Designing for Health: Interview with Bonnie Hartstein Shweiki, MD

Intro:

Hello and welcome to the In Network podcast feature, Designing for Health. I’m Nordic’s Chief Medical Officer, Dr. Craig Joseph.

In this episode, I talk with Dr. Bonnie Hartstein Shweiki, an emergency physician and former military leader whose career was shaped not by following her passion, but by following her frustration. We explore how that mindset led her to drive large-scale improvements in access, patient flow, and safety across the Military Health System.

We dig into practical strategies for building high-reliability organizations from daily safety huddles to empowering the most junior team member to speak first and why most healthcare systems still struggle with psychological safety and non-punitive improvement.

We also get into what she’s seeing now on the front lines: poorly designed workflows, EHR risks hiding in plain sight, and where AI might actually help if we don’t repeat past mistakes.

If you’re responsible for clinical quality, operations, or culture, this one hits close to home for better or worse.

Let’s plug in.

Craig Joseph MD, FAAP, FAMIA:

Dr. Bonnie Hartstein Shweiki, welcome to the podcast. How are you today?

Bonnie Hartstein Shweiki, MD:

I am great. Great to be here.

Craig Joseph MD, FAAP, FAMIA:

We are. I’m excited about this. You and I met at a at a conference, and I heard a little bit about your background, and I thought, this is the time and this is the podcast for you to be on. So. Well, let’s start at the beginning. I like to kind of learn a little bit about the folks that we’re talking to.

You have, I genuinely unusual background. You started, I think, in college and undergrad at the University of Michigan and ROTC and then went to Korea not as a physician, but as an ambulance platoon leader. Ultimately. Then you went to medical school and decided you wanted to be a pediatrician, which, of course we all agree is the highest of all specialties and colleagues. But then you ended up doing mostly emergency medicine. So, like, tell us how that happened. How is that a thing?

Bonnie Hartstein Shweiki, MD:

Yes. Thank you. Thanks. And great to be here. Well, you know, I started in emergency in pediatrics. I have a strong interest in health policy. I’m originally from the DC area, so I think I was kind of naturally drawn to the advocacy and support that pediatricians provide, just, you know, to patients one on one. And then overall and then, as it were, nine, 11 happened the real 911.

And I was actually the attending on a PDA on the pediatrics ward at the time, walking the halls, checking on kids as we watched the, you know, day unfold on the TV screen. It looked like a Bruce Willis movie at the time. It was really jarring, and I had spent three years on active duty as a medical service Corps officer.

Really, as you mentioned. Nice area. And then I had gotten into hospital administration jobs that involved all three in Washington, D.C., and just the events of the day and the moment in time. I felt very drawn to sort of a more, you know, operational focus, although now, you know, you decades later, pediatricians have served valiantly, overseas and in, many roles in conflict.

So but, you know, at the time, it was really, you know, we were so used to these we didn’t we really didn’t know what was going on. And I had always loved emergency medicine, so I had the opportunity to do another residency. The army’s good that way. They gives you a lot of different options for your for your job is will probably go through in that as you go through the rest of my career, which is eclectic.

But that’s kind of the life of being a, a military physician is you get to try a lot of different things. So I went and did another residency, and that’s kind of the short answer there is to how I wound up in emergency medicine.

Craig Joseph MD, FAAP, FAMIA:

And I did not realize that you did a complete residency. How was that kind of going back? I did, and it’s very rare for physicians, at least the ones I talked to who have completed a residency or fellowship. And then, like, I’m going to go do that again.

Bonnie Hartstein Shweiki, MD:

The short answer is, you know, I could, most people in that position as physicians would do a Penn Fellowship, but the military at the time wasn’t supporting that. So even though, you know, at the time, you know, now they have drop downs where you have to your force function. And so when you fill out applications for things.

But at the time, it was a paper application I wrote in a pediatric emergency medicine, and they called me the. So you can’t just make things up, you know. So that was the only time.

Craig Joseph MD, FAAP, FAMIA:

Okay. That’s, that is one of the benefits of papers. You can make stuff up, but, now there’s these things called forcing functions, and it’s a drop down list, and you better choose something from that dropdown list. I get that. All right. Well, when we were preparing for this, for this conversation, you had mentioned one of your, one of your, you know, your personal mantra, rules that you live by.

