Approaching Technology Solutions as a Hospitalist with Dr. Arun Mathews, Chief Medical Officer for MultiCare Health System

[00:00:05] Welcome to the Mimora Health Care Delivery Podcast.

[00:00:08] Through conversations with industry leaders and innovators, we uncover ways to simplify

[00:00:12] how patients and care teams navigate complex care delivery.

[00:00:18] Hi everyone, this is Dr. Jamie Colbert, Chief Medical Officer of Mimora Health and host

[00:00:24] of the Care Delivery Podcast.

[00:00:26] I'm joined today by Dr. Arun Mathews, the Chief Medical Officer at multiple facilities

[00:00:31] within MultiCare Health System in Washington State.

[00:00:35] And Arun, really, I'm excited to talk to you today with your background in health information

[00:00:41] technology, your strong background as a clinician, having led hospitalist programs in the past

[00:00:48] as I think you've heard from our previous conversations.

[00:00:52] I myself am a hospitalist, so I'm always excited to get to chat with others about

[00:00:57] our trade.

[00:00:58] And to start off, why don't you just tell our listeners a little bit about yourself and your background?

[00:01:04] Of course. Thanks for having me, Jamie. It's such a pleasure to be on the podcast.

[00:01:08] So a little bit about myself. I was born in South India, raised in parts of Africa,

[00:01:15] the Middle East, did the international baccalaureate as a high school student, which allowed

[00:01:20] me to apply to medical schools in Europe.

[00:01:22] And I went to the World College of Surgeons in Dublin, Ireland as a result of that,

[00:01:27] hopped over to Baltimore to do a residency in internal medicine, which is where I met my wife.

[00:01:33] And then I did a fellowship in clinical informatics, a research fellowship at Hopkins.

[00:01:39] And because we are both foreign medical grads, we essentially had to spend some time

[00:01:44] in a medically underserved area as part of our J1 waiver sort of road to our green card journey.

[00:01:51] So I had the opportunity to work for Apogee Physicians as a program director in a small

[00:01:58] startup program in Southeastern New Mexico and then transitioned on to a program in Midland, Texas,

[00:02:07] where the CEO and CIO had, I think, discovered my background in clinical informatics.

[00:02:14] And that was when meaningful use stage one and stage two were starting to hit.

[00:02:18] And I distinctly recall the meeting where the CEO and CIO sat me down and said,

[00:02:25] Arun, do you have any interest in going to meetings and being yelled at by your colleagues?

[00:02:30] And that sounded fantastic.

[00:02:32] But yes, all of a sudden I became the implementation lead for our transition from paper

[00:02:37] medical records to an electronic medical record.

[00:02:40] That was the McKesson system at the time.

[00:02:43] And then I transitioned over to a full-time chief medical information officer as we did

[00:02:47] a system-wide transition from McKesson to CERNR.

[00:02:51] I was in that role and our chief medical officer at the time departed.

[00:02:56] And because I was doing about 80% patient safety and quality work,

[00:03:02] it made sense that I kind of inherit into that role as a CMO, CMIO.

[00:03:08] Doing that for a few years, I looked at opportunities around the country

[00:03:12] and saw that multi-care was expanding.

[00:03:16] And there was a really interesting opportunity to not only be a CMO of a facility,

[00:03:20] but to actually open a brand new hospital.

[00:03:24] And that was something I'd never done before.

[00:03:27] And so seven years ago, hopped over to the Pacific Northwest with my family

[00:03:32] and have been here since we opened the Covington Medical Center in April of 2018.

[00:03:37] And then I feel like the second act of my career here at MultiCare

[00:03:41] has been working through the pandemic piece and then the post-pandemic era

[00:03:47] and then helping to shepherd some interesting conversations

[00:03:50] from a technology innovation and possibly even venture capital standpoint

[00:03:55] on a system side while also maintaining my operations had a CMO of those two facilities.

[00:04:01] So that's a little bit about me.

[00:04:02] Apologies for the verbal diarrhea.

[00:04:05] No, it's a great journey that you were able to describe.

