CHAPTER 5

Take Two Robots and Call Me in the Morning: Robots in Health Care

Chapter Overview

Hospitals and assisted living facilities are likely to be among the first places where consumers experience robots in a significant and personal way. Hence, we devote this entire chapter to robots in health care. We first explore the various ways robots are already being used in health care, including as delivery robots in hospitals, as companion robots to keep the elderly company and also aid them in their health care regimes, as roving information sources in hospitals, as assistants in dental surgery, and (soon) as phlebotomists. We then explore public opinion regarding specific health care tasks, and see how accepting people are of robots taking on a variety of roles. We dig deeper to understand why there is support for robots assisting people with highly personal activities such as bathing and personal grooming, but resistance to robots taking on roles of greater skill and importance in health care, even though robots will likely be quite capable of handling these roles in the near future.

As we discuss throughout this book, over the next couple of decades there will be numerous areas of life where consumers will find themselves increasingly interacting with robots. The health care industry, and in particular hospitals, nursing homes, and assisted living facilities will likely be among the first places to significantly integrate robots into their daily functions. And this integration will be done in a manner that is highly visible and in many cases up close and personal with patients and visitors. We anticipate this for three reasons: (1) health care is a labor intensive industry where staff interact closely with patients, (2) many health care facilities must operate 24 hours a day, 7 days a week, with significant patient-oriented activities taking place around the clock, and (3) health care is a growing industry due to aging populations worldwide. Hence, we felt an exploration of robots in the health care industry, and the likely consumer response, was worth extra attention.

Robots in Hospitals

Moving food and supplies around a hospital is a larger task than many might realize. A recent study suggests the average moderate-sized hospital with 200 beds moves meals, linens, lab samples, waste, and other items the equivalent of 53 miles a day (Case Western 2018). That requires a lot of staff time and energy. Hence, enter the robots! Robots are currently being used in many hospitals for daily delivery services. The TUG robot by Aethon Inc. is a mobile robot that is advertised by its manufacturer as a multifunctional device that can assist hospital staff with activities such as: (a) delivering meals to patients and returning dirty trays, (b) delivering supplies, tests, and medications to patients and staff in a secure manner—using biometric security and pin codes, and (c) safely removing waste, including hazardous waste.

The TUG robot resembles a lockable mini-fridge on wheels. It has the ability to maneuver autonomously and intelligently around a bustling hospital, since it is programmed with the building’s detailed floor plan. It avoids collisions with humans and other equipment in the hallways and rooms via a system of sensors on its body. It also has voice capabilities to talk to people that it encounters during its daily duties. TUG is also used in hotels and other venues, though currently hospitals are the major user of this hardworking robot (see TUG robots at https://aethon.com/mobile-robots-for-healthcare/).

While TUG robots are currently deployed in U.S. hospitals, it is perhaps not surprising that Japan is in the forefront in using robotics in health care. This is due to Japan’s dramatic shortage of heath care workers, which far outpaces shortages in other developed countries. It is estimated that Japan will have a deficit of 380,000 nurses by 2025, a result of Japan’s aging population, declining number of working age individuals, and a national resistance to immigration (Emont 2017).

The Japanese have employed a fleet of delivery robots, similar to TUG, throughout their hospitals. These hospital delivery robots are programmed to maneuver around humans in their way or say “Excuse me, please let me pass,” if there is no way around. They are also programmed to return to charging stations when low on energy (Chang 2018; Osborn 2018). Like the TUG robot, these robots resemble rolling cabinets with an interactive screen on top.

In addition to hospital delivery robots, scores of other health service robots are in various stages of development in Japan. One, called Robear, is a robot developed in collaboration by the Japanese firms Riken and SRK. The human-sized robot resembles a friendly bear and is meant to carry disabled patients from their beds to the bathroom or to other places they need to be (Emont 2017; see photos of Robear at www.newatlas.com/robear-riken/36219/). Robear’s development has had some setbacks, such as difficulty ensuring that the robot does not hurt the frail skin and bones of the elderly. However, its developers are still bullish about its future.

