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derekdahmer 2 hours ago [-]
I RFTA and the majority of the complaints are about call center metrics and the pressure to ration care. These are real concerns about misuse of metrics, but not AI. The AI empathy thing was a 2024 pilot that was discontinued.
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.
thatfrenchguy 32 minutes ago [-]
Cardiac events from Apple Watches is not “AI” though
ch4s3 1 minutes ago [-]
It’s machine learning, which people routinely called AI not so long ago.
eru 2 minutes ago [-]
It would have been, 20 years ago.
Quarrelsome 12 minutes ago [-]
everyone is very thirsty for AI hate, so its not unexpected. Today its a mixed bag of corpo hate, anxiety about the future, inequality and traditional class warfare, combined with the typical technical ignorance.
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.
ihsw 1 hours ago [-]
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ai_fry_ur_brain 54 minutes ago [-]
I personally will not use a provider who uses llm tools. I know it makes me and my coworkers less careful and lazier. Qualities I dont want in a health care providor.
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.
flir 8 minutes ago [-]
Funny how we assess risk. Not criticising you - I'm as irrational as the next guy - but "I found the oldest doctor I could" seems like it has a different set of risks baked in.
bevr1337 9 minutes ago [-]
My current provider shows me their computer monitor for the entire appointment. I didn’t ask for that treatment but I really appreciate it.
aaron695 1 hours ago [-]
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api 2 hours ago [-]
“AI” in title gets clicks. So “AI” must be in title.
nerevarthelame 1 hours ago [-]
AI is directly mentioned in 24 of 53 paragraphs from the article.
wrecked_em 1 hours ago [-]
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segfault99 10 minutes ago [-]
Workplace metrics and surveillance... What could possibly go wrong?
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.
neaden 3 hours ago [-]
If you think using a machine to evaluate how well a human is showing empathy is a good idea, you probably shouldn't have any position of power.
akudha 37 minutes ago [-]
If a human’s performance for 40 plus hours a week can be reduced to a performance score, that too in a field like healthcare, that alone feels weird. Sure there needs to be some way to reward people/evaluate their work etc, but I dunno if management by metrics is the best way, especially when those numbers are calculated by an algorithm.
Where has all the empathy gone? And common sense? :(
avaer 2 hours ago [-]
Maybe we should replace those people in power with machines that show empathy.
LastTrain 42 minutes ago [-]
Why not? This is the tier that AI would replace best
caycep 3 hours ago [-]
sadly, this is happening more as medicine and healthcare become more and more corporate. Seeing this as hospitals all get acquired into these mega health systems (ostensibly to fight the now merged mega health insurance companies), that then like to throw their weight around.
Xeoncross 2 hours ago [-]
I can't imagine why people are looking into alternative healthcare
jagged-chisel 2 hours ago [-]
What alternative?
ElProlactin 1 hours ago [-]
Prayer, as in "pray you don't get sick".
markdown 2 hours ago [-]
Bloodletting works well, particularly agains the vapours.
a bit upside down - wealth extraction is a measure of power.
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.
datsci_est_2015 3 hours ago [-]
Increasingly true in Trump’s America.
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.
willmadden 1 hours ago [-]
Can we not do this here? You're all so busy rooting for your respective teams like sportsball morons that you've completely missed that the teams' owners have the same plans and go to dinner parties together. There's a thousand other forums for this tedious, shallow, uninformed bickering. This thread is a perfect example of why HN has a "no politics" guideline. Do it on reddit or X please.
QuadmasterXLII 1 hours ago [-]
isn’t that how we got here though? Everyone in silicon valley was so busy making sure they were open minded, steelmanning, and not treating politics like a sport that no one in the silicon valley halls of power pointed out that the emperor has no clothes and now we have a (sorry woke police) shrieking retard president leading us through the singularity.
bluefirebrand 44 minutes ago [-]
It definitely seems like having Trump in power suits the rich and powerful tech lobby just fine, that's for sure
forgetfreeman 2 hours ago [-]
I'ma keep it creamy with you, both parties have had the kind of political majority required to clamp down on the corporatization of our society, and neither have so much as paid lip service to doing so. You want to be mad at the current administration by all means there's fertile ground, but don't waste anyone's time blaming them for a situation that's been decades in the making with both major political parties pushing in tandem to realize it.
jimbob45 1 hours ago [-]
The last time was 2009-2010 for the Democrats. The Republicans have never held 60 seats.
