Transcript
Marla: Welcome to the Practice Growth Podcast. Chris, I'm so happy to have you here today.
Chris: Yeah, great to be here.
Marla: And I'm really excited to talk about a topic where it's very relevant to what's going on, talking about how we can help implement technology and, and make a change in our organizations, especially in a large organization.
And you're the perfect person for this, um, being the chief Clinical Transformation officer. At Therapeutic Associates and Hi Carra Health.
Chris: Okay.
Marla: Um, and you also had some research that you did in this area. You have a PhD in biomedical informatics. Did I say that right?
Chris: Yeah. Yeah. Well done.
Marla: So really focused on studying sociology and transformation and innovation.
How to implement that a large, wide scale and how to make sure that people can adopt it. There's all this great technology out there, but we wanna make sure they're able to adopt it.
Chris: Yep. The nail on the head. That's kind of a weird background,
Marla: so I would love to hear a little bit about you, your story about going from a clinician to a chief clinical transformation officer, and just tell us how you got there and, and what were your motives.
Chris: Yeah, yeah. I mean, the 30,000 foot view, I've been a PT about 25 years. Was really into teaching quality and clinical excellence when I started, so I did my residency right outta PT school down at Kaiser Hayward and focused on manual therapy. I went in the ops system and became a instructor. I wanted to teach, become a mentor.
I became a fellow of the American Academy and then about. Six years into my career said, wait, there's quality. Quality is, this is my thing. How do you measure it? How do you get people to do it? How do you make sure that organizations can improve? And in that, I say like COID, I caught informatics. I didn't know I had it.
I just woke up one day and said, I like this Google along. And you say, what's this biomedical informatics thing? And oh, how do you use data to make better decisions? I went in to do a certificate. I wanted to make better clinical decision support tools in the EMR, uh, came out of it, a social scientist basically understanding it's all about people at the end, and the tools are awesome, but people have to adopt them and the tools have to make their lives better.
So that became the focus of my PhD that I never intended to get, but it kind of drew me in. Um, and my research kind of. Flew from there, and then that got me into my role of clinical transformation officer, which I say is the corporate scab picker. You basically find things that need to be improved and you keep poking and keep poking so that we can keep making things better.
Marla: And that's a really key, important concept to have as a chief Clinical Transformation officer because you wanna identify what needs to be changed, what technology, what process improvements, and implement that technology. But implementing technology is really hard, large, on a large scale enterprise organization.
Um, so tell me a little bit about using your research and your studies, how do you implement technology across. Hundreds and hundreds and thousands of clinicians.
Chris: Yeah, I mean at the end of the day it's, it's about change leadership. I hate the term change management 'cause it means you're like riding a bull.
You're just holding on for your life rather than leading it. So change leadership is really the key. There was some decent research done about 10 years ago that basically looked at, uh, tech change, EMR changes was the big one. And what they found was when organizations. Go through this change. They go through all the stages of the Kuba Ross stages of grief.
So denial. Then they're gonna start to bargain all the way out to grief and then get to the acceptance at the end. But if you can put. The why in front of the organization. If you can have it aligned with vision and culture, what happens, not surprisingly, but it may change leadership research come to life, is you can hasten that process.
It happens faster, the people get to a better way of being. And in fact, on the other side, it becomes part of that change became an improvement piece rather than something thrust upon them that they just had to tolerate. So I think the key is aligning it with structure. Sorry, with strategy. Which means you have to have a strategy, you have to have a vision, you have to communicate that vision.
It all starts there.
Marla: The why, putting it to the why. Absolutely. And sometimes that is forgotten about when making a big organizational change. Um, but let's start at how do you identify the organizational change needed? So what are you doing to, to say, okay, here's the problem and here is what needs to be changed?
Um, and here's the process that I should
Chris: Yeah, I think a few layers. And so first of all, an organization need to know what your. Where your pillars are, your strategic pillars, where are you going? What are you trying to achieve at three months, six months, two years, five years, 10 years? That gets much harder.
And in tech you have to think out that that distance. So ultimately, what are we trying to achieve? I think that's one. Two, understanding your culture. So what are the pinch points? What are the, the passions of your people and making sure that we're trying to. Make the passions bigger and make the pinch points smaller.
Right. I think the third thing is, and this is where I spend a lot of my time, where is tech going? Because if you're reacting to tech, which I believe many organizations are right now. You're gonna catch it at the tail end, which means you're gonna change it in a year and then you're gonna keep changing it.
Versus if we've been pretty pioneering, and that's been my fault with the organizations that I work with, but we tend to try to get ahead of it, which is uncomfortable 'cause you're typically on the bleeding edge of that. But then what happens is it catches up with you. The, the ambient scribing is a great example.
