Building on a legacy of innovation to deliver healthcare of the future

Imagine the hospital of the future. What will it look like? How can we use technology to make hospitals’ processes more efficient? Where can we leverage AI and machine learning to support clinical decision making?

These are just a few of the industry challenges that the visionary innovators and healthcare providers in HCA Healthcare’s Department of Care Transformation and Innovation (CT&I) are focused on in order to accelerate the integration of technology into patient care.

Formed one year ago, CT&I builds on HCA Healthcare’s legacy of innovation and aims to transform the future of patient-centered care. The CT&I team is working to identify, build and roll out new technology solutions and process innovations that will create better outcomes and experiences for care teams and patients. To celebrate CT&I’s one-year anniversary and the launch of its first new technology solution, we sat down with HCA Healthcare’s Senior Vice President of Care Transformation and Innovation, Dr. Mike Schlosser, to discuss challenges facing the healthcare sector today and his insights on how CT&I is working to solve them.

Q: What is HCA Healthcare’s Department of Care Transformation and Innovation (CT&I)?

Within HCA Healthcare’s Clinical Services Group (CSG), CT&I is a team focused on future-forward innovations, designed to solve big problems in healthcare delivery. We leverage our clinicians, our data, machine learning and more to address those complex challenges, with a goal to transform care delivery through the clinically-led integration of technology into care.

Since its founding in 1968, HCA Healthcare has always innovated, which I experienced firsthand working as a neurosurgeon for 10 years at TriStar Centennial Medical Center in Nashville and in our hospital operations over the next five years. I developed a deep appreciation for how data and technology can be leveraged to improve patient care. And with more than 2,300 sites of care, I knew that no other health system had the ability to scale evidence-based technology solutions quite like HCA Healthcare.

The COVID-19 pandemic underscored a need for the healthcare industry to think and work differently to solve today’s problems and shape the future of healthcare. So, when the opportunity presented itself, I jumped at the chance to lead a team solely focused on technology and innovation to redesign patient care.

Q: Who have you engaged across HCA Healthcare to make CT&I’s vision come to fruition?

CT&I brings together clinical, data science, engineering, technology, operations, change management and finance groups who embrace the unknown and look into the future to develop new processes, enhance patient care and save lives.

We work elbow to elbow with frontline clinicians and hospital leaders to test, scale and measure solutions that make healthcare delivery more efficient and more effective by solving things that get in the way of delivering care. This gives clinicians and care teams more time to do what they do best, and patients more time communicating with care teams, while also improving patient outcomes and hospital operations to continue to invest in these technologies. With this model, the entire spectrum of healthcare improves and everyone’s experience gets better.

Q: You touched on COVID-19. Can you tell us how the pandemic was an impetus for the creation of CT&I?

The pandemic highlighted both strengths and weaknesses of the entire health system, but largely demonstrated how fragile our collective models of care can be. We rely heavily on our doctors and nurses knowing what they need to do for patients, but that knowledge often exists only in their heads. Clinicians are required to interpret copious amounts of data, make decisions, deliver care and then document everything they did. And when you have a situation like the pandemic where your care teams are overwhelmed, and some of them are sick amid burnout and staff shortages, it becomes hard to continue to deliver care in that same model. It showed us that we could do better to support our care teams and create more resilient models of care – not only here at HCA Healthcare, but really in our healthcare system at large.

The other big lesson that came out of the pandemic is the positive realization that we had the power to make big, transformational changes. We had to transform on a dime in March of 2020 and we made big changes to processes and protocols very quickly. It opened our eyes to the fact that we could make these types of changes if we had focus and energy and dedication. So, we wanted to harness that, not just to react to something like the pandemic, but to proactively set out to solve some of our industry’s biggest challenges and transform the way patient care is delivered.

There is a roadmap from many other industries that are using data and technology to improve, and as an industry leader in healthcare, HCA Healthcare has a responsibility to develop a modern approach to digital healthcare. In many ways healthcare is more challenging… but we need to catch up.

Q: What is CT&I’s approach to digital healthcare and how different is it compared to what HCA Healthcare has already been doing?

As most large healthcare systems tend to be, HCA Healthcare is highly focused on patient outcomes, and also very operations focused. We are really good at managing our hospitals and other sites of care, and solving issues to make improvements that support ongoing safe, effective and compassionate care.

Our Clinical Services Group – comprised of approximately 300 physicians, nurses, pharmacists, data scientists, researchers and process improvement experts – plays an integral role in disseminating those improvements and best practices across HCA Healthcare. Examples include a predictive algorithm to detect sepsis more quickly (SPOT), our research on elective deliveries to improve care for mothers and babies (39 Weeks), and our efforts to reduce healthcare-associated infections (REDUCE MRSA and ABATE).

So, we benefit from HCA Healthcare’s scale, expertise and DNA as a learning health system committed to innovation. But to do innovative work that is future facing, where you build solutions for long-term improvements across all departments and services that you don’t see the full impact of until two, three, five years down the road – that requires a team that can see beyond current healthcare issues and is focused on solving problems of today and for tomorrow. By creating CT&I as a separate team, we can be completely dedicated to innovation and transformation work, and not get wrapped up in day-to-day operational priorities.

Q: How does the CT&I team identify challenges that require big, transformative solutions, and how do you go about solving them?

We like to use the phrase “clinically-led integration of technology into care” to describe the work we do. What we mean by that is clinical input comes first. What are our frontline caregivers saying are pain points? Where are they getting tripped up in current processes and systems?