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.
inigyou 57 minutes ago [-]
The democrats aren't the left. How would the left exploit a democrat majority? That is like saying the democrats didn't exploit a republican majority.
pstuart 2 hours ago [-]
If you're going to play the "both sides are the same" game you need to be more precise in what that means. DNC is absolutely subservient to their patrons and party leadership in general owned by the donor class.
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.
inigyou 2 hours ago [-]
On this particular issue both sides are identical. On other issues they are not.
pstuart 12 minutes ago [-]
On corporate whoredom? Absolutely.
My pushback is that now is not the time for both-sides-ism. It needs to be addressed but most voters are poorly informed or vote their emotions and that talking point needs to go in the back pocket for later, if there is one.
I get your point, and the other one stating that Democrats are not "the left", but they are the the least worst option that a 2 party system offers.
The game is rigged, but this quote nails it:
On Undecided Voter s: "To put them in perspective, I think of being on an airplane. The flight attendant comes down the aisle with her food cart and, eventually, parks it beside my seat. “Can I inter est you in the chick en? ” she asks. “Or would you prefer the platter of shit with bits of broke n glass in it?”
To be undecided in this elect ion is to pause for a moment and then ask how the chick en is cooked.”
― David Sedaris
insane_dreamer 2 hours ago [-]
sure, US political parties have been largely pro big-biz
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
thin_carapace 3 hours ago [-]
isn't that exactly what a class terrified of the guillotine would want underclasses to believe?
optimiz3 3 hours ago [-]
In the future that class will control the guillotines in the form of Boston Dynamics guard dogs.
3 hours ago [-]
sscaryterry 3 hours ago [-]
Êtes-vous français?
api 2 hours ago [-]
That project was cancelled. This is mostly about workplace surveillance.
Most of the replies are large pop subReddit level junk.
gyanchawdhary 2 hours ago [-]
[flagged]
BeetleB 3 hours ago [-]
If you employ a few hundred nurses, how exactly would you evaluate how well they show empathy?
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.
kulahan 3 hours ago [-]
"You can't ask people because the experience is so universally terrible they'll just tell you it's terrible" isn't really an argument against surveys, it just means you need more specific questions they'll be fired up to answer
BeetleB 3 hours ago [-]
Let me suggest the following: Ask the nurses if they want the customer to rate them.
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.
TheOtherHobbes 2 hours ago [-]
Classic "1 star review because UPS lost my delivery" metric.
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."
3 hours ago [-]
lostlogin 3 hours ago [-]
> how exactly would you evaluate how well they show empathy?
How would you want yours rated?
By someone you have communicated with, or some data centre somewhere?
BeetleB 3 hours ago [-]
By a knowledgeable/skilled person who listens to the call. (Which the AI solution provides).
I suppose you could do that with the survey as well. It'd be an interesting study to see which is more reliable.
AlotOfReading 2 hours ago [-]
By a knowledgeable/skilled person who listens to the call. (Which the AI solution provides).
Can you point me to the information you evidently have about which models Kaiser is using? All I can find is that they're using innovaccer, which can use any of anthropic, openai, and meta models on AWS or azure. Even their published papers don't seem to specify a particular model or capability level, just "AI". For all we know it's a gpt mini or similarly cost-effective model that has the context awareness of a Labrador hearing the word "walk".
BeetleB 1 hours ago [-]
> For all we know
We don't know, so let's not pre-judge.
gusgus01 22 minutes ago [-]
Or we listen to the experts who are frustrated with the system? They see the effects even if they don't know the AI model causing it.
lostlogin 2 hours ago [-]
> 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?
BeetleB 1 hours ago [-]
No - read my original comment.
malfist 3 hours ago [-]
Actually, you can rely on the customers. They're the only ones that can tell you.
ak217 2 hours ago [-]
Yeah, this whole discussion cracks me up. I have a number of direct experiences with Kaiser nurses. They repeatedly got into arguments with doctors in front of me, tried to countermand doctors' instructions, ignored their patients, and complained to each other about their patients while they were right there.
