Kaiser nurses say AI, surveillance are making their jobs and patient care worse
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FWIW my wife works for Kaiser and finds a lot of value in the the medical LLM tools available to her. She tells me being able to do live translation, summarize notes, and quickly get comprehensive answers save her time and help her give better care. Her older patients also frequently come in bringing AI-powered alerts from their apple watches that detected cardiac events.
It's annoying that we use broad terms to describe a set of technologies that in some ways can be problematic and in another ways are very beneficial. We gotta evaluate each of these as they come rather than talk about blanket bans.
As executives and analysts increasingly use the "AI" craze to push automation and computerization (and layoffs) generally, even aside from AI proper, it should not be surprising that the individuals and groups opposing those moves also use the same labels.
The lack of precision in language here sucks. It sucks for the discourse and it also sucks when it comes to focusing anger and productive energy on the core problems (obfuscation of human responsibility, erosion of human agency, declining institutional flexibility, deprofessionalization, etc.). But it doesn't begin with the critics of AI.
It's a feature. Or at least, a perk. If they want to claim this new shiny rock is AI and people buy it, then of course it's in their best interest to keep the black box mysterious. Being subterfuge for muddying the discourse of critique is just a nice side bonus.
Yes, it makes sense that the confusion aligns with their interests, and they are unavoidably a big part of the conversation. But it remains a problem for the non-overlapping group of people who actually value the social contract, and for us finding a solution which helps take one more step to defeat the scammers remains valuable.
X, Open AI and Anthropic, to name three
Do you have anything I could read to understand your reading better? I would love to be able to dive back into one of my favorite books with a new lead.
I remember the novel relating similar themes more generally, which has shaped how I even think of the title after reading the book. Being "closer to the machine" isn't just about working at a lower level; it's about the way working with computer systems reshapes the people developing for them and the people using them. It's about how even "cushy" software companies lean into, hire for, and draw out obsessive, dissociative traits: the included lunches, the laptop you can bring home and continue to work on, the places to nap or crash on-campus.
Maybe a very dark reading, and certainly colored by some of my own experiences in tech and where I was at in my career when I read it. But for me there's absolutely this sense that the need and desire to be "close to the machine" is also something that lures us away from ourselves and from each other.
And I think this is a big part of the problem. Being a shell of a human does not lend yourself well to empathy and solidifies your ego and that you are “worth” more than others, reinforced with a lucrative salary, praise, and those perks you mention.
Relying on LLM to summarize things for you has one more issue. To outsiders, this seems like a tedious process, but is actually very important part of the thought process. Wording your thoughts and writing these down helps people to discover new aspects of the problem. It's how people learn.
At the moment consensus is that it must not be banned, but also not mandated in any way - people must take responsibility, and they must be able to decide for themselves where and when the LLM use is justified and where it is not.
What I’d personally be most concerned about would be the risk of bad models instead of SOTA being used which would be especially error and hallucination prone.
If you’re gonna do it, do it right. Otherwise don’t bother at all.
How is this not a good thing for everyone?
"fun" fact, a number (some? many? all?) of the LLM speech to text models will editorialize or hallucinate words for you, to make your speech fit the pattern it expects.
I don't think it's appropriate to use a model that can editorialize in a medical transcription setting. I feel that crosses a huge number of ethical lines.
> At the moment consensus is that it must not be banned, but also not mandated in any way - people must take responsibility, and they must be able to decide for themselves where and when the LLM use is justified and where it is not.
I have a really hard time understanding how supposed experts in their field, have been taken in so perfectly and so completely. You're a trained and certified medical/healthcare worker, responsible for the health, safety and well being of other humans, and yet willingly turn over parts of the process that exists to protect the safety and health of others, to a machine that you know can and will make mistakes you wouldn't or even couldn't ever reasonably make. You're supposed to make sure it works and is safe for everyone you're responsible for before you start using it... but then, I prefer healthcare that doesn't move fast, and break humans.
I'm sure someone will try to play devil's advocate and suggest it's a good thing to ration care, and that you have to acknowledge that you can't save everybody, faster is better after all But no, I'm angry enough about it that if a licensed person suggests that, I'll gladly complain to your licensing board (rhetorically speaking, I'm not gonna try to doxx anyone). You can't ethically argue for rationing care, and letting a machine known to make errors in ethics or care decisions, that you have been trained not to make. (Advocating for a reduction in the standard of care in order to increase profits.) (Yes, you're correct, if you're in a state of triage, you're required to, and in those cases, using an imperfect machine is possibly preferable, and probably ethical, but still objectionable. I currently refuse to believe that the US is in a state of emergency, but perhaps that's where I'm wrong) Part of your licensure you promised to prioritize patient care above personal gain. You can't then make decisions to experiment with systems you cant prove are safe.
