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Care without compromise:
The Real-time story

Leaders at Scottish Rite for Children, a pediatric orthopedic hospital in Dallas, Texas, wanted to reduce wait times for new patients. They did not, however, want to compromise on their organization’s high standards for care.

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Scottish Rite for Children (SRC) is a pediatric orthopedic hospital in Dallas, Texas. It’s also a venerable local institution. By consistently delivering high-quality care, SRC has earned the trust of its community. In an area the size of Dallas, this means high volumes, a steady stream of referrals, and full appointment books.

All this was already a decisive vote of confidence in SRC’s care. It did, however, present a problem when new patients wanted to get treatment. These patients often had to wait a long time for a slot to open up. Intervals for new appointments could stretch into several months, which left potential patients feeling frustrated.

Leaders at SRC wanted to resolve this situation. They wanted to treat more patients without compromising on care quality, or on the time that patients got with their providers.

To accomplish this, SRC’s leaders needed a way to assess their patient data, explore possible solutions, and take measured, strategic action. They found a way—through NRC Health’s Real-time Feedback solution. Real-time allowed them to:

  • Reach more patients, without the need for additional staffing
  • Receive feedback in real time
  • Maintain patient satisfaction with the care experience
  • Design a pilot program to serve a niche population

“We’ve been on Real-time for a few years now, and we absolutely love it. If we receive feedback immediately, that’s very valuable when you’re using it to make strategic changes.”

Lori Karol, MD, Chief Quality Officer, Scottish Rite for Children


Real-time is a patient-survey solution that reaches 100% of patients within 48 hours of their care episodes. The solution embraces a variety of modalities to meet patients where they are, delivering survey prompts over email, SMS, or interactive voice recognition (IVR) technology. Compared with mailed-in paper surveys—which can take weeks to reach a patient’s mailbox—Real-time’s rapid turnaround gives leaders immediate clarity on what their customers experience.

Perhaps more importantly for SRC’s purposes, Real-time also