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.
drknownuffin 52 minutes ago [-]
To one degree or another, this is endemic among nurses. It's part of a broader cultural element: nursing programs have entrenched a culture of nurses vs. doctors. There are literally questions on their licensing exam to the effect of "which of these orders from a doctor should you refuse to enact?" (rather than, say, "which of these orders should you contact the doctor to seek clarification on?" or some other collaborative take). Nurses are taught their job is to protect patients from physicians. Given they don't have the expertise to do that , the general result is more broadly a power struggle in the guise of patient care.
ak217 15 minutes ago [-]
I agree (with the obvious qualification that there are excellent nurses out there who do a great job and don't let this stuff get in the way of helping their patients, some Kaiser nurses included). But I also see a marked difference in behavior and outcomes in other hospitals I've been to. Yes, there are still some unprofessional nurses in those networks as well, but judging by the outcomes, the hospitals don't let them do damage.
lostlogin 3 hours ago [-]
> you can rely on the customers.
Patient or customer?
I even struggle with that, but I guess that’s what people are in a privatised healthcare system.
munk-a 3 hours ago [-]
Most of the folks here on HN are dealing with customer feedback in systems automation in one form or another - it's pretty unavoidable in this age of LLM trendiness. The customers of healthcare (in both private and publicly funded systems) are the patients. So while the term might not be super natural it's an understandable one to use.
datsci_est_2015 3 hours ago [-]
Patients are not customers, or at least I don’t want to live in a world where patients are considered customers. Customers and vendors are usually more of a symmetric relationship: price transparency, alternatives, lack of urgency. These are all characteristics of transactions that healthcare often lacks.
deejaaymac 27 seconds ago [-]
Customer, user, patient...it's all the same.
markdown 2 hours ago [-]
If the hospital is owned by private equity, the owners definitely think of the patients as customers. Doctors and nurses shouldn't, but the owners do.
Quekid5 14 minutes ago [-]
Lack of empathy tends to trickle down, alas.
groby_b 3 hours ago [-]
But they don't want to, because figuring that out is your job as a supervisor.
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.
BeetleB 3 hours ago [-]
> 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.
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.")
kxrm 2 hours ago [-]
I am quite heavily in AI, and I would say I am pro AI. However this use-case for AI is putting AI in the wrong position. AI should be in service to all humans. An administrator building out a middle management KPI based on AI is a misapplication of AI.
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.
ClumsyPilot 30 minutes ago [-]
> You can't rely on asking the customer
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.
ImPostingOnHN 3 hours ago [-]
Not asking the customer because you're afraid they'll tell you they're upset is a good indicator that you should do it more, and fix the issues.
You can ask the customer enough times that unreasonable customers or surveys are averaged out.
A good question might be "why are you upset?"
weard_beard 3 hours ago [-]
Isn’t it a running joke at this point that if you do what customers ask instead of focusing on the highest quality of service you get worse outcomes and the customer is still unhappy?
gusgus01 10 minutes ago [-]
I thought that was more about correctly interpreting their asks, and not just actioning without consideration. If all your customers are saying your chair could use a cushion, it doesn't mean add a cushion, it means the chair is uncomfortable and you need to investigate why.
wisty 2 hours ago [-]
There's a great academic book called "Stupid Rules". Excessive rules (or KPIs - often rules in disguise) exist because we don't like authority.
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.
xp84 2 hours ago [-]
When reading the headline I was thinking we were talking about evaluating things like whether a nurse asked the right questions of the patient from a best practices point of view (say you have <insert condition> and the best practices for that are to ask the patient about pain level and which side it's coming from and check in with them every X hours).
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 >
BeetleB 60 minutes ago [-]
> Get the doctor to assess the nurse.
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.
abeindoria 2 hours ago [-]
That is surprising. My primary care provider had a different response. Basically he said something in line of
"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)
terminal-bloom 2 hours ago [-]
I’d be more willing to consent to these tools if I had confidence that the underlying software truly was built to honor my privacy.
Too many AI tools are built hastily for me to give my doctor’s (visibly awful) software the trust.
xmprt 2 hours ago [-]
Nursing and PCP are very different jobs. Ones a lot more cognitive than the other whereas the other involves actually doing/executing on a plan. I can see how AI would help reduce the cognitive burden while actually increase stress on the execution side.
