#239: Akram Boutros (Nexus Bedside) — The Future of Healthcare and Nursing

Akram Boutros [00:00:00]:
So think about this. These numbers is you take a 12 hour shift and out of that 12 hours we're saying is about three to four hours is all that you need a bedside nurse for. Or that is the amount of time they're actually dedicating to activities that only they could do. That that was an absolute light bulb moment. Forget how you deliver nurse care today. Tell us how you would, in a utopia, be able to deliver the care.

Jeffrey Stern [00:00:37]:
Welcome to the Lay of the Land podcast where we are exploring what people are building in Cleveland and throughout Northeast Ohio. I am your host Jeffrey Stern and today I had the pleasure of speaking with Akram Boutros, co founder and CEO of Nexus Bedside. Akram brings more than 30 years of experience experience as a healthcare leader, executive and clinician. He previously served as CEO of the MetroHealth system here in Cleveland from 2013 to 2022 where he led a team of more than 6,000 employees and 3,500 medical staff overseeing a nearly billion dollar revenue operation and complete Transformation of the MetroHealth Campus and Care model. Prior to that, Akram held senior leadership roles at multiple health systems across the country and he began his career as a physician and earning his Doctor of Medicine from SUNY Downstate Health Sciences. Akram is also a serial entrepreneur and in 2025 he raised a few million dollars of seed capital to found Nexus Bedside, a company reimagining inpatient nursing staffing working to fundamentally improve outcomes for patients, nurses and health systems overall. In this conversation, Akram and I unpack his full journey and perspective on healthcare and entrepreneurship from immigrating to the US and becoming a physician and to his decade leading MetroHealth to navigating a public and controversial departure from the public health system and ultimately experiencing the healthcare system as a patient himself. We explore how these experiences shaped his decision to start and build Nexus Bedside, his philosophy on leadership, lessons learned as an entrepreneur and the massive opportunity for AI in healthcare, and what he believes the future of inpatient care and nursing should be.

Jeffrey Stern [00:02:19]:
So with that, please enjoy this awesome conversation with Akram Boutras. Lay of the Land is brought to you and is proudly sponsored by Serity Partners. As a wealth management firm, Serity Partners shares Lay of the Land's same dedication to serving local business owners and the Serity Partners Cleveland team understands the challenges that entrepreneurs and founders face here in Cleveland, Northeast Ohio and beyond. Wealth comes with complexity and increased demands on time and resources. It is easy to become overwhelmed. Serity Partners clients benefit from a unified team of local specialists who coordinate across both business and personal needs. With Serity Partners commitment to transparency and putting clients needs first, complexity can become clarity. To learn more, please visit seritypartners.com or call 216-464-6266.

Jeffrey Stern [00:03:11]:
Today, Serity Partners proud to be recognized as one of the top financial advisory firms in the country. So, Akram, I know you've been through a pretty remarkable journey, I think professionally, from clinician to leading a large public health system here in Cleveland, to navigating the public conclusion of that chapter and reentering an experience both as a patient and now as a founder yourself. And if you zoom out kind of across the entire arc of that, I'm curious what you feel and see as the through lines and what connects that professional journey that you've been on and, and what underlying you're working towards.

Akram Boutros [00:03:55]:
So, you know, I would literally have to go back to being 15 years old and experiencing trauma. So I was hit by a moving truck when I was 15 years old and spent time in the hospital. That was really a pivotal moment in my life in which I decided since I couldn't really figure out what's coming next or how long I'm going to live, it's best to make the most of it and just try to make progress each and every day, be a better person, do more, be more helpful and more effective. So this, you know, I think the ups and downs of my career, there have been incredible highs and terrible laws, lows, excuse me, that there, there isn't. They don't matter as much as looking forward and not living in the past. Right. So I always say to my kids, the only time you look in the rear view mirror if you want to go backwards. So that's not something I want to do for any reason whatsoever.

Akram Boutros [00:05:09]:
So I constantly look forward. From my point of view, it's your delta set of cards and you gotta figure out how to play them and just keep moving forward.

Jeffrey Stern [00:05:23]:
Well, if you would indulge a retrospective look for a moment and some of the cards you were dealt, you know, I know beyond that, I mean, real tragic bus incident, you know, you also had immigrated to the US when, when you were a kid. And I'm just curious what that was like. And when you look back from where you are now, despite maybe you're not wanting to do that as much, what do you feel were some of those most formative moments and experiences and lessons from your upbringing that you feel have shaped who you are today and how you operate?

