646 - Patients as Partners: A Digital Approach to a Fairer, More Connected Surgical Journey

0:00Peter Birch: Welcome to the Shocking Health Tech Podcast. My name is Peter Birch. Today on the show, I'm joined by Dr Cory Williams, researching clinical lead at Five Faces. G'day, Cory. How are you going? Yeah, great, Pete. Thanks for having me. It's good to have you on the show, man. Looking forward to having a chat. I especially love speaking to people that's got a bit of an eclectic, diverse mix within healthcare that can bring some real world stories and perhaps new insights too. So firstly, Corey, for those unfamiliar, tell us about you, your role, and maybe your journey to getting into it as well, before we dive into a bit more about what's happening with Five Faces.

0:35Yeah, thanks, Pete. So my name is Corey Williams. Clinically, I've got a background in nursing, so about 15 years of working in the surgical and perioperative stream, and still work clinically today as a clinical nurse consultant, service proven and innovation. and I am the researching clinical lead here at Five Faces. And yeah, my background is an interesting one because I essentially saw the issues in the clinical space and I thought, oh, how simple it's going to be to just ask my executive to give me a digital solution to fix this, to be introduced to these sort of multitude of issues in the digital space and how complex it is.

1:17So I went about undertaking a PhD with QUT under Professor Jet Duff, co-designing what conceptually you need for a feasible and practical perioperative surgical journey solution. That led me to Five Faces. So, yeah, I've certainly been persistent in trying to find the problems to what started in my clinical space.

1:40Peter Birch: Love that. And I don't know if that's just a statement about, you know, how to get things done in healthcare, But when the more sensible path seems to be rather than pursuing, you know, implementing a digital solution within a healthcare setting, it's probably easier just to get a PhD to then work out a better way to do. I'm having a joke, but no, at the same time, that's probably given you a lot of in-depth experience that maybe others wouldn't. So a valuable asset on the five-faces side. But tell me a bit more about the, like, you know, in that real world scenario, the thing that kind of bugged you or the challenges that were actually faced, like on the ground, you know, within the hospital setting that really pushed it to the point of looking at there's got to be a better way.

2:28Yeah, 100%. For me, it was when I was in a role as the orthopedic case manager. So you're the one point of call for about a thousand electrosurgery patients at any given time. And your primary role is to help coordinate those patients through that journey, but to also coordinate the bookings of surgeries for these patients, making sure that they're ready to go and coordinating that surgical team as well. So a lot for one position. And what I was finding was that there's a lot involved in that process. You know, from the patient side of things, I would answer phone calls all the time. They're continuously feeling lost.

3:09I don't know where I am. I don't know what I'm supposed to do. I don't know. Am I still on the wait list? Do you guys still know about me? Because we haven't had the time to call every single patient and check in. So not knowing where they are, where they're going and what they're supposed to be doing. And then that resulting, unfortunately, a lot of the time because of lack of visibility from us to see those patients in day of surgery cancellations, delays, inevitably readmissions, the inefficiencies that we see every day. And also, importantly to me, it's important that we consider patient-centered care is great.

3:45We've got the patient at the focus. But for me, clinician well-being and clinician focus is important too. Our clinicians work in such a time-poor, resource-constrained environment. And it's important to acknowledge that as clinicians, we want to do more. We want to check in with our patients. We want to give them the education that they deserve. but in this landscape and the way it is now it's not possible and when I saw those issues it was a no-brainer for me that something in the digital space was where we can close these gaps and that yeah led me to pursuing that and and you know the obstacles that I found along the way in trying to create this made me go down that PhD route and really get some sort of backing behind this and moving into industry to do so.

4:33Peter Birch: Makes a lot of sense. The, um, if I think about what I would expect as a patient, you know, maybe sitting on a wait list or at any point in that journey through, um, you know, getting surgery or something, the there's, you know, it's hopefully not something I do regularly. So I come in with some preconceived ideas or expectations of, um, you know, I'm going to have a thing done to me. So I guess it's a service that's provided. So So there's an expectation of service level and all this kind of thing. So you'd expect to be, and there's a lot of costs and logistics involved too. So you kind of feel like the touch points along the way are going to be pretty, like I, you know, there's the, all the jokes we make about, you know, you get real time updates and when your pizza came out of the oven and all that, like you kind of get told every single step of the way through a service these days as a consumer.

