How I Built This with Guy Raz - How I Built Resilience: Dr. Iman Abuzeid of Incredible Health

Episode Date: November 25, 2020

Dr. Iman Abuzeid is the co-founder and CEO of Incredible Health, a digital platform that helps streamline the hiring process for nurses and recruiting hospitals. After seeing an increased demand for nurses in April, and a shift to hiring digitally, the platform has now been able to expedite the hiring process to 15 days or less, compared to an industry standard of 90 days. These conversations are excerpts from our How I Built Resilience series, where Guy talks online with founders and entrepreneurs about how they're navigating turbulent times. Order the How I Built This book at:https://smarturl.it/HowIBuiltThisSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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And today we're going to hear from Dr. Iman Abuzhade, the co-founder and CEO of Incredible Health. It's a digital career platform where nurses create profiles and are matched with hospitals, making the hiring and onboarding process much quicker and much more efficient. It's currently being used by hundreds of leading hospitals across the country. So hospitals and health systems, they use our platform. and our custom matching technology to hire permanent nurses in what is 15 days or less right now. Usually the industry average is 90 days. Now, the reason the average is so high at 90 days is because we are experiencing a massive nursing shortage.

Even before the pandemic, the shortage was pretty bad. And it's now become even worse. So the few unique things about our platform and the way it works is that the hospitals apply to the nurses instead of the other way around. And so by flipping it around like that, it's a magical experience for the nurses. They create a profile. They sit back and relax and they hear from different employers. And they get to choose which interviews to accept or decline. And we also use our software and automation to screen the nurses as well as to custom match nurses to the right employers too.

So it's sort of like a job site, but of course the nurses are not applying for jobs, just putting up a profile. It's sort of like LinkedIn meets match.com in a way, I guess, right? And hospitals. You're right. I mean, chief nursing officers refer to us as the match.com of hospitals and nurses all the time. So, yeah. So how does hospitals applying for nurses instead of the other way around help the shortage issue for both sides? Our demand for health care as a country keeps going up. You know, our population is aging.

Of course, pandemics don't help. And we just simply don't have enough workers in the system. Like by 2024, we're going to be one million nurses short. And that shortage just keeps getting worse. worse. Now, what's happening inside a hospital or a health system is the way they hire really hasn't changed since the early 90s, right? Like, it's posted a job and hope something happens. Unfortunately, like, that process and that kind of outdated technology is not sufficient to operate in such a competitive talent market like this. That's why by adding the, you know, changing the model

so they're applying to the nurses, adding the screening, adding the custom matching has really accelerated the hiring and why we're used at over 250 hospitals and health systems across the country today. My step-sister is a nurse, and this shortage crisis that you mentioned is obviously an acute crisis. Before we talk more about, you know, how incredible health is kind of streamlining this process. Let's just talk for a moment about this crisis in nursing. I mean, I know maybe people watching don't know. You are a doctor by training. You're an MD and also an MBA. How do we even begin to change this? Presumably, you have to attract more people to. the nursing profession, how do you do that? Yeah, that's a great question. Yes, we have to,

as a country, have to solve the underlying supply. And we need to not only attract more people to the nursing profession, but even for the nurses that are graduating, we need to expand the amount of training that we have for them as well, because there's bottlenecks in both places. There's a few ways to do that. So one is really, I guess, promoting the profession as a fantastic profession. Look, at the end of the day, yes, nurses are, they do work a lot. You know, sometimes they do feel underappreciated, but this is a relatively high-paying profession after you complete your education. It seems to me that we should pay or subsidize their education, that becoming a nurse should essentially be free. I 100% agree. So for Incredible Health

specifically, you know, we provide free continuing education to every single nurse in the country. Continuing education is needed to renew and activate their licenses, and they usually have to pay out of pocket for it. Just on continuing education, which is, you know, those are courses that you do after you become a nurse. You know, we figured this is crazy. Let's just give it away for free. It's accredited in all 50 states, and they can just simply get it done inside the incredible health application. So there needs to be more programs like this across the board that essentially make the education and the training of nurses cheaper and cheaper and ideally free. I just cannot believe that you've packed so much into your life already. You have a medical degree and an MBA.

