Facing the Future of Healthcare: Leadership, Automation, and the Importance of Self-Care Post-Pandemic

Discover a roadmap to navigating the turbulent waters of healthcare leadership in the wake of a global pandemic, as I, Dr. Sapna Shah-Haque, engage in a profound conversation with the insightful Sarah Worthy. We're peeling back the layers on why many talented clinicians are hanging up their white coats – not due to a deficit in skill, but because of the systemic failures that have left them disillusioned. Together, we scrutinize the troubling rise in medical errors and consider whether the physician's traditional business training is complicit in the industry's woes or if a deeper grasp of financial stewardship could be the salve our ailing healthcare system needs.

Brace yourself for an exploration into the digital frontier of healthcare and its latent potential to reclaim time for overburdened medical professionals. With administrative tasks devouring precious hours, we dissect the promise of automation in streamlining tedious processes like credentialing and CME scheduling. The spotlight turns to the untapped power of centralized data systems in enhancing decision-making and the disproportionate balance of power tipping towards administration. This conversation serves as a clarion call for healthcare professionals to harness their influence and advocate for a reimagined allocation of resources that places patient care at the forefront.

The emotional and psychological scars left by the pandemic on healthcare teams lead us to examine the vital role of support from leadership. We traverse the landscape of potential technological aids, such as AI, and their capacity to support rather than replace the human touch in medicine. The imperative for an EHR system overhaul that champions interoperability and patient data fluidity comes into focus. As we wrap up our dialogue, the mantra of self-care as a cornerstone for healthcare professionals reverberates, reminding us that personal well-being is the foundation upon which the future of healthcare must be built.

Connect with Sarah Worthy.
Connect with DoorSpace, Inc.

Though I am a physician, this is not medical advice. This is only a tool that physicians can use to get ideas on how to deal with burnout and/or know they are not alone. If you are in need of medical assistance talk to your physician.


Learn more about female physicians' journey through burnout to thriving!
https://www.theworthyphysician.com/books

Let's connect for speaking opportunities!
https://www.theworthyphysician.com/dr-shahhaque-md-as-a-speaker

Check out the free resources from The Worthy Physician:
https://www.theworthyphysician.com/freebie-downloads

Battle of the Boxes

21 Day Self Focus Journal

Transcript

Dr. Shah-Haque: 0:01

Welcome to another episode of the Worthy Physician. I'm your host, dr Sapna Shah-Haque, reigniting your humanity and passion for medicine, and today I have an awesome guest, Sarah Worthy, who is here to tell us about her thought process and really some of the pressure coming out of the pandemic. Is that right?

Sarah Worthy: 0:23

Yes, and, of course, not just coming out of the pandemic, as I think of it as the straw that broke the camel's back, really. And thank you so much for having me here today. As I was telling you a little bit before we started our conversation, I'm a huge fan. I've been listening to you. I ran across your podcast at some point during the pandemic when things became more localized to my home office, and what you're doing is so necessary, it's so important. Our mental health, our sense of self-worth, are really crucial to this conversation of solving the problems that we see in healthcare, with our talented clinicians leaving in droves.

Dr. Shah-Haque: 1:02

No, thank you for that, and I couldn't agree more. The pandemic is what broke the camel's the straw that broke the camel's back. Unfortunately, we're seeing physicians leave practice, we're seeing physicians retire early and we're also seeing nurses leaving bedside and other clinical practitioners leaving bedside medicine, and it's just horrifying. I don't know what that will mean for the future.

Sarah Worthy: 1:30

Oh, it thinks that we turn around quickly. I think we do know exactly what that is. We just don't want to admit it right. It means that our healthcare system will collapse Already. We're seeing the data coming in from the last year. That's technically the post-pandemic year, when things are supposed to be returning to normal but preventable medical errors and these are errors that are generally caused because of a physician or nurse being tired or missing the right training or not having the right team around them for that patient case. They're things that are systemic and related to the environment that we place physicians and nurses to work inside of. It has nothing to do with their own competencies and abilities.

