Amanda Wilde (Host): Next, a Future Trends expert speaks about disruption, data, and all things AI. Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm your host, Amanda Wilde, and in this podcast episode, we are joined by Paul Zikopoulos, Vice President of Skills at IBM. He is known as a Future Trends expert, reshaping how audiences perceive business potential through the lens of big data and technology. Author of 21 books on AI and data, Paul Zikopoulos will be one of the keynote speakers at ACHE's 2025 Congress on Healthcare Leadership, which takes place in Houston, March 24th through the 27th. To learn more and register, visit ACHE.org/congress. Paul, thank you so much for being here. Welcome to the podcast.

Paul Zikopoulos: Well, thank you for having me. I'm excited to be here and excited to see you all in Houston, by the way, in March. So great times ahead.

Host: Exactly, something to look forward to. You are Vice President of Skills at IBM, as I mentioned. Can you unpack what that title means and the work you do at IBM?

Paul Zikopoulos: Yeah. I'm not sure what it means to be honest. So I'll, I'll spread it out for you. I've done a lot of stuff at IBM, led development, led product management, tech sales, and then the notion came across that every day from a business perspective, we walk by problems that we could solve or make better with technology.

And this moment of generative AI, which most of you would have heard through ChatGPT, hit us. And it created an inflection point for data and analytics. That said, it got democratized. It got democratized because you didn't need the superpowers that I had to use AI. You didn't have to be a programmer. You could just use natural language, the way you use ChatGPT.

So then, my job evolved as VP of Skills in how do we upskill the many? And this is going to be the challenge no matter your business, whether you're in continuum of care, whether you're in retail, p& G, et cetera, et cetera, et cetera.

It's how do you upskill the many so everyone doesn't walk by problems that they can solve and make better with technology. And that is what I'm doing for all of IBM, to help IBM and to help our clients. And that's the job. 

Host: So AI was a turning point, and how have you learned to adapt to disruption in your industry? It sounds like that is your job.

Paul Zikopoulos: Yeah, I'm going to suggest to you that disruption has been around forever. It seems like it hasn't. I want to hit you with a little quote from someone and you may recognize it. He talks about living in an "age of disturbed, confused, and bewilderment with many voices of counsel, but few voices of vision. Feverish activity, but little concert of thoughtful purpose. People doing many things, but nothing for the long." That was in around 1919 in a address by your, I think number 28, President Woodrow Wilson at Princeton. And so that was disruption at the time. So I would tell you disruption has been here forever.

So then the question then becomes, how have you learned to adopt, or to adapt to disruption in your industry? And there's a couple of key things that I'll recommend for anyone in any industry. One is solid leadership.

Technology as it turns out, is easy. Culture is hard. And having a culture where you can change, pivot, where you listen to staff, where you listen to clients is critical. And then the other piece, which is really what I'm driving at IBM, is learning never ends. And you gotta bring those things together into what I'll call a constructive tension.

Too much tension is not good. Too much stress, anxiety, we break down. Not enough tension, we remain stagnant. You've seen companies remain stagnant. Look at Kodak. I mean, what happened to Kodak? They thought they were in the film business. But they were in the memory making business. And when the modality of how we make memories changed to digital, they lost their business. So think about when you go to the gym, you have just enough tension to create movement forward.

And that is how you kind of adapt to disruption. And that is tested in time for decades. It's not just a moment in time of today.

Host: So you're talking about solid leadership and a solid culture of flexibility and adaptability and listening. And I like how you couched that fact that tech advances are happening historically, whether it's AI or the invention of the telephone. What kind of advice do you give leaders in different sectors to help them adapt and also keep that balance you were talking about?

Paul Zikopoulos: It goes back to what my job is, what I talked about earlier, learning never ends. So, if you're ahead of the curve and you're understanding the opportunities, then you can address the challenges of today with a full toolkit. I'll tell you, here are some challenges today, right? Right now, all but five countries in the world have declining population rates. Most countries in the world, including Mexico, USA, Canada, have declining productivity rates. How do you challenge those things? So there's a shrinking of talent and we're getting less productive. If I look over into a hospital network, maybe 2 to 5 percent of their net patient revenue is the budget that they run on.

