Expert Interview Series, Episode 17: Cheryl Kilbourne, Director of Inpatient Nursing, Wakemed Health and Hospitals
Hi, everybody. Welcome to another in our series of interviews with leaders in the patient experience world. My name is Andy Roth. I am Head of Customer Success at Feedtrail. Today I’m very excited to talk to Cheryl Kilbourne, the Director of Inpatient Nursing at WakeMed North Hospital in Raleigh, North Carolina. She and I have known each other for a few months now, and I’m very excited to hear what she has to say about patient experience and learning from patients and how she goes about doing that.
By Andy Roth
Andy: Good afternoon, Cheryl, how are you?
Cheryl: I’m very good, Andy. How are you?
Andy: Doing great, I’m really looking forward to this. Why don’t you tell the good people a little bit about yourself, where you work, and what it is that you do?
Cheryl: I have been the leader over Women and Children’s Services for about 16 years between two organizations, and most recently came to WakeMed North in Raleigh in February of 2015 to help open a smaller, boutique-style hospital for women’s services. That process has led into widening our patient scope here and now we have med-surg and orthopedics. Women and Children’s Services has been my primary focus for the last 15, 16 years, and then emergency room medicine along with general inpatient care. All of my experience has been in the acute health care side for a little over 35 years.
Andy: Excellent. Thank you for that. Could you tell me a little more about WakeMed as an organization and where you fit in to that organizational structure?
Cheryl: We have three hospitals along with many outpatient and freestanding emergency rooms. Our three hospitals all have Women and Children’s Services along with med-surg services in them. I am at the smallest location of the three and between the three of us, we deliver about 8,500 babies a year. It’s a very large service line in WakeMed.
Andy: I did not know that. That’s really interesting. Tell me a little about what your average day looks like in terms of things you repeatedly do, in terms of how you manage patient experience. Are you taking meetings? Are you meeting with patients? What does your average day or week look like?
Cheryl: For the most part, I’m handling the operations of inpatient services. I have very experienced folks on the educator and management side, and we watch everything — census, patient volume is very important, how the patient flow works, and then we’re also involved in rounding with our patients. Our goal is to see every patient every day —as many people know, in healthcare that gets derailed from time to time. Getting that feedback from our patients has always been very important to us in regards to what their experience has been like, so that you can intervene and do something to help improve their experience. From day to day, it is about the operations of the unit, patient flow, and any staff-related issues and then patient-related items as well.
Andy: Let’s talk problems or issues or challenges either at WakeMed or over your career as a whole. What are some of the biggest patient experience challenges that you’ve had to face?
Cheryl: I think census demands sometimes are a big issue. The flow of patients, making sure that our surgery patients are coming in timely and have a bed, the emergency room as well. Also, the dynamics of what is going on with a patient — that is a big deal, because you don’t know if they’re fearful of a diagnosis, or if this news has just been dropped in their lap. Watching those dynamics and meeting those needs are a big priority for us.
Andy: Let’s talk more about that last one, meeting the needs of the patient where they’re living in that moment. How does that affect you or your team as an organization at whatever level you’d like as you move forward and, because you’re at the operational level, put processes in place?
Cheryl: Well, I think one thing that’s really important for all of us to remember is what it’s like to be a patient. Some people have never been a patient, or it’s been so long ago, or it was such a minimal experience that it doesn’t affect them the way it does when there’s big events going on, maybe a heart attack and then the patient goes for open-heart surgery, or a recently diagnosed stroke. There are lots of things around the dynamics of the patient care that we worry about. You want to make sure you’re meeting those needs.
The patient’s family network might be very busy, so there’s no one really available to help care for this individual if an ongoing stroke is something that’s going to limit their ability to care for themselves. Those dynamics, I think, are very stressful for all of our patients — and, by extension, for the care teams helping patients and their families meet those needs. And, of course, every situation is different. I think that’s why I love this career path I have been on. Every situation is different; how can we as a team help support this family and that diagnosis or event that’s going on in their life?
Andy: How have you met that part of the challenge, making sure that every individual patient or every individual family gets individualized attention?
Cheryl: Working to make sure that your ratios are maintained, so that nursing is not overstretched any more than absolutely necessary. That way, nurses have the time to meet their patients’ needs. Then, rounding with the patients and checking in to see how they’re feeling. I remember when I had a family member in the hospital, the manager of the unit checked in on us every single day, and that was very nice to have that connection with that individual, and also to know that you could count on seeing her, so that if something had come up, that you would just mention it to her when she came in.
Andy: It sounds like you’ve been interested in patient feedback for a very long time and have made it an important part of your processes.
