1 00:00:00,080 --> 00:00:02,720 Hello everyone. This is Erica Spicer Mason with 2 00:00:02,720 --> 00:00:04,879 Becker's Healthcare. Thank you so much for tuning 3 00:00:04,879 --> 00:00:07,620 into the Becker's Healthcare podcast series today. 4 00:00:08,240 --> 00:00:10,160 So today we're going to learn how Nemours 5 00:00:10,160 --> 00:00:13,039 Children's Health and NRC Health are using data 6 00:00:13,039 --> 00:00:15,564 and empathy to reimagine the patient and family 7 00:00:15,625 --> 00:00:16,125 experience, 8 00:00:16,824 --> 00:00:19,644 moving beyond measurement to equity centered action. 9 00:00:20,184 --> 00:00:22,344 And joining me for this conversation, we have 10 00:00:22,344 --> 00:00:24,984 with us Rachel Hamilton, the vice president of 11 00:00:24,984 --> 00:00:28,410 customer strategy at NRC Health, and Doctor. Peggy 12 00:00:28,410 --> 00:00:31,690 Greco, vice president and chief patient experience officer 13 00:00:31,690 --> 00:00:33,229 at Nemours Children's Health. 14 00:00:33,690 --> 00:00:35,609 Rachel, Doctor. Greco, it's so great to have 15 00:00:35,609 --> 00:00:37,130 you here with us. Thank you for joining 16 00:00:37,130 --> 00:00:38,030 Becker's today. 17 00:00:38,490 --> 00:00:39,950 Thank you for having me. 18 00:00:40,814 --> 00:00:42,335 So happy to have you both. And before 19 00:00:42,335 --> 00:00:43,554 we get into our conversation, 20 00:00:43,934 --> 00:00:45,375 I'd love to learn just a little bit 21 00:00:45,375 --> 00:00:47,454 more about you both, your roles and your 22 00:00:47,454 --> 00:00:48,354 work in healthcare. 23 00:00:48,894 --> 00:00:50,674 Doctor. Greco, would you get us started? 24 00:00:51,295 --> 00:00:51,795 Absolutely. 25 00:00:52,810 --> 00:00:56,109 So I've been a, long time, health care 26 00:00:56,170 --> 00:00:56,670 advocate. 27 00:00:57,049 --> 00:00:58,729 I started when I was 20 and a 28 00:00:58,729 --> 00:01:01,229 college junior working at Eggleston Children's Hospital 29 00:01:01,850 --> 00:01:02,350 and, 30 00:01:02,729 --> 00:01:04,270 evolved from there to, 31 00:01:05,064 --> 00:01:07,645 become a pediatric psychologist. So that's a psychologist 32 00:01:07,704 --> 00:01:10,105 who specializes in working with kids with chronic 33 00:01:10,105 --> 00:01:10,605 illness 34 00:01:11,145 --> 00:01:13,545 and began working at Nemours Children's Health thirty 35 00:01:13,545 --> 00:01:14,525 two years ago. 36 00:01:14,905 --> 00:01:16,844 So at Nemours, I've been a clinician. 37 00:01:17,465 --> 00:01:19,885 I've been a researcher, a health care administrator, 38 00:01:20,899 --> 00:01:22,500 and a lot of the research we looked 39 00:01:22,500 --> 00:01:24,200 at, which focused on communication 40 00:01:24,979 --> 00:01:27,479 and the resulting impact on health outcome, 41 00:01:27,859 --> 00:01:31,000 wasn't always translated to our clinical staff. So 42 00:01:31,299 --> 00:01:33,700 started to fill a translational role in terms 43 00:01:33,700 --> 00:01:34,200 of 44 00:01:34,784 --> 00:01:37,584 teaching our clinical staff more about communication and 45 00:01:37,584 --> 00:01:38,084 interaction 46 00:01:38,784 --> 00:01:41,504 that led to better and safer care, and 47 00:01:41,504 --> 00:01:43,265 that opened up the whole new world of 48 00:01:43,265 --> 00:01:45,665 patient experience. So I became more broadly involved 49 00:01:45,665 --> 00:01:48,165 in that as well, over the last decade. 50 00:01:49,099 --> 00:01:50,619 So great to learn that about you, doctor 51 00:01:50,619 --> 00:01:51,119 Greco. 52 00:01:51,500 --> 00:01:52,939 I love when we have a leader on 53 00:01:52,939 --> 00:01:54,619 the line who has a lot of tenure 54 00:01:54,619 --> 00:01:56,299 at an organization. You know, you've seen it 55 00:01:56,299 --> 00:01:58,299 grow through the years and change, and so 56 00:01:58,299 --> 00:02:00,219 we'll get some great perspective from you. And 57 00:02:00,219 --> 00:02:02,159 so glad to hear about this research and, 58 00:02:02,795 --> 00:02:04,715 kind of data back perspective that you're that 59 00:02:04,715 --> 00:02:06,555 you're taking on at Nemours when it comes 60 00:02:06,555 --> 00:02:08,814 to staff communication and patient experience. 61 00:02:09,995 --> 00:02:11,594 So with that, Rachel, would love to learn 62 00:02:11,594 --> 00:02:13,115 more about you and your work at NRC 63 00:02:13,115 --> 00:02:13,775 as well. 64 00:02:14,469 --> 00:02:15,209 Sure. Wonderful. 65 00:02:15,830 --> 00:02:18,069 So I've been, in the health care industry 66 00:02:18,069 --> 00:02:20,969 for about twenty years now. Started with, 67 00:02:21,430 --> 00:02:23,909 actually going to Indiana University for my health 68 00:02:23,909 --> 00:02:24,650 care administration, 69 00:02:25,110 --> 00:02:25,610 degree 70 00:02:25,989 --> 00:02:27,830 and have worked in health systems for the 71 00:02:27,830 --> 00:02:29,610 majority of those twenty years 72 00:02:30,064 --> 00:02:32,944 and turned into a patient experience role within 73 00:02:32,944 --> 00:02:34,884 that within my last organization 74 00:02:35,745 --> 00:02:38,485 and got to see insights and and oversight 75 00:02:38,625 --> 00:02:41,284 of the patient experience program at that system. 