Loughla 21 minutes ago [-]
Do you still get doctors for primary care? Our local hospital is hiring nothing but nurse practitioners now.
They're amazing in a support role, but not equipped as well for primary care roles.
dqv 1 hours ago [-]
You're seriously saying it's surprising that your PCP had a different response to AI that is presumably not mandatory for him to use? Cmon dude.
jmye 2 hours ago [-]
Similarly, I think anything we can do to help take the burden off the mundane parts of the job has helped clinicians focus on the actual hard parts. Where we get... bristling, is when there's any suggestion of "legislating" (operationally, not like, governmentally) care patterns and telling clinicians how to care for their patients.
Which is great, because anyone suggesting AI should replace clinical judgment and work is an idiot.
Loughla 24 minutes ago [-]
The nurses at our local rural hospital are tagged and tracked wherever they go on the hospital campus. Time spent in one spot is part of their review.
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.
lukeschlather 2 hours ago [-]
The article mentions uses of AI but doesn't really give any examples of harm from AI. It does give specific examples where it sounds like Kaiser is optimizing calls to minimize cost rather than improve quality of care. It's also pretty easy to expect that the examples given (treating longer calls as a problem and penalizing nurses for giving more than 3 pieces of advice) reduce the quality of care.
gorszon 38 minutes ago [-]
They talk about workplace survillience. They use a machine learning tool that try to assess their emphaty, and such. The AI, while the tool technically can be called that, in the article is there to be a buzzword.
doodlebugging 3 hours ago [-]
This problem with workplace AI interfering with nurses ability to manage healthcare obligations for their clients is not confined to Kaiser. UHC has also introduced the AI surveillance tools and are using it to do similar things.
inigyou 3 hours ago [-]
Isn't that the insurance company whose CEO was murdered because of the terrible quality of care they delivered?
doodlebugging 3 hours ago [-]
Yes it is. Somehow that might appear to be incentive to improve quality of care but maybe their corporate culture is a bad fit for quality.
teachrdan 3 hours ago [-]
> that might appear to be incentive to improve quality
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)
doodlebugging 2 hours ago [-]
Indeed, increasing quality tends to increase costs and decrease profits so keeping costs aligned with their profit goals automatically degrades quality.
inigyou 2 hours ago [-]
How many dollars is a dead CEO worth?
Joel_Mckay 3 hours ago [-]
Psychopaths don't care about other peoples pain. Some MBA only care about their own ego, power, and money. They do well in corporate cultures that reward parasitic relationships with customers. =3
doodlebugging 2 hours ago [-]
Slurping their way up to the C-suite.
tomjakubowski 47 minutes ago [-]
Mangione had back issues and apparently some difficulty in getting treatment for it, but he wasn't insured by UHC. According to his manifesto, he chose Brian Thompson as his victim because UHC was the largest health insurance company in the United States.
inigyou 12 minutes ago [-]
His alleged* manifesto. There is no reliable evidence that Luigi Mangione committed any crime. It seems more likely that Brian Thompson was killed by a disgruntled customer.
Joel_Mckay 3 hours ago [-]
It is true that Despotism structures major failing was the scaling cost of surveillance necessitated to differentiate fact from fictional narratives.
Truth is most nurses care for people having the worst day of their lives. =3
doodlebugging 2 hours ago [-]
The nurses in my family would agree with your assessment.
There is an unfortunate cycle that has been playing out this year in USA. Insurance companies are arming up with AI to deny billing codes charged by providers. Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit (And teach providers to use keywords in session).
The loser, as always, is the patient's quality of care.
jmye 2 hours ago [-]
> Providers are arming up with AI to listen in on provider-patient sessions to prove the billing codes are legit
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.
dependsontheq 3 hours ago [-]
Thinks that are not allowed in the EU thanks to the AI Act.
none_to_remain 1 hours ago [-]
They want you to blame "AI" like Claude jumped up and decided to start hassling nurses, not individuals in management
gorszon 36 minutes ago [-]
If you read the quotes from the union, they blame the management, and they cite workplace survillience as one issue, wich is happened to be a machine learning tool. So, of course the article talks about AI, because thats the trendy buzzword.
dqv 29 minutes ago [-]
They already did a trial which used the trendy buzzword to surveil the nurses. The nurses want to implement controls on that trendy buzzword before it is further misused by management to cause harm to patients (by way of making the nurses focus on meeting some arbitrary performance metric rather than focusing on patient care).
dqv 48 minutes ago [-]
... They're aware that it's individuals in management, which is why they want to use their union contract to dictate how management can use AI.
