1 00:00:00,240 --> 00:00:03,139 Hello, everyone. Welcome to the Becker's Healthcare Podcast. 2 00:00:03,759 --> 00:00:06,879 I'm Mackenzie Bean, associate vice president and managing 3 00:00:06,879 --> 00:00:09,059 editor of Becker's Hospital Review. 4 00:00:09,439 --> 00:00:11,599 And today, I'm so thrilled to be joined 5 00:00:11,599 --> 00:00:13,599 by doctor Sadie Durham, who is the chief 6 00:00:13,599 --> 00:00:17,175 nursing officer at Ascension Saint Vincent's Clay County 7 00:00:17,554 --> 00:00:18,934 in Middleburg, Florida. 8 00:00:19,394 --> 00:00:21,394 Doctor Durham, thank you so much for joining 9 00:00:21,394 --> 00:00:22,914 us on the podcast today. How are you 10 00:00:22,914 --> 00:00:23,414 doing? 11 00:00:23,795 --> 00:00:25,954 I am doing well. Mackenzie, thank you so 12 00:00:25,954 --> 00:00:28,355 much for just having me. I'm I'm excited 13 00:00:28,355 --> 00:00:30,134 about the opportunity to share, 14 00:00:30,679 --> 00:00:33,240 the progress that we've made, as it relates 15 00:00:33,240 --> 00:00:35,960 to our patient experience score. Yeah. Well, we're 16 00:00:35,960 --> 00:00:37,899 we're so excited to have you, and 17 00:00:38,280 --> 00:00:40,359 let's jump in and start talking about that. 18 00:00:40,359 --> 00:00:41,820 As I understand it, 19 00:00:42,600 --> 00:00:44,344 back in 2014, 20 00:00:45,045 --> 00:00:46,825 you really identified an opportunity 21 00:00:47,605 --> 00:00:48,105 to, 22 00:00:49,045 --> 00:00:52,005 refocus on fundamental nursing practices. And as you 23 00:00:52,005 --> 00:00:52,745 said, it's 24 00:00:53,125 --> 00:00:54,585 led to some pretty significant, 25 00:00:55,285 --> 00:00:55,785 improvements 26 00:00:56,164 --> 00:00:59,600 in patient experience. So maybe you could just 27 00:00:59,820 --> 00:01:01,520 start there looking back, 28 00:01:02,140 --> 00:01:03,920 you know, what really, 29 00:01:04,700 --> 00:01:07,439 motivated the effort to refocus on nursing fundamentals 30 00:01:08,219 --> 00:01:09,120 for your team? 31 00:01:09,500 --> 00:01:10,560 So it was was, 32 00:01:11,020 --> 00:01:12,700 that's a good question. It was back in 33 00:01:12,700 --> 00:01:14,454 2024, 34 00:01:14,454 --> 00:01:17,334 and what we recognized is we just we 35 00:01:17,334 --> 00:01:20,075 saw a significant decline in our patient experience 36 00:01:20,215 --> 00:01:22,534 scores, and and we really couldn't figure out 37 00:01:22,534 --> 00:01:24,774 why at the time. Of course, we're looking 38 00:01:24,774 --> 00:01:27,174 at the comments. We see wait times. We 39 00:01:27,174 --> 00:01:27,994 see communication. 40 00:01:28,454 --> 00:01:29,900 We see all of these things. 41 00:01:30,520 --> 00:01:32,540 So brought the team together, 42 00:01:32,920 --> 00:01:35,480 the frontline nursing leaders and their director, and 43 00:01:35,480 --> 00:01:36,460 said, hey, guys. 44 00:01:36,920 --> 00:01:39,400 Let's let's figure out what's happening. Let's figure 45 00:01:39,400 --> 00:01:40,700 out what's going on. 46 00:01:41,400 --> 00:01:43,340 And what we determined was, 47 00:01:44,064 --> 00:01:46,224 in just our general assessment, is there were 48 00:01:46,224 --> 00:01:47,045 some key, 49 00:01:47,584 --> 00:01:50,325 fundamental nursing things that we just had, 50 00:01:51,025 --> 00:01:52,965 weren't doing or we weren't doing consistently. 51 00:01:53,424 --> 00:01:56,805 And those things were were, bedside shift reporting 52 00:01:57,025 --> 00:01:58,165 and hourly rounding. 