I can understand in when SWEs ignore the best interests of the humans they're working for. But Doctors and Nurses? I guess I expected better from my former colleagues?
A medical scribe isn't just taking dictation, they're doing some level of interpretation and often entering structured, coded data directly into an EHR. This is a more complex role and requires some clinical skills. There are some new LLM products that automate this to an extent, but ultimately the licensed clinician is still legally accountable for what goes into the patient chart.
I can absolutely ethically argue for rationing care. All healthcare systems ration care although the means vary. Demand is effectively infinite, especially from older patients with complex or terminal conditions. Resources are finite.
Since then pt has had to re-explain to multiple doctors how the ER report was incorrect, to their usual MD skepticism. So, for now, I figure LLMs are for shite. Maybe in another 15 years...
And it pays to read everything on a medical report before leaving the facility.
Yes, surely it’s not you. It’s all the experts that are wrong and being hoodwinked. Why can’t they just see what you can?
Most humans use a default trust model for life; they've been lied to. That's part of why I'm angry, if you trust other people; why would you look for it? This entire article is about the fallout from not looking for it, and the resulting harms to pt care. So, it turns out, it was a mistake to adopt the new tech quickly; you know, as evidenced by the harms to patients?
So I don't know, why do you think they couldn't they predict the harms that I thought were obviously predictable, and then happened?
while being bombarded with articles like "AI makes things worse", "AI consumes all the water" and the like
Surely these are “good old-fashioned AI” (statistical learning) and not LLM, though.
I just want to be clear that the “medical LLM” tools are the new ones, and the Apple Watch alerts aren’t.
I work in a bank and a can tell you that the customers absolutely hate ML when it rejects their loan application. Over the pond in the US, I have an impression that the fico score is not exactly popular either, but I have no first hand experience.
The rising LLM = AI equivalency is unfortunate.
[1]: https://en.wikipedia.org/wiki/Artificial_intelligence
Ctrl-F Machine Learning. Apple Watch alerts are Machine Learning
The textbook definition of AI is a system that solves problems that are difficult for humans. Whether the approach uses formal logic, machine learning, neural networks as a special case of machine learning, optimization, search problems, etc. does not matter.
You should listen better. The University of Edinburgh had an entire Department of Artificial Intelligence when I was an undergrad there in the 1990s, and one of the things it researched was machine learning.
This isn’t exactly the same, but nothing in the book Paradigms of Artificial Intelligence would be considered AI today.
So machine learning became the marketing.
A paint conveyer belt is not a robot. A sprinkler system is not a robot. A CnC machine might be a robot. A conveyer belt that sorts items might be a robot. A roomba is a robot. And all of these function just fine.
> It would have been, 20 years ago.
No, it would have been called what it is both then and now; an asynchronous message emitted by a device having sensors capable of detecting when to do so.
Nor is this a trivial decision. AI has the potential to change society and economic relations as profoundly as the industrial revolution, or the invention of the printing press.
These boundaries are also contested, as interests which benefit from a particular application are different from those whose interests are harmed. Society needs to identify which usages have a net benefit.
It also needs to define which usages cause "absolute" harms which is will consider unacceptable regardless of benefits to some parties. Such as, potentially, reductions in personal autonomy, increased leverage or dominance by government or private interests.
Not only that, but data and models which were collected/ built for one purpose can easily be adapted for others.
This is also basically now happening all at once in many domains.
In short, you can expect there to be tension over these boundaries for some time. It's not realistic to expect that others will agree with your personal perception of which applications are "obviously" unproblematic.
I totally get it. I think few years, if some company said they record and transcribe every meeting/interview they take, it would be concerning. Now, its somewhat a norm for people to use these AI meeting tools which record everything you say and then go back to recording and exactly what people said. I'd call it surveillance than AI
I would expect companies to blend shit metrics with AI systems, if not at Kaiser then at other places. People lack imagination and using AI to monitor your workforce has to be one of the possibly worst ways to use it. Alternatively some dickhead will "lean startup" their way into measuring "performance" in such a way with the "help" of AI that they will do something even worse.