76 00:02:41,905 --> 00:02:43,344 And then it led me to a role 77 00:02:43,344 --> 00:02:45,025 here at NRC Health where I've had the 78 00:02:45,025 --> 00:02:46,930 pleasure of of working for the last eight 79 00:02:46,930 --> 00:02:48,770 and a half years. I've worked with many 80 00:02:48,770 --> 00:02:51,750 of our, premier partners like Nemours Children's Health, 81 00:02:52,129 --> 00:02:53,909 and I have just really enjoyed, 82 00:02:54,370 --> 00:02:57,009 working alongside helping them achieve their goals and 83 00:02:57,009 --> 00:02:59,650 obviously improving patient experience across the health care 84 00:02:59,650 --> 00:03:01,635 continuum. So it's a pleasure to be here 85 00:03:01,635 --> 00:03:03,715 today. Oh, it's great to have you here 86 00:03:03,715 --> 00:03:05,735 too, Rachel. And with all of your experience 87 00:03:06,034 --> 00:03:07,474 and the line of work that you're in, 88 00:03:07,474 --> 00:03:09,314 you're going to offer that great high level 89 00:03:09,314 --> 00:03:10,694 perspective in our conversation 90 00:03:11,155 --> 00:03:12,675 just with the sheer number of partners I 91 00:03:12,675 --> 00:03:15,120 know NRC is working with. So excited to 92 00:03:15,120 --> 00:03:16,979 get your perspectives on this as well. 93 00:03:17,439 --> 00:03:19,280 But I I did wanna start our conversation 94 00:03:19,280 --> 00:03:21,439 by talking a bit about a case study 95 00:03:21,439 --> 00:03:24,239 that I understand Nemours Children's Health and NRC 96 00:03:24,239 --> 00:03:27,039 Health collaborated on. And so this case study, 97 00:03:27,039 --> 00:03:27,405 I understand, 98 00:03:29,084 --> 00:03:30,925 focused on improving clarity and equity in both 99 00:03:30,925 --> 00:03:32,145 patient and family experiences. 100 00:03:32,764 --> 00:03:34,604 So, doctor Greco, can you first give us 101 00:03:34,604 --> 00:03:37,084 an overview of why you pursued this work 102 00:03:37,084 --> 00:03:39,485 at Nemours Children's Health and what really prompted 103 00:03:39,485 --> 00:03:40,224 this focus? 104 00:03:41,210 --> 00:03:44,090 I'd be happy to. So as everyone knows, 105 00:03:44,090 --> 00:03:47,210 the patient family voice is very important to 106 00:03:47,210 --> 00:03:50,189 integrate into improvement work in health care settings. 107 00:03:50,650 --> 00:03:53,129 And a key part of that patient family 108 00:03:53,129 --> 00:03:55,025 voice comes to us in the form of 109 00:03:55,025 --> 00:03:55,925 survey responses, 110 00:03:56,544 --> 00:03:59,284 both responses to questions and open ended, 111 00:04:00,064 --> 00:04:01,284 information as well. 112 00:04:01,825 --> 00:04:04,385 And, one of the things we started doing 113 00:04:04,385 --> 00:04:06,750 in 2020, thanks to NRC Health's 114 00:04:07,629 --> 00:04:09,810 responsivity to, our request 115 00:04:10,430 --> 00:04:13,949 to break out, data based on, race and 116 00:04:13,949 --> 00:04:15,250 ethnicity and language, 117 00:04:15,949 --> 00:04:17,709 was we began to look at our survey 118 00:04:17,709 --> 00:04:19,490 responses through those lens. 119 00:04:20,074 --> 00:04:22,475 And what we noticed was that there were 120 00:04:22,475 --> 00:04:26,175 some equity gaps, for some specific clinical areas. 121 00:04:26,955 --> 00:04:29,514 And that ability to identify the gap then 122 00:04:29,514 --> 00:04:32,175 motivated us to look at improvement opportunities, 123 00:04:33,400 --> 00:04:36,439 specifically for the question that had the highest 124 00:04:36,439 --> 00:04:38,520 gap, and that was, did you know what 125 00:04:38,520 --> 00:04:40,279 to do if you had questions after your 126 00:04:40,279 --> 00:04:40,779 visit? 127 00:04:41,319 --> 00:04:42,620 And as you might guess, 128 00:04:43,000 --> 00:04:44,300 just from the 129 00:04:45,175 --> 00:04:47,735 from that question can be pretty significant. So 130 00:04:47,735 --> 00:04:49,894 if you have confusion after a visit or 131 00:04:49,894 --> 00:04:51,254 you're not sure what to do, are you 132 00:04:51,254 --> 00:04:53,334 gonna follow through with the recommendation? Are you 133 00:04:53,334 --> 00:04:55,194 going to give the medication as prescribed? 134 00:04:56,134 --> 00:04:57,414 Are you going to reach out? Are you 135 00:04:57,414 --> 00:04:58,634 gonna call the right person? 136 00:04:58,939 --> 00:04:59,919 So that confusion, 137 00:05:00,539 --> 00:05:01,680 and perhaps misunderstanding 138 00:05:02,060 --> 00:05:03,599 can have some safety implications 139 00:05:03,979 --> 00:05:04,639 as well. 140 00:05:05,019 --> 00:05:07,979 So given that it, was a question that 141 00:05:07,979 --> 00:05:10,219 tapped into safety as well as with the 142 00:05:10,219 --> 00:05:10,719 identified 143 00:05:11,180 --> 00:05:12,014 equity gap, 144 00:05:12,735 --> 00:05:14,254 we knew that this was an area we 145 00:05:14,254 --> 00:05:16,435 wanted to focus on for improvement. 