Akram Boutros [00:05:59]:
Yeah. So I'm the youngest of three boys we all came here. I was 12 and a half, my middle brother was 15 and my oldest brother was 17 and we left Egypt. And you know, I, I certainly didn't speak a word of English and, and my parents were both educators at certain points in their lives, so they took education and our school is the most important thing. So my brother and I weren't permitted to do anything except excel. My mom drove us pretty hard with my dad, instilled in us in a work ethic that was uncompromising. So it was a very, very difficult time and not a lot of folks who were from the Middle east at the time when I came in 1974. And so we have learned to overcome obstacles.

Akram Boutros [00:07:06]:
And as I said, there were no excuses either for my mom or my dad. You just had to get it done. And so I learned a great deal to analyze problems and try to overcome them. I went to the most violent school in New York City for 10 years in a row. We had murders inside the school. We had a lot of, really a lot of fighting going on in the school. And so you also learn to get along with a lot of people if you wanted to get out of there alive. So we, college was pretty good.

Akram Boutros [00:07:52]:
Met the most important person in my life and that's my wife at the age of 18. Went through the journey of being together, went to med school, got married while I was in med school, went to academic medicine to do business. I've always had businesses, even at the age of 15. I started the business at 17 and wanted, was asked to go into the business side of healthcare and that started my journey.

Jeffrey Stern [00:08:24]:
What, what drew you to, to medicine in, in the first place?

Akram Boutros [00:08:28]:
So I always liked sciences. I will tell you that it probably was my mother's cousin who in Egypt was just a terrific human being. Just he was such a wonderful person. And as a young person I equated his profession with who he is, that if I wanted to be as nice, as good of a person as he, as he was, I would go into medicine. So he would have been amazing in any profession. I just didn't realize that it just because he was a wonderful human being that he was in medicine. So that's what really drew me to it. And then the idea of being trusted at the most vulnerable times in people's lives.

Akram Boutros [00:09:11]:
And I consider it an honor, and I still do, to be able to impact people, people when they're in most in need.

Jeffrey Stern [00:09:19]:
And you mentioned you had also this kind of entrepreneurial inclination since you were pretty young as well.

Akram Boutros [00:09:26]:
Yeah, well, my dad was always in the business world and there was no risk taking, especially in the business side was something to be managed. It wasn't something to be avoided. So I sold you when I was. I was hit by the truck. I was hit while I was delivering papers and I had this great hip around and. Except I now ended in the hospital with both my legs broken and couldn't deliver papers. So I met the. The manager of the paper Rats called me and said, well, we're going to give you paper right away.

Akram Boutros [00:10:03]:
I said, hell no, I have a great paper, I have great customers. I am going to have someone deliver it for me. And I called a few of my friends and said, I'll take 20% of the tips, you guys get the rest of it. Let me tell you everything about everybody and how to do well. And that was my first foray into business.

Jeffrey Stern [00:10:28]:
Yeah. So I want to set a good stage here for the work you're doing with Nexus today. And I thought an interesting way to do that would be to explore the experience you've had really at every level of healthcare as a clinician, as a CEO, as a patient, as an entrepreneur, and just from your purview and perspective that you have, which I think is pretty unique as far as healthcare entrepreneurs go. Just what you came to understand about how healthcare works and where it works well and where it doesn't work and how that's kind of shaped your strategy in an approach to building something within this world.

Akram Boutros [00:11:13]:
Sure. So there is a. Think of it this way. I have the perspective of being frontline staff where I take care of patients and alongside nurses, technicians, other folks in the healthcare field. I've also had the opportunity to manage people who deliver kid. So did that and running departments and all of these types of activities to have the perspective of setting direction, analyzing problems and seeing if we can develop solutions through the strategy lens. And I did strategy for many years, then had to figure out how to keep all the trains running on top and they're not colliding with each other, which is by operating that I'm this chief operating officer and then finally a CEO, which is having 50 things on Flint view on understanding that there are lots of fires going on in hospitals today. And my job is not to actually put out the fires.

Akram Boutros [00:12:19]:
My job is to build the fire suppression system. All of those things, all of those wings were done from an experience, from an episodic interaction with the staff and patients and other personnel and always done from the vertical position where I was standing right when I was. When I was diagnosed with non Hodgkin's lymphoma. I ended up having this continuous interaction with the healthcare system that spend weeks and overall two months of continuous care from healthcare system. And this one was experienced from a horizontal position. And I would just tell you it gives you a very, very different perspective. I'm not sure the entrepreneur side makes much of a difference. I think these two aspects on what I've ended up experiencing and is really what shapes my view of health care and what needs to happen to improve.

