Technique vs. technology: The robots are coming! Anticipate a hybrid world where technology remains a tool rather than a takeover

By Rick Dana Barlow

Fictional worlds explored in books, comics, movies, television shows and video games almost universally warn about machines and technology overtaking or even taking over and somehow subjugating humans, no matter if the premise starts out utopian or dystopian.

In some ways, it's about as romantic as escapist thought as the theme of underlying love in monster, vampire and zombie fiction. Forget about clowns.

From an economic standpoint in terms of communication, finance, operations and production, few can argue against technology continuing to develop and assuming greater, if not more intricate, roles in work as well as leisure.

What technological development means for healthcare remains malleable and open-ended. After all, a quarter-century ago, healthcare supply chain professionals foresaw robots being used in, if not performing, most surgical procedures as well as running a number of functions in sterile processing of devices and instruments. Oh, and by now, the internet would be so ubiquitous and universal that healthcare organizations would have no need for contracting, group purchasing organizations (GPOs) or distributors because everyone could order what they needed and wanted online for dramatically reduced pricing (the government quickly figured out how to levy sales taxes online so that closed one convenient loophole).

Still, healthcare has progressed somewhat through the application, development and implementation of technology. But, to paraphrase the venerable poet Robert Frost, there are still miles to go before humans can sleep as the machines do everything.

Crossing lines, streams

Any conversation about technology could go in many ways, according to Steve Kiewiet, FAHRMM, FACHE, COO, CCS Health, but he steadfastly stands behind one observation.

"I don't believe it will ever be as clear cut as human vs. machine," he said. "From the advancements in natural language processing, machine learning, artificial intelligence, augmented reality, the metaverse and beyond — we are headed into a time where humans will be aided in almost everything they do by technology. Yes, there are some tasks that can be — and will be — completely automated.

"The bigger value, to me, is how much better we all become at performing human tasks when we get help from the technology," Kiewiet continued. "Think about the next generation of robot-assisted surgery, a sensor traveling through the body giving information back to a clinical team wearing VR headsets. A robot traveling to every storeroom and taking inventory. An area where I believe humans will continue to excel — and need to excel — is thinking up the 'impossible.' Machine learning will likely be limited to what is known and what can be learned. Humans are dreamers. It is those dreams that become the reality of tomorrow. Machine and technology make our ability execute dreams much easier and much more likely."

Much depends on how you view concept of supply chain, taking into account the underlying meaning of its name, indicates Tom Lubotsky, Bellwether Class of 2022, Senior Vice President, Supply Chain, Allina Health, Minneapolis.

"Supply chain as it is denoted in its term is a series of workflow steps to ensure products are reliably and efficiently delivered to the end user's benefit," Lubotsky said. "As technology has grown to assist with improving the supply chain flow, so has the elimination of steps to conduct daily activity. Yet, I would make the argument that we do experience some more steps added to our daily workflow since required integrated technologies to create common IT back-office backbones for supply chain, finance and human resources do not offer the optimum supply chain features required. These efficiencies will be restored and improved in time."

Lubotsky points to artificial intelligence (AI) as part of the long game of process efficiency.

"There has been a tremendous amount written about the advancement of using AI technology to reduce non-value-added steps in carrying out our supply chain duties," he noted. "Clearly the introduction of 'bots' has allowed us to target these non-value steps in the areas of identifying and resolving three way matches among receipts, invoices and purchase orders. Other examples of using a supply chain bot can be found in the following areas:

• Improved customer service
• Easier inventory tracking
• Real-time status updates
• Secure shipping process
• Faster purchasing process

"Hence, the use of technology will certainly touch productivity, procure-to-pay, product reliability via better inventory management and safety enhancement," he continued. "AI offers a clear overview of the entire supply chain and claims to predict demand, supply and movements better and faster than any human data analyst. This enables healthcare systems to make better decisions and booster resilience."

Lubotsky dismisses the notion of machine over, if not in place of, man.

"Yet, I would caution that these technologies do not replace the diagnostics and interpretation required by an analyst to make sound decisions in advancing our supply chain today," he added. "Perhaps replacing key tasks to arrive at recommendations, but certainly not substituting good judgment."

Dick Perrin, Bellwether Class of 2014, CEO, Active Innovations Inc., Annapolis, MD, proffers a more pragmatic perspective.

"Certainly, the robots are coming," he contended. "The question is whether it is man or machine that is winning the race and your question of techniques versus technologies muddies the water. Certainly, it is man that is the winner since there is no basis for saying that machines win unless they are created and guided by man. Robotics are an extension of mankind's capabilities for handling advanced manufacturing and distribution and supply chain management support.