5:20Peter Birch: And so everyone's got these high expectations of the, of the type of service, I guess you'll, you'll get through the health system. and then there's this massive gap you talked before about like oh we've just got such a long list we haven't been able to get through to you know check in with people but i feel like if it was an issue of resource if you know that we just need more people um i'm not sure that would actually fix the problem anyway because if you just throw more people at a broken process it's there's going to be more leaks so what is that big gap yeah i agree and and for me whether it clinical or research what I've found is fundamentally our issues in the health care landscape are that we still rely on what's seen as the traditional model of care which is that face-to-face interaction for for those moments of teaching for educating checking in with patients and a lot of the sort of issues that flow on effects that lead to those bigger problems like I said day of surgery cancellations you know hospital acquired infections readmissions you You know, we're relying on patients when we give them verbal instructions, maybe a little bit of a, you know, if you're lucky, a paper handout of information to remember this information in eight to nine months time when they're coming in for surgery.

6:37We don't check in with patients as regularly as we would like to. I mentioned clinicians, we have our own motivations. We'd love to be able to do it, but within the constraints that you've got. so i give an example for this is if we're relying on face-to-face um sort of interaction piece p you come into a pre-emission clinic let's say 12 10 weeks before your um before your surgery and you go through an immense amount of information of things you need to do and make sure you stop taking this medication at this time um you know here's your fasting instructions you need to turn up here at this time and then you go away you know and that's in a rushed clinic You know, so this information is given to you verbally.

7:18Hopefully, they've given you some documentation, which you'll probably lose before you leave the door. But the idea is that we expect without checking in with patients, because we don't have time or ability to call every patient. Did you stop that med? Did you start fasting at this time? There's no visibility for us as clinicians. And there's no, more importantly, there's no reminder piece or visible reminder piece, education, a check in or a place to go for a central amount of information about your surgery. to remember these things. So what often happens is Pete turns up for surgery, you check in, you go upstairs, it's an anxiety situation, you're getting ready, we're putting you in a gown.

7:57All right, let's finally go through this checklist. Oh, you stopped your aspirin, right, Pete? Oh, no, I thought you said to stop my diabetes medication. Now we've got two problems. So then, you know, and these things happen all the time, whether it, you know, to be honest, whether it's things like stopping medications, not fasting at the correct time um people you know common one is people you know mistaken what a clear fluid is and you know um we say only clear fluids up to two hours before what does that mean if you're just remembering a conversation from you know two months ago um there's many things that happen in that space so i actually think to answer your question is to go back we rely too heavily on patients putting the responsibility on them to remember things from these face-to-face interactions with that little follow-up or a little education piece to go back and re-educate and reiterate with themselves in the meantime.

8:51Peter Birch: Yeah. Like I was thinking too, like as you were explaining, the fact that often with surgery, you know, you need to have a pre-appointment just, you know, to discuss what to do and that makes a lot of sense. But there's so many requirements or constraints like things that need to happen in order for this to be successful because it's a pretty big deal uh you know having surgery done so and that all seems like well that's a no-brainer but the and i was thinking geez well when you said oh you know cancellations on the day i'm like it's a pretty big deal i mean how often would that actually occur because i know that you know things that if i just need to go to you know i've got an important thing to happen you kind of just make sure that that thing's going to happen it's not something you wake up and go oh yeah i forgot about that, I'll just defer it to next week.

9:40Peter Birch: So I would have thought that cancellations on the day aren't as big of a thing, but you're saying that they are. And I'd imagine that because there's a bunch of people you've got to line up for surgery as well, and there's rooms and things. That's got to be pretty expensive when that happens as well. Is it more common than what I'm thinking? Yeah, it really is. There's a mass amount of surgeries and we do have a lot of cancellations and on day of surgery. There's always going to be an element of surgeries that are cancelled for, you know, things that weren't preventable. But the truth is a lot of these are preventable and it's from that sort of space there we talked about in the preparation pieces, people not, you know, not having something that reminds them or a clear enough sort of education preparation piece to refer to to keep them on that track.

10:33More importantly, when we talked about the staff as well, you know, there is, without that capacity to be able to call patients, you can't track that yourself either. So what that takes off the board is the ability for risk mitigation to mitigate these cancellations and delays. And that's a huge problem because it leads on to what you were saying there, Pete, with if a patient turns up on day of surgery, well, doesn't turn up, even worse, we don't have the surgery, There's problems there. Like it still costs money. You know, if you look at the research, you know, we had$3 ,000 to$6 ,000 an hour, depending on the complexity of the surgery, because you get your overhead costs, your staff, the equipment you've ordered in.