Jeffrey Stern [00:13:30]:
What do you wish more people understood about what it takes to run a health system?

Akram Boutros [00:13:36]:
Well, there are, there are things that I think people don't realize and I think there are things that we whine about too much as healthcare executives. So I don't think people realize that it is incredibly complex. The rules of engagement, whether the regulatory, financial operations, quality, personnel, management, they interact like no other industry today. You can tell when with great flare, Google, JP Morgan and Berkshire Hathaway came together about eight or nine years ago. Instead they're going to reform health care and three years later they gave up and never created anything. It tells you how very capable people end up getting stymied with the amount of contradictory rules and nonsensical and non value added issues. So people don't understand how complex it is. But on the other hand is that the inertia, I can tell you is the vast majority of people who are in healthcare today complain about the status quo, but will do almost nothing about the status quo.

Akram Boutros [00:14:58]:
So they need a burning platform to really make these leaps of improvements and they have to be almost forced into it.

Jeffrey Stern [00:15:11]:
So when you think about your time at Metro and really this billion dollar transformation of the system, the culture, the capital plan, the expansion, what were the bets that you were making in light of the way that it works that you came to understand and what was your kind of vision for how to ameliorate a system like that?

Akram Boutros [00:15:38]:
So there were three things when I was interviewing that I noticed. I noticed that three problems that I noticed. I noticed many wonderful things. I noticed a staff that was absolutely committed to taking care of patients. People who could have gone and worked for University Hospitals or the Cleveland Clinic, but chosen to work at Mental Health to serve the underserved. There are so many positive things, their heart being the most important and really most extraordinary thing. The three things that I noticed was that first is that we treated patients as if we were the hospital of the last result resort. So that meant is that you, you got what you get.

Akram Boutros [00:16:36]:
We Expect patients to get what they get. I'm not gonna. And I said that's, that's absolutely the wrong way to do this. We should want patients to choose us, not that they don't have any other choice. We want everyone, those who have a choice and those who don't have a choice to want to talk to mental health. So, so that was the first thing I needed. The second thing is I noticed that everybody was willing to step in and help solve a problem, except we were like a centipede with every leg is going in a different direction. So a lot of frenetic energy, but not a lot of forward momentum.

Akram Boutros [00:17:18]:
So we needed to create, and literally during my first six weeks, create a new mission, vision and values for the organization to align us. And it's still the same mission, vision and values that we created 13 years ago. So that was a second thing. And then the third things was that I had to tell the frontline staff and the providers was their job was to take care of people. Their job was not worry about how we get paid, where we get paid, all of those different things. That was administration responsibilities. So I, I didn't, I wanted them to focus on what they know best and let us focus on what we know best. And that's why Metro Health, the last, the 10 years before I got there, they averaged about $6 million profit or $60 million across those 10 years before I got.

Akram Boutros [00:18:22]:
And in the 10 years of my tenure, instead of 60 million, we ended up having 600 million profit.

Jeffrey Stern [00:18:33]:
What's the best case scenario for a health system? Like, how do you think about what, as far as, like how good a health system could be? What does that look like? Like what was your North Star?

Akram Boutros [00:18:46]:
So there are four quadrants that I think about. So I think about outcomes, quality, safety and honestly, safety is the bare minimum, right? You want to go to a hospital and you want to not get hurt and we have way too many patients who get hurt in hospital. So safety and the quality of care is absolutely the most important of all the, you have to perform well in them while you are also having satisfied patients and providers. So I look at that from the service side. Having a committed staff that wants to stay and wants to be and is happy there and patients who want to come back and utilize the health system. The other one is operations which is making sure things are efficient so that they are. We don't have a lot of these non value added steps. I remember one process I did years ago, there were 43 different steps that needed to happen for a patient to get to the operating room and we reduced them to 14.

Akram Boutros [00:20:03]:
So that's a lot of wasted energy when you have 43 that you can reduce the and then financial strengths. You need to be able to be profitable whether you're a not for profit household or not, because you need to reinvest in care. So these are the four quadrants. Is there anybody who does them incredibly well? There are, there are organizations that I think have beaten odds. In New York, NYU Langone Health System does an amazing job. Northwell does incredible work Intermountain. So there are some extraordinary health systems. All of them still have challenges and all of them still have really monumental opportunities to improve.