9x39 3 hours ago [-]
It sucks because AI reduces call center costs in many toil tasks very effectively, regardless of whether you want to help or dissuade customers - it's just well-suited to the task and it's going to accelerate. It's a win for capital and the technology implementers, even if it's a loser for the call center employees and callers.
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.
Think of AI as a tool... for data leaks. </s> (not 100% sarcasm)
pydry 2 hours ago [-]
90% of the time when I call a call center I need a human to fix an organisational bug - e.g. faulty billing or some other kind of mixup. AI cannot help with this.
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.
r0m4n0 35 minutes ago [-]
The HN crowd is not the usual demographic for call centers. Im willing to generalize a vast majority of callers can find the info they are looking for if they tried a little
ACCount37 1 hours ago [-]
Neither can an average call center human.
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.
syngrog66 2 hours ago [-]
AI is making lots of jobs and workplaces worse.
cromka 3 hours ago [-]
I'd like to think it's not meant to make life better for a regular nurse, but rather to weed out the abusive ones? At least that's how I see it from my flawed, post-communist country perspective.
api 2 hours ago [-]
Every time “relentless push for efficiency destroying X” comes up I should repost this:
the more I read about how AI is being used, the more I'm coming to the conclusion that despite me personally find it quite useful in my work, and even my personal life to some extent, it is a net negative to society as a whole, and if the choice is between zero AI or the AI that is being deployed, we'd be better out without it
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
3 hours ago [-]
munk-a 3 hours ago [-]
> "Nurses fear that having long calls can lead to bad performance reviews"
> 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.
BeetleB 3 hours ago [-]
I have some inside information (but not much!)
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.
Broken_Hippo 3 hours ago [-]
It might not be a written metric, but do you actually believe that someone isn't being evaluated partially based on how many times they've had to talk to them about issues?
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.
BeetleB 3 hours ago [-]
> but do you actually believe that someone isn't being evaluated partially based on how many times they've had to talk to them about issues?
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."
munk-a 3 hours ago [-]
Yeah, I didn't even want to lean out that far but I'm sure average handle time is incorporated in some manner.
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.
BeetleB 3 hours ago [-]
> the statement Kaiser gave in response was worded in a precise smug corporate America style to dodge the main concern raised
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?
toomuchtodo 3 hours ago [-]
Are these nurses currently represented by a union?
BeetleB 3 hours ago [-]
Yes.
toomuchtodo 3 hours ago [-]
Tremendous.
BeetleB 2 hours ago [-]
It helps with their pay ;-)
Terr_ 3 hours ago [-]
There's definitely a lot of room for weasel-wording there, where the metric really being used isn't the mathematical mean, but punishes people just the same.
monknomo 3 hours ago [-]
balls, that's the metric line managers use to figure out who's out of whack
but but but... the line! it has to go up, doesn't it?
Avicebron 2 hours ago [-]
Yes brother. This is the way. We pray to the line, only it can shelter us in these dark times of labor revitalization. HODL. May your returns be colossal.
apercu 3 hours ago [-]
Maybe healthcare shouldn’t be primarily for profit?
anubistheta 2 hours ago [-]
Every healthcare system optimize costs and rations care based on the price. It has nothing to do with profit or non-profit status.
caturopath 2 hours ago [-]
I'm not sure the for-profit approach is exactly what's to blame. HMOs like Kaiser are legally forced to spend a certain fraction (80% percent for the worst case, more for large group plans) of their premium revenue on medical services. They can't save and pocket the money like a traditional for-profit enterprise.
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.
sarchertech 2 hours ago [-]
> spend a certain fraction (80% percent
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.
caturopath 2 hours ago [-]
> Increasingly health insurance companies and healthcare providers are intertwined.
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.
sarchertech 1 hours ago [-]
I’m not talking about Kaiser. I’m talking about companies like UnitedHealth Group Incorporated who own UnitedHealthcare the insurance company and Optum the healthcare provider.