The Chinese robotics company Qihan Technology Company, under the brand Sanbot, has created a robot it calls Elf. This cute, three-foot tall robot can be used in both informational and entertainment roles in health care, and can be found bustling about the halls of hospitals and elder care centers in China and other countries (it can also be found in private homes, as it can be used for a variety of functions). Regarding health care information, the Sanbot Elf can answer over 80,000 health-related questions that patients and their families may pose. Its informational database is continually updated with the latest medical information from a team of health care specialists, so these robots stay on the cutting edge of medical knowledge. Regarding entertainment, the company’s website (with perhaps not the best English grammar) says Sanbot ELF’s unique posture, action, voice and expression are embodied in fun and interactive capabilities, combining the entertainment, leisure, service applications in APP market, can reduce boredom and dull living atmosphere for more elderly users …. The robot has facial recognition technology so it can greet a patient by name. It can converse with the patient, play games, and show movies on its screen. See photos and videos of Sanbot Elf at en.sanbot.com/).

Turning to a different common health care activity, two billion blood draws are conducted annually in the United States alone. Researchers at Rutgers University in New Jersey are developing a robot that can quickly and efficiently draw blood. Using infrared and ultrasound technology, this robot can autonomously find an appropriate blood vessel faster than a human phlebotomist, and with robotic precision, can insert a needle into the human body with less error (Matchar 2018). In the near future, rather than banter with a human phlebotomist about how much you hate needles, you may find yourself conversing with a robot as it draws your blood. You can certainly still complain to the robot about your hatred of needles, though if the robot works as quickly as planned you will have significantly less time to do so.

There are also numerous robotic devices that assist with surgeries. However, since patients are generally sedated during surgery, there is little conscious interaction and hence will not be a focus of this chapter. Also, there is still a human surgeon at the helm, as opposed to a robot performing surgery completely on its own (though that will happen eventually).

Robots in Eldercare

Robots are currently actively supporting the elderly and disabled in nursing homes, assisted living facilities, and in private homes. These robots provide companionship, remind people about activities critical to their care (such as appointments and when to take their medication), and also assist in their treatment. Mabu, from Catalia Health, is one of these helper robots, designed to sit atop a desk or counter, with large eyes that blink, a permanent smile, and pleasant little face (See Figure 5.1). Mabu lives with elderly individuals, and communicates with them regularly, asking them about any symptoms they might be feeling and reminding them about medications and other treatments they need to undertake. As Rayfield Byrd, a 68-year old with diabetes who lives with a Mabu robot, recently stated in a Time magazine interview, Mabu keeps me on my toes about remembering to take my medication. And she asks if I’ve had any shortness of breath and other questions pertaining to my health. She keeps me aware of my breathing (Park 2019). Sounds like a positive and beneficial relationship, at least in Mr. Byrd’s case.

Figure 5.1 Mabu from Catalia Health

Buddy, from Blue Frog Robotics, is a more advanced social robot particularly suited for eldercare (though it has many other human-interactive applications for families and children). Buddy is a medium-sized robot (its height is up to an adult’s thigh), and certainly among the cutest, with an impish face projected on its screen. The robot is described on its manufacturer’s website as having a friendly and caring personality that will make you feel good (see Figure 5.2; also access a video of its home usage at www.youtube.com/watch?v=51yGC3iytbY). It is in the final stages of development and expected to be on the market in 2020.

Figure 5.2 Buddy from Blue Frog Robotics

Buddy has many social capabilities, such as the ability to play interactive games. Its facial recognition software allows it to read faces and expressions, and Buddy has the ability to respond with a variety of facial expressions of its own (happy, sad, surprised, etc.). It also provides home security, and can send alerts in the case of an intrusion or other unusual events. Its face serves as a computer touchscreen, allowing for the playing of music, sending messages, and other useful interactive functions. Buddy has sensors that allow it to move (via wheels) around the house, and facial recognition software to recognize people. It has the ability to read emotions and respond to them. In terms of its core functions, Buddy essentially does what many computers and home security systems can do. However, by placing these functions into a robot with a personable face, and the ability to recognize human faces and respond to human emotions, it can provide a degree of companionship to the elderly. Some might argue that a dog or cat can be excellent companions to the elderly, and they would well be right. However, live animals require care that is often beyond the abilities of an elderly person, or are not appropriate for certain health care settings. A robot such as Buddy is more hygienic and requires less maintenance than does a live animal.