And then look at the inflation associated with healthcare rates. In my next book, it's coming out this year, I actually grabbed the inflation rates from 2011 to 2019 in the USA, and it was about 1.75%, which is a great management monetory policy. The inflation rate of healthcare costs during those eight years was 7.4%. You're looking at almost a four times increase in that. So to get your hands around that, you have to figure out, well, we got shrinking population, shrinking productivity. We've got to be ahead of the things that can help us here, and AI is a moment in time that can really help us here. And I want to just say something, and you might get to it as we go on.

This is not about replacing people. It's augmenting the fact that we have less people doing the work, and they're becoming less productive.

Host: That is exactly leading into my next question, which is about AI. How do you use artificial intelligence? How do you use it both at work and in your personal life? And what have been the benefits and challenges?

Paul Zikopoulos: I'll give you some examples in a framework, which I'll share with everyone at the conference. And it is about shifting left, so you can shift right. When I'm at development, we have this concept of shifting left, and it would be the same in manufacturing or automobiles of defect detection. If I could find a defect before it got shipped to a client, before it got into the code at a hospital, and the CIO would then have to patch it, that's probably eight to twelve times less effort required expense and human effort to go and get that fixed, right? So we would always try to shift left the exact same thing in a car, et cetera, et cetera. There's opportunity in generative AI and how to use AI and put it to work, is to look at what I just talked about declining population. So net negative birth replacement rates, declining productivity. And then the, how do I shift left the rote tasks?

So, I do that in my personal life, and we do it at IBM. What are the tasks that could be better handled with AI, with what AI is good at, and then we free up a human's time to not think about rote tasks, if you will, and to work on higher order value tasks and those types of things.

So in work at IBM, I mean, we do all kinds of things from self service. You have a question in HR, I think we handle 90 percent of our HR questions with AI now. A simple thing like moving someone to a new team used to take an average of 22 minutes in our ERP program for a manager. And the failure rate was 40%, had all kinds of nuances to it.

We moved that to AI in a natural language; our failure rate is 1%. We literally returned 4,000 hours to the business. So now I think in your particular industry, what about documentation systems? Oh my God, like electronic documentation takes up 40 percent of a nurse's shift. I talk to doctors all the time and they tell me how they get about 15 minutes with their patients.

And they're probably not even looking at them. And what about shifting left? Workflows in the continuum of care. For example, AI could handle the generation from primary caregiver to referral notice and go straight to an ortho, cutting the referral time in weeks, depending on the system you're in or where you live, what state, what country, et cetera, et cetera.

So, just think about what are the mundane, rote tasks. And let's shift them left.

Host: So those are the real positive benefits of AI, but there's always that fear that, that's going to mean fewer employees and what other challenges have you run across on the other side of talking about benefits?

Paul Zikopoulos: I love that you brought this up because this also is something that we struggled with forever. I would tell you for the longest time humankind has been inventing technology that can hurt us or bring us great harm. Think of nuclear for a moment. Nuclear power, nuclear medicine, and nuclear war. And so when we look at people taking technology, we have good actors and bad actors or upstanders and bystanders.

I think we've seen what bad acting looks like. And, you know, I just think if you look at some of the ills of current society around social stuff like that, I would suggest we weren't acting as a society in the best manner forward. It's how you balance the promise is that you decide that trust is the ultimate license to operate.

And so when you get into AI, you need to ask big questions. I'll give you an example. Where did the data come from for this AI model? Some vendors will tell you, it's none of your business. Some vendors will tell you, we have no idea. And some vendors will say, here's the data, here's the full lineage and the provenance of it, and now you can look at it.

