Discover how AI and appreciative inquiry can transform health care [PODCAST]

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We explore the powerful intersection of artificial intelligence (AI) and appreciative inquiry (AI) in health care. Anesthesiologist Wael Saasouh and health care executive Lisa Scardina share their insights on how technology can support collaboration, boost morale, and improve clinical practice. Joined by physician advocate and physical therapist Kim Downey, we discuss the importance of finding purpose, maintaining healthy connections, and fostering a supportive environment for both clinicians and patients. Discover how positive inquiry and thoughtful AI integration can inspire hope and drive meaningful change in health care.

Wael Saasouh is an anesthesiologist. Lisa Scardina is a health care executive. Kim Downey is a physician advocate and physical therapist.

They discuss the KevinMD article, “The role of AI in improving health care: artificial intelligence and appreciative inquiry.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we bring back Wael Saasouh, Lisa Scardina, and Kim Downey. Wael is an anesthesiologist, Lisa is a health care executive, and Kim, of course, is our physician advocate who brought everyone together. Today we’re going to talk about artificial intelligence, “The role of AI in improving health care: artificial intelligence and appreciative inquiry.” Everybody, welcome back to the show.

Kim Downey: Thanks, Kevin.

Kevin Pho: All right, Kim, as always, we’ll start with you. I’m not going to ask you how we brought everyone together, because we talked about that last time. But the role of AI: How did this topic come up with everyone here?

Kim Downey: I interviewed Wael and Lisa for my own YouTube channel, and we talked about so many things during that episode. This came up, and that’s how we ended up with both of the articles, because there were so many good nuggets in our conversation. It was too much for one article, so we divided it into two.

Kevin Pho: Perfect. So what did you guys talk about during your show? As you know, AI has its tentacles in so many different aspects of health care. So what were some of the highlights when you talked to them?

Kim Downey: Well, I thought Wael had some great points about the ways of AI that I hadn’t been directly thinking of. I had more thought of it in regards to making things easier for physicians when they’re with patients, but he had brought up things like direct recognition, gamified reward systems, employee education opportunities, fostering collaboration, and research and academic advancement. I hadn’t really thought about any of those things before our conversation.

Kevin Pho: All right. So I’m interested in hearing everyone’s perspective. We’re going to talk about appreciative inquiry and its intersection with AI. So Lisa, tell us more about that.

Lisa Scardina: Yeah, I think there’s a really interesting, obvious play on words between AI as artificial intelligence and AI as appreciative inquiry. I have a certification from Case Western Reserve University and have really enjoyed getting to know more about that model. The idea about asking positive questions really is a marker of a high-performing team and really taking a strength-based approach to working in teams.

So when Wael was sharing some of his thoughts about the technology solutions, and the ways that Kim just mentioned, it was just a complement to what he was speaking to. When thinking about how this lands with people, that’s the work we’re doing and the conversations we’re having with our teams: to understand technology and think about the implications and opportunities with technology, but to do so in a way that really works from where a team is at, and how to ensure that there’s a healthy culture within the team as we think about some of these technology implementations.

Kevin Pho: So Lisa, give us some examples of some of this positive framing of the intersection between AI and health care.

Lisa Scardina: Sure. And so it’s interesting, too, that this model comes out of Case Western Reserve, based out of Cleveland, and the original research was done at the Cleveland Clinic. So it really has its DNA in the health care setting. Ultimately, it’s the classic: When a team is looking at a scorecard in terms of performance, we have a human habit of looking at the reds on the scorecard and thinking, “OK.” There’s a deficit mindset: “What’s wrong with this situation?” When you’re doing that, teams back up and say, “Yikes, I don’t want to be part of that. That’s a hard conversation to have.” What if we look at the greens on the scorecard and say, “What’s going well here? Where is the strength in this group?” And we know that high-performing teams, it’s three to one or five to one, positive to negative comments.