146 00:05:17,775 --> 00:05:19,615 Yeah. Doctor Greco, thank you so much for 147 00:05:19,615 --> 00:05:22,335 the overview, and great to learn how you 148 00:05:22,335 --> 00:05:24,175 uncovered some of these important gaps and what 149 00:05:24,175 --> 00:05:26,035 it means for safety as well. 150 00:05:26,589 --> 00:05:28,189 Rachel, do you have anything that you'd like 151 00:05:28,189 --> 00:05:30,269 to add to from NRC's perspective and and 152 00:05:30,269 --> 00:05:31,970 how you contributed to the case study? 153 00:05:32,670 --> 00:05:34,990 Sure. Yeah. So we meet with our partners 154 00:05:34,990 --> 00:05:37,230 on a very regular cadence and basis. And 155 00:05:37,230 --> 00:05:39,504 so one of the opportunities we have during 156 00:05:39,504 --> 00:05:41,045 those discussions is to 157 00:05:41,425 --> 00:05:43,585 hear about kind of what are those strategic 158 00:05:43,585 --> 00:05:46,064 initiatives our partners are focused on and or 159 00:05:46,064 --> 00:05:47,585 what are the problems that they're trying to 160 00:05:47,585 --> 00:05:50,145 solve. And so through these ongoing discussions with 161 00:05:50,145 --> 00:05:51,605 Peggy and her team, 162 00:05:51,939 --> 00:05:54,500 we really collaborated to say, okay. We we 163 00:05:54,500 --> 00:05:56,100 see the gaps. One is how can you 164 00:05:56,100 --> 00:05:57,779 see the gaps? So making sure that our 165 00:05:57,779 --> 00:05:58,279 reporting 166 00:05:58,740 --> 00:06:01,139 provides the visibility for them to see where 167 00:06:01,139 --> 00:06:03,000 they need to focus and hone in on. 168 00:06:03,060 --> 00:06:05,194 And then once you have that data, what 169 00:06:05,194 --> 00:06:06,634 are you gonna do with it? Right? And 170 00:06:06,634 --> 00:06:08,074 so what are those steps, and how can 171 00:06:08,074 --> 00:06:11,035 we walk with them through that process of 172 00:06:11,035 --> 00:06:13,295 taking that data and turning it into action, 173 00:06:13,514 --> 00:06:14,654 whether that's through, 174 00:06:14,955 --> 00:06:16,254 some custom surveying, 175 00:06:16,829 --> 00:06:19,790 to identify what are those needs that maybe 176 00:06:19,790 --> 00:06:23,310 those patients from those different whether it's racial 177 00:06:23,310 --> 00:06:26,589 disparities or language disparities and gaps, what are 178 00:06:26,589 --> 00:06:28,189 those things that they need? And so we 179 00:06:28,189 --> 00:06:30,269 can help partner with them to get additional 180 00:06:30,269 --> 00:06:31,410 information and feedback 181 00:06:31,735 --> 00:06:34,235 to help support them in supporting their patients. 182 00:06:35,095 --> 00:06:35,595 Fantastic. 183 00:06:35,895 --> 00:06:37,514 Thank you for those add ons, Rachel. 184 00:06:38,055 --> 00:06:40,055 And I I wanna just highlight something you 185 00:06:40,055 --> 00:06:42,215 said, which is this important piece of turning 186 00:06:42,215 --> 00:06:43,514 data into action. 187 00:06:44,199 --> 00:06:45,479 So I'd love to go a little bit 188 00:06:45,479 --> 00:06:47,639 deeper on that. And, doctor Greco, maybe you 189 00:06:47,639 --> 00:06:49,800 can give us your perspective first. You know, 190 00:06:49,800 --> 00:06:52,060 what steps did Nemours Children's Health 191 00:06:52,759 --> 00:06:53,259 take 192 00:06:53,639 --> 00:06:56,439 to translate that insight into action? And would 193 00:06:56,439 --> 00:06:58,964 love to also know, Rachel, how NRC helped 194 00:06:58,964 --> 00:07:00,425 to drive that change as well. 195 00:07:01,205 --> 00:07:03,305 We've used the information on disparities 196 00:07:03,605 --> 00:07:05,064 to shape our improvements, 197 00:07:05,764 --> 00:07:08,165 and we knew that from the data that 198 00:07:08,165 --> 00:07:09,944 our Spanish preferring families, 199 00:07:10,564 --> 00:07:13,699 scored 15 points lower on average, which is 200 00:07:13,699 --> 00:07:16,740 very significant for a survey item than our 201 00:07:16,740 --> 00:07:18,839 English preferring families. And so, 202 00:07:19,300 --> 00:07:21,399 a number of our intervention aspects, 203 00:07:22,019 --> 00:07:25,779 really focused on language and assuring that every 204 00:07:25,779 --> 00:07:27,800 family, you know, despite background language, 205 00:07:28,314 --> 00:07:29,995 left with a clear understanding of what to 206 00:07:29,995 --> 00:07:31,935 do next and how to get questions answered. 207 00:07:32,475 --> 00:07:33,675 We also saw, 208 00:07:34,154 --> 00:07:35,295 significant difference, 209 00:07:35,834 --> 00:07:37,935 along race and ethnicity lines. 210 00:07:38,475 --> 00:07:41,115 There was 21 points between the highest top 211 00:07:41,115 --> 00:07:42,779 box score and the lowest. 