Latest / Becker’s Healthcare Podcast / Strengthening Nursing Fundamentals to Improve Patient Experience with Sadie Durham, DNP, RN

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Strengthening Nursing Fundamentals to Improve Patient Experience with Sadie Durham, DNP, RN · Becker’s Healthcare Podcast

• 0:00
  Hello, everyone. Welcome to the Becker's Healthcare Podcast.
• 0:03
  I'm Mackenzie Bean, associate vice president and managing
• 0:06
  editor of Becker's Hospital Review.
• 0:09
  And today, I'm so thrilled to be joined
• 0:11
  by doctor Sadie Durham, who is the chief
• 0:13
  nursing officer at Ascension Saint Vincent's Clay County
• 0:17
  in Middleburg, Florida.
• 0:19
  Doctor Durham, thank you so much for joining
• 0:21
  us on the podcast today. How are you
• 0:22
  doing?
• 0:23
  I am doing well. Mackenzie, thank you so
• 0:25
  much for just having me. I'm I'm excited
• 0:28
  about the opportunity to share,
• 0:30
  the progress that we've made, as it relates
• 0:33
  to our patient experience score. Yeah. Well, we're
• 0:35
  we're so excited to have you, and
• 0:38
  let's jump in and start talking about that.
• 0:40
  As I understand it,
• 0:42
  back in 2014,
• 0:45
  you really identified an opportunity
• 0:47
  to,
• 0:49
  refocus on fundamental nursing practices. And as you
• 0:52
  said, it's
• 0:53
  led to some pretty significant,
• 0:55
  improvements
• 0:56
  in patient experience. So maybe you could just
• 0:59
  start there looking back,
• 1:02
  you know, what really,
• 1:04
  motivated the effort to refocus on nursing fundamentals
• 1:08
  for your team?
• 1:09
  So it was was,
• 1:11
  that's a good question. It was back in
• 1:12
  2024,
• 1:14
  and what we recognized is we just we
• 1:17
  saw a significant decline in our patient experience
• 1:20
  scores, and and we really couldn't figure out
• 1:22
  why at the time. Of course, we're looking
• 1:24
  at the comments. We see wait times. We
• 1:27
  see communication.
• 1:28
  We see all of these things.
• 1:30
  So brought the team together,
• 1:32
  the frontline nursing leaders and their director, and
• 1:35
  said, hey, guys.
• 1:36
  Let's let's figure out what's happening. Let's figure
• 1:39
  out what's going on.
• 1:41
  And what we determined was,
• 1:44
  in just our general assessment, is there were
• 1:46
  some key,
• 1:47
  fundamental nursing things that we just had,
• 1:51
  weren't doing or we weren't doing consistently.
• 1:53
  And those things were were, bedside shift reporting
• 1:57
  and hourly rounding.
• 1:58
  So instead of employing something new or adding
• 2:02
  something new to the mix, essentially,
• 2:04
  we just said, let's go back to the
• 2:05
  basics. You know, let's go back to the
• 2:07
  fundamentals and rest let's redeploy that. So that's
• 2:11
  really where it where where it started at
• 2:13
  working.
• 2:15
  Mhmm. Yeah. And I think, you know, we're
• 2:16
  in a moment where you constantly see health
• 2:18
  care pushing towards new tools or technologies and
• 2:21
  innovations. But like you said, you made a
• 2:23
  very intentional decision to focus on those foundational
• 2:26
  nursing behaviors.
• 2:27
  Can you talk to me a little bit
• 2:29
  more about that decision, and how do you
• 2:30
  think that aligns with your own
• 2:32
  philosophy as a nurse leader?
• 2:34
  You know, when I think about my personal
• 2:37
  philosophy
• 2:38
  as a nurse leader,
• 2:39
  ultimately, it's always to ensure that we're giving
• 2:42
  our patients the best care possible,
• 2:44
  care that's safe,
• 2:46
  and care that's of quality.
• 2:48
  Right?
• 2:49
  And in doing that, it's it's really important
• 2:52
  for us to engage our patients, to listen
• 2:55
  to their voice,
• 2:57
  and and really to ensure that they do
• 2:59
  have a great experience.
• 3:01
  And I think in ensuring that we're keeping
• 3:04
  our patients at the center,
• 3:07
  that's the core. Right?
• 3:08
  So
• 3:10
  that's really where it came from is making
• 3:12
  sure that they're at the center of that
• 3:14
  care. And we're doing the best that we
• 3:15
  can to ensure that, a, again, their experience
• 3:18
  is great, and then, b, that it's in
• 3:21
  alignment with the care that we provide to
• 3:23
  them. Mhmm.
• 3:25
  So you've identified
• 3:26
  the the opportunities to, to standardize and, refocus
• 3:30
  on bedside shift reporting, hourly rounding, a lot
• 3:32
  of those fundamentals.
