Hello, everyone. Welcome to the Becker's Healthcare Podcast.
I'm Mackenzie Bean, associate vice president and managing
editor of Becker's Hospital Review.
And today, I'm so thrilled to be joined
by doctor Sadie Durham, who is the chief
nursing officer at Ascension Saint Vincent's Clay County
in Middleburg, Florida.
Doctor Durham, thank you so much for joining
us on the podcast today. How are you
doing?
I am doing well. Mackenzie, thank you so
much for just having me. I'm I'm excited
about the opportunity to share,
the progress that we've made, as it relates
to our patient experience score. Yeah. Well, we're
we're so excited to have you, and
let's jump in and start talking about that.
As I understand it,
back in 2014,
you really identified an opportunity
to,
refocus on fundamental nursing practices. And as you
said, it's
led to some pretty significant,
improvements
in patient experience. So maybe you could just
start there looking back,
you know, what really,
motivated the effort to refocus on nursing fundamentals
for your team?
So it was was,
that's a good question. It was back in
2024,
and what we recognized is we just we
saw a significant decline in our patient experience
scores, and and we really couldn't figure out
why at the time. Of course, we're looking
at the comments. We see wait times. We
see communication.
We see all of these things.
So brought the team together,
the frontline nursing leaders and their director, and
said, hey, guys.
Let's let's figure out what's happening. Let's figure
out what's going on.
And what we determined was,
in just our general assessment, is there were
some key,
fundamental nursing things that we just had,
weren't doing or we weren't doing consistently.
And those things were were, bedside shift reporting
and hourly rounding.
So instead of employing something new or adding
something new to the mix, essentially,
we just said, let's go back to the
basics. You know, let's go back to the
fundamentals and rest let's redeploy that. So that's
really where it where where it started at
working.
Mhmm. Yeah. And I think, you know, we're
in a moment where you constantly see health
care pushing towards new tools or technologies and
innovations. But like you said, you made a
very intentional decision to focus on those foundational
nursing behaviors.
Can you talk to me a little bit
more about that decision, and how do you
think that aligns with your own
philosophy as a nurse leader?
You know, when I think about my personal
philosophy
as a nurse leader,
ultimately, it's always to ensure that we're giving
our patients the best care possible,
care that's safe,
and care that's of quality.
Right?
And in doing that, it's it's really important
for us to engage our patients, to listen
to their voice,
and and really to ensure that they do
have a great experience.
And I think in ensuring that we're keeping
our patients at the center,
that's the core. Right?
So
that's really where it came from is making
sure that they're at the center of that
care. And we're doing the best that we
can to ensure that, a, again, their experience
is great, and then, b, that it's in
alignment with the care that we provide to
them. Mhmm.
So you've identified
the the opportunities to, to standardize and, refocus
on bedside shift reporting, hourly rounding, a lot
of those fundamentals.
Can you talk us through where did you
go from there once you identified that opportunity?
How did you, take the next steps to
implement it, and what did that really look
like in practice?
So the first thing that we did is
we really needed to figure out why weren't
we practicing this way anymore? Why were we
not consistent with bedside shift reporting?
Why weren't we rounding on our patients hourly?
So we really started with just going to
our bedside nurses and saying, hey. Why aren't
we rounding? Why aren't we doing bedside nursing?
We really wanted to understand what their perceived
barriers were,
because that would help us to develop,
our program moving forward and and determine how
we can mitigate those perceived barriers.
And then after that, we decided that we
need some champions. Right? We needed people we
needed cheerleaders for the cause, essentially.
So we pulled in our charge nurses,
and we did training with them,
talked to them about what their perceived barriers
were,
and, really, we wanted to them to be
those resources for their peers to be able
to,
help to
disseminate
why these practices are so important, not just
for the patients,
but for them as well.
And then we came up with an education
plan
and made sure that we included the how
and the why,
why these practices were so important. And then
once we educated everyone, and I mean everyone
had to go through that education. So it
it took us a few months to get
everyone through.
We put the practice into motion. Right? And
then we had our leaders
validate the adoption. So it was more than
just saying, hey. Go out and do.
The leaders would go and they would validate.
They would observe. And then they would provide
feedback,
sometimes in real time,
other times, you know, immediately after the
after their observation,
just to help to coach,
and to help the the associates feel more
comfortable in the process. Because remember, we had
some associates that had experienced their side shift
recording and rounding, and then we had some
that this was fairly new because our processes
were very inconsistent.