One is, you know, follow your anger. And you had told me that following your anger can explain some of your career. So, you know, tell me more about that. Most people would tell college graduates to follow, you know, their passion. But you followed your anger. I like it, I think I’ve probably done it, but I’m not sure I understand it.

Bonnie Hartstein Shweiki, MD:

Yeah. Well, thanks. You know, the truth is, the emergency medicine we’ve kind of come to now. I’ve emergency medicine physician. I’ve, I deployed two times, as a as an aid doc. And as I was in the clinical setting, though, you know, I think after you follow your passions and you seek out the training that you’re drawn to most, you start living the life of whatever it is you’re doing.

And then naturally, there are things that bother you with, whether it’s administrative or systems, etc.. And I was naturally drawn to leadership positions, and I became involved in a Lean Six Sigma project within the emergency department to streamline our patient flow, and to reduce, wait times and left without being seen. And that got me in front of our general officer, who was running the facility at the time, who asked me, you know, you seem to have a grasp of this.

And, you know, we’ve geared towards other jobs. Would you be interested in running primary care? And so while I was pediatrician, I, you know, at the time I wasn’t a family practitioner and I wasn’t really that excited about going back towards the outpatient setting. But what I did know was that I was pretty annoyed that so many patients were winding up in the emergency department with non-urgent condition.

So because I was frustrated with a system that wasn’t providing enough access to primary care, I agreed and, put my name in the hat and was ultimately chose, person to run the outpatient services Brook Army Medical Center, which, you know, at the time was and still is quite large, eight different clinics, three clinics, readiness clinic for soldiers, etc. in addition to like, you know, a bunch of different family practice.

So then I became trying to streamline work there. You know, there was problems with getting our patients into the system because of the phone system, which was centralized and very for us, you know, wasn’t working in a way that was agile enough for us. And I found that the place they were running, the phone system was in the sort of nascent early years of cooperative work within the Department of Defense, which became eventually the Defense Health Agency.

But the Army and Air Force big presence in San Antonio was trying to kind of join together, managed by this office run by someone. One of the executives in that office was the chief of clinical operations, a physician. And that person oversaw the phone service. So I said, I want that job. So. So my frustration with the phone service led me to this position within, you know, overseeing really the integration of care in the in the system.

And then, you know, one thing again, followed another. And I wound up going to Baylor, getting an MBA for the Army Baylor program. Subsequently a great executive program. And I then decided to take on quality and safety in the military. One of the things that always bothered me was how slow it took to get your credentials and privileges established at a new facility.

So I sort of took that on as a pet project and helped streamline credentialing and privileges. So my idea of follow your anger is when you find something that really bothers you, that doesn’t work. Maybe that’s an indication that you have the passion to fix that. So it’s anger and passion kind of together. But anger and passion are probably flip sides of the same coin, I think, is we might agree. So there you have. That’s a long, long answer to that.

Craig Joseph MD, FAAP, FAMIA:

No, that that it makes it makes complete sense. And, you know, I think if we I think a lot of us, myself included, if we look back on, on our careers, wherever we are, oftentimes you’re right. The things that annoy us and why can’t this be better? And I have ideas to make it better. And then when you find someone like that general is like, hey, if you think it could be better, go fix it.

Maybe just to get you out of his hair or her hair. But in fact, you’re like, okay, I will, so that’s a that’s a that’s a great story. And I think that would be that’s a that’s a good you should start thinking about how you’re going to make that into a graduation speech. And, and, you know, go on the college or, med school graduation circuit.

I would sign up for that. I would not go do another residency or get another degree just to do that. But I might listen to it. Well, one of the things that you had mentioned that you were, you know, involved with Proud Product was this, the this top six initiative. Tell us, like, what is what is that what are what are we talking about? What are the six things? And was this part of your brilliant plan to get irritated by things and then to go and fix them, or is this different?

