The critical role nurses play in the direct care of patients has never been more apparent. As nurse burnout and mental health challenges have contributed to a long-term nationwide nurse shortage – a trend that has been greatly exacerbated by the COVID-19 pandemic. While the need to keep staff in the workforce is paramount, it needs to go hand-in-hand with optimizing new, more efficient models of care. New innovations are coming online with the aim to prevent burnout and provider turnover, while also increasing the level of care and access for patients.
On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, and Head of Thought Leadership Jerome Pagani, PhD, are joined by Bre Loughlin, CEO and founder of Nurse Disrupted, Inc. They discuss how technology and new workflows can enable health systems to do more with fewer resources while retaining experienced staff and providing flexibility that helps to combat burnout. They also talk about Bre’s background as an EHR executive, how she discovered a passion for product design, and the importance of simplicity when it comes to new innovations.
In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple Podcasts, Amazon Music, Google, iHeart, Pandora, Spotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.
Want to hear more from Dr. Joseph and Dr. Pagani? Preorder a copy of their upcoming book, Designing for Health.
Show Notes:
[00:00] Intros
[01:10] Bre’s background
[08:24] Value of real-world observations in design work
[09:28] The origins of Nurse Disrupted
[14:24] The principle of simplification
[16:00] Scaling up Nurse Disrupted
[18:39] Balancing software configurations with hardware
[20:37] The factors behind the ongoing nursing shortage
[25:22] The role of virtual care in alleviating nurse turnover
[30:46] Understanding the problem before designing
[31:52] Adding versus subtracting complexity
[34:35] The human should be at the center of design
[36:28] Balancing functionality and simplicity
[37:41] Well-designed things that bring Bre joy
Transcript
Dr. Craig Joseph: Bre, welcome to the podcast. We're very excited to have you.
Bre Loughlin: Well, I'm so excited to be here.
Dr. Craig Joseph: So, let's go over your background. You're a nurse. You've been an EHR vendor executive. Now you're the founder and CEO of a startup. And I think everyone wants to know, when are you going to decide what you're going to do when you grow up?
Bre Loughlin: I know I keep saying that, too, and I'm not sure. I'm just going to keep on this path, and I'll grow up someday.
Dr. Craig Joseph: So, I need a date.
Bre Loughlin: Can I get back to you on that?
Dr. Craig Joseph: Yes. So, kind of give us a clue. How did you get to where you're at right now? You went to nursing school?
Bre Loughlin: I did go to nursing school. I mean, what an interesting question. Like, how did you get to where you were going? It was not a carefully plotted course, that's for sure.
Dr. Craig Joseph: I'm shocked.
Bre Loughlin: Yeah, I have one of those non-traditional pathways, I suppose. But it's been a great road. You know, I started working when I was 14. I went on my own when I was 16. I think that that plays into how the path went. Worked my way through college. I was an Olympic contender in taekwondo for the University of Washington. As I was building on my life when I started four-year college because I paid my way through a junior college first and then got into the University of Washington with honors. I was actually a chemistry major. I was thinking about going into medical school, had the grades for it, but I really wanted - and I thought about computer science; always, always loved computers. But I really thought about that personal connection with people, the way that I wanted to impact people's lives, in the way that I wanted to continue having a diverse path in life. I was an athlete and a musician and a scientist, and I wanted it all. And so, University of Washington had the number one nursing school in the United States at the time, I was very competitive person, and I thought, that's for me.
Dr. Craig Joseph: So, you wanted to go to nursing school to prove that you could get into a very competitive nursing school?
Bre Loughlin: How did you get that? From the story, I gave you, like, a fast-word, Bre Loughlin story.
Dr. Craig Joseph: That's what I got. So, you went to nursing school and you became a registered nurse, and then what happened?
