Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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.

Speaker 1: 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.

Speaker 0: Mhmm. Really having them serve as their change management champions and setting that example.

Speaker 1: Yes.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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?

Speaker 1: 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.

Speaker 0: 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.

Speaker 1: Thank you. Thank you for having me. Thank you so much.

Speaker 0: Of course. And thank you everyone for listening in as well. We will see you on the podcast next time.