Minimizing Medical Burnout: Manny Krakaris Of Augmedix On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Dan Rodrigues
Strong leadership is also important for reducing burnout. Company culture and work ethic always trickle down from the top level of an organization. Ensuring you have a leadership in place that is constantly aiding your staff is essential.
The pandemic was hard on all of us. But statistics have shown the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors causing a shortage of doctors. Some experts say the US may soon be short almost 124,000 physicians. (See here for example.) What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are they doing to help solve the scourge of burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout.” As a part of this series, I had the pleasure of interviewing Manny Krakaris.
Manny currently serves as Chief Executive Officer at Augmedix, a digital healthcare company that has revolutionized virtual medical documentation through an innovative technology platform that saves physicians up to 3 hours each day while improving physician and patient satisfaction. As an accomplished executive leader with deep expertise in finance, operations and business strategy, Manny has a wealth of experience in bringing innovative solutions to market rapidly in a wide range of industries including online music distribution, digital media, solar panel manufacturing, fabless semiconductors, asset management software and smart parking, among others. Prior to his work with technology companies, Manny was Group Vice President of BNP Paribas’ Leveraged Finance Group focusing on M&A and structured finance transactions. Manny was also co-founder of China Solar Power, China’s first thin film photovoltaic solar module manufacturer. He has worked extensively with many top-tier Venture Capital firms including Canaan Partners, Polaris Ventures, NEA, Draper Fisher Jurvetson, Interwest Partners, JP Morgan Partners, Sutter Hill Ventures and August Capital, among others.
Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your backstory?
I started my professional career as a banker and worked in New York and San Francisco for several years. I had what I consider to be a pretty successful career, moving to the position of group vice president at a pretty young age in the western region of BNP Paribas. I transitioned my career joining a portfolio company of the bank’s VC arm, and through this opportunity, I ended up getting into tech and never looked back.
I had a lot of exposure to successful VCs and had the opportunity to work in a variety of industries for companies. Over time, I developed a reputation for fixing troubling situations. I was the ‘Mr. Fix-It’ kind of guy within this group of VCs and that’s what ultimately led me to Augmedix.
I had previously worked with a couple of VCs who were Augmedix board members and what they showed me was that Augmedix was a great company with exciting plans. They were seeking a leader with my expertise to help it scale. What ultimately convinced me to make the jump was my doctor.
My doctor is an Augmedix customer. I remember her reaction when she described the new process to me. In her words, she said the service was “life changing.” I carried this memory with me over the next year as I spoke with other customers who had very similar reactions to the product. It was with this that I ultimately decided to join the board as an advisor.
I learned as much as I could in my short time as an advisor and began to outline what I thought needed to change. The board agreed to my proposal, on the condition that I join the company as Chief Operating Officer. I agreed, began to implement some of the changes I had proposed, and just a few months later I was asked to be the CEO.
Who inspired you to pursue your career? We’d love to hear the story.
For my finance career, a professor at my undergraduate school inspired me. What I learned after attending business school is that I would apply maybe 2% of what I was being taught as it was very theoretical and way ahead of where the real world was. However, I learned something that would stay with me my entire career — how to think critically and how to break down large, complex problems into much smaller, simpler problems that you could actually solve. I think that is the most important thing I learned in business school.
In terms of my career, I got great advice from several VCs. Some of those inspirational leaders who helped me along the way are Tim Draper, who was on the board of one of my companies, John Balen, Jim White and Dick Kramlick, who was a great inspirational mentor, and several others along the way. These are legendary leaders in their field, and they provided invaluable guidance to me over the years.
What are some of the most interesting or exciting projects you are working on now? How do you think they might help people?
Something exciting and really special that our Augmedix team is working on is the expansion to acute care and inpatient care environments. Traditionally, we’ve been in the ambulatory or clinical care setting. What we are doing now is expanding outside of the ambulatory and clinical environment into these new areas. I’m proud to be part of the group spearheading this initiative.
These care settings are much more difficult because the clinician workflows are not scheduled. In the acute care and impatient market setting, workflows are often random. They are dictated by when people who have acute healthcare problems are in need of attention immediately. The workflow tends to be very erratic, so trying to organize your own operational workflow to mimic that of an acute care provider is complex.
If we can solve this, it will allow healthcare organizations to decrease their medical staffing capacity to accommodate peak demand and peak documentation needs.
You are a successful leader. Which three character traits do you think were most instrumental in your success? Can you please share a story or example for each?
Perseverance. In business, there are all sorts of things that you encounter that you can’t anticipate. How you react to those things can make a big difference in how you emerge from any kind of challenging situation.
