Latest / The Operator | Healthcare Business / Who Runs Your Day?

Transcript

Who Runs Your Day? · The Operator | Healthcare Business

• 0:04
  All right, let's reframe.
• 0:05
  If you're just catching up,
• 0:06
  here's the entire argument in one breath.
• 0:09
  AI isn't here to replace the clinician.
• 0:12
  Used with discipline, it hands back,
• 0:14
  one at a time,
• 0:15
  the five things burnout quietly stole by
• 0:18
  putting a well-behaved agent on the boring
• 0:21
  machinery so the human lands where only a
• 0:24
  human can.
• 0:25
  Now, three so far.
• 0:26
  For each agent wired into the EMR,
• 0:29
  our clinician, Sarah,
• 0:30
  already uses the scribe.
• 0:33
  took documentation off her evenings and
• 0:36
  gave her back presents.
• 0:37
  The revenue agent took billing anxiety out
• 0:40
  of the treatment room and gave back focus.
• 0:43
  And the intelligence agent brought the
• 0:45
  evidence to the table, gave back growth.
• 0:48
  Now today, the fourth in five,
• 0:50
  the one that decides whether Sarah directs
• 0:53
  her day or spends it reacting to one.
• 0:56
  Everybody talks about burnout like it's
• 0:58
  working too many hours,
• 1:00
  but Larry's latest article on Substack
• 1:02
  argues something different.
• 1:03
  Maybe burnout starts much earlier,
• 1:06
  like at seven forty five in the morning
• 1:08
  when you're already reacting to your day
• 1:10
  instead of running it.
• 1:11
  So, Larry, let's start there.
• 1:13
  You began this week's article on Substack
• 1:15
  before the first patient even walks in the
• 1:18
  door.
• 1:18
  You open with Sarah, our clinician,
• 1:20
  standing at her workstation dutifully at
• 1:23
  seven forty five,
• 1:24
  trying to reconstruct her day for memory.
• 1:27
  Who is this again?
• 1:28
  Are they week one or week six?
• 1:29
  Or was that billing issue solved?
• 1:32
  Or is it going to pop up mid-session?
• 1:34
  Why was that the scene you wanted us
• 1:36
  to see first?
• 1:38
  Yeah, it's interesting.
• 1:40
  Each one of these, as you allude to,
• 1:41
  has a different clinical or life concept
• 1:46
  or construct.
• 1:47
  But what I will tell you is when
• 1:48
  you're at your workstation at seven forty
• 1:50
  five trying to reconstruct your day from
• 1:52
  memory,
• 1:53
  the scene that you want to see is
• 1:57
  Nobody logs those fifteen minutes.
• 1:59
  There's not a CPT code for standing at
• 2:01
  a workstation trying to remember twelve
• 2:02
  patients.
• 2:03
  Yet it's the most expensive if you think
• 2:05
  about a quarter hour of the clinical day
• 2:08
  and it's invisible.
• 2:09
  It doesn't show up in a productivity
• 2:11
  report.
• 2:11
  It doesn't show up in an exit interview.
• 2:14
  Your boss doesn't know about it.
• 2:16
  You're not getting these reports saying
• 2:18
  you're not doing it enough.
• 2:19
  You know,
• 2:19
  every clinician listening has lived,
• 2:22
  you know, this exact scene.
• 2:24
  Coffee gets cold,
• 2:25
  doing detective work on your own caseload.
• 2:28
  All those things happen.
• 2:29
  You know,
• 2:29
  I wanted the wound on the table before
• 2:31
  anybody said the letters AI.
• 2:33
  If you feel if you don't feel the
• 2:35
  seven forty five, the rest of the piece,
• 2:39
  frankly, is just a, you know,
• 2:41
  a product demo.
• 2:42
  Yep.
• 2:43
  So, so far,
• 2:43
  we reviewed this in the top of the
• 2:45
  show.
• 2:45
  Presence has been given back.
• 2:47
  Focus is given back.
• 2:48
  Growth is given back.
• 2:50
  This article, it gives back control.
• 2:53
  Why is control something clinicians lose
• 2:56
  so quietly, you add?
• 2:59
  Yeah.
• 3:00
  And it's a big, big part of,
• 3:02
  you know, evolving into burnout.
• 3:05
  In human beings,
• 3:06
  we're control-oriented animals.
• 3:08
  So it's a basic human need to have
• 3:10
  some level of control.