Are there no actual problems with what it promises/how we're expected to use it at work/how it is used against us by people who use it at work? Is it just anxieties and feelings, that aren't actually grounded in anything? Everything's getting better for everyone, no downsides?
Or are the providers just pocketing the difference?
Given that prices are definitely not going down, I'm not sure how this makes my life any better.
I think OP is a good case in point where people are blaming AI but really the issue here is the human in the loop, the person implementing these abhorrent policies that happen to be powered by AI.
I don't care if the torture nexus itself is not at fault, now that it has been created, it has enabled its owner to do a bunch of novel bad things, and it deserves a large part of the blame.
Ive actually moved primary care physicians over this once already, found the oldest guy I could who barely knows how to use a laptop but spends a bunch of extra time with me.
For example, a 60 yo doctor would have been born before the first heart transplant, the recipient lasted 18 days. Now 5000 are performed each year and after 5 years 80% of recipients are alive.
Too bad for me, it’s a real mixed bag. I need a doctor who is an AI-using LLM skeptic, I guess.
Better the devil you know ...
- will not see a “provider”. A doctor (MD/DO) only please.
- will not see a doctor who uses LLM tools (or therapists for that matter)
- Make it abundantly clear that if you do then we’re not a match.
- Will pay significantly more/go out of my way for for this.
We all have our biases.
Where has all the empathy gone? And common sense? :(
Contrary to popular belief, I don't think common sense has gone away. It just has been deprioritized at the altar of profit. It'll be visible loud and clear the very instant if/when the lives of the assholes chasing profits was on the line.
> Contrary to popular belief, I don't think common sense has gone away. It just has been deprioritized at the altar of profit.
Or perhaps it has been left to starve due to apathy and an unrelenting pursuit to reduce the difficult job of leadership into a much simpler one based on arbitrary numeric values which are defensible to those higher in the managerial food chain.
Defensible on account of discharging their relentless duties of generating shareholder value within legal limits... i.e. profit.
The fact that it is done in a lopsided way at the expense of everything else is just sign of societal decline due to deification of money and letting the tiger of capitalism roam without boundaries.
development of power can be based on all sorts of things, it depends on the framework.
a nurse who is utterly incompetent will be fired quickly.
after a certain threshold though, obviously, competition won't be about 'ability' so much - but there are baseline ability and professionalism thresholds.
It’s somewhat the point of democracy to maintain a limit on rent seekers’ and wealth extractors’ power on the political process. It should come as no surprise that the individuals who have grifted and extorted their way into power are also fiercely antidemocratic. The xenophobes and bigots that have hitched their wagons are equally deplorable.
But the real crime is that the left never exploited that. If I was in charge, I’d have mountains of draft legislation vetted, proofread, run by every lawmaker, and printed out years before any potential majority just in case it ever came about. Whoever was in charge of the DNC in 2009 should feel ashamed of letting a generational advantage largely go to waste.
Fillibuster is a senate procedure rule. That's about the weakest a thing could be. At any point Democrats could have gotten rid of the filibuster with a 51 majority.
Democrats would much rather let congress do nothing than do something. It's hurt their reputation so much.
But the similarities stop there. The party platforms are in stark difference, and the GOP is now literally a cult of personality run by a mob boss. The naked corruption is off the charts.
In fact right now Trump is working to cancel or refusing to acknowledge mid-term elections and acts as if he were king.
I say this as someone who used to be a Democrat but left in disgust when Clinton remade the DNC into pro corporate puppetry. Partisan politics is a cancer on the citizenry and may very well be the end of what we call democracy in the United States.
I've tracked presidential politics since watching the Watergate hearings and what is happening today is beyond the political pale.
but if you can't see the stark difference in pro-mega-corp policies and blatant pay-to-play corruption in the last 1.5 yrs with the previous 4 years, you're clearly not paying attention
the fact that BigCorp couldn't wait to get rid of Lina Khan, and found a willing ally in Trump, is just one tiny example
Most of the replies are large pop subReddit level junk.
You can't rely on asking the customer. When they're upset (they often are in these calls), they'll lean towards the negative regardless.
I don't know how well these AIs evaluate, but if they're even a little bit good, it makes sense to use it to screen for outliers, then have a human listen to those outliers and judge.
A significant fraction of the calls they answer are patients shouting at them because of:
- Long wait times
- They don't like their doctor
- They don't like the advice they're given (sorry, but we're not going to book you as a high priority appointment if all you can tell me is you have a headache. Sorry, we're not going to prescribe a narcotic for a scraped knee.)
