Counterpoint

Why the most important KPI for every hospital CEO is KYC:
Know Your Congressman

In the 1990s, Stanford University established itself as the premier institution in the world for teaching, seeding, and fostering technology innovation, and an email ending in “@stanford.edu” became a passport to an elite network of people who co-founded PayPal, Yahoo, Instagram and, most famously, Google.

Just as Victor Frankenstein set out to build a beautiful creature, Stanford presumably set out to encourage the use of technology to improve the world, even investing in a company whose motto was “Don’t Be Evil.” In fact, the Stanford Persuasive Technology Lab was established in 1997 because of “the need for an ethical approach for designing persuasive technology.” [1]

Of course, the road to hell is paved with good intentions, and Stanford’s Frankenstein now threatens several American institutions, including hospitals throughout the land. The catalyst for Stanford’s Frankenstein? The COVID-19 pandemic. The victims? Stanford’s own faculty, including some of the most prominent physicians and scientists in the world.

It began in April, with the use of technology to vilify Stanford professor John Ioannidis, M.D., one of the leading epidemiologists in the world, about his prescient estimates of the infection fatality rate of COVID-19. Notably, the World Health Organization acknowledged and endorsed Dr. Ioannidis’ findings last week. [2] It continued a few weeks ago with the (temporary?) efforts of Google and YouTube to “filter” search results for the Great Barrington Declaration [3], co-authored by Stanford University Medical School professor Jay Bhattacharya, M.D., an epidemiologist, health economist, and public health policy expert focusing on infectious diseases and vulnerable populations. And, over the weekend, Stanford professor and Nobel Laureate Michael Levitt, a PhD from Cambridge, was disinvited as the keynote speaker from a bioscience conference whose very existence is based on his own discoveries because of his research on COVID-19.

If concepts taught by Stanford professors and developed by Stanford students can be used to silence world-renowned Stanford physicians and scientists from sharing their clinical views of a pandemic, then that technology can certainly be used against anyone or anything else.

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Every hospital CEO and Board Chair who ignores this threat does so at the peril of his or her hospital.

The concepts taught at Stanford's Persuasive Technology Lab for the past 23 years have been perfected and deployed into algorithms embedded into the products of each of the “FAANG” technology companies. As detailed in the Netflix documentary The Social Dilemma [4], many of the creators of these algorithms are concerned about the power of their intended uses, much less their unintended consequences. As a company that builds algorithms to make things better for hospitals, Trilliant knows a little about how they work. Trilliant's algorithms “terminate” upon the completion of a task, which is defined by humans but not intended to influence human behavior. Social media’s algorithms never terminate, because they never finish with the task of influencing the thoughts and behaviors of their human subjects.

If you reflect on the mainstream and social media coverage of the last six months, then you will likely find that there are many stories and narratives about hospitals, most of which befit the Halloween season. You will also find that there are almost no stories about your hospital’s experience, about the way that your team adapted to a previously unknown pathogen, about how after a few days, or at most a few weeks, your team was able to navigate the new terrain, about how your most significant operational challenge was a shortage of nurses, not ventilators. You know, and I know, that much of what is disseminated by the minute on social media about the pandemic is misleading, because you are on the front lines. You know that this Kaiser Family Foundation study is accurate, because this is what you have lived through the last six months. 

On March 18, the CDC issued recommendations that almost destroyed our industry [5]. I know from conversations with executives from numerous national and regional health systems how the CARES Act saved many hospitals and health systems from massive reductions in staff and even bankruptcy.

America’s hospitals cannot survive another lockdown, and America’s communities cannot survive without hospitals. More importantly, it should not happen, because America’s hospitals have now demonstrated their ability to navigate the pandemic and are prepared to handle the long-predicted “second wave.”

The media – especially social media – is an existential threat to your hospital's existence and, therefore, your mission. If you hope to avoid a repeat of what happened in March, then there is only one thing to do and, fortunately, that thing does not cost any money: you should call your Congressional representative.

Two decades ago, I learned the immense power of having a Congressional representative who knows the story of the hospitals in their district. From August 2000 until June 2002, I was part of a team that consummated the first for-profit hospital conversions in Connecticut and Massachusetts. We were supported by Representative Nancy Johnson in Connecticut, and we were opposed by Senator Edward Kennedy in Massachusetts. We succeeded in completing each transaction, but we would never have succeeded in Connecticut without Representative Johnson’s support.

I would encourage you to think about what you know about COVID-19 today. Not the complete horror show that was March and April, when a virus none of us had seen was menacing Seattle and the Northeast, but what you know today. 

Only you know the story of your hospital’s experience with treating patients with COVID-19, what really happened then and what has really happened recently. Only you know how your hospital is now prepared to treat patients with COVID-19 so that you can continue to treat patients with heart disease and lung disease and cancer and depression and addictions. Social media will not tell your story, because social media’s algorithms are not designed to tell stories of bravery and courage and competence.

Why do you need to talk your Congressional representative? Because he or she gets information two ways: from conversations with lobbyists, donors and constituents, and from briefings compiled by legislative aides in their early 20s…who get their information from social media.

Only you can tell the story of your hospital to your Congressional representative. Only you are qualified to tell that story. You have unique influence with your Congressional representative because of your hospital’s essential role as not only the provider of last resort but the source of jobs and stability in the community. The fact that only you can and should tell your story is meaningless to the algorithms built into the technology platforms of the most dominant media companies in the world, and those algorithms work 24 hours, 365 days of the year. If you don’t tell your story, then machines will tell their version of your story.

Don’t let Frankenstein make you a victim…

[1] https://captology.stanford.edu/go/welcome?from=

[2] https://www.who.int/bulletin/online_first/BLT.20.265892.pdf

[3]https://www.reddit.com/r/LockdownSkepticism/comments/j8iglo/google_removed_the_great_barrington_declaration/

[4] https://www.netflix.com/title/81254224

[5] https://www.cms.gov/newsroom/press-releases/cms-releases-recommendations-adult-elective-surgeries-non-essential-medical-surgical-and-dental