Speaker 0: Hello everyone. This is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series today. So today we're going to learn how Nemours Children's Health and NRC Health are using data and empathy to reimagine the patient and family experience, moving beyond measurement to equity centered action. And joining me for this conversation, we have with us Rachel Hamilton, the vice president of customer strategy at NRC Health, and Doctor.

Peggy Greco, vice president and chief patient experience officer at Nemours Children's Health. Rachel, Doctor. Greco, it's so great to have you here with us. Thank you for joining Becker's today.

Speaker 1: Thank you for having me.

Speaker 0: So happy to have you both. And before we get into our conversation, I'd love to learn just a little bit more about you both, your roles and your work in healthcare. Doctor. Greco, would you get us started?

Speaker 1: Absolutely. So I've been a, long time, health care advocate. I started when I was 20 and a college junior working at Eggleston Children's Hospital and, evolved from there to, become a pediatric psychologist. So that's a psychologist who specializes in working with kids with chronic illness and began working at Nemours Children's Health thirty two years ago. So at Nemours, I've been a clinician.

I've been a researcher, a health care administrator, and a lot of the research we looked at, which focused on communication and the resulting impact on health outcome, wasn't always translated to our clinical staff. So started to fill a translational role in terms of teaching our clinical staff more about communication and interaction that led to better and safer care, and that opened up the whole new world of patient experience. So I became more broadly involved in that as well, over the last decade.

Speaker 0: So great to learn that about you, doctor Greco. I love when we have a leader on the line who has a lot of tenure at an organization. You know, you've seen it grow through the years and change, and so we'll get some great perspective from you. And so glad to hear about this research and, kind of data back perspective that you're that you're taking on at Nemours when it comes to staff communication and patient experience. So with that, Rachel, would love to learn more about you and your work at NRC as well.

Speaker 2: Sure. Wonderful. So I've been, in the health care industry for about twenty years now. Started with, actually going to Indiana University for my health care administration, degree and have worked in health systems for the majority of those twenty years and turned into a patient experience role within that within my last organization and got to see insights and and oversight of the patient experience program at that system. And then it led me to a role here at NRC Health where I've had the pleasure of of working for the last eight and a half years.

I've worked with many of our, premier partners like Nemours Children's Health, and I have just really enjoyed, working alongside helping them achieve their goals and obviously improving patient experience across the health care continuum. So it's a pleasure to be here today.

Speaker 0: Oh, it's great to have you here too, Rachel. And with all of your experience and the line of work that you're in, you're going to offer that great high level perspective in our conversation just with the sheer number of partners I know NRC is working with. So excited to get your perspectives on this as well. But I I did wanna start our conversation by talking a bit about a case study that I understand Nemours Children's Health and NRC Health collaborated on. And so this case study, I understand, focused on improving clarity and equity in both patient and family experiences.

So, doctor Greco, can you first give us an overview of why you pursued this work at Nemours Children's Health and what really prompted this focus?

Speaker 1: I'd be happy to. So as everyone knows, the patient family voice is very important to integrate into improvement work in health care settings. And a key part of that patient family voice comes to us in the form of survey responses, both responses to questions and open ended, information as well. And, one of the things we started doing in 2020, thanks to NRC Health's responsivity to, our request to break out, data based on, race and ethnicity and language, was we began to look at our survey responses through those lens. And what we noticed was that there were some equity gaps, for some specific clinical areas.

And that ability to identify the gap then motivated us to look at improvement opportunities, specifically for the question that had the highest gap, and that was, did you know what to do if you had questions after your visit? And as you might guess, just from the from that question can be pretty significant. So if you have confusion after a visit or you're not sure what to do, are you gonna follow through with the recommendation? Are you going to give the medication as prescribed? Are you going to reach out?

Are you gonna call the right person? So that confusion, and perhaps misunderstanding can have some safety implications as well. So given that it, was a question that tapped into safety as well as with the identified equity gap, we knew that this was an area we wanted to focus on for improvement.

Speaker 0: Yeah. Doctor Greco, thank you so much for the overview, and great to learn how you uncovered some of these important gaps and what it means for safety as well. Rachel, do you have anything that you'd like to add to from NRC's perspective and and how you contributed to the case study?

Speaker 1: Sure.

Speaker 2: Yeah. So we meet with our partners on a very regular cadence and basis. And so one of the opportunities we have during those discussions is to hear about kind of what are those strategic initiatives our partners are focused on and or what are the problems that they're trying to solve. And so through these ongoing discussions with Peggy and her team, we really collaborated to say, okay. We we see the gaps.

One is how can you see the gaps? So making sure that our reporting provides the visibility for them to see where they need to focus and hone in on. And then once you have that data, what are you gonna do with it? Right? And so what are those steps, and how can we walk with them through that process of taking that data and turning it into action, whether that's through, some custom surveying, to identify what are those needs that maybe those patients from those different whether it's racial disparities or language disparities and gaps, what are those things that they need?

And so we can help partner with them to get additional information and feedback to help support them in supporting their patients.