So for me, in a really practical way, both with my group and as well in the physician recruitment space that I work in, it’s those cultural underpinnings about whether teams are leaning in and there’s a positive environment, whether teams have a sense of what their strengths are, are able to name those strengths. It’s a little bit of that hard-to-put-your-finger-on cultural piece, but it really is around: Is this group really having a positive mindset or a deficit mindset? And I think that’s a little bit of what Wael was talking about, too, in our previous conversation, and continues to speak to from his perspective.

Kevin Pho: And Lisa, are you seeing that with the adoption of AI? How are most of your clinicians approaching that? Are they approaching it with a growth mindset, an open mindset, and excited about its implementation, or is it more from a deficit side? What are you seeing?

Lisa Scardina: Well, what I see from the artificial intelligence side of AI, of what you’re speaking to, and again, sitting in this physician recruitment space between hundreds of different practice settings and thousands of physicians and providers: I think that there’s a curiosity there about the opportunities that we have in health care with the application of AI. I think that the most important thing that happens, especially during the recruitment process, or as physicians or APCs are looking at new practice settings, is that cultural piece. Is this a healthy culture? How do you describe the culture? How are decisions made? How is the team interacting with each other? That’s where that appreciative inquiry, strength-based approach shows up for me.

Kevin Pho: All right. Well, so what Kim said earlier, in terms of right now, how we’re using AI, a lot of it is these AI scribes, right? How to make our jobs easier. But of course, the potential of AI goes much, much deeper than that. So tell us about the ways that you’re seeing AI infiltrate our health care space.

Wael Saasouh: I think this can be split into two sides of the argument: one side where we focus on how AI can help in other ways, and the other side is how AI can hinder work. Some of the fears, let’s talk about clinicians, since that’s the topic, some of the fears of clinicians about introducing AI technology into the clinical day-to-day work are that, “Well, now we’re more efficient. Are we supposed to be doing more? Are we supposed to see more patients to cover the expense of including AI or similar technologies in our care?” We tend to see some of the thought processes going that direction in some places, and that automatically makes people who are already hesitant to adopt these technologies even more fearful of them, because, “Oh, great, now I have to work more, and I have to see more patients.” So we have to keep that in mind.

The other way is how we can utilize this technology to advance care and to relieve some of that burnout that we talked about last time. Think about a game reward system, where people have achievements and they have rewards and they have points. Again, going back to what Lisa was saying, the culture matters a whole lot, because if that system becomes an unhealthy competition, then it’s not working towards what you want it to work towards. What you want to do is get people involved, get people to adopt that technology, and then see the good in it, and then see how it can help them as individuals and them as a team, and then go from there.

So if you have something like a rewards system, where the rewards don’t necessarily mean that you get promoted, but they mean maybe you get an extra something you’ve been wanting to get in your office. Or if you say you’re interested in a certain aspect of what you do, you want to specialize in it, you want to get some training in it, say that covers your training: Your employer can cover your training if you get to a certain achievement. Things like that, as long as it gets people involved and gets people talking to each other, then it’s more of a healthy competition, and it promotes the advancement of everybody as a team. But you can’t just pick this up and introduce it into a culture that doesn’t support this. So I would start straight from the culture and then start introducing these additives.

Kevin Pho: Well, that’s a great point. I think that the culture certainly matters, and that’s why we’re having this discussion here. That point about these AI scribes increasing productivity, but then eventually clinicians are going to be forced to see more patients to pay for this, that is very salient, and I’m actually seeing that in other systems as well. So Wael, talk to me about how we can prime the culture to be more appreciative in terms of taking that growth mindset to adopting AI. What are you seeing? Are you talking to administrators in order to prime them for that approach? Or what are you seeing in your system or other systems?

Wael Saasouh: These conversations are ongoing constantly, and most of the time they’re informal conversations, because these topics come up in almost anything that we talk about. Going back to a focus on culture, we have to start by focusing on what’s happening, what’s happening well. How is our team strong? How is our team productive? How is our team connected? Obviously, all of this doesn’t work if the entire team is burned out, whether it’s clinicians or administrators. This all feels like a luxury that we can’t afford. So we start by addressing baseline issues. Where are you guys? Do you think that you’re happy where you’re working? What’s making you happy? What’s not making you happy? Let’s work on a few of those things first, which is pretty much what Lisa does, and then we start adding layers to that.