Knowing how to separate the noise from the real issues. Every day, we are required to make hundreds of decisions, but rarely are any of those hundreds of decisions actually impactful. Overstressing or paying too much attention to each one of those decisions can cause paralysis.
Knowing how to break down a big problem into smaller problems that are much more manageable. That’s something that’s really important. It keeps you from being overwhelmed. Almost every problem can be broken down into sub-problems that are much more manageable. You just need to apply the proper perspective in order to figure out how to break it down. It’s not impossible, and once you get the hang of it, the thought process you go through becomes increasingly intuitive.
One final trait worth mentioning is the importance of helping people realize their full potential. I think that is probably the biggest quality you can have as a leader. I’ve always felt that people can do more than what they think they are capable of. We are conditioned from our early days to avoid making mistakes. When you reinforce that conditioning enough, people start to live within pretty narrow parameters, especially when it comes to a job. I’ve encountered it everywhere I’ve been. So, what I try to do is give people more responsibility until they experience some discomfort. At that point, we slow things down, understand the source of discomfort, provide support in those areas, and then open up the spigot again. The vast majority of people, in my experience, are then able to do more on their own. It is human nature to want to do more. As a leader, your job is to build more leaders. This has been my goal since way back when I was a banker.
How do you define physician and healthcare worker burnout?
My definition is based on what I’ve observed, what I’ve read, as well as what I’ve been told by healthcare organization leaders.
A manifestation of burnout for anybody is when they feel that there is no end in sight to their plight. They feel unheard and that what they do is not making a difference. They become frustrated to the point of becoming indifferent, and that is the worst thing that can happen to a healthcare provider — being indifferent.
Unfortunately, indifference is the state of healthcare for many providers in this country. They hate it. They don’t want to be in that state, but the conditions to which they are subjected leave them no alternative. That’s the outcome of what happens when you put people in a situation where you ask them to do a lot more, with a lot less, and to do a better job. That’s not a sustainable proposition, it creates a state of disequilibrium. Something needs to be done to put that dynamic back into equilibrium.
How do you define or describe the opposite of burnout?
From my own example, the opposite of burnout is asking yourself, “at the end of the day, did I accomplish something that was meaningful? Did I make a difference in someone’s life? Did I do something that advanced the cause of the company I work for?”
It all comes back to a sense of fulfillment. For me at least, that feeling of fulfillment is the opposite of burnout. It motivates you. It energizes you, makes you feel good about yourself and pushes you to want to do more.
As a leader, what I try to do is create an environment in which that can happen. I try to give people as much latitude as they need to do as much as they want and expose them to the impact of their work. That, I think, can be highly motivating to people.
From your experience, perspective, and research, what are the main causes of physician and healthcare worker burnout?
There’s frustration with the tasks that are being asked of the physician that are, in their minds, unrelated to delivering care to the patient. If those tasks were frictionless and easy, you’d say “okay, I can live with this, it’s part of the job.” But think of yourself as a physician who is being pushed to do something that is outside your normal workflow, and yet that something is incredibly inefficient and time consuming. You get frustrated. Now imagine having to do this with every single patient encounter, every day. It can create a negative work environment.
Have you seen burnout impact your own organization? Can you give me a first hand description of how burnout can impact the operations of an organization?
We host all hands meetings bi-weekly to get a pulse check on our entire team and open it up to questions or concerns. We also accept anonymous feedback from our team. It is a priority for our leadership team to ensure we are regularly checking in on our employees to prevent issues like burnout from happening.
In terms of burnout, I can’t say I have directly noticed it within the Augmedix team. One indicator of this is our employee attrition rate, which is actually very low. However, those that we serve are experiencing burnout regularly.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
Of course! That was the whole reason I got really excited about this business. Technology enables people to do more. That’s the whole point. Technology can enhance the efficiency of most processes, regardless of the business you happen to be in. That’s our mantra and it’s what we are all about.
At Augmedix, it started with tools that could make creating a medical note easier. When I first came to the company, I spent time with our medical documentation specialists to get a feel for the work that they do in creating a medical note. During this time, I concluded that there is no way I could do their job. Not only was it hard, but I was shocked at how good these people were at the work they did. I thought to myself, “how could you possibly observe an interaction that’s happening, in real time, while also extracting and free-typing the things that are relevant at the same exact time? I could never do it!”
I felt strongly that we had to level the playing field in order to scale the business. The people doing this type of work have very high cognitive skills. Not everyone you recruit is going to be like that. Especially as you start to scale to 50,000–100,000 people, there is no chance that everyone will be able to keep up — you have to give them tools to make the job easier.