We were way ahead of the curve on that. Everyone's catching up with you now versus you having to speed up and react to tech.
Marla: And let's use that an example. 'cause ambient scribe is a hot topic right now. People right now are saying, oh wow, there's AI out there. And you said, I've been using AI for over a year now, everybody.
Yeah. So tell me about what metrics you identified first to say we need ambient scribing. Um, and then we'll talk a little bit about how you made that transformation happen.
Chris: Yeah. And so metrics will set the quantitative metrics. I'll bring in a second, but. I'm a qualitative researcher and, and really where this started, I'm part of a research team at a, the school that I teach at, uh, OHSU Medical School.
And we, we've been looking at medical scribing for years prior to AI scribing even being a thing. And we started that research to understand what's the value of scribe, what's a quality scribe, what's a safety of scribe? And then the research, I looked at PT and said, why are we not doing this? Like it's the number one cause for burnout.
It's the number one reason people are leaving the field. Why are we not doing scribing? So we created human scribe. Processes. The problem with that is you have to hire people, train people, retain people when they leave, what do you do? And so we kind of stumbled across AI in that process. The metrics we look at is really, we look at what is the level of burden on our providers.
So when are they signing their notes off? The medical, uh, profession has this concept of pajama time. So in your pajamas at home, documenting, can we minimize or eliminate that? So we've been measuring that for years. Uh, can we look at time to sign off? Can we look at, we created a Joy index again, part of being change in our organization.
We said, how do you measure joy? It's not a tool. And we said you could use data to measure it. So we created a joy index and that joy index pointed us to. This is something we have to correct. When we change it, we could see the joint index move, and so we ultimately can put lots of things together. The last piece is revenue.
So clearly this is a big driver in our organization. So can you maximize revenue? Can you decrease expense? Can you, um, at least get optimal productivity? I'm not say maximize productivity, but get optimal. So we look at all those metrics, but in addition to your people, what's, what's wearing on them? Where do they want to go?
Marla: Oh, the Joy Index. I love that. And you may have many people after this call asking you for that after this podcast asking you for that joy index.
Chris: Yeah. Yeah.
Marla: Um, so, so that's really helped you decide what are the metrics that we saw? Burnout being one, retention and being able to have your therapist and clinicians be happy so we're able to identify those metrics and then you.
Put in place this AI scribe tool. Um, and what did you see as your results after implementing it?
Chris: Yeah, if we go qualitative to quantitative qualitative, and you hear this, you guys post on this all the time now, just individual anecdotal, you made my life better. We had providers in tears that I've not been able to hang out with my kids at nine.
Now I've been to sports games that I missed forever. All because I have the ability to do my documentation at the point of care. So if I had no data, but I had that. That's why we do this. Right? At the end of the day, that's why you do these things. Uh, I think the other things we look at though, uh, I will, we'll come back to this, but I think AI scribing in and of itself without some other metrics.
Uh, like, how's your billing efficiency doing? How's your coding? How's the quality of your notes that. At least we use on the, the other side, the insight side. I don't think the actually ambient scribing in and of itself is as valuable as folks would make it out to be. This is what our research now is telling us that most organizations, if you measure for turnover, it actually doesn't change with ambient scribing, uh, in, uh, rural areas.
If you have ambient scribing, it doesn't really help retention, or sorry, recruitment. If you're in a city, it probably would. Uh, so I think. Just the ambient scribing won't have a ton of measurable impact right now unless you tie it to these other things. We saw revenue or RVs go up. We saw revenue go up, we saw productivity go up.
Can we attribute that just to the scribing or to the insights? We rolled them out together and I think they should be rolled out together. So,
Marla: and what about the Joy Index? Did you see that improve?
Chris: Yeah, and we did a lot of other things. So right over the top of this, we were doing a lot of things. Um, portions of the Joy Index are connectedness, meaningfulness, and so we did a lot of things in the organization to really improve communication, to improve our, um, our shared purpose and these sorts of things that was right on top of this.
So this was a portion of that, but could we have a cause and effect that it was just this? No. But did it play a role? For sure. Got it.
Marla: And can you give actual metrics of it improved from X to X and in terms of all those different KPIs that you just identified?
Chris: Yeah, so our PJ time has gone down. We've saw about a 20% reduction in PJ time on most of our providers.
We need to recognize that, uh, not all providers get the same thing out of an ambient scribe, but those people that were really burdened by documentation, those people that wanted to change, wanted to write a good note. Those people saw a significant reduction in their notes. Those people that don't care about their notes.
I think their notes got done faster. They're happier, but they're still doing it at night. They're just using the scribe to do it at night versus their memory to do it at night. So, but about a 20% reduction in the early stages of this is a pretty good.
Marla: And what about the RVU and the finance on those different metrics that you identified?
