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  • Writer's pictureBruce Cummings

Constructive Feedback to the California Nurses Association (CNA): Rethink Your Position or at Least Re-work Your Public Pronouncements Regarding Artificial Intelligence (AI)

Updated: May 13

There was some interesting saber rattling by the California Nurses Association this week:  a demonstration at Kaiser Permanente's San Francisco Medical Center against the adoption of artificial intelligence (AI). 


I'm hoping this was merely a staged event to emphasize in a very public, media-covered way the importance of having front-line clinicians -- physicians, nurses, pharmacists, and other caregivers --  to be appropriately consulted about the acquisition and deployment of AI-enabled solutions in healthcare settings.  If that's what it was really about -- raising awareness that AI should be used to assist, not replace RN's -- then "good on you" as they say in Australia.  On the other hand, if this was truly a frank, unvarnished, categorical opposition to the use of all AI in hospitals and other healthcare settings -- in short, an angry, implacable "not in my house" pronouncement from modern day Luddites -- then the CNA is out to lunch.  More to the point, the CNA would be doing a disservice to its members and, by extension, as the nation's largest nurses union, to the entire nursing community.


Call me old fashioned, but I am still predisposed to believe that people -- apart perhaps from politicians -- generally say what they mean and mean what they say.  Is the following statement, then, just posturing or should one take it at face value?


I have been a Kaiser nurse for more than 40 years, and I promise you, union nurses will never stop fighting for a health care system that guarantees person-to-person, hands-on care for every patient,” said Cathy Kennedy, a registered nurse at Kaiser Permanente Roseville Medical Center and a president of CNA. “Human expertise and clinical judgment are the only ways to ensure safe, effective, and equitable nursing care. We know there is nothing inevitable about AI’s advancement into health care. No patient should be a guinea pig and no nurse should be replaced by a robot. [emphasis added]"


Again, I want to emphasize that if these comments were essentially meant to say "we want to be consulted about AI selection/purchasing decisions that affect patient care and/or how nurses do their work", I am fully supportive of that position.  But that's not what Ms. Kennedy, a President of the California Nurses Association, said.


Healthcare Leaders + Clinicians + AI


Urging leaders to directly involve clinicians in AI selection and deployment -- as well as participating in decisions about other aspects of the clinical work environment -- are entirely consistent with the recommendations my colleague, Paul DeChant, MD, MBA, and I routinely make to client hospitals or health systems.  But Ms. Kennedy is flat out wrong about AI robots, no matter how sentient, ever replacing nurses.  No one is recommending that; no one wants that.  Compassion, deep listening, and human:human "connection" -- not to mention clinical assessment and providing direct, hands-on care -- are part of what makes nurses indispensable.  She's wrong about "human expertise and clinical judgment" always being superior (AI-enabled assessment of mammograms and other diagnostic imaging modalities already have been shown to be often more accurate than unaided radiologists' interpretations.  AI is helping to improve OR scheduling and flow.  AI is showing promise in identifying patients who are at-risk of readmission -- before  they are even admitted to the hospital.).  And she's either unaware or does not appreciate that AI can profoundly improve nurses' workflow -- and their lives -- by reducing or eliminating data entry in the EHR and by reducing the many burdensome non-clinical tasks nurses and other clinicians are currently required to complete.  

 

To be specific, nurses spend only about one-third of their time doing what they were trained to do and enjoy best:  direct care of and interaction with patients.  Instead they spend about two-thirds of their time doing non-value added work.  This is a major reason for why so many nurses report feeling burned out and is a key factor in why hospitals have trouble retaining nurses.  To use Dr. Paul DeChant's memorable phrase "flipping the ratio", what if instead of the current state nurses could spend two-thirds of their time in direct patient care and only one-third of their valuable time handling administrative or data gathering/reporting requirements?  I think that desideratum may well become possible in the relatively near future but it will only  happen if AI is part of a comprehensive solution which frees nurses from tasks that interfere with, not support, direct patient care.


Organizational Wellbeing Solutions for Hospitals, Health Systems, and Medical Group Practices:  Leadership-Driven Changes


The locus to curing clinician burnout and staffing shortages runs through the c-suite.  Here are examples of leadership-driven changes my colleague Paul DeChant, MD, MBA and I often recommend:

  • regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays

  • consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches

  • expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)

  • create and require leader standard work (LSW).

  • develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors

  • judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add

  • support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")

  • get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)

Ready to transform your hospital or workplace?

Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.




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