In this episode of 4x4 Health, we talk with Si Luo, the CEO of PatientSafe Solutions. Si began at PatientSafe as a founding team member in 2009 and, before taking over his current role, he served in a variety of leadership roles across the organization. Before he helped found PatientSafe, Si worked in strategy and operations roles at several different organizations both within and outside of healthcare. Throughout the conversation, Si and Dr. Dave discuss how PatientSafe is addressing the workflow challenges in healthcare through innovative technology paired with an emphasis on design. Si and PatientSafe are on the cutting edge of workflow innovation, especially when it comes to mobile solutions, and this episode emphasizes the powerful potential they have.
Dr. Dave Levin: Welcome to 4 x 4 Health, sponsored by Sansoro Health. Sansoro Health, integration at the speed of innovation. Check them out at www.sansorohealth.com. I’m your host Dr. Dave Levin. Today I am talking with Si Luo, CEO of PatientSafe Solutions which provides Unified Clinical Communications and Workflow Applications for Frontline Care teams. Their patient touch platform consolidates secure messaging, voice calls, critical reverts, nurse calls and clinical workflows including rounding, specimen collection, nursing documentation and the rest into an all-in-one mobile application for hospital staff to use as a communication device. Si was a member of the group that founded PatientSafe in 2009. Prior to becoming CEO, he served in a variety of leadership of roles across sales, business development, product strategy and customer operations. Si has served in strategy and operations roles across a wide range of industries, spanning private equity, biotechnology, enterprise software and venture consulting. As you can tell from this brief bio, Si has his hands in a lot of things and a track record of real success. Welcome to 4 x 4 Health, Si.
Si Luo: Thank you for having me.
Dr. Dave Levin: So, let’s get into this and today I’m gonna ask you a series of four questions and we’ll take about four minutes to discuss each one. Let’s start by having you tell us a bit more about yourself and your organization.
Si: Sure. I think to start on my end, my first aspirations for making a dent in healthcare which is something I’ve always wanted to do, I think from early on, really started in the Biological Engineering and Bioinformatics Research Program at University of California, San Diego. As I left the University setting, I actually first went to work for Illumina which is a huge genomics business now but at the time they were actually a pre-IPO startup that were growing quite rapidly. That’s also where I first got a taste of applying the science and engineering sensibilities to the business building process. So, soon after that I somehow found myself rotating through the consulting and private equity world for a brief period. Before I met my mentor, Mr. Jim Sweeny who was the founding CEO of PatientSafe Solutions and a very successful serial entrepreneur in the healthcare setting, he really inspired me to spend time and energy to figure out all the impactful ways to improve the care delivery experience on the provider side starting in the hospital environment. At PatientSafe, what we do is a lot of work directly on the provider side in the hospital setting but our mission is to fundamentally make the experience of care simple and effective through transformational technologies and processes that linkage between simplicity and effectiveness exist as a philosophical truth but somehow happens to be profound rebuilt [Unclear] go through setting and our current focus is to make a dent on the clinician side of the care delivery experience by providing them with a delightful mobile platform that can help them consolidate communication, collaboration and certainly clinical workflow execution onto a single easy-to-use mobile app that’s integrated across their EHR and telephony infrastructure.
Dr. Dave Levin: We’re gonna go deeper into this because so much of what you’re doing really goes to the heart of actionable information and workflows that are pleasing but before we go there, I’m always curious folks who have come from ‘non-traditional pathways’ into healthcare, their impressions and what they see and used a really interesting phrase. You said, you applied these sensibilities. You know, cast your mind back in time a little bit and tell us about you know, as you were doing that you know, what did you see, what did you bring in terms of prior experience or ideas or visions that allowed you to look at healthcare and perhaps unique or creative ways.