11:14So a number of things there. But then you've got to look at it from a couple of other aspects too. if you if you look at it one from the patient side of things you know i always think i feel quite passionately about this one is that we label some things patient initiated cancellation you know poor janet has turned up and forgotten that uh forgotten to take that aspirin so we say it's a patient initiated cancellation but the truth is you know i seem to think about it what could we have really done realistically to stop that from having how much are we putting that on the patient but also if we look at it from what the cost of a surgery is there's a financial piece there's the piece of the patient if you think of janet now add this context how do you feel for janet she forgot that even you know we're relying on her to um remember from two months ago what if i told you i'm here in brisbane and she's having a complex surgery she's from far north queensland yeah she's had to take two boats and now two planes to get here yeah for this to be the reason that we turn around and say well time to get you home today because that's the reason and then the other big piece is if you look at it from what's publicly scrutinized is always our elective surgery waitlist if if we had found that issue earlier we can reschedule it we can get a patient in and we keep churning away at these elective surgery waitlists instead what we have we don't have Janet going in for that surgery we're not taking anyone off that elective surgery waitlist.

12:44Those clinics are still happening upstairs where people are now getting put on the waitlist. And this is where we have these sorts of problems. So coordination, communication, and visibility are huge issues. And if we had that, we'd have some ability to start mitigating these problems and the flow on effect.

12:59Peter Birch: Yeah. Yeah. It's not like you could, if there was a last minute cancellation, you can't just call up a patient who was on the list for next week to be like, oh, can you be here in 20 minutes? It doesn't work like that. So when you've got that that gap and and i yeah from the page i was initially just thinking from a if you're going in for surgery someone's probably going to take you which then puts your family out or someone or like any anyone that that you've there's been a lot of logistics that have been coordinated on the patient side that probably aren't even really that factored in which then puts strain on relations it's such a compounding thing yeah if we can get it it is it is complex but you're right you're touching it there like there's so many elements like you know we as clinicians in the hospital in a busy environment we can be quick to think of the clinical aspect oh well now we can't have surgery because of this and now we're a waste of time but also that patient's you know social logistical clinical and emotional elements to this you know think of the anxiety and yeah you know and then also think about you know you've you've now organized people to look after your kids you've had to take three weeks off work uh you know you've changed your whole life around for this um and a real simple if you think about we just go about the medication issue or maybe forgetting to fast properly you know something real simple has huge fallout in in so many domains whether that's patient whether that's provider or whether that's health service it's yeah there's a large flow no it is and i um i don't know why but it reminded me of you know when you go through the security scanners at the airport and the security and you never know whether you should take your laptop out of the bag or not and whenever you do the opposite they look at you like you're an idiot they're like yeah of course you leave it in there or of course you take it out and it's like well i don't know like so often you changed it but the and from them they probably see a million of them a day and it's like well that's just another one and i kind of think that's what you were um sort of sort of different but the the situation was from a clinician it's like well why did she take it like now we can't do it it's like well when's the last time she didn't need to take the aspirin for a surgery that she's never had before you know just well And that's a great point because what you've labelled there is we as clinicians, and it might be the small segment of that surgery journey that we work in, we know it inside and out.

15:10Peter Birch: Yeah. The patient doesn't. And we can't assume that. And what we need to look at really is what education do we provide, how do we provide it, and when do we provide it? And have we given the patients adequate options to escalate concerns in an easy way instead of just calling up the hospital, playing phone tag from a switchboard, trying to find who you need to talk to? Because it can be the reality of the situation in a lot of ways for a lot of patients. Yeah. And so if I was to play this out and say there was a digital solution, and I know this is Five Faces world, you know, back and forth, but the one thing you probably don't want to do, well, maybe it addresses some of the issue, but there's still an underlying problem.

15:49Peter Birch: Because there's a lot of this that goes on in healthcare too, where it's like, maybe we'll initiate a reminder pinging system over the top, but then underneath is a big wad of old school paper processes that still exist. Or like the underlying problem's still there, but now we've got a neat little UI layer over the top that might solve some of the direct point issues, but overall it's structurally kind of a problem. Do you think it's a concern if we're leaning more into digital solutions to address some of these issues in healthcare, do we run the risk of applying more and more of these digital wrappers over the top of, you know, inherently broken systems?