• 3:33
  Can you talk us through where did you
• 3:35
  go from there once you identified that opportunity?
• 3:37
  How did you, take the next steps to
• 3:39
  implement it, and what did that really look
• 3:41
  like in practice?
• 3:42
  So the first thing that we did is
• 3:44
  we really needed to figure out why weren't
• 3:47
  we practicing this way anymore? Why were we
• 3:49
  not consistent with bedside shift reporting?
• 3:52
  Why weren't we rounding on our patients hourly?
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  So we really started with just going to
• 3:56
  our bedside nurses and saying, hey. Why aren't
• 3:59
  we rounding? Why aren't we doing bedside nursing?
• 4:02
  We really wanted to understand what their perceived
• 4:05
  barriers were,
• 4:06
  because that would help us to develop,
• 4:09
  our program moving forward and and determine how
• 4:12
  we can mitigate those perceived barriers.
• 4:15
  And then after that, we decided that we
• 4:17
  need some champions. Right? We needed people we
• 4:19
  needed cheerleaders for the cause, essentially.
• 4:22
  So we pulled in our charge nurses,
• 4:24
  and we did training with them,
• 4:27
  talked to them about what their perceived barriers
• 4:29
  were,
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  and, really, we wanted to them to be
• 4:32
  those resources for their peers to be able
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  to,
• 4:36
  help to
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  disseminate
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  why these practices are so important, not just
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  for the patients,
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  but for them as well.
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  And then we came up with an education
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  plan
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  and made sure that we included the how
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  and the why,
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  why these practices were so important. And then
• 4:54
  once we educated everyone, and I mean everyone
• 4:57
  had to go through that education. So it
• 4:59
  it took us a few months to get
• 5:01
  everyone through.
• 5:02
  We put the practice into motion. Right? And
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  then we had our leaders
• 5:06
  validate the adoption. So it was more than
• 5:08
  just saying, hey. Go out and do.
• 5:10
  The leaders would go and they would validate.
• 5:12
  They would observe. And then they would provide
• 5:15
  feedback,
• 5:16
  sometimes in real time,
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  other times, you know, immediately after the
• 5:21
  after their observation,
• 5:22
  just to help to coach,
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  and to help the the associates feel more
• 5:27
  comfortable in the process. Because remember, we had
• 5:29
  some associates that had experienced their side shift
• 5:32
  recording and rounding, and then we had some
• 5:34
  that this was fairly new because our processes
• 5:37
  were very inconsistent.
• 5:39
  Mhmm.
• 5:41
  That makes sense. So I'm curious as these
• 5:43
  practices became more and more consistent, nurses were
• 5:47
  receiving the feedback.
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  What were some of the positive shifts that
• 5:50
  you noticed whether in patient interactions, nurse experience,
• 5:54
  or, of course, in your in your actual
• 5:55
  metric?
• 5:57
  So I think the first, I would call
• 5:58
  it a a a a nonanticipated
• 6:01
  victory is, you know, prior to that, when
• 6:03
  you would go on the floors, everyone's at
• 6:05
  the nurses' station hovered.
• 6:07
  But after we implement it,
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  I think one of the the measures of
• 6:12
  true success is going on a floor
• 6:15
  on a weekend when there are no nursing
• 6:18
  managers,
• 6:19
  when there are no directors walking around,
• 6:23
  and seeing that at 7AM,
• 6:25
  the floor is clear because the staff are
• 6:28
  in the rooms doing bedside shift reporting.
• 6:31
  So I think that was an immediate,
• 6:34
  shift that we saw, which is great because,
• 6:36
  typically, what happens
• 6:38
  when you roll out these new processes, it's
• 6:40
  great Monday through Friday, but then on the
• 6:42
  weekend, people settle back into to their, prior
• 6:45
  behaviors and performances.
• 6:47
  Mhmm.
• 6:48
  Yeah.
• 6:49
  Talk more about that. How have you been
• 6:51
  able to
• 6:52
  sustain some of the progress that you've seen
• 6:54
  and and make sure there isn't that slippage
• 6:57
  back, not just, depending on the weekday, but
• 7:00
  also over time as I know this was
• 7:01
  back in 2024 when you first started it.
• 7:04
  I think one of the key pieces, of
• 7:06
  course, you know, your managers are there, but
• 7:09
  the key piece is ensuring that your frontline
• 7:11
  leaders, meaning your charge nurses,
• 7:14
  are modeling the behavior
• 7:16
  and then helping to reinforce
• 7:18
  the
• 7:18
  expectations.
