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For Nurse Project Manager, focusing on meaningful connection and the patient-care experience is all in a day’s work

Providing meaningful care for patients is of the utmost importance for every healthcare provider—and that’s particularly true in a children’s hospital, where both children and their parents often face the most difficult situations of their lives.

In the case of the Cancer and Blood Disease Institute at Children’s Hospital Los Angeles (CHLA), healthcare providers not only bring empathy and care to each patient encounter, but they also bring the same level of care to their staff.

NRC Health recognizes this level of care with its Excellence in Human Understanding Award. This article is one of a series celebrating one of our nominees for this award and the achievements of healthcare workers who have had a transformative impact on patient care.

One of this year’s nominees is Destinee Carrington, Nurse Project Manager at CHLA. To ensure the patient experience remains a critical focus at the hospital, attention is continuously given to discovering and making necessary improvements. The Cancer and Blood Disease Institute at CHLA created an RN Project Manager role to focus on patient-experience and quality efforts, and Carrington has served in this role for the past six years.

“Despite all the challenges brought on by the pandemic, Destinee was able to find ways to maintain a connection with patients and families and to engage staff to continue improving the care experience,” says Rita Secola, Clinical Services Director in the Institute. “What makes Destinee unique is her experience as a nurse and the connections she makes with families.”

Carrington started her nursing residency at CHLA and served as a nurse in the Bone Marrow Transplant Unit for five years. She then transferred to the Hematology-Oncology Clinic for a year before transitioning into her current role, a blend of Nurse Educator/Patient Experience Specialist and Project Manager. CBDI created this role to focus on the patient experience and give it the attention it deserves, and Carrington’s diversity of knowledge, gathered from working in various parts of the cancer center, is one of the reasons she excels in the position.

“She came from the acute care inpatient Bone Marrow Transplant (BMT) Unit, where many patients and families stay for months at a time. For all the BMT patients she cared for, they eventually receive care in our Hem-Oncology Clinic and Infusion Center. This allowed Destinee to see the different experiences and care needs, giving her a better perspective for this important patient experience work,” says Secola.”

Carrington also had a personal touch with families on the BMT Unit, where her experience was gained. She has triumphed with families who thought they wouldn’t do well, and cheered for them as they walked off the unit.

“When you get to know the families and connect with them—see their struggles, their triumphs—you start to realize how much benefit is in connection and meeting the families at their level,” Carrington says.

“We got a lot of feedback about how she’s so understanding and so available,” Secola says. “We do annual employee peer evaluations, and there are always comments about how patients and families call her out as someone special, saying, “Thank God we had Destinee through this whole hospitalization.” Families continuously give feedback about how she listens and follows up attentively.”

The Virtual Parent Focus Group

Carrington’s efforts to improve the patient experience in the Institute through parent focus groups and other creative and engaging initiatives have inspired others at the hospital as well. She truly understands the value of soliciting direct patient/family feedback, Secola says—last year, she helped ambulatory areas host four virtual focus groups.

During the pandemic, Carrington also created her first series of virtual parent focus groups to continue to gain parent feedback and creatively engage staff to improve on the items parents shared most. She led and coordinated the focus groups, which elicited a large amount of positive and constructive feedback that would be used to improve care.

“Hosting the virtual parent focus group and receiving positive feedback was incredible because we were dealing with all the things people dealt with during COVID-19,” Carrington recalls. “Staff were dealing with personal pain as well, and still coming in every day and going above and beyond. The feedback reflected the work they delivered, so for that reason, I was excited about it.”

Based on her extensive patient experience expertise, Carrington was selected to be a steering committee member for the hospital’s newly created Ambulatory Patient Experience Workgroup.

Understanding the why behind focus group feedback

As Secola explains, parent focus groups aim to gain direct feedback from parents and patients cared for by the CBDI, and Carrington handles all aspects of those groups. She collaborates with multiple team members to formulate the most meaningful questions to ask families, and includes NRC Health survey questions to better understand the why behind parents’ answers.

Carrington says this year was unique because we were not holding in-person meetings, so she knew she had to be more creative in how she shared the feedback with staff. She knew that staff were overloaded with information—especially email updates, education around COVID-19, and changing protocols—and if staff satisfaction didn’t remain high, they wouldn’t be in a place to receive any kind of feedback.

“I’m a nurse at heart,” she says. “I remember what it felt like to be completely giving everything you have, working yourself to your last bit of energy, and feeling like you don’t have the energy to participate in a project or engage with other things.” Acknowledging that tapped-out feeling, she wanted to find a way to give staff members constructive feedback without making them feel defensive. “I knew that if we wanted this feedback to be meaningful, we had to figure out a way to give it to them in a positive way,” she says.

Carrington created a menu that included “Shareables”—items parents enjoyed when they were done efficiently and consistently—“Main Courses”—NRC Health survey items that parents asked for improvement on—and “Desserts”—direct quotes and compliments for division units. She then emailed all clinical services staff with the menu, and to ensure staff read the feedback, she added an incentive to respond. Lastly, she communicated with every team member who replied, discussing what affected them and what they could improve based on that feedback. Staff who responded to the email put their names into a drawing to receive one of six Starbucks gift cards. The program was a huge success, allowing the opportunity to share and brainstorm ideas individually and as a team.

Boosting employee communication and morale during COVID-19

The focus group is only one of many tactics Carrington has deployed in the CBDI that have been replicated in other hospital areas. She has also created and deployed multiple educational sessions on high-priority patient experience items like AIDET and the teach-back method, and helped ambulatory clinics develop “Who to Call, When to Call” documents to help parents easily reach the right staff members when they return home.

“When you walk in at the beginning of a shift or patient visit and ask a patient or family, ‘Is there anything I can do today to make you have a great day?’ it makes a big difference,” she says. “Although it may take an extra few minutes of conversation, you know what’s important from the start. Making sure you address their specific needs lets them know you are on their side and will ensure that individualized patient care is provided.”

Based on this approach, the Institute created “What’s Your One Thing?” posters to remind staff and families to communicate their most important needs. Even if staff answered a hundred other questions, Carrington says, if they didn’t answer that one important question, they may still leave unsatisfied. “Just those small conversations help the family understand that you care about them,” she says.