Dr. Shah-Haque: 2:12

Now, thank you for pointing that out, because the way that we are trained in medical school, the physiology, the pathophysiology, we can, we nail that down, but we're not taught how to navigate a system that really doesn't give a care about anybody except for the bottom line.

Sarah Worthy: 2:33

It's a systemic thing, and so it's challenging to deal with systemic-based problems because they are not simple and they are not linear and there is no one root cause we can point to fix and it will all be done. Once you have a systemic-based challenge like this, you have typically many roots that you have to tackle simultaneously if you want to see any change, and that's why it's been so hard for us to get out of this vicious cycle that we were caught inside that again. It began before the pandemic. We were already seeing large numbers of doctors and nurses retiring early, leaving, especially in my space in the tech startup world. I run into doctors and nurses all the time. In fact, a couple of the companies that we did early pilots with at my startup Doorspace, the founders and owners of these businesses have gone on to start their own tech companies and leave the healthcare industry, and I like to take a little credit for influencing them and inspiring them a little bit. But it just doesn't surprise me. It's horrible, even as an executive. Right now. It's horrible to work in healthcare because, as you said, it's become very financially focused and, more importantly, profit focused.

Sarah Worthy: 3:46

One of the things I've heard on your show what I hear from doctors all the time, and so physicians don't feel they've gotten enough business training, and I don't necessarily disagree. I think more education to learn about us to subject is always good, but I do question if more of the same profit driven business training is going to help or hurt the problem. I think maybe we need a better understanding of what profits really mean. One of the things I hear people who are outside of the business world talk about profits is somehow, for example, the company can't pay me more even though it's making a profit that somehow they think the profits are what pay for the salary. But if a company is making a profit, it absolutely can afford to pay its employees more, because profits are after expenses have all been covered.

Sarah Worthy: 4:44

It's what's left over In healthcare. What is happening with that leftover profit right now is, instead of it being distributed into the salaries of all of the employees right, because we're seeing physician nurse salaries clearly stagnate and in many cases go backwards and also in investing in the organization itself and the tools that it needs and upgrading things, and especially some of the smaller hospitals, when they take profits and direct them to shareholders or to real estate instead of two investments back into making the system and the talent better and more supported, then we end up with a toxic system that we're in today. So I don't know if physicians need more MBAs. I just I don't know.

Dr. Shah-Haque: 5:26

Yeah, I don't think necessarily MBAs. I didn't mind before med school, just it was something to do while I was applying. But I think you make a good point. You make an excellent point of understanding finances and also understanding how the real world works. But I think one thing that the business model has left out and I say this over and over again is we're not operating with a conscience.

Sarah Worthy: 5:54

Yeah, the numbers remove any of the emotion from it. I think it's by design. I really do. I have a more progressive view, I think, of how healthcare should be managed than a number of other people. So there's going to be some disagreements.

Sarah Worthy: 6:12

But I'm honest, I think some of the ideas that I and others in this space have that are new ideas. We know that they're untested, they're unproven and people will use that. We don't know if it will work, so we shouldn't try it. And also, except we know that what we're doing down doesn't work, so are we just going to continue doing what we know doesn't work or are we going to try something else that we don't know? And I think in healthcare it's really difficult because as a physician, your training and it has to be this way for patients' well-being your training is not to take huge unknown risks, to do no harm. If you don't know if you'll do more harm by trying that risky thing, it's often better not to for the patient's well-being. But when you're not talking about patient healthcare, I think that same training gets in the way and I think that's one of the things physicians can be evaluating. But again, it makes me really upset that a lot of this ends up being put on physicians and on nurses. Physicians and nurses have to take a stance in. A lot of them are the unions, the strikes. Those are really important. But what I think healthcare leaders and, in a lot of times, cnos, cmos y'all are straddling both that executive, administrative role as well as the clinical role, and I think what we're really missing more than business training is really leadership training.

Sarah Worthy: 7:34

Healthcare in 10 years looks completely different than 10 years ago, less than I think. Less than 50% of physicians 10 years ago were employed by a hospital. They worked in small private practices, usually for themselves or for another physician, and in 10 years, more than 75% of employees are now employed in a large hospital system. And managing a workforce of doctors and nurses when there's 10 of you versus 1,000 of you looks very different. And what I have not seen anywhere are investments in and experiments in, and research and understanding.