• 3:12
  Losing control doesn't look like a loss,
• 3:14
  but it is.
• 3:15
  It looks like being busy.
• 3:16
  And we hand out medals for being busy.
• 3:19
  Everybody says, oh, I'm so busy.
• 3:21
  Nobody ever sends you a memo saying,
• 3:22
  effective Monday, the schedule runs you.
• 3:26
  It leaves in fifteen-minute increments,
• 3:28
  one squeezed inpatient, a portal message,
• 3:31
  one flyer at a time.
• 3:33
  and you know burnout research which i pay
• 3:35
  a lot of attention to has said for
• 3:37
  a long period of time that lack of
• 3:39
  control is the one core driver you know
• 3:43
  nobody ever writes i lost the order of
• 3:45
  my day on a resignation letter they write
• 3:47
  i'm tired control is the loss that hides
• 3:51
  inside that word tired
• 3:53
  When they say tired,
• 3:54
  they're really saying,
• 3:56
  I'm losing my control.
• 3:57
  And yet you never see it show up
• 4:00
  as a reason people leave.
• 4:01
  But the reality is they no longer feel
• 4:05
  they're in control of their own
• 4:06
  destination, autonomy, purpose, mastery,
• 4:10
  all of those kinds of things.
• 4:11
  The one we dig at is treating therapists
• 4:16
  and doctors like fungible commodities.
• 4:18
  And what that is a real euphemism for
• 4:20
  is we try to take away their control.
• 4:23
  Yeah.
• 4:24
  I always look for lines.
• 4:25
  Like if I had to find a subtitle
• 4:26
  or a pull quote,
• 4:27
  and there's a line I underlined,
• 4:28
  a dangerous master doesn't just bury you
• 4:31
  in work.
• 4:32
  It decides the order you do it in.
• 4:34
  And I've always noticed that the bosses
• 4:36
  that I've had have said,
• 4:37
  I'm going to show you the process and
• 4:39
  the result I'm looking for.
• 4:40
  You sort of figure out how you want
• 4:41
  to do it.
• 4:42
  That feels like you're talking about more
• 4:44
  than AI though.
• 4:45
  What are you really describing?
• 4:47
  Yeah,
• 4:47
  so I have a lot of military influence
• 4:50
  because, you know,
• 4:50
  I was in the army and it's,
• 4:52
  you know, in this case, it's sequence,
• 4:54
  not volume.
• 4:55
  And the one thing the military understands
• 4:57
  better than healthcare does is whoever
• 4:59
  sets the tempo owns the fight.
• 5:02
  The EMR, the inbox, the schedule grid,
• 5:04
  none of them buried Sarah,
• 5:06
  they just sequenced her.
• 5:07
  So it's the tyranny of the urgent is
• 5:09
  really the tiring,
• 5:10
  the tyranny of somebody else ordering
• 5:12
  things.
• 5:13
  So yes, the line is bigger than AI.
• 5:15
  It's every system that took over deciding
• 5:18
  what you do first.
• 5:20
  Drucker's old, you know,
• 5:22
  Peter Drucker's old distinction applies.
• 5:24
  Doing things right is efficiency.
• 5:26
  Doing the right things in that right order
• 5:28
  is the whole job.
• 5:30
  You lose that order sequencing,
• 5:32
  if you will, and the workload,
• 5:34
  wins by default.
• 5:36
  It's another form of loss of control.
• 5:39
  Yeah, spirals out of control.
• 5:40
  You also wrote,
• 5:41
  there's a world of difference between a
• 5:42
  clinician who chooses where her attention
• 5:44
  goes and one who spends the day chasing
• 5:48
  whatever is on fire.
• 5:49
  I feel like anybody who's ever served in
• 5:51
  a clinical environment
• 5:53
  feels this in their gut,
• 5:53
  they've been there.
• 5:54
  So how does someone know when they've
• 5:56
  crossed that line?
• 5:58
  I know, and it always sounds,
• 5:59
  you always start the days with the best
• 6:01
  intentions, right?
• 6:02
  But, you know, I think there's sort of,
• 6:03
  I guess, two tests.
• 6:05
  The one would be the morning test, right?
• 6:06
  The eight AM,
• 6:07
  can you name the two or three patients
• 6:09
  who are going to need the most out
• 6:10
  of you today?
• 6:11
  If the schedule answers before you do,
• 6:13
  the schedule is running the day.
• 6:15
  And then there's the four thirty or five
• 6:16
  o'clock test straight from the piece.