53 00:01:58,739 --> 00:02:02,260 So instead of employing something new or adding 54 00:02:02,260 --> 00:02:04,040 something new to the mix, essentially, 55 00:02:04,500 --> 00:02:05,939 we just said, let's go back to the 56 00:02:05,939 --> 00:02:07,939 basics. You know, let's go back to the 57 00:02:07,939 --> 00:02:11,294 fundamentals and rest let's redeploy that. So that's 58 00:02:11,294 --> 00:02:13,455 really where it where where it started at 59 00:02:13,455 --> 00:02:13,955 working. 60 00:02:15,215 --> 00:02:16,415 Mhmm. Yeah. And I think, you know, we're 61 00:02:16,415 --> 00:02:18,735 in a moment where you constantly see health 62 00:02:18,735 --> 00:02:21,455 care pushing towards new tools or technologies and 63 00:02:21,455 --> 00:02:23,215 innovations. But like you said, you made a 64 00:02:23,215 --> 00:02:26,080 very intentional decision to focus on those foundational 65 00:02:26,080 --> 00:02:27,139 nursing behaviors. 66 00:02:27,919 --> 00:02:29,439 Can you talk to me a little bit 67 00:02:29,439 --> 00:02:30,800 more about that decision, and how do you 68 00:02:30,800 --> 00:02:32,340 think that aligns with your own 69 00:02:32,639 --> 00:02:34,260 philosophy as a nurse leader? 70 00:02:34,800 --> 00:02:37,460 You know, when I think about my personal 71 00:02:37,520 --> 00:02:38,020 philosophy 72 00:02:38,319 --> 00:02:39,379 as a nurse leader, 73 00:02:39,760 --> 00:02:42,314 ultimately, it's always to ensure that we're giving 74 00:02:42,314 --> 00:02:44,094 our patients the best care possible, 75 00:02:44,715 --> 00:02:45,854 care that's safe, 76 00:02:46,555 --> 00:02:48,254 and care that's of quality. 77 00:02:48,555 --> 00:02:49,055 Right? 78 00:02:49,514 --> 00:02:52,495 And in doing that, it's it's really important 79 00:02:52,634 --> 00:02:55,514 for us to engage our patients, to listen 80 00:02:55,514 --> 00:02:56,495 to their voice, 81 00:02:57,169 --> 00:02:59,729 and and really to ensure that they do 82 00:02:59,729 --> 00:03:01,270 have a great experience. 83 00:03:01,969 --> 00:03:04,689 And I think in ensuring that we're keeping 84 00:03:04,689 --> 00:03:06,389 our patients at the center, 85 00:03:07,009 --> 00:03:08,469 that's the core. Right? 86 00:03:08,770 --> 00:03:09,270 So 87 00:03:10,335 --> 00:03:12,574 that's really where it came from is making 88 00:03:12,574 --> 00:03:14,175 sure that they're at the center of that 89 00:03:14,175 --> 00:03:15,854 care. And we're doing the best that we 90 00:03:15,854 --> 00:03:18,814 can to ensure that, a, again, their experience 91 00:03:18,814 --> 00:03:21,215 is great, and then, b, that it's in 92 00:03:21,215 --> 00:03:23,215 alignment with the care that we provide to 93 00:03:23,215 --> 00:03:24,034 them. Mhmm. 94 00:03:25,219 --> 00:03:26,360 So you've identified 95 00:03:26,819 --> 00:03:30,579 the the opportunities to, to standardize and, refocus 96 00:03:30,579 --> 00:03:32,500 on bedside shift reporting, hourly rounding, a lot 97 00:03:32,500 --> 00:03:33,319 of those fundamentals. 98 00:03:33,860 --> 00:03:35,379 Can you talk us through where did you 99 00:03:35,379 --> 00:03:37,479 go from there once you identified that opportunity? 100 00:03:37,620 --> 00:03:39,705 How did you, take the next steps to 101 00:03:39,705 --> 00:03:41,064 implement it, and what did that really look 102 00:03:41,064 --> 00:03:41,965 like in practice? 103 00:03:42,825 --> 00:03:44,825 So the first thing that we did is 104 00:03:44,825 --> 00:03:47,145 we really needed to figure out why weren't 105 00:03:47,145 --> 00:03:49,625 we practicing this way anymore? Why were we 106 00:03:49,625 --> 00:03:51,805 not consistent with bedside shift reporting? 