 2024 when we see rates on commercial insurance up 7, 8, 9, 10, 15 percent because what’s going on right now is that those hospitals that are lucky enough to have commercial patient flow are doing what is logical in terms of a cost shift which is to try and extract higher prices from the commercial purchasers.

It’s hard to do that on Medicare and Medicaid because, you know, those that are administered prices, but, but even there, we are seeing hospitals walk away from Medicare Advantage contracts because of the hassle factor. So, I think what you’re seeing is this, your point about crisis, it will be manifest in prices on the commercial side on it will be manifest, I think, and increasing political angst by the purchasers, both public and private that, you know, the pressures are intensifying.

Having said that, I mean, the one piece of good news over the last decade is Medicare’s burden on the total public purse has been relatively flat. So that is one of the reasons that Congress doesn’t see it as a crisis. It’s somebody else’s money that is sustaining the healthcare enterprise.

[00:09:46] Karen Wolk Feinstein: Well, I will say this. I do recognize a crisis response to the financial crush and maybe as you refer to the indicator days with cash on hand. I had to go for an MRI. And it was scheduled for 4, but at 3:30 they shooed me out of the waiting room and I sort of went to wait in a little closet. They had no one that seemed to know how to get the contrast started because they were closing much of the unit at 3:30, as, I think, a cost move. But that that’s not reassuring to me. I do want the financial crisis to be addressed. But, you know, as a purchaser of care for all my employees and myself and my family, you know, I’d like to also know they’re responding to a quality and safety crisis that’s going along with it.

Let me ask you a question. What is the likelihood that health systems are rethinking, in a serious way, their whole approach to how they do business? Not tinkering at the edges, you know, like closing the MRI department at 3:30, letting most people go home, even though they still have MRIs scheduled, but really rethinking the whole enterprise?

Are they bringing in futurists or human factors engineers? Are they saying, look, there is something wrong with our design? As we go forward with fewer workers, we are going to have to revisit everything. Are you seeing any of that?

[00:11:30] Ian Morrison: Oh yeah. No, absolutely. I mean, and look, the conversation I think that is going on right now, and I’m sure you’re involved in it with the folks you work with, here’s the way I think about it. There are really two business models going on right now. One is health systems who are trying to be big where they are, have dominant market position, who own a big chunk of their doctors and are employing them and subsidizing them to keep them in house, and they’re trying to manage their payer mix to the extent they can, and manage their footprint so that they have got a sufficient flow of commercial patients to sustain the enterprise financially.

And that works like a hot dam, unless you have site neutrality, payment rules, or you get disruptors taking away the patient flow. And on the other hand, we are seeing massive investments being made by big retailers, spending tens of billions of dollars to acquire primary care capacity. And “disrupt” the front end of health care, you know, to give slightly better customer service for routine things like having an MRI and visiting a physician or having a set of tests done.

The problem is, Amazon is not going to do heart surgery. Amazon is not going to do complex interventions of diseases. What I’m seeing is, not reluctantly, but I think strategically, a lot of health systems are partnering. We just announced yesterday that Hackensack, a client of mine in New Jersey, the largest health system in New Jersey, is partnering with Amazon on a whole series of One Medical clinics in New Jersey. And they are part of a consortium of hospitals with the venture capital firm General Catalyst to invest in potential new technologies and solutions going forward. So long-winded way of answering your question is I see leaders stepping up trying to think about, I mean, they have this laser focus in the short run on trying to turn the corner, as I call it, but in the longer run, they understand that they’ve got to fundamentally change the way they do what they do to make it cheaper, too, because the cost structure is unsustainable in the long run, particularly for employers paying the bill. But I do see them, you know, embracing new technologies and new solutions and trying to weave those into the care platforms that they’re building for the future.

[00:14:25] Karen Wolk Feinstein: Well, it’s interesting. I think you’re leading us to what people refer to as disruptors. And the disruptors see opportunity in this crisis, which could be good for patients. It’s going to be good for everyone because they’re going to bring this new thinking –they are not afraid of technology — and the other advantage perhaps, and you can comment on this, the disruptors aren’t doctor dominated.

