Expert Interview Series, Episode 21: Paul Carrington, Director of Quality, Pratt Regional Medical Center
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 we’re really excited to get a chance to talk to Paul Carrington, the Director of Quality at Pratt Regional Medical Center in Pratt, Kansas. He and I have known each other for a bit now, and I’m very excited to hear what he has to say about patient experience and learning from patients and how he goes about doing that.
By Andy Roth
Andy: Paul, why don’t you introduce yourself?
Paul: Hi, like Andy said, I’m Paul Carrington. I’m from Pratt Regional Medical Center in the middle of Kansas.
A little bit about me. I’ve been a nurse now 21 years. I am the Director of Quality here. One of the great things that we’re going to talk about today is the solution to finding out what our patients think about us. Andy’s going to be asking me some questions. Here we go, I guess this is the first time I’ve been interviewed like this, so bear with me.
Andy: [laughs] We will muddle through together. Just by way of introducing some context, Paul, what does your average day look like in terms of how you spend your time with patient quality and patient experience, and how do you monitor that?
Paul: Any of you out there that are working in quality, you probably know that a lot of your day ends up in meetings. For us, there’s a fair amount of meetings, but there’s also times when we get our data from our CAHPS surveys and now from our Feedtrail surveys. We review those numbers, looking specifically at how we’re doing, how our patient experience is. Before Feedtrail, we had a lot of trouble with those numbers because they were so old. We’d been looking at our Press Ganey numbers and they were three months old by the time we got them.
At that point, there’s really nothing you can do about that individual patient’s experience to make it up to them, make it better. That was pretty disturbing for us, and it was really hard to hit a moving target when we didn’t even know what the bullseye really looked like for three months.
Most of my day, it starts out in the morning with getting my list of patients to whom I’m going to be sending out the Feedtrail survey links, and then looking at the responses from the night before, and all the new feedbacks, the feedback that we need to get answers to. The feedbacks that are low on one score or another.
Then I start sending to those leaders in the organizations that hadn’t seen those yet. The feedbacks that I want them to respond to. Sometimes I need to open up their charts, look into them a little bit more in-depth to be able to answer the questions that the patients have.
Andy: Would you say that this — to use your phrasing — “old data” was the biggest challenge that you and your team were facing?
Paul: Certainly. What it created was a disconnect. The further you are removed from your data, the less impactful it is, and the less you feel like you can make any difference on it. Now our data is so in the moment that we feel like we can really make a difference. When our patients hear back from us within a day, within a few hours of their comments, they feel important. They feel like their voice has been heard.
Most of the time, we are able to reconcile any concerns that they have. Maybe they wonder about a lab result that they hadn’t heard about before they were dismissed and they can just let us know, “Hey, I want to know what my labs are.” We can certainly do that for them. Instead of not having dialogue like our other surveys out there that we’re required to participate in, this gives us the ability to have dialogue.
Andy: How would you identify this challenge before you learned of Feedtrail? What were the kinds of things you were doing to try to fix it or address the issue?
Paul: : It’s a little bit crazy. You guys may have tried this… we would troll Facebook! We would go on Facebook, trying to find out what people were saying about us. We still keep a presence monitoring what’s going on out in Facebook because of course we should. So, social media. We would also do paper surveys, specific areas that we were not getting our various CAHPS surveys and whatnot. We would do a paper survey for them.
A great example is our outpatient rehab centers. We would send those patients paper surveys. And they always came back really good, but there’s still that feeling of not learning enough because we didn’t get very many surveys back. We thought we were doing pretty good. We didn’t know how honest the patient would be when they bring us back the paper and say, “Okay, here’s my survey and my evaluation on how you did,” because those patients were still going to be seeing us for the next six weeks.
This way it’s very clear that they can say virtually anything they want to say — and they do! They’ve told us some very interesting things. Some of them we get chuckles about. A lovely lady once wrote that her biggest complaint was that they needed to rebalance the scales at the clinic because every time she steps on it, it’s a little bit heavier.
Paul: I responded back to her that I agree that happens to me when I go see the doctor at that clinic, and I think the scales are entirely broken. Then she responded back to me. We had this great little funny dialogue, and it also let her know that this guy with a masters degree here in an office at the hospital is a real person who has a sense of humor and who cares about her. She even mentioned that to our CEO and it was really funny.
We’ve gotten to know our patients in a way that we’ve never been able to know them. Particularly people like me that spend probably 70% of my time in an office, I’m really getting to know them.
I’d hate to have people think, “Oh, he’s all about data. He’s just a number cruncher guy.” When I first met you, Andy, you asked me an interesting question: “what does success with Feedtrail look like for you?”