Sarah Worthy: 8:13

How do we train CMOs, cnos, ceos of healthcare to care for their people? We're really not seeing a lot of that. There are a few people out there Ian Richardson, somebody I'll call out on that. It does a lot to try to talk about healthcare with heart and how to do this. But the vast majority of what we provide these healthcare leaders with for trading, it's the MBA, it's the financials. We view leadership as you understand how to balance the budget and how to maximize shareholder profits, which that's not really leadership, but that's what we call leadership today in healthcare.

Dr. Shah-Haque: 8:49

True or words have never been spoken and we forget that we're working with people to manage the health of people and, yeah, that's the crux of medicine where we're at. Can you tell us more about your startup Doorspace?

Sarah Worthy: 9:07

Yeah, Doorspace is not the most novel idea. In some ways it's looking at. So EHRs track a lot of different patient-related data and the financial-related data to that, but a lot of Anything that doesn't directly touch on the patient journey in healthcare. All that back office work credentialing, keeping up with your malpractice insurance, renewals, background checks, peer references, getting all that information in triplicate organizations, matching scheduling, scheduling for patients A lot of those things are still very manual. They're not being digitalized and they're not being measured. Most organizations, if I asked, how much time is your physician spending every year just to find and schedule their required CME, and what CME is that? Physician learning and how are you supporting that learning to align with what their work outcomes are, the types of patients they're seeing All of those questions, healthcare organizations are saying we're not doing any of that, they aren't measuring it. The reports that talk about the 27-hour day that physicians are spending don't even include they don't just not include sleeping and eating and all of these wellness things that are being touted, but they don't include the time that physicians are spending preparing and managing all of this information in order to be able to go and walk into that patient room and treat that patient, so there's countless hours, and that's really where door space is focused. A lot of this. We still have questions we have to answer across the industry and we're looking into that. But I see that there's a lot of opportunity to start digitalizing and automating the back office of healthcare, getting rid of all of that nonpatient related paperwork that is taking up an average of eight to nine hours of time for physicians every week, and that's really the best low hanging fruit that people can be doing and then giving leaders real time access to know their clinicians. An organization today might have 12 to 15 different copies across their different systems of what that position looks like. The recruiting system says something, the HR system, the talent system, your scheduling system they all have disparate data that often conflicts with each other, and there's a time period for that, and so we're really thinking about how can we centralize all of this data, how can we give that control and ownership of that data to that clinician? And then how do we give leaders access to see one single picture of who each of their employees is? This will enable them to use tools to personalize the employee experience for their clinicians. It'll equip managers with real time information across your C&O and you have a thousand nurses that you have to track this for. You can't manually keep up with this and our solution will show them instantly. Here's skills gaps, here's differences we can integrate with patient outcomes. And what I really want to see change, and this is going to be hard. I think a lot of.

Sarah Worthy: 12:13

I've talked to a lot of physicians, especially about this, and nurses. But physicians in particular and I don't blame them are very jaded about their CME requirements and their training and development at work, Even though it's one of the top three cited reasons for leaving. They cite I wasn't being supported in my professional development at work. That's one of the top three reasons why doctors and nurses leave. They don't really believe that that CME has any impact. It's just a waste of time for them, and what I really want to do is start using this and, over a long term, automate it, get it out of the way and then start helping provide the data, evidence to show what types of trading, what types of credentials improve clinical outcomes and which ones are a waste of time Because right now, depending on what state you are in, the law says you're a talented doctor or nurse with different types of educational requirements, and so it's all subjective and I really want to remove that because it's wasting everyone's time.

Dr. Shah-Haque: 13:11

So you're talking about automating a lot of these things and give a clearer picture, and not only that, but weeding out things that are more of the administrative burden that physicians and nurses that we squawk about. Is that correct?