"Productivity will certainly be influenced by the increase in the ability to reduce/shift low-level labor required for manual activities to automated technology support across the supply chain," Perrin persisted. "Automation/machines make a lot of sense for both manufacturing as well as for order picking activities and distribution."

Perrin believes its incumbent on today's supply chain leaders to learn all they can about technological development as tomorrow's supply chain leaders likely will already know about it and have it an active part of their workflow.

"Supply chain management professionals should specialize in understanding what the issues are for developing and applying technology with artificial intelligence (robotics) and development of machine-learning capabilities to meet enhanced supply chain manufacturing, distribution and management needs," he said. "The reasons for continuing to develop technologies and advanced manufacturing capabilities are myriad but certainly include current problems exacerbated by the pandemic on supply chain replenishment and impacts on manufacturing. Of course, these problems have been exacerbated by the shifts to a global economy with off-shore production to reduce manufacturing costs, and we are now being faced with constraints on international shipments."

Means to an end

Ray Seigfried, Bellwether Class of 2012, former Delaware State Representative, Dover, DE, embraces the idea that technology represents a means to an end.

"We must never forget that patients must win all the time and that everything we do must advance patient care," he declared.

Seigfried cites noted efficiency guru W. Edwards Deming who was quoted as saying, "If you don't understand how to run an efficient operation, new machinery will just give you new problems of operation and maintenance."

He then juxtaposed Deming's focus with the philosophy of management guru Peter Drucker.

"Deming's focus is on efficiency or doing things right to reduce costs," Seigfried said. "Drucker extended this by focusing on effectiveness or doing the right thing. It is not about obtaining the best-marketed software or robotic technology; it's about 'developing a resilient operation.' Technology is not a driver; it's a supporter. It's about our perspective, insights and learning that create efficiency and effectiveness. This action will advance the Supply Chain to contribute to the health of individual patients and populations."

Supply Chain leaders must meet the future head-on and adapt, adjust as necessary as he listed a litany of spiraling ongoing developments.

"Success in the current and future state will depend on our ability to confront the velocity and complexity of change which exists in our healthcare system," Seigfried said. "Many forces are at play. COVID will continue to provide disruption throughout the supply chain. Political pressure to reduce reimbursement will increase due to underfunding of Medicare and Social Security. Healthcare organizations will continue to experience chronic staff shortages and deficiencies of physicians and nurses, together with increased demands for compensation and benefits. Patients will experience increased costs for home care and nursing home services. Incidents of chronic illness will continue to rise. Medicaid patients many of whom are people of color, experience reduce access to quality care and poor health outcomes due to low reimbursement rates. Healthcare organizations will experience more consolidation leading to reduced competition and possibly increased cost. Not to mention the disruption in obtaining raw materials due to climate change and global energy changes."

Through all of this Seigfried posits that the healthcare system is experiencing a "state of great transition," he observed. "This calls for building a resilient supply chain operation — one that is not engineered to keep the status quo but confronts obstacles with the realization to evolve, adapt and transform to move forward. This will take skills of continuous learning and changing systems."

Jamie Kowalski, Bellwether Class of 2017, Retired CEO, Jamie C. Kowalski Consulting LLC, Milwaukee, WI, emphasizes more of a utilitarian fusion.

"Man v. machine should not be the issue," he argued. "It should be what is the best mix of the two. What should people be doing, applying their judgment in which situations, and using the tools/machines for situations that are repetitive, rote and do not have the need for judgment that only people can exercise. If machines can get the job done and not have to struggle with potential or likely fatigue that people experience, and if they can do the job efficiently and less expensively, without sacrificing quality, then the best mix is easy.

"People should focus on applying the unique skills people have, such as intelligence — no offense to the AI fans — judgment, fairness, empathy, compassion, morals and ethics and respect for mankind," he added. Kowalski also is Bellwether League Foundation Co-Founder and Board Secretary and prior to that, Bellwether League Inc. Co-Founder and Founding Chairman, 2007-2013.

The issue revolves around service, according to Charlie Miceli, C.P.M., Vice President and Network Chief Supply Chain Officer, The University of Vermont Health Network, Burlington, VT.

"Supporting the needs of the patient is critical," he noted. "Supply chain is the caregiver to the caregiver. [Robotic Process Automation] and other machine-learning processes give us time to think and create better ways to serve."