Cheryl: Absolutely. I’m always worried about things that happen that we don’t know about because we were in meetings or didn’t have the opportunity to round, or the charge nurse didn’t have an opportunity to round. The piece that helps me solve that is patient feedback, which has always been a huge interest of mine. Through our patient surveys or HCAHPS, you can see your total scores and see how you’re trending over time, but we’ve never had that individual piece.
Years ago, I wanted to bring a patient focus group together to provide feedback on the experience and ask how we were meeting those needs, and what things we needed to change to better meet those needs. But I never had the opportunity to do it because all of our surveys are all confidential. It created a little bit of limitation which has been solved through Feedtrail’s ability to identify the patient — getting that feedback now has been a huge help to us. Although we started out intending the platform to be for service recovery, to facilitate early intervention for any patients that needed something, it just has grown into a much bigger, positive feedback mechanism that we can use to give kudos to the care team all the way around.
Our patients have taken advantage of the ability to leave notes about their favorite nurses; they have written some of the most beautiful personal notes to us in regards to the care that they have received. They have mentioned many nurses and other staff members by name, which is wonderful. Giving that feedback to the care team has been such a positive reinforcement, and it’s helped us focus on what we do well and what we want to continue to do well because we see how it impacts the patient and how they have such a positive reflection of their experience.
We are not saying that everything always goes perfectly because we know that that is not the case all the time, but the little things don’t necessarily matter when you have affected a patient in such a positive way and they know that you care about them. I think that’s the piece too that I’ve seen in these comments is there is a relationship and an effort that is made at a level that a lot of patients don’t necessarily get to feel. When you have that kind of relationship, that’s really something.
For example, you might have waited a little bit longer than what you’d preferred to on something, but it doesn’t necessarily have a global effect on your opinion of your entire visit when you’ve got a really good relationship with your care team. Having that feedback and being able to give that feedback to the care team has been a very, very positive thing for us.
Andy: Following up on that, in terms of the quantitative feedback that you’re getting versus the qualitative feedback, it sounds like the qualitative feedback is as useful or more useful than the quantitative.
Cheryl: Originally, because we first approached this as a service recovery initiative, we wanted everything to be as timely as we could. We have had a couple of comments come through that we were able to get in and see our patient right away because we get that notification as soon as it’s sent from the patient, and myself or another leader will make sure that we round on that patient within a few hours of that comment coming in.
That has been beneficial, but the most beneficial piece is the positive comments. Adding a follow-up question for patients submitting the highest scores started us getting the kind of comments that we just wanted to reinforce. We always want to perform service recovery and fix things where necessary, but we’ve only had three comments in the six months that even needed service recovery.
Without minimizing the service recovery piece because that’s incredibly important, we have now focused on all of the top rankings or ratings that have come from our patients and then the beautifully written notes. That is the part that means so much to everybody because that is a personally written note from the patient, and it involves the names of the many people that took care of them. That is what we really care about.
You can put up there yes, we’ve got a 5 star rating or a 4.8 star rating, but when you see the notes from the patients and how much they felt the compassion from their care team and how they felt cared for, it makes all the difference in the world.
Andy: Let’s chat about how you implemented this solution and this process. Did you have to create buy-in from your executive team, your nurses, and your direct reports, or were people bought in to the process from the beginning?
Cheryl: Well, it’s not any different than anything else that you roll out or implement. As far as the executive team goes, we were asked to be the trial unit for this. My unit and another unit on another campus were the trial locations. The person that asked me to get involved, I highly respect and trusted that she had looked into it enough and felt that it was something that we could possibly benefit from.
For myself, I had no hesitation whatsoever and just listened to the demo on it and thought, “Yes, we can go live with this.” We went live the following week after hearing about it. I didn’t need to do much to create buy-in — I just sent out an email and talked about it when I rounded. Then we had a department meeting a few weeks after that, and then a full presentation at the department meeting.
I didn’t see any harm in doing it that way, because we were informing people as soon as it was available to us. I didn’t want anyone to see it without having heard anything about it. That’s why we went ahead and did it as quickly as we did. Then after the department meeting, we had more buy-in.
One of the things I did want to share with you is I was rounding and asking people, “How do you feel about asking for this?” Because people thought I was asking the patient to rate them as a part of the care team. That’s not what I wanted them to focus on. What we changed at that point was, I wanted them to talk about it’s an opportunity for our patients to give us real time feedback on their care team, which means the entire stay in the hospital, not just about who was talking to them about it at the time.