Bre Loughlin: Then I started off in kidney liver transplant, and I actually had been working as a nursing assistant through nursing school. So lovely night shifts where, you know, you're doing the grind and then going to school during the day. And I loved that. Then got my nursing license in June of 2000, went right to work on the floor, made charge nurse all too soon. But that really informs you know; I had a great career. But like a lot of nurses, you know, especially when you're knocking it out of the park, the way things would go is you would get more patients, you would get higher acuity patients. You would get the most challenging surgeons, the ones that would come up and just give it to you. It's a physical job as well as knowing your pharmacology, anatomy and such. There's a lot of psychological stress when you're dealing with patients in their families and you're really body to body, which I love. 2008 I burned out. There was a day that I was in my car outside of the hospital and I couldn't walk through the doors. And it was a dark day, and I, I returned to the profession, and I thought a lot about why that day happened. And I think about the quote that I had where a patient was bleeding out and there weren't enough people in the room. We couldn't find a compression packet or that compression device that would get blood into him faster. I think about a bariatric patient that I was working with and there was nobody there to help me turn them. She was in her sick and her mess and I couldn't leave her that way. And so, I turned her at the expense of my back, and it took me two years to recuperate. I think of a 14-year-old patient that I had that was mentally handicapped and impregnated by her uncle. She was scared and she needed more, and I didn't have anymore. And as I put these pieces together, the darkest moments of my career became the building blocks of the system design and the technology that later I would build in my career, that I would think back each day to my worst moments and how we can make them better, how we could make the promise of making things better. So, I returned to the bedside, but I really started exploring what else I could do in the profession. It brought me right back to technology. I went to work for a startup in Seattle. I was also an electronic musician, so people knew that I was good with software - brought me right into a company that I'm in touch with people today called Jobster out of Seattle. That led to a consulting job at Hitachi Consulting, where I got to work with big software companies like Microsoft on organizational strategy and design back then with Sutter Health in Northern California. That's how I got on Epic's radar and wound up being transferred out here in 2012, and started Nurse Disrupted in 2020.
Dr. Craig Joseph: So, hang on. First, I'm going to look up this company. How do you spell M-I-C-R? How do you spell that?
Bre Loughlin: So, on your computer.
Dr. Craig Joseph: Microsoft.
Bre Loughlin: You’ve got a Surface in front of you.
Dr. Craig Joseph: Are those two words or is that one word, Microsoft?
Bre Loughlin: I think it's two words.
Dr. Craig Joseph: I'm going to look that up.
Bre Loughlin: It might be pronounced Microsoft.
Dr. Craig Joseph: So ultimately, you moved to Madison and worked for this EHR vendor called Epic. And what did you do there, what did you learn there? What were you working on?
Bre Loughlin: Yeah, well, I brought that background to the table, really passionate about product design and really, you know, I came out from the West Coast. My family will never forgive me, but I really believe that I can make a difference for nurses, that we could elevate the practice of nursing and practice healthcare through technology. So, you know, move I did, I had never been to the Midwest before. I didn't know you could exist in negative 20-degree weather. You know, found out about long johns and really good winter jackets. But product management, product design, I got to actually create two products I'm really proud of. LDA Avatar is something that gamified nursing documentation and became beloved and so I'm very proud of that. And then being able to launch Precision Staffing, which had everything to do with figuring out how, you know, there's been a nursing shortage for a long time, for decades, and how to use a limited workforce, you know, looking to the data and machine learning to say, okay, we can more strategically place our staff to get better outcomes. I think that there's growth to go on that. But, you know, managing products like behavioral health, you know, working with inpatient nursing, of course. Yeah. I mean it was a great eight years and really got to work with a big engine, really talented developers, and then my favorite thing was to get at the elbow of people using the software. I mean, really getting at the elbow of the nurses and saying, well, why do you use this and why do you do this this way? Because, I mean, you guys are design guys. We can design something, but then how are the humans actually going to use it? And isn't it surprising so many times where it's like, you know, the best laid plans in the most beautiful and elegant designs when you see it in the wild, when everything else is at play, or the other competing technologies and the other people, what actually winds up happening and how you can iterate on the design based on, you know, there's the wild card, which is us.
Dr. Craig Joseph: Aren't humans the worst?
Bre Loughlin: So complex.
Dr. Craig Joseph: I think we all can agree that people should just use the tools that we create for them the way we expect them to and be done and move on.
Dr. Jerome Pagani: But we frequently are designing for what's going to be the optimal process or the optimal way to interface, and the cognitive constraints of the situation. The things that we're not thinking about that may intersect the person who's using that piece of technology or working with that process are hard to anticipate and to your point, brings up the importance of actually going to see them in the wild, doing a safari, if you will, and watching them in their day to day to really understand sort of how they'll be using it in real life becomes so important to the process.