[00:04:09] And I have so many questions, but actually before we unpack some of the meteor topics,

[00:04:14] I'm actually really intrigued by your experience in New Mexico

[00:04:17] because before I went to medical school, actually way back in college,

[00:04:21] I spent a summer bumming around New Mexico, doing a lot of hiking and camping.

[00:04:26] I ended up going almost every corner of the state.

[00:04:28] And I really fell in love with it.

[00:04:30] Where were you living in New Mexico?

[00:04:31] I'm curious.

[00:04:32] We were in Hobbs, New Mexico, the southeastern quarter out nearby Carlsbad

[00:04:38] and very close to middle in Texas.

[00:04:41] And honestly, I have to tell you, it was a magical experience for us.

[00:04:45] It was my wife and I's first job outside of residency.

[00:04:49] We were both starting up that hospitalist program.

[00:04:53] We had just an incredible small team of hospitalists

[00:04:56] that we just cherish those memories of bringing inpatient specialty care to that facility

[00:05:04] and working with the community physicians who had been holding that facility up for many decades.

[00:05:11] And honestly, it really spurred a genuine love and appreciation for rural medicine

[00:05:16] and the unsung heroes that inhabit a rural health care centers all around the country

[00:05:23] with very limited resources, taking care of huge swaths of geography

[00:05:29] and doing it the best they can.

[00:05:31] And honestly, it was just such a foundational experience for us.

[00:05:35] That's really amazing to hear.

[00:05:37] I think that we as a country just owe so much to the physicians

[00:05:41] who are making those commitments to move to some of these rural underserved areas

[00:05:47] that are just so in need clinicians.

[00:05:49] And they're so appreciated, right?

[00:05:52] That these physicians are willing to come and to take care of these populations.

[00:05:57] How many beds were in your hospital?

[00:05:59] I'm curious.

[00:06:00] Oh, it was a 200 bed regional referral center, good sized hospitals.

[00:06:04] Yes, you can solve it.

[00:06:05] Yeah, we had, I believe an eight bed ICU and we were it largely

[00:06:12] in terms of both acute inpatient care and a lot of the subspecialty care.

[00:06:18] When we needed significant subspecialty care and or interventions,

[00:06:22] we would rely on our community partners at University Medical Center,

[00:06:28] UMC Covenant based in Texas to help manage some of those transfers out.

[00:06:34] And but my goodness, talk about managing some incredible pathology

[00:06:39] and really spreading your wings in terms of all of the nooks and crannies

[00:06:44] associated with internal medicine.

[00:06:46] It was definitely a foundational experience.

[00:06:49] I have to say, I've always had a soft spot for rural medicine.

[00:06:53] I grew up in a small town in the western part of Massachusetts.

[00:06:58] And when I was doing my residency, I was in a city,

[00:07:02] but I did have the opportunity to spend a month on the Navajo Reservation

[00:07:06] actually in the northeast area of Arizona.

[00:07:09] So that was a really eye-opening experience to be working in their very small hospital.

[00:07:17] We're talking handful of beds and for anything serious,

[00:07:20] you would have to fly those patients out Flagstaff or to Phoenix.

[00:07:25] Really, it allows you to operate top of license

[00:07:27] because most of the specialists are just doing video consults

[00:07:30] and you as the generalist have to be comfortable managing everything

[00:07:35] from ICU issues to some more specialty specific concerns,

[00:07:41] whether that's cardiac endocrine gastroenterology issues

[00:07:45] or really amazing to be able to fully practice top of license

[00:07:49] in some of these settings.

[00:07:51] That is so true.

[00:07:53] That is so true.

[00:07:54] And I will say the relationships that you make

[00:07:57] and how closely connected nursing and the ancillaries are to you as a physician

[00:08:04] that just you walk in.

[00:08:06] And that is certainly why I think I'm drawn to community medical centers.

[00:08:12] I purposefully chose Auburn and Covington Medical Centers

[00:08:15] because of that culture of when you walk in through the door,

[00:08:20] you largely know everyone by name, you recognize fellow your faces.

[00:08:26] And I certainly that's a part of my core need,

[00:08:30] I think as a physician when I walk into a space.