• 6:18
  Did today feel like something you ran?
• 6:21
  Or did it feel like something that ran
• 6:23
  you?
• 6:24
  You don't need a survey instrument.
• 6:26
  Your own end-to-end,
• 6:27
  day-to-day exhaustion tells you which one.
• 6:29
  The chased fire tired is very different
• 6:32
  than a well-run day engagement tired.
• 6:35
  And every clinician,
• 6:37
  every clinician knows the difference.
• 6:39
  And when you feel you've been run over,
• 6:42
  that can happen once in a while.
• 6:44
  But it's when it happens repeatedly.
• 6:46
  And that has just a dramatic effect.
• 6:49
  on your engagement and your wellbeing as a
• 6:52
  person and then what your confidence as a
• 6:54
  therapist.
• 6:55
  Yeah.
• 6:56
  I feel like when most people hear AI,
• 6:58
  especially now where I feel like it's
• 7:00
  being mentioned every other sentence and
• 7:01
  think automation,
• 7:03
  but you describe something smaller
• 7:05
  actually,
• 7:06
  almost like preparing someone to do their
• 7:08
  best work.
• 7:09
  Why is preparation so much more valuable
• 7:12
  than just simply automation?
• 7:15
  yeah no it's interesting you know
• 7:17
  automation removes the human preparation
• 7:24
  fulfills or arms the human so military
• 7:28
  again you know in the military there's a
• 7:29
  big thing i try to do this in
• 7:30
  my own companies they call it the morning
• 7:32
  brief
• 7:33
  And it exists so that the commander walks
• 7:36
  into an already oriented room.
• 7:38
  The staff is prepared,
• 7:41
  the commander decides.
• 7:43
  Nobody calls out automating the commander,
• 7:45
  right?
• 7:46
  The whole discipline of the series is that
• 7:48
  AI drafts, clinician decide,
• 7:50
  it's empowering.
• 7:51
  If AI is gonna be done right,
• 7:53
  it's about,
• 7:54
  empowering the clinician so automation
• 7:56
  what it does when it works well is
• 7:58
  it promises fewer decisions preparation
• 8:01
  delivers better timed ones so if you look
• 8:03
  at sarah at seven forty five a.m doesn't
• 8:05
  need a machine making calls for she needs
• 8:08
  the reconstruction already done so her
• 8:10
  doctorate gets spent on making clinical
• 8:12
  judgment instead of recall that's a
• 8:16
  smaller promise than automation but it's a
• 8:18
  much bigger gift yeah
• 8:20
  I also noticed that you were careful to
• 8:22
  say in your article that the briefing
• 8:24
  doesn't make decisions.
• 8:26
  You just hit on that.
• 8:27
  It reconstructs that day,
• 8:29
  then gets out of the way.
• 8:31
  Why is that distinction so important?
• 8:33
  Hammer that again.
• 8:34
  Yeah,
• 8:35
  so because the minute the tool decides the
• 8:37
  order,
• 8:38
  we've rebuilt the master with better
• 8:40
  manners.
• 8:41
  We're just following it.
• 8:43
  And deciding what matters first,
• 8:45
  who gets more of Sarah today?
• 8:47
  Which flag can wait?
• 8:49
  That's the clinician's job.
• 8:50
  You know that your patients,
• 8:52
  while they may be scheduled every thirty
• 8:53
  minutes,
• 8:54
  some need more of you than others.
• 8:55
  It's never the paperwork.
• 8:57
  And there's a harder edge underneath all
• 8:59
  this, Jimmy.
• 8:59
  The liability stays with the human.
• 9:02
  It stays with the clinician.
• 9:04
  If the briefing decided and Sarah just
• 9:06
  kind of complied with everything,
• 9:08
  we haven't restored control.
• 9:10
  We transferred it effectively to an AI
• 9:12
  vendor.
• 9:13
  You know,
• 9:13
  a servant sets the table and leaves the
• 9:15
  room.
• 9:16
  The moment, you know,
• 9:17
  it starts choosing the menu, you know,
• 9:19
  you got to get out of there.
• 9:21
  Right, right, right, right.
• 9:22
  One thing I did notice in this series
• 9:24
  is the fact that there are five agents.
• 9:26
  There's five distinctions, right?
• 9:28
  And you're sort of highlighting that every
• 9:30
  AI tool has a limit.
• 9:31
  It has a place in guardrails where it's
• 9:33
  good.