Did you, by the way, did you ever practice? I actually did not. So I finished medical school, and I always wanted to make an impact kind of on a more system level. And don't get me wrong, look, one-on-one patient care is amazing, but it's not very scalable. Things like software and technology are highly scalable. You can literally transform an entire industry. The genesis of incredible health came from my background. right? So I am an MD. I have a lot of friends and family members that are doctors as well

who are often complaining about understaffing. At the same time, my co-founder, who's a software engineer from MIT, Rome Portlock, his sisters are nurses. And they were saying, hey, I'm experienced and I'm qualified, and it still takes me two, three months to get my next job. I apply to 10, 15 places. I often don't hear back. This is a very common experience for nurses, by the way, even today. And so we just figured there just has to be an easier way to solve this problem. So essentially the problem you identified was this kind of the process, right, of hiring nurses was broken, which doesn't make sense, right? Because you would think, you know, with a shortage and hospitals needing nurses, they would bring them on. But hospitals are also big bureaucracies with lots of different challenges.

So I guess it does make sense. You identified this problem, which was the hiring, the onboarding process and all the bureaucracy involved. You decided to figure how to streamline it. And that was the genesis of Incredible Health. That's right. And it's now expanded beyond just the place where a nurse finds a job. It's a place where he or she manages their career. I mentioned continuing education earlier.

We also have free salary estimators. We have a couple more services that are launching at the end of this year as well. That's exclusively for nurses. So it's really become the place where you can manage your entire career on Incredible Health. Wow. I'm wondering, Iman, how does the businessmen, model work. Do hospitals subscribe, pay a subscription fee to the site, or do they pay, you know, every time they hire somebody, you get a fee, sort of like Zoc Doc's model? Yeah, it's designed as a

subscription, and within that, you know, the hospitals are picking, are selecting different tiers that are based on volume. But it's, of course, 100% free for the nurses. When nurses go and work at hospitals, do they tend to stay at the same hospital for a long time, or is there a high turnover? Are they moving around to different hospitals? Yeah, so, for For our platform specifically, we only do permanent workers, right? We don't do any contract workers. Now, look, nursing in general is known for high turnover, right? So usually it's at 17% as a national annual turnover right now.

And so retention is also a hot topic and a very important topic for these employers as well. And we'll try to do whatever they can to keep their nurses. So let's go back to the beginning of this year. At what point did you realize that this pandemic was going to be a major problem and that the service you offer was potentially going to be in high demand? I figured this out, put this all together probably in January, early February, and that was because I was on Twitter. And honestly, the most amount of information was coming from epidemiologists and MDs and public health experts around the world because we weren't getting real-time data here. in the U.S. So Twitter was actually my source for figuring this out. I know you've got a team of about 30 people. You're based in San Francisco, right? We are headquartered in San Francisco,

but our team is in different parts of the country. So when you realize that this was potentially going to be a huge issue, did you see an immediate spike in demand for your services? We did. Certainly by April, there was a spike in demand for specific types of nurses. If you were an ICU nurse or an ED nurse, like hiring for that, like, increased like by 3X on our platform, like, right away. And we saw it drop for some of the other specialties because, you know, surgeries were getting canceled. But since then, since July, August, the demand for every single role has dramatically increased because not only our hospitals operating at full capacity, they're also dealing with this pandemic. So how did you start to position your, your company,

your business to meet that demand? So there were a few things that we did. A few months ago, we launched what we called the pandemic hiring suite, right? And what that is, is a range of features and tools that even more dramatically accelerates the hiring and really helps the hospitals reduce costs because they had gone through some very severe financial hardship, right? So a couple of the things that we did was we added in automated interview scheduling, remote interviewing, because that's just what you have to do during a pandemic. in-app chat, you know, enhanced our matching algorithms. All of these were the goal of accelerating the hiring even further.

So we got it down to 12 days now. And on average, we save every hospital that we work with at least $2 million because they dramatically try to reduce their travel nurse costs as well as their overtime and HR costs. So essentially last year or the year before, if you were a nurse using your platform, you would have done an in-person interview at least one. you would have traveled to the hospital. And that, of course, has gone away. That's gone.

So that's not even a feature anymore. Now everything is happening virtually. Correct. And that has accelerated the process. So now it's meant that the average hiring period is just 12 days. From the time that somebody identifies a nurse they want to the time that nurse has offered a job. From the time the nurse accepts the offer. Yeah.