Si: Yeah, that’s a great question and I think I’ll answer that in two parts. First, is sort of my initial sensibilities and then the second part is how much healthcare has humbled me ever since. So, in the beginning as a science and engineering background, I remember the very first project I engaged with, I was employee number three on the product side when Jim brought me in for the business and the first project was actually working with the design firm IDEO and looking at across different healthcare settings and the different in efficiencies involved in those settings. I remember living inside of a hospital in the Bay Area for 45 days shadowing nurses and physicians. The first 15 days is just a mind-boggling amount of problems and issues that they have to deal with in the human form while realty accommodating all these brokenness on the backend, right. The initial sensibility was while there’s really no shortage of problem to solve here and then gradually we really come into understanding about all the reasons why these inefficiencies occur. The regulatory pressures, the process pressures and certainly still would be, I call it be the harder goal for every clinician that I’ve ever met which is their pure mission driven core to still deliver the best experience they could despite all the constraints that are at the individual level as well as at the system level.
Dr. Dave Levin: Yeah, it’s part of what’s so fascinating to me about this field is this mix of some of it’s hard core science, some of it is engineering and process engineering but it all eventually meets the human condition and that’s where you really find out, well, what really works, what doesn’t work, things that looked good on paper that turn out in the real world to not work that way or have unintended consequences.
Dr. Dave Levin: And say, you said that it’s made you more humble and you know, a number of our guests have talked about this idea of you know, be humbly bold, you know, because we need to be bold, because we got a change but we also need some humility because it’s a hell of a lot harder than it looks…, [Laughing]. You said something else that really caught my attention too. So, you’ve done some work with IDEO, that’s I D E O for our listeners. Strongly urge you to check them out, fascinating company that really goes to the heart of design and human factors. I’ve found in my own experience, once you’ve looked at stuff like that or you’ve read the work of Don Norman, their design of everyday things, the whole world looks different, you just see stupid design everywhere and it sounds like you would agree with that.
Si: Yeah, the design mindset and as I’m thinking now getting quite popular in the health system, leadership setting as well, it really helps you into it, the world in a very different way and also help you come to appreciate on every decision and it’s unintended consequences and how that pile up against one another to lead to where we are today.
Dr. Dave Levin: Yeah, I personally think this is a huge opportunity in healthcare. Clearly in the world of Information Technology but it goes beyond that and the example I always use for my clinical colleague is remember the bad old days when you could mix up the different gas lines in an operating theater and patients died because anesthesiologist made mistakes and when we went back and we re-engineered those fittings so you could only connect things to the things they should be connected to. It’s not that the Docs were stupid or lazy, they were human beings and we had not designed the system to be as foolproof as possible and it’s to me anyway, I look at though that our whole world of healthcare and just see so much opportunity around there. Am I making any sense here?
Si: I’m not imperiously understand this. I say, there’s no shortage of problem to solve and then the, be humble and bold at the same time. The humble part always comes into the equation on how difficult some of those things might still be.
Dr. Dave Levin: There you go. Well, let’s go a little deeper and tell us a bit more about you know, what’s the most important or interesting thing that you’re working on right now?
Si: Yeah, the most important thing that we’re working on right now as a technology and a product that needs to be constantly evolving to deliver against that long term mission of simplifying the experience of care, we’re actively partnering with a few innovative businesses and health system leaders to advance our core workflow engine that really powers our mobile experience on the front end that we’ve developed towards transitions of care in care coordination use cases. We’ve done very well inside the hospital setting but as hospitals become health systems and we really wanna look at the entire continuum of care and the efficiency and effectiveness in between the transitions, we wanted to help the care team to communicate and collaborate better towards that end. Especially, as we talk about how to have a real strong focus on systemness, as the patients to leave the hospital as well as traverse through the broader primary care system to help them stay outside the hospital as well.
Dr. Dave Levin: There’s a couple of things about your approach that I personally find intriguing. The first is, is you’re sort of merging a bunch of different data streams to turn those into information. You’re also trying to make that information actionable, so don’t just show me this thing, let me do something in response to it and then the other thing that I find kind of striking is, the emphasis on the whole care team. This is not a tool for Docs, this is not a tool for nurses or exclusively, it’s for the care team. So, could you talk about those two aspects, the actual information and why you chose to focus on the team rather than targeting the individual members?