• 9:34
  In fact,
• 9:34
  this week you warned that RTM can become
• 9:37
  like more of a surveillance instead of
• 9:38
  support.
• 9:40
  How do leaders know when technology has
• 9:42
  crossed that line or some of those
• 9:44
  guardrails is now acting outside of its
• 9:47
  scope?
• 9:48
  yeah so before we get to the cross
• 9:49
  the line question i just want to remind
• 9:51
  you that you know what i just what
• 9:52
  i had done in this article actually tim
• 9:54
  plin and i had co-wrote an article had
• 9:56
  some help from my son on it on
• 9:58
  very academic oriented ai agents and how
• 10:01
  it could transcribe healthcare and how emr
• 10:04
  companies ought to fulfill it we had even
• 10:06
  backed up with a lot of citations and
• 10:08
  a lot of drawings and graphs
• 10:09
  And it was rejected from the academic
• 10:11
  papers.
• 10:11
  And so I thought, well,
• 10:12
  maybe I can encourage the EMR carriers by
• 10:14
  just going into five potential constructs
• 10:18
  around AI agents that if you really want
• 10:22
  to liven up the clinician and embrace them
• 10:25
  and put them back at the core and
• 10:27
  restore that and prevent burnout,
• 10:28
  you can do it.
• 10:29
  And so this week, we're on number four.
• 10:32
  And when technology has crossed the line,
• 10:36
  I think there's two or three reasons.
• 10:38
  it streams instead of summaries, right?
• 10:40
  If your clinicians are getting pinged in
• 10:42
  real time with step counts and pain
• 10:44
  scores, that's not intelligence.
• 10:47
  That's a dashboard with a leash on it,
• 10:48
  right?
• 10:50
  I would say that's number one.
• 10:51
  Number two is there's no set review time.
• 10:54
  If the data can interrupt any hour of
• 10:56
  the day, like a text message, the tool,
• 10:58
  again, owns the tempo and the sequencing.
• 11:00
  And then I actually think there's probably
• 11:02
  a third thing,
• 11:02
  and this one's sort of the giveaway.
• 11:04
  If the system penalizes patients who don't
• 11:06
  check in,
• 11:07
  you've turned the patient into a
• 11:08
  compliance object, right?
• 11:09
  So you've patterned and you've taught the
• 11:12
  patient.
• 11:14
  The test is one real simple question.
• 11:16
  Does the between visit data
• 11:18
  make the visit better?
• 11:20
  Does it arm the clinician to help the
• 11:23
  patient support him or her?
• 11:25
  If it does, makes the reporting better.
• 11:27
  If it's not,
• 11:29
  it's just surveillance wearing medical
• 11:31
  scrubs.
• 11:32
  And I like RTM.
• 11:35
  I think it should be adopted.
• 11:37
  I hate the vendors who only tell you
• 11:39
  about how it's there to make more money.
• 11:41
  I would do it in the form of
• 11:43
  care because PTs,
• 11:44
  we've heard this our entire life about,
• 11:47
  oh,
• 11:47
  we need to be doing this because it
• 11:48
  produces more revenue.
• 11:51
  Now I think we have an ability to
• 11:54
  implement RTM,
• 11:55
  but if implemented incorrectly,
• 11:56
  it's only going to contribute to moral
• 11:58
  injury and more burnout.
• 11:59
  And we have to be careful about that.
• 12:00
  And frankly,
• 12:01
  I think that's where it's at right now.
• 12:02
  And then you have leaders coming in and
• 12:05
  unprofessional managers coming in and
• 12:06
  saying, don't even do RTM.
• 12:07
  It doesn't pay enough.
• 12:10
  You got to use another lens.
• 12:12
  Yeah, that stings.
• 12:14
  There's another line that I liked and
• 12:16
  highlighted.
• 12:17
  A clinician who spends the morning
• 12:18
  reconstructing her day from memory has
• 12:20
  already lost the part of it that mattered
• 12:23
  most.
• 12:25
  What has she actually lost?
• 12:27
  Is it the thing we're fighting for in
• 12:29
  this one?
• 12:29
  Is it directing their day?
• 12:32
  What is it?
• 12:33
  Yeah, so you've just primed.
• 12:36
  and connected that therapist and they've
• 12:39
  lost their eight AM patient,
• 12:40
  that very first patient.
• 12:43
  They got a clinician who was physically in
• 12:45
  the room,
• 12:45
  but mentally still assembling their
• 12:47
  caseload.