Chris: It's a hard number to move. And again, we've been doing lots of other things alongside of this, but in an organization of our size and our, our tenure of trying to move these to be able to move it just a hundred. Is is significant. So we moved at a couple hundredths just in this process of, of three to six months of doing this move.
And if you've been stable for two years and you move at a hundredth of a large organization, that's a big deal and a large organization, that's a fair amount of revenue.
Marla: Great. And that's from the, uh, prediction Health sky. But what about from the insights part, the. The prediction insights piece.
Chris: Yeah. And that's where we can't separate 'em, but we, we rolled those out together.
Um, I pushed in our organization, I didn't do the training, but I'm adamant that if you just roll out the scribing, you're minimal impact. If you roll out the scribing tied with this is what a quality note looks like, this is what, uh. Linked care from what you're billing to what you're writing looks like.
Here's what a good note looks like from an audit perspective. They have to go together. If they're not, you've just said, congratulations. You have a little bit of a burden reduction, but fun. But that missed the main impact of why we're using these sorts of tools.
Marla: And in terms of that compliance and insights, now you're able to have better conversations with clinicians where they don't feel like somebody who is just a operator is telling them to write a better note who's never written a note.
You actually have a good, uh, data set and a, a way to explain and help them improve in areas that they need to.
Chris: Yeah, and a hundred percent, this comes back to the change leadership piece. For three years, we worked with Prediction Health before they even had their scribe tool. We helped them dial in their amp, their insights metrics.
We helped them train their models to get the AI scribing, but we were collecting data on all of our folks for two years and nothing changed. So the organization just putting in the technology doesn't do anything if no one manages it. If you don't have those conver use that data to have a conversation, nothing's gonna change.
But the end of the story is when we did the formal training, when we took an active management role, when we rolled it out and gave people access to their dashboards, that's when things changed. So again, I love tech, that's why I got into informatics. But it's tech plus people. It's tech plus leadership.
It's tech plus leadership and vision that ultimately is gonna get your organization to change. Yeah.
Marla: Yep. It's not just having the tech tool, it's how you implement the tech tool. So that gets me into the, the nuts and bolts of this where everybody wants to know how did you implement it? Tell me from the, using the why, the steps, what did you do to actually make people change, adopt, and have great results?
Chris: Yeah, and so one semantic word, so making people change, we can never do, giving them the opportunity and make it easy for them to adopt the behavior you want. That's what we do. Um, so I think the biggest thing is one, having that compelling. Why. So the organization took a step back and said, okay, we need to be a little careful.
Operationally, yes, we want an outcome from this. If this comes from an operational lens, do this. And we hope to see this change in your RVU per visit to your productivity. You know what's gonna happen, right? That doesn't resonate with a shared purpose. So we took a step back and gave it to our clinical practice and quality and compliance team that said, this is about the pt.
Now, all those other things are outcomes. We ultimately want the outcome, but we're gonna train to the habit. We're gonna train to how this is gonna impact the daily life of your professionals and, and make our bet that that's gonna give you a good outcome. And so we started there. It came from that group.
That group then. Did an analysis ahead of time to say, where are our folks struggling? In the notes, we tied it to other training we've been doing on what makes a good note. So we harmonized what they were already hearing in other training with what we were gonna roll out to the next step. And the last thing is we did a very formalized training.
We took the clinicians outta the clinic, which to do ai well, you should be able to turn it on and it should be intuitive and you shouldn't have to train them. I believe that to be true, to get them to change a behavior. That's not true. You have to show them why it's important. You have to invest in making it important.
So we took everyone outta the clinic asynchronously. So not at one time, but did a synchronous uh, training on in pods of individuals. We trained them on note quality. We trained them on how to use the technology, which took only a few minutes of that training. 'cause the technology is then we train them on how to look at their insights.
We then discussed with them how they're gonna work with their clinics in implementing this. And then the last piece is, and then we measured them and then we gave them feedback. Yeah.
Marla: And those clinicians actually got to see the data and see the measurements so they can see that how it's helping change.
Chris: Yeah. Why would we hide it? Right. At the end of the day, uh, I think we do that too much in fear that they're gonna be offended if their, if their numbers are low. And this was part of my research and that's not true, but it's a fear, a fear organizations have, uh, or we think it's gonna overwhelm them. Give them the data, tell them what to look for, make it easy to look at.
So we take some of the data and summarize it down so we don't give them everything to kind of get lost in the details. But yeah, make it easy and let them see the impact.
Marla: Great. Wow. And how many clinicians did you start with? A small amount and then scale? Um, just for, you know, we've got all different size practices looking.
Can you give an example of how many you started with and how quickly are, are
Chris: certain scaled? Yeah. Technologically, we started with one clinic because we, you wanna work out the kinks even though the technology from the vendor might. Be great as it interoperates with your EMR as it just works through your tech stack and all the different policies you have on your computers.