16:28Yeah, it's an interesting one. And I kind of look at it, especially when I'm looking in the surgical perioperative space. For me, digital solutions, I look at digital solutions as, you know, supplementing care, not replacing it, if that makes a lot of way. So I feel like a good way to say it is extending the care reach beyond those sort of touch points that we have and those face-to-face interactions. Because a lot of, you know, our systems still work currently in a lot of ways. We do have day of surgery cancellation in a lot of ways, but we get patients through. Where we can use digital is to streamline the process a bit further.

17:06We can provide educations, check-ins to patients. we can do these things on an automated basis you're able to create these sort of pathways so you know for for a clinician sorry for a patient first what you get when you have a solution like this for instance is you you may get your information in a timeline fashion so start to finish overall milestones and what that does is it lets you know where you are where you're going to go what's next and what am I supposed to do now and at each of those stages you can put education pieces in regarding specific information um i i've talked at nauseam about people forgetting whether that they're fasting instructions or their um anticoagulants but if you can if you know a patient is on these you know has these particular requirements you can schedule these in so for a patient they see that education they can orientate themselves to the process not just not just their surgery what what their surgery is about what the process is going through and what's next for the clinician what you're able to look at for instance the two key pieces i say for clinician digital is you can streamline through building those pathways like i said so you can build a pathway out and it can be allocated to a patient automatically so they're getting all the right education at the right time when they need it they've got check-ins that are pre-scheduled An example of a pre-scheduled check-in might be every patient three days before surgery.

18:35Have you got the flu? Do you know your fasting instructions? Those simple things. And seeing that information on a dashboard that allows you to prioritize, is my patient on track? Are they at risk? Or are they compromised? Allows you to jump into that sort of mitigation piece I was talking about earlier, about getting on top of that before it actually becomes a problem here in the hospital. So for me, extending the reach of the clinician's care, giving that ability to communicate, to coordinate and have visibility of the journey, as well as the patient, the same thing, visibility of their journey and escalate concerns.

19:15It's really supplementing the great care that we do already by providing more capacity without throwing people at it, basically.

19:24Peter Birch: Yeah. Oh, yeah, 100%. I agree. The service we provide in Australia in healthcare is worldwide, but we're going to need a lot more of it. And there is that wait list and there are a lot of challenges and there are issues where people that need the care the most can't get access to it. Or to your very real example of in the regional or remote situations where the care can be provided. it, it's not a, not a, you know, quick afternoon job that can be done. It's a costly exercise, both financially and emotionally and a bunch of other things too. So if I was to then package all of this up, then, you know, we know the current situation and there is hope in terms of the care that we can provide across the country is second to none.

20:13Peter Birch: We just need to be able to do more of it and in the process, not burn out all our clinicians. So it's not a factor of just going harder. at it and we don't have more clinicians or more staff or we can't afford it so we can't just throw more people at it what's your vision then for it after you've done all the research you're the nerdy one on the the surgical workflows here on the so you got the theory side what's the um uh desired end state or your kind of vision on on uh what a good process looks like from that patient journey from start to end yeah i think for me what's been really interesting of jumping between In my career, it's been a great opportunity is jumping between and staying in clinical research and industry is seeing...

20:58It's actually given me a lot of hope, to be honest, in this space for not just for surgical but complex journeys broadly because going into the industry side of things, I've seen what is capable. And that's the thing. When you're in clinical, you have all these ideas and research, you can conceptually kind of say, this is what we need through great co-design pieces. And then when you tee in with, you know, the industry side of things, seeing what's actually capable in terms of, let's say, integration, for instance, being able to integrate in with EMRs and PAS systems is not, it's not this unattainable goal that you can think when you're working in the clinical system.

21:38it can be done and the features and functionalities that we you know as clinicians go geez this would help me every day if i could see what my if my patients could you know respond to a check-in or a fill out a form and let me know where it is this would save so much work for me and i'd be able to make sure that they're ready to go so that could have transitioned piece between the three has been great for me and gives me a lot of optimism um that this can be achieved and in In terms of the surgical space where it's going, I believe that these, you know, pretty much what I'm working on at Five Faces and what's happening out there broadly, I believe that the digital health sort of solutions that have been built are going to be able to help streamline work for clinicians.