> 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.
caturopath 1 hours ago [-]
Right, but the article was about Kaiser and I was talking about the thing the article was about.
sarchertech 23 minutes ago [-]
Sure, but the person you replied to said
>Maybe healthcare shouldn’t be primarily for profit?
Which is a far larger topic than what the article was about.
arjie 3 hours ago [-]
Well, I suppose you can rest easy on that count. Kaiser is principally a non-profit.
ButlerianJihad 3 hours ago [-]
> principally a non-profit.
I hate to break it to you, but "non-profit" doesn't mean what you literally think it means.
Also, KPMGs are indeed "for-profit" while Kaiser Permanente as a whole is constituted as a "consortium" of both types.
wilg 3 hours ago [-]
Do you suppose thats why they wrote "principally"?
ButlerianJihad 2 hours ago [-]
You're absolutely wrong!
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.
wilg 24 minutes ago [-]
Can you just say the point you're trying to make about nonprofits directly?
procflora 2 hours ago [-]
Ok fine, but I bet you can't come up with a good gluten free banana bread recipe.
insane_dreamer 2 hours ago [-]
agree 100%; but kaiser is already a non-profit organization, that's not the main issue in this case
bendergarcia 3 hours ago [-]
But what about competition!?!?
wilg 3 hours ago [-]
There's no law saying you can't start a non-profit healthcare provider or insurance company. Why not do it?
nojito 3 hours ago [-]
Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them.
It’s going to be very improbable that these statements are true.
gyanchawdhary 2 hours ago [-]
I 100% agree.
apercu 3 hours ago [-]
Compared to what?
bmitc 3 hours ago [-]
> Kaiser has some of the best healthcare outcomes in the country/world due to their protocols and how good they are in ensuring adherence to them.
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.
BeetleB 2 hours ago [-]
Customer satisfaction in California is not great.
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...
nojito 3 hours ago [-]
Not sure if you’re serious but just search the name Kaiser in any research search engine.
Their secret sauce is their ability to standardize protocols throughout their entire organization.
ak217 2 hours ago [-]
Well then their protocols suck. I have many anecdotal data points about them fumbling in major ways when it matters (missed major pathologies, messed up surgeries, etc.).
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.
lostlogin 3 hours ago [-]
That’s the measure for one pathology, but in terms of a provider comparison, what’s the measure? It isn’t dollars versus life span or morbidity.
guelo 3 hours ago [-]
Study is from 2000-2013, their care has deteriorated significantly since then. I know because I've been a patient the whole time.
kulahan 3 hours ago [-]
The care quality of all major healthcare providers in the US is some pretty available data, and I've never heard anyone of being suspicious of Kaiser, of all companies. They're specifically known for having really good outcomes. It's like asking for a source that McDonald's sells the most burgers in America. It might not be true - maybe technically it's someone selling sliders or whatever, but it's so close it's probably not worth arguing over anyways.
nttylock 57 minutes ago [-]
[flagged]
ori_b 3 hours ago [-]
There's a reason that among Americans, telekinesis and creationism are more mainstream positions than sloptimism.
About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.
doodlebugging 3 hours ago [-]
With all of that in mind I have to wonder whether there is overlap between these response groups and if so, how much. Could be zero to 100% without more information.
ori_b 6 minutes ago [-]
Good question. How many people that you know are in all three groups?
14 3 hours ago [-]
I would love to learn the cost of the AI versus how many new workers they could afford to hire and get more calls done. But I assume the end goal will be full replacement of human workers once the AI has had enough time to learn the job.
caturopath 2 hours ago [-]
The article doesn't seem to be about replacing nurses staffing their phones with AI. It seems to be about making sure the care they're providing is what the company wants.
BeetleB 3 hours ago [-]
The AI is a lot cheaper. Kaiser nurses are amongst the highest paid in the nation.
saltcured 3 hours ago [-]
Now let's talk about how AI could replace Kaiser middle management and streamline bureaucracy to preserve more budget for doctors and nurses...
joe_the_user 2 hours ago [-]
People enjoy saying "AI can replace middle management" as a comeuppance but it's not what people think. In many ways, AI is primarily serving as middle management, yes. But what happens is that instead of one manager engaging in petty surveillance, harassment and browbeating to increase work intensity, you have ten clones of the manager doing the same thing. That's not the "woo hoo, automated middle management!" you were looking for.
apercu 3 hours ago [-]
Subsidized Gen AI maybe.