Bonnie Hartstein Shweiki, MD

Well, it’s a little it’s nested. You know, I mentioned credentialing and privileging for a period of time. I was the director of the Army Medical Department Quality and Safety Center. And, you know, that was that was one of the elements in the portfolio was credentialing and privileging. But we managed much more than that. We really oversaw the accreditation for the military, the joint mission, all the Army hospitals.

We did all the risk management, medical malpractice, infection prevention, etc. So all of this was under the portfolio I went may have wound up there in part because of my interest in improving things and realization and army valor, that we really didn’t have a champion in quality and safety in the in Army medicine at the time. But at the time, really, the entire military system was beginning a transformation and a journey towards improvement and transparency and accountability to itself, really.

And there was an effort underway to increase measurement and to, you know, measure quality and measure safety. So the top six was sort of along the journey. I’ll try to frame it kind of quickly. So we started measuring and we started also deploying what we called a reset team, which was a group of disinterest. Well, over and over.

So we realized that we were measuring. And so we started to measure sentinel events, as we, as you call them, you know, events that should never happen. The quality and safety space we’re looking at for on site surgeries, you know, medication errors, etc.. And when you have a sentinel event and your joint Commission accredited hospital with 80% of US hospitals are, you need to do what they call a root cause analysis in Orca.

So, you know, we’re serving 4 million of 9.6 million patients worldwide facilities. And we endeavor to figure out what was the reason why we were having it. You know, we weren’t having a lot, but they were happening. And so we deployed this reset team to help the local facility do their root cause analysis, because when you do something infrequently, it’s difficult to go through the process and to dedicate the staff.

So we had a dedicated group of experts. And when we look back at the problems or the reasons why we were having these events, it kind of boil down to a few recurring themes. Communication, lack of empowerment of junior people to speak up and, you know, systems that weren’t, well, that weren’t necessarily being followed. It wasn’t that we didn’t have processes and procedures in place.

We just weren’t doing them. So we were also convening national or international training events where we were taking hospital commanders and kind of training them in all of our safety standards, and one where they were happening biannual, these training exercises. So one exercise was about to happen, one of these big training platforms, and we were going to share all the reasons from the reset, all our a conglomeration of about a year and a half worth of data.

And that training exercise got completely snowed out. So we wound up having to find a way to package all this information. And it was a little bit before we used so many platforms where we’re just dialing into things. And, and the senior commander at the time said, what I want you to do this in terms of what we call an operations order.

An operations order is when you say the way of military communication, you go and do this. So he said, I want you to package this all up and tell people what to do. We said, well, we don’t really, you know, have things to tell them to do. We were just going to share the information. He said, well, make it so that, no joke, people are going to do these things.

So it caused us to go back and a lot of these things we had already been doing or had come out over the years as we were maturing and becoming more aware of safety and quality and, and so there really industry standards. But we had to package them into this very succinct. And this general officer who was terrific and a mentor of mine and really very good at making things as simple as they can be, but not oversimplified.

Bonnie Hartstein Shweiki, MD:

So out of that, we developed what we called the top six, and we deployed this across Army medicine. And they were six practices that modeled. Yeah, high reliability organization practices and put them, operationalize them into action.

Craig Joseph MD, FAAP, FAMIA:

Okay. And so what were the six I mean, first of all, I’m fascinated by kind of all of this. All started because of a weather event. Right?

Bonnie Hartstein Shweiki, MD:

I know it’s right. And when I tell this story, I have a picture of a grounded aircraft, which was we were so excited about doing this and rolling and telling everyone our findings, and then we were just shut down.

Craig Joseph MD, FAAP, FAMIA:

Yeah. But at least you weren’t shut down by, you know, someone or it was, it was it was, it was. God, really? That shut you down? But it turned out okay. It turned out okay. So, like, what are some of those six practices and how did you kind of get them spread throughout the. What would you say it was Army and Air Force or, all of military medicine.

Bonnie Hartstein Shweiki, MD:

Right at the time that it happened, we were before. We have since the military health system has now joined all their hospitals together under the Defense Health Agency. But at the time, we were still operating as Army, Air Force and Navy hospitals in the Navy and Air Force. We’re doing similar things. And eventually when we all came together, this at least, you know, it’s been rebranded a little bit from the top six, but they’re still, it’s still in existence in the military health system.