I gave probably the weirdest answer you’ve gotten! I said, “Ultimately, I don’t care about the data. What I care about is knowing that our employees are engaged with what they’re doing. If I can measure the patient’s experience, and tie that back to the employees’ engagement, day in and day out, and move the needle of employee engagement, then I’m going to get a tremendous return on investment, and having more of our day to day frontline employees engaged in the valuable work that they’re doing every day.”
That’s a hard thing to judge, but if you go to our organization now, these Feedtrail comments that our patients are putting in there, they’re all some version of “the staff was excellent.” And they’re naming people by names and saying how nice someone was. We put comments like that in the break rooms! We put them up in big bold lettering, showing out staff how they’re making differences in patients’ lives every day. Those things get read, we put new comments up, and it’s just a swarm of people coming to see the latest comments that people are putting on there. Before Feedtrail, we didn’t have anything positive like that in the break room at all. Now, the break room is all abuzz.
Andy: That’s really great, Paul, thank you for sharing that. That’s amazing. Okay, let’s go back to how you found Feedtrail. How were you first made aware of our solution? How did the process start?
Paul: One of my friends, Mike Miller, he’s our risk manager. Somehow he found out about Feedtrail. He came to me and he says, “Hey, there’s this really great thing you need to check it out.” Mike brings stuff to me five times a day, “Hey, there’s this great thing,” and everything’s the next great thing. I love him to pieces, but not everything can be the next great thing. My initial reaction was like, “Okay.”
Well, he told me to look into it a little bit more, and about a week later, he says, “Hey, did you check that Feedtrail thing out?” and I’m like, “Not really.” Sure enough, I get a little bit of guilt and I’m like I’m going to look it up, so I look it up. Then, I start realizing, “Wow, wait a minute, he’s right.” I realized Feedtrail could be the missing link we could utilize to connect between when a patient experiences something here at the hospital and sometime down the road, before it’s too late and we don’t know what’s going on.
I got excited about that, so we had a couple of phone meetings where I learned more about the platform. It was immediately evident to me how simple the platform was. The simplicity is just beautiful. It’s like Einstein said, “If you can’t explain it simply, then you don’t know enough about it.” The system is so beautiful in its simplicity that while I was still being shown the steps of how to use the platform, I just knew the training wasn’t really necessary, like, “Okay, I know I can figure this out, I’m just going to log in.”
So I did! I logged into the dummy site and I started changing questions right when I was supposed to be getting trained on how to do it, and within about 15 minutes, I had a whole question set made. Literally, the rest of that week, my colleagues were like, “Paul’s working on Feedtrail again — he’s been at this the whole week,” and I was, because it was exciting! It was a new great toy, and it still is a new great toy. I’m figuring out new ways to use it pretty much every day.
Andy: What was the specific thing that attracted you to it? Was it the real-time aspect?
Paul: It was a big part of it, the real-time nature of it. The other thing that intrigued me was the customizability of it all, the complete control I had. Some might call me a control freak, and I’m okay with that. I was able to essentially go in and change the questions any possible way that I wanted. And the team is really responsive — if the system couldn’t do something that I wanted in that moment, then I’d mention it at our weekly and bi-weekly check-in calls. I would make the suggestions, and things would get changed almost by magic. I’m pretty sure someone at Feedtrail is taking a wand and just hitting the computer screen and suddenly, you know, “you can do that now.”
That was amazing to me, the level of customization. Here’s a perfect example: our registration director. She’s wonderful, progressive, wants to make her department absolutely fantastic. I had a question in there about how the registration process was. It really focused on how kind and compassionate the registration clerk was. We were getting top-notch scores for weeks and weeks and weeks.
She came to me, she says, “I can’t do anything with this data.” I was like, “Well, it’s great data. You’re top-notch every single day.” She said, “Yes, I want something that I have to fix.” I’m like, “Okay. Well, let’s change the question.” She’s like, “Yes.” We sat down, we talked about what we want the question to be, and we changed the wording to prompt more constructive feedback. So now she’s got something to fix. That’s the beautiful thing: within an hour of changing that question, we were already getting feedback that, hey, the registration process isn’t timely enough, takes too long, it’s not easy enough for the customer.
She’s been trying to implement a lean registration process to make it more timely and easier for the patient, and we can track that now. Before, there was no way to do that unless we trolled Facebook to see if someone was upset about their registration process.
Andy: What was the process like for you internally getting the leaders of each of these areas onboard? Did you show them the platform and ask them what they wanted?