Si: Yeah, that goes back into the design sense that I think PatientSafe is really on the leading edge to that when it comes to designing certain healthcare IT tools from that, from that end. In the very beginning when we look at our mission of simplifying the experience of care and finding that linkage between simplicity and effectiveness. We know we couldn’t just do local optimizations across an individual persona, let’s say nursing only. We very quickly realized that nursing carries a lot on their shoulder but a lot of the information streams, a lot of the context that determines the next action or the next best action is hugely dependent on this network effect across the entire care team. Not only with physicians, but even the transport staff, EVS staff, everybody that works around the hospital, all have an input into the stateful machine sort of view on the patient as the patient condition change, as the patient care pathway need to be adjusted. How do we have an eye towards the holistic care team versus only optimizing on one particular user group? That became very important to us first and foremost and secondly, we looked at what are the three central value proposition and design every feature, every workflow, every impact against each and every one of these value proposition and the three central themes for us became consolidation, aggregation and execution and consolidation meaning that we ought to be in a position to consolidate all the disparate communication devices and modality for the entire care team and then you know, in the hospital setting, typically any clinician interact with four to six different modality throughout their shift to communicate, collaborate, document to chase down a piece of information and with the smartphone capabilities, if we can consolidate all of that, that helps us satisfy the simplicity angle of the design and secondly, we need to get very good at aggregation and which is why we were very grateful about the partnership that Sansoro and a few others that are really pushing the envelope on interoperability as a general theme in the marketplace to help all digital health vendors to get their aggregation of appropriate context from EMRs, nurse call, scheduling, monitoring systems and as we move beyond the hospital setting, some of the transitions of care systems as well, how do we aggregate the appropriate context, you know, they engender the right position and the right action and then on, finally on the execution side, once you have the right aggregation of context in the appropriate setting, how do we trigger that in terms of execution of a communications enabled and communications depended workflow and as you know, in the healthcare environment everything comes down to moments. We like to think of ourselves as, how do we unify at the moments of need from the patient and the moments of interaction and moments of coordination from the full care team and if you aggregate that across millions and millions of moments and the interaction in between them, this sort of in totality streams together our healthcare delivery experience.
Dr. Dave Levin: I want to come back as well. I wanna share one of my stories from my own past. I was a VP of a hospital. We were looking at expediting patient flow and we did some experiments around, just broader communication and I’ll never forget, I bumped into one of the housekeeper’s in the hallway and she said to me, Dr. Levin this new communication thing is great, now I know the patients going home, I don’t clean the room twice. You know, I did almost a spit-take and I said, what do you mean you’re cleaning the room twice? She said, well, we didn’t used to know, so we go in, in the morning, we do a full clean thinking the patients gonna stay and we find out they are leaving in the afternoon when I could have just come in and done a little tidying up and gone on to the next thing. So, simple example and maybe not something that was top of mine from a clinical perspective but has a huge impact on the flow of clinical efficiency and the rest. The question I really wanted to ask you though is so, what you’re trying to do is really hard. A lot of people have tried and they basically turned out really crappy solutions. It’s one of those things where a few people could sit in a room and think they’ve done a brilliant design and then as we talked about earlier, you meet the real world. So tell us, how have you made this real, what has been your process from to optimize it and to learn so that the thing that was theoretical in the beginning is actually doing what you envisioned it would do?
Si: Yeah, yeah and I think the God-honest truth behind that is where the humility and humble part really comes in. I think as you bring together team of designers and technologists, there’s no shortage of different prototypes and different designs and approach you can attack any given problem with. The rubber really needs to roll for us when we put our obsession towards the customer validation piece of it and I think in healthcare in particular, nothing ever gets real until you really get into an enterprise-wide implementation which is an iterative journey in nature that’s by how waterfall that we make it look like on behind, right and we have sort of really taken it to heart that we are only as good as our very last implementation and those implementation will bring our design into the corners of its constraints will test the user experience to its maximum burden and what we want to learn from them is how to continuously refine that experience by setting, by caregiver, by the type of workflow and adapt to the underlying system’s change that the broader EMR world and the broader clinical infrastructure world happens. So, that’s a long winded way of describing that. We don’t design is an one-and-done thing, we think design is a continuous experience and we also think design requires a lot of listening and that, the more that we listen and observe and apply it and iterate, the more we can sort of make the platform as a living breathing evolution together with our customers as their demands change.