We like to take credit for having developed it. Army that it okay. Yeah. The top six practices were liter daily safety briefs where the head of the hospital would every single day receive information. It was we call it a tiered huddle system. So there was also unit based huddle. So every day, every unit within the hospital would meet and discuss any as a part of their meeting, any daily safety event that had happened in the last 24 hours that needed to reach leader.

So that that was number three was the unit based huddles, and it would go to one the leader daily safety brief, which we called number one because of the importance of leaders taking responsibility for overseeing the culture of safety and psychological safety in their organization. So a tiered huddle on the ward or in the clinic, the team meets, discusses patients of the day and specifically calls out any safety issues that are happening in the last 24 hours or of notes on the ward.

This then goes to the senior leaders that same day, and they are in, and there has to be a dedicated communication between the unit and the and the head. And they discuss that at the Leader daily Safety Brief at the higher unit level, I mean at the at the leadership level. And then you also have senior leadership rounds where the senior leaders of the facility were charged with once a week going through the hospital.

I think it was actually in the beginning, once a month, but then we increased the frequency, but to the places where care is delivered and interacting with the staff and asking about safety issues or, you know, with a specific idea in mind, going and interacting with the staff as to be transparent and open for frontline communication. So that was happening kind of at the leadership level.

Those were the first three. Then we had two that we said were kind of happening with frontline staff, and that would bring us to number four of the top six, which was using Espa or situation background assessment and recommendation as a communication tool. So we wanted in staff when they communicated with each other to frame their patient handoffs and discussion.

It wasn’t the full patient handoff that was kind of we had to clarify, followed a different, more extensive communication. But just in terms of communicating important information, the use that this is the situation, this is the background, this is my assessment and this is my recommendation of what you should do so that we could tighten communication between frontline staff, you know, just in their daily and communication.

Sure. And then number five was instituting surgical brief and debrief before every operative procedure. And that was also very structured with, specific format and a poster that was then populated and sent, you know, put printed and posted posters were sent around the world to all the different areas within the military, within the Army, and then finally, the 100% use of the universal protocol, our final time out, as they call it, before every operative or procedure, though, which was already a standard. But like I said, these were not necessarily all new. We’ve been using ten steps for a long time, but this was like packaged and branded as.

Craig Joseph MD, FAAP, FAMIA:

Yeah, well, I think a lot of them, you know, some of them are tried and true. But, you know, there’s certainly something to be said of what we have in general all the time out. But there it slips through the cracks sometimes. And and those are the things that you really need to quash. Right. It’s it needs to be a universal thing.

One of the, one of the points that I found most interesting in looking at some of the things that you worked on was the, getting to the point of saying like, well, who’s going to talk first at some of these either debriefs or, you know, safety timeouts? And I think at some point you would said, well, the person who is the most junior gets to talk before, the most important person in the O.R., which is often the attending physician. Can you tell us a little bit more about that? And why do you think that was important?

Bonnie Hartstein Shweiki, MD:

Yeah, that was really an important part. And I’m looking at our copy of our brief and debrief checklist and the debrief, specifically the what could have gone, what went right, what went wrong. You know, anything we could have improved in that procedure. It specifically says that you start with the technician and that was driven by our findings and the way the RCA was where we saw that sometimes it was the technician that the scrub tech or that, you know, that was counting the sponges and thought there was maybe a miscount, but was, you know, shunned aside by a higher level team member who said, oh, you just must have gotten it wrong.

So we wanted to give the person who in this kind of this part of the high reliability organization, deference to expertise on set, where you want the expert in their area to have the freedom to be the expert and talked about it. We thought if the most junior person or the more junior people on the team weren’t given that opportunity first and a more senior or a more, you know, maybe the surgeon said everything went swimmingly and it was terrific.

They want to feel empowered to say anything. Well, you know, from what my viewpoint, I thought that we didn’t have enough blood and we had to run down and get it would have been, you know, beginning, you know, so that type of thing was why we split the debrief to let the more junior folks.