[00:08:32] I love understanding kind of all of the personalities

[00:08:36] and having deep seated relationships with the health care team

[00:08:40] so that we can actually function together truly as a team

[00:08:43] and get patients out of some tight spot.

[00:08:46] Yeah, that's something that I'd love to explore further.

[00:08:50] So tell us about some of the big challenges

[00:08:53] that you are facing in your current role.

[00:08:56] What are the things that are top of mind

[00:08:57] and keeping you up at night right now?

[00:08:59] Of course, post pandemic, we never really saw

[00:09:02] at least at one of our facilities

[00:09:04] a reduction in the congestion in our facilities.

[00:09:09] And we routinely live at about 110, 120 percent capacity.

[00:09:16] And what that translates into is incredibly congested

[00:09:21] emergency rooms, patients on gurneys waiting for inpatient beds,

[00:09:26] inpatient doctors coming down, managing a lot of care in and then us

[00:09:33] as an org having to learn how to manage that special

[00:09:37] and unique type of care because we consider patients

[00:09:40] that are boarding in the ED to be a vulnerable population.

[00:09:45] Their care is fundamentally a little bit different.

[00:09:47] It's almost a hybrid care between the inpatient nurse

[00:09:50] that comes down to help manage the care,

[00:09:52] but also the ED nurse that still has sort of agency

[00:09:56] and can assist with more emergent instances.

[00:10:00] And then what do you do when you're in a hallway

[00:10:02] about things like mobility, about things like frequent turns,

[00:10:06] about managing regular interval, medication administration

[00:10:11] with the rigor that would occur on a medical floor,

[00:10:14] but in the tumult of an ED space?

[00:10:17] How do we as an org learn to do that safely, effectively

[00:10:21] and with a high degree of reliability?

[00:10:23] So we're in the midst of a high reliability journey.

[00:10:27] And this has certainly been one of those leading

[00:10:29] edges in terms of learning how to build a new culture

[00:10:32] around managing this type of care.

[00:10:34] Now, you have a background in informatics.

[00:10:37] So curious, how are you thinking about leveraging IT

[00:10:41] to help with some of these challenges that you're mentioning?

[00:10:44] Such a great question.

[00:10:45] Honestly, one of the great gifts of informatics has been

[00:10:49] this notion of appreciating that with any technology

[00:10:53] intervention, it is people fundamentally then process

[00:10:57] and technology.

[00:10:59] And people in process, I don't think it's unique to the

[00:11:02] space of informatics, but it certainly hearkens back

[00:11:05] to the strength of needing to define a vision,

[00:11:09] make sure that you're transparent with your

[00:11:12] communication pathways, both bidirectionally,

[00:11:15] as well as recognizing that healthy teams have

[00:11:20] degrees of redundancies and safety nets, and that we

[00:11:23] recognize that we need to extend grace so that

[00:11:26] we can build trust so that people can be human.

[00:11:29] People can act out from time to time.

[00:11:32] And that's perfectly understandable when we are

[00:11:35] expecting them to undergo a great deal of change

[00:11:38] in a short period of time.

[00:11:40] Once you manage that relationship part, then

[00:11:42] it's all about the process.

[00:11:43] We use an ID, PDSA methodology here at MultiCare,

[00:11:48] which is all about breaking the process down into

[00:11:52] its constituent parts, doing tests of change,

[00:11:55] respecting the complexity of the Gamble or the

[00:11:58] workspace and not overly simplifying these

[00:12:02] processes so that we recognize that in complex

[00:12:05] systems when you make a simple change, there are

[00:12:07] often unintended consequences.

[00:12:09] And after we've walked through these tests of

[00:12:12] change, then we get to the actual technology

[00:12:14] implementation.

[00:12:16] You have to do the people in the process work

[00:12:19] upfront and gain that trust so that then when you

[00:12:23] roll in with the technology solution, people are

[00:12:26] ready and willing to recognize the value

[00:12:29] that this brings.

[00:12:30] But even that value comes at a cost of workflow

[00:12:34] changes.