Jeffrey Stern [00:20:57]:
Lay of the Land is brought to you and is proudly sponsored by Roundstone Insurance, headquartered in Rocky River, Ohio. Roundstreet Roundstone shares Lay of the Land's same passion for bold ideas and lasting impact from our community's entrepreneurs, innovators and leaders. Since 2005, Roundstone has pioneered a self funded captive health insurance model that delivers robust savings for small and medium sized businesses. They are part of the solution to rising healthcare costs, helping employers offer affordable, high quality care while driving job creation and economic growth throughout Northeast Ohio. Like many of the voices featured on Lay of the Land, including Roundstone's founder and CEO Mike Schroeder, Roundstone believes entrepreneurship, innovation and community to be the cornerstones of progress. To learn more about how Roundstone is transforming employee health benefits by empowering employers to save thousands in per employee per year healthcare costs, please visit roundstoneinsurance.com Built for entrepreneurs, backed by innovation, committed to Cleveland. So, you know, making our way towards Nexus here. Your your departure from from Metro was, was sudden.

Jeffrey Stern [00:22:09]:
It was, it was public. What does that period teach you in reflection about governance and trust and just those kinds of processes.

Akram Boutros [00:22:24]:
You know, I expected governance to perform the way I expected my staff and myself to perform. We were always prepared, we always documented our decisions, we always remembered them and we were very open about what we were doing and how we were doing it. As a matter of fact, the board would tell me that I often shared too much and explain too much and I just don't think that's the case. I if an employee in a town hall asked me a difficult question, they got an answer. It was the truth. So I expected that from the board. It turned out there are some folks who don't remember things, they don't record them as well as they should have and especially in meetings when I was not in there. So for example, most boards when they discuss compensation for executives.

Akram Boutros [00:23:20]:
They recuse that executive and rely on consultants to go through that information. But also, most boards would tend to provide a summary of the outcomes to the executive, not. Not the discussion itself. But. But look, here's what we examined, and here's the conclusion we've made. I never received any of those things, so I couldn't tell them that they, for example, that they weren't looking at actual numbers. They were looking at hypothetical, hypothetical numbers. Well, when they found out that they been doing that, that's a very embarrassing moment for people.

Akram Boutros [00:24:01]:
And the way they ended up. Trying to rectify what I would say is lack of governance on their part. And the auditor said there was a problem with governance. The higher ethics commission said I didn't violate any ethics laws or anything else. The county prosecutor said there were nothing criminal in anything that I did. And the auditor said my contract was ambiguous. So everything that I had done was according to the contract, my interpretation was fine, and also all the resolutions the board approved. So what it taught me is that you can't just assume that other people are working to the same level that you expect of yourself and your staff, that you have to make sure.

Akram Boutros [00:24:57]:
You have to make sure that that's happening. And you can't just assume that just because they're going into hours and hours of discussion with that consultant that they have all the information, just because the consultant's contract says that they will provide the compensation committee or the board with your actual remuneration, that that's happened. Right. So these are the things I assume because I read the contracts, and that's what it is. And that turned out to me to be not true. So for me, what I learned, I will tell you, is that who. The most I learned from this entire thing is that I may have had 2,500, 800 contacts in my contact list who I considered to be friends and colleagues. That number dwindles very quickly to about 200 when something like this happens.

Akram Boutros [00:25:54]:
And I so appreciate now committing my energy and love and care to these 200 rather than the 2800.

Jeffrey Stern [00:26:08]:
So with the time and space to reflect, perhaps additional perspective, you mentioned the horizontal one. How did you decide what to work on next? Again, I imagine from the perspective that you had, both as a clinician and as a leader of a large healthcare organization, just a really deep understanding of not only where the system is structurally strained, but structurally broken. And just of all the things you could have focused on, what is it about Nexus that got you inspired enough to focus your time and energy on this specifically and maybe just help introduce what Nexus Bedside is.

Akram Boutros [00:26:48]:
Sure. So when I was leaving Metro Alpha and I had announced my retirement and 21 that I was going to leave at December 31 of 22, I looked at what are the. Where, where are the areas where I could make a lasting impact, where I could help change things. And we had just come through Covid and the nursing crisis. Any way I sliced it, diced it, looked at solutions we were going to. Nurses were leaving the bedside at such a rapid rate and people were getting older at such a rapid rate that we are going, if the crisis is bad now, it's going to be disastrous in the next 10 years. So I said, well, having experienced inpatient nursing and inpatient care, there is no alternative. When you need a hospital, you need a hospital.