Mhmm.
That makes sense. So I'm curious as these
practices became more and more consistent, nurses were
receiving the feedback.
What were some of the positive shifts that
you noticed whether in patient interactions, nurse experience,
or, of course, in your in your actual
metric?
So I think the first, I would call
it a a a a nonanticipated
victory is, you know, prior to that, when
you would go on the floors, everyone's at
the nurses' station hovered.
But after we implement it,
I think one of the the measures of
true success is going on a floor
on a weekend when there are no nursing
managers,
when there are no directors walking around,
and seeing that at 7AM,
the floor is clear because the staff are
in the rooms doing bedside shift reporting.
So I think that was an immediate,
shift that we saw, which is great because,
typically, what happens
when you roll out these new processes, it's
great Monday through Friday, but then on the
weekend, people settle back into to their, prior
behaviors and performances.
Mhmm.
Yeah.
Talk more about that. How have you been
able to
sustain some of the progress that you've seen
and and make sure there isn't that slippage
back, not just, depending on the weekday, but
also over time as I know this was
back in 2024 when you first started it.
I think one of the key pieces, of
course, you know, your managers are there, but
the key piece is ensuring that your frontline
leaders, meaning your charge nurses,
are modeling the behavior
and then helping to reinforce
the
expectations.
That was an opportunity that we we identified
early on as we were working through the
process is if you don't have charge nurses
that hold the teams accountable and model the
behavior,
then the staff will say, okay. We don't
have to do it because our charge nurse
isn't doing. So I would say that was
probably
one of the most pivotal pieces is ensuring
that the frontline leaders that are there day
to day
and spend the most time leading the team,
so to speak, are modeling the behaviors and
reinforcing the expectation.
Mhmm. Really having them serve as their change
management champions and setting that example.
Yes. Yeah. And I know I reported a
a significant increase in the hospital's
net promoter score, which I wanna make sure
we mention. Can you
explain that improvement as well, please?
It it was a great improvement. It was
about 40 points. So the prior fiscal year,
you know, as I mentioned before, we really
struggle. Right? And we listened to our patients,
and they said, hey.
It's too you guys are taking too long
to respond. There are some opportunities in responsiveness.
There's opportunities in communication. There's opportunities in care
team connection.
And that's how we were able to build
it back to those pillars of bedside shift
reporting and,
and hourly rounding. But in doing those things,
we saw almost, I would say,
within about
six to eight weeks of rolling it out
and the everyone being trained and probably about
50%
50 to 60% of the staff being validated,
we saw immediate
increases
in our scores, in those points. So that
was,
very eye opening and and very rewarding. And
to share that with the staff so that
they can correlate
our patients' experience with us just doing something
as simple as keeping our patients at the
center, checking on them every hour, and exchanging
that, having a good handoff
in front of our patients within the center.
Mhmm. It's significant to see such an immediate
improvement
there.
I'm curious for nurse leaders who might be
listening
to this and also working to strengthen their
own patient experience or or team connection or
or other fundamentals.
What advice would you have for them based
on your own journey here?
So I think the the first thing is
very evident is we don't always have to
look to new technology.
Mhmm. We don't always need significant
financial investments.
Sometimes it's just as simple as going back
to our basic practices
and ensuring that we're executing them. I think
that when we
start different initiatives or when we work on
action plans, we come up with all these
different tactics, and sometimes we don't see progress.
I think where sometimes we fail as leaders
is we wanna throw something new at it
instead of looking at the current tactics and
determining,
are we really doing
what we said we would do?
Another component is that standardization.
What we recognized early on is in some
of our departments, they were doing really well,
but when staff have looked to another department,
there wasn't that consistent accountability.
So
from, like, a director standpoint, a CNO standpoint,
there's also going to need to be some
validation that all of your leaders are operating
in a standard way,
and making sure that that leadership presence is
there because that really matters as well.
And then just remember that our fundamentals,
they're truly the core of of why we
do what they do, and they do drive
quality and patient experience.
Mhmm. It's such a good reminder that even
as health care continues to change, the heart
of nursing really remains the same.
So, Sadie, thank you so much for joining
us on the podcast, sharing your leadership approach
in this experience. I think it'll resonate with
a lot of listeners, and we so appreciate
it. Thank you. Thank you for having me.
Thank you so much. Of course. And thank
you everyone for listening in as well. We
will see you on the podcast next time.