In other words, you know, our health systems have been led by the medical profession, and in many ways that’s good, but also it has left out the other expertise that is technological, often, or human factors engineering expertise. The disruptors can draw down. They are not dominated in any way in how they set up their hierarchy and who makes decisions. They have the flexibility to build on new technologies, available technologies. But they have the flexibility to rethink it all. You know, they don’t have a legacy system, so do you see this as something that’s going to have a positive or negative impact on our traditional health systems?

[00:15:45] Ian Morrison: I think, well, let’s back up a second. We have run a natural experiment. I mean, 2021 was the sort of peak of investment in digital health and the wannabes, including several unicorn companies that made it into the public markets with IPOs who have gone to zero in the last 18 months in terms of valuation, you know, I’m thinking about Babylon Health and Bright Health and Clover. I mean, if you look at the financial history of these unicorns, they have collapsed. The ones who have survived have been bought by deep-pocketed retailers like CVS Health and Amazon, who are taking a much longer view, in my opinion, to look at this disruptive opportunity. I mean, Amazon is basically saying health care is roughly 20 percent of GNP. Where else are we going to go to grow our revenue footprint? And they will keep chipping away at it till they get something right. And they can afford to do that using stock as their currency. But, you know, I think I’m hopeful though, here’s what I’m hopeful about, that the lessons and contribution of these disruptors and  to your point, the skill set, I mean, part of the part of their problem, the reasons these unicorns blew up is they didn’t know anything about healthcare, right? I mean, they were completely naive about that, and sometimes embarrassingly so, but by the same token, we need the expertise of the folks with the technology and human factors competencies to drive transformation because here’s the punchline, I think, for all of this stuff, and it directly relates to patient safety.

You know, if all we do is pave the cow path of doing telehealth visits, we have not done anything. That is basically replacing bus fare. Big deal. What we need to do is fundamentally redesign clinical care processes to be more digital and more consistent, more automated, more standardized across end to end for the benefit of consumers and for clinicians. And that is what I’m hopeful that we will start to deploy these interesting and important technologies more widely within the existing healthcare system. I am not of the opinion that we should be trying to blow up Johns Hopkins you know, or UCSF and, you know, I have a serious medical condition and I’m getting care at Stanford and family members and the last thing I want to do is see them falter. You know, the best hope we have as a nation is that we harness innovation and technology to improve the performance of our existing institutions.

[00:18:56] Karen Wolk Feinstein: I think you sort of said it all in that last paragraph. The big players are moving forward. And they have the cash reserves, they have the resources to tinker with this until they get it right.

And I will say, I have found virtual visits. There are times when it’s incredibly useful, incredibly helpful, and there are times when you need to be hands on, you need to be there. But I do think we are getting better at, you know, which we, I think listening to you, we will get better as we start using technology more appropriately and harness innovation.

If you were advising me, I’m the CEO of a very large, traditional health system: to whom should I be listening right now? I mean, who would guide me? I am surrounded by people who are very wedded to legacy systems and how they have done business in the past, and often led by physicians who get no grounding in this kind of harnessing of innovation in their medical school education from, in most instances. If I were the head of a health system, a large health system, to whom should I be listening now? Where would I turn for guidance in how to do some painful retooling, but get the kind of wisdom I need, to operate much more efficiently with fewer staff and, frankly, with happier staff?

[00:20:34] Ian Morrison: Right. Well, I, look, I wrote a book 30 years ago, not quite 30 years ago, 27 years ago called The Second Curve about transformation in business. And you know, the first curve is the old business. The second curve is the new business. And it is extremely difficult to re-engineer the first curve while you’re trying to build that second curve.