And so being very forthright in the AI and how it was built gives you that trust and confidence. And then the other piece is explainability. I never think that we should regulate, the technology, but we should definitely regulate the use case. And if I'm looking into things like diagnostics, with AI and assisting maybe a radiologist, you have to be able to explain yourself AI. And these AIs are often black boxes. You have no idea what's going on inside of them. That is a challenge we have to overcome. It's specific to your industry as super important.

Host: That makes sense how you framed how healthcare leaders can sort of balance the benefits with the risks. You'll be addressing future tech trends during your address at ACHE's 2025 Congress on Healthcare Leadership. What can attendees expect to hear in your remarks there?

Paul Zikopoulos: I'm gonna give you a lay of the land of AI. I'm gonna explain to you how it works without being a nerd. So what you'll be able to do is no longer walk by problems every day that you could solve or make better with technology. And those problems could be anything from clinical trials to follow up care, to billing, to avoiding fraud and upcoding and all those types of things.

And all pieces in between. Because from the boiler room to the board room, there's a place for AI to assist in those rote tasks. So I'm going to give you some use cases. I'm going to tell you about the things you have to watch out for. Like I will tell you right now, hospital networks and so on and so forth; many see security, cyber security as the least effort to comply, like we just can't get hacked. And it's a cost center. And I'm telling you, it's going to be a value crater. So I'll share with you that stuff. I'll show you some live demos and putting it to work. And you'll leave that session a touch overwhelmed, which I want you to be.

Overwhelmed not by technical details, because that's not going to be what we're talking about. Overwhelmed by the sense of urgency that you need to do more. And day one starts at the end of my talk on how you start thinking about how you're going to do more for your workplace. 

Host: Yes, we certainly should note that as these trends and technologies develop, it can sometimes be exponential, so it happens faster and faster. What trends are you going to be looking out for in the next few years that will affect health care leaders and the way they work?

Paul Zikopoulos: Some of these trends haven't arrived yet, but I'll share some of them with you. One of them I referred to earlier. I think explainability. I think accountable AI is going to be key. There's a new administration in the United States, but the administration aside, you're already seeing this in states and cities with local laws.

For example, New York Local Law 144 literally puts a requirement on anyone who uses a recruiter or recruiting software to be able to explain why that software made its decision. You're seeing this in the European Union, and I think you're going to see it more and more. So more and more requirements on explainability.

I think that the buzz term for 2025 is going to be something called agentic AI. I can tell you what that is now, but I want you to show up to the talk and I'll tell you all about it then. I think the other two big things you're going to see around technology in general, is national security.

This is going to be a kiki thing with AI. And the final piece, which is going to evolve in the next five years, especially in healthcare, is quantum, quantum computing. We're not going to talk about that, but those are the four big things to keep your eyes out for.

Host: This talk is gonna be so exciting. I think one reason for your success is that you are able to communicate in a way that is actually accessible to most of us.

Paul Zikopoulos: You know, I appreciate that. Out of those books I wrote, I wrote a couple dummies books, and I like to think that I can take the technical details and communicate it to the many, because the truth of the matter is, that's the only way that we are going to move society forward. It's the only way we're going to be equitably moving forward, and in your industry, it's the only way we're going to create better patient outcomes, which is the goal, and we have to obviously pay the bills and make profit there, but we can do all of that together if we all understand the opportunity in front of us.

But the problem is there's this divide of capabilities with technology because we're not all keeping up. And my goal is to eliminate that divide in your talk, in my writing, and just in my day to day life. I want everyone an equal opportunity to participate in this generation of technology.

Host: Paul, thank you so much for these valuable insights on the emerging technological trends and innovations that are driving transformation in healthcare.

Paul Zikopoulos: Yeah, it's been a pleasure. Can't wait to see you.

Host: Paul Zikopoulos will be one of the keynote speakers at ACHE's 2025 Congress on Healthcare Leadership, which takes place March 24th through the 27th in Houston. To learn more and register, visit ache.org/congress. For more resources and information, visit healthcareexecutive.org. Subscribe so you won't miss an episode and stay tuned for our next discussion.

This is Healthcare Executive Podcast from the American College of Healthcare Executives.