Healthcare – Thy Enemy is Toil!


Feb 15, 2017 Brad Brooks, Co-Founder & CEO, TigerText

I was recently reading an e-book published by Google that details how they manage their worldwide server operations when I came across an amazing term they use internally – “Toil.”  Google describes Toil as “the kind of work that tends to be manual, repetitive, automatable, tactical, devoid of enduring value, and that scales linearly as a service grows.” They go on to describe an internal objective to keep Toil to no more than 50% of an engineer’s time lest they risk burnout. They have found that Toil can quickly exhaust up to 100% of an engineer’s time if left unchecked.

This notion is profoundly applicable for TigerText as we observe Toil almost every place we look across the healthcare enterprises we service. For several reasons, Toil has built up and impedes care, drives up costs, and demoralizes physicians and nurses. So how did this happen?

I think there are 3 key drivers behind the skyrocketing rate of Toil in healthcare. First, the digitization of healthcare information. While Electronic Health Records are fundamentally needed, they have the unintended consequence of turning caregivers into data entry specialists. A study by the Annals of Internal Medicine found that for every hour spent with patients, physicians spend 2 hours on electronic health records (EHR) and desk work. And, most of this data entry often addresses billing capture but not actually treating the patient. Just converting information to digital form does not in and of itself derive value for a health system. Logging into an EHR typically takes 3-4 minutes to retrieve relevant information. Multiplied by 15-20 times per day results in over an hour in lost productivity. As a result, physicians and nurses feel an intolerable sense of manual repetition divorced from actually caring for patients.  Crazy Toil.

Second, hospitals continue to rely on antiquated communications and workflows that don’t scale. Whether the 2 million pagers still in use, old IP nurse phones coupled with whiteboards used for scheduling, or third party human answering services that triage phone calls, the way most of acute care communication occurs has the unintended consequence of slowing response times and impeding care coordination because it fundamentally requires synchronous communication (2 or more people speaking live) to exchange information. Can you imagine how much business productivity would slow across the country if we could only complete workflow through synchronous means? One report cited in the Wall Street Journal calculated that Nurses spend as little as 2 hours of a 12 hour shift actually treating patients because the remainder is spent doing such things as hunting down supplies, tracking down physicians and interacting with pharmacists. Insane Toil.

Third, the industry is fundamentally shifting to value–based care. Whether through the Affordable Care Act or other secular trends to control costs, caregivers are being asked to see more patients at a lower cost. Thus with heavier data entry requirements and antiquated communications that scale linearly, caregivers are deluged. Overwhelming Toil.

Nevertheless, there is a way out. With the rise of smartphones and an open API cloud-based communication platform, health systems can meaningfully reduce Toil and restore time for meaningful care to its physicians and nurses. Critical lab results can now be routed automatically at the point of care from the EHR to a physician’s smartphone rather than a physician wasting 4-5 minutes logging into an EHR to manually get results.  Further, just routing physician consult requests out of the EHRs to the appropriate physician cut patient length of stay by over an hour at one of our hospital customers. This saved time resulted in millions of dollars in cost savings, never mind increased patient satisfaction.  In another example, allowing an ACO caregiver group to collaborate in a group chat prior to a patient discharge resulted in dramatic reduction in readmission rates (over 60%) and millions of dollars of reduced costs.

We have also observed that supporting departments can meaningfully contribute to Toil. At one of our customers, the Translation Services department was frequently absent when a physician needed to see a patient who didn’t speak English. This $15 an hour support service was slowing down care delivery and hampering $300 an hour physician productivity. By reaching translators in real-time, physicians were able see almost 2 more patients during a rounding session. Incredible productivity implications.
I have written previously that we believe that healthcare communications is in a state of crisis. Maybe one day we will thank Google for labeling an enemy we can all unite behind – Toil.  Defeating Toil will save incredible amounts of money (we estimate over $100 billion annually), improve patient outcomes and restore time back to doctors and nurses to do what they love most-caring for those who need it.  Time to slay thy enemy!