It can be done. So, I have always been of the opinion, you need to honor both systems. So on the one hand, you know, if I was and I have advised several hospital systems, you want to have diversity on your boards and bring in  voices and leaders who can bring perspective from financial services or technology companies about ways of thinking about strategic issues, but you also need to honor those physicians you point to because you’re not going to get very far with a passive aggressive medical staff who feels that this change doesn’t make their lives better. And I think we need to, I mean, because I just got to tell you as a patient, I have uniformly had, and I’ve had several surgeries over the last couple of years as well as this chronic condition I have, but, but I have uniformly had outstanding care. All the way through the pandemic, all of my care was delivered at Stanford and the Palo Alto clinic, and all of it happened in the course of the pandemic.

I never felt unsafe at any time. And I think that’s testimony to the leaders of those institutions to, you know, despite the headwinds we talked about, do the very best they can. And, and of the people in the front line who, brave young people who are going onto the battlefield every day to help patients. I salute them. We need to support them and their work going forward.

[00:22:34] Karen Wolk Feinstein: So you told me an interesting story about your experience on the board of a safety net hospital that turned itself around, right? It’s Martin Luther King and had a nickname “Killer King” and has become a model and revisiting the whole issue of how to offer more reliable, higher quality, safer care.

Talk to me a little bit about boards. You mentioned boards, and I’m not sure that, and I know because I’ve led panels on this topic at conferences. I’m not sure that a lot of boards are playing a major role. I mean, they are listening, they are listening, they are hearing, they get reports, they do their checklist for the Joint Commission, but your board sounded so unusual. And I wonder if you could talk a little bit about getting governing boards to actively, actively govern and what that would look like.

[00:23:29] Ian Morrison: Right. No, that’s a very good question. Well, it’s just a 30-second history. Martin Luther King Hospital was closed in 2005, the old hospital through both economic and clinical failure, quite frankly, and it was known as “Killer King.” It was exposed by Charlie Ornstein, a great journalist who and team who, you know, dug deep and found horrendous patient safety lapses. You know, I have been advising a governor, Mike Leavitt. He was head of Health and Human Services at the time and, you know, was the people that yanked their CMS license, and he was right to do so.

But what happened was a number of leaders in the Los Angeles area, including many of my fellow board members, were really the instigators of the recreation of a public-private solution. It was effectively a county hospital run by an independent board. And we, you know, were formed and reopened in 2015.

So, I have been on the board just over 10 years. Through 2012, we were in planning mode and, and, it is a long story, but essentially what we have is a hospital that is there to serve a community. Now we are in a crisis financially for all the reasons I talked about, we had $20 million worth of temporary help, which you know, caused our bottom line to disappear.

And we had significant losses last year having weathered the storm through the first part of Covid. And the real reason for that is we don’t have commercial patients as an outlet. We are 97% Medicare and Medicaid. We make, we break even and make a modest surplus in good years by the largess and special deals we have from three levels of government.

And so I mean, what I would say the lesson of leadership, to come back to that point, what we were as a board and my predecessors who have been there longer than I have, our colleagues have been there longer than I have, we have a unique board, very qualified people, CEOs have led major organizations, I’d exempt myself from that statement, experts on patient safety, and we have been uncompromising in focusing on safety, given the history of the old hospital.

We built a new hospital, or the county did, and we lease it back, and we operate it, and we are five-star CMS accredited. I think the only public health, public hospital in California has that. We are level seven Cerner board certified, fully high tech, and we’re a beacon of quality in what is a medical desert, quite frankly. We have been building out a specialty medical group because that’s the need in the community. There are a few FQHCs, but there are no pulmonologists or neurologists in Watts, right? We have been building out that capacity as well as our inpatient care. But here’s the kicker. We were designed for a 40,000-emergency room visit run rate. We are currently running about 130,000 per annum, which, you know, I was early in my career in Canada, I was based at the Vancouver General Hospital, which was the largest hospital in the British Commonwealth. And they were doing 80,000 emergency room visits. So, I mean, it’s like, it’s crazy. And you know, we have had our challenges financially because Medicaid in California, even with our special deals, doesn’t pay sufficiently to sustain an economic enterprise that is completely dependent on looking after poor people.