Dr. Dave Levin: Yeah, I’m gonna pic up on that listening theme because my career experience has been, organizations that take the time to really think about workflow, to gather the frontline staff that are actually doing the jobs and to listen carefully, those projects go much better and unfortunately that seems to be the minority. I think typically we’re doing stuff to people based on how we imagine the work is done or what a manager told us and we think that’s faster and efficient and I think that in fact, it ends up costing us a whole lot more in the long run in a lot of different ways. So this, as you said, slowing down and really listening, it requires intentionality, it requires belief that investment, you know, going slow to go fast later will pay off. My guess as you would agree with all of that.
Si: Absolutely and I think an expanded dimension of that, I’d certainly resonate with what you just said is also in healthcare would realize a lot of technologists approach it as, how do we solve a particular workflow, how do we design a particular feature? In healthcare, the ultimate, ultimate pursued and the final validation of your design lies in what type of outcome can you really deliver and is it tangible enough and is it measurable enough. So, we since learned to really add a goal to every design iteration, every deployment on the very outside with the customer to say, let’s envision what specific outcome we would like to achieve, clinically, financially and operationally and don’t become that vendor, that you know, signs up a logo, implement very quickly and in the pursuit of growth, go on to the next one, right. You will find this rarely leaving a hospital or leaving a customer without validating with them to say, have we accomplished what you’ve intended to accomplish? If there are certain ways that we haven’t done that and the exact say to results ratio, what were the contributing factors towards it and both they can learn and we can learn and that apply learning velocity is really what we lean on to compete in that value.
Dr. Dave Levin: Yeah, the way I simplify this is I usually just say, are you doing stuff to your organization or with your organization, are you doing IT too, your clinical staff, are you doing it with them? And it’s usually very obvious, very quickly which of, which mode they are operating in, so… If you’ve just joined us, you’ll see in your 4 x 4 Health and we’re talking with Si Luo, CEO of PatientSafe Solutions. Si for question three, I always remind my guests this show is PG-13, so please keep this family-friendly but, what’s your favorite pet peeve or rant thee days?
Si: That’s a good question. I’m typically a petty easygoing person, there’s not a whole lot of pet peeve but I do find myself the deeper I go into my healthcare journey, the more relationship I build with our healthcare customers, the more I almost have an intense offensiveness when I hear an entrepreneur or an executive from outside of healthcare, that very much accomplish or just starting out in their entrepreneurial journey. When they begin their conversations on, uh, healthcare is so full of inefficient way of doing things, how do they where it is, it’s so easy to fix, there’s a lot of low-hanging fruit and here’s the way that we’re gonna go and transform it, right. The more I have events in my journey with our healthcare partner, is the more I felt an intense offensiveness around that and then when I break down that offensiveness, I realized there’s a oversimplification from those outside of healthcare when they don’t have a healthy respect for the constraints in the system that are very complex, they are all multivariable, regulatory driven, workflow driven, incentive driven and even regional market and structure driven. When you don’t have that level of empathy and healthy respect first, I actually think it’s a very difficult to truly transform healthcare and in healthcare by buying, by starting with an empathy driven approach to really understand how we got to, where we got to, what are the constrained based designs that we need to be overcoming and how do we partner with people collectively versus the sort of bravado that come in to say, here’s how we’re going to transform it and inevitably history has proven that we tend to humble the biggest companies and the most innovative innovators.