That helped, people began to have more conversations with their patients about it, and they did not feel uncomfortable about at all. We had one nurse mention, “I’m not sure how good I feel about this because I feel like I’m ranking myself as an Amazon product.” After she saw the results, though, she quickly came around. Soon, everyone started feeling a lot more comfortable about it because it wasn’t about them individually.
I send the feedback we receive out to everyone. Each Friday, I just copy and paste it into an email and send it to our groups. I don’t send it just to the individuals that receive it, I send it to the entire team so that they can see the positive feedback on what is being shared, whether it involved them or not. They’re seeing what everyone is getting.
Andy: How quickly did you start seeing these results, either on the service recovery side or on the positive comments side?
Cheryl: It only took us a couple of weeks. I would say we rolled out the very end of January, and by the middle of February, we were starting to see the scores come in. But the scores didn’t have any comments with them because we didn’t have the note availability right away. Because we were getting these great scores, adding the ability to add a comment with a high score helped us get some beautiful notes.
Andy: What are your next steps?
Cheryl: One of the things that we would love to do is to add our doctors. Our doctors, they get the same scores we do, and just as there used to be with nurses, there’s trouble determining who to attribute the feedback to. You want to give that specifically to the individual that’s involved.
We’ve also got a rehab hospital that’s very interested in rolling this out, and I would like to see our med-surg patients get it because it’s just on the women and children side right now, and it’s a very tech-y age group that we serve. I would like to test this a little bit on the older population that may not be as tech-y as your 30- and 40-year-olds, just to see if there would be some modifications that would be helpful to them. Those would be our next steps. That’s what we would like to do.
Andy: Would you mind telling a story that illustrates what your experience has been like so far?
Cheryl: We had a new nurse start with us in January, and in March, we started getting a lot of comments about her. She was in labor and delivery and had only been a labor nurse for about a year and a half. Emergency room and cardiac was her experience prior to that.
So she had just been with us a few months, and all of these wonderful stories started coming in as part of her feedback. Huge long paragraphs. It was a great opportunity for me to have a hallway conversation with and tell her, “Wow, what an impact you are making with these families.” Because these families would write about her as though she was an angel that graced their room and saw them through every difficulty that they had ever experienced, and they wanted her to go home with them. You couldn’t improve upon that experience in any way.
Again, this was someone brand new. It wasn’t someone that had tons of experience with WakeMed or in this service line, and she just was rocking it out. When we would read these, even we were like, “Gosh, I want to be a patient of hers.” That’s how much she affected her patients. That was very fun to be able to see. As a brand-new person who was in orientation and then just learning her way with us as a labor and delivery nurse, new to WakeMed, it was great to see how much she shined right out of the gate. That was wonderful to be able to have that feedback.
If I take it to the other side, two of our three service recovery scores were the same nurse. That also was able to help serve us and concentrate a little bit more on process improvement, workflow, evaluation, and coaching for that individual.
The other piece that I really like is being able to send an email to the patient straight from the comments so that I can say, “Thank you very much for this feedback,” and it logs at all and I can give them a little bit about what our next steps were going to be in regards to whether it was the low score or something positive. We really appreciate being able to do that.
I believe the patient appreciates it as well because they have received those emails and concrete information from me after I was able to visit with them on the initial stage. Even though we had occasionally been able to do something on the service recovery side previously, that positive reinforcement and the wow factor is what has been we’ve been able to accomplish recently.
Andy: That is fantastic, Cheryl. Thank you for sharing all of that. And that brings us to the end of our interview! The last thing I’ll ask: is there anything else that you’d like to share with our audience about WakeMed or your patient experience process?
Cheryl: I would just highly encourage anyone to consider this type of feedback and process because it has given us an opportunity to focus on the positive instead of focusing on what’s wrong. I can sometimes be that person that focuses on the what’s wrong because it’s my job to get everything fixed and to help coach other people towards fixing problems. So focusing on the positive and reinforcing what we’re doing right is an even better way of giving us what we’re looking for because, “Wow, that went well, I really want to impact another patient that way.”
I think that just the positive feedback was a blessing in disguise. I had no idea how much we were going to get. Even though we had pretty decent scores, I just had no idea. The other piece I’d like to add about this is we were a brand-new hospital in this community that had to build our reputation. That feedback and that reputation is so important to our future, being a great place to work and also being a great place to receive your care.
Andy: I really appreciate you taking the time to speak with me today. If any of our listeners would like to get in touch with you, if they’d like to learn more about your process, about what you’re using, is there a way that you’d like them to do that?
Cheryl: Yes, email or phone is fine. My email is firstname.lastname@example.org, and then my office number is 919-350-1348. Thank you for inviting me to do this, Andy.
Andy: Thank you so much, Cheryl!