- Several reasons that have nothing to do with the nurse, but the customer will still blame the nurse.
I'd guess most people have had a situation where there's a corporate problem, the support person you talk to literally doesn't have the tools or the agency to fix it, but then you're asked to rate their performance on whether or not they solved the issue, with no option to say "Actually they did their best but this isn't their fault."
How would you want yours rated? By someone you have communicated with, or some data centre somewhere?
I suppose you could do that with the survey as well. It'd be an interesting study to see which is more reliable.
By a knowledgeable/skilled person who listens to the call. (Which the AI solution provides).
Are you saying that the AI is the same as a knowledgable/skilled person?
It’s not even been five years of AI, and we’ve already arrived at the point where the human is wrong and the AI is right.
Mind you this is in an area where the benchmark is the opinion of the human ! So if the customer is saying you’ve shown enough empathy but AI says you haven’t, then you take opinion of the AI?
Soon we’re going to have a situation where the patient is breathing, but the AI says he’s dead.
Repeated unprofessional behavior with no discernible change after trying to address it. My take is that the Kaiser nursing org has a serious discipline and customer (patient) focus problem.
Patient or customer? I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
If you outsource that work to customers/patients, you'll end up with the car dealership model, where the sales rep begs you to give a 10 on every single question including on the interior design so they don't get fired.
That's the part most of this discussion misses. Supervisors exist for a reason. Congrats on your flat org structure, you fucked up an important feedback channel.
Oh yes, and the nurses did employ strategies like that pre-LLM (don't know if they still do). They had to be very strategic about it (you can't just say "Rate me a 10.")
You can ask the customer enough times that unreasonable customers or surveys are averaged out.
A good question might be "why are you upset?"
Hospital systems are incentivized to avoid the real problems with healthcare. People want timeliness and they want quality care which hospital systems are not incentivized towards in the US. The incentives are profit, which given budgets means corners cut.
Triaging is an opaque system to the patient. It's an important process to doll out finite resources but it also very frustrating to be told, "soon" when you've been waiting 15 hours to see someone. Frankly, if I were King for a day, the first thing I would do is break up the monolithic hospital systems and build out more urgent care.
I would also try to find a way to facilitate transferring less critical patients from ERs to urgent care centers. Right now a hospital won't take the risk, especially if you are sitting in waiting room because beds are full. You can't easily punt a patient because them leaving would be against medical advice.
Get the doctor to assess the nurse. Or the head nurses if you don't trust doctors. The nurses have managers, and if none of the doctors or head nurses can be trusted with a simple matter like assessing whether nurses are doing their jobs then you got bigger issues.
Oh no, the boss might play favourites if it's not an objective measure! Oh the injustice /s
But stupid rules or KPI also allow favourites. You can use an officious 30 point checklist and play favourites while ticking boxes. You can even rig "objective" data by controlling other factors (e.g. giving someone difficult customers do deal with).
Yeah, data driven would be nice, if you have good data. But data driven is a power tool. You don't measure SLOC or reward token use in software because of perverse incentives.
But evaluating tone and empathy? Great, now every nurse is gonna be wasting their time and energy making sure to recite the best canned, optimized text-adventure incantations for the KPI every time they enter the room instead of using their brains to see what the patient actually needs.
"Hello Mr. Smith our patients are our top priority at Kaiser and your nursing staff here at Kaiser Raccoon City are here to make sure you are cared for, comfortable, and safe. If you have any concerns or are feeling anxiety be sure to press the nurse button and we will be happy to assist you, we appreciate the trust you place in us and are eager to celebrate your recovery with you." < nurse now realizes Mr. Smith has been choking and losing consciousness while she was reciting that spiel >
Definitely don't do this. I know doctors. I know nurses. Plenty of doctors view nurses as their slaves.
And besides, doctors aren't qualified. These are different roles.
"You wouldn't believe how much of a relief it has been. In your last visit, you saw me typing everything you were saying, right? I don't have to. I can listen to you and take very specific notes as necessary as opposed to focusing on both typing and listening to you at the same time. It has bought my stress levels down to here." (Indicated by his hand lowering)
Too many AI tools are built hastily for me to give my doctor’s (visibly awful) software the trust.