Akram Boutros [00:27:52]:
You don't have a, you can't have somebody who's hit by a truck or somebody that needs cardiac surgery, say, okay, I'm going to hold off. That was a very. I saw that as an area that needed a resolution. I also saw that we, the frontline staff have become slaves to that, to the electronic medical record, that they spend more time on that than other things. So that was a very large issue that I looked at. And then the last one was that there was a significant opportunity to provide more teamwork, especially on the inpatient side, that we were all acting like ships that. So when I left thinking about that and in February 23rd came up with a hybrid nursing model that uses virtual nursing and bedside nursing, the same team that switches roles on a regular basis to be able to deliver more efficient and better kit. And so I began looking at the technology to do that and began looking at studies and how to make create a new business, how do you fund it, all of those different things.

Akram Boutros [00:29:21]:
By September of 23, I was diagnosed with non Hodgkin's lymphoma and required inpatient stays one week about every month in the hospital. And that's when I got the horizontal perspective. And I became absolutely appalled at what nurses had to do to get through a shift and began to seriously understand why 60% of new nurses leave the bedside within two years. So I looked at nurses get interrupted, med storage, nurses get interrupted about 10 times and that's unsustainable. 20% of the work that they do is completely non valuable. Another 20% can be done by a non professional, non nurse. And of the remaining 60%, half of it has to be done could be done by a virtual nurse, a nurse that's not on site, that is not providing hands on care. And 30% has to be done by a nurse that's providing hands on care.

Akram Boutros [00:30:34]:
So think about this, these numbers is, is you take a 12 hour shift and out of that 12 hours we're saying is about three to four hours is all that you need a bedside nurse for. Or that is the amount of time they're actually dedicating to activities that only they could do. That that was an absolute light bulb moment. And it created, we began very quickly to look at new workflows that we started with nurses and asked them forget how you deliver nurse care today, tell us how you would in a utopia, be able to deliver the care. And I had a lot of experience with that. In the nineteen early nineties there was a company called Melamin, which still exists, it's a major actuarial company. And they said we want to create something called optimal recovery guidelines. And the optimal recovery guidelines is that if you had all the resources in the world and everything went spectacularly well, smooth, how long would it take to treat a patient with pneumonia? How long would it take to treat a patient who needed open heart surgery? And we had this fantasy that we created of these things that ended up becoming the optimal recovery guidelines.

Akram Boutros [00:32:04]:
Well, I did the same thing with nursing and we created these workflows that ended up taking away 60 to 80% of the documentation, electronic medical record documentation from the bedside nurse, permitting a bedside nurse, even if they have more patients than they had before, to spend twice as much time with every patient face to face hands on care than they did before the change, eliminate errors in medication delivery, eliminate falls and inpatients with injury, falls with injury, and improve the happiness of both the patients and the nursing staff. So, so we designed this thing and then we went to Ochsner Healthcare to do to test it and their stimulation lab and results were absolutely spectacular. And since going live in July, our results have really surpassed every other company in this space.

Jeffrey Stern [00:33:12]:
So what, what does this look like in practice? And what, what are those those results yield in reality?

Akram Boutros [00:33:20]:
So what we do is we go on a unit and see, watch exactly how they deliver care. We create, document the workflows and then work with them to eliminate the time wasted things and then break up the entire workflow between virtual and bedside nurses. And we utilize artificial intelligence to consistently improve and constantly improve workflows. And so if you are a patient and you get admitted to the hybrid unit, the bedside nurse comes in, greets you, gets the virtual nurse on tv, tells you that they are member of the team explains to you that they may be your virtual nurse today and then tomorrow they're going to be your bedside nurse and vice versa. And the virtual nurse now can and that takes about two minutes by the way. And the virtual nurse now can do the admission, the vast majority of the admission. They do about 80% of the admission and documentation and everything else in the medical record and leave only the physical exams for the bedside nurse. And once they're complete, they answer all your questions, do everything else.

Akram Boutros [00:34:33]:
They the bedside nurse comes back and first finishes the admission. And every time a nurse needs to check on you or you need to talk to a nurse, all you have to do is say hey Nexus, get nurse. Then they will pop up. We utilize cameras and very high definition cameras and AI to understand what's going on in the room and be able to take care of patients. We can monitor patients vitals as we can. We utilize our cameras to be able to do that. We can even diagnose a patient who we've diagnosed patients who are having a stroke using the ETZ camera. We've diagnosed patients who are having a seizure.