Speaker 0: Fantastic. Thank you for those add ons, Rachel. And I I wanna just highlight something you said, which is this important piece of turning data into action. So I'd love to go a little bit deeper on that. And, doctor Greco, maybe you can give us your perspective first.

You know, what steps did Nemours Children's Health take to translate that insight into action? And would love to also know, Rachel, how NRC helped to drive that change as well.

Speaker 1: We've used the information on disparities to shape our improvements, and we knew that from the data that our Spanish preferring families, scored 15 points lower on average, which is very significant for a survey item than our English preferring families. And so, a number of our intervention aspects, really focused on language and assuring that every family, you know, despite background language, left with a clear understanding of what to do next and how to get questions answered. We also saw, significant difference, along race and ethnicity lines. There was 21 points between the highest top box score and the lowest. And so, we designed really a a full enterprise wide approach that touched every clinical area in terms of adapting different tools.

And, it really, was a comprehensive approach that involved previsit preparation. When you think about, did you know what to do if you have questions after the visit, it's tempting to think, oh, that that's something that is only pertinent in the very end. But, actually, if we're preparing beforehand, for example, making sure we have interpreters and preferred language needs are being met, ensuring that we're asking families when they check-in to write down their questions and get organized, They're gonna be more likely to know, what those answers are, responses before they leave. Within the visit, we make sure they've got the language interpretation. We, worked with our clinical teams on teach back and clarification.

So, best practice communication techniques that make sure that we're communicating in ways that are comprehensible and that families are getting all of that information they need. And then, technology support. So there's some EMR based tools that are very, helpful for multiple languages, such as Med Action Plan Pro. We looked at all the different tools we could use that would translate, some of the recommendations and medication instructions in multiple languages, and then focused on discharge communication tools, in terms of handouts, business cards, app based messaging so that it was really clear who to call, what to do, and sometimes even establish new processes. So for example, our hospitalists at one of our hospitals, established a new phone line, since often families didn't know which clinic to call since they're followed by multiple clinics, and that way have one central phone number to call with any post discharge confusion.

So comprehensive approach, really across the board.

Speaker 0: Yeah. Comprehensive is the right word for it, doctor Greco. I appreciate all the specific examples. And what struck me as you were describing all of these tools and support systems, they seem quite empowering, not just from the patient perspective, but from your staff's perspective as well to really support better communication. Absolutely.

And, Rachel, would love to learn a little bit more about the role NRC played as

Speaker 2: Sure. So, again, partnering with Peggy and the team, one, two, after we understood where those gaps were at, how we can get more around the what, the why, and the how to help support, in making sure that these families know exactly what to do when they leave and where to go to if they have questions. And so we have the wonderful opportunity of engaging with their patients and families after they leave in more of a virtual patient and family advisory council. So we can recruit patients and family members to be a part of their virtual advisory council through their surveys. And so we have that opportunity to connect with them and ask them questions around those strategic priorities and initiatives that Nemours Children's Health would like to incorporate patient and family feedback in.

And so we have that opportunity, to field questions to those families to understand what are their needs, why do they have questions, and how can Nemours help them. And so we take that data from those studies and we give it right back to Nemours to help them guide, what those action plans were so they know, and have the ideas around having those cards and or just other areas, providing a good phone number for those families. By doing those custom studies and getting that additional feedback, it just helped provide a little more clarity as to where they can help their patients and families.

Speaker 1: And I wanted to emphasize a few points you made, Rachel, because I think we can't overemphasize the engagement of our NRC health team and the impact, that they had on our overall success. And so just a few specific examples for what Rachel was touching on. They helped us create a fairness survey, which provided a lot of insights from our families. They also helped to develop more visibility for our clinicians on this goal. So it became part of our clinician summary and highlighted so that it was very clear how we were making progress.

And just overall, the collaboration was, very close, and there was a lot of responsivity, when we needed new tools to develop those.

Speaker 0: What a what a great partnership and collaboration your your organizations had here. And doctor Greco, I I wanted to go back to something that you had touched on earlier when we first started touching touching on the case study. You'd mentioned, that the initiative, something that started as a patient experience focus kind of evolved into a broader patient safety priority. So can you share a little bit more about that evolution and the impact that it's having internally across your organization?

Speaker 1: Absolutely. And I think that is really has really been key to its success. Given my background as a clinician, I think, our team tends to really take clinician perspective into account. And in fact, we have clinician liaisons as part of our team, which really makes us feel more fully integrated. And we knew that this needed to be a meaningful goal.

And so we looked at a couple of health outcome metrics, and we found that, the question of did you know what to do if you had questions after the visit was, predictive of return to the ED within forty eight hours. So those families who, answered yes, they knew what to do had a three percent return rate within forty eight hours to the ED. Those who answered that they didn't had a 6% return rate. Well, not only did we find that the return rate was doubled as they didn't know what to do, but we found some differences based on, race, ethnicity, and language. So for those families who preferred, speaking Spanish, they had a 9.2% emergency department return rate within forty eight hours, and families identifying as black had an 8.6 or almost 9% return rate.