There's lots of potential failure points, and so we didn't want the. The value of the, the tool, the AI tool, to be sullied by something in our system where they said that's, that tool stinks. All they know is it didn't work for them. But they would blame that on the tool where we'd say it was actually our fault.
So we worked a lot of kinks out with that first group and a lot of frustration, a lot of it was on our part. Some it was on the vendor to get the links happen. So we got the technical piece done. That group. Then we ran through a dry run of the training to make sure that they could help us with that. And then once we did that, we rolled out at scale.
We took pods of groups and rolled them out over the course of couple months.
Marla: And how many clinicians are using it now?
Chris: We have about 80% of our clinicians using it now. So we have about, well, so about 250 clinicians, so about 80% of those folks are using it on a regular basis. Um, like my research in hospitals is showing that's, that's pretty good.
I mean, hospitals at 30% adoption is really quite good. So we're higher than those. We have not rolled this out to our PTAs and we've not rolled this out to our newer providers for a few different reasons. So these are our folks that have been with us a while and our physical therapists.
Marla: And is there a sociology strategy about whether you.
Let them choose if they wanna use it or tell me about that.
Chris: Yeah. It no reason to force this on someone unless there's an operational reason that we do that. And so we didn't force it on anyone. Now what we then do is look back at their profile, how they're performing in their documentation, and if they're having a struggle, we're gonna come lie alongside of them and say.
Help me to understand what you're doing, where the problem is, and help me to understand why this is not a solution. 'cause we're paying for it, so why wouldn't we use that? Um, my research shows this and our, our organization shows this. Some people don't need it. It's actually ambient, scribing is not right and actually would be detrimental for some people to use it.
So we're not gonna force it on everyone. Some people are just laggards and they're slow to adopt. Some, that's fine. Be a laggard and as long as everything else is going fine, you be you and you don't get the benefit of this great tool. Some in the middle are laggards and they should be moved. Those are the ones that we need to, to work on.
Marla: Great. And how do you, in a large organization with 250 providers, how do you make sure communication goes to those people and transcends down from leaders or. Or transcends up. What is your communication pathways to get the message out? The why, the implementation. What do you utilize from that?
Chris: Yeah, and this goes beyond this, this, um, implementation, but an organization of our size needs to rely on your.
Your regional managers and your clinic managers as a conduit for that information. So we certainly have to use them over our 70 plus years of existence. We've probably played with that pipeline of how we get and over utilize those endpoint leaders too much. So I think the key is use them, but you have to connect the end user.
With the people who have the most skin in the game, which is the compliance group. The operations group. So they hear from us, here's why it's important, here's what you need. They get communication directly from us and augmented by their, their director, and then feedback from them. We have the ability for those folks to come directly to us.
We like them to work through their director so we can kind of throttle that information, but you shouldn't stifle. Good feedback. 'cause good feedback makes everything better.
Marla: And I know you're sharing the data. How much qualitative, um, first quantitative data are you sharing in terms of people saying, this is how I felt about this, because I know that's really valuable when helping others implement, is using really specific examples of people sharing
Chris: their success.
Yeah. So yeah, so we share that information out with folks. We're hearing this, we do a cohort for all of our newer PTs when they come in. Um, so again, we don't. Implement new PTs on the system until they've been with us for a while. It's for clinical reasoning development reasons. Um, but we, we tell them what's coming, we show them what we've done.
We give them quotes of people that they said, here's this tool we have for you. Here's why you don't get it in in the next little bit. Here's what we're gonna do over the next six months to make you a good consumer of the technology. So yeah, we, we use that feedback loop for them.
Marla: Great. Right. Um, and you said that you were an early adopter, so.
Where there's struggles being an early adopter, but you also said there's a lot of benefits. Can you tell us why you like to early adopt a tool? Um, I know you hit on it a little bit before, but what you feel can really be an asset when being at the forefront of something instead of a, a fast follower or slow.
Chris: Yeah. I, at the forefront always for me is you get a voice in where the product goes, right? So at, at its core, we can see things now that I say. That was from input that we gave you. I can see that works that way because that came from our feedback. Um, if you wait. You get what you get and don't throw a fit.
So I, and I'm always a, I, I have a tendency to want to go ahead of things and build things. So that's just how I'm wound. Most of our organization is not that way, and I recognize it, so we have to throttle those things. But I think having a say in where it goes, that's one. Two, having the ability to iterate.
So rather than waiting, investing a ton of money in something and it maybe fall flat and be like, oh, that was a failure. We can say, look, we're gonna do a trial of this. And we're gonna change it, and we're gonna change it, and then we're gonna change it. It's this process of, of inertia where you're creating this change, inertia versus a big bang.