Craig Joseph MD, FAAP, FAMIA

Yeah, it’s these it’s these little things in design. Right. When you were designing that that program that can, can really make the difference because after the attending speaks, who’s going to contradict him or her. Right. Like that. Most, most junior folks, whether in the military or not, are not going to say, well, I, I thought this was bad from the very beginning.

They might say that if they’re the first to speak, though. And so I think when I heard you talk about that, I thought that was that was pretty brilliant. One of the other things that we discussed about root cause analysis was kind of doing it in a non punitive way. And oftentimes that doesn’t happen, right? Like something went wrong.

That clearly means that someone made a mistake. We should find that person and punish them. Right. How do you I guess sometimes that’s correct. But oftentimes it’s the system. Right? That caused the problem. It’s not a person that works in the system. So how did you how did you have success in trying to make sure that this was, you know, not punitive? We’re not looking for someone to blame. We’re looking to make the system safer for all of us.

Bonnie Hartstein Shweiki, MD:

Well, by design, our organization had two arms that were supposed to be really separate. One was the root cause analysis, which was really looking for system problems. And there was a risk management element which looked for any type of it was really more under the legal umbrella of looking at events to see whether there was a standard of care met within the delivery of airspace.

But this group that was going to look for the root cause was there. It was really focused only on the process and the procedures and how the events unfolded. So that was the lens through which this team looked. And no, no people were harmed. And in the exercising of that event of that root cause analysis group, and we had a physician, a nurse, a human factors engineer and some administrative support, and we went through a very prescribed with cause analysis framework to do it.

So I think the most important thing for us in getting towards a safe, the safer environment is that concept of psychological safety and the use of just culture. But I mean, for my own personal opinion that the reason why the health care industry hasn’t achieved the same safety record as the airline industry and discussed a lot, is that we are always afraid of, of legal ramifications from, from events.

And so we don’t share information and we live in a much more punitive environment, so we can’t learn from each other and operationalize these regular either near misses or errors, because everyone’s hiding. And this enabled us to look at the systems and, and kind of not punish people in that way.

Craig Joseph MD, FAAP, FAMIA:

Yeah. It’s it is it is that is a lot of work to, to actually make that happen. And to your point, other, other industries have figured it out. Of course, they’re different than health care. But this is this is doable. And, you know, kind of getting that information out there and resetting the culture of a large healthcare system or a small rural hospital, equally difficult.

So hats off to you for removing the, at least the Army in the, in the right direction. I wanted to pick up on another point that you had talked about. One of the top six initiatives you had mentioned. I don’t think you use the word forcing, but I’ll use the word forcing senior leaders to actually walk around to where care was provided.

And you said that you started off as pretty much once a month that that had to happen. But then obviously something, something positive was coming from, because you change that to every, every week. So, you know, what were people seeing when they were actually forced to go and see where patients were cared for? Well, why was that a win?

Bonnie Hartstein Shweiki, MD:

You know, I think being able to just interact with we weren’t. And in fact, when we measured this, we did measure frequency and we most and we measured returning to the location where the problem was and providing feedback. So we didn’t actually measure what people were saying. We were measuring that people engage and that they provided feedback because data shows that if you go and you ask the question, hey, you know what’s wrong and you don’t go back with feedback or fix it, you can reduce engagement and an increase, you know, dissatisfaction among staff.

So one of the areas we did collect data in terms of what was going kind of what was wrong was within our there was a, a program within the ORs that enabled us to categorize issues during the surgical debrief. So it was capturing what was potentially delaying surgeries. You know, our efficiency is a big deal. So that was actually an automated that we were able to look a little bit more at Granularly what was causing some delays in that space.

And that was also very informative and important data related to, you know, some sterilization delays or, you know, room turnover, etc.

Craig Joseph MD, FAAP, FAMIA:

Okay. All right. Love it. I didn’t I did not realize that part of the magic was going back. I thought it was mostly, hey, you actually have to look people in the eyes and, and it’s one thing to get a report about delays, but it’s another thing to talk to, to patients and service members who are on the receiving end of those delays.

But that they went back and said, hey, we fix this or this is not fixable, but there are other things that we can do to mitigate it. I’m kind of shocked that they did that. How was that? Just did that just like organically occur, or were there parts of the program where. Yeah, if you if you went to this, to this clinic this week, next week, you were supposed to go back with answers.