It's a shame, if they had an AI transcription tool that kept everything in-house I'd be much more comfortable with it. Or perhaps some kind of zero-knowledge cloud-based product where I hold the keys.
On the one hand, pre-LLM there was plenty of software out there for medical use, and they had to be HIPPA compliant, etc. I've worked with people who used to write that SW (they hated the job because HIPPA was so strict). The rational side of me is saying I shouldn't be biased against these, and that there's no way they would relax the requirements.
On the other hand, the emotional side of me screams: It's LLMs! Huge privacy concern!
I try to let the rational side win. I've always given consent. Especially because I liked my doctor pre-LLMs, and it seems silly to suddenly mistrust him and go to a doctor I don't know at all.
I've seen summaries that implied the opposite of what was actually said, and even the transcripts themselves often contain egregious errors. I can so easily imagine these tools summarizing "I drink coke often" to "I use cocaine often", as a random simple example. All nuance gets lost, all context gets lost and unless you're vigilant and looking out for these types of errors it's so easy to slip by the cracks.
They're amazing in a support role, but not equipped as well for primary care roles.
If you present with anything other than healthy and fine, the ones I have had to see are less than helpful.
They simply do not have the depth or breath of training as a doctor. They're very good at executing a plan as part of a care team, and even making changes to that plan based on patient need. But they just simply aren't as good as doctors.
There's a reason they're replacing doctors. . . They're cheaper. That's it.
Which is great, because anyone suggesting AI should replace clinical judgment and work is an idiot.
I made a single presumption: that the PCP's use of AI for this situation is not mandatory. Is it mandatory or is it not?
In 2024 when the AI empathy snakeoil machine was inflicted on the nurses, the nurses had no choice in the matter. And management has already established that they may do something like this again.
Your situation is completely different. It's a doctor overseeing their own tool. If the AI makes a mistake, the doctor is responsible and would presumably take responsibility. Who is responsible if an AI tool makes a mistake in a performance evaluation of an employee? The employee! The employee is guilty until proven innocent. But the employee gets no choice in whether that AI tool is used against them (absent a union agreement which dictates how AI tools can be used).
The reason I fear the misuse of AI is because it is so useful.
That being said, more than one (female at that) doctor has told me in confidence and based upon their observations during residencies, etc. that if I'm ever admitted, be very careful how I modulate my interactions with nurses. They're not all Florence Nightingale and Mother Theresa and there exist those who will @#$% you up on various pretexts or are just plain sloppy and negligent.
Despite all the moralising fluff, it's just a job, not some saintly vocation. Some safety oversight is needed, just as it is for any other work function. Still, can bet that anything 'Corporate' has mandated will be Goodharted up the wazoo.
> Mother Theresa
I read a good chunk of the criticism against Mother Theresa as either willfull misunderstanding and/or just repeating the same literal three quotes from Hitchen's book (seriously, they're always there). I cannot say whether she was a good person or not, but I can say: if you ask "which evidence is there which doesn't lead back to a man with a personal vendetta?", the list gets significantly shorter.
Truth is most nurses care for people having the worst day of their lives. =3
Their goal isn't to provide high quality care. Their goal is to increase profits. It's not hard to imagine how improved quality would lead them to spend more money. (faster diagnoses of serious illnesses and recommending expensive care)
How can UHC use AI in the same way? They're an insurance company. They're not administering the actual healthcare?
UHC, the HC stands for Health Care, does have a field operation that handles home health care evaluations for those who live in rural areas with minimal access to medical facilities. Those patients are visited regularly by field personnel, trained nurses, who evaluate their conditions and insure that they have access to appropriate treatments for their conditions. Part of the evaluation of appropriate treatments has recently been pushed off to an AI-based system which uses various inputs to determine eligibility for treatment options.
I wondered why they zip in and out of the rooms, when just a few years ago they would spend fifteen to twenty minutes in each room. The patient load hadn't grown. The number of nurses has gone up, not down.
So I'm blaming the stupid metric on their evaluations for a worse standard of care.
Healthcare utilization, number of unique patients, amount of care per patient has all gone up.
American has a massive overutilization problem driving cost but is unwilling to be honest with itself about it.
Although Kaiser tends to repel such patients (they'll happy say "No" and tell you to find some other provider). The bulk of complaints I've heard about KP in California boil down to "They wouldn't give me a referral to a specialist".
what significant improvements to society or humanity have come about as direct result of AI, that wouldn't have been achieved without it? faster protein folding is the only one I can think of and that more a matter of "faster" than "impossible without AI"
I think at some point there's going to be some version of the Butlerian Jihad
That tool was a trial that they put away (but may come back).