Paul: Yes, I started with small group of leaders and showed them the platform. They were pretty quickly excited to help me come up with some of the first questions that I wanted to put into the system. After that, I pretty quickly just went straight to the top. I went to the executive staff, showed them what I could build, pulled out a whiteboard, and said, “These are the areas I want to question, and these are the reasons why, because we don’t have any feedback from them: imaging, the emergency department, laboratory, et cetera.”
I said, “If we don’t start taking these areas seriously with what our customer believes about their experience, then we just don’t know. They come in, they have either a good or bad experience, they walk away, and no one knows. We could theoretically, unknowingly be sending customers down the road day in and day out by something that we could fix easily and quickly.”
When I pitched that to our executive team and they saw what I could do with the questions, I sent them Feedtrail surveys right there in the boardroom, straight to each of their phones. They answered the questions right then and there and they said, “You know what? This is infinitely easier, infinitely better than what we’re doing now. Well, I say we give it a try.” That’s all it took to convince them, just one meeting trying out the product themselves on their phones, and then we signed up.
Within the first three weeks using Feedtrail, we had leaders throughout the organization coming up to me and say, “Hey, did you see that response that I got? Did you see that response that I got on Dr. so-and-so? Yes, I’m going to have a conversation with Dr. so-and-so and find out why they’re not spending very much time with their patients in the ER.”
Leaders were taking it upon themselves to have difficult, challenging conversations and address important issues that had probably been unknown or ignored until now, because now our executive staff was seeing every day what our patients really felt about us. That made all the difference. Our CEO yesterday came up to me and said, “If you ever are feeling down about what you do, I just go into the Feedtrail app and I start reading the comments. It makes me realize that we do good things. That’s worth every penny and then some.”
Andy: That’s fantastic. So, you’ve already spoken to it a little bit, but can you just say more about how getting the executive team on board make your job and then your life easier in terms of implementing the solution and then moving forward?
Paul: It was infinitely better. I was worried going into the meeting that they wouldn’t see the value, but one of the things that I said in that meeting was, “I don’t ask for a lot, guys, but I think this is going to be the single most important decision that you make all year, because if we don’t know our patients and if we don’t have our finger on the pulse of what they feel about us, then what are we really doing? Yes, we’re taking care of people in healthcare, but we don’t know how well we did. We don’t know that we made a difference, we don’t know that we met their needs.”
Having that conversation and having them support me and say, “Yes.” I remember very clearly the later conversation that we had where we were starting to talk money. That’s the tough conversation that people want to avoid, “This is going to cost you how many thousands of dollars?” We were talking money in that same boardroom that we met three months before when I had first shown them Feedtrail.
The overwhelming satisfaction with the product to date was an instant sell. If you can have the CFO sitting at the table, the guy with the purse strings look at you and say, “We would be stupid not to pay for this. I’ll just write them a check today,” well, the meeting is pretty much over. It took five minutes. When the CFO was so convinced after reading the comments from our patients that we would literally be stupid if we didn’t do it, then I was able to just walk away and be like, “Well, that was the easiest meeting I ever went to.”
That kind of support was awesome because some of the questions are tough. I put a question in there, “The amount of time that our physician or advanced practice provider has spent with me as the patient.”
Initially, they didn’t want any questions about the physicians, because that’s a sensitive subject. Are we going to make physicians unhappy if we- but they had enough faith and that, “Yep, we want to know,” we can pretty much ask any question we want to… as long as it’s not dirty jokes or something.
Andy: [laughs] That’s great. Since that conversation, and since full implementation in all of these different areas, have your patient experience goals changed since then? Is it, “Hey, we’ve got things we can fix now,” or is it, “Oh, now that we know, we have insight into things we didn’t before, let’s do these other things that we weren’t previously able to get to.”
Paul: I think all of the above. Individually, now we have leaders, like the manager in the ER. She watches the feedback like a hawk because that’s one of the hardest areas to keep people really happy. Every morning, she comes in, and she’s usually got a voicemail to me before I get one to her and she’s like, “Hey, I need to know who this person is because I need to look at their chart and see what I can figure out.” We’re figuring it out and we’re collaborating together on a daily basis.
For her, certainly, her individual goals on how the experience is going for the patient have adjusted, because she’s looking at things like how the nursing staff is doing, did the ER treated patients with compassion, addressed patients’ pain needs, made sure that patients feel like they’re a part of the decisions regarding their own medical care, those type of questions. She’s wanting to involve the patients and get the nurses and staff to involve the patients in their decision making.