Akram Boutros [00:35:17]:
We've also eliminated a lot of falls and been able to do a lot of these different things. We answer questions for patients and families when the doctors and the nurses aren't available. The virtual nurses do that and we monitor the patient on a regular basis. So typically bedside nurses are supposed to do go see every patient every two hours at least once. Well, they're passing medications, they're answering phones, they're writing in the medical record, all of that. And a typical hospital you see compliance rate between 35 and 40, 45% with our model, 93% compliance rate with hourly rounding. And that helps patients get better quicker because we're constantly taking care of them and responding to their needs and lowers length of stimulus.

Jeffrey Stern [00:36:22]:
What is the business model?

Akram Boutros [00:36:24]:
We get paid for our technology and our workflows. And we also, I think we're the only company that has a nurse executive who actually stays with organization that we pay for a client success partner that is working with the staff every day to make sure they're optimizing the process. So we get paid per patient per day amount. And then because we are so confident in our results, we guarantee certain results and we get paid on improvements. These could be everything from payroll reduction per discharge to length of stay reduction, to patient satisfaction improvements to reductions and vacancies reduction and turnover. A lot of different things, quality measures, all these different things. So we have base amount that we get paid and then we get paid on results.

Jeffrey Stern [00:37:34]:
So you mentioned this deep rooted inertia, kind of structurally embedded in the system and also your eye towards know the future and what comes next. And when you take everything that you're working towards and you imagine this version of the company that fulfills the reason that you founded it in the first place, like what, what does that world look like? What is the ideal state? How do you know you have gotten it right at that point? And what, what is, how do you think about what success means for an exis?

Akram Boutros [00:38:08]:
So success means we will have enough market share to have changed how the industry works so that this hybrid model gets adopted. And by the way, we are very happy to have other companies copy us and provide the same type of services. We can't take care of everybody, we cannot provide these services everywhere. We just want to be the best, we don't want to be the, the most utilized. Right? So it's not about how many units we're selling and how many people we're taking care of. We want to be constantly at the tip of the sphere. We want to be able to provide that through. Imagine never having to wait in an emergency room.

Akram Boutros [00:38:47]:
Imagine that we are working on a product right now that as soon as you walk into the emergency room, you are triumphed by our AI. And her name is Amy. She has artificial intelligence for monitoring the education and engagement and virtual nurse and a bedside nurse. You have literally zero wait time and we have enough information to be able to manage the care. We're working now on a really crazy idea that for people to be able to live and age at all, so a couple who are in their and someone gets sick, that is going to become needs care. We actually are integrating with robotics to be able to help that robot clean the house, put away the groceries, help lift the patient, get them to the bathroom. And utilizing the computer vision of the, of the robot, we can actually provide virtual nursing care. We are now thinking about AI and this is the frontier here, AI.

Akram Boutros [00:39:55]:
AI is going to be entering the physical world where AI will actually be able to do things for you. So I think within the next three years we'll be able to deploy that and we will be deploying Amy in hospitals early next year.

Jeffrey Stern [00:40:12]:
So you've integrated AI into the workflow for all this inpatient care. When you think about AI in healthcare today, I mean, where do you believe it creates real leverage? Where do you see it's limited? In other words, like what today can it actually solve and what if anything, needs to remain, you know, fundamentally human in healthcare.

Akram Boutros [00:40:40]:
So the reason we're called nexus is, is that we're at the nexus of technology and compassion. So compassion cannot be delivered by, by AI able. The ability to. AI can do three things. It can be always present, so, so it can be an extension of you. It can help garner information that you cannot garner because you can't be at 10 places at the same time. So, so that's one thing. It can, does not have compassionate fatigue.

Akram Boutros [00:41:16]:
So it can actually gain more information than you could ever spend with anybody on these things. And it can put it in a way, it can group it in a way that it utilizes the latest research to help you see the problem a lot quicker. So the cognitive overload of being a clinician, the amount of stream, it can actually help reduce that. So these are the three things that I think AI can do today. What it cannot do today is take care of patients. What it can't do today is do things that are incredibly human. It cannot hold your hand and make you feel better. Well, one day be able to start your IV and that's when AI enters into the physical world.

Akram Boutros [00:42:15]:
Absolutely. Will it be able to do your scan and interpret the scan? Absolutely. Do you want, do I want anybody to go through, I mean, look at, even Star Trek, right? They use tricorders. They did all of those things. There were doctors and nurses. That will not change. It just extends their capabilities.

Jeffrey Stern [00:42:40]:
What's been most surprising to you in this journey so far as an entrepreneur in the industry rather than as an administrator or a practitioner?