[00:12:36] And fundamentally, the question that it always

[00:12:39] boils down to is how is this going to change my

[00:12:43] day?

[00:12:45] And is this going to make the time that I return

[00:12:48] back home to my family and my safe space?

[00:12:51] Is this going to impact that?

[00:12:53] Like, that is perfectly, these are perfectly

[00:12:55] reasonable explorations and questions that we

[00:12:58] need to have.

[00:12:58] So we take that approach as we look at

[00:13:01] technology solutions with regards to the

[00:13:03] boarding challenge and capacity management piece

[00:13:06] in general.

[00:13:08] Stepping back, our big concern is this notion of

[00:13:11] throughput.

[00:13:12] And on the front end of the hospital, that's the

[00:13:15] ED and that's where the congestion is occurring.

[00:13:17] But throughput fundamentally is all about

[00:13:20] our patient progression and recognizing that

[00:13:24] getting a patient to a safe discharge and working

[00:13:28] with our hospitalist teams is what opens up

[00:13:31] that capacity to allow for the congestion to be

[00:13:35] alleviated on the ED side.

[00:13:38] And then if you contemplate stepping back from

[00:13:42] the hospital writ large into the management of

[00:13:45] the hospital in a larger healthcare system

[00:13:48] context, now we get into a technology

[00:13:51] application around capacity management.

[00:13:53] And so I think if you were to ask me the

[00:13:56] simplest sort of way that we have started to

[00:13:59] manage our capacity at Auburn Medical

[00:14:02] Center was actually developing a mission

[00:14:05] coordination center for the entire health

[00:14:08] system that could look at capacity and do

[00:14:12] things like level loading and capacity

[00:14:14] management in real time, understanding

[00:14:17] things like staffing, things like acuity,

[00:14:20] things like when an ED was overwhelmed, how

[00:14:23] to effectively divert.

[00:14:25] It's the technology that we've implemented in

[00:14:27] our multi care coordination center that I

[00:14:31] think is having a genuine impact on our

[00:14:33] ability to try and manage reasonably

[00:14:36] effectively our capacity challenges in this

[00:14:39] one particular facility.

[00:14:41] And that's probably my short answer to

[00:14:44] addressing that technology approach with

[00:14:46] regards to managing our capacity and

[00:14:48] boarding challenges.

[00:14:50] Yeah, I like that you're really identifying

[00:14:54] explicitly the people challenges that are

[00:14:57] part of using technology and healthcare and

[00:15:00] the fact that adoption is critical and

[00:15:04] convincing staff members that technology

[00:15:08] is going to have a positive impact on

[00:15:11] them is really the biggest part of the

[00:15:14] battle here.

[00:15:15] So I'm curious if in thinking through some

[00:15:20] of your other experiences working with

[00:15:22] technology in current role or prior roles,

[00:15:26] there were IT implementations that did

[00:15:29] not go well, right?

[00:15:30] Where the staff just did not buy in or

[00:15:33] they didn't feel like it was truly helping

[00:15:36] them.

[00:15:36] And I'm curious just to hear a couple

[00:15:38] of learnings from that didn't go well.

[00:15:41] No, I have just a I think a very timely

[00:15:43] example of something that initially felt

[00:15:46] like it was not going well and then it

[00:15:50] was really doubling down on the people

[00:15:53] aspect that actually helped us change

[00:15:56] that script.

[00:15:57] Mid pandemic because we like to take on

[00:15:59] big projects in the midst of unprecedented

[00:16:02] global pandemic.

[00:16:03] We opted to explore, to be fair, it was

[00:16:08] understandable because mid pandemic there

[00:16:09] were tremendous challenges placed on

[00:16:12] health systems from a supply chain

[00:16:14] standpoint, from a finance standpoint.

[00:16:16] We recognize that there existed

[00:16:20] opportunities around clinical stewardship

[00:16:22] to essentially make sure that we were

[00:16:26] practicing the highest quality medicine

[00:16:29] that was evidence based, that was also

[00:16:32] reasonable steward of our resources.