So for example, people are OK where they’re working, and they feel like they’re just disengaged. Introduce the gamified reward system, or some version of it, and say, “OK, so let’s boost performance a little bit while keeping it light and productive,” and then we go from there. If you start from a place where the culture is really down, the morale is down, then start from there. Address the morale first, and then start adding layers to it. If a place is overproductive and they’re doing great, then you can introduce the technologies and the reward system to lighten the mood a little bit, to just make them happier to be where they are, not just forced to keep producing the whole time.

Kevin Pho: So Kim, after hearing the perspectives of Wael and Lisa, how does that change how you feel about AI in health care?

Kim Downey: Well, I’d call myself a technology dinosaur, so I’m kind of fearful myself. So hearing the things that Wael said makes me a little more open-minded about it myself. And also, bringing to the point, what Lisa said is that we have to involve people, and just the positive aspects, and what’s going well, and what’s going right. We can’t approach it from a punitive standpoint.

I’m just now thinking about when we were first introduced to the EMR. I was working in a nursing home, and they said, “Oh, it’s going to be more time for your patients, less time on paperwork,” and that was the biggest lie ever. So as we’re approaching this, we also have to be honest, and you have to be honest with your team.

Kevin Pho: And Kim, I know you talk to a lot of physicians who are burned out. Are you seeing AI make a difference? Are you seeing that AI scribes, for instance, are moving the needle for some of these physicians who were previously burned out?

Kim Downey: I think it’s still mixed. I do, it just seems to be mixed: Some are able to use the scribes, and then others are still fearful.

Lisa Scardina: Well, and I might say, too, that my lens within health care operations is that maybe sometimes we take a more grand definition of what AI is, when in fact there are lots of small efficiencies happening that are aided by some of these, the definition of artificial intelligence. We’ve got a lot of that already embedded in some of our workflows and some of our operational efficiencies. And so I think there’s this opportunity for the larger ways that AI could come into a practice setting, and the ways that Wael is talking about.

And what I see, bright spots within the different organizations I’m working with, is when we have physician leaders able to step up, work with a team, promote new ways of doing the work, given the physician shortage that we’re faced with, given the technology opportunities. Again, where are those bright spots inside of an organization where we actually see a physician leading an initiative to say, “Hey, let’s do this work a little bit differently,” whether it’s team-based care or augmenting with some technology? What are ways? Like you said, Kim, I think the electronic medical record is a real riddle, but what are some of those efficient ways that we see good work happening there, and how do we build on those opportunities? That’s a little bit of what I think about, too.

Kevin Pho: And Lisa, the administrators that you’re seeing, are they taking that open-minded approach? Are they listening to those tenets of appreciative inquiry? What are you seeing?

Lisa Scardina: Well, I think, over my twenty-year-plus career in health care, I do see the physician voice coming into leadership differently, and that’s exciting. I think that there is more of, especially given the complexity that we see with the amount of information that’s out there, how do we become more of a learning organization, so that we can take physician leaders who are making recommendations? And there are new structures that I’m seeing, medical group boards or otherwise, so that decision-making can happen with a physician voice at the top and really put a bright spot on some of the good work that’s happening. I think that does shift the thinking a bit, to just have that voice and perspective at the table differently. So again, that’s my bias: to look for the bright spots and how to tell those stories, because we all know that there are so many gaps and deficits that contribute to the burnout that we’re speaking to.

Wael Saasouh: You can’t call all of AI good or bad, and you can’t say that all of AI works or doesn’t work. You have to really fine-tune what you want from it. You have to ask very specific questions, and you have to apply it to very specific scenarios. It’s very interesting that we’re seeing a whole lot of advertising for AI in medicine specifically. We’re not seeing a whole lot of experience or feedback on the use of AI, which goes back to your points, Kevin and Kim. It’s there, but we don’t know if it’s being used appropriately, and we don’t know if it’s helping as much as we’d like.