Dr. Dave Levin: Well, so you can imagine what that feels like. The people have been doing it for 30 and 40 years. So, there’s something good at, you know, the thing that I, this is a theme we hear frequently on this podcast and so there’s a couple of things I like to say about this topic. The first is, for the most part people in healthcare are not bad, stupid or lazy. I mean, there’s reason that things are the way they are. Doesn’t mean that they are right or should be that way but it’s not for lack of trying or intelligence or those sorts of thigs.
Dr. Dave Levin: And, you’ve outlined a lot of the, sort of constraints we operate under but I also think there’s a mirror to this which is we tend to be very Conservative as a tribe and we do need to be more open to new ideas and some of those ideas need to come from outside of healthcare and so we come full circle back to you know, together we’re better and we have to all approach each other, you know, with kind of an open mind and some humility which again, it’s a theme for all of us, isn’t it? Because sometimes I do need someone from outside, they ask me, well, why is it that way, five times before I realize, well, maybe it really doesn’t have to be that way but as you’ve also pointed out, it sure looks a lot simpler from the outside than it really is on the inside.
Dr. Dave Levin: For our last question, what I’d like you to do today is share some of your most sage advice.
Si: Yeah. I think this is not, definitely not original that this sort of makes its rounds and all the entrepreneurial cycle but yeah, but the more we wave into this healthcare journey, the more we wave into this entrepreneurial journey, our team, myself and all of those around us are very much subscribing to this notion of, be very stubborn about your long-term vision but remain very flexible about the details along the way and that sort of goes towards exactly what you said about the balance for the healthcare and Trench Minh to be more open to different ideas, to be more open and looking at things from the first principle spaces, ask why five times but then I think I’ve also seen a huge amount of evolution and even revolution happening in our landscape. For the new generations of the leaders in the healthcare administration side are looking at a long-term vision of a value-based care and how to transition towards that. The steps to get there and the steps to build a technology company in service of that can be very flexible. I needed to have an iteration type of mindset versus kind of the sharpest fear against the strongest shield kind of conversation all the time and I think that has served us very well in our short journey so far and that will continue to serve many digital health entrepreneur well when we’re very bold and very stubborn about the long-term vision because I think the more we drive that, the more we engage in that dialogue, the more we tweak at the edges of it to crystalize that long-term vision, the more we realize that we actually have shared vison with our customers and then if once we identify that and be very flexible about the ways that we’re gonna go about approaching it and accomplishing it, I think really transformed where that thing can happen from the back end.
Dr. Dave Levin: Well, this resonates deeply with me. I had a mentor that said, you know, be true to your vison but don’t fall in love with your strategy or your org chart because those need to change regularly.
Dr. Dave Levin: And, I think that’s a real, it’s a good summary of the wisdom that you shared with us. So see, the great thing about this podcast is, I get to do what I want and so I’m actually gonna ask you as fifth question today which I do sometimes. I recently participated in a collaborative in Cleveland that involved health systems, payers, technology companies and the theme was physician burnout and quickly was broadened to the topic of clinician resilience because first of all, burnout is kind of negative and we recognize that this is not just about physicians, it’s about all the clinicians, all the whole care team and as I thought about the work that your company does, I suspect that you have an interesting window into this issue because one of thigs that I’ve come to understand from listening to my colleagues is, there are two, at least two things that really impact their resiliency. One is, bad technology that wastes their time and it’s just awkward to use but much deeper than that is things that interfere with the mission, with their calling which is to care for others and perhaps I’m connecting dots that don’t connect but as I read about the work that you do and I’ve learned more about what you guys do, it struck me that this is directly relevant to both of those themes and I’m curious if you would agree and if you’ve seen things in the field that relate to this.