[00:27:37] Karen Wolk Feinstein: So, I love the lesson I learned from you about what board leadership can look like and what an active, engaged board can do, even with the significant challenge of not having a lot of private pay clients and an emergency room that is stressed to the breaking point. And as you mentioned, relying on tents and anything else they can do to take care of patients.

[00:28:04] Ian Morrison: But still being uncompromising. I mean, we start every board meeting with a review of our quality scores and take them very, very seriously and have very sophisticated staff who are monitoring and working and doing root cause analysis when we have failures.

And I take my hat off to the folk who, despite the fact it looks like a Bedouin village sometimes with the tents at MLK, are still  delivering high quality care as evidenced by the fact that community comes to us when they have issues because they know they’re going to be treated well.

[00:28:41] Karen Wolk Feinstein: But I got the sense, and I know you won’t have time to go into it, that the board did much more than listen to reports. That the board was actively engaged in this journey to reinvent MLK as a very high quality, very safe place to get care, in spite of all the challenges. It is a much more active board role, and I, I’m, you really, you really inspired me to think that there still is hope that boards could start to play a much more active role.

Let me go back. You pushed an interesting button when you talked about the lesson of leadership and Secretary Leavitt. And I had the pleasure of getting to work with him on a number of initiatives when he was secretary. And then he pulled the license of a hospital that he thought wasn’t providing care that was safe and high quality.

So, I have this interesting issue. Where should the energy be coming from? From where should it be coming to help our hospitals and health systems reboot? The times demand it. And Medicare has an advantage. It can hold even. But it does it on the backs of the private insurers. And the health systems are going to have to make some serious adjustments going forward.

Where should some support come from? Medicare can hold even, but what is the responsibility of HHS? And I know Secretary Leavitt has devoted the rest of his life to safety and quality, which has been interesting. What should HHS be doing to help reboot and to help the health systems of today learn from the disruptors? And what about, I call them all the initials? AHA, American Hospital Association, the Medical Association, Joint Commission. Are they in a crisis mode? Are they trying to help our struggling health systems figure out how to manage the financial crunch while they are providing even safer and higher quality care?

[00:30:56] Ian Morrison: Right. Well, let, let me start at the end and come back to, and I agree with your comments about Governor Leavitt. He is a fine man, and I had the honor of working with him for about five years as an advisor. But here is, let, let me start with the initials as you call it, because I’ve spent a good chunk of my career working with the AHA, the AMA. Even the governance, the Joint Commission, to Jonathan Pearl and we were on a panel earlier on in the year. But funnily enough, what came across my desk yesterday was this patient safety, White House Patient Safety Advisory Panel, I guess it was reported out in September. And what struck me in going through that you know, briefly, and I’m not, as you know, a patient safety expert, but the locus of what they were suggesting I think was sort of, we need White House leadership, you know, and direct the secretary to do a whole bunch of things in terms of transparency and reporting.

I agree with all of that. I would say the other thing we should be doing is simplification of all of what I call the quality police, because I think that is the frustration that clinicians in the front line have, is they are overwhelmed by well-intentioned regulators who are asking them to do things.

I will give you a perfect example of that, which is My Chart, right? You know, if you have a chronic condition or you’re going through a hospitalization, you’re dependent on getting access to the Epic patient facing portal to keep you informed about test results and all the rest of it. The problem is you start sending messages to your doctor. So, in every, every healthcare organization, we have seen a fivefold increase in clinical messaging to physicians in the last five years, that’s data from UCSF, and you know, it’s uncompensated. It is basically just more they’ve gotten into their inbox at the end of the day. What we need to do is hold providers and systems to account. Do it through HHS because of the power of purchasing both from Medicare and Medicaid, and I think one of the problems we have is we need to federalize Medicaid, both funding and oversight much, much more because we basically have lost, you know, with the redetermination process of Medicaid, we’ve got 10 million more uninsured again.