Akram Boutros [00:42:50]:
So I've always started businesses either for my, for the hospitals that I worked for or for the companies I, I started, I think when I was very young, the most successful Gamma Knife startup in the, in the country at one of my small hospitals. The lessons I learned is that if you're an entrepreneur, you have to fail effectively. And what that means is you fail small, you fail fast, and you fail forward. You're constantly learning, constantly iterating. And that is why our technology partner makes sure that we iterate every four weeks. So that's important. What, what I've learned is that the wisdom of people who have done these things, they create a framework that really doesn't look, does not challenge the status quo and works on incrementalism. Everybody told me it's going to take us two and a half years to get to our first customer, two years to sign a contract, six months for us to go live, and then it's going to take us another year.

Akram Boutros [00:43:54]:
A year and a half. So four years total for us to get recognized in the business. We finished our raise in February of 25. We signed our first contract in April of 25. We went live in July 25. We are a pipeline of folks that we are looking to roll out the fourth and quarter and first of this year and first quarter of next year. So we challenged the status quo and we just said. And we actually had to turn hospitals down who said we want to work either piecemeal or slow in this.

Akram Boutros [00:44:45]:
And you cannot deliver transformation by working at them.

Jeffrey Stern [00:44:53]:
How do you get health systems to move faster?

Akram Boutros [00:44:57]:
I think you just present them the opportunities and those who are either innovative enough or understand the system well enough will move faster, or those who are desperate enough will need to move faster. These are the two clients that we're seeing that are very receptive.

Jeffrey Stern [00:45:13]:
What do you feel have been the biggest challenges of Nexus so far?

Akram Boutros [00:45:18]:
Really finding these individuals who are not afraid of the transformation. I cannot tell you how many people you talk to who you can demonstrate to them a better outcome. And they just say, well, what's going to happen here? And think of the worst case scenarios. And I end up telling them the worst case scenario is what you have. That is the worst case scenario. And for me, the worst decision is no decision.

Jeffrey Stern [00:45:55]:
Are you optimistic about the situation for nurses writ large?

Akram Boutros [00:45:59]:
Yes, very much so. I believe there is enough attention right now and there are enough technology and focus that we will see faster adoption. When I began thinking about this in 23, less than 15% of the chief nurse executives knew about virtual nursing or had been contemplating to start a pilot today. It's expected that by the end of this year, 80% of Chief Nurse executives will have at least designed a pilot, if not impacted. You know, that's incredible. Adoption, that is not what you normally see in healthcare, especially on the inpatient side.

Jeffrey Stern [00:46:53]:
Yeah. And the reception is generally well received.

Akram Boutros [00:46:57]:
Yeah. So, so today, if you're a chief nurse executive and you have, you're not looking at virtual nursing, you are behind the time. You are a laggard, you are not an innovator, you're not even early adopter, you're not in. And you are, you are allowed, you are in the last 10, 20% of people who don't know that that train is coming.

Jeffrey Stern [00:47:20]:
So you've, you've chosen to build Nexus here in, in Cleveland. And you know, I'm curious as to the geographic decision, you know, as someone like yourself who's also not, not from here originally.

Akram Boutros [00:47:33]:
Yeah. So we we live here. This is our home. My, my daughters live here. We have a home in Florida. We actually have a, a location in Florida that we do our back office from. So it doesn't matter. I wanted a team around me that, that I could see each and every day.

Akram Boutros [00:47:58]:
Most of our core team, all of our core team works actually from the office this year every day. I don't think I just. While care or virtual technologies have improved a lot, that's why we use a hybrid model or that nurses that move from virtual to bedside and from bedside to virtual because teamwork requires a single team that sees each other on a regular basis and works together towards the same goals. So that's what we, that's what we do and that's what I believe in.

Jeffrey Stern [00:48:30]:
What else have you learned from about leadership that feels particularly salient that you've channeled into the culture of Nexus?

Akram Boutros [00:48:41]:
I would say tell you the lessons is killing effectively. Like I talked about also, we don't have a culture of blame here. Things happen and our job is to make relentless forward progress. It doesn't matter what happened yesterday. And never listen to people who say you can't do something that is absolutely a reason for you to examine it and make a decision yourself. I'm not telling you there they sometimes can't be right. But I will tell you there are many where.

Jeffrey Stern [00:49:16]:
I'll ask a kind of a greenfield question, which is when you reflect on this whole journey, is there something that feels particularly important as part of it that we haven't talked about yet that you would like to.