• 7:20
  That was an opportunity that we we identified
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  early on as we were working through the
• 7:26
  process is if you don't have charge nurses
• 7:28
  that hold the teams accountable and model the
• 7:30
  behavior,
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  then the staff will say, okay. We don't
• 7:33
  have to do it because our charge nurse
• 7:34
  isn't doing. So I would say that was
• 7:36
  probably
• 7:37
  one of the most pivotal pieces is ensuring
• 7:39
  that the frontline leaders that are there day
• 7:41
  to day
• 7:43
  and spend the most time leading the team,
• 7:45
  so to speak, are modeling the behaviors and
• 7:47
  reinforcing the expectation.
• 7:49
  Mhmm. Really having them serve as their change
• 7:52
  management champions and setting that example.
• 7:56
  Yes. Yeah. And I know I reported a
• 7:59
  a significant increase in the hospital's
• 8:02
  net promoter score, which I wanna make sure
• 8:04
  we mention. Can you
• 8:06
  explain that improvement as well, please?
• 8:09
  It it was a great improvement. It was
• 8:11
  about 40 points. So the prior fiscal year,
• 8:15
  you know, as I mentioned before, we really
• 8:16
  struggle. Right? And we listened to our patients,
• 8:19
  and they said, hey.
• 8:20
  It's too you guys are taking too long
• 8:22
  to respond. There are some opportunities in responsiveness.
• 8:25
  There's opportunities in communication. There's opportunities in care
• 8:28
  team connection.
• 8:29
  And that's how we were able to build
• 8:31
  it back to those pillars of bedside shift
• 8:33
  reporting and,
• 8:35
  and hourly rounding. But in doing those things,
• 8:38
  we saw almost, I would say,
• 8:41
  within about
• 8:43
  six to eight weeks of rolling it out
• 8:45
  and the everyone being trained and probably about
• 8:48
  50%
• 8:49
  50 to 60% of the staff being validated,
• 8:52
  we saw immediate
• 8:54
  increases
• 8:54
  in our scores, in those points. So that
• 8:57
  was,
• 8:58
  very eye opening and and very rewarding. And
• 9:01
  to share that with the staff so that
• 9:03
  they can correlate
• 9:04
  our patients' experience with us just doing something
• 9:08
  as simple as keeping our patients at the
• 9:10
  center, checking on them every hour, and exchanging
• 9:14
  that, having a good handoff
• 9:16
  in front of our patients within the center.
• 9:19
  Mhmm. It's significant to see such an immediate
• 9:23
  improvement
• 9:24
  there.
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  I'm curious for nurse leaders who might be
• 9:27
  listening
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  to this and also working to strengthen their
• 9:30
  own patient experience or or team connection or
• 9:33
  or other fundamentals.
• 9:35
  What advice would you have for them based
• 9:37
  on your own journey here?
• 9:39
  So I think the the first thing is
• 9:41
  very evident is we don't always have to
• 9:43
  look to new technology.
• 9:45
  Mhmm. We don't always need significant
• 9:49
  financial investments.
• 9:51
  Sometimes it's just as simple as going back
• 9:53
  to our basic practices
• 9:55
  and ensuring that we're executing them. I think
• 9:58
  that when we
• 9:59
  start different initiatives or when we work on
• 10:02
  action plans, we come up with all these
• 10:04
  different tactics, and sometimes we don't see progress.
• 10:08
  I think where sometimes we fail as leaders
• 10:10
  is we wanna throw something new at it
• 10:12
  instead of looking at the current tactics and
• 10:15
  determining,
• 10:16
  are we really doing
• 10:18
  what we said we would do?
• 10:20
  Another component is that standardization.
• 10:23
  What we recognized early on is in some
• 10:26
  of our departments, they were doing really well,
• 10:27
  but when staff have looked to another department,
• 10:30
  there wasn't that consistent accountability.
• 10:33
  So
• 10:34
  from, like, a director standpoint, a CNO standpoint,
• 10:38
  there's also going to need to be some
• 10:40
  validation that all of your leaders are operating
• 10:43
  in a standard way,
• 10:45
  and making sure that that leadership presence is
• 10:47
  there because that really matters as well.
• 10:50
  And then just remember that our fundamentals,
• 10:54
  they're truly the core of of why we
• 10:56
  do what they do, and they do drive
• 10:59
  quality and patient experience.
• 11:01
  Mhmm. It's such a good reminder that even
• 11:03
  as health care continues to change, the heart
• 11:06
  of nursing really remains the same.
• 11:08
  So, Sadie, thank you so much for joining
• 11:11
  us on the podcast, sharing your leadership approach
• 11:13
  in this experience. I think it'll resonate with
• 11:15
  a lot of listeners, and we so appreciate
• 11:17
  it. Thank you. Thank you for having me.
• 11:19
  Thank you so much. Of course. And thank
• 11:21
  you everyone for listening in as well. We
• 11:23
  will see you on the podcast next time.