[00:16:35] And so we engaged with a health technology

[00:16:38] company that was focused on clinical

[00:16:41] decision support, but with a sub focus

[00:16:44] of that clinical decisions support

[00:16:46] around clinical stewardship.

[00:16:48] And we rolled out this clinical

[00:16:51] decision support at the point of care

[00:16:53] tool and the company's names are

[00:16:56] Lumacare and we shared it.

[00:16:58] We did our standard sort of people

[00:17:01] engagement and process engagement,

[00:17:03] which included we shared the why

[00:17:06] we shared with our physicians that

[00:17:08] this was applying the best clinical

[00:17:10] evidence, namely the ABIM choosing

[00:17:13] wisely database of interventions

[00:17:16] around standard hospitalist care.

[00:17:20] And it would remind you really at the

[00:17:22] point of decision making about

[00:17:24] opportunities around clinical

[00:17:25] stewardship. Let's give you an example.

[00:17:27] So patient comes in for

[00:17:30] a an acute api set of labs are

[00:17:33] done, magnesium is a little low, needs

[00:17:35] to be topped up a little bit because

[00:17:37] the patient's NPO for surgery, you're

[00:17:39] repleting with IV magnesium and

[00:17:41] post update to the IV magnesium still

[00:17:44] running magnesium is, let's

[00:17:47] say still a little low, but the

[00:17:49] patient's able to take PO and

[00:17:51] fundamentally because now

[00:17:54] the gut is available.

[00:17:55] Oftentimes because the hospitalist

[00:17:58] in the health care team is just

[00:17:58] bombarded with the task of trying

[00:18:00] to get the patient home.

[00:18:02] That one little decision to switch

[00:18:04] over from IV to oral magnesium

[00:18:06] with a Delta with a cost

[00:18:08] differential can sometimes get

[00:18:09] overlooked. This technology would

[00:18:12] essentially just bubble that up to

[00:18:13] your awareness at the point of

[00:18:15] decision making to say, hey, AB, I

[00:18:17] am choosing wisely states that

[00:18:19] it makes sense to use PO when

[00:18:21] available. And we shared that

[00:18:23] rationale. We shared that we felt

[00:18:25] fundamentally it was good medicine

[00:18:27] to follow these evidence based

[00:18:29] protocols. And we rolled

[00:18:32] it out. And subsequently crickets

[00:18:34] like I we did lunch and

[00:18:37] learns and we engaged our docs

[00:18:39] and our docs were good sports

[00:18:41] about clicking into the app and

[00:18:43] just showing that yet they look

[00:18:44] at the at the intervention, but

[00:18:47] they didn't change their behavior.

[00:18:49] It wasn't enough for them to say,

[00:18:51] you know what? I'm going to stop

[00:18:53] this, go into my other order

[00:18:54] profile and change it.

[00:18:56] So when we came back to the docs

[00:18:58] and we asked them, is there

[00:19:00] something about the tool that you

[00:19:01] don't like? Is it the user

[00:19:02] interface? Does it take too long?

[00:19:04] What's going on?

[00:19:05] We had some very earnest

[00:19:07] conversations with our hospitalist

[00:19:09] and they were like, what?

[00:19:10] Here's the thing.

[00:19:11] Clinical decision support makes

[00:19:14] my day fundamentally worse.

[00:19:16] Oftentimes, the the bog

[00:19:18] standard decision support is stuff

[00:19:19] I already know and I'm just

[00:19:21] trying to click through to get

[00:19:22] through to my day.

[00:19:23] And then when I see these

[00:19:24] clinical stewardship alerts,

[00:19:26] I can't but help feel like

[00:19:28] I just I get this notification

[00:19:31] that's evidence based.

[00:19:32] And now I have to do this

[00:19:34] thing where I reconcile

[00:19:36] that evidence, confirm that it's

[00:19:39] valuable and then reconcile

[00:19:41] that with my plan of care for

[00:19:43] that particular moment, for that

[00:19:44] particular patient.

[00:19:46] And now I have to go into the

[00:19:48] ordering pane, stop this

[00:19:50] medication and start a new

[00:19:51] medication or change my order.

[00:19:54] It's just too much.