212 00:07:43,339 --> 00:07:46,620 And so, we designed really a a full 213 00:07:46,620 --> 00:07:47,920 enterprise wide approach 214 00:07:48,379 --> 00:07:50,639 that touched every clinical area 215 00:07:51,100 --> 00:07:53,360 in terms of adapting different tools. 216 00:07:54,300 --> 00:07:55,519 And, it 217 00:07:55,995 --> 00:07:56,495 really, 218 00:07:57,115 --> 00:08:00,415 was a comprehensive approach that involved previsit preparation. 219 00:08:01,035 --> 00:08:02,395 When you think about, did you know what 220 00:08:02,395 --> 00:08:03,915 to do if you have questions after the 221 00:08:03,915 --> 00:08:06,154 visit, it's tempting to think, oh, that that's 222 00:08:06,154 --> 00:08:07,995 something that is only pertinent in the very 223 00:08:07,995 --> 00:08:08,495 end. 224 00:08:09,160 --> 00:08:11,259 But, actually, if we're preparing beforehand, 225 00:08:11,800 --> 00:08:14,439 for example, making sure we have interpreters and 226 00:08:14,439 --> 00:08:16,379 preferred language needs are being met, 227 00:08:16,920 --> 00:08:19,639 ensuring that we're asking families when they check-in 228 00:08:19,639 --> 00:08:22,060 to write down their questions and get organized, 229 00:08:22,814 --> 00:08:24,355 They're gonna be more likely to know, 230 00:08:24,735 --> 00:08:27,555 what those answers are, responses before they leave. 231 00:08:27,935 --> 00:08:30,014 Within the visit, we make sure they've got 232 00:08:30,014 --> 00:08:31,074 the language interpretation. 233 00:08:32,254 --> 00:08:32,754 We, 234 00:08:33,294 --> 00:08:35,615 worked with our clinical teams on teach back 235 00:08:35,615 --> 00:08:36,355 and clarification. 236 00:08:36,815 --> 00:08:37,315 So, 237 00:08:37,799 --> 00:08:40,919 best practice communication techniques that make sure that 238 00:08:40,919 --> 00:08:42,860 we're communicating in ways that are 239 00:08:43,160 --> 00:08:45,720 comprehensible and that families are getting all of 240 00:08:45,720 --> 00:08:48,139 that information they need. And then, 241 00:08:48,600 --> 00:08:49,820 technology support. 242 00:08:50,144 --> 00:08:53,125 So there's some EMR based tools that are 243 00:08:53,345 --> 00:08:53,845 very, 244 00:08:54,625 --> 00:08:56,884 helpful for multiple languages, 245 00:08:57,425 --> 00:08:59,285 such as Med Action Plan Pro. 246 00:08:59,665 --> 00:09:01,345 We looked at all the different tools we 247 00:09:01,345 --> 00:09:03,125 could use that would translate, 248 00:09:03,959 --> 00:09:06,139 some of the recommendations and medication 249 00:09:06,519 --> 00:09:08,379 instructions in multiple languages, 250 00:09:09,320 --> 00:09:11,980 and then focused on discharge communication tools, 251 00:09:12,360 --> 00:09:12,940 in terms 252 00:09:13,480 --> 00:09:15,259 of handouts, business cards, 253 00:09:15,959 --> 00:09:18,195 app based messaging so that it was really 254 00:09:18,195 --> 00:09:20,674 clear who to call, what to do, and 255 00:09:20,674 --> 00:09:23,654 sometimes even establish new processes. So for example, 256 00:09:23,954 --> 00:09:26,214 our hospitalists at one of our hospitals, 257 00:09:26,995 --> 00:09:30,034 established a new phone line, since often families 258 00:09:30,034 --> 00:09:32,034 didn't know which clinic to call since they're 259 00:09:32,034 --> 00:09:33,120 followed by multiple 260 00:09:33,500 --> 00:09:35,980 clinics, and that way have one central phone 261 00:09:35,980 --> 00:09:38,480 number to call with any post discharge confusion. 262 00:09:39,179 --> 00:09:40,559 So comprehensive approach, 263 00:09:41,420 --> 00:09:42,720 really across the board. 264 00:09:43,500 --> 00:09:45,735 Yeah. Comprehensive is the right word for it, 265 00:09:45,735 --> 00:09:48,555 doctor Greco. I appreciate all the specific examples. 266 00:09:48,615 --> 00:09:50,555 And what struck me as you were describing 267 00:09:50,695 --> 00:09:53,035 all of these tools and support systems, 268 00:09:53,495 --> 00:09:56,134 they seem quite empowering, not just from the 269 00:09:56,134 --> 00:09:58,774 patient perspective, but from your staff's perspective as 270 00:09:58,774 --> 00:10:01,100 well to really support better communication. 271 00:10:01,480 --> 00:10:01,980 Absolutely. 272 00:10:02,759 --> 00:10:04,679 And, Rachel, would love to learn a little 273 00:10:04,679 --> 00:10:06,279 bit more about the role NRC played as 274 00:10:07,000 --> 00:10:09,320 Sure. So, again, partnering with Peggy and the 275 00:10:09,320 --> 00:10:12,059 team, one, two, after we understood 276 00:10:12,679 --> 00:10:13,659 where those gaps 277 00:10:14,004 --> 00:10:17,284 were at, how we can get more around 278 00:10:17,284 --> 00:10:19,044 the what, the why, and the how to 279 00:10:19,044 --> 00:10:19,784 help support, 280 00:10:20,245 --> 00:10:22,564 in making sure that these families know exactly 281 00:10:22,564 --> 00:10:24,004 what to do when they leave and where 282 00:10:24,004 --> 00:10:25,704 to go to if they have questions. 