How are the interviews happening? Do they go through an interface on your site or is it just like a Zoom? call. Yeah, the first set of interviews are all facilitated through our software and our site. And we have automated interview scheduling built in that requires like zero integration with hospital IT teams so that it was very rapidly adopted by both the recruiters and the nurses. Did you build that this year? Yeah, at the beginning of this year. I mean, it was in our roadmap. We just had to accelerate it because of the pandemic. How did you ramp that up so quickly? It's just a case of prioritization when it comes to product roadmaps, right? Like, you just kind of, you just kind of

to shift things around and you prioritize what your customers most urgently need right away. Half our team is software engineers. And so we are able to ship product. Honestly, we ship code every single day and do product launches every single quarter. So when you release that, that's a pretty, you know, sophisticated feature right on your site where you can now interface and do an interview through the site. When it was initially released, was it perfect? Has it been improved upon? Was it a little glitchy at first? Yeah, of course. It was not perfect. You know, the priority was to release it fast, even if it was imperfect, and then we dramatically, you know, rapidly improved it over time.

Do you think that you could have done something like that so quickly without the urgency of the pandemic? Honestly, yes, because one of the values of our companies is speed. I just believe one of the only competitive advantages you have as a startup is you can operate and you can execute far faster than any of your incumbents and anyone else. So we generally move as quickly as humanly possible. And so the improvements to our platform are rapid, even before the pandemic. Tell me about your workforce. I mean, you're based in San Francisco, but you've got a distributed workforce or pre-pandemic where most people coming into an office in San Francisco? Yeah, so half our team is in San Francisco,

and we do have an office here in San Francisco, but half the team are in other parts of the U.S. That's been really helpful because we do serve clients, you know, all over the country. And, of course, at the moment we're fall fully remote. We are going to keep our office, so we're likely going to do this hybrid model. So people will kind of work from home or come in a couple days a week, depending on how it works for them. You know, you said half of your workforce are engineers, so presumably they are kind of self-sufficient. But what about the rest of the team? I mean, you are the CEO of the company, and, you know, even the best of employees are, it's a challenge this year, right? So there are lots of challenges of people are dealing with, whether it's family,

issues or just, you know, loneliness and isolation, morale, how are you, how have you been handling those challenges with your team? You're right. I mean, it's, it's been a very challenging year mentally, right? We had done a quick survey of our team and it was like 50% were experiencing some kind of symptoms of anxiety or depression. And I think that's pretty common across the board, across the country. So there were a few things that we did. So the first thing is just in the acknowledgement and communication of the problem. Everything from just like, hey, like, we understand everyone's going through a tough time right now and just saying that explicitly and saying that we understand.

And then also for certain groups of employees, like, you know, the parents with the young kids, right? Or the person in an apartment with three other roommates. I mean, they were under even additional strain and saying that, hey, it's okay if we're on a Zoom call that your, you know, your kids shows up, right? That's perfectly acceptable. The second thing we did is just really invest more time on just improving the setup, right? So everyone got a work from home like stipend to set up their office space at home. For some employees, they did have to like scale back a little bit in terms of their hours

and switch from full time to part time, which is completely understandable. And then the third major thing that we did is just kind of dramatically improve our communication and our interaction as a team in a remote setting. So whether it be like our weekly hangouts or coffees that we do every Friday, our game, you know, game afternoons, you know, just adding more of these intentional communication touchpoints was really helpful as well. When we come back in just a moment, Imman describes the biggest changes she's seen in the healthcare industry during this unprecedented year.

Stay with us. I'm Guy Raz, and you're listening to How I Built This Resilience Edition from NPR. And one more thing, the New York Times best-selling book, How I Built This, is now available. It's a great read and a great gift for anyone looking for ice. Ideas, inspiration, wisdom, and encouragement to have the courage to put out an idea into the world. It's filled with tons of stories you haven't heard about how some of the greatest entrepreneurs you know and respect started out at the very bottom. Check out how I built this, The Book, available wherever you buy your books.

Hey, welcome back to how I built this Resilience Edition. And I'm talking with Dr. Iman Abouzaid, the co-founder and CEO of Incredible Health. And she says the healthcare industry has had to adapt very quickly to meet the increased demand for services during the pandemic. The biggest change I've seen is the rapid decision-making and rapid adoption of whatever solution there is, right? So, you know, historically, the healthcare industry has just been known for lots of red tape, bureaucracy, like, can't get anything done fast. And this year just, like, really dramatically changed all of that. whether it's the adoption of telemedicine, adoption of, you know, operational infrastructure like incredible health and others.

Like it was the speed in which they started to move and operate and make decisions has been, we've never seen anything like this before. I've had two consultations with my doctor this year for minor things, you know, like a skin issue and I got a COVID test just out of safety a couple months ago. You know, the doctor that I used to go see, she was just a remote call. And as you know, CMS is now reimbursing doctors for consultations with Medicare patients, which is a new feature this year. Do you think telemedicine now is here to stay and will actually be the predominant form of medical care in the future? I think it is here to stay.