Bre Loughlin: I can almost hear the narrative of the wildlife episode as you're talking about. You are observing them in their natural habitat.
Dr. Jerome Pagani: Marla Perkins would be, would be very proud, yes.
Dr. Craig Joseph: The nurse approaches, you know, the computer on wheels. Let's watch. Oh, he's backing up. No, she's got she's ... nope. Looks like she's been distracted by a patient. All right, well, we'll come back to that.
Dr. Jerome Pagani: Necessity is definitely the mother of invention, but you've started to touch on some of the other pieces that came together. Creation, your passion for people and patients that you care for. Some of your technical background and experiences. Tell us about how Nurse Disrupted came about and what it was originally designed to do.
Bre Loughlin: Necessity is the mother of invention, and the pandemic was one big mother, and in 2020, as things are starting to shut down, I also was working with one of Madison's homeless shelters called Porchlight. And because of their incredible executive director, Carla Thennes, she's a powerhouse, just an incredible human. But as the science was emerging in the pandemic, shelters were trying to figure out, just like everyone else, what to do. But there's a lot of barriers. I mean, they have a rotating volunteer staff and really a shoestring staff because the budgets aren't just very good in homeless shelters. But she was reaching out on social media, listing out what they needed, and her and I were talking about what it was like for people to come in the shelter at night. And in March of 2020 was a very cold March. In fact, if I remember 20, 30 degrees, it was still snowing, and people were waiting outside the shelter. Well, then everyone's terrified, and there were the volunteers, and the question was, what do we do? And from a nursing perspective and looking at the Wisconsin Department of Health or the CDC putting together what could be done, which is largely either COVID-19 screening as informed by the evidence that was coming down, in March, there were three screening questions and went three, seven, eleven, I think there was one more iteration in there in how you can appropriately screen people. Testing wasn't largely available, still wasn't largely available. So short story long, on the 25th, Carla and I were talking and she's like, we're trying to figure out how to get people safely into this shelter. I was like, I know how to do this, and it was a quick design in my head. There was a utility trailer out on West Washington Avenue that we could plug into a lamp post. So, there's no Internet. There's very low power and then there's not very much staff. It couldn't be a high touch system. I knew it had to be some way to bring providers in, which because I'm a nurse and I am very deeply tied to the nursing community here, it was like, we're going to bring nurses in to do the screening, but we've got to bring them in remotely because there's no way they can get in physically. That was the 25th. I also had an elected position on the Wisconsin Nurses Association workforce advocacy group, and we were doing COVID-19 emergent meetings to see what we needed to create. One of my colleagues was a dean of Marian University, and she's like, Bre, I've got nine NP students that aren't going to graduate because the nursing practicum sites, inpatient sites got shut down. They got prioritized to positions, so the nurses where we needed them the most weren't going to graduate, and the bags under my eyes got really big. So, I'm going to bounce up this telehealth system, and I had to create the documentation system because they didn't have to quickly soup up a documentation system. And oh, by the way, we're going to do this with nursing students. We had it live two days later, on Wednesday, we had our first four volunteer nurses, and three years later we’ve served over 47,000 people experiencing homelessness and helped 400 nurses graduate. Did not mean to start a company at the time, but the need was so big it just snowballed, and it was like a few things are happening at the same time. People needed access to health care, homeless shelters have poor access to health care in the best of times, and in the pandemic, it was shut down. Telehealth is fantastic. It boomed in COVID-19, but this population really needed something crazy simple and truly out of the box that it simply worked, and anyone could walk up to the system and use it. The original design for a patient to use was a telehealth kiosk that had four buttons, and I thought I couldn't ever get simpler than that. And what I learned in also being the technical services person, is that it was three buttons too many. It was when we really, I was looking at the way people are engaging this, and that's from the staff to the people who desperately needed care. Is we needed to decrease barriers to trust anything that was complex because truly everything needed to melt away so that there was just this provider-patient engagement, and when we were able to melt the technology away to where it really felt like that, that's when we found success in the most impossible situations.
Dr. Craig Joseph: So, Bre, your first design principle, as you just said, is simplification. Simple, simple, simple. How easy was that to kind of melt everything away? It sounds simple to me to do. You see what I did?