The rest of the stuff all existed pre-LLMs and isn't even machine learning (time per call).
https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart....
This is a well understood phenomenon.
Some of the tech is pretty scary. One big vendor's solution [0] can provide not just AI agents but also use AI to snoop on calls in progress, evaluating sentiment from both sides [1], verifying phrases are said - pretty dystopian in theory. From experience, these things tend to go downhill based on the attitude at the top - is the mission to slash costs or take care of customers? A 1000 decisions follow from this one, and like Jira, it can be a useful tool or a prison-like hell.
[0] https://www.cisco.com/c/dam/en/us/products/collateral/contac...
[1] https://www.cisco.com/c/en/us/products/contact-center/webex-...
If it's to do something normal you could do through the website there was no need for AI - a website or app suffices - provided it isnt terrible.
Capital definitely thinks it can save costs here but capital is getting increasingly delusional these days.
A good 90% of call center humans are flesh interpreters for support scripts. They are being paid to act like they don't have free will.
if it was easy enough for an AI responder to solve I would have solved it myself
<s>
Hey, company's AI can help a lot in stealing its service's user passwords, which you usually cannot do yourself _that_ easy:
https://news.ycombinator.com/item?id=48350239
Think of AI as a tool... for data leaks. </s> (not 100% sarcasm)
I'm sure he doesn't think AI is making his job worse.
The loser, as always, is the patient's quality of care.
This is not a decrease in quality of care - this is your provider having actual evidence of the care needs they discussed with you when they close their note, hours or days after seeing you.
Do these idiots not know how intelligent assholes work? If you make this a policy, everyone who has a gripe will eventually learn to delay a call to 14 minutes and then make an absurd ask.
The sad thing is that there are many issues, but the study didn't really address them. One would hope for more effective critics.
The AI application I'd like to see would be to identify the elective hyper-utilizers (so we could try to demotivate them by addressing what's really bothering them). That would improve quality of care for them and quality of life for providers, and create time for outreach to the under-utilizers who need preventative care.
> A company spokesperson said, "Kaiser Permanente does not use Average Handle Time to assess agent performance"
So uh, average time wasn't raised as a concern, calls beyond a certain threshold was. I wish this semantic discrepancy was better highlighted in the article.
They claim they do not use average handle time, but it is very common to get called into meetings to discuss why they spent a lot of time on some calls. The nurses get defensive (by definition - they have to justify the time used - it is a defense).
They also do get called into meetings if their average handle time is large.
It may still be true they don't use it for evaluating performance, but they absolutely do utilize it to "coach" the nurses.
I highly doubt it. If this is the reason your manager knows who you are, you are absolutely going to be judged on it. It doesn't really matter what the policy says.
And the nurses absolutely feel like they are being punished for it. Just like having to consistently remind HR that your "absence problem" is due to covered FMLA leave - they know who you are because they've had to talk to you about absenteeism. In a call center of 500 people, it isn't likely they remember that you had issues because of their faulty systems.
This is true for any job. I was unfairly fired from a job because somehow the manager got a perception of me being incompetent, because he often talked to me about problems in my work - most of those conversations ended with him saying "Oh, now I see why you did it that way."
But, just purely semantically, the statement Kaiser gave in response was worded in a precise smug corporate America style to dodge the main concern raised. I think it's important to call out weasel words.
I know nurses. And I know their unions. Kaiser can be extremely clear and tell the truth, and they'll still say "We don't believe you!" without any evidence other than being called in to talk about it.
I'm not anti-unions - I've benefited from them. But it's well known that distrust goes up when you have (or need) unions. It typically degenerates from "We" to "Us vs them".
Let me ask you this: Are you saying they shouldn't monitor the time at all?
Again: A tidbit of inside information: A number of Kaiser patients get such long wait times that they're issue isn't addressed when they try to call (i.e. they are told they'll be called back, and they're called back some other day). I don't know the percentage - likely small - but from a healthcare standpoint, it's unacceptable.
Another bit of information (likely not inside): Kaiser has a serious budget problem. They already pay amongst the top salaries for nurses, and they can't simply solve the problem by hiring more.
So: How would you solve it?
I hate to break it to you, but "non-profit" doesn't mean what you literally think it means.
https://en.wikipedia.org/wiki/Kaiser_Permanente
Also, KPMGs are indeed "for-profit" while Kaiser Permanente as a whole is constituted as a "consortium" of both types.