At the end of the day, the healthcare industry as a whole needs to really focus on customer service, which is like basically the patient experience or many phrases for that. And if patients are adopting telemedicine and you're going to get reimbursed for it, like as you just described, then there is no reason why it would not be fully adopted. Now, there's a few, you know, areas that need to get figured out. You know, there are entire communities in the U.S. that don't have access to these devices and don't have Internet access and so on. So it's not a solution for everyone in every single location and every person. But the adoption of it, the dramatic adoption of it is here to stay. Anyone who's been to a hospital for any reason knows that you interface mostly with nurses.

And nurses are the people who make your experience better. There's a bunch of questions coming in. I'm going to ask, this is more of a comment from Paddy McLaughlin. She says that she is a registered nurse. She went through a refresher course at the age of 63, but nobody would hire her. And she believes it's blatant age discrimination. You know, she says she had great references and did really well in her refresher course. She got certified in BLS and ACLS.

I don't know what those mean, but you do. Yeah, they're certifications. And apparently we're getting a lot of nurses responding to that comment on Facebook who are saying, yeah, same experience. First of all, do you think that is a common experience? And then the second question I would have is, if there's a shortage in nurses now, wouldn't hospitals want to hire somebody like Patty at age 63? Yeah.

So unfortunately, it is a common experience. not only do older nurses get hired less, even if you took a gap from the workforce, right? Like you had to raise your kids or, you know, you just have to take a few years off. That also reduces your hiring, you know, chances and opportunities. And you're right, that is really unfortunate because, like, there's a dramatic shortage. And we need every able body we can get. You know, a lot of that has to do with just the existing, I don't know, bias, right? That just exists among employers today.

And that's across all industries, not just healthcare. And so this is one of the, a really important topic because it's something that we track really carefully because we're a software platform, we have so much data on this. Like I'll give you another example of a human bias that's been introduced or that we noticed. We noticed that nurses that lived further away from a facility were less likely to get interview requests on the platform, even though they wanted to, you know, live in wherever it was L.A. or Dallas or whatever it was. And what we did is we just removed the current location of the nurse, right?

And we just saw that human bias just removed. It was gone. You know, hiring in general, you know, there's a lot of preconceived notions and biases and so on that just have to constantly be addressed in order for it to get better. And the great thing about a software platform is it can really highlight this data at scale and so we can have more informed discussions about it. Could you also remove age from the site? The tough thing with age is that, you know, work experience.

of course is required. And so absolutely age is not part of the nurse profile, but work experience is. And so sometimes, you know, employers can tell from that. I mean, I would rather have a 63-year-old nurse than a nurse just out of nursing school. Not to say that a nurse out of nursing school isn't great, but I mean, a 63-year-old nurse or 65-year-old nurse is coming with decades of experience. I mean, to me, it would seem like a no-brainer that you would want somebody with that experience at a hospital. And you do. Look, and that's not to say that older nurses don't get hired. Look, there is a huge. huge cohort of nurses that is approaching retirement, which is going to be at another stream when they do retire. So regardless of what age you're at, like nurses are needed, whether you're a new

graduate, 10 years experience, 30 years experience, you're needed. Yeah. Here's a question for Mark Monroe. It's more asking you to put on your entrepreneur's hat for a moment. He writes, as someone who's built a hiring platform, I'm wondering what your, I'm on what your best interview practices are. Oh, that's a great question. So, well, there's interview practices for nurses specifically, and there's interview practices for technology workers, and so I'll just answer it in two different ways. So in terms of interview practices, when we're hiring for our team, the most critical thing is to get phrases like cultural fit and like my gut feeling.

These kinds of phrases need to just be removed from any hiring process. Totally. They're nonsense. They're complete nonsense, right? So what we've done is like really have improved on this and got really diligent with our hiring process. So every single interviewer has specific questions that they must ask. Like literally there's a guide and they have to follow the guide, right?

The way the rubrics that the interviewers fill out afterwards are very regimented. We do training for the interviewers as well. And then we think through a hiring process is not just like asking behavioral questions, but you have to ask case studies or you do a presentation to kind of test like a range of different skills. Now for nurses specifically, I don't think nurses should assume because they're very, experience that they know how to interview. And we've just seen it time and time again that, you know, very experienced nurses can sometimes bomb interviews. And so we have put together pretty

detailed interview preparation and guides that are available on our site and free to everyone that have like the do's and don'ts for nurse interviewing. Everything from like, you know, don't bash your former employer. Don't say you're looking for the job because of money. You should be saying it's because it's about patient care. And, you know, just things like that. You just need to present yourself in an extremely professional way. I'm sorry, I keep calling you, Amon, I should be calling you Dr. Abizaid. Oh, no, please. That's totally fine.

