Kaiser nurses say AI, surveillance are making their jobs and patient care worse
Kaiser nurses say AI, surveillance are making their jobs and patient care worse
凯撒医疗护士称：人工智能与监控正在恶化他们的工作环境及患者护理质量
KAISER PERMANENTE NURSES who answer advice and triage calls say their duty of care for patients is being increasingly threatened by workplace surveillance. Seven current and former nurses told CalMatters that those who spend more than 15 minutes on a call with a patient routinely face criticism from Kaiser management or get called into performance evaluation meetings. Call time, they said, factors into monthly performance scores they receive.
凯撒医疗（Kaiser Permanente）负责接听咨询和分诊电话的护士们表示，他们的患者护理职责正日益受到工作场所监控的威胁。七名现任和前任护士告诉《CalMatters》，凡是与患者通话超过15分钟的人，通常会面临管理层的批评，或被叫去参加绩效评估会议。他们表示，通话时长会被计入他们每月的绩效评分中。
In addition to tracking call length, they said Kaiser uses software that tries to predict on a daily basis whether they’re being unproductive or failing to answer calls quickly. Artificial intelligence systems have also been used to rate their empathy and tone of voice. Their comments come as the California Nurses Association begins negotiating a new contract with Kaiser this month with AI a likely issue. Kaiser nurses went on strike against AI for one day in March and picketed against AI last fall. The CNA is bargaining for 25,000 nurses, including 1,000 in call centers.
除了追踪通话时长外，他们还表示，凯撒医疗使用软件来预测他们每天是否“效率低下”或未能及时接听电话。人工智能系统甚至被用来评估他们的同理心和语调。这些言论出现之际，加州护士协会（CNA）正于本月开始与凯撒医疗进行新合同谈判，人工智能很可能成为焦点议题。凯撒医疗的护士曾在3月份为抗议人工智能进行了为期一天的罢工，并于去年秋天举行了抗议活动。CNA此次代表2.5万名护士进行谈判，其中包括1000名呼叫中心护士。
At the same time, California lawmakers are considering several bills regulating AI in the workplace, including one that would protect from retaliation doctors and nurses who override automated care recommendations. Kaiser defended its use of AI, saying it deploys the technology with patient safety in mind and does not use “average handle time” to assess performance.
与此同时，加州立法者正在审议几项监管职场人工智能的法案，其中包括一项旨在保护那些推翻自动化护理建议的医生和护士免受报复的法案。凯撒医疗为其使用人工智能的行为进行了辩护，称其部署该技术时始终将患者安全放在首位，且并未将“平均处理时间”作为评估绩效的指标。
Kaiser Permanente is the largest private employer in California, providing healthcare services to more than 9 million people in the state and to 3 million other Americans. That means the company’s use of artificial intelligence could set important precedents for managing workers with AI. It could also have a big impact on patient care, providing an early example of how the healthcare sector balances cost-cutting automation with human presence or touch.
凯撒医疗是加州最大的私营雇主，为该州超过900万民众以及其他地区的300万美国人提供医疗服务。这意味着该公司对人工智能的使用，可能会为如何利用AI管理员工树立重要的先例。这也可能对患者护理产生重大影响，为医疗行业如何在削减成本的自动化与人文关怀之间取得平衡提供了一个早期范例。
Raquel Alvarez Sanchez, a Kaiser Permanente advice nurse in Vallejo since 2010, said she was on a call with a patient who was suicidal last year that took more than an hour because she had to wait for police to arrive before hanging up. She tried to make the man feel cared for, even though she was cognizant that staying on the call that long would throw off her average call time for weeks and could lead to questions from management.
自2010年起在瓦列霍担任凯撒医疗咨询护士的Raquel Alvarez Sanchez表示，去年她曾接到一名有自杀倾向患者的电话，通话持续了一个多小时，因为她必须等到警察到达后才能挂断。她努力让对方感受到关怀，尽管她清楚通话时间过长会拉低她未来几周的平均通话时长，并可能引来管理层的质询。
Sanchez, a union steward, said she’s accompanied colleagues to performance evaluation meetings, where they were found to have done everything right on a call — except staying on the line for more than 15 minutes. She said she hasn’t seen nurses get fired for doing that, but she fears that continued pressure can lead nurses to quit or retire early. “I think at some point all of the nurses have been talked to about their average handle time,” she said. “The only thing I can think of is they’re doing it for profit.”