22:19So clinicians can provide more education. They can provide more education and more support and reassurance without overextending their time by doing it in these automated fashions and being able to really prioritise their time with patients instead of doing all this administrative work behind the scenes, patients are going to be able to receive the education that they desire and need and know where to find help and when. And I always go back, the biggest one for me is patient, and it breaks your heart, patient's call and say, I have no idea what's going on. Am I still on the wait list? I haven't heard from you guys in 10 months.

22:58And you think, geez, that, you know, you can see the frustration and being on the organisation side, you can see why. So for me, I certainly see the future in this space is going to be, you know, very positive, very beneficial for, again, everywhere I look out for is patients, clinicians and the health service. I think there's some real optimism in this space. Yeah.

23:23Peter Birch: I can't help but think, as you were saying that too, if we get the workflow piece right from inside a hospital, let's say, or things right for a clinician, yes, that means then patients can be more educated and perhaps less frustrated at the system because they know a little bit more. But I guess the outcome of that too surely is, you know, we can address some of those real challenges around equity for access for patients. And even for such a standard process of, say, you know, preparation for surgery while there's kind of a certain checklist per se if it felt like hey this was customized or personalized for my particular situation if we've got the right kind of data and be able to um you know notify the people at the right time and and all of that then that really opens up you know all these cool opportunities for for personalized journeys and if in time then that improves the the trust that people have in their health care system like while we talked about the knock-on effect at the start of the conversation about when you when a patient doesn't show up it has all these snowball effects surely we get to start getting that fundamentals right all those other knock-on effects come out the other end too yeah 100 % and I think you touched on a few really important points there one being personalized care you know I did my PhD ingrained in co-design which means you're getting the end user's perspectives right from the start generating what the outcome is going to be because I think a lot of a lot of past examples have potentially gone the other way of saying this is the solution and make it work for you where if you work with clinicians you work with patients you find out the true sort of problems what's a feasible solution you come out with a fit for purpose sort of solution and then Part of my PhD, you touched on there as well, Pete, was equity.

25:18You know, you've got to think about as well, like, you know, we say digital and then people automatically jump to like, oh, how is that going to help? You know, that's not going to help everyone. Not everyone's going to be part of this. And that's a great point because it is. So a great co-design activity I used during my PhD was using scenarios and personas and challenging the consumers, the ex-patients with the clinicians and challenging them to say, all right, how could a digital solution in the surgical space be beneficial to someone who is visually impaired, someone who has dementia, someone who is a three-year-old child, someone who lives rural and remote?

25:59How can this be beneficial? And then, you know, it's great. You see the cog's turning in people and they think, oh, actually it can't. But no, wait, it can because you can think of things like delegate and carer access. You've got things in that space. And then parents are obviously going to need to be the one actually a solution like this on behalf of their child in the care. But then you also look at it from ways of like, regardless of any situation, there's going to be some people who do not want to engage with the digital side of things. And that has to be completely fine. When we talked about digital being a supplementary to the care of our patients, it's where a patient goes I don't want to receive the digital part of it they still get the same care that they would without it which is what's ongoing right now but from a staff perspective a clinician perspective that interaction you have with them whether it be in face over the phone email however you are getting your message through to these patients you're supporting you're still using the digital facing side for you to track care and keep it amongst the priorities of everyone else.

27:07So it's important to understand those equity considerations. And as well as this, I think a big undertone for me, not just from research but clinical, is we want patients to be partners in the journey. You know, they're going through this journey and the worst thing you can do is have them just as a passive recipient of care. You want them to be an active part because when people are an active part and they want to be informed, they want to be influencing their own health outcomes that's where engaging with their education information like pre-habilitation you know optimizing their general health all these things that they can sort of you know empower themselves with to get better outcomes is working towards the same goal as you are and then there's multiple ways to look at why digital can be

27:55Peter Birch: supportive in that space love it cory really grateful for your time in this conversation today being able to speak with someone that's so passionate but also like such a deep understanding through all the work that you've done you know in in the real world through academia and now in the the um industry side or the technology side too so lots of great insights there and i get you know such a valuable asset to the five faces team too and it's um you know good reminder about you know from from everything i was like five faces you know strong partner of talking health Tech and we've done a lot of episodes which you can get in the back catalog there but there's you know a lot of these problems which are digital they're not just simple forms or little pingy reminder things you've got to have a real passion and understanding of what healthcare needs and where the ball is going so Corey I really appreciate you making the time for this discussion today always a pleasure and look forward to chatting with you again soon thank you so much Thanks, babe.