Then she’s taking those scores and trend lines right off that, printing them out and sticking them on the bulletin board right there where they’ve all got little bumblebees in there. It’s all a cute board that she’s done really neat just to say, “Look, this is how we’re trending on making our patients feel like they were a part of the decisions in their care today.” That number has gone from “not so hot” to “we’re getting fives out of five most of the time now” in the ER that our patients feel involved. Which is… I don’t know how other ERs are, but that seems unprecedented to me, that level of improvement.
And that’s happening throughout the organization. So yes, our goals are adjusting. Me, I still feel like the goal of employee engagement is still number one, and I think we are winning that bit by bit every day. Are we doing different things with it? We’re talking about seriously addressing the thing that probably most people never want to address, the billing cycle, and using Feedtrail to answer questions, ask questions about the billing cycle. How do you understand your EOB? How do you know how much to pay? If you need to be put on a payment plan, then please mark this box, and it goes to the right person and they can get all that set up.
It sends that message to a person in billing and accounts payable and they can do all that. That’s what we’re thinking our next iteration of the use of Feedtrail is, and I know that sounds totally like a weird use of it, but when you ask a patient, “What is the most stressful thing about coming to the hospital?” They’re probably not going to say, “Are you going to take good care of me?” It’s “How am I going to pay for it? How am I going to leave with a $10,000 hospital bill?” Those questions we can address with Feedtrail, and that’s what we’re going to be doing next. It’s really exciting.
Andy: That is really exciting! I don’t have much more to ask you about. Do you have any other stories you’d like to share?
Paul: There are so many. It’s crazy, one of the things that’s the greatest is that when you get leaders talking about the stories about their patients, and some of them are funny, yes, but some of them are really serious. We had a guy who said he got poked four times in getting his blood drawn. He was so upset about that. He hated needles, he was very upset. He said, “I am never ever, ever, ever, ever coming back to your hospital. I’m going to drive 30 minutes down the road to go there so I don’t have to come back to you.”
That was eye-opening, right? We did a lot of things internally and we said, “Okay, we shouldn’t be sticking people four times, we need to figure out a better way.” We did all that which you would expect. We reached out to this guy and we said, “Hey, tell us more. We want to know more.” He came in, we talked, we had a pretty good time, and then at the end, he’s like, “You know what? I’m going to give you another shot, you guys care.” That made all the difference to him, just that we cared.
Bottom line is, we are in healthcare and if we don’t use all the tools at our disposal to fill the “care” part, then we’re really not doing the patient any service. Feedtrail for us has been a huge link in filling that last part, the care part, and making sure that they know their voices are heard and we care.
Andy: Wow, that’s a really powerful story. Thank you for sharing that. Last question: what does the future look like with your organization and Feedtrail? Going forward we talked about how your goals have changed, but if you could paint the future the way you wanted with patient experience, what does that future look like now for you?
Paul: So, this is taking a little selling, but I think I’m a pretty good salesperson, so I think we’ll get there. Being able to not only know and keep our fingers on the pulse of our patient but keep the finger on the pulse of our employees as well. From a management standpoint, our employees should be our customers as well. When our employees are happy and engaged and doing the valuable work that we employ them to do, then they make the patient’s experience better. What I’d love to, down the road, be able to keep that finger pulse on our employees and see how our management styles, skills and perhaps management errors are impacting their engagement.
Then how that engagement damage or that engagement improvement, whichever way it goes, affects the patient’s experience. My hope is to be able to show concretely to the executive team that when we treat our employees like they are the most valuable customers from a management standpoint, then they treat our patients like they’re the most valuable customer. Then our patients go out into the community and talk like they felt like they were the most valuable customer. Then the community sees the hospital as the most valuable organization, employer, etc. in the community. What could be better than that? That’s where my hope is in the future.
Andy: That sounds amazing, best of luck with that! That actually brings us to the end of our interview. If anyone out there has further questions for you, what are the best ways for them to get in touch with you?
Cheryl: Kansas is the flyover state so you could always use skywriting. Just kidding.
Paul: Yes, I didn’t pull out very much of my humor during this interview, but there’s lots of it. Give me a call anytime, my phone number is 620-450-1169. Or you can always email me at firstname.lastname@example.org. If you’re in Kansas, you can always drop by Pratt Regional Medical Center. It’s a great place to work and put down roots and be able to make a difference. We’re always looking for camaraderie and people to join in the battle with us.
Andy: Well, excellent. Paul, thank you so much for this. We really appreciate your time and sharing your story. It’s been really helpful and instructive. And thank you for the nice things you said, certainly! Even more than that, just learning your process, I think I found it valuable and I think everyone out there will too. Thank you so much.
Cheryl: You’re welcome. This was fun.