That didn’t need to happen if we had sort of a sane, more federalized Medicaid policy that didn’t, that gave sufficient inducement to states. in the south to expand other Medicaid programs. But the locus has to be, there’s got to be some federal oversight. What I worry is we will duplicate at the state level and in other not for profit oversight entities, and we will end up with more clutter on the desk of the people who are running these organizations. That is my concern, I guess. Well intentioned as all those organizations may be, it provides, you know, an ever more complex environment in which caregivers and hospital CEOs must operate.

[00:34:30] Karen Wolk Feinstein: Well, I hear what you hear –a great deal of keening over regulation. Please don’t give us more regulation. And I hear that, and we have a lot of regs that should be reexamined, that they serve their usefulness, they’re not appropriate to the modern era. On the other hand, here is something that I worry about. Innovation and progress in healthcare doesn’t spread. It doesn’t get sustained. You will have an amazing improvement in a couple of places.

An example is the automated medication dispensing machines that use three letters. Three initials rather than two, which prevents a lot of medication error, which is the number one source of fatalities in health care. This is really a great improvement, and many hospitals have decided we’re going to just change our automated dispensers and we’re going to use three letters to access as a code.

And others have just decided not to bother. We don’t have a place in health care that can regulate and standardize known improvements, proven improvements. But I look at other industries that are much safer. And I, I have this one example I use from the coal mining industry, which is now, believe it or not, extraordinarily safe. It would never be safe without regulation. But I looked at the fact that one cart. It was a big metal cart driven by a single driver and overturned in one coal mine, and it either killed or seriously disabled the driver. They retrofitted the coal cart so that it wouldn’t turn over on uneven surfaces. And then every coal mine had to retrofit their similar vehicles, their similar equipment, so that nobody would get killed or permanently disabled. We have no one in health care who will get something regulated every once in a while, for instance, crash carts. I think it was the Joint Commission anyway said no more nonsense, standardize your crash carts. Although nobody has done that for defibrillators, we still have defibrillator deaths because they’re not standardized.

You refer to the President’s Council of Advisors on Science and Technology National Patient Safety Team and their working group on safety. One thing they did recommend was a National Patient Safety Team which would do this kind of research, discovery, proof of concept. And then we hope somebody would standardize it. If they found out that the three-letter code saved many lives, prevented many medication errors of great consequence. So how would you feel about a National Patient Safety Team? It was the first recommendation from what we call PCAST Working Group. And what is intriguing is almost all high-risk industries that are much safer, they do have regulation and a fair amount of regulation. But they are safe.

[00:37:49] Ian Morrison: Yeah, no, look, I agree with the point about regulation. I just would hope we make it targeted and limited and effective in terms of getting the goal we want.

But on your point of, in fact, we, we talked about this, your experience in Australia with these SWAT teams of experts. I think that is a very important idea. The question then is then what? That’s what you’re saying is, well, even if you got the answer and you did the fact finding and, you know, I’ve learned this from Governor Leavitt and, and my work with AHA and others over the years, America is unique because we don’t trust government the way they do in other countries.

So, you know, to say that while the government is going to do it, you’ve got a lot of stakeholders. So unfortunately, and this is something that Governor Leavitt and others have been masterful at, you have to build coalitions of stakeholders of common cause so that, good that there would be a federal, you know, institute or whatever on patient safety that would go in and do the fact finding and that, your coal mining example is a brilliant one, but we also need a kind of institutional framework for that to be promulgated and accepted as standard.

I share your concern that, you know, we are slow at innovation. I mean, I wrote a thing about some of these disruptors a couple of years ago where I pointed out that I wrote the justification for an all computerized hospital in Canada in Vancouver in 1979 when I was a management engineer, you know, and it’s, you know, it’s kind of pathetic that it took us another like 40 years or whatever to get the electronic health record deployed in this country.

And they still haven’t done it properly in Canada. So, you know, we are not, our pace of innovation is much slower than most other industries. Now, to be fair, we’re innovating constantly clinically, which is less perceptible, perhaps. But we’re not innovating in terms of business processes and models and care delivery platforms as much as we should.