Sarah Worthy: 13:29

Yeah, absolutely. I read a study somewhere and I don't think doctors and nurses realize just how out of sync, away from the norms, healthcare is compared to other industries. So the study said that there's an average of something like eight or nine administrators in healthcare for every physician. I cannot think of a single other industry where you have more managers than specialists Education we have way more teachers and superintendents In technology, way more software engineers, designers, creatives than we have the C-suite. It's crazy to me that you have all of these people and in what they're doing, most of these administrators are just data pushers. They're moving data from one place to another because there isn't an automated system for that and that takes up money and resources. When a hospital says they can't meet nurse to patient staffing ratios because they can't afford to hire more people, if we could get half of those administrators to become nurses instead, and not necessarily directly, but if that money could be shifted, then we have that.

Sarah Worthy: 14:39

I hate to. I know nobody wants to think about their jobs going away, but when we're having legitimate, serious conversations and I don't know why, I don't know why these are legitimate, but we're having legitimate conversations out there and we see this all over. Let's replace doctors and nurses with AI because we can't afford or find doctors and nurses, but meanwhile we have eight to nine administrators for every physician. It just it makes no sense from my perspective outside of healthcare. And I think physicians and nurses they have a lot more power than they realize. They've been trained to follow this. But you could be untrained. You do have to do a little untraining yourself and I think again, that's why your show is so valuable, because it starts with the mindset it does and it starts with a sense of self-worth. I love how you talk about self-worth on here. It's so crucial because I do hear it a lot, especially physicians. Y'all are so trained to think about your patients while being above them, beyond your own, and it reminds me of so.

Sarah Worthy: 15:39

I was a lifeguard in high school and went through some of the very basic certifications with first aid, cpr and so forth that clinicians all have to go through and I just remember in one of the training classes they were very clear about you do not go into an emergency situation if you are putting yourself at risk. If the water in the pool that someone is drowning in has a line down and it's electrocuted, you going in will not say that person, you're just going to kill another person, and I think of that every time. I think about what physicians and nurses are doing when they put the patients first instead of themselves. In the current environment, doctors and nurses are walking into a burning down, exploding building effectively without the right protective gear and without a warning every time they walk into work today, and that sounds extreme, but that's all the data shows. It's effectively what's happening.

Sarah Worthy: 16:35

Y'all are walking into a war zone to see patients, and most of that can be fixed through better leadership and management. But physicians and nurses and that's why y'all are leaving. As much as I hate watching the healthcare system decline, as afraid as I am as a patient and a mother, I tell everyone the last thing you want right now is to have to go to a hospital. It is not safe, it is not. It is not a safe place and that's terrible. But we need doctors and nurses to continue to quit until it gets so bad because I don't think leaders are going to be motivated to change until it gets so bad that they have to shut down in that profit stocks. I had to say that. I had to say that.

Dr. Shah-Haque: 17:16

No, I think you're right. I think you're right. I think this is respiratory season and we're already seeing the delay of care from last year. I think it's going to be worse this year Time will tell but with the lack of staffing that impedes the ability to treatment in a timely fashion, you're absolutely right.

Dr. Shah-Haque: 17:35

I think one of the reasons why I talk about self-worth and all that comes with it is because we're not just our job title, not just a physician, not just a nurse. We're human beings that are critically thinking individuals and we're very creative. And if we can refill our cup and we can truly dig into who we truly are, we can come up with solutions, and a lot of that is going to be. I'm navigating working as a physician much differently than 10 years ago, when I was fresh out of residency. A lot of it is a learning curve, but, no, I couldn't agree with you more that we have to step up and we have to start speaking up, speaking out, and we can be diplomatic and, in the same way, create that change that we want to see, even if it's on a micro level. That's a great place to start, because when that change comes from the correct intention and the right place that has a ripple effect, and that ripple effect can be huge.

Dr. Shah-Haque: 18:49

It may not be overnight six months, 12 months, 18 months that you can definitely see a positive change again if we lead with good intention. That is one thing that I have not seen in many people. In leadership. I can say that where I work, we have excellent leadership and that's been one of the strong points. But at the same time, that's not the truth everywhere and I think things will get worse before they get better. But I also think that in the tech space, I'm really appreciative of the innovation and for solutions like door space, because this is where we have to embrace change and automate some things, and it's okay to incorporate AI into the processes if it makes it more efficient and better for not only the patient but also the workers.