You wait, do it, stop. And then the next one, wait, do it and stop. We're always just rolling these things a little farther forward. It just creates a cultural norm of we get in early, we iterate, we try, we change. That's just how we roll. And again, that's probably me with my fingerprints all over it. Um, but I, I have found it to be effective for us to get better outcomes.
Marla: You get what you get and don't give a get a fit.
Chris: Don't, don't throw a fit. Don't. That's what I tell my kids. Yeah. It's ultimately, sometimes it is what it is. If you're gonna wait and be the receiver,
Marla: I love that. I am quoting that and using that. Now what about on an organization side? It's really hard to sometimes convince your other leaders when you see something, you know, this is the next bit of innovation.
This is going to affect our organization positively. How, and using your research, how do you influence the leaders? To say, yes, let's adopt this new technology.
Chris: Yeah, yeah. I will. First and foremost, I'm blessed, uh, within therapeutic associates and, and working with other organizations. Is that just the leadership dynamics, the interplay between the leaders, the trust between the leaders has to be there.
Uh, and knowing your roles and knowing your personalities just we're all different. And so we're a complimentary team. If, if you don't have that baseline trust, if you don't have that baseline, what's your role in the org? What's your role in knowing how we communicate? Everything else is gonna fall flat.
So that's, it Sounds a little bit esoteric, but you have to start there. Right? Once you have that though, it, it's ultimately knowing what each person needs to hear. So I, I couldn't come to my CFO and say, we're gonna do this because it's great. Our providers are really hurting and they really want to feel better.
He's like, yeah, I agree with you, and how much does it cost? Right? And I agree with you. And what's the ROI? So I have to come prepared with, here's what it's gonna cost, here's what it's, uh, gonna offset. Here's gonna be our ROI, here's how I think it's gonna play out. To our chief people officer. I'm not gonna do the C FFO spiel.
I'm gonna come to her and I'm gonna say, Hey, really these people are hurting. This is the number one reason you're struggling with recruitment and retention. I believe if we do this, we're gonna move the dial. Can you get some metrics in place here so that when we implement, then we can measure on the other side and see the change?
Right? I think our CEO is their job is really to see it all. So you can give them the more holistic view and then the operator, again, different yet. This is where we're gonna see the changes in your units. So I, I think from that perspective, making sure that you're, you're coming together. But if you have a good group and relationship, first it, it takes care of itself.
'cause it, it happens kind of naturally.
Marla: So you really recommend that stakeholder mapping and saying, what does this person care about and what do I need to present to them? Just this information. 'cause they don't need to see the reps. What does this person care about? And how can I make sure that holistically this tool is going to affect all of those different lives and make a difference in their business metrics or what they are.
Are working on, um, and putting that forward. I, I think that's a great way to go. Yeah.
Chris: And hold it loosely. I think the last piece is, um, I'm a very competitive individual, so there is the risk of something like this. This is my pet project, this is something that I have passion in. I've done research on it.
I'm gonna make this happen. And I think there's a value in that. But if that's the only perspective you have when you do, when you engage with these other stakeholders with their own perspectives. It comes across and now this becomes a battle of wills and it's not gonna happen. Maybe it's a okay, no. Help me to understand why not.
Is this a no forever a no, not now. Okay. And now we can work forward. If I'm just gonna get my thing and I'm gonna throw my fit. If I don't get what I want, well then that's not, it's gonna come out in the process.
Marla: Yeah. And with new technology, are you ever afraid of failing with a tool and saying that wasn't right, and saying, okay, we had to pivot and maybe try a different tool?
Yeah. Or, or not this at all.
Chris: Am I Or is the organization
Marla: The organization,
Chris: yeah. I say it that way because ultimately that the only way to make, uh, tech work is to iterate and fail if you're gonna learn. Uh, to learn you have to fail. Right? And this has always been my perspective. And, uh, again, not the whole org takes this.
Um, yeah. I think portions of our organization are, are failure fearful. And so how do we, um, do it in small enough, uh, doses? This is typically my refrain to that is to say, okay, well what's the worst thing that could happen? Alright, if we roll this out and we crash and burn, okay, we tick off a couple patients in the pilot.
Okay. How are we gonna mitigate that? Are we good? If that's all that happens, well then let's roll. Help me to understand what are the other worst things that could happen? Right. Um, but yes, there's always gonna be a fear of failure. Our, our other refrain is that we then never want that perfect to be the enemy of a really cool or really good.
And so we're always gonna say, let, is it good enough? Is it 70%? Roll with it? If it's 60%, probably still roll with it and just watch it. If it's 90%, you waited too long. And so we have to have that. Right. Um. Uh, with speed indicator of how fast you should go into the these things based on the risk that you have.