107 00:03:52,139 --> 00:03:54,400 Why weren't we rounding on our patients hourly? 108 00:03:54,459 --> 00:03:56,780 So we really started with just going to 109 00:03:56,780 --> 00:03:59,500 our bedside nurses and saying, hey. Why aren't 110 00:03:59,500 --> 00:04:02,239 we rounding? Why aren't we doing bedside nursing? 111 00:04:02,379 --> 00:04:04,799 We really wanted to understand what their perceived 112 00:04:05,099 --> 00:04:06,000 barriers were, 113 00:04:06,594 --> 00:04:08,534 because that would help us to develop, 114 00:04:09,314 --> 00:04:12,754 our program moving forward and and determine how 115 00:04:12,754 --> 00:04:14,855 we can mitigate those perceived barriers. 116 00:04:15,314 --> 00:04:17,314 And then after that, we decided that we 117 00:04:17,314 --> 00:04:19,560 need some champions. Right? We needed people we 118 00:04:19,560 --> 00:04:21,899 needed cheerleaders for the cause, essentially. 119 00:04:22,360 --> 00:04:24,219 So we pulled in our charge nurses, 120 00:04:24,919 --> 00:04:26,699 and we did training with them, 121 00:04:27,240 --> 00:04:29,319 talked to them about what their perceived barriers 122 00:04:29,319 --> 00:04:29,819 were, 123 00:04:30,519 --> 00:04:32,680 and, really, we wanted to them to be 124 00:04:32,680 --> 00:04:35,204 those resources for their peers to be able 125 00:04:35,204 --> 00:04:35,704 to, 126 00:04:36,165 --> 00:04:37,225 help to 127 00:04:37,764 --> 00:04:38,264 disseminate 128 00:04:38,564 --> 00:04:41,204 why these practices are so important, not just 129 00:04:41,204 --> 00:04:42,104 for the patients, 130 00:04:42,404 --> 00:04:44,104 but for them as well. 131 00:04:44,725 --> 00:04:46,824 And then we came up with an education 132 00:04:46,964 --> 00:04:47,464 plan 133 00:04:47,930 --> 00:04:49,770 and made sure that we included the how 134 00:04:49,770 --> 00:04:50,670 and the why, 135 00:04:51,209 --> 00:04:54,410 why these practices were so important. And then 136 00:04:54,410 --> 00:04:57,129 once we educated everyone, and I mean everyone 137 00:04:57,129 --> 00:04:59,050 had to go through that education. So it 138 00:04:59,050 --> 00:05:01,129 it took us a few months to get 139 00:05:01,129 --> 00:05:02,189 everyone through. 140 00:05:02,495 --> 00:05:04,495 We put the practice into motion. Right? And 141 00:05:04,495 --> 00:05:05,714 then we had our leaders 142 00:05:06,014 --> 00:05:08,495 validate the adoption. So it was more than 143 00:05:08,495 --> 00:05:10,595 just saying, hey. Go out and do. 144 00:05:10,895 --> 00:05:12,915 The leaders would go and they would validate. 145 00:05:12,975 --> 00:05:15,055 They would observe. And then they would provide 146 00:05:15,055 --> 00:05:15,555 feedback, 147 00:05:16,209 --> 00:05:17,589 sometimes in real time, 148 00:05:17,970 --> 00:05:20,610 other times, you know, immediately after the 149 00:05:21,169 --> 00:05:22,149 after their observation, 150 00:05:22,930 --> 00:05:24,470 just to help to coach, 151 00:05:25,009 --> 00:05:27,649 and to help the the associates feel more 152 00:05:27,649 --> 00:05:29,889 comfortable in the process. Because remember, we had 153 00:05:29,889 --> 00:05:32,745 some associates that had experienced their side shift 154 00:05:32,745 --> 00:05:34,745 recording and rounding, and then we had some 155 00:05:34,745 --> 00:05:37,404 that this was fairly new because our processes 156 00:05:37,545 --> 00:05:38,605 were very inconsistent. 