Bre Loughlin: You underhanded a pitch to me is what you did.
Dr. Craig Joseph: How do you make it? How do you make complex things simple?
Bre Loughlin: Yeah. I think it's the hardest design principle that there is. It is so, so easy to stick buttons on a piece of technology to say, well, let's have a button to do this and that and let's put a couple of buttons, you know, to do the same thing and make sure you don't miss. It is very difficult to say this is the problem that we're going to solve and what is the fewest touches? What are the fewest things that the human has to do in order to successfully achieve a goal, or an outcome? It's a design principle that I've had, you know, back in Seattle, where it's this kind of competition, but it's just a different methodology. When you're a developer, you are incentivized by how much you can get into a platform, how many things that you can create and that you can fight to keep it in there. But as a clinician and as a consumer of technology, really, I'm focused on the outcome and the problem. It's like how invisible can the technology be? It's very, very difficult to do. Buttons are easy to make, any non-developer person can go on and do a little bit of coding and stick a bunch of buttons on a piece of technology. But to create something that feels invisible and that you get the experience that you need or that the technology was designed for, it takes a lot of time and sophistication and a different way of looking at technology design.
Dr. Jerome Pagani: One of the many reasons I dislike the movie Field of Dreams is for that phrase ‘If you build it, they will come.’ A lot of really great ideas and actually really great products and solutions get put in a box and they stay in a box forever, and you were worried that this might happen in Nurse Disrupted. So how did you overcome that? How did you get it to be the success that it is?
Bre Loughlin: I wasn't so much worried that it would stay in a box. I was watching people who needed help so badly. You know, I think earlier in my career when it wasn't this like desperate need of saying solve, fix, you know, iterate, iterate, get this across the finish line. But, you know, before that, I mean, I knew I had seen beautifully designed technology in a drawer, like I would show up to a customer site and they’d be so excited they’d be like, Bre, we’ve got Rover set, and we're so excited and they’ve got all the boxes ticked off, and I'm like, great, let's go see it, we drive to the hospital and look. I'd be like, Hi I’m Bre, I’m a nurse, I'd love to see Rover. And they're like, oh, and they would walk me into the back room where there's four devices locked into a cabinet, and I mean, this is a beautiful piece of technology, gorgeously designed, but the way that it had been configured is three devices were configured for one workflow, one was configured for a separate workflow. The nurses didn't know which one would do what. So, they grabbed one for one workflow and it wouldn't be unlocked for that. And so, you know, the end configuration, you know, and, and even getting the elbow things, it's like this gorgeous, beautifully designed thing that really does work when it's done right was in a drawer and, you know, seeing these things again and again, you can have the most incredible technology but going unused, it's useless. So that always is on my mind is how are you using it? Are we solving the problem when I would see and we still do this today, when we see a decrease in utilization, we're looking at this with our data and analytics. The question isn't how did the human fail, it's how did the technology fail to support the human and the workflows that they're doing? So, we see adoption in that way. Not that message I would always get where it's like the nurses refuse to adopt this. I'm like, surely, they don't. However, is it solving their problem? You know, is the effort of utilizing the technology worth it and getting an outcome that's worth that effort? So, there's always effort in in using technology and the things you do.
Dr. Jerome Pagani: So, I hear you saying two things that are critically important. One is that the technology has to solve the problem, but it has to solve it in a way that is usable for the people who are working on that problem.
Bre Loughlin: Yeah, and it has to equip.
Dr. Jerome Pagani: Yeah. The benefit has to be immediately available.
Bre Loughlin: Exactly. Yeah.
Dr. Craig Joseph: It's actually when you were, you're discussing, you know, how brilliant the software was, but the devices were configured in a way that I'm kind of, you know, you're going to go down this path or this path, but you didn't know which path you were going to go down when you grabbed the device. Kind of reminds me of the Apple versus Android phone situation. You've got one that's brilliantly designed but very constrained. I think that’s the Apple one, and so it's really hard to get down the wrong path because there's just one path, and as long as that's the path you want to take, that's great. Whereas Android gives their users much more opportunity to customize, and then once you customize, maybe that works great, but you've often destroyed the design principles that the software engineer kind of wanted you to go down and how you find, there's a balance somewhere there. But it's something that you have to think about. It's not obvious, and when you mess it up as you saw, or as you just kind of described, it's sad.