[00:40:11] Karen Wolk Feinstein: And, you know, I think maybe it is arrogance or just politics. I am betting it’s even more politics. But last summer I got to visit some Scandinavian countries. And they can’t believe the chaos that is our electronic health record system here, you know, that they’re not interoperable and they’re not giving people in a simple way, what they need, when they need it. And we looked at a couple of others that were just state of the art and they look at the US, you know, with all of our expertise and its sort of What is holding you back? Well, I think, I think a lot of it is, unfortunately, [00:40:00] politics and the fact that we have very little control over lobbying.

So, let me ask you my final question. And that is, what makes you hopeful as you look at what is on the drawing board or what is out there now in the U. S., what makes you hopeful that these issues will be addressed effectively?

[00:41:25] Ian Morrison: You know, just before we came on, I was listening to the head of Microsoft talk about his AI platforms. I am actually encouraged and I’m not a technology booster in the sense of unrealistically. I used to say when I ran the Institute for the Future, we’re not in the business of making personal helicopters by the year 2000. You know, I am more of a pragmatic futurist, I think. But what I would say is we are at the cusp of unbelievable power increases in artificial intelligence that properly harness, you know, we are not going to replace doctors. I keep saying AI for healthcare is going to be Hamburger Helper for doctors, which dates me as my metaphor, but it is making a scarce resource go further. Here is the bright spot. The example I gave about the inbox at UCSF that my friend Bob Wachter shared a couple of years ago.

I mean, there are now a lot of solutions, including at Houston Methodist and at UCSF and other places where they’re using generative AI tools to simplify the notes and give clinicians time back on their shift, take away the drudge work. Cause you talk to people on the floor, what drives them crazy is documentation.

And yet it is the lifeblood of patient safety at one level. Because you’ve got to document stuff, if you’re going to find out, you know, care processes. What we need to do is to automate the collection of that information as part of the work. With a combination of voice activation, generative AI you know, the use of very sophisticated sensors, we can build care systems that are safer and leaner in terms of manpower, person power going forward.

I am excited by that. I am not saying that that is going to solve all the things we started with overnight because I do think the blocking and tackling is going to be important over the next couple of years. But I think most leaders I talked to realize in the longer run, five years out, the power of these tools is going to be immense, and we have to find a way to harness it to look after an aging, sicker population that’s going to have higher rates of morbidity and disease that, you know, if we, if we’re going to have a [00:43:00] humane and decent health system.

[00:44:04] Karen Wolk Feinstein: Well, I know that my brain is not able to wrap around all the things that generative AI is going to do to change my life. I mean, even the little things I use it for now, trip planning, questions about medication, it’s extraordinary. I only hope that as we have these breakthroughs, we will find a way to get our health systems to pay for, adopt, and spread breakthroughs because the adoption and the acceptance of anything new in health care is so slow. It is so painfully slow that it does hold us back. And it has always been sad how long it takes. I remember it’s what, almost 20 years or whatever for a healthcare innovation to actually spread throughout the system. I mean, most of us may not have 20 years left. Could you get these things paid for, adopted, and spread faster? We are all waiting.

But thank you so much, Ian Morrison. This was an excellent romp through your experiences, your observations over many years of being a futurist and looking at the health system with uncluttered vision. Coming from the outside, you bring that kind of clarity to focus. I can’t thank you enough for giving us this time today.

[00:45:36] Ian Morrison: Thank you, Karen. It’s my pleasure and thank you for the work you’re all doing.

[00:45:41] Karen Wolk Feinstein: Up Next for Patient Safety is a production of the National Patient Safety Board Coalition in partnership with the Pittsburgh Regional Health Initiative and the Jewish Healthcare Foundation. It is hosted by me with enormous production support from Scotland Huber and Lisa George. This episode was edited and engineered by Jonathan Kersting and the Pittsburgh Technology Council. Special thanks also to Lisa Boyd, Carolyn Byrnes, and Robert Ferguson for their ongoing assistance. Special thanks also to Ariana Longley and Lauren Payne for helping with the series.

Thank you for listening, and please take action, whatever you can do to advance patient safety.