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Becker’s Healthcare Podcast
Designing Reliable Systems and Empowering Clinicians with IHI’s CareOS
00:13:54
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- [00:00]
A
Hi, everyone. This is Mackenzie Bean with Becker's Healthcare. Thank you so much for tuning in to the Becker's Healthcare podcast series. Today we're going to talk about designing reliable systems for the future with technology that enables care. Joining me for today's discussion is Josh Clark, the vice president of quality and safety operating systems for the Institute for Healthcare Improvement. Josh, thanks for joining us today. How are you?
- [00:25]
B
I'm doing great. Thank you for having me.
- [00:27]
A
Of course. Excited for our conversation today. To kick things off, I was hoping you can just introduce yourself and tell us a little bit more about ihi.
- [00:34]
B
Sure. So, as you mentioned, I oversee our work in system transformation, quality, safety, operating systems. So we'll talk a little bit about that language here throughout our discussion. But I'm a nurse by background. I did leadership in quality and safety and started to embed those principles into operations over the last 10 years or so and have been with IHI for a little over a year and a half, so still fairly new. For those folks who are not familiar with ihi, I've got some questions of like, what's IHI doing here at a health IT conference? People think about us around improvement science and helping to create the foundation of improvement as a science over the last three decades. But our mission is to improve health and healthcare, and so that that helps us to have a necessary presence in conferences that are not just focused on quality and safety and experience and things like that.
- [01:27]
A
And some context for our listeners. Josh and I are here talking live at the Becker's Health IT Conference in Chicago. And we're going to talk a lot about today right in that intersection with improvement science. So let's jump in. We hear a lot about the promise of AI, especially digital health and advanced data tools, but there's still a lot of systems who are struggling to get value from that, especially when they can be such significant investments. How is IHI really helping organizations translate the technology and the data into meaningful improvements in care?
- [01:59]
B
Yeah, I think it starts with helping both the vendors and the healthcare systems and providers themselves understand systems better. Because we're here actually talking to both and offering to help with both, because when a healthcare system is really excited about a new innovation and technology and they, they want to invest in that and implement it into their system, and then they don't achieve the full value of that in the technology space, that's often called the impact gap or the adoption gap, where the value of the technology is not fully achieved. And the reason for that is, is the complexity of the system that IT'S being implement. And so there's a lot of science behind that that's used in other industries that's not being applied in healthcare. And so that's where IHI has really started to expand into operations and into technology so that folks can better understand systems and better understand how they need to intentionally design to get the most out of that investment of the new technology.
- [03:01]
A
That makes sense and sounds like it really is a natural evolution into that space for IHI just based on the needs of the industry and health systems as well. So I know IHI has been developing careos as a way of aligning improvement technology and daily operations, which is so core. Can you talk a bit more about what CARO OS is and how is it different from other IT programs or projects out there?
- [03:24]
B
Yeah, well, I think the first thing to say is that it's. It's not an IT program. That's often the question that we get is IHI creating an IT solution that's going to fix all of our other IT solutions? And the answer is absolutely not. We often advise that you should pause in continuing to buy up technologies until you have done some work to optimize the system that you that you have in place. We talk to systems all the time that have over $100 million IT budget and we'll ask, have you spent 1% of that to optimize the system so that they're fully integrated, they're interoperable, and they're actually setting up the clinicians for success? And a lot of times we get crickets when we ask that question.
- [04:06]
A
Interesting.
- [04:07]
B
And so CARE operating system is an approach when we partner organizations with CARE operating system to customize and co design a CARE operating system that ensures that they're getting the most out of the technology. And when we say that, we actually mean is IT enabling and empowering the frontline clinicians to do their best work? If we don't start at that point of care with the folks who are going to be using the technology, we often find that IT can inhibit instead of enable. And so we learned a lot around how we rapidly adopted electronic health records. Right. Over the last 20 years gone as smoothly as we would have liked. And it's been a topic of dissatisfaction and even burnout for clinicians. And so as we approach this next wave of gen AI, let's not make those same mistakes. There's tons of AI vendors here at the conference and I know they're all doing amazing work. But if you take a really special technology and you imp and you Implement it into a system that's not optimized, it will suboptimize that technology and in a more worst case scenario, it may actually contribute to physician or nurse dissatisfaction. And emotional fatigue and burnout really have.
- [05:23]
A
The opposite effect of what you're intending. A great reminder. You always need to be thinking about the end user and be wary of just adding technology on for technology's sake. And you've pointed to that idea, right, of clinicians being frustrated when technology is added and becomes a burden versus an enabler. How does IHI's approach, and specifically with Careos, really aim to flip that dynamic so that the tech can empower the workforce and restore joy and work?
