Alexis is director of content at AIMed, with responsibility for the research, development and delivery of products across events, digital and publishing. A highly experienced events executive with a career focus on the intersection between healthcare and technology, he is also a school governor leading on teaching, learning, and quality of education.
Chief Nursing Informatics Officer at Hospital for Special Surgery and Inspiren founder Paul Coyne reflects on his experiences as a patient, analyst, nurse and business leader, advocating for proper clinician-led innovation in healthcare.
You suffered a stroke at a very young age. How did this change your outlook on life?
In the initial years following the stroke, I would have answered this question by stating that the stroke changed my outlook because it helped me not take anything for granted, to be forced to find an internal drive to overcome, and to be driven to have a life of meaning and purpose. While all that is still true, now I would also say that suffering a stroke at 22 provided a foundation for me to realize that how one views life in general, and also how one views their own life specifically, is a constant evolution. For, with each day, comes an opportunity to modify one’s outlook.
What many people do not realize is that, with deliberate effort, this outlook can be whatever they wish for it to be. From a place of feeling the ultimate loss of control as I struggled while attempting to put back together my own mind, I was given the opportunity to realize that the overwhelming majority of how we experience life happens within our own mind, and thus can be controlled. This has led to me creating an outlook on both life, and myself, that leads to fulfillment.
How has your early career experience as a financial analyst informed your approach to nursing and healthcare?
My experience in business, my experience as a patient, and my experience as a clinician has shaped my approach greatly. I like my money, I like being alive and as healthy as possible, I like taking care of people. I expand these three inner beliefs as goals that should each be sought more broadly.
1) Make and do not waste money
2) Give the patient the best chance possible for optimal outcome
3) Create an environment for clinicians to do their job as best as they can
The pursuit of all of these goals at the same time simply is not happening like it should right now in healthcare. Many people who focus on money in healthcare forget that there is a patient at the end of the decision. Many who focus on patient care forget that the care they seek to deliver needs resources to happen. Failing to make the effort to reconcile the goals of fiscal responsibility and optimal patient care, in every single situation, from a local hospital to the federal government, leads to wasted money and suboptimal patient outcomes. These goals must be pursued together or they will fail together.
I have deliberately sought to become equipped with knowledge in both business and clinical practice to help however I can, and there is so much more to learn. I would strongly encourage other leaders, clinicians, government officials, and the general public to do the same.
Adoption and spread of innovation is a universal challenge for healthcare. What has been your experience of this – both as a frontline practitioner and as an executive with overall operational responsibility?
In order for innovation to be successful in healthcare, clinicians, business leaders, and technologists must come together. There are few people in the world with true experience in all three areas, and so it is not possible for one person to do it alone – as perhaps would be possible when seeking to innovate in another less complex industry. Unfortunately, there are few systemic structures in place that allow for those with these skill sets to have an opportunity to come together. And so, they exist and operate independently, leading to this problem, which is not one within the process of adoption, but one within the process of creation.
What often happens is that the business leaders have an idea, and the technologists make it, and then it is time for “end user testing.” This means that the majority of healthcare innovation comes to fruition without asking practicing front line clinical staff, “Does this make your job easier?” until the end of the innovation cycle. Naturally, with this framework, adoption will continue to be difficult. The answer is that the clinicians should be driving and leading innovation with the patient at the top of their mind. Everyone else in healthcare must collectively create the structure for this to happen and modify their business or technology framework to adopt as needed when a solution is created that benefits the clinicians ability to care for a patient. Not the other way around.
It was your frustration at the rate of translation from basic research to bedside that set you on the path to founding Inspiren. Tell us a little about that experience.
Mike Wang, the CEO of Inspiren, and I went to Columbia Nursing School together and became great friends. A couple of years later, he was working the bedside and I was helping lead analytics at the same hospital. The majority of the dashboards our team was making had no direct benefit to him on the floor – he didn’t even know most of them existed. And yet, his leaders would call him and all the other staff in for meetings and relay the message from the aggregate data over the last quarter and that they needed to improve fall rates, or pressure injury rates, or various other metrics.
Hospital management is overwhelmingly well-intended with a sincere desire to do all it takes to improve, but often without the proper tools. Mike said it felt like listening to a coach at halftime who says, “We are losing, but it’s OK, I know how we can win. We just need to score more points!”
We wanted to create something that would put real actionable data in the hands of front line clinicians and empower them to do their jobs better, feel less overwhelmed in their attempt to do the best they can for their patients, and reward them for the great work that they do. We realized that, in order to truly make a transformative impact, the metrics could not come from an EHR that requires clinicians to manually input data. This, by definition, takes time away from their ability to care. We believe that all data must be simultaneously generated, aggregated, and delivered to the clinicians without detracting their focus away from caring for the patient for one second. As this is a bold vision that had not yet existed, we realized that we would need to create novel hardware, software, mobile application, and an analytics platform in order to bring it to reality. And so, we founded Inspiren and created AUGi.
You have accrued numerous plaudits and awards over the course of your career. What do you consider to be your greatest achievement?