Bre Loughlin: Yeah, I mean, don't even get me started on competing technologies on a single piece of hardware as well. I mean, every app, every piece of technology is at the mercy of whatever else is loaded on a piece of hardware. I mean, you're having fun with your computer right now. I mean, this interplay of software and hardware and those ecosystems and the way that these variables can just absolutely block what another piece of technology is doing is incredible. The number of variables that we're introducing, the type of technology we're designing is, you know, can be infinite or incredible. I mean, we really focus on also limiting the hardware form factor just because that interplay of what's going on with chips and processors and batteries and antennas and all that kind of fun stuff and the way it goes with your design. It can get so uncontrollable.
Dr. Jerome Pagani: Bre, earlier you touched on the fact that there is a nursing shortage and there has been for quite some time. From an experiential point of view, from what nurses live and breathe every day, what are the factors that are contributing to that?
Bre Loughlin: Yeah, the there's been a shortage of nurses for decades and there's been the status quo in the hospital systems, which is recruit, turnover, augment, recruit, turnover, augment, you recruit your new grads, you put money in marketing into attracting nurses to your hospital. But then practices don't change, care delivery models for nursing have been largely the same. Some people argue in the eighties we went to primary nursing, it wasn't that different. And then the nurses turnover and then there's augmentation with temporary staff, which is really expensive. And then the hospitals say, I can't sustain it, let's recruit and then turnover. There are a few historical things that have impacted the practice of nursing in hospitals. One is the way that nursing salaries are rolled into a hospital cost, so there's no real sense of incentivization. You wind up with these incredibly ambitious scientists, not angels, not people who are doing it out of the goodness of their heart. I mean, the campaign saying they're the heart of our hospital rubs me really in a tough way because it's like we are ambitious scientists that are committed to our profession, but the career pathways and the incentivization and just the infrastructure hasn't been there. It's not about the money. But when you look at nursing work, the amount of work, as we talk about patients becoming more complex, as we talk about lengths of stay becoming shorter, the amount of work that nurses do has become greater than what the nurses can actually physically do. What we find is that people who love and are passion about their profession are becoming physically broken, back Injuries are extremely common with nurses. Unfortunately, addiction comes with that, with the opioid addiction, you know, disproportionately affecting nurses because of the high incidence of injury violence, you know, 85% of nurses - I think that's the stat we'll have to go back and look at it - experience violence in the workplace and it's not what other disciplines experience and it's physical and verbal abuse and it's from staff and it's from patients. So, there are a lot of things contributing. But when the pandemic hit, the exodus of nursing was massive, and so a lot of companies put in money and time to say what would keep nurses in their profession and at the bedside. So, this was McKinsey, and this was American Nurses Association. So now it's all over, and there's three things that we know. This rings absolutely true with me. The very first thing that needs to happen is a manageable workload. Nurses are hard workers, but when you're physically getting crushed, when I did, thank god I was in my twenties, I could bounce back, but I mean that wear and tear on your body when the workload is so big, you don't eat, you don't go to the bathroom, you barely get to stop moving in that eight, ten, twelve hour period of time and you care about your patients. You want to do a great job, and it's just not possible when that workload is so out of whack. The second thing that nurses are asking for is flexible shifts. We're still 85% female. We talk about the massive influx of men into our profession. Yep, we went from 95% to 85%. But when we think of and we can talk about, you know, the different things that happen when you're a woman in the workforce, you know, I think of, you know, I was a single mom and when the pandemic hit and kiddos were at home, it would have been if I was still on the floor, like my kids versus my career. How are you going to do that? So, flexible shifts and the concept of working from home, a four-hour shift is life changing for an ambitious nurse who has a lot of other competing priorities that you know, that a female dominated profession, you know, that you would expect from that. The third thing is innovative career path. We are scientists, we love what we do, and that grind at the hospital where it's like, just get the meds in, just get the wounds changed, get those IVs set, just get the basics like bread and butter. That is not what we've devoted our careers to, and so an innovative career path. So just in summary: reasonable workloads, flexible shifts, and innovative career paths, again and again, you're seeing that this is what nurses want. Give them what they want. Listen, because they will stay.