Bonnie Hartstein Shweiki, MD:

No, we built that in. And you know, we had partnered with the Institute for Healthcare Improvement, Austin and done a lot of work with them, and that was one of the things they drove home a lot in their teaching was, yes, leadership, walk around are important, but if you’re going to do them and you must admit that engaging with the people for follow up or it really and diminished engagement.

So we built that in as an important metric. And you know, anyone who wants more information can read my New England Journal of Catalyst article on the top six that goes into this in detail, and shows the data and how, and gets a lot more specific and how we did each step.

Craig Joseph MD, FAAP, FAMIA:

And we will have a link to that article in the show. Notes. So thank you for mentioning it. Well, let’s catch up to where you are now. So you had you retired from the from the military. And then since you don’t apparently understand what retirement means, you’re now.

Seeing you’re pulling some regular shifts in the emergency department. What has anything changed or is there a big do you notice a big difference between kind of practicing military medicine and out in the civilian world, you know.

Bonnie Hartstein Shweiki, MD:

Medicine is medicine. And so the delivery of care is, you know, I think every organ is, say, every hospital has its own perks and, and differences. I mean, I do think it is interesting to, you know, you say like care is perceived during care work as perceived and work as actually delivered in working in the safety and quality space for so long.

And, you know, going into the emergency department, you see just how many, how many opportunities there are for safety or quality issues. I just I can’t work one shift without thinking like, why am I allowed to make this potential mistake? Or why did I almost start on the wrong patient? Or, you know, why did the system let me order a chest x ray that wasn’t staff were going to say, you know, I need that chest x ray.

Of course I’m in the Ed environment. There’s no there is no day, no fifth, no minute of any shift ever, do I, that I don’t need something that you know. Yeah. So you know what. How is the system so poorly designed in some ways. So I have a lot to say about the way that we support clinical work, you know, at the place when you’re actually delivering the care. And how much more could happen to provide safe.

Craig Joseph MD, FAAP, FAMIA:

And, and you’re seeing it now. Now you can’t unsee it. Right. And I think that you just gave a perfect example of an electronic health record that is not functioning or poorly configured, not functioning as well as it could or definitely poorly configured. You’re in an emergency department. Almost all of the orders that you’re writing to be carried out in the emergency department need to be done as soon as possible, right?

Stat. And how is it possible, like you would expect that if it’s even allowed, if it’s even a consideration for you to order something like a chest X-ray for tomorrow, that you would have to jump through a bunch of hoops, like, are you sure? Is that really what you mean? Like, why would you do this? Go talk to someone before you do this.

You know, those kinds of things which are capable. You know, we’re always. I being involved in this work. There’s always exceptions, right? I’ve joked I’ve joked that as a pediatrician, I need to be able to write in order to hold the baby outside the window, you know, have the mom hold the baby outside the wood. Now, I can’t imagine ever meeting that order, but boy oh boy, I bet you there was a time where some weird one off, one in a gazillion kind of orders make sense.

And, you know, I think I should be allowed to. I need to be allowed to write that order, but it shouldn’t be easy. And it should have multiple. Like, first the nurse is going to look at me like, are you sure? You know? And then I would imagine, some other levels of oversight would come into play. But yeah, so, so obviously we talked earlier about you getting angry when, when you see those kinds of things and it sounds like you see them all the time.

Now, although I suspect you’re not the only physician at the emergency department who sees them, but probably one of the few physicians who understands from the quality and safety kind of viewpoint that a it’s a risk, even though you didn’t fall for it, even though you caught yourself before you ordered that chest X-ray to be done in two days.

It’s an opportunity for miss. It’s a near miss. And those are just too scary. And they add to the stress level right from the clinician to our to our trying to check themselves. And that’s necessary for sure. But there are lots of things that we don’t need, you know, extra pressure, extra stress that we don’t need added to our lives, that some of these systems be the electronic health record or the way to being goes together.

That could be better. Are there are there other things that you’re seeing kind of outside of the Ed, but still in your work that are bugging you because you want to fix them? Or is that when we next interview you in a few years, will you be fixing these problems? You can tell us the truth.