157 00:05:39,705 --> 00:05:40,205 Mhmm. 158 00:05:41,305 --> 00:05:43,785 That makes sense. So I'm curious as these 159 00:05:43,785 --> 00:05:47,199 practices became more and more consistent, nurses were 160 00:05:47,199 --> 00:05:48,339 receiving the feedback. 161 00:05:49,120 --> 00:05:50,800 What were some of the positive shifts that 162 00:05:50,800 --> 00:05:54,319 you noticed whether in patient interactions, nurse experience, 163 00:05:54,319 --> 00:05:55,839 or, of course, in your in your actual 164 00:05:55,839 --> 00:05:56,339 metric? 165 00:05:57,040 --> 00:05:58,639 So I think the first, I would call 166 00:05:58,639 --> 00:06:00,405 it a a a a nonanticipated 167 00:06:01,185 --> 00:06:03,585 victory is, you know, prior to that, when 168 00:06:03,585 --> 00:06:05,425 you would go on the floors, everyone's at 169 00:06:05,425 --> 00:06:06,805 the nurses' station hovered. 170 00:06:07,585 --> 00:06:10,085 But after we implement it, 171 00:06:10,465 --> 00:06:12,689 I think one of the the measures of 172 00:06:12,850 --> 00:06:15,269 true success is going on a floor 173 00:06:15,810 --> 00:06:18,470 on a weekend when there are no nursing 174 00:06:18,529 --> 00:06:19,029 managers, 175 00:06:19,649 --> 00:06:22,470 when there are no directors walking around, 176 00:06:23,009 --> 00:06:25,589 and seeing that at 7AM, 177 00:06:25,889 --> 00:06:28,404 the floor is clear because the staff are 178 00:06:28,404 --> 00:06:31,305 in the rooms doing bedside shift reporting. 179 00:06:31,764 --> 00:06:33,625 So I think that was an immediate, 180 00:06:34,324 --> 00:06:36,485 shift that we saw, which is great because, 181 00:06:36,485 --> 00:06:37,625 typically, what happens 182 00:06:38,085 --> 00:06:40,310 when you roll out these new processes, it's 183 00:06:40,310 --> 00:06:42,149 great Monday through Friday, but then on the 184 00:06:42,149 --> 00:06:45,349 weekend, people settle back into to their, prior 185 00:06:45,349 --> 00:06:46,569 behaviors and performances. 186 00:06:47,269 --> 00:06:47,769 Mhmm. 187 00:06:48,470 --> 00:06:48,970 Yeah. 188 00:06:49,349 --> 00:06:51,430 Talk more about that. How have you been 189 00:06:51,430 --> 00:06:52,250 able to 190 00:06:52,714 --> 00:06:54,954 sustain some of the progress that you've seen 191 00:06:54,954 --> 00:06:57,435 and and make sure there isn't that slippage 192 00:06:57,435 --> 00:07:00,074 back, not just, depending on the weekday, but 193 00:07:00,074 --> 00:07:01,754 also over time as I know this was 194 00:07:01,754 --> 00:07:04,014 back in 2024 when you first started it. 195 00:07:04,490 --> 00:07:06,330 I think one of the key pieces, of 196 00:07:06,330 --> 00:07:09,050 course, you know, your managers are there, but 197 00:07:09,050 --> 00:07:11,470 the key piece is ensuring that your frontline 198 00:07:11,529 --> 00:07:13,550 leaders, meaning your charge nurses, 199 00:07:14,089 --> 00:07:15,550 are modeling the behavior 200 00:07:16,009 --> 00:07:17,709 and then helping to reinforce 201 00:07:18,009 --> 00:07:18,509 the 202 00:07:18,964 --> 00:07:19,464 expectations. 