Dr. Craig Joseph: So, all of those seem like something that, you know, we should be moving towards. Obviously, those three things. One of them involves virtual care, and this is something that you've been focusing on at Nurse Disrupted. How does virtual care fit in? How do those four-hour shifts that you just described fit into the health care system that we know and sometimes love?
Bre Loughlin: Yeah, it's a total transformation of nursing work. When people ask, how is this going to work in an inpatient setting, it's going to be different than it was. But the way that virtual nursing is working, and there's a spectrum. Anyone who has video and audio capability right now because virtual nursing is such a tsunami, they're trying to get into the game and some people are failing and some people are absolutely succeeding. When you get it right, get it really, really right. What happens is that when you offer when you say Bre, I want to reward, you, you’re a rock star bedside nurse, would you be interested in working a four-hour shift from home additionally? The nurses are saying, yeah, yeah, I do, like I'm working three twelves, or three tens and I'd love a little more cash in the bank. And oh, by the way, I get to do this cool new care delivery model and be a part of that. They're saying, yes, I will work more and then I get to work four-hour shifts from home is all the difference in the world. So that's the first thing, the second thing is, is efficiency. When you redesign the way that nurses are engaging with patients, you can create some workflows and make it very efficient. Then the bedside nurse, you can lift that workload from the bedside nurse so that they can do the things that you have to do in person, right? There's nursing that has to be done in person. I have to do my wound dressing changes in person. I have to manage my IVs in person. However, patient education is really good to do virtually. So, the nurse working from home can do that engagement with the patient while the bedside nurse has that work lifted from them, and then they can do the hands-on piece and then that bedside nurse knows that they're going to get the next shift at home. That's a nice four hour shift, a little bit of physical respite, a little bit of psychological respite, but still challenging work, still critical thinking, still intense nursing, but in this cool, innovative way. Then we're finding that not only will nurses say, yes, I like it, you know, an extra four-hour shift. So, you're making more of the limited resources that you have. But we find that nurses will come back, or they will go to the hospital that offers this opportunity for them. They will say, holy cow, if I'm going to choose between hospital A that's traditional bedside work or hospital B, where I get the opportunity or the promise of working virtual nursing, they're going to choose Hospital B. So that attraction, that talent attraction, it's also our very first virtual nurse with Nurse Disrupted was 75 years old. It was great. I mean, she was head of home health on this health system in Bend, Oregon, and she was like, Bre people don't let me touch computers. They assure me that they will explode like I don't get to touch computers. So, we were designing to Geri and we were designing for people, any nurse, any clinician, to be able to walk in and putting the patient at the forefront, instead of lots of bells and whistles. We've got this expert nurse and this incredible desire to continue to engage with patients. So, we're finding we can re-attract retired nurses to the workforce. So, when we're staring down the barrel of a now 1.6 million nurse shortage, if you think of being able to attract 400,000 nurses, we lost in the duration of the pandemic. If we find that, you know, and I asked a lot where it's like 85% of nurses ... There was a Becker's report that came out in May, and the report said 85% of bedside nurses now intend to leave the bedside in the next year. Hospital executives no longer can go ‘La la la la, la. Like this storm is going to pass. We can just go back to the way we done things.’ You can't. And I always say, well, what if your nurses didn't leave? Right? And that's what we're seeing here is that 1.6 million nursing shortage becomes 1.2 million nursing shortage. If we can bring people back and it becomes a 600,000-nurse shortage, if we don't have that tsunami event that happens and then if we start to attract people to the profession because it's something that is respected and that it's work that can be done. Not every nurse that leaves do you have a nursing student that's like, ‘do I want to do this? Is this really what I want to do?’ Versus when you have the investment going into a nursing workforce in this innovative way, you know, hospitals stand to flywheel cash. I mean, that's why we talk about, and I don't, I won't even get into ratios like the reason hospitals are like ‘ratios need to increase for nurses.’ It's like, no, you need to save money. Let's talk about what we're let's talk about the topic. You're talking about cash. If we can save you $20 million with this by decreasing our dependency on agency, by decreasing turnover, by, you know, getting your vacancy rates somewhere below 15%, finally, you know, and increasing throughput, by the way, couple of elective surgeries. I mean, now we're talking about the real topic, which is cash for hospital systems, and you can have your cake and eat it too, with virtual nursing done right away.