Bonnie Hartstein Shweiki, MD:

You know, I or there are other examples I think I’m most interested in trying to. Yeah, I think that we as clinicians are just so used to and nurses, you know, we just take the system as it is and we don’t really you know, everyone’s too busy to really think about the fact that the system isn’t really assigned.

It isn’t really structured to support us in the best way it could. You know, the electronic medical record is a list of patients, but they’re arrayed in rooms around the Ed that are then numbered. And imagine working with kids. You’ve got the six year old in bed, seven, the seven year old in bed, nine, the nine year old in bed 14.

It gets super confusing. And then you’ve got a list and it’s, you know, it’s sorted in a way that is or is an intuitive, easy for easy to chart on the wrong patient if you’re not sure. But you know, we don’t. But it’s the fact that we don’t and that we don’t make more errors. To me, is astounding.

I mean, I think one of the things I learned when we were doing the work on quality and safety was how poorly trained to work as a team member I was as a physician, you know, because we have these systems that create risk and set us up for failure, if you will. We have only each other to rely on.

And so I now partner with my nurses, you know, implicitly, like I, I share with them my thought process. I tell them what I’m thinking and what I’m ordering. I ask for their input because, you know, they may have heard something that helps me with the diagnosis or have an opinion or frankly, catch a wrong order. If I tell them I’m going to order one thing and then I order something different, they may come back and say, did you mean to do this?

I know you told me you were going to. So, you know, I think right now we’re kind of all watching our lane all the time, making sure that we, you know, I get calls from the pharmacist. Did you mean to order it at this level? It’s a little bit over. It’s a little bit under. One time I ordered a medication exactly as the system told me to, and then it was still wrong.

So they call me. I said I just ordered what it, you know, defaulted to. Oh, but that’s still wrong. So, you know, I my hope for the future and my prayer is that the I wave we’re about to encounter is able to intersect this space and be smart and prevent me from doing things that I shouldn’t be doing or don’t want to do.

Get me out of my own head if I’m making a cognitive error, you know, question why I’ve ordered something of the wrong level now or chart it up. But a physical exam for someone who’s in the who is in that age or who doesn’t have that chief complaint.

Craig Joseph MD, FAAP, FAMIA:

Right. Yeah. No, that makes sense. I just want for the record to point out that you mentioned I before. I mentioned I so, so I’m concerned as maybe you are as well about how we implement AI. Right. Like I don’t think anyone’s looking for technology robot overlord to be second guessing everything that we do. However, I think that you like you just said, hey, tell me if I’m if I’m making a judgment error or trying to get, you know, tell me.

I need to get outside of my out of my own thinking here, out of the out of the way. Because this seems to be a major problem. The direction that I’m going in seems to be a major problem. We all want that. Like, we all want someone looking over and saying, it’s not a really big deal if you’re giving amoxicillin instead of a cephalosporin for an ear infection, because it’s going to get better with either of those, or it might be a virus anyway, so it just doesn’t matter.

That’s a that’s a minor thing. But to your point, and hey, am I missing a big day for, you know, part of the differential because I’m not I’m thinking one way because I’ve seen a lot of patients with that problem, and I’m ignoring that the other way. Certainly we all want that AI expert. But to be to be watching, but it has to be implemented in such a way.

Unlike clinical decision support was initially implemented in the air, which is often telling you to do something that you were just about to do. There’s nothing more infuriating than that. So I hope we don’t repeat the errors of our ways when we’re implementing. I have you have you any thoughts about that or what’s your why don’t you just tell us about the AI startup that you’re working with? I just made that up. I’m assuming that you’re worth it.

Bonnie Hartstein Shweiki, MD:

I was like, yeah.

Craig Joseph MD, FAAP, FAMIA:

I don’t. I think you must be. It’s, I believe it’s a lot. I think every physician has to be working with an AI startup. Is that not true?