- [05:49]
B
Yeah, it's naturally leading back to the frontline clinicians and obviously the patients are end users of this as well. But really, I think IHI is positioning ourselves globally as advocates for those who are at the point of care in really complex systems and especially over the last two decades, experiencing a lot of disruption. And I know in the innovation space we often say disruption is a good thing, and we hear that terminology here at the conference. But really, disruption for our frontline clinicians is not a good thing. And distraction is something that has been, something that has been a major dissatisfier, not just for the clinicians, but for the patients. And so really I actually heard today that AI should be, should go unnoticed. If it's working as well as it could be, it's in the background, it's providing the right information at the right time and it's just making it easier to do the right thing. So that, that's our opportunity to really start with the workforce and work backwards from there. And I do want to point out that again, there is, there is science around this. And so one of the things that we're helping to bring to organizations and to vendors is often referred to as safety sciences. So human factors engineering, systems engineering, resiliency. There's engineers out there who are amazing problem solvers and they want to make healthcare better. They're just mission driven and passionate about it, whether from a personal experience or a family experience. And they have no pathway into this industry to help. And we need their help as we help folks understand systems. And this is for vendors and for the healthcare providers. It's important for us to point out that our system emerged organically. So we compare ourselves to other high reliability organizations, like commercial aviation, for instance. They have a system that's very meticulously and intentionally designed to produce the outcomes that they get. Quality and safety is fully embedded in their operations and technology is there to ensure that they're able to operate safely. So that's very different than how we've set up our industry to function. And so we are working to make sure creating a platform to bring in those sciences into the industry and for folks to be able to come to ihi, to be able to access those.
- [08:10]
A
I know I've spoken with various clinical executives or quality leaders who mentioned historically quality has been sort of functioning side by side with just daily health care operations. But really it's like, how are we integrating this into everyday work and really making part of the culture and day to day for everyone?
- [08:26]
B
Yeah. And that's really what care operating system intends to do at some point. When I CHAI was founded and introduced, it got kind of put into the box of the quality department, which is great. It's helped a lot of people and there's been training way beyond quality to clinicians across the world. Millions of folks have been trained using the IHI methodology. But in terms of how systems work and how you actually design work to occur every day, with those principles of quality and safety and high reliability, there's opportunity for us to do that better. And we're starting to shift into that.
- [09:04]
A
Direction, which makes so much sense. And I think it goes hand in hand with how quickly we're seeing the health care industry transform, especially as AI and other technologies continue to shape it. What advice do you have for leaders about balancing the excitement that we feel around innovation with the need for very stable, reliable operations that patients and staff can trust on a day to day basis?
- [09:28]
B
I think just to be cautious of the shiny objects, it's really easy to get excited about the new thing that's coming down the pipe and see that as something, as a silver bullet that's going to solve a lot of your problems. But if you take the time to be more intentional about how the system's currently performing, that can give you much more information about what the system needs to be improved and work towards an end goal. So if you have an overarching strategy, how's that technology going to enable your frontline clinicians and your workforce and your leaders to execute on that strategy and work backwards from there. And so just to pause and be more intentional about those decisions and have a better understanding of how the system is structured and functioning when you're vetting potential opportunities for new innovations? We certainly are supportive of innovation. It's a major driver. But I think as you compare the healthcare industry to other industries and how We've benefited from technology, it's been good, but it could have been much better if we had been more intentional about how we introduce it into our complex.
- [10:36]
A
Systems and if those proper systems were in place to support the maximum ROI on that technology.
- [10:41]
B
Exactly, exactly.
- [10:43]
A
All right, looking ahead five to 10 years, what is your aspiration for healthcare systems that are embracing technology through a systems lens? And what role do you see IHI and careos really playing in shaping that future?
- [10:57]
B
Well, I think it starts with hoping that in five years, folks around the world understand what embracing technology through a system lens means. Right now I think that that's very limited in healthcare executive leadership teams. And so that's another reason why we're here is building partnerships with chief medical information officers and chief nurse information officers and AI officers. All these folks who are now playing really key roles in how the healthcare future delivery looks and how we're going to give them support to be able to make strategic decisions for the continued evolution. But in terms of the role IHI will play, I think it's not too dissimilar from the role that we've done over the last 30 years. We connect expertise, we create will. I think our mission is one that everyone would believe in. Right. We're trying to improve health and health care globally, we're working in every continent. But we're also looking inwardly about how we need to evolve to better achieve that mission and getting beyond our traditional audience of quality leaders and quality departments. And how do we really start to embed into operations and into technology and partner with a lot of the attendees that are here, such as those, the CMIO CNIOs to have a better understanding of how systems work and the resources and skills and methods that they need to be able to function at a really high level reliably in those systems. And so CARE OS is just our approach and how we engage with folks to create an operating system that works for them. It's not a black and white blueprint that we say you have to do this, this and this. It's what works for you. In different regions of the world, it can be very different in terms of regulatory expectations and electronic health records and funding, but in terms of, in that five to ten year window, if we have more folks who understand the importance of an operating system and how they manage the complex systems that their folks are working in every day and really being able to message to their frontline clinicians that our job as executives is to make your day to day life easier so that you can deliver the best possible care and stop asking so much of our clinicians to adopt and be resilient to these really complex systems and start asking more of the systems to be resilient and adaptive for them.
- [13:25]
A
I think your message speaks to that spirit of collaboration and peer learning that I think is needed in the industry today and will go such a long way of improving healthcare for everyone globally. Like you said. So Josh, thank you so much for your time and insights today. This has been really fascinating discussion. I'd also like to thank our podcast sponsor, Institute for Healthcare Improvement listeners. You can tune into more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.