Sarah Worthy: 19:47

Yeah, and AI is a fantastic tool. People follow me on LinkedIn. Sometimes I'm a pragmatist, but I love AI and there are a lot of reasons why AI is fantastic right now. But that's another thing I'd say to anyone in healthcare right now, stop thinking about innovation at the bedside for a minute, just for a minute, because that's part of why we have this problem the pandemic. Again, people talk about the pandemic as though the reason doctors and nurses quit is because watching patients suffer and deal with problems is so horrible. And it is horrible and all that. But that's not what the pandemic did. That caused this acceleration.

Sarah Worthy: 20:30

When the pandemic proved to doctors and nurses is that their leaders really don't care about them and don't know how to care and support them. It wasn't about the fact that there was a sudden cry. We have trained clinicians who go into war environments. We have doctors without borders. Clinicians are trained to deal with emergency triage situations and it is traumatic. I don't want to do that. I don't want to do that.

Sarah Worthy: 20:56

Definitely a huge burden emotionally, mentally and physically for clinicians to be in these types of environments like a pandemic creates. But when your leaders, the people who are there, who are supposed to be the ones you look to for help, for support, for guidance, when they're saying, no, profits are more important than PPE gear, profits are more important than your lives. I don't know how anyone could trust and stay in that environment and be mentally healthy. I don't see how that's possible, and I think that's really what we need to look at is we need to be looking at the right root causes and tackling them, because preventing another pandemic isn't going to change the toxic culture that is being cultivated inside healthcare organizations.

Dr. Shah-Haque: 21:44

I couldn't agree more. I couldn't agree more.

Sarah Worthy: 21:47

And I want physicians to think about in particular. Again, going back to that, stop thinking about the patient for a minute. One of the there's studies on this that when people are faced with solving a problem, nine times out of 10, even if there is a better solution by removing something in that mix, people tend to look at ways to add something to solve the problem, and in healthcare and patient innovation. That's why I see patients have a certain condition, let's create another device, let's create another device. There's something like 200 or more medical devices approved by the FDA every year in the US and hundreds more drug treatments and things like that that are approved. And if you think about, a single physician is supposed to learn hundreds of these new innovations in order to take care of their patients. That alone is overwhelming and impossible to expect every year. Yeah, and meanwhile nothing has been done. So I think that's a really good idea where AI really is a great place and I would encourage I would encourage everyone in healthcare.

Sarah Worthy: 22:54

Ignore the conversations about AI replacing clinicians right now. Just ignore them. Look at what is out there to use AI to improve and eliminate a lot of these menial tasks. I was just speaking at a conference in Boston and one of the physicians there was talking about how they're using AI to help them transcribe their notes. They're basically talking during their patient exams instead of having to look at a keyboard. All of that's being recorded. It goes into an AI that has been trained to summarize what's being said in those notes and then the physician reviews it and that cuts down on their paperwork time by at least 30 minutes or an hour per patient. That's an incredible amount of time and the AI didn't have to do any diagnosis in this. The AI is just acting as one of those eight tonight administrative roles that's following these doctors around.

Dr. Shah-Haque: 23:47

Yeah, these are great tools. And, going back to the 27-hour work day, this is a way to delegate to something else that was pretty cost effective as well and decrease that administrative burden that, even though notes are the backbone of how we build, it's something that we can delegate to a non-human.

Sarah Worthy: 24:10

Absolutely, and you don't have to worry about things like hallucinations and fiction when you use AI in that capacity. A lot of people are concerned about that. I was like you're asking AI to make something up that sounds good. That's the definition of something that's going to be partially fiction in a lot of situations. Right, because we don't always want to hear bad things and stuff. A lot of marketing and advertising is going to benefit greatly from AI and the hallucinations, but medicine really needs to be looking at.

Sarah Worthy: 24:36

How can they take things out? How can we streamline this? Honestly, if I were to be able to wave a magic wand, I would also. I would just delete everything we've done in the HR space and start over. I know that this is a very costly suggestion, but I would encourage healthcare leaders out there to start thinking about and learning about the sunk cost fallacy.