[00:19:55] It's just too much.

[00:19:55] And I was like, and that was a

[00:19:57] big moment of awareness

[00:19:59] for us when we actually took

[00:20:01] the time to do

[00:20:03] a workflow diagram

[00:20:06] that gave us a sense of the

[00:20:07] cognitive load, what each

[00:20:10] of these alerts resulted in.

[00:20:13] That was powerful.

[00:20:14] That made us realize, look, there's

[00:20:16] value here that we're asking

[00:20:18] the docs to take on this extra

[00:20:19] cognitive work.

[00:20:21] There needs to be some sort

[00:20:23] of recognition of that.

[00:20:25] So as it happened,

[00:20:26] we are working with our sound

[00:20:28] physicians partners and we were

[00:20:29] due for a revision

[00:20:31] of our quality metrics dashboard.

[00:20:34] That's the incentives that we

[00:20:35] put in for things that we

[00:20:37] consider as a health system

[00:20:38] important that drive forward

[00:20:39] quality.

[00:20:40] So we actually partnered with

[00:20:42] Sound and Illumicare to develop

[00:20:45] and design a clinical

[00:20:47] stewardship metric that would

[00:20:49] allow for shared savings.

[00:20:52] So we targeted, I think

[00:20:54] something like a $16

[00:20:57] total cost of care reduction,

[00:20:58] very sort of conservative

[00:21:00] estimate if the physicians

[00:21:02] harshly interacted with this

[00:21:04] tool.

[00:21:05] And we shared with the docs

[00:21:07] that look, it is not only

[00:21:10] if you're practicing evidence

[00:21:11] based medicine that results in

[00:21:13] shared savings for the health

[00:21:15] system and the patient, you

[00:21:17] should get some sort of

[00:21:18] recognition for that.

[00:21:20] And so we were like, OK, we've

[00:21:21] designed this and then we said,

[00:21:24] oh, wait a sec, shared savings

[00:21:25] programs that I the hairs

[00:21:28] on the back of our compliance

[00:21:29] heads started rankling

[00:21:31] a little bit.

[00:21:32] Are we paying doctors to

[00:21:33] ration care, etc.?

[00:21:34] So we then partnered

[00:21:36] with our legal and clients

[00:21:38] teams and we did a search

[00:21:40] of the literature to look at

[00:21:42] shared saving, the ethics

[00:21:44] of shared savings.

[00:21:45] And we were pleasantly surprised

[00:21:47] to find that there are multiple

[00:21:48] precedents for this in health

[00:21:50] systems around the country

[00:21:51] that fundamentally show

[00:21:53] primarily in the orthopedics

[00:21:55] world.

[00:21:55] But we also found some in the

[00:21:57] oncology spaces that these

[00:21:58] types of programs do move the

[00:22:00] needle in terms of behavior

[00:22:01] change.

[00:22:02] So we presented that to our

[00:22:04] legal and ethics partners

[00:22:05] in the form of an S bar.

[00:22:07] They came back saying, yes,

[00:22:09] what fundamentally because

[00:22:11] you are not forcing these

[00:22:13] decisions, the practitioner

[00:22:14] at the end of the day still has

[00:22:16] the agency to say yay or nay

[00:22:18] with the recommendations.

[00:22:20] However, we do recommend

[00:22:22] because this is a novel new

[00:22:24] quality metric, we recommend a

[00:22:26] countermeasure assessment,

[00:22:28] whether it be patient

[00:22:29] experience or readmissions.

[00:22:31] And we decided to monitor both.

[00:22:33] So long story short, I

[00:22:35] apologize for all of the

[00:22:38] extra explanation, but it

[00:22:39] enriches the story.

[00:22:41] Long story short, we rolled

[00:22:43] this out through 2023

[00:22:45] and were blown away

[00:22:46] by the uptake and

[00:22:49] the engagement by our physicians

[00:22:51] now that it was recognizing

[00:22:53] that the work that they were

[00:22:55] doing cognitively had value

[00:22:57] and they were getting a

[00:22:58] recognition of that value.