We tap into their expertise to identify those problems or pain points, and then we dive deep to understand why it is the way it currently is. What are the behaviors that cause it to be that way? How do the care teams think it could be better? How would they design it if they could do it differently?

One of the most important things about the work we’re doing – and something that sets it apart from a lot of innovation work you often see in healthcare – is that we are not just layering tech solutions on top of what care teams are already doing. We are fully transforming these processes from top to bottom and ensuring that technology is integrated into and improving the workflow, not just adding another thing for care teams to deal with.

Q: What is the first challenge CT&I has set out to solve?

We began our work in the Labor and Delivery (L&D) space, as it presents immediate opportunities to improve outcomes, which generally are inconsistent across the healthcare industry. It also allows us to build on our legacy of innovation in maternal and fetal well-being, including the aforementioned work with 39 Weeks as well as oxytocin standardization. Further, L&D offers a clearly defined space within a hospital, with primarily one type of patient – mothers having babies – with clear transitions of labor and care. This provides an ideal environment to test solutions that may be implemented across other hospital units. To begin, we have focused on nurse scheduling and staffing as well as clinical documentation to improve care team and patient experience while delivering better outcomes.

In June, we launched a pilot of our first “product,” a Staff Scheduler that 1) uses a machine-learning algorithm to predict staffing needs, 2) measures the complexity of different procedures and 3) optimizes staffing according to competencies and preferences. Staffing and scheduling are major challenges in the healthcare industry, especially given current labor shortages.

With Staff Scheduler, our goal is to have the right people in the right places at the right time to deliver the best care possible for our patients. Since we began to pilot Staff Scheduler, we’re already seeing significant time savings, improvements in nurse satisfaction and, importantly, optimized staffing to meet patient demand and needs.

Over the next few months, we will explore the effectiveness of Staff Scheduler in a few other L&D units first, and will then expand to L&D units across all of HCA Healthcare. The goal is to deploy a staff scheduling solution that works for all units in our hospitals, while we continue developing other products for L&D and beyond.

Q: In addition to data-driven scheduling, what other priority areas does CT&I have?

Another key focus area, like I mentioned, is clinical documentation. We’ve done some workflow studies and found that our nurses are spending a significant amount of time documenting. And this is an industry-wide problem. In fact, a recent study found that less than one-third of registered nurses’ work time was spent with patients. So how can we use technology to transform our documentation processes to allow our care teams to spend more time operating at the top of their license?

There are three primary ways that we’re tackling documentation.

The first has nothing to do with technology, and everything to do with process change and change management. Are we asking people to document something that just doesn’t need to be documented or is documentation happening in a way that’s redundant or excessive? You’d be surprised at how often inefficient processes continue just because it’s always been done that way.

The second is to automate. Are there situations where care teams are taking information from one system and entering it into another? If so, can we connect those systems so data transfer happens automatically? How can we integrate automation tools so that our care teams are editors and approvers instead of data entry analysts?

The third is advanced technology. We have a pilot at HCA Healthcare’s UCF Lake Nona Hospital in Orlando, Florida, where physicians wear technology that resembles a pair of eyeglasses during conversations with patients – with patient consent, of course. The smart eyewear uses AI to listen and process everything that occurs in that conversation and then turns it into a document, like a transcript. When doctors walk out of the patient room and go back to the computer, all they have to do is review and edit instead of starting from scratch. The implantation of the glasses is still a long-term play, and there will always be a human element to the documentation process, but it’s the type of thing we’re working on to leverage today’s technology to make our clinicians’ lives easier and patient experiences better.

Q: Where does CT&I’s work happen?

We have specific innovation locations where we can test and refine these solutions. We have two Innovation Hub hospitals, one at UCF Lake Nona Hospital and the other at TriStar Hendersonville Medical Center in Hendersonville, Tennessee. The Innovation Hubs provide a living environment for our design and testing work, allowing us to learn and quickly integrate changes into our processes and solutions. 

Then we have Innovation Departments, which we currently have at Henrico Doctors’ Hospital in Richmond, Virginia, and Medical City Dallas in Dallas, Texas, to field test products and processes. We’re using these two locations to test the aforementioned Staff Scheduler for labor and delivery. And then as we embark on new projects, we will open Innovation Departments in other hospitals as needed.

Q: What’s next?

What’s next is scaling solutions so that every clinician and every patient within our system can benefit from them. We’re running alpha and beta tests right now within our Innovation Departments focused on labor and delivery. As those pilots wrap up over the next few months, we’re going to start expanding these new processes and tools to other departments across our organization.

The future of patient care demands data science-informed decision support (not replacing clinicians, but supporting them). Our Google Cloud partnership is designed to help create a secure and dynamic data analytics platform for HCA Healthcare and enable the development of next-generation operational models focused on actionable insights and improved workflows. With privacy and security as a guiding principle, our data platform is aimed at empowering physicians, nurses and others with workflow tools, analysis and alerts on their mobile devices to help them respond quickly to changes in a patient’s condition. Leveraging this type of technology to envision new models of care is absolutely something we’ve done with technologies like SPOT… but there is so much more we can do to improve patient care in this way.

My ultimate goal is to provide a technology-driven clinical experience that makes our hospitals a destination for care team members who want to operate at the top of their license and for patients who want the highest quality care. These will be the hospitals of the future, and we are building them now at HCA Healthcare.