203 00:07:20,245 --> 00:07:23,384 That was an opportunity that we we identified 204 00:07:23,845 --> 00:07:26,245 early on as we were working through the 205 00:07:26,245 --> 00:07:28,485 process is if you don't have charge nurses 206 00:07:28,485 --> 00:07:30,485 that hold the teams accountable and model the 207 00:07:30,485 --> 00:07:30,985 behavior, 208 00:07:31,480 --> 00:07:33,000 then the staff will say, okay. We don't 209 00:07:33,000 --> 00:07:34,360 have to do it because our charge nurse 210 00:07:34,360 --> 00:07:36,199 isn't doing. So I would say that was 211 00:07:36,199 --> 00:07:36,699 probably 212 00:07:37,240 --> 00:07:39,800 one of the most pivotal pieces is ensuring 213 00:07:39,800 --> 00:07:41,960 that the frontline leaders that are there day 214 00:07:41,960 --> 00:07:42,620 to day 215 00:07:43,000 --> 00:07:45,319 and spend the most time leading the team, 216 00:07:45,319 --> 00:07:47,884 so to speak, are modeling the behaviors and 217 00:07:47,884 --> 00:07:49,185 reinforcing the expectation. 218 00:07:49,964 --> 00:07:52,685 Mhmm. Really having them serve as their change 219 00:07:52,685 --> 00:07:55,665 management champions and setting that example. 220 00:07:56,285 --> 00:07:59,644 Yes. Yeah. And I know I reported a 221 00:07:59,644 --> 00:08:01,665 a significant increase in the hospital's 222 00:08:02,339 --> 00:08:04,180 net promoter score, which I wanna make sure 223 00:08:04,180 --> 00:08:05,959 we mention. Can you 224 00:08:06,339 --> 00:08:08,439 explain that improvement as well, please? 225 00:08:09,459 --> 00:08:11,540 It it was a great improvement. It was 226 00:08:11,540 --> 00:08:15,060 about 40 points. So the prior fiscal year, 227 00:08:15,060 --> 00:08:16,819 you know, as I mentioned before, we really 228 00:08:16,819 --> 00:08:19,235 struggle. Right? And we listened to our patients, 229 00:08:19,235 --> 00:08:20,294 and they said, hey. 230 00:08:20,754 --> 00:08:22,514 It's too you guys are taking too long 231 00:08:22,514 --> 00:08:25,014 to respond. There are some opportunities in responsiveness. 232 00:08:25,235 --> 00:08:28,354 There's opportunities in communication. There's opportunities in care 233 00:08:28,354 --> 00:08:29,094 team connection. 234 00:08:29,410 --> 00:08:31,250 And that's how we were able to build 235 00:08:31,250 --> 00:08:33,809 it back to those pillars of bedside shift 236 00:08:33,809 --> 00:08:34,549 reporting and, 237 00:08:35,570 --> 00:08:38,230 and hourly rounding. But in doing those things, 238 00:08:38,529 --> 00:08:41,190 we saw almost, I would say, 239 00:08:41,924 --> 00:08:42,664 within about 240 00:08:43,365 --> 00:08:45,524 six to eight weeks of rolling it out 241 00:08:45,524 --> 00:08:48,345 and the everyone being trained and probably about 242 00:08:48,565 --> 00:08:49,205 50% 243 00:08:49,445 --> 00:08:51,705 50 to 60% of the staff being validated, 244 00:08:52,485 --> 00:08:53,544 we saw immediate 245 00:08:54,085 --> 00:08:54,585 increases 246 00:08:54,980 --> 00:08:57,300 in our scores, in those points. So that 247 00:08:57,300 --> 00:08:57,800 was, 248 00:08:58,660 --> 00:09:01,379 very eye opening and and very rewarding. And 249 00:09:01,379 --> 00:09:03,300 to share that with the staff so that 250 00:09:03,300 --> 00:09:04,279 they can correlate 251 00:09:04,740 --> 00:09:08,019 our patients' experience with us just doing something 252 00:09:08,019 --> 00:09:10,514 as simple as keeping our patients at the 253 00:09:10,514 --> 00:09:14,054 center, checking on them every hour, and exchanging 254 00:09:14,195 --> 00:09:16,294 that, having a good handoff 255 00:09:16,595 --> 00:09:19,014 in front of our patients within the center. 256 00:09:19,554 --> 00:09:22,774 Mhmm. It's significant to see such an immediate 257 00:09:23,235 --> 00:09:23,735 improvement 258 00:09:24,115 --> 00:09:24,615 there. 259 00:09:25,509 --> 00:09:27,669 I'm curious for nurse leaders who might be 260 00:09:27,669 --> 00:09:28,169 listening 261 00:09:28,549 --> 00:09:30,789 to this and also working to strengthen their 262 00:09:30,789 --> 00:09:33,429 own patient experience or or team connection or 263 00:09:33,429 --> 00:09:34,329 or other fundamentals. 