283 00:10:26,564 --> 00:10:28,320 And so we have the 284 00:10:28,879 --> 00:10:32,480 wonderful opportunity of engaging with their patients and 285 00:10:32,480 --> 00:10:32,980 families 286 00:10:33,440 --> 00:10:35,120 after they leave in more of a virtual 287 00:10:35,120 --> 00:10:37,139 patient and family advisory council. 288 00:10:37,600 --> 00:10:39,759 So we can recruit patients and family members 289 00:10:39,759 --> 00:10:41,440 to be a part of their virtual advisory 290 00:10:41,440 --> 00:10:43,725 council through their surveys. And so we have 291 00:10:43,804 --> 00:10:45,725 that opportunity to connect with them and ask 292 00:10:45,725 --> 00:10:46,544 them questions 293 00:10:47,084 --> 00:10:50,444 around those strategic priorities and initiatives that Nemours 294 00:10:50,444 --> 00:10:52,924 Children's Health would like to incorporate patient and 295 00:10:52,924 --> 00:10:54,845 family feedback in. And so we have that 296 00:10:54,845 --> 00:10:55,345 opportunity, 297 00:10:56,220 --> 00:10:58,879 to field questions to those families to understand 298 00:10:59,339 --> 00:11:01,500 what are their needs, why do they have 299 00:11:01,500 --> 00:11:04,379 questions, and how can Nemours help them. And 300 00:11:04,379 --> 00:11:06,779 so we take that data from those studies 301 00:11:06,779 --> 00:11:08,459 and we give it right back to Nemours 302 00:11:08,459 --> 00:11:09,679 to help them guide, 303 00:11:10,165 --> 00:11:12,985 what those action plans were so they know, 304 00:11:13,445 --> 00:11:16,165 and have the ideas around having those cards 305 00:11:16,165 --> 00:11:19,125 and or just other areas, providing a good 306 00:11:19,125 --> 00:11:20,825 phone number for those families. 307 00:11:21,605 --> 00:11:23,684 By doing those custom studies and getting that 308 00:11:23,684 --> 00:11:25,829 additional feedback, it just helped provide a little 309 00:11:25,829 --> 00:11:28,069 more clarity as to where they can help 310 00:11:28,069 --> 00:11:29,370 their patients and families. 311 00:11:30,549 --> 00:11:32,230 And I wanted to emphasize a few points 312 00:11:32,230 --> 00:11:34,709 you made, Rachel, because I think we can't 313 00:11:34,709 --> 00:11:35,209 overemphasize 314 00:11:35,589 --> 00:11:38,709 the engagement of our NRC health team and 315 00:11:38,709 --> 00:11:39,370 the impact, 316 00:11:39,835 --> 00:11:41,615 that they had on our overall success. 317 00:11:42,154 --> 00:11:44,475 And so just a few specific examples for 318 00:11:44,475 --> 00:11:46,095 what Rachel was touching on. 319 00:11:46,394 --> 00:11:48,475 They helped us create a fairness survey, which 320 00:11:48,475 --> 00:11:50,815 provided a lot of insights from our families. 321 00:11:51,754 --> 00:11:54,475 They also helped to develop more visibility for 322 00:11:54,475 --> 00:11:55,054 our clinicians 323 00:11:55,409 --> 00:11:57,569 on this goal. So it became part of 324 00:11:57,569 --> 00:12:00,209 our clinician summary and highlighted so that it 325 00:12:00,209 --> 00:12:02,309 was very clear how we were making progress. 326 00:12:03,169 --> 00:12:06,529 And just overall, the collaboration was, very close, 327 00:12:06,529 --> 00:12:08,069 and there was a lot of responsivity, 328 00:12:08,690 --> 00:12:11,110 when we needed new tools to develop those. 329 00:12:12,334 --> 00:12:14,914 What a what a great partnership and collaboration 330 00:12:15,294 --> 00:12:17,394 your your organizations had here. 331 00:12:17,855 --> 00:12:19,534 And doctor Greco, I I wanted to go 332 00:12:19,534 --> 00:12:21,294 back to something that you had touched on 333 00:12:21,294 --> 00:12:23,534 earlier when we first started touching touching on 334 00:12:23,534 --> 00:12:25,490 the case study. You'd mentioned, 335 00:12:26,350 --> 00:12:28,750 that the initiative, something that started as a 336 00:12:28,750 --> 00:12:31,309 patient experience focus kind of evolved into a 337 00:12:31,309 --> 00:12:33,250 broader patient safety priority. 338 00:12:33,629 --> 00:12:35,309 So can you share a little bit more 339 00:12:35,309 --> 00:12:37,549 about that evolution and the impact that it's 340 00:12:37,549 --> 00:12:39,970 having internally across your organization? 341 00:12:40,795 --> 00:12:42,795 Absolutely. And I think that is really has 342 00:12:42,795 --> 00:12:44,335 really been key to its success. 343 00:12:45,035 --> 00:12:47,595 Given my background as a clinician, I think, 344 00:12:47,835 --> 00:12:50,894 our team tends to really take clinician perspective 345 00:12:50,955 --> 00:12:53,535 into account. And in fact, we have clinician 346 00:12:53,595 --> 00:12:55,889 liaisons as part of our team, which really 347 00:12:55,889 --> 00:12:57,750 makes us feel more fully integrated. 