The Doctor is Out

According to a 2017 report commissioned by the American Association of Medical Colleges (AAMC), we are facing an unprecedented shortage of doctors in America.¹ By 2030, we may be short over 100,000 physicians. Medical specialties that are expected to be hardest hit include primary care, surgery, and psychiatry. Over the same period, the percentage of Americans over 65, who require the most healthcare resources, is expected to increase by 55%. This is a huge problem.

The situation in nursing is projected to be even worse. According to the Bureau of Labor Statistics, there will be over a million unfilled nursing positions by 2022.² Some experts warn that this could become the worst nursing shortage in U.S. history. A 2007 report from the Institute of Medicine details the tremendous impact that adequate nurse staffing has on quality of care and patient safety. ³ Nurses bear the crucial responsibilities of monitoring and educating patients and of implementing their treatment plans. They are in a unique position to detect problems early and to correct the mistakes of other staff. A 2011 study published in the New England Journal of Medicine showed that patient death rates increase significantly when hospital nursing is understaffed.⁴  Studies have shown that being short on nurses increases rates of infections,⁵ readmissions to the hospital,⁶ medication errors,⁷ and other adverse events.

Shortages of healthcare workers are being compounded by a downward spiral of burnout and attrition. Nearly half of U.S. Physicians say they are experiencing burnout, and the numbers are getting worse.⁸ A 2011 survey by the American Nurses Association reported that every 3 in 4 nurses were feeling burned out, most of them blaming chronic nursing shortages as a major factor.⁹ Burnout leads to fatigue and psychologic distress and can lead to serious problems like alcohol and drug abuse. Undue work stress results in absenteeism, increased employee turnover, and difficulty recruiting new staff. Staff burnout impairs performance, patient safety, and patient satisfaction, and in the end is very costly to hospitals.

Organizations like the AAMC, the American Association of Colleges of Nursing (AACN), and others are working to recruit faculty and create more training positions to meet the increasing demand for providers. Unfortunately, skilled providers take many years to train and current efforts will not meet demands in time to prevent dangerous shortages of doctors and nurses.

Luckily, all is not lost. The solution to this problem, as in many other industries, is technology. We have arrived at what is being called the Fourth Industrial Revolution.¹⁰ The First Industrial Revolution hit in the 18th century with steam engines and industrial machinery. The Second, in the 19th century, gave us electricity and mass production. The Third came in the 20th century with computers, the internet, and automation. Now the Fourth Industrial Revolution is at hand with the progressive integration of physical, biological, and cyber systems. Sensors, monitors, connectivity, actuators, and machine intelligence surround us, in everything from cars to refrigerators, phones, home environment, lighting, home security, and much more. It is believed that there may be over 50 billion connected devices by 2020.¹¹

So how can technology help us with doctor and nurse shortages? One important solution lies in scheduling software. Scheduling workers turn out to be a very hard problem. When you have more than just a few people and a few considerations, like not working nights or weekends, the number of possible solutions grows exponentially and it becomes very hard to find the fairest, most balanced schedule. Only in the past few years have we benefitted from a convergence of data connectivity and advanced computing technologies like artificial intelligence and machine learning to yield robust solutions to this difficult problem.

Efficient, fair, and flexible scheduling means better use of limited staff. It also means increased staff satisfaction. People can trade shifts, provide notifications and requests over mobile devices, and find replacements faster, over larger pools of qualified, credentialed colleagues. Automated systems, based on sophisticated algorithms, are able to keep track of myriad rules and considerations, and the systems are able to weigh literally thousands of alternative schedules to constantly deliver the best possible solution. These systems have emerged from decades of academic research and are now being deployed as commercial applications that are saving hospitals millions of dollars.