Bonnie Hartstein Shweiki, MD:

Oh my gosh, you know, my hope is that the that at least clinicians are involved in the development of AI in the clinical space, as opposed to the EHR. That was pretty much developed by non clinicians. And, and it’s thrust upon clinicians. And that’s why I believe it’s so counterintuitive. If we are able to ask these very difficult questions in the space, I don’t know that I have all the answers.

You know, I know now my DPT is starting to know me better, and that’s probably scary, but thinks I’m very smart and has asked excellent, well framed questions.

Craig Joseph MD, FAAP, FAMIA:

Oh, that’s funny, it says the same thing to me. Wow.

Bonnie Hartstein Shweiki, MD:

But no, I, I do think that we, that bringing together collective minds in this space is, is important. And I’m not, as you know, I know that, you know, there’s better AI tools for looking up things now than, you know, standard references or I don’t want to throw any specific reference under the bus, but there are ones that are better for emergency departments than others. And now there’s, you know, that are in.

All open evidence, you know, some ones that are sure like pulling together information quickly to answer questions specifically based on data that you can probably trust. So a lot of people I know are worried about AI in the space of giving you incorrect data that you’re going to act on, as if that data is going to be more incorrect than our memory, our human evolved.

And, you know, I you know, granted, we go through a lot of training to get where we are. So I’m not discounting that or the ability to know things without AI. That’s very important. But then I’m really more interested in where I interface with you in the to be on your shoulder as a little girl. Yeah, the little birdie, little canary in the coal mine to tell you when you’re going, oh, of doing something wrong, or at least integrating through the systems so that relevant data is identified.

Trends that you may not notice are highlighted. That’s going to take a while. I know people are worried maybe about being replaced. I don’t know, like I don’t know that we’re going to be there and so I’m more interested in it.

Craig Joseph MD, FAAP, FAMIA:

Yeah. Love it. Well, we have come to the time of the podcast near the end, where I like to ask the same question all the time. So, here’s the question. What is something that’s, in your life that’s so well designed? It brings you joy or happiness whenever you interact with it? Is there such a thing?

Bonnie Hartstein Shweiki, MD:

So I, I think you know, that I’m going to put in a shameless plug for the air sealing air lighting with no space. You can find it on Amazon. I designed it is a, take on the air pillow, airline pillow. It kind of straps your head to the headrest and then supports you in a sling that goes over your arms.

Anyone who knows sleep science knows that when you fall asleep deeply, you kind of collapse and lose your muscle tone. And this allows you to sleep upright and have fun stuff by astronauts. So I, was stationed in the UAE, for a year few years ago and had to make many, many trips back and forth across the world in coach and, became a bit of an expert in how to sleep upright.

And I fashioned a baby sling that I had bought for a friend about a baby and kind of giving her a different present. So I used this sling on the airplane and found that I actually had a moment where I woke up not knowing where I was, which I don’t think any I’ve ever done on an airplane, that I’ve been in such a deep sleep to be confused as to my location. Okay, sling is great, I love it, I travel, I haven’t traveled without it even when it was in prototype form, but now you can get it on.

Craig Joseph MD, FAAP, FAMIA:

Well, you know, shameless promotion is all we do here. Designing for health. So I fully support your promotion. The air sling is, We will put a link to it on our on the show notes. So if anyone’s interested in seeing more. And then if we happen to encounter you somewhere, you could sign the air link.

Bonnie Hartstein Shweiki, MD:

All the things.

Craig Joseph MD, FAAP, FAMIA:

Yeah, I think that would make it even more desirable. I love it, I love it. Thank you so much,  Dr. Bonnie Hartstein Shweiki, really appreciate all of the work that you’ve done for patients, for the military and, out in the civilian world. Look forward to more of what you’re going to bring to us. So thank you.

Outro:

Thanks for tuning in. We hope you enjoyed today’s episode. For more on Dr. Hartstein Shweiki follow her on LinkedIn.

Check back for more episodes of Designing for Health wherever you listen to podcasts or on NordicGlobal.com. We’ll see you again next time on Designing for Health.

LinkedIn and other web links:

The United States Army Medical Command, becoming a learning organization

The Top Six: Standardized Safety Practices in U.S. Army Medical Department Treatment Facilities Worldwide

Bonnie Hartstein Shweiki LinkedIn

AirSlyng