Akram Boutros [00:49:31]:
You know, there was a movie that talked about a doctor who became a patient and then required all the residents and other staff to become patients. I wish without people having to get sick, that we could spend 24, 48 hours, 72 hours in a stimulation and that we do that as a part of everybody becoming a physical therapist and a nurse, a doctor, anybody who's providing care and do that. I remember when I was in leadership Cleveland, we did a poverty simulation. And that truly impacted me because when we came from Asia to Queens, New York, we did not have a lot of money. We weren't poor. We all ended up working. Even myself as a young person ended up working. So we all had the opportunities to collect the money and be able to live and, you know, not have housing and all those things.

Akram Boutros [00:50:41]:
Not great housing, but it was, it was what it is felt state. When I did the poverty simulation, it felt out of control. And I learned a lot about poverty and it also led me to the creation of the Institute of. For Hobart Metro House. So I would want to find a way for people to spend one to three days in a simulated environment and patients to understand what it's like and be able to manage the insurance and everything else. So. So the. The system is so complex and we end up focusing on our own piece of it.

Akram Boutros [00:51:21]:
And I wish people would have broader knowledge of what it takes.

Jeffrey Stern [00:51:25]:
Yeah. Do. Do you think empathy can be taught at. At scale? Because.

Akram Boutros [00:51:31]:
Absolutely. The Cleveland Clinic actually showed that they were the first people to teach empathy at scale, and they did a great job with it.

Jeffrey Stern [00:51:40]:
Yeah, I know. I think that would be a pretty powerful experience for folks who, unless you do experience it, it is hard to understand, you know, what it entails.

Akram Boutros [00:51:53]:
And empathy isn't how you think. It's. Empathy is how you act. People. Here's the thing that I could tell you that we didn't talk about. People believe that you change the way you act by changing the way you think. That is absolutely backwards. You change the way you think by changing the way you act.

Akram Boutros [00:52:20]:
So you have to take action first and that action will change the way.

Jeffrey Stern [00:52:26]:
Yeah, I could see that. You know, experience shaping your mental model.

Akram Boutros [00:52:32]:
Yep.

Jeffrey Stern [00:52:34]:
I like that. Amazing. Well, Acrima, I just want to thank you very much for taking the time, sharing a little bit about your story and reflecting on the journey. I know your proclivity is to look forward, but I appreciate you taking the time to look backwards a little bit.

Akram Boutros [00:52:48]:
Oh, you know, you have to examine it. You just can't dwell on it and wish it didn't or it could have gone a different way. You have to reflect on what just happened. But once the lesson is learned, let's just move on. Right. You can't live in the past. You can't. I see it as re.

Akram Boutros [00:53:09]:
Victimizing myself. I don't want to become a victim of other people. I want to be able to take control. So, Jeff, thank you very much for having me. It was wonderful. Speaking.

Jeffrey Stern [00:53:21]:
No, thank you. I'll. I'll ask one more traditional closing question, which is for a hidden gem in Cleveland.

Akram Boutros [00:53:29]:
Oh, there are so, so many hidden gems. I will tell you. I will tell you this. Every. Every now and then, I want to get New York style Chinese food and New York style Chinese food. The closest I get is hoa. So that is where I go when I watch New York style Chinese food.

Jeffrey Stern [00:53:54]:
Perfect. I love it. Well, if folks had anything they wanted to follow up with you about, learn more about Nexus, where would you point them?

Akram Boutros [00:54:05]:
It's Abootrosis Awesome.

Jeffrey Stern [00:54:09]:
Well, thank you again. Really appreciate it.

Akram Boutros [00:54:12]:
Have a great day.

Jeffrey Stern [00:54:15]:
That's all for this week. Thank you for listening. We'd love to hear your thoughts on today's show, so if you have any feedback please send over an email to jeffreyofthelandfm or find us on Twitter oddleftheland or Sternfa J E F E If you or someone you know would make a good guest for our show, please reach out as well and let us know. And if you enjoy the podcast, please subscribe and leave a review on itunes or on your preferred podcast player. Your support goes a long way. Way to help us spread the word and continue to bring the Cleveland founders and builders we love having on the show. We'll be back here next week at the same time to map more of the land. The Lay of the Land podcast was developed in collaboration with the UP Company LLC at the time of this recording.

Jeffrey Stern [00:54:59]:
Unless otherwise indicated, we do not own equity or other financial interests in the company which appear on the show. All opinions expressed by podcast participants are solely their own own and do not reflect the opinions of any entity which employs us. This podcast is for informational purposes only and should not be relied upon as a basis for investment decisions. Thank you for listening and we'll talk to you next week.