Si: Yeah, and I resonate with that so much and I’m so happy to hear the industry’s willingness to move from burnout discussion to resilience discussion and the two components you talk about is what we’ve seen day in and day out. Like in the beginning of the discussion together, the healthy respect that I’ve developed and our team developed for healthcare is that every clinician, regardless if you’re a physician, a nurse, an allied health professional, your mission driven core is what makes you very unique and what makes you very impactful in the pursuit of your career and the pursuit of your impact and things that get in the way, the things that creates a level of cynicism so to speak is a, if I need it to go out there and accomplish an impact, accomplish an outcome, make the right diagnosis, prescribe the right treatment and follow the patient in the appropriate way and do what I do best and unfortunately if the technologies and tools that theoretically should enable you to do that, gets in the way and create more friction than intended, you know, that sort of adds to the context burden every clinician experience, right. As a physician yourself, as you know, when you piece together the whole system of a patient in that mental model in your head, if one or two things start to accumulate on an open loop that just couldn’t close, a piece of context that you wanna get that just couldn’t arrive on time or just couldn’t get to the information that you need and the more that accumulates and then you multiply that across the hundred patient that you need to see in a single day and that absolutely adds to a mental fatigue, that’s quite frankly getting to a point where it could be inhumane in certain cases but your soul and your spirit is still driving to them ten sense of responsibility. You don’t want to lay in care, you wanna achieve the best outcome, you wanna refine your craft and you just wanna be continuously better at what you do, so that piece of technology must be aiming at continuously removing whatever friction that is between what you do the best and what the patient should experience best and that’s a high order, that’s a high pursuit, that’s us, our peers and I’m sure everybody in that industry are recognizing and still working towards and I think the second piece of what you said is absolutely true is what gets into the mission of what we pursue, right and I think that as we build a community of support, as we build a community of dialogue around resilience, hopefully we can introduce the cultural underpinning of how to support our physicians and how to support our clinicians in sharing their painful experiences. Sometimes you know, create an empathy feedback loop, builds the resilience, right and you know, what we do is not easy and what we do is also mission critical and if we can continue to appeal to the higher calling, walk, figure out a continuous path to incrementally reduce the burden, I think we could be on a good path. I happen to be an optimist on that end to significantly change the physician, burnout to a clinician resilience equation.
Dr. Dave Levin: Well, obviously we both agree on a lot of this and my guess is when you deliver the kinds of solutions that you can. Like, the Patient Touch Platform, those hugs all around because you’ve made the work easier, you’ve made the work more effective and you’re giving back the thing that clinicians want most which is time to connect with patients.
Dr. Dave Levin: So, like I said, I imagine there’s hugs all around when this goes really well.
Si: Yeah, absolutely and when I interviewed our customers, frontline staff and when I bring those stories back in our company, all hands meetings, the things that connect everybody at PatientSafe the most is our genuine passion for their experience. Some of the most emotionally impactful stories are around clinicians that give us hugs and tell us almost in tears about, hey, I practiced in two hospitals. One is without your technology, one is with your technology. You know what, I would never wanna practice at another hospital without this type of tools ever again.
Dr. Dave Levin: Right.
Si: When those experiences come back to you, that’s when you realize all of the struggle in terms of the flexibility along the way from long-term vision is well worth the effort and well worth the sacrifice.
Dr. Dave Levin: Well, you’ve made the second point I wanted to make for me as well but I’m just gonna put an exclamation point on it. You’ve said some very kind things about clinicians being mission driven. Part of what I’ve learned is healthcare is full of all kinds of people and all kinds of roles that are mission driven. See and talking to you today, it clearly comes through that this is what animates you and as the CEO of the company, I suspect that, that translates pretty much throughout the whole organization. So, I just want to acknowledge that and recognize that. For the most part, everyone that’s working in healthcare, whether they’re delivering clinical care or they’re cleaning up the rooms or they’re delivering the technology we need or the food or what if it, whatever it is, we’ve all got a part in this very, very important and I view it as a sacred kind of mission and it can be very, very fulfilling and as I said, I think it comes through loud and clear in you and in the way you think in the way you’ve talked about the issues today. So, thank you for that and thank you for the contributions you’re making to the cause.
Si: Thank you.
Dr. Dave Levin: You’ve been listening to 4 x 4 Health, sponsored by Sansoro Health. We’ve been talking with Si Luo, CEO of PatientSafe Solutions. Si, thanks again for joining us today.
Si: Thank you.