Intelligent, automated healthcare scheduling and staffing solutions are meeting another new requirement in modern healthcare: itinerant staff. Yesterday’s healthcare workers signed on at one or two hospitals and tended to stay there for their entire career. Now it is not unusual for doctors and nurses to travel year round, maintaining credentials in numerous states and organizations. They are following higher pay to areas of greatest need, easing the burdens of hospitals and communities to provide adequate staffing. Obviously, this itinerant workforce creates even more scheduling complexity.

We are fortunate to be at a point where accelerating growth in both computing power and connectivity have converged to enable technological solutions that were only pipe dreams a few years ago. Global policy efforts are also breaking down the silo-like sequestering of healthcare data, promoting the safe sharing of outcomes, performance data, and patient information. Historically, hospitals spent millions of dollars to hire consultants to painstakingly review their operation and advise improvements. The expense and effort required meant that such analyses occurred rarely, often years apart. Healthcare analytics software now enables statistically meaningful comparisons to be done continuously. Drawing on decades of artificial intelligence research, new and powerful analytics can be applied to identify areas of greatest need and to provide practical, useable advice to health care workers and administrators continuously, in real time.

Other new technologies that are compensating for provider shortages include predictive analytic software that identifies bottlenecks and offer advice to increase the speed and efficiency of patient care. Patient flow, scheduling, and staffing technologies will occupy an increasingly vital and central role in the delivery of healthcare. The degree to which they will be able to compensate for nursing and physician shortages remains to be seen, but it is clear that they will continue to have substantial and lasting benefits.

White paper: Potentia Analytics, Inc.

Computational Intelligence in Medical Informatics

Intelligent Provider Scheduling | Patient Flow Optimization | Predictive Analytics

References:

1. AAMC Projections Update 2017. https://aamc-black.global.ssl.fastly.net/production/media/filer_public/a5/c3/a5c3d565-14ec-48fb-974b-99fafaeecb00/aamc_projections_update_2017.pdf. Accessed April 11, 2017.
2. Juraschek SP, Zhang X, Ranganathan V, Lin VW. United States registered nurse workforce report card and shortage forecast. Am J Med Qual. 2012;27(3):241-249. doi:10.1177/1062860611416634.
3. Philip Aspden, Julie Wolcott, J. Lyle Bootman, Linda R. Cronenwett, Editors Preventing Medication Errors: Quality Chasm Series Committee on Identifying and Preventing Medication Errors. The National Academies Press, Washington, DC., 2007.
4. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med. 2011;364(11):1037-1045. doi:10.1056/NEJMsa1001025.
5. Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and healthcare-associated infection. Am J Infect Control. 2012;40(6):486-490. doi:10.1016/j.ajic.2012.02.029.
6. Tubbs-Cooley HL, Cimiotti JP, Silber JH, Sloane DM, Aiken LH. An observational study of nurse staffing ratios and hospital readmission among children admitted for common conditions. BMJ Qual Saf. 2013;22(9):735-742. doi:10.1136/bmjqs-2012-001610.
7. Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA. 1995;274(1):35-43.
8. Physician Burnout: It Just Keeps Getting Worse. http://www.medscape.com/viewarticle/838437. Accessed April 11, 2017.
9. 2011 ANA HEALTH & SAFETY SURVEY – The-Nurse-Work-Environment-2011-Health-Safety-Survey.pdf. http://nursingworld.org/FunctionalMenuCategories/MediaResources/MediaBackgrounders/The-Nurse-Work-Environment-2011-Health-Safety-Survey.pdf. Accessed April 11, 2017.
10. What Is The Fourth Industrial Revolution? https://www.forbes.com/sites/jacobmorgan/2016/02/19/what-is-the-4th-industrial-revolution/#3f1e5ca9f392. Accessed April 11, 2017.
11. Evans, D. How the Next Evolution of the Internet Is Changing Everything Cisco Internet Business Solutions Group (IBSG), 2011. http://www.cisco.com/c/dam/en_us/about/ac79/docs/innov/IoT_IBSG_0411FINAL.pdf. Accessed April 11, 2017.