Marla: Wow. I do feel like you guys are a little bit of an anomaly because a lot of the industry is very fearful and change and fearful to take that next step. So I appreciate this and hope that people can adopt a little bit of this. It doesn't have to be perfect. You don't have to wait till a hundred or 90%.
You said you waited too long. You actually should be jumping in a little bit earlier to help say, okay, what are, what are the changes needed to make it perfect? And I know we do that in tech, we call it the agile process. Yeah. Because it helps you keep reiterating to the, the perfect spot, um, and not wait too long to get it back.
Chris: Yeah. I, I, and you used it, I mean, interesting term, fear of failure. If, if there's no fear, you have a problem. If fear is paralyzing, you have a problem. There will always be fear. So I think the key is don't wait until you don't have fear and then do it. Make sure that you have a contingency plan. Make sure you understand the risks and step out in fear and watch it.
Maybe be careful, but don't let that niggling. It's in my gut. I don't know. That's normal, right? But step through that. You cannot let that stop you. You should still go forward.
Marla: And now you presented all this forward to your team, to your clinicians, to your leaders, um, what would you say the, the success. At the end, after now doing it for a year, year and a half, what could you say, wow, we said it was gonna do this and it really did do this.
How do you feel about that final outcome?
Chris: Yeah, and we're not final. Now. If I'm gonna iterate in doing new things, I'm always gonna iterate on something that I've already implemented. And so there's, there's still learning to be had and that the story is not done. I would say the things we've seen now is.
Everybody we talk to who's used the tools that fit that profile of that key user has found benefit. We haven't had a single person tell us this was awful and made my life worse. Now we've had people tell us I didn't need it and it didn't make my life better. Great. It's not gonna be perfect for everyone.
So I think the biggest indicator is when we culturally, when we talk to our people, they feel that we've given them a tool that made their life better. If that's all I can do in my career. Then we succeeded. Right? At the end of the day, we've seen our operations go up. We've seen our quality documentation go up significantly.
That was probably a 10 to 15 point rise of our audit scores went up through this process. I think they can go up more as we continue to wrap the technology and more training. Um, so jury is still out. The one measure and the reason that we, I put the ROI on, this is retention. It's gonna take us a while to see that number move, and there's so many other confounding variables in that one that.
Maybe they're gonna overshadow the impact that this tech could have. Uh, but I believe that number will change, but it needs more time before we can see if it has.
Marla: Yeah. Well, as you said earlier, burnout is directly related to how much time you're taking notes home. Um, and that that ability to feel like all you're doing is working and not doing.
The unnecessary work, let's call it, and not having that patient care and patient time. So if you could reduce that time at home and the work life balance and be able to be with your patients more and show that the quality metrics, like the outcomes and the, the compliance and documentation, uh, that, that's a lot really important to the clinicians 'cause they wanna get quality care.
They really do.
Chris: Yeah. Yeah. I think so. Interesting thing that's coming out of our current research, and we're not done with it yet, but we've done the qualitative phase. And this is not in PT O only. This is pt, but also in hospital systems. Um, many providers, when they're using ambient scribing, we would think they're doing the ambient notes.
And as soon as the patient walks out the door, they close the note. And that's the ideal state. We need to ask ourselves why that's not happen happening more. 'cause what's happening a lot is they're using the ambient scribing, I believe. 'cause they want to have an engagement with the patient. They don't want that computer between them.
And so a plus check that has worked. But what now we're finding the providers are doing is they're saying, well, I, I don't have to take any notes now because I know it's there. So at home tonight, when I do my notes like I've always done, I don't have to worry about bringing all those pieces of paper or working real hard to remember this.
'cause the AI has done it. We've actually facilitated pajama time. This would be my challenge to the industry as you've actually, I believe, made pajama time easier to do for folks. And this is what we're seeing in the data. This time to close hasn't. Closed the gap in many folks because they're just, they're doing habit.
They always have the habit of doing it at night. It's not that bad. I can still hang out with my kids and then I can do my notes. Stop it. How much better would it be if you didn't have to do your notes? So I, I think there's still movement in the tech side of this and also in our in implementation side to help these providers to see the best way to run this is, you should close the note before the patient leaves.
Isn't that amazing if you could do that. I don't believe that story's told enough. And so people are kind of making their own story around it and it's not getting the effect it could.
Marla: Yeah. Now I know you're using Prediction Health with your EMR system, Athena, um, you know, uh, what we've seen with, in our.
Data with prediction Health and Prompt. We've actually seen 95% of clinicians complete their note before the end of the day and a decrease in 75% drama time. So hopefully, I mean, I, I know we, we are all researching that and really seeing that that's what we want. We want them to go home and have the ability to just have their personal life and come back and focus on their care and
Chris: yeah, quality patients and get your lunch back.