Dr. Jerome Pagani: So, this is one of the things that we tell folks a lot is to get as you're as you're saying, really get at what the root of the problem is, and before you start designing. Then when you're thinking about the solution, make sure that you're designing a solution that hits as many parts of that problem as possible. So, I hear you saying, the cash for the hospital system. Key, right? No money, no mission. Being able to give nurses a career path that spans their entire lifespan, not just the part where they're the most physically able, pulling people back into the workforce at a time when attrition rates are high, but also the gap between the need and the supply of those really well-trained people is at an all-time low. Then pulling people back in who are the most expert, who have the most experience. And so you're sitting at that by digging to the root of that problem. You're sitting at the sweet spot of a lot of problems on the hospital side, on the patient side, and on the caregiver side.
Bre Loughlin: So, it’s the perfect storm in a good way!
Dr. Craig Joseph: Bre, you had mentioned earlier developers that like to solve problems by creating more buttons or adding things on to their design or their software instead of removing it. Certainly, that hits a sweet spot with me as a physician. I certainly like to add complexity because I've never seen a patient with high blood pressure. They all have hypertension, and I've never seen a high heart rate. It's always tachycardia. So how do you get around that? How do you make that better?
Bre Loughlin: I think it’s the way that we incentivize design. I mean, the way that developers are incentivized right now, I mean, everyone's hanging their egos on the complexity of their design and what needs to be at the center instead of the technology is the human, and when we look at the design, the simpler, the more invisible that that design is, so that it's melted away into the humans and the problems and what it is that we're truly trying to do - that is hard. That takes time, that takes work. And we're not incentivizing our developers and our teams to create these very, very simple products.
Dr. Craig Joseph: Yeah, I could not agree more. I guess that's the human of human centered design. You know, sometimes I find when I'm working on trying to solve a problem with a client, that technology's not even the answer. There's a stuff called I don't remember the name now it's trees, and you chop them very thinly and you can take a, can take like graphite or … what is it.
Dr. Jerome Pagani: Deli meat. Deli paper. Paper, paper.
Dr. Craig Joseph: Paper! There are times where paper’s actually the right answer and it's not another app or additional, you know, technological. There are there are workflows where, you know, paper make sense. Workflows, were just talking to someone, makes sense as opposed to sending them a message and kind of keeping that in mind, you know, getting it as simple as you can and not necessarily focusing on the factors that get you there can really make all the difference.
Bre Loughlin: I'm a big fan of talking to people. Great path.
Dr. Craig Joseph: When I worked at that EHR vendor that you mentioned earlier, I would be at go-lives of the electronic health record and people would say, okay, well how do I tell, you know, a doctor might say to me, how do I tell a nurse that this is really important, that I need it to get done now? I said, I think we didn't shut off the phones. The phones are still functional. You could call the nurse, or if you see the nurse, you could ask them in in person if it's really important. Probably sending a message that they won't see for 5 minutes to 5 hours, probably not the right answer.
Bre Loughlin: But I think that we often put the wrong protagonist in the center of our story. The protagonist is always, always the human. It is not the technology at the center, and that should always be the way that our design emanates, it emanates with the correct protagonist, and we're just incentivizing, it's the bonus structure, it's the way that we're paying people who create technology. We've talked about this. I mean, really, you need to flip it on incentivizing developers and people who design tech for the simplest solutions, incentivizing subtraction.
Dr. Jerome Pagani: I'm hearing that the importance of the design itself, that it should be baked right into whatever the solution is.
Bre Loughlin: Right. And the human, the technology that we design needs to be like oxygen. It needs to be invisible and vital.
Dr. Jerome Pagani: Which is a great way of thinking about it. It's just it's there. It's ubiquitous, right? But you don't even notice it until it's done poorly and lacking.