264 00:09:35,350 --> 00:09:37,110 What advice would you have for them based 265 00:09:37,110 --> 00:09:38,570 on your own journey here? 266 00:09:39,235 --> 00:09:41,154 So I think the the first thing is 267 00:09:41,154 --> 00:09:43,554 very evident is we don't always have to 268 00:09:43,554 --> 00:09:44,695 look to new technology. 269 00:09:45,795 --> 00:09:48,695 Mhmm. We don't always need significant 270 00:09:49,154 --> 00:09:50,295 financial investments. 271 00:09:51,089 --> 00:09:53,649 Sometimes it's just as simple as going back 272 00:09:53,649 --> 00:09:55,029 to our basic practices 273 00:09:55,490 --> 00:09:58,529 and ensuring that we're executing them. I think 274 00:09:58,529 --> 00:09:59,589 that when we 275 00:09:59,970 --> 00:10:02,289 start different initiatives or when we work on 276 00:10:02,289 --> 00:10:04,575 action plans, we come up with all these 277 00:10:04,575 --> 00:10:07,394 different tactics, and sometimes we don't see progress. 278 00:10:08,014 --> 00:10:10,495 I think where sometimes we fail as leaders 279 00:10:10,495 --> 00:10:12,835 is we wanna throw something new at it 280 00:10:12,975 --> 00:10:15,615 instead of looking at the current tactics and 281 00:10:15,615 --> 00:10:16,115 determining, 282 00:10:16,470 --> 00:10:17,850 are we really doing 283 00:10:18,309 --> 00:10:19,850 what we said we would do? 284 00:10:20,549 --> 00:10:22,730 Another component is that standardization. 285 00:10:23,190 --> 00:10:26,149 What we recognized early on is in some 286 00:10:26,149 --> 00:10:27,909 of our departments, they were doing really well, 287 00:10:27,909 --> 00:10:30,009 but when staff have looked to another department, 288 00:10:30,149 --> 00:10:32,644 there wasn't that consistent accountability. 289 00:10:33,664 --> 00:10:34,164 So 290 00:10:34,945 --> 00:10:37,684 from, like, a director standpoint, a CNO standpoint, 291 00:10:38,384 --> 00:10:40,144 there's also going to need to be some 292 00:10:40,144 --> 00:10:43,205 validation that all of your leaders are operating 293 00:10:43,664 --> 00:10:45,125 in a standard way, 294 00:10:45,550 --> 00:10:47,950 and making sure that that leadership presence is 295 00:10:47,950 --> 00:10:49,970 there because that really matters as well. 296 00:10:50,509 --> 00:10:52,769 And then just remember that our fundamentals, 297 00:10:54,029 --> 00:10:56,430 they're truly the core of of why we 298 00:10:56,430 --> 00:10:59,070 do what they do, and they do drive 299 00:10:59,070 --> 00:11:00,690 quality and patient experience. 300 00:11:01,284 --> 00:11:03,924 Mhmm. It's such a good reminder that even 301 00:11:03,924 --> 00:11:06,164 as health care continues to change, the heart 302 00:11:06,164 --> 00:11:08,664 of nursing really remains the same. 303 00:11:08,965 --> 00:11:11,684 So, Sadie, thank you so much for joining 304 00:11:11,684 --> 00:11:13,524 us on the podcast, sharing your leadership approach 305 00:11:13,524 --> 00:11:15,284 in this experience. I think it'll resonate with 306 00:11:15,284 --> 00:11:17,149 a lot of listeners, and we so appreciate 307 00:11:17,210 --> 00:11:19,290 it. Thank you. Thank you for having me. 308 00:11:19,290 --> 00:11:21,290 Thank you so much. Of course. And thank 309 00:11:21,290 --> 00:11:23,290 you everyone for listening in as well. We 310 00:11:23,290 --> 00:11:25,470 will see you on the podcast next time.