Beyond serving as a companion, some robots have been developed to assist the elderly with various mental health and wellness treatments. For example, Paro, made by the Japanese firm AIST, is billed as a therapeutic robot, and is used regularly in the treatment of patients with dementia. Paro looks like a cute little harp seal. Its intelligent software allows it to react to being held and petted, much like an actual domesticated animal. It moves its head, closes its eyes, and makes happy sounds when held and stroked. It incorporates machine learning to remember what movements lead to it getting petted, and it repeats those movements in the hope of continuing the petting (not unlike a real animal). Research suggests interactions with Paro can have a calming and healthy impact on patients with dementia (Takayanagi, Kirita, and Shibata 2014; see images at www.parorobots.com/).

As mentioned earlier, Japan has gone further in utilizing robots to interact with the elderly in hospitals, nursing homes, and other settings than most other countries. Fuji Soft’s Palro, for example, is a conversational robot that entertains the elderly via conversations and game playing (Choudhury 2018). The name for this small but energetic robot is meant to be (in English) a combination of “Pal” and “Robot” (see images at www.palro.jp/en/).

What might a health care experience look like in the not-too-distant future? Perhaps something like as follows:

Consumer Opinion Regarding Robots in Health Care

Roboticists are feeling positive about the future of robots in health care, but are American consumers ready for the future these experts are envisioning? In one of our national surveys (sample size = 321), we tested 24 different health-related activities. For each, we asked respondents if they would prefer that activity be performed by a human worker, performed by a robot, or if they had no preference between the two. The set up for the questions was stated as follows to the respondents: Assume in the future robots are advanced enough to perform many tasks currently performed by people. Also assume at that time you are much older and dealing with a long term illness, and due to that illness you need help at home for a variety of tasks, and you also frequently interact with the health care system. For each of the tasks below, for you, would you rather that task be performed by a robot (which includes any type of smart, automated device) or by a human, or would it not matter?

This question set-up was included in the survey so that respondents would not think of robots as they currently exist but rather as robots in the future, when they could perform these tasks at the level of a human worker. This was done to help make it a fair comparison. It was also worded this way so that respondents could better envision themselves requiring these services, even if currently young and healthy.

The results showed a fairly strong preference for humans performing most health care activities. For only four of the 24 activities consumers preferred a robot over a human. For two activities, consumers had no preference between the two, and for the other 18 there was a clear preference for humans.

Health Care Activities Consumers Prefer a Robot (vs. Human) to Do

In only four of the 24 health care activities tested did consumers prefer a robot over a human to assist them (see Table 5.1). All four of these activities are highly personal, meaning the activities involve seeing the person’s body naked or while performing a personal bodily function. They are also simple activities, namely: help using the toilet, help bathing, help brushing teeth, and help dressing. Respondents feel that having a robot assisting with these private functions would be more discrete and less embarrassing than if a human assisted. As one respondent stated during one of our in-depth interviews, I don’t like the idea of hospital staff seeing me naked while helping me change or use the bathroom. Having a robot do that would be better. I guess I’m shy about that stuff and would feel less embarrassed with a robot. … I’d have to be sure it [robot] wasn’t, like, taking pictures or anything.

Table 5.1 Health care activities consumers prefer a robot (vs. human)

Health Care Activities Consumers Have No Preference Between a Robot and a Human

Two of the 24 activities we tested found a plurality, 47 percent in each case, saying it does not matter to them if a human or a robot performed the task as you can see in Table 5.2. The two activities are bringing food to your room and cleaning your hospital room. Regarding bringing food, of the half who had a preference, they were fairly evenly split between preferring a robot versus a human. Regarding cleaning the room, the half with a preference was twice as likely to opt for a robot cleaner versus a human cleaner.

Table 5.2 Health care activities consumers have no preference between a robot and a human

Health Care Activities Consumers Prefer a Human (vs. Robot) to Do

For the vast majority of health care activities we tested (18 out of 24), people prefer a human versus a robot to perform the activity for them. For 10 of the activities, consumers have a very strong preference for humans, with a clear majority preferring a human to do the task versus a robot. Some of these activities are seen as requiring a high degree of health care skill and insight, such as performing surgery, performing annual check-ups, answering medication questions, and analyzing scan results. Interestingly, one of the activities where people strongly prefer a human over a robot is purely social, namely acting as a companion. Another activity tested where a human is preferred in the role has a significant social component—acting as a personal trainer. As one respondent stated, I’d do better if I had a human trainer. I might just ignore a robot trainer. But with a person trainer, I’d have to do what they say.