And here is why: I guarantee you that the nurses are working in the "for-profit" units, and also, that still betrays ignorance of what "non-profit" actually means, which is the load-bearing topic of this thread.
This doesn't seem like a money-saving measure exactly. The main AIs the article talks about is making sure nurses on their nurses' lines aren't being assholes. I guess this used to be spot checked before so you save on that? Maybe? It seems like they are trying to solve the problem of some of their nurses staffing their nurses' line not treating their patients the way they're supposed to.
Increasingly health insurance companies and healthcare providers are intertwined. So they may spend 80% on healthcare, but then a big chunk of that could go to the urgent care clinics that they own.
And even if they don’t own the provider, they don’t have much incentive to lower total cost because 20% of a larger number means more total profit.
Kaiser is an HMO. They are the insurer and try to have their employees, such as these nursing lines, perform almost all of their care. Shifting from one line of business to another is purely internal and can't game Medical Loss Ratio like your scenario.
> they don’t have much incentive to lower total cost because 20% of a larger number means more total profit
There is some bad incentive here for sure. That being said, insurers do compete on price so they lose customers if they charge more than other insurers. Also, regulatory rate review can decide whether they can raise premiums a given amount.
> That being said, insurers do compete on price so they lose customers if they charge more than other insurers.
Yeah but that’s a second order effect. Most companies are incentivized to cut costs because they will directly realize the profit. Insurance companies are incentives to cut costs only to grow market share.
I understand the point of the profit limits, but I don’t think it works very well in practice. I think it would probably be better to just have private companies without that profit cap and add a government insurer to compete with them.
The problem has always been pharmaceutical prices, liability costs, and inadequate supply of healthcare.
The government does not want to decrease the price of medicine by funding trials so medicine is in the public domain and cheaper, the government does not want to increase the number of matriculating doctors and bring down their time/money/stress costs, and the government does not want to enact tort reform so every step of the healthcare chain is spending inordinate amounts of time and money to prevent litigation.
In the US, you should always be double checking what your provider (or guidelines or whatever) is telling you to ensure that the information is maximizing your benefit instead of minimizing their liability.
[edit] preemptively, if you're going to claim "but this isn't art so irrelevant" then I claim bull fucking shit. It's the same problem no matter how you slice it whether it be engineering, support, art, or medicine. Get real. Look inward. Touch grass. If you think AI is a good thing for your profession--whatever that profession might be--you're probably a delusional psychotic. It's OK, you'll thank me later.
About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.
0 people that I know are in all three. Pretty confident about that.
For the any two of three cases where [A] includes creationists and those favorable to AI; [B] includes creationists and those who believe in telekinesis; [C] includes those favorable to AI and who believe in telekinesis.
[A] 0 ; [B] 0 ; [C] 0
Considering people that I know who could be part of one of the three groups now is an interesting question. I am pretty sure that two relatives are creationists based on interactions over the years. I haven't ever heard anyone I know talking about telekinesis so I probably have to say that this could be a non-zero number. If it is a non-zero number then [B] could end up being non-zero. AI is universally hated or even feared by those that I know who are being forced to use it or whose employer is adopting AI tools in their workplace.
So based on my own recollections I have to say that there are only 2 people that I know who belong to one of the three groups you identified. Interestingly enough, the children of those two creationists are not religious as adults. I think they had all they could stand growing up in that environment and as soon as they went to college they 'rebelled', leaving the parents disappointed that the kids didn't want to tote all that baggage in their own lives.
Sample size is small though since I don't know many people.
They will vocally rationalize it.
I did it. "I'm more productive work from home." But then I do dishes, take an hour break, paid.
Foucault says that when people are observing them, power is placed over them.
If you are a worker you should hate this.
If you are a customer or owner, you should like this.
But I certainly won't be automatically believing people under surveillance who make claims it makes their quality worse.
> Another nurse speaking on condition of anonymity said “AI did not understand our job and would grade us wrong all the time.”
It's always worth remembering Goodhart's law https://en.wikipedia.org/wiki/Goodhart%27s_law - "When a measure becomes a target, it ceases to be a good measure."
In theory AI could usher in the first time in history where one can escape from this trap - because qualitative judgments can be made at scale, from an unbiased and universal baseline. In this situation, for instance, rather than collapsing call transcripts and reports into metrics, it could evaluate whether red flags are encountered in the context of a call, and allow for qualitative guidance on improvement, across a comparative corpus of situations that are themselves chosen qualitatively.