Through these tools we have built, we have transformed the job from creating content, where our specialists were free-typing the entire note, to editing content. Being an editor is a much easier job. So that’s how we went about building ‘Notebuilder’, which serves as the foundation of the Augmedix Ambient Automation Platform. And we’ve taken it a lot further, by incorporating automated speech recognition at the front end and NLP to automate this process, but it all started by creating tools to make the job a lot easier.
Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
Reducing physician and healthcare worker burnout is not an easy task. There are, however, a few things that hospitals and medical practices can do to better support their workers.
The first would be to create a company culture that focuses on worker wellness. This is achieved by constantly monitoring your workforce for concerns, areas of struggle, etc. to determine where your workers need the most support.
Strong leadership is also important for reducing burnout. Company culture and work ethic always trickle down from the top level of an organization. Ensuring you have a leadership in place that is constantly aiding your staff is essential.
Mental health and wellness services can also be very effective. As leaders, we want to do everything we can in our power to foster wellness amongst our workforces. Providing services to help address the issues of burnout at the psychological level tends to be incredibly helpful for workers who are reaching the end of their tolerance.
As technology continues its integration into common practice, we can also utilize this technology to help reduce burnout. Implementing healthcare IT that helps to alleviate some of the more mundane tasks affiliated with health practice, documentation for example, can alleviate a lot of burdens affiliated with their roles.
And finally, the simple action of recognizing people for the work they do can make a huge difference. As I mentioned earlier, fostering fulfillment in the workplace can go a long way in reducing burnout. We all want to feel like we are making a difference and contributing to the greater good. Letting your workers know that they are, indeed, making a difference can help to inspire and motivate towards that sense of fulfillment.
What can concerned friends, life partners, and colleagues do to help someone they care about to reverse burnout?
I’ve been telling my kids to take a step back and smell the roses. Most things in life are not critical. The journey we are all on is a marathon, not a sprint. All those cliches you hear actually come from a place of experience and wisdom. And this ties back to my earlier point that it’s so important to identify what really matters versus what is noise.
What are a few of the most common mistakes you’ve seen people make when they try to reduce burnout in themselves and others? What can they do to avoid these mistakes?
In some situations, people experiencing burnout are met with platitudes. “Don’t worry you’ll get through it. You’ll get them next time. Try harder.” Superficial platitudes are not helpful. What can be helpful is reminding them of what’s important and to focus on the things that they can control. One out of a hundred decisions you make is actually material. The rest just dim with the passage of time.
Can you share the funniest or most interesting mistake that took place during the course of your career? What lesson did you take away from it?
In a former career position, I sought out to make a video that spoofed the executives of my employer. We had several colleagues who acted as the executives in question. It wasn’t supposed to be seen by those executives, however. The subject matter had to do with our frustration of the “go- or no-go” decisions on financing opportunities we presented for approval. We didn’t get good explanations of why our deals were rejected when we thought they were solid.
We had this video made — including some acting scenes in a men’s bathroom with some embarrassingly funny costumes worn by characters representing our executives at HQ. It premiered at our regional Christmas party to great laughter. Somehow, a copy found its way to headquarters overseas. You can imagine how mortified I was when I learned that the subjects of our humorous film had seen it. Much to my surprise, I didn’t get fired, and actually got promoted that year. It was a pretty embarrassing story, but I suppose our point was made!
Could you share your favorite life lesson or quote? Why does it resonate with you so much?
“Don’t give up on your dream.”
It might not happen overnight, but that doesn’t matter. Realizing your dream is great but what is even better is the path you took, the effort you made and the challenges you overcame to achieve it. It’s the ride that counts. Following your dreams is what makes the journey worthwhile. I don’t know who coined that phrase, but I definitely believe in it.
If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would it be?
I’d say education and access to information. Those aren’t movements, but they are so important. The more you educate people, the better equipped they will be in evaluating information they are exposed to and in making informed and educated choices that are best suited for them, no matter where they live in the world.
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
About The Interviewer: Dan Rodrigues is the founder and CEO of Kareo, a Tebra company, a leading provider of cloud-based clinical and practice management software solutions for independent healthcare practices and billing companies. Rodrigues is known for his visionary leadership in the healthcare technology industry. Rodrigues’ future-forward expertise has led companies such as Scour and Skematix. He is highly committed to providing patients with a seamless, digital experience in healthcare. Rodrigues’ business insights have been featured in publications including Forbes, Fierce Healthcare, and AP News.