• 12:47
  They're half present.
• 12:49
  They're doing memory work with somebody
• 12:50
  telling them about their weekend flare up
• 12:52
  with all kinds of information and data
• 12:56
  that is just hard to really piece and
• 12:57
  assimilate together.
• 12:59
  You know, presence is not a warm-up act.
• 13:01
  You know,
• 13:02
  the first ten minutes of a visit and
• 13:03
  really the first sixty, ninety seconds,
• 13:05
  according to the research, is connection.
• 13:08
  And connection is dosage.
• 13:10
  And that has to be done correctly.
• 13:12
  You have to have presence.
• 13:14
  You have to have attunement and empathetic
• 13:16
  listening.
• 13:17
  and on top of that you have to
• 13:18
  have a boundary about it we can talk
• 13:19
  about that at a different time but the
• 13:22
  bigger loss is you've lost that presence
• 13:24
  you've lost that first fresh attention
• 13:27
  because the best hour of clinical thinking
• 13:28
  she'll have all day got spent on
• 13:30
  reconstructing her patient load the single
• 13:32
  lowest level of use of a license operating
• 13:36
  at the top of the license doctoral
• 13:37
  education you don't get that you don't get
• 13:39
  that hour back at three o'clock you can
• 13:41
  write it off it's gone
• 13:43
  Right.
• 13:43
  If an operator is listening now and they
• 13:45
  walked into work tomorrow morning,
• 13:48
  what's one thing they could change that
• 13:49
  would help them feel like they were
• 13:52
  running in the day instead of the reverse,
• 13:54
  instead of the day running them?
• 13:56
  yeah i'll relate it to business and we
• 13:58
  call it the daily huddle and it is
• 14:01
  a really evidence-based part of having a
• 14:03
  successful business is the daily huddle we
• 14:05
  talked about this in the meeting podcast
• 14:07
  series so go back and listen to that
• 14:10
  so now at a clinic level they need
• 14:12
  the daily huddle to get updated around
• 14:13
  their clinic but then they need fifteen
• 14:16
  minutes back on purpose before you open
• 14:19
  anything
• 14:21
  you have to have that fifteen minutes.
• 14:23
  No inbox, no portal, no fires.
• 14:26
  Look at the day and answer one question.
• 14:28
  Which two or three patients gets the best
• 14:30
  of me today and why,
• 14:31
  or gets more of me?
• 14:32
  Write it down, three lines.
• 14:33
  Then let everything else route around that
• 14:35
  decision instead of everything else
• 14:37
  directing your decision another way.
• 14:40
  And I think here's the part that people
• 14:43
  miss.
• 14:43
  You don't need a single piece of AI
• 14:45
  to start.
• 14:46
  Control begins as a decision.
• 14:48
  not a technology the agent the briefing
• 14:51
  rtm all that just makes the reconstruction
• 14:55
  free so the fifteen minutes gets spent on
• 14:57
  judgment instead of detective work but the
• 15:01
  ownership move is yours and it's available
• 15:04
  at seven forty five a a a m
• 15:06
  the day you react
• 15:08
  to a day is a day you've already
• 15:09
  lost because you cannot ever get ahead
• 15:11
  again.
• 15:12
  So take that first fifteen minutes.
• 15:14
  You won.
• 15:14
  Take it in that order.
• 15:16
  And that order, that sequencing,
• 15:18
  as we've said, is the whole game.
• 15:19
  When you lost the ability to control your
• 15:21
  own sequencing,
• 15:22
  it really goes downhill from there.
• 15:24
  This series has never really been about
• 15:27
  AI, not specifically.
• 15:29
  It's been more about what AI should give
• 15:31
  back.
• 15:31
  This week it was control,
• 15:33
  not more productivity or not more
• 15:35
  notifications, not more billing,
• 15:36
  not another dashboard.
• 15:38
  but just a chance to start your day
• 15:39
  knowing you're the one running it,
• 15:41
  not the other way around.
• 15:42
  If you're following Cult Care and the Age
• 15:44
  of AI on Substack,
• 15:45
  you can subscribe there to the operator.
• 15:48
  It is free.
• 15:48
  Part five is where Larry brings the entire
• 15:50
  series home.
• 15:52
  Until next time, keep operating.
• 15:56
  Thanks, Jimmy.
• 15:57
  All right.
• 15:58
  How are we doing on the