身为工会代表的Sanchez说，她曾陪同同事参加绩效评估会议，会上发现同事在通话中表现完美，唯一的“问题”就是通话时间超过了15分钟。她说，虽然目前还没看到有护士因此被解雇，但她担心持续的压力会导致护士辞职或提前退休。“我认为所有护士在某个阶段都被谈话过，内容都是关于他们的平均处理时间，”她说，“我唯一能想到的就是，他们这样做是为了利润。”
Another nurse who spoke with CalMatters on condition of anonymity due to fear of retribution described how that surveillance affected a call with a patient last year. Initially she thought her patient, an elderly woman who just received a terminal cancer diagnosis, was suicidal, but quickly came to understand that she was in shock and really needed somebody to talk to. The nurse wanted to take time to show compassion or comfort to the woman, who acts as a caretaker for her daughter, but she stopped herself out of fear it would hurt her monthly performance score and lead to a reprimand from her manager. She became a nurse to provide people with compassionate care, but “I had to ask myself: Am I going to get disciplined for going off script or saying more than what is necessary?”
另一位因担心报复而要求匿名的护士向《CalMatters》描述了这种监控如何影响了她去年与一名患者的通话。起初，她以为这名刚被诊断出患有晚期癌症的老年女性患者有自杀倾向，但很快意识到对方只是处于休克状态，非常需要有人倾诉。这名护士本想花时间去安慰这位还要照顾女儿的女性，但她克制住了自己，因为担心这会影响每月的绩效评分并招致经理的训斥。她成为护士是为了提供充满同情心的护理，但“我不得不问自己：我会因为脱离脚本或说了必要之外的话而受到纪律处分吗？”
Kaiser Permanente says its performance evaluations help improve patient outcomes. A company spokesperson said, “Kaiser Permanente does not use Average Handle Time to assess agent performance or enforce call time metrics. Any tools used in contact center settings support our quality assurance efforts and have human review and oversight.”
凯撒医疗表示，其绩效评估有助于改善患者的治疗效果。公司发言人称：“凯撒医疗不使用‘平均处理时间’来评估员工绩效或强制执行通话时长指标。呼叫中心使用的任何工具都是为了支持我们的质量保证工作，并有人工审查和监督。”
In a statement provided to CalMatters, spokesperson Vincent Staupe added that Kaiser uses AI responsibly, with human oversight, and by “prioritizing patient safety, privacy, and equity,” but he said, “As a large organization, we do not share specific information about internal technology systems for security and operational reasons.”
在提供给《CalMatters》的一份声明中，发言人Vincent Staupe补充说，凯撒医疗在人工监督下负责任地使用人工智能，并“优先考虑患者安全、隐私和公平”。但他同时表示：“作为一个大型组织，出于安全和运营原因，我们不会分享有关内部技术系统的具体信息。”
Is technology putting patients at risk? It’s not clear how patient care is affected by algorithmic management, nor is the impact of limiting the length of triage and advice calls on patients. Kaiser call center nurses can’t say for certain whether the pressures they face results in adverse outcomes for patients because their contact with patients ends after they hang up the phone. A 2024 public records request by CalMatters to the California Department of Managed Health Care found no complaints by patients against Kaiser related to call times. But nurses insist the risk to patient safety and quality of care is real.
技术是否正在让患者面临风险？目前尚不清楚算法管理如何影响患者护理，也不清楚限制分诊和咨询电话时长对患者的具体影响。凯撒呼叫中心的护士无法确定他们面临的压力是否会导致患者出现不良后果，因为他们与患者的联系在挂断电话后就结束了。《CalMatters》在2024年向加州管理医疗保健部提交的公共记录请求显示，没有患者针对凯撒医疗的通话时长提出过投诉。但护士们坚称，对患者安全和护理质量的风险是真实存在的。
Consumer Watchdog patient advocate Michele Ramos said many Kaiser patients begin their care on the advice line. They later complain to her, mostly about things that happen in Kaiser facilities, but “I can see now where a lot of the problems” start, given the call constraints nurses are under. “Kaiser’s been known through the years to manage dollars over managing care, … which is only going to fail patients.”
消费者监督组织（Consumer Watchdog）的患者权益倡导者Michele Ramos表示，许多凯撒医疗的患者都是从咨询热线开始他们的护理流程的。他们后来向她投诉，大多是关于在凯撒医疗设施内发生的事情，但“鉴于护士们所受的通话限制，我现在可以看出很多问题的根源在哪里。”她说：“多年来，凯撒医疗一直以管理资金而非管理护理而闻名……这只会让患者失望。”
Ramos said the time pressures may fit a broader pattern at Kaiser of putting costs over quality. The health giant was hit with a record fine, $50 million, as part of a settlement over findings from the California Department of Managed Health Care that it delayed behavioral health appointments beyond statutory limits and too often moved patients into group therapy.
Ramos认为，这种时间压力可能符合凯撒医疗将成本置于质量之上的更广泛模式。这家医疗巨头曾因加州管理医疗保健部的调查结果而被处以5000万美元的创纪录罚款，原因是其将行为健康预约时间拖延至法定限度之外，并过于频繁地将患者转入团体治疗。