Some of the other human-preferred activities are fairly simple, such as drawing blood and checking on you at night while in the hospital, yet consumers still show a strong preference for a human to perform that task. Regarding drawing blood, in-depth interviews suggest the fear of needles is a driving factor, and robots are seen as possibly lacking the care and emotional intuition to do this right every time. As one respondent stated, If a robot screws up, it can jam the needle deep into my arm. At least a human would know not to do this. A human can at least tell when you’re in pain. In terms of having a robot check on a patient at night, general distrust of robots makes many prefer a human should do this task. As one respondent said, It’s creepy to have a robot coming into your room while you are asleep. I can interact with a robot when I’m awake, but I don’t want it in my room while I’m sleeping. That’s just weird.

For eight of the activities, consumers have a moderately strong preference for a human versus a robot. In these cases, a plurality prefer a human—not quite over half, but still more than those who prefer a robot as shown in Table 5.3. These are generally more simple and straightforward tasks, such as serving as a receptionist, checking vital signs, and preparing food. It is worth noting that for two activities, the percentage preferring a human is numerically higher but the difference versus preferring a robot is not large enough to be statistically significant.

Table 5.3 Health care activities where consumers prefer a human (vs. robot)

*No significant statistical difference between robot and human preference for these two activities.

Robots in Dentistry

A separate survey of 500 respondents conducted by Embry-Riddle Aeronautical University of Florida asked American consumers about their receptivity to robots performing various activities in dentistry (Holland 2018). Their core findings were similar to ours—Americans are more accepting of robots performing simple procedures (such as dental cleaning and teeth whitening) and far less open to robots performing more advanced or invasive procedures where any significant health implications are involved (such as dental fillings or surgeries). The feedback from respondents was that they do not see robots being sophisticated or reliable enough to do these advanced procedures.

Yet, the dental industry, like other areas of health care, is charging forward into the robotic future. Neocis, based in Florida, received FDA approval in 2017 to market a first-of-its-kind dental assistant robot, named Yomi, that will help dentists with surgical procedures. Yomi looks like a giant robot hand attached to a high tech table, with multiple screens. According to the manufacturer’s website (www.neocis.com/), the Yomi robot physically guides the hand of the dentist to improve precision throughout the surgical procedure, relying on its in-depth analysis of the patient’s anatomy. Unlike surgery on other parts of the body, in many dental procedures the patient is awake. Hence, patients will see and interact with the surgical dental assistant. As we have witnessed elsewhere, China and Japan are pushing the envelope in robotics in this area. In 2017, China reported the first case of a robotic dentist installing two dental implants in a patient (Lui 2017).

In sum, the health care industry is investing heavily in a robotic future, driven by the intense labor pressures of high-touch services that often must be delivered around the clock. In many ways, health care will be the “tip of the spear” of the robotic revolution, because it will be one of the first settings where consumers will experience robots in an up close and highly personal way. Clearly, people are more comfortable with robots doing some of these health care tasks than they are with others, much as we have seen in the other areas of life that we explored in previous chapters. This does not mean they will never accept robots in many of the roles in which they currently have trouble seeing them. It does suggest, however, that health care companies need to be aware of the tasks and services regarding which there is the greatest public resistance, and put in place measures to slowly build up public trust. Trust in robots in health care, or any area of life, will take concerted communication efforts to build and sustain.

Implications for Consumer Behavior and Marketing Strategy

The implications for this chapter are the same as those for the last chapter, except applied to the health care industry. Take a stepwise approach to the health care roles in which robots are implemented. Start your implementation in roles where consumers are most comfortable with robots, such as help with bathing and personal care, with food delivery, and room cleaning. Build confidence there and then move to roles such as checking vital signs and assistance with medication. If possible, allow patients choices. Such as when robotic phlebotomists are implemented, give patients a choice between human versus robot. Let word of mouth spread among those willing to try the robot option, to inform their less trusting friends and relatives of their (hopefully) successful experiences.

As robot implementation is launched and expanded, maintain a communications campaign to get consumers to increasingly accept robots in these roles. Testimonials from previous patients should be a key aspect of these communications. Also, take a stepwise approach to the quantity of robots used, so that it is a gradual transition. In the near term, allow for a mixed team of robots and humans in support roles in hospitals and assisted living facilities. Be sure to get customer feedback on their experiences with robots, so you can continue to adjust accordingly.

As this chapter showed, there is already a fair amount of use of robots in consumer-facing roles in health care. Keep a close eye on these developments. Learn what is and is not working so you can optimize the robot implementation for your organization and, most importantly, optimize the experiences for your end users.