How do you prevent, or as best you can, systemic bias in hiring? Nurses come from diverse backgrounds, and there's an incredible need. For example, nurses who are bilingual, who speak Spanish, et cetera. But how do you build in barriers to prevent the kinds of bias that, that happened in the hiring process? Yeah, that's a great, great question. I mean, look, there's several tactics for addressing bias, but a huge one is just acknowledging it and measuring it, right?

So there's a whole set of best practices around just measuring your entire funnel, how you're sourcing and like almost like tagging every candidate that's coming through based on some kind of demographic data, right? And then that way you can quickly, based on the data, acknowledge and realize where the bias is happening. After getting that information, you know, then it's time to implement some best practices to reduce the bias. That could just simply be training that's needed for the interviewers. That could be, you know, completely adjusting your sourcing methodology and like attracting candidates from different sources. You know, for Incredible Health specifically,

there's a few things that we do. For example, nurses can pick avatars instead of their profile pictures if they don't want to kind of reveal how they look. We absolutely do a random sort inside the application on the employer side. The nurses are randomly listed, so everyone has equal opportunity to interview requests. You know, there's a few other things that we do to kind of constantly reduce the bias that can be introduced. You can imagine working with like social scientists, for example, to experiment with, you know, not using names, for example, because as you know, names are often a source of bias, right? It's often where the bias begins. We've tried, you know, removing names, even removing pictures, the number of interview requests you receive drops.

There's something about software where like it's, there's almost like a human connection that you're trying to enable inside a software platform. Things like names and pictures enable. I mean, how do you think that this year has changed your company's overall strategy? It's changed our strategy in a few ways. So one in terms of just, we talked about the product changes, has to dramatically reprioritize and reconfigure things and really double down on what's it going to take to help hospitals and nurses find each other faster and interview remotely and dramatically reduce the cost for the hospitals too. The other thing that's changed is just like where we expand geographically. You know, when the pandemic first hit in, you know, April,

you know, we just have to delay all our New York expansion plans, basically, right? And as a pandemic has spread throughout the country, we have to adjust where are different expansion plans. At this point, hospital and health systems have honestly become quite accustomed to the pandemic, and they're very prepared, and they have the personal protective equipment, and they're making adjustments needed, and they're not, just a lot better prepared now. So we've been able to kind of really roll out our geographic expansion plans as normal. Last question for you, Ma'am, I'm going to ask you, again, to put on your entrepreneur's hat. For someone watching this, who's looking at you now, an MD,

an MBA from Wharton, I believe you are the child of immigrants. Am I right about that? I am, yeah, yes. I think your parents came from Sudan. Is that right? That's correct. Yeah. So if somebody, somebody looking at you now and, you know, looking at you as somebody who's inspiring them, do you think it's a good time right now to start a business or maybe to go to business school or to, you know, to dive into this uncertain world of entrepreneurship? Okay. So obviously, I'm heavily biased here. But I, an opinion I have is the epitome of what you can do with your business career is to start a company. And that's just, that's not a fact. That's an opinion. The excitement, the learning, the skill

development that comes from entrepreneurship is dramatic. Now, of course, with that comes an intense amount of resilience that's needed and, you know, you got to manage your mental health pretty carefully as well. But it's the quickest way to learn as much as possible. And sometimes we need to evaluate the risk and the perceived risk a little more carefully. It's not, you know, there have been a lot of layoffs this year. So like just working a normal job is not necessarily like full proof either. So yeah, I highly recommend it. That's an excerpt for my conversation with Dr. Iman, Abu Zaid, the co-founder and CEO of Incredible Health.

To see our full interview, you can go to facebook.com slash how I built this. And if you want to see all of our other past live interviews, you can find them there or at YouTube.com slash NPR. And if you want to find out more about the How I Built This Resilience series or other virtual NPR events, you can go to NPRPresents.org. This episode was produced by Liz Metzger with help from Jacey Howard, Will Mitchell, Bruce Grant, Matt Adams, Elmanion, Gianna Cappadona, John Isabella, Julia Carney, Neva Grant, and Jeff Rogers. Our intern is Farah Safari. Thanks for listening. Stay safe and happy Thanksgiving. I'm Guy Raz, and you've been listening to How I Built this Resilience Edition from NPR.