Sarah Worthy: 24:59

It's a logical fallacy. It's a common bias that human brains do, where, when we start to invest a lot into something, we even if that something is a terrible idea and, in the long run, is going to not fix the problems because we've invested in it emotionally, we become attached to staying the course and what we have done by having this failure of interoperability, this profit and greed centered idea around the way EHRs were designed. You can't fix that with software patches. Interoperability needs to be done from the ground up, and these EHR systems are going to continue to be in a very expensive waste of money until the correct architecture is built in and started, and so I do think that has to start a lot differently and it has to start again with the idea of portability of patient data.

Sarah Worthy: 25:56

I talked to physicians here and I'm here in Houston with the Texas Medical Center and I talked to physicians who not only have to fill out their own personal credential information three or four times per the four hospitals they're privileged at meaning they're doing this 15, 16 times but when they see a patient at one of the hospitals they're privileged out on a Tuesday, and the next week, on a Thursday, they're seeing that same patient at a different hospital.

Sarah Worthy: 26:21

It takes them several hours to go to the IT teams behind these hospital EHRs and extract that and to compile that at home on a laptop on their own in a spreadsheet, just to get their patient's information into one place. And so, before you thank people in my industry, I'm mad at a lot of people in the health tech industry. I think we've done healthcare a huge disservice. I really think we are, and I just I think we should all be mindful that physicians are right to be skeptical of some of these technologies, though we can bring a great deal of value using them correctly. They need to be there to solve the problems that patients and clinicians have, not the problems the CFO or a shareholder has.

Dr. Shah-Haque: 27:03

Thank you so much for that insight and if the listener wanted to reach you, what is the best way and what is your website? Our website is doorspaceinccom.

Sarah Worthy: 27:15

I don't necessarily recommend anyone go there. You can find our app of your clinicians One of our. We really want to give everyone value, so we do have an app on the app store that's free for clinicians. We don't sell their data. Everything is encrypted. I look at this as a bank account that is yours for your professional use and we make it just as easy to put things in as we do to take out. You can email everything to your employers from our app and so forth. That's you just search doorspace app on your app store and you'd find me there. The best way to find me, to talk to me, is connect with me on LinkedIn and say, hey, I'm very active there. I'm not active on the other social media sites, but on LinkedIn I find it's very helpful for meeting new people and in the healthcare administrative side. So I think they can go there and find me and I'd love to talk to anybody about this.

Sarah Worthy: 28:05

I love to hear more insights and doctors and nurses like I came from a non-health I mean, I come from, you know, 20 years of enterprise technology and I've worked on the front side in health tech before, but it's been tech, it's not so much health, and I will say a lot of times I think doctors and nurses assume that patients know what is going on, and I know you had once in an episode talking to me about this.

Sarah Worthy: 28:27

You had once in an episode talking about how, when you communicated to your patients about your schedule change, how much more supportive they were. I just want to reiterate what I have learned specifically working on this problem in the last few years is mind blowing and I constantly am telling my friends outside of healthcare about it and they are mind blown. They don't know. Physicians, feel free to educate your patients. We want to know about your lives and your struggles. We're voters, right, we have a chance and we're the ones who determine insurance. So we have a voice and can be your allies and want to be, but we just don't know. The propaganda that the average consumer gets is driven from health insurance companies and politicians and it's very biased and very one-sided.

Dr. Shah-Haque: 29:15

Sarah, thank you so much for that and thank you for your time, and all these links will be in the show notes. So just again, thank you for your support and your words of wisdom.

Sarah Worthy: 29:26

Thank you, no, thank you, and every single person who is listening to you is in healthcare, yeller during yourselves. A huge favor, really, that reinforcement of our own self-worth, our own mental well-being. That has to come first. For this change to succeed, every clinician out there, you have to put yourselves first. You can't put your patients first. You can't walk into a burning building and save other people if that building is going to collapse on you and kill you. Thank you so much. Thank you, thank everyone of you out there who has not quit medicine. Thank you so much for still going at it, still believing we can fix this and we will. It will change, but it's going to take all of us moving the needle.

Dr. Shah-Haque: 30:11

So if you have found this helpful share with a friend, because we could all use camaraderie.