These, the only people don't talk about, we look at when people sign their notes off, it's. The day, the day, the day lunch. Right? So how can we decrease and actually be able to eat a sandwich without having to be documented? That'd be amazing.
Marla: Eat a sandwich. Talk to a coworker about a tricky patient. 'cause that's engagement.
That's what helps with the depersonalization of your work. You know, when you, you did have that lunch with all your coworkers and you're all sharing some good stories or funny stories and mentoring each other. That's a big piece of burnout too.
Chris: You got it. Yep.
Marla: So you talked a lot, a lot about what organizations can do to make it go well, but what are they also doing?
What are some pit points that actually make it not go well?
Chris: Yeah, there, there's decent research that, uh, on technology adoption and ultimately when, uh, basically technology gone wrong, how it, how it affects healthcare systems. And a lot of this, if you think in the hospital systems is. Something happened in your EMR and the patient died or something happened in the EMR and you operated on the wrong limb.
So some groups have gone and taken a look at, um, what were some root cause factors every time one of those near misses or bad events happened. And what they really distilled it down to is it comes down to one of eight factors. It's pretty straightforward and pretty well researched. So a lot of times we would simply say, well, the technology broke.
That's one. So potentially maybe the computer didn't turn on or, or you had an out network outage and this great application couldn't run because you had a network outage. That's rare. Sometimes the application itself had a hiccup or gave you the wrong information. That's possible, but that's also rare.
It now becomes these social factors that are more common. So was the person not trained on the tool? Right. Was the user interface? This is a real common one, was the user face. User interface confusing. So they didn't know where to look for that piece of information, and so they found something else when if the user interface was better, it was there.
It was just in the wrong place or not evident enough. So there's a lot of research and change, I think, to be done here. If we remove ourselves from the tech end. The one person though, maybe there was some team dynamics things, maybe they were short staffed that day and everyone was stressed out. Maybe there's weird communication dynamics in that team and that even the best tool is gonna fail there because of bad dynamics.
Now, if the team's right, maybe the organization has different standards that are making them not be able to do things right. Maybe they have unreasonable productivity standards, maybe they have unreasonable additional tasks that they have to do, and then even if the organization is doing it well. Maybe there's other regulatory standards.
Medicare is a big one right now. We say administrative burden, and it hits the front office. It hits the providers. It distracts them from doing what they're supposed to. So I bring this up just because the organization can implement a technology well. But you also have to keep feeding and petting the beast, right?
You need to keep the thing working. And there's all these pieces we think about just the technology. Once you implement it, let it roll. You have to continue to make sure team dynamics are where they need to be. You need to still make sure that the organization is prioritizing what's a priority, and you need to think about the other pressures on your providers.
'cause any of those things can make a perfectly well done technology fail and turn into a bad outcome.
Marla: And how do you. How do you keep doing that? What is the ways that you guys have done that in your own organization?
Chris: Yeah, so I think the key is again, identify what are your priorities and make those clear.
Ask yourselves what can we do every day to reduce those redundant tasks, to reduce those things that we see are a stressor on our providers that take away from the easy stuff and that the technology's working on. Try to buffet them from those external regulations. So. Let other people do work that they don't have to do.
So it's really supporting them.
Marla: You've dedicated your career to looking at how organizations work and how clinicians evolve. What gives you the most hope heading into the future of this industry?
Chris: Yeah. Uh, this is gonna sound a little bit, uh, dark, but I think that best thing about what's happening right now is that the healthcare reimbursement system is failing.
Because we've talked about quality and value for years, but we've really done it a disservice, right? We've ultimately said, well, if you collect a PRO, good on you. If you do Medicare's mips, uh, requirements, then you get paid a little bit of money. That has not done anything to improve the care to our patients and more so it hasn't done anything to improve the value of care.
So because there are these cost constraints, because we have to, um, make changes, we have an opportunity. Now, this can be a horrible opportunity if we sit back and wait for the system to impose upon us and the payers and legislators dictate what's their primary focus? It's money. So you're gonna just simply get the money squished down and then we're gonna have to fight as our expenses go up.
And that's a bad thing. That's why I say it sounds dark 'cause left to someone else's devices. You're gonna squeeze us out of the market, right? And the hinges in the swords of the world are gonna come in and say, well, like I don't cost that much so I can do it cheaper. And I love. What Hinge and SWORD stands for, but they should stand together.
I think our opportunity is, and you can see organizations and payers starting to deal with this, it takes us pushing this just to say, we are gonna define value. Yes, there's a cost component and we have to drive that down, but we're gonna drive quality. Here's how we measure it. Here's how we make it easy through technology for providers to deliver on it.
Here's how we hold our providers accountable to it through organizations. Uh, organizational processes and accountability plans and technology. I think we have amazing opportunity to move that forward. But it's gonna change one way or the other. So this is one of those, if you wait for it to be perfect, payers aren't gonna wait.