348 00:12:58,209 --> 00:12:59,889 And we knew that this needed to be 349 00:12:59,889 --> 00:13:02,449 a meaningful goal. And so we looked at 350 00:13:02,449 --> 00:13:05,009 a couple of health outcome metrics, and we 351 00:13:05,009 --> 00:13:07,569 found that, the question of did you know 352 00:13:07,569 --> 00:13:09,644 what to do if you had questions after 353 00:13:09,644 --> 00:13:10,684 the visit was, 354 00:13:11,164 --> 00:13:11,664 predictive 355 00:13:12,125 --> 00:13:14,285 of return to the ED within forty eight 356 00:13:14,285 --> 00:13:14,785 hours. 357 00:13:15,325 --> 00:13:17,184 So those families who, 358 00:13:17,884 --> 00:13:20,445 answered yes, they knew what to do had 359 00:13:20,445 --> 00:13:22,524 a three percent return rate within forty eight 360 00:13:22,524 --> 00:13:24,820 hours to the ED. Those who answered that 361 00:13:24,820 --> 00:13:27,940 they didn't had a 6% return rate. Well, 362 00:13:27,940 --> 00:13:29,779 not only did we find that the return 363 00:13:29,779 --> 00:13:31,620 rate was doubled as they didn't know what 364 00:13:31,620 --> 00:13:34,259 to do, but we found some differences based 365 00:13:34,259 --> 00:13:37,125 on, race, ethnicity, and language. So for those 366 00:13:37,125 --> 00:13:39,625 families who preferred, speaking Spanish, 367 00:13:40,404 --> 00:13:42,165 they had a 9.2% 368 00:13:42,165 --> 00:13:45,465 emergency department return rate within forty eight hours, 369 00:13:45,845 --> 00:13:48,644 and families identifying as black had an 8.6 370 00:13:48,644 --> 00:13:50,610 or almost 9% return rate. 371 00:13:51,089 --> 00:13:53,350 So we knew that that difference was exacerbated 372 00:13:53,649 --> 00:13:57,029 for certain families and really highlighted the need, 373 00:13:58,049 --> 00:14:01,009 to change our processes and our communication and 374 00:14:01,009 --> 00:14:03,649 interaction styles in order to prevent that return 375 00:14:03,649 --> 00:14:04,389 to the ED. 376 00:14:05,144 --> 00:14:07,464 Again, I think having some clear tie in 377 00:14:07,464 --> 00:14:09,004 with a clinical outcome, 378 00:14:09,865 --> 00:14:12,105 engaged our clinical teams. We didn't have to 379 00:14:12,105 --> 00:14:14,284 do a lot of explaining about the why. 380 00:14:14,904 --> 00:14:16,584 It was very clear in terms of the 381 00:14:16,584 --> 00:14:17,220 need for, 382 00:14:17,779 --> 00:14:20,279 clear communication and lack of confusion 383 00:14:20,659 --> 00:14:22,919 and understanding of how to get that confusion 384 00:14:23,620 --> 00:14:24,120 clarified. 385 00:14:24,659 --> 00:14:25,379 And so, 386 00:14:25,860 --> 00:14:27,159 with those statistics, 387 00:14:27,939 --> 00:14:30,360 we had really good participation and engagement, 388 00:14:30,740 --> 00:14:33,095 across the board clinically as well. Mhmm. 389 00:14:33,875 --> 00:14:36,034 Yeah. These are really significant outcomes that you 390 00:14:36,034 --> 00:14:39,235 uncovered here, doctor Greco. The the double return 391 00:14:39,235 --> 00:14:42,034 rate to the ED when folks didn't didn't 392 00:14:42,034 --> 00:14:43,634 know or weren't sure what to do after 393 00:14:43,634 --> 00:14:46,115 a visit, that's a really compelling stat to 394 00:14:46,115 --> 00:14:47,309 highlight, and I'm sure, 395 00:14:47,789 --> 00:14:49,549 sounds like it resonated with your clinical teams 396 00:14:49,549 --> 00:14:50,370 just as well. 397 00:14:51,309 --> 00:14:53,549 And I know you've you've given already some 398 00:14:53,549 --> 00:14:56,110 really great tidbits and best practices as as 399 00:14:56,110 --> 00:14:58,110 to how this worked for your organization, you 400 00:14:58,110 --> 00:15:00,909 know, sharing those clinical outcomes or those those 401 00:15:00,909 --> 00:15:03,055 goals with your team seem to be really 402 00:15:03,055 --> 00:15:05,375 helpful with buy in. But we'd love to 403 00:15:05,375 --> 00:15:08,415 know what other important lessons or recommendations you'd 404 00:15:08,415 --> 00:15:10,175 share with others that are hoping to improve 405 00:15:10,175 --> 00:15:12,575 equity and ensure that every family leaves with 406 00:15:12,575 --> 00:15:14,035 clarity and also confidence. 407 00:15:15,019 --> 00:15:16,639 So I think there's some broader lessons, 408 00:15:17,019 --> 00:15:19,580 and I've tried to take those lessons forward 409 00:15:19,580 --> 00:15:21,360 with some of our current initiatives. 410 00:15:21,740 --> 00:15:23,340 And one is the what I just touched 411 00:15:23,340 --> 00:15:25,340 on. I think goals really have to be 412 00:15:25,340 --> 00:15:25,840 meaningful 413 00:15:26,220 --> 00:15:27,440 clinically. And so 414 00:15:27,764 --> 00:15:30,325 shifting away from metrics that may relate more 415 00:15:30,325 --> 00:15:31,065 to marketing 416 00:15:31,684 --> 00:15:34,884 and instead finding more actionable measures that really 417 00:15:34,884 --> 00:15:35,545 have implications 418 00:15:36,004 --> 00:15:38,565 for safety and or outcome means you're gonna 419 00:15:38,565 --> 00:15:39,625 get greater engagement. 