Kevin Pho: Hey, Wael, if you were advising administrative leaders at health care institutions when it comes to adopting AI, and I’m sure they hear a lot about that AI hype, tell them the type of questions they need to specifically consider before they try to implement it within their health care systems.

Wael Saasouh: If you’ve ever run any search on an AI engine, you know that you can get all sorts of responses to the same question. So it’s all about defining your parameters. If somebody in administration asks me, “Should I get AI or not?” my first question would be, “What do you want from it? Where do you want to apply it?” Be as specific as possible, because if you’re trying to apply it to increase your revenue, then fine, you can go do that with a billing system. If you’re trying to apply it to increase morale, that’s a very different thing, and it’s a very different subset of skills that you want from that AI. So know what you want. Know your why. We go back to the same question. And figure out how that plays into the culture within your institution, because not everything works everywhere.

Kevin Pho: We’re talking to Wael Saasouh, Lisa Scardina, and Kim Downey. The KevinMD article we’re talking about today is “The role of AI in improving health care: artificial intelligence and appreciative inquiry.” So I’m going to ask each of you just to share some take-home messages about AI to the KevinMD audience. We’ll start with Lisa, then Wael, and we’ll end with Kim. So Lisa, why don’t you go first?

Lisa Scardina: I would just encourage listeners to learn a little bit more about appreciative inquiry. It’s really based in psychology. How we make decisions, how we interpret information, really matters. And so as a leader, I have found it very valuable to just understand the basic tenets of how asking positive questions can help teams feel better. That’s one small step on combating burnout. I just encourage a level of curiosity about this as a model, and the fact that it’s based out of research that originated in health care, at the Cleveland Clinic, I think gives it a little bit of credibility for this particular audience.

Kevin Pho: And Wael, what are some of your take-home messages?

Wael Saasouh: I would say to everybody on either side of this: Just maintain a sense of purpose and a sense of wanting self-improvement. We all talk about altruism in medicine and how it’s part of our core, that we were there to help everybody else. Keep an eye on yourself, too, because that’s important. If you’re not doing OK, then your patients won’t do OK, or your employees won’t do OK. And as technological as we get, simple gestures matter. Talk to somebody face to face. Smile at somebody. Say thank you. Say please. Things that we take for granted, that we don’t see as much. And then you don’t want technology and advancements to get in the way of that. So maintain a human aspect of what you’re trying to do, and things will just fall in place.

Kevin Pho: And Kim, we’ll end with you. What are some of your take-home messages?

Kim Downey: Sure. I’ll speak to both. First, as far as artificial intelligence, I do see the potential to really help doctors, and I sincerely hope it happens, and I hope that no leaders then expect doctors to produce more as a result. Doctors need time with their patients, and they need time to think about their patients, and there’s no substitute for this. I fully understand it as a PT: I had a caseload of thirty-plus patients, and doctors have caseloads in the thousands. And I fully understand it as a patient: Patients are craving more time and more feelings of connection with their doctors, and no robot can ever replace human connection.

And about appreciative inquiry, at the heart of it is improving communication, and we can all benefit from making an ongoing, conscious effort to improve our communication skills. Personally, I continue to work on it, and I’ve seen a tremendous difference, most recently in relation to this week’s election, where a friend and I with differing political views, because we have a safe and trusting relationship, were able to have a thoughtful dialog that we both benefited from.

And similarly, I talked to a lot of doctors, and I’ve consented to doing something as a patient next month that I really don’t want to do. I was sharing my perspective with the doctor, who had just had a bad day, and I also listened to him, and I got to hear his perspective, and we both felt better afterwards. Our conversation will inform how I show up for an upcoming appointment with one of my own doctors. It all matters, and it all makes a real difference. And I’ll end with the concluding line of our article: “Artificial intelligence needs appreciative inquiry.”

Kevin Pho: Well, thank you, everyone, for sharing your perspective and insight, and thanks again for coming back on the show.

Kim Downey: Thanks for having us.

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