[00:23:00] All told, I think we had

[00:23:02] anticipated the total cost of

[00:23:03] care savings per patient

[00:23:05] at around 16 percent.

[00:23:06] We are now appreciating

[00:23:08] total cost of care savings of

[00:23:10] about seventy five dollars per

[00:23:11] patient, which amounts to

[00:23:13] for that limited pilot that we

[00:23:15] did in the Puget Sound region

[00:23:17] of about five hospitals,

[00:23:20] about two point five million

[00:23:21] dollars worth of total cost

[00:23:23] of care reductions.

[00:23:24] That felt tangible and

[00:23:25] important.

[00:23:26] And with those savings,

[00:23:28] that's potentially another

[00:23:29] program that we can invest into

[00:23:31] for the community.

[00:23:33] And that was, I think, an

[00:23:34] example of going back

[00:23:37] to the drawing board,

[00:23:38] recognizing the fundamental

[00:23:40] tenets of informatics being,

[00:23:43] hey, start with the people

[00:23:44] and investing in the people

[00:23:46] to understand what their

[00:23:49] concerns were with the

[00:23:50] technology and then rolling

[00:23:51] out a platform that was

[00:23:54] really in partnership with

[00:23:56] our hospital.

[00:23:57] So that's, I think, the

[00:23:58] story that we're continuing

[00:23:59] to explore together.

[00:24:01] I love that story.

[00:24:02] It just really highlights

[00:24:04] so many great examples

[00:24:06] of human behavior,

[00:24:09] how to motivate change

[00:24:11] because we know that change

[00:24:13] is so difficult in organizations

[00:24:16] and in health care in particular

[00:24:18] when we're dealing with

[00:24:19] patients' health.

[00:24:21] We're dealing with practices

[00:24:22] that in many cases have

[00:24:24] developed over time and

[00:24:26] routines.

[00:24:27] Right.

[00:24:27] It can be very challenging to

[00:24:28] change how things are

[00:24:31] done in clinical settings.

[00:24:34] And so I think this is a

[00:24:35] remarkable example of

[00:24:37] implementing a technology

[00:24:39] that was really meant to

[00:24:41] improve care for patients,

[00:24:43] to ensure that evidence

[00:24:45] is being followed

[00:24:47] in clinical decision making

[00:24:49] that's also helping to

[00:24:50] use resources most appropriately

[00:24:53] such that we're not wasting

[00:24:55] valuable resources.

[00:24:57] We're trying to keep health

[00:24:57] care costs down.

[00:24:59] And so I think it's a

[00:25:00] really a fantastic example

[00:25:02] for us to end on,

[00:25:03] to just help to highlight

[00:25:06] all of the opportunities

[00:25:07] to look at when something's

[00:25:09] not working in health care.

[00:25:12] How do we go to the GEMBA?

[00:25:14] How do we make sure that

[00:25:15] we're really looking at

[00:25:17] what's happening on the ground?

[00:25:19] What are those

[00:25:19] minute steps in the process

[00:25:22] that make up

[00:25:23] the day-to-day workflow

[00:25:27] processes of

[00:25:28] caring for these patients

[00:25:30] making sure that they're getting

[00:25:31] what they need.

[00:25:33] And then we see where are their

[00:25:34] pieces of opportunity

[00:25:36] for a better

[00:25:39] interventions, etc.

[00:25:41] So on that note, I think we

[00:25:42] are going to have to end

[00:25:43] because unfortunately

[00:25:45] our time is up today.

[00:25:47] But Rune, I thank you so much

[00:25:48] for spending the last half hour

[00:25:50] discussing this with me,

[00:25:52] sharing your story,

[00:25:54] your insights.

[00:25:56] And until next time,

[00:25:57] this is Dr. Jamie Fulbert

[00:25:58] from the Care Delivery Podcast.

[00:26:00] Thanks for having me, Jamie.

[00:26:07] Thanks for listening to

[00:26:08] the Mimora Health Care

[00:26:09] Delivery Podcast.

[00:26:11] For more ideas on simplifying

[00:26:12] complex care for care teams

[00:26:14] and patients, visit

[00:26:15] memorahealth.com.