420 00:15:40,230 --> 00:15:42,789 I think ownership of an initiative, we're always 421 00:15:42,789 --> 00:15:45,129 very careful that it's not a patient experience 422 00:15:45,190 --> 00:15:47,269 goal. It's a no mores goal that belongs 423 00:15:47,269 --> 00:15:47,929 to everyone. 424 00:15:48,549 --> 00:15:50,570 There's really cross functional involvement. 425 00:15:51,110 --> 00:15:53,909 And so we made sure that, there's really 426 00:15:53,909 --> 00:15:54,809 shared ownership, 427 00:15:55,274 --> 00:15:57,214 for the goal. It really has to, 428 00:15:57,674 --> 00:15:59,914 belong to the entire system. It's not our 429 00:15:59,914 --> 00:16:01,134 goal. It's your goal. 430 00:16:01,514 --> 00:16:01,995 And, 431 00:16:02,394 --> 00:16:05,434 staying the course is important. This was a 432 00:16:05,434 --> 00:16:06,254 three year, 433 00:16:07,115 --> 00:16:08,574 initiative, and I appreciate, 434 00:16:10,019 --> 00:16:12,340 the great senior leadership support we had for 435 00:16:12,340 --> 00:16:14,420 this initiative because sometimes there is pressure to 436 00:16:14,420 --> 00:16:15,960 do something different annually. 437 00:16:16,740 --> 00:16:18,279 But the long term, 438 00:16:18,740 --> 00:16:21,000 persistence really led to the success. 439 00:16:21,779 --> 00:16:23,540 It does not come overnight, and I would 440 00:16:23,540 --> 00:16:26,524 say we really didn't see system wide consistency 441 00:16:26,745 --> 00:16:28,445 and impact until year three. 442 00:16:29,225 --> 00:16:30,745 And so, again, that, 443 00:16:31,304 --> 00:16:31,804 improvement 444 00:16:32,264 --> 00:16:35,245 option improvement focus really has to be persistent 445 00:16:35,304 --> 00:16:37,304 and long term, I think, sometimes to get 446 00:16:37,304 --> 00:16:38,605 the impact you want. 447 00:16:39,350 --> 00:16:41,370 And then lastly, I think I would say 448 00:16:42,070 --> 00:16:44,310 always coming back to the story, the human 449 00:16:44,310 --> 00:16:44,810 impact. 450 00:16:45,350 --> 00:16:48,090 So how does your initiative, your focus impact, 451 00:16:48,389 --> 00:16:49,529 patients and families? 452 00:16:50,230 --> 00:16:52,009 I think if you can make it clear 453 00:16:52,230 --> 00:16:53,370 what an improvement 454 00:16:53,750 --> 00:16:56,024 initiative will do in terms of that impact, 455 00:16:56,264 --> 00:16:57,945 you'll always get buy in. And I think 456 00:16:57,945 --> 00:16:59,404 that's when you get transformation, 457 00:17:00,024 --> 00:17:02,184 when there's the understanding that you can impact 458 00:17:02,184 --> 00:17:03,485 lives, that this matters. 459 00:17:04,345 --> 00:17:06,265 So those are some of the broader lessons, 460 00:17:06,664 --> 00:17:08,744 we took from this three year initiative, and, 461 00:17:08,744 --> 00:17:10,559 hopefully, we still hold on to as we 462 00:17:10,559 --> 00:17:11,299 move forward. 463 00:17:11,839 --> 00:17:13,759 Yeah. That's such a great point, and I'm 464 00:17:13,759 --> 00:17:15,700 glad that you highlighted the fact that 465 00:17:16,079 --> 00:17:18,399 in that that broader recommendation to stay the 466 00:17:18,399 --> 00:17:20,640 course and to be patient, you know, the 467 00:17:20,640 --> 00:17:21,380 fact that 468 00:17:21,759 --> 00:17:24,399 perhaps results might not become apparent until the 469 00:17:24,399 --> 00:17:26,355 third year of a three year initiative that 470 00:17:26,355 --> 00:17:28,355 I think that's important for organizations to hear 471 00:17:28,355 --> 00:17:30,515 because there is such a pressure for, you 472 00:17:30,515 --> 00:17:32,755 know, immediate ROI, I think, on a lot 473 00:17:32,755 --> 00:17:35,174 of initiatives that leaders are carrying out. So, 474 00:17:35,954 --> 00:17:37,954 love to hear that best practice about staying 475 00:17:37,954 --> 00:17:39,734 the course, communicating impacts, 476 00:17:40,130 --> 00:17:43,090 driving ownership across teams, not just the patient 477 00:17:43,090 --> 00:17:45,830 experience folks and having meaningful goals. 478 00:17:46,529 --> 00:17:47,830 So thank you, doctor Greco. 479 00:17:48,769 --> 00:17:51,570 And before we wrap, I understand Nemours is 480 00:17:51,570 --> 00:17:54,205 also partnering with NRC Health to host a 481 00:17:54,205 --> 00:17:56,144 twenty twenty six pediatric collaborative. 482 00:17:56,845 --> 00:17:59,005 So, Rachel, I'd love to learn more about 483 00:17:59,005 --> 00:18:01,325 the collaborative and how the work that we've 484 00:18:01,325 --> 00:18:03,244 talked about today connects to the themes of 485 00:18:03,244 --> 00:18:03,985 that event. 486 00:18:04,924 --> 00:18:05,904 Yeah. Absolutely. 