So we knew that that difference was exacerbated for certain families and really highlighted the need, to change our processes and our communication and interaction styles in order to prevent that return to the ED. Again, I think having some clear tie in with a clinical outcome, engaged our clinical teams. We didn't have to do a lot of explaining about the why. It was very clear in terms of the need for, clear communication and lack of confusion and understanding of how to get that confusion clarified. And so, with those statistics, we had really good participation and engagement, across the board clinically as well.

Mhmm.

Speaker 0: Yeah. These are really significant outcomes that you uncovered here, doctor Greco. The the double return rate to the ED when folks didn't didn't know or weren't sure what to do after a visit, that's a really compelling stat to highlight, and I'm sure, sounds like it resonated with your clinical teams just as well. And I know you've you've given already some really great tidbits and best practices as as to how this worked for your organization, you know, sharing those clinical outcomes or those those goals with your team seem to be really helpful with buy in. But we'd love to know what other important lessons or recommendations you'd share with others that are hoping to improve equity and ensure that every family leaves with clarity and also confidence.

Speaker 1: So I think there's some broader lessons, and I've tried to take those lessons forward with some of our current initiatives. And one is the what I just touched on. I think goals really have to be meaningful clinically. And so shifting away from metrics that may relate more to marketing and instead finding more actionable measures that really have implications for safety and or outcome means you're gonna get greater engagement. I think ownership of an initiative, we're always very careful that it's not a patient experience goal.

It's a no mores goal that belongs to everyone. There's really cross functional involvement. And so we made sure that, there's really shared ownership, for the goal. It really has to, belong to the entire system. It's not our goal.

It's your goal. And, staying the course is important. This was a three year, initiative, and I appreciate, the great senior leadership support we had for this initiative because sometimes there is pressure to do something different annually. But the long term, persistence really led to the success. It does not come overnight, and I would say we really didn't see system wide consistency and impact until year three.

And so, again, that, improvement option improvement focus really has to be persistent and long term, I think, sometimes to get the impact you want. And then lastly, I think I would say always coming back to the story, the human impact. So how does your initiative, your focus impact, patients and families? I think if you can make it clear what an improvement initiative will do in terms of that impact, you'll always get buy in. And I think that's when you get transformation, when there's the understanding that you can impact lives, that this matters.

So those are some of the broader lessons, we took from this three year initiative, and, hopefully, we still hold on to as we move forward.

Speaker 0: Yeah. That's such a great point, and I'm glad that you highlighted the fact that in that that broader recommendation to stay the course and to be patient, you know, the fact that perhaps results might not become apparent until the third year of a three year initiative that I think that's important for organizations to hear because there is such a pressure for, you know, immediate ROI, I think, on a lot of initiatives that leaders are carrying out. So, love to hear that best practice about staying the course, communicating impacts, driving ownership across teams, not just the patient experience folks and having meaningful goals. So thank you, doctor Greco. And before we wrap, I understand Nemours is also partnering with NRC Health to host a twenty twenty six pediatric collaborative.

So, Rachel, I'd love to learn more about the collaborative and how the work that we've talked about today connects to the themes of that event.

Speaker 2: Yeah. Absolutely. So our pediatric collaborative, we host it annually, and we are very excited to partner with Nemours Children's Health, to host it this, coming year. It will be March 25 through the twenty sixth in sunny Orlando, Florida, so at the Orlando facility. Our pediatric collaborative is a a wonderful event to be able to connect with others that are doing this work, a chance to collaborate and share ideas, best practices, and talking about how each organization is focusing on their data informed decision making within each of their organizations.

And to top it off, we get a wonderful tour of the Nemours Hospital as well. So we're all very much looking forward to being in sunny Orlando in the March.

Speaker 1: I'd love to add that being on-site, really makes a pediatric collaborative powerful, and the previous ones I've attended to be able to see, other health care systems in action, to meet some of their leaders, to hear about their initiatives when you're on the ground, to tour and to see, for example, in one of the recent tours, we saw a sibling care center, just, really innovative, strategies to take care of patients and families. So, I really appreciate the in person learning opportunities that go beyond what a traditional conference would provide.

Speaker 0: Absolutely. Well, it sounds like a fantastic event, and I'm so great it's so great that you'll both be able to see one another in person and and, Rachel take that tour of the Nemours facility. How exciting. It's been a really great time talking to you both today. I really appreciate all of the insights and and how you've candidly shared how this initiative has gone and the successes that you've seen.

Before we wrap, Rachel, wanted to see if you could just share with our listeners how they can learn either more about the event that we've talked about or even the case study.

Speaker 2: Sure. Absolutely. So, our pediatric collaborative, you can register online, at nrchealth.com. We have an events page where you can go and you'll find, the collaborative and, additional information about that, as well as on our nrchealth.com website. You can also go to that and find the case study that just went live, that we just discussed with Nemours Children's Health.

Speaker 0: Fantastic. Thank you for highlighting that, Rachel. And doctor Greco, wanna thank you again for joining the podcast today. It's been great having you both with us. Thank you very much.

I've loved being here.

Speaker 2: Yeah. Thank you so much for having us.

Speaker 0: And we'd also like to thank our podcast sponsor for today, NRC Health. Listeners, be sure to tune into more podcasts from Becker's by visiting our pod page at beckershospitalreview.com.