All of us achieve and experience joy and feelings of adequacy. All of us struggle and experience suffering and feelings of inadequacy. My life is no different than the universal human experience of these two realities.
However, I suppose an argument could be made that both the examples of my success and my suffering are at the extreme ends of the spectrum. Therefore, my greatest accomplishment has been arriving at a place where I, more often than not, am able to reconcile these two parts of me, view myself as both simultaneously, and love all of who I am. This is a significant accomplishment because, in order to look in the mirror and say “I love who I am”, one needs to believe that what they have been, what they are, and who they will be, is someone that is worthy of that love. Unless one is delusional, that requires accomplishing great things in the past, present, and future. Of course, this will never be finished or complete as there is no perfect person, and so, one also needs to accept the parts of themselves that have not been that great, are currently not that great, and those parts that will never be great no matter how hard they try.
Only when a balance of striving and accepting is achieved, can the person in totality state, “I am proud of what my life brings forth. I accept the things that my life cannot bring forth. In totality, I love myself.”
A lot of conversations about AI in healthcare are between academics, physicians and data scientists. How can organizations engage nurses and other healthcare professionals in the implementation of new technologies?
The issue for this not happening is not due to a lack of desire from those on the front line to be engaged, but due to a lack of structural framework and business model that supports their desire.
Despite having the most first-hand knowledge about what works and what doesn’t with patients, front line clinicians rarely have sufficient time during their working hours to be engaged in the innovation process. Therefore, when they are asked to engage, they are being asked to engage tangentially to their role in support of the innovation process of another, typically without compensation. Often this problem is even more egregious, and they are asked to “adopt it” after it is created. Attempts to create engagement within this framework are ultimately futile.
We must collectively work to create a structure that allows the clinician to lead the innovation themselves. We can begin to shift this paradigm right now by engaging healthcare professionals, not by pulling them into a focus group, but by going right to them. Every healthcare organization across the world should be sending their IT and analytics teams to the bedside, to work side by side with our clinical teams for numerous hours weekly, with the goal of innovating together. Every healthcare technology business should be standing outside hospital executives’ doors asking them to partner to create something, not knocking when it is time to sell a completed product.
The fact that this question can even be asked speaks to just how problematic we have allowed healthcare to become. In no other industry would anything be able to be successful if it were created and implemented without the engagement, throughout the entire process, of those who will actually use it.
What do you see as the main barriers to effective deployment of AI?
The main barrier to effective deployment of AI in healthcare is not that it will fail to be possible technically, but that it fails to be helpful practically.
This issue stems from a flawed conceptual framework within our higher education system where each person is taught to have a hyper specialized skill set that correlates to a profession where that skill set remains “enough” to succeed for the remainder of one’s career. There is never “enough” one can learn.
Contrary to how we are taught, the goal is not to succeed in your discipline or profession. Rather, the goal is to succeed in truly improving the industry which you seek to serve and, as a byproduct, succeeding in your own profession. Currently, the most qualified and brilliant clinicians know little about AI and the most qualified and brilliant AI experts know little about clinical practice. However, both individuals can be quite successful in healthcare. Yet, while both can currently succeed in the field of healthcare independently, healthcare itself cannot succeed unless they come together.
We must relook at how we allocate government funding to ensure the proper teams are truly assembled on every grant for meaningful results that bring about real change. We must relook at how hospitals and organizations are structured and break down departmental silos. We must relook at how businesses that are creating technology engage with healthcare organizations and those on the front line. But most importantly, each of us working in healthcare must look within ourselves and determine if we are here to succeed in our discipline, or at our company, or if we are here to succeed in transforming healthcare for the better.
After graduating from Providence College, Paul Coyne worked as a financial analyst at Goldman Sachs. After residual effects of a stroke forced him out on disability, he went back to school and simultaneously enrolled in Columbia University’s Bachelor’s, Master’s, and Doctorate program in nursing as well as Northeastern University’s combined MBA,Healthcare Management / MS, Finance program.
Over the course of the next four years, he completed all five degrees, becoming an adult-gerontology nurse practitioner with a subspecialty in palliative care. While completing his doctorate, he served as Manager of Analytics at NewYork-Presbyterian Hospital. He then transitioned into a clinical operations role at Hospital for Special Surgery and has subsequently held numerous positions of increasing responsibility, now serving as Vice President, Clinical Practice & Chief Nursing Informatics Officer with responsibility for Advanced Practice Providers, Clinical Informatics, Infection Prevention, and Occupational Health.
Paul is President & Co-founder of Inspiren, a nurse-led healthcare technology company, whose flagship solution has received over 20 awards for design and impact to patient safety from Fast Company, SXSW, Edison, TIME, and the American Nurses Association. Due to his unique knowledge of the interplay of clinical practice, technology, and finance, Coyne has been internationally recognized, having been named Crain’s 40 Under 40, AI Person of the Year by the Global Achievement AI Awards, a top 25 innovator by Modern Healthcare, as well as Healthcare Leader Under by Becker’s and Business Insider. He is the author of the “The Nurse’s Guide to Innovation”, an Amazon Best Seller, and serves on the Board of Visitors at Columbia University School of Nursing. He lives in New York with his wife and son.