487 00:18:06,205 --> 00:18:06,705 So 488 00:18:07,159 --> 00:18:08,140 our pediatric collaborative, 489 00:18:08,759 --> 00:18:09,899 we host it annually, 490 00:18:10,359 --> 00:18:12,539 and we are very excited to partner with 491 00:18:12,679 --> 00:18:16,279 Nemours Children's Health, to host it this, coming 492 00:18:16,279 --> 00:18:18,359 year. It will be March 25 through the 493 00:18:18,359 --> 00:18:21,159 twenty sixth in sunny Orlando, Florida, so at 494 00:18:21,159 --> 00:18:22,299 the Orlando facility. 495 00:18:22,634 --> 00:18:25,595 Our pediatric collaborative is a a wonderful event 496 00:18:25,595 --> 00:18:27,855 to be able to connect with others 497 00:18:28,154 --> 00:18:30,394 that are doing this work, a chance to 498 00:18:30,394 --> 00:18:33,994 collaborate and share ideas, best practices, and talking 499 00:18:33,994 --> 00:18:37,309 about how each organization is focusing on their 500 00:18:37,309 --> 00:18:40,109 data informed decision making within each of their 501 00:18:40,109 --> 00:18:40,609 organizations. 502 00:18:41,309 --> 00:18:42,669 And to top it off, we get a 503 00:18:42,669 --> 00:18:45,309 wonderful tour of the Nemours Hospital as well. 504 00:18:45,309 --> 00:18:47,149 So we're all very much looking forward to 505 00:18:47,149 --> 00:18:50,049 being in sunny Orlando in the March. 506 00:18:51,095 --> 00:18:53,434 I'd love to add that being on-site, 507 00:18:54,055 --> 00:18:55,755 really makes a pediatric collaborative 508 00:18:56,055 --> 00:18:56,555 powerful, 509 00:18:57,095 --> 00:18:59,095 and the previous ones I've attended to be 510 00:18:59,095 --> 00:18:59,994 able to see, 511 00:19:00,535 --> 00:19:03,190 other health care systems in action, to meet 512 00:19:03,190 --> 00:19:04,950 some of their leaders, to hear about their 513 00:19:04,950 --> 00:19:06,730 initiatives when you're on the ground, 514 00:19:07,430 --> 00:19:09,750 to tour and to see, for example, in 515 00:19:09,750 --> 00:19:11,430 one of the recent tours, we saw a 516 00:19:11,430 --> 00:19:12,650 sibling care center, 517 00:19:13,350 --> 00:19:14,890 just, really innovative, 518 00:19:15,904 --> 00:19:18,065 strategies to take care of patients and families. 519 00:19:18,065 --> 00:19:18,565 So, 520 00:19:19,105 --> 00:19:22,085 I really appreciate the in person learning opportunities 521 00:19:22,144 --> 00:19:24,625 that go beyond what a traditional conference would 522 00:19:24,625 --> 00:19:25,125 provide. 523 00:19:27,279 --> 00:19:29,119 Absolutely. Well, it sounds like a fantastic event, 524 00:19:29,119 --> 00:19:30,000 and I'm so great 525 00:19:30,640 --> 00:19:31,920 it's so great that you'll both be able 526 00:19:31,920 --> 00:19:32,420 to 527 00:19:32,799 --> 00:19:34,720 see one another in person and and, 528 00:19:35,039 --> 00:19:37,140 Rachel take that tour of the Nemours facility. 529 00:19:37,440 --> 00:19:38,180 How exciting. 530 00:19:38,799 --> 00:19:40,400 It's been a really great time talking to 531 00:19:40,400 --> 00:19:42,674 you both today. I really appreciate all of 532 00:19:42,755 --> 00:19:45,555 the insights and and how you've candidly shared 533 00:19:45,555 --> 00:19:47,475 how this initiative has gone and the successes 534 00:19:47,475 --> 00:19:48,295 that you've seen. 535 00:19:48,914 --> 00:19:51,235 Before we wrap, Rachel, wanted to see if 536 00:19:51,235 --> 00:19:52,914 you could just share with our listeners how 537 00:19:52,914 --> 00:19:54,914 they can learn either more about the event 538 00:19:54,914 --> 00:19:56,755 that we've talked about or even the case 539 00:19:56,755 --> 00:19:57,255 study. 540 00:19:57,820 --> 00:19:58,559 Sure. Absolutely. So, 541 00:19:59,500 --> 00:20:02,140 our pediatric collaborative, you can register online, 542 00:20:02,460 --> 00:20:04,240 at nrchealth.com. 543 00:20:04,460 --> 00:20:06,059 We have an events page where you can 544 00:20:06,059 --> 00:20:09,019 go and you'll find, the collaborative and, additional 545 00:20:09,019 --> 00:20:10,244 information about that, 546 00:20:10,805 --> 00:20:12,805 as well as on our nrchealth.com 547 00:20:12,805 --> 00:20:14,484 website. You can also go to that and 548 00:20:14,484 --> 00:20:16,404 find the case study that just went live, 549 00:20:16,724 --> 00:20:19,144 that we just discussed with Nemours Children's Health. 550 00:20:19,605 --> 00:20:22,244 Fantastic. Thank you for highlighting that, Rachel. And 551 00:20:22,244 --> 00:20:24,644 doctor Greco, wanna thank you again for joining 552 00:20:24,644 --> 00:20:26,589 the podcast today. It's been great having you 553 00:20:26,589 --> 00:20:27,650 both with us. 554 00:20:28,190 --> 00:20:30,450 Thank you very much. I've loved being here. 555 00:20:30,509 --> 00:20:32,450 Yeah. Thank you so much for having us. 556 00:20:32,509 --> 00:20:34,349 And we'd also like to thank our podcast 557 00:20:34,349 --> 00:20:36,529 sponsor for today, NRC Health. 558 00:20:36,910 --> 00:20:38,990 Listeners, be sure to tune into more podcasts 559 00:20:38,990 --> 00:20:41,662 from Becker's by visiting our pod page at 560 00:20:41,662 --> 00:20:43,842 beckershospitalreview.com.