Also, California has a high cost of living.
indoorfish 3 hours ago [-]
How dare the people who take of the sick and dying be paid well. Unacceptable waste that must be optimized!
We're liberating them from work so they can focus on what matters
btown 3 hours ago [-]
> Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice, Capulong and other nurses said, which means they may sometimes need to decide whether to withhold advice or face a performance evaluation hearing.
> Another nurse speaking on condition of anonymity said “AI did not understand our job and would grade us wrong all the time.”
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.
lostlogin 3 hours ago [-]
> Nurses are instructed to stick to a script on phone calls and give no more than two to three pieces of advice
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.
uhhhhwhaaaa 3 hours ago [-]
Unpopular opinion: People want to be lazy and hate things that force them to work harder.
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.
CodeMage 2 hours ago [-]
Your anecdote talks about taking breaks and doing dishes, but fails to talk about measures of productivity.
caycep 3 hours ago [-]
clearly you have never been a floor nurse at a hospital...
cindyllm 3 hours ago [-]
[dead]
profdevloper 1 hours ago [-]
Just think -- with the increased efficiency, they will have more time for Tik Tok dances.
throwaway13337 3 hours ago [-]
What these complaints always boil down to is autonomy and control.
The more centralized an organization, the more it relies on metrics to understand and exert control over its employees and customers.
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.
neumann 3 hours ago [-]
Everyone pushing tools/AI during initial development/investment and building its demand in the cultural discourse always highlights its ability for good.
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.
throwaway13337 2 hours ago [-]
Certainly, I agree that using AI to dehumanize - generally what companies seem to be doing with it - is super bad. And it's also what is being sold to existing companies right now.
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.
einpoklum 3 hours ago [-]
> AI is just a tool
"To the man with a hammer, everything looks like a nail." [1] There is no such thing as "just" a tool.
While I'm sympathetic to the frictions of newly introduced AI and the fact that AI in healthcare, especially calls, can seem very uncaring, between the lines the article reads a bit like the typical union complaining about modern tech that reshapes their work, given the multiple mentions of protests, nurses union, etc.
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.
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.
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.
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.
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.
Where has all the empathy gone? And common sense? :(
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.
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.
My pushback is that now is not the time for both-sides-ism. It needs to be addressed but most voters are poorly informed or vote their emotions and that talking point needs to go in the back pocket for later, if there is one.
I get your point, and the other one stating that Democrats are not "the left", but they are the the least worst option that a 2 party system offers.
The game is rigged, but this quote nails it:
On Undecided Voter s: "To put them in perspective, I think of being on an airplane. The flight attendant comes down the aisle with her food cart and, eventually, parks it beside my seat. “Can I inter est you in the chick en? ” she asks. “Or would you prefer the platter of shit with bits of broke n glass in it?”
To be undecided in this elect ion is to pause for a moment and then ask how the chick en is cooked.” ― David Sedaris
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.
We don't know, so let's not pre-judge.
Are you saying that the AI is the same as a knowledgable/skilled person?
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.")
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.
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.
You can ask the customer enough times that unreasonable customers or surveys are averaged out.
A good question might be "why are you upset?"
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.
They're amazing in a support role, but not equipped as well for primary care roles.
Which is great, because anyone suggesting AI should replace clinical judgment and work is an idiot.
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.
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)
Truth is most nurses care for people having the worst day of their lives. =3
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.
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 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)
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.
https://sohl-dickstein.github.io/2022/11/06/strong-Goodhart....
This is a well understood phenomenon.
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
> 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?
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.
>Maybe healthcare shouldn’t be primarily for profit?
Which is a far larger topic than what the article was about.
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.
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.
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...
https://pmc.ncbi.nlm.nih.gov/articles/PMC8032167/
Their secret sauce is their ability to standardize protocols throughout their entire organization.
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.
About 14% of Americans think AI is moving us towards a better world. About 17% are creationists. About 26% believe in Telekinesis.
Also, California has a high cost of living.
We're liberating them from work so they can focus on what matters
> 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.
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.
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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[1] - https://en.wikipedia.org/wiki/Law_of_the_instrument
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.