Bre Loughlin: Right, and I think we need to break away from our assumptions about humans that truly we're overestimating what we think people can do with the technology that we design. I'm not saying that we're not highly intelligent beings. Absolutely we are. However, when you look at everything that's going on around a person who has several pieces of technology that are interacting and you create something very complex, they're working with 6 to 10 other things that are very complex, and then they're working with the other human beings and everything else that is happening. So really complex design is not freeing up our time. It's not making our lives better. It is making it more complex. Design the other way how is it that the technology is not the center of my focus, that it is, like we keep talking about, that the technology melts away and suddenly we're elevating the human condition through design that makes us better.
Dr. Jerome Pagani: How do you balance functionality and simplicity in design?
Bre Loughlin: The most important thing is not designing in a room with a bunch of people that are like you and that think the same way as you, so to be those observers in the wild that we were talking about. ‘There is a nurse approaching the Pyxis machine,’ but look at the way that people are interacting with the technology. I mean, in the beginning of Nurse Disrupted, getting into the shelters, looking at the physical layout, learning what the staff, the resources, the staff had you know, the internet connectivity is poor, they don’t have IT teams, they don’t have project management teams, the people are that are in there have, you know, people who are coming into the shelter at 5 p.m. They have to go out of the shelter at 7 a.m., and understanding things like trust, trust of technology, workflow. If your technology takes a lot of time, and you're standing between somebody warmth and dinner. You better redesign it and really getting at the elbow of our humans instead of, you know, in these distant rooms thinking of, you know, what great thing we could do, you know, create and why aren't the humans using it the way that I thought it should be used, like get into to the wild.
Dr. Jerome Pagani: Bre, at the end of the podcast, we like to ask everybody the same question, which is to think about two or three things, and they could be outside of healthcare, but two or three things that are so well-designed that they bring you joy to interact with.
Bre Loughlin: Well, I mean, of course, the first one would be our patient facing app, that’s one touch. I mean, I eliminated every single button that could be on there until it was simply the person, and that's ringing true in the hospitals where the nurses have a million things and have that breath of fresh air where it's like, oh wow. So of course, I love what we do. But aside from that, and I have a tragedy for you both, and perhaps you're aware of it. I think it was 2013, there was this gorgeous, gorgeous collaboration between Alda Brand and SoftBank, SoftBank, the Japanese robotics company and Alda Brand is a French AI company. They had come out working together with the robotics, the hardware piece and the software, the interplay of them and the way that the hardware and software would work together was using some really incredible things, like facial recognition of the video and seeing things like depression is very effective. Seeing things like Parkinson's and Alzheimer's, that emerging science is really good. So, the original iteration now you're going to know the name Pepper the robot, because Pepper, the robot became famous, famous, famous. But what happened is that everyone got so excited about the original iteration of Pepper with Alda Brand AI. Everyone wanted to put their own AI into this beautiful robot. We’d go to trade show after trade show, and they turned her into a bucket with a remote control. With a promise of their new AI that they're going to put into, and they gutted the original Alda Brand AI, which was really, really exciting. I got to see Pepper in person at all these trade shows. You know, the robotics, no doubt is a gorgeous design, soft hands, articulate hands, a kind face. But I, I loved the original design and how the two companies worked together. And the tragedy is that it doesn't exist in that way anymore, and do you know what the biggest bummer is? Is in 2013 you could buy that combination for about $5,000. But the only problem is that you had to be in Japan to update the operating system, and I was like, $5,000 is a steal, but I just can't make it to Japan. But I think that's a tragedy where that hardware-software piece was beautiful. It solved, it was looking to solve problems and detecting depression and then everyone just got so excited about the robot that they gutted the cool AI. I think that every technology comes with frustration and it's always a wait of does it solve the problem in a fast enough and meaningful enough way for us to tolerate the things that are glitchy or the negatives of it? There's not a piece of technology, it’s like medications? Right? Every medication has a side effect. Every piece of technology has a downfall, and you know, what are the technologies? You know, my phone has a ton of things that go wrong. Do I still have my phone? I do. You know, my car drives me crazy. The electronics in a drive me crazy, but I still drive my car and still listen to the radio. I think that people try, or they think that technology can become a more perfect design than we are as humans ourselves. And I think that that's a mistake that technology design will not be more perfect than who we are. So, I always say we need to try and be better, and by being better people we’ll design better technology.
Dr. Jerome Pagani: Those are great answers. Bre, this has been a fantastic conversation. Thanks so much for joining us today.
Bre Loughlin: Thanks for having me.