Right? We have a great opportunity to make quality, patient-centered care, value-based care at the center of where we go with technology leading the way, but we also have the opportunity to sit and wait and be paralyzed until someone else does it.
Marla: And we're never gonna get to that value-based care unless we have the data and the technology to support us.
Because in order to be able to communicate that to the insurance companies, the reimbursements and the employer groups, we do need that data. So that's a fantastic point. And I look forward to seeing what you guys will do with all of that.
Chris: Yeah.
Marla: And how you will be bringing that to the next one.
Chris: Yeah. And da, I'm a data guy, but I will tell you data is absolutely worthless without context and out a story and without a vision.
It's just like tech adoption data itself means nothing if you don't have a plan for it. But I think the other thing is we need to recognize that, just like with stakeholder analysis that we talked about earlier in trying to push tech adoption in my organization. It's the exact same thing. With this value, you have to understand the different players and what's their priority, what, how do they speak?
And we have to speak their language. If, if, if I go to a legislator and just talk about a PRO. The eyes will glaze over, right? If I can go to say it's gonna save this amount of money and it's gonna increase, it's gonna touch this many lives and it's gonna improve satisfaction, well now I touch their their heart.
And so we need to be able to know what other folks are interested in and sell that, and to do that. We don't have the whole data story, so we have to get data from the payers. We have to get data from the, the employers. We have to get data from these larger entities of population health to understand the impact of physical therapy.
On that. We really, we do bits and pieces of that, but we have not done a great job of have a compelling vision led story. So that opportunity is there. But you gotta grab it. 'cause otherwise someone else will take their story
Marla: and that's a good place to go for our tech. Um. Tools out there is how are we now being able to connect and communicate with those insurance companies, with those hospital systems, with those claims, and put it all together to be able to bring it back.
Chris: Yeah. Interoperability. I mean, I could speak for a whole nother podcast on interoperability, but it's great if I see the information but person who referred them to me or that even a physician who doesn't know me from Adam but sees they had physical therapy and can see what we've done and it's impact their life and they can just see it in their EMR.
You're gonna start telling the story through the patient healthcare record. This is the value of a connected healthcare ecosystem, but one, we have to be clear on what is our value proposition. Two, we have to kind of have the data to tell the story. And three, we have to have the means to tell that story to people in their daily lives without having to make a special.
Time to connect with them. 'cause that day is hard to make.
Marla: Well, I love that outlook. And it's true. If we don't, if we don't change, as you said earlier, and we don't jump on it earlier to help make it there, um, we are going to get left behind. I have to say this has been so valuable, understanding more the perspective of how to.
Implement technology, how to think about it, how to talk to the different stakeholders to say, this is why we need to do it. Um, and make sure that your clinicians are able to adopt it. So, uh, any last minute words for clinicians listening or leaders listening? Um, just about technology and adoption in general?
Chris: That, I mean, I, I tell folks I'm a socio technologist and, and in that I would challenge organizations to think of. When you implement technology, it's actually another team member. It basically, you have a team member, you have individuals, you have your organization, and the technology becomes basically another team member.
If you were to bring in a new team member and never introduce yourself to that team member, never learn what, how that team member communicated, never have that commu, that team member learn about how you communicate. Would that be a good working relationship? Absolutely not. So why do we take technology and throw it at people and wonder why the teamwork didn't work?
It. It's because you treated the technology like this thing that should just be perfect. And because it's technologically great, it should naturally work into the sociology. It doesn't. So ask yourself as an organization, both in planning and after you've implemented, how is that team member integrating Into my world and far too long, people have bent their workflows to adopt to the technology.
I think all the tech vendors, you guys included, have done a nice job of. changing that, but ask ourselves, how is that team member implementing into our workflow and how can we do a better job of implementing it rather than just thinking, I paid for the thing and it should have been perfect. So why isn't it no different than hiring a great employee but never talking to them?
Marla: Technology is only technology without people, like you said earlier. Yeah. I love that it's a team member and it's a part of your team now, and you have to think about how do we, uh. Onboard and implement that team member as much as we're learning about.
Chris: Yeah, especially with ai. 'cause right now, now ai, you can train it now AI's gonna talk to you and train you.
So I use this a little bit facetiously, but it's gonna become real. That's gonna be an actual team member that you actually have to integrate with. If you want to get the most out of it, you better start practicing it.
Marla: Well, the future of physical therapy and rehab, and as you said, medical in general. Uh, is is really bright with a lot of these tools in implementing them right way and helping.
At the end of the day, just clinicians get the best patient care they can. Thank you, Chris. Really appreciate you having you.
Chris: Yeah, my pleasure.