Advancing Equity and Clarity in Pediatric Care: Lessons from Nemours Children’s Health

How Nemours Children’s Health reduced disparities and improved patient understanding through a multi-year initiative—and what your organization can learn. 

Healthcare disparities often hide behind strong aggregate scores, as Dr. Peggy Greco, Vice President & Chief Patient Experience Officer at Nemours Children’s Health, shared during a recent NRC Health webcast. 

“When you dig deeper, the story changes,” she said. “On the surface, your scores can look strong, suggesting families overall understand their instructions. But when we start diving deeper and breaking down those scores, you uncover some meaningful gaps.” 

Nemours discovered significant disparities in patients’ understanding of post-visit instructions—particularly among Spanish-speaking families and between different racial groups. These gaps weren’t just a matter of experience; they had direct implications for patient safety and outcomes. 

The Data Behind the Disparities 

In partnership with NRC Health, Nemours began analyzing patient experience data by demographics in March 2020. The findings were striking: 

• Families who didn’t know what to do after a visit were more than twice as likely to return to the emergency department within 48 hours. 

• Spanish-speaking families had a 9.2% ED return rate when they answered “No” to knowing what to do after a visit, compared to 3% for families who answered “Yes.” 

“It was very clear that if you don’t know what to do after the visit, you may guess, or you may not give a medicine correctly or follow the right timing,” said Dr. Greco. “That has real impact on people’s lives.”  

Turning Data into Action

Recognizing the urgency of the situation, Nemours launched a multi-year, system-wide initiative focused on three pillars: 

• Clarity in Communication: Ensuring families fully understand care instructions through strategies like teach-back and open-ended questions. 
• Equity: Making sure no child or family is left behind because of race, culture, language, or circumstance. 
• Frontline Engagement: Empowering care teams to take ownership and make meaningful changes at the point of care. 

“Meaningful change doesn’t happen quickly,” said Dr. Greco. “Our most significant gains came throughout years two and three. When you give it time, you hardwire the impact.” 

Nemours implemented a comprehensive approach across all care settings—specialty clinics, primary care, emergency departments, and inpatient units. Key strategies included: 

• Pre-visit preparation to identify language needs and ensure interpreter access. 
• Question cards in English and Spanish to help families articulate concerns. 
• Teach-back techniques to confirm comprehension of care instructions. 
• Technology tools like Med Action Plan Pro and Kids Health educational flyers in multiple languages. 

“We really wanted everyone involved,” Dr. Greco shared. “This was not something tasked to one specific role. There’s something that everyone can do—from front-desk staff to nurses, physicians, and executive leadership.” 

Measurable Results: Closing the Gap 

Over three years, Nemours achieved sustained improvement in patient understanding scores and reduced disparities: 

• English-speaking families: 79.7 → 81.6 
• Spanish-speaking families: 62.9 → 67.6 

While gaps remain, the disparities have narrowed significantly—proof that targeted, equity-focused interventions work. 

“It was wonderful to see that closing of the gap and the decreased language disparity,” said Dr. Greco. “There’s still work to be done, but we learned a lot in the process.” 

Sustaining Success: Lessons for Every Organization 

Nemours framed this initiative as a patient safety effort, which resonated with clinical staff and drove engagement. Dr. Greco shared three key takeaways for sustaining success: 

• Make it meaningful: Tie initiatives to outcomes that matter, like reducing harm and confusion. 
• Make it everyone’s initiative: Shared ownership across all roles ensures lasting impact. 
• Stay the course: Multi-year efforts hardwire change and keep teams focused. 

“If it’s meaningful to patients, it will definitely be meaningful to staff,” she said.  

Want to dive deeper into Nemours’s strategies and results? Watch the full webcast on demand and hear directly from Dr. Peggy Greco and NRC Health’s Rachel Hamilton. 

And don’t miss the NRC Health Pediatric Collaborative, March 25–26 in Orlando, Florida, hosted in partnership with Nemours Children’s Health. This event brings together pediatric leaders from across the country to share best practices and explore innovative strategies for advancing equity and improving care. 

“Past Pediatric Collaboratives are some of my favorite conferences,” said Dr. Greco. “There’s something different about being onsite and seeing what patient experience has been able to impact.”