But very few managers are empowered to take this kind of approach; they're evaluated by their ability to report quantitative metrics, and thus they must implement regimes of quantitative metrics. And leadership instructs them to use AI to build that regime more quickly.
If you want to see an "AI native" organization, it's one where leadership actively fights this tendency, and sees managers as product designers who make the end-user experience a beloved and empathy-driven one, as opposed to a gear that turns accountability into a single number on a screen.
So stupid. If you had ever made a phone call to a patient, or their family member, you’d soon realise how bad this is.
You need to talk to the patient and something a family member too. Be too hasty and you cause more harm than good.
It’s going to be very improbable that these statements are true.
Where and how is that determined? I.e., any references to back that up?
And you can't in one breath say they have the best healthcare but then say their employees' reports of their experience are unreliable.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/
Their secret sauce is their ability to standardize protocols throughout their entire organization.
https://healthy.kaiserpermanente.org/northern-california/pag...
There’s no best healthcare for everyone but that doesn’t change the fact that Kaiser is objectively one of the best.
If you have a choice of hospital networks, research carefully. Kaiser might be fine for many people's needs, it's not fine when it comes to intensive care.
But it doesn’t change the fact their protocols are top notch as reflected by their quality metrics.
Plus, a quick Wikipedia glance shows they have a fair share of controversies, including major fines due to poor COVID protocol adherence.
In the Northwest (Oregon + Washington), it's pretty high. Not sure about other locations (Hawaii, etc).
But again: Customer satisfaction doesn't mean best outcomes...
I shouldn't really have referenced "replace" at all, but rather "optimize". And not targeting middle management but the whole non-medical structure above. This is where I think most of the waste in our modern US medical system lives.
But I understand it is still mostly a half-baked concept. We'd need a revolution far outside of just some management system. I believe it's the whole enclosing system that is rotten and driving medical costs away from the actual encounter costs. Profiteering, risk management, regulatory capture, etc.
I woudl argue there was a point, long ago, where these things have taken on a life of their own and no longer serve the need of improving care outcomes and the actual medical cost-benefit tradeoff we should be optimizing in a just and caring society.
Also, California has a high cost of living.
We're liberating them from work so they can focus on what matters
People started hating tech right around the time metrics became popular. I don't think it's a coincidence. AI just accelerates the trend.
The problem is the misidentification of AI as the issue. As long as we don't understand the real issue, we won't solve it. AI is just a tool. It's being used in a way that denies human agency.
Our cultural values need to shift away from safetism that demands centralization. And shift toward valuing human agency. That starts with talking about the core issue.
Now, like many tools, the majority of those selling AI to make money off of large enterprise sell its ability to increase productivity, efficiency, compliance. Either to make money or to minimise risk. And so like you say, they just become tools to make these metrics move or report them at higher granularity. And often there is either a lack of imagination or a willful ignorance of the perverse outcomes with relationship to humans because they are in service of the organisation not it's employees.
But that same AI could cause those companies to no longer exist.
The AI I'm happy about allows people without much tech knowledge create small apps to do exactly what they want. And, for those that know just a little more, use it to help them extend open source software for their niche use case.
This makes computing more personal and gives back agency to the computer operator.
Mix that with the rise of much more competition in much more custom software, and you'll see that a future can exist, if we want it, where software becomes more personal and humane.
The software vendor will capture less value, though - the margins will be thinner. Instead that value will be captured (in non-money terms) by the end users.
That also means that software companies, unable to capture so much value, must shrink and become more boutique. The software that contributes to our centralized world would lose a lot of power.
That's the future I can see. The only way it doesn't happen is if a cynical narrative wins out and manages to lock it out through regulatory capture so that only licensed operators can use or provide AI. The anti-AI narrative helps the cynics.
"To the man with a hammer, everything looks like a nail." [1] There is no such thing as "just" a tool.
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Given how healthcare is one of these sectors that seems to relentlessly resist efficiency increases and is the prime example of Baumol's cost disease, I think any developed country with a costly healthcare system needs to do these AI experiments. The current versions will be shit, but the only way out is through if you still want to provide affordable care.
I honestly have no doubt that AI going forward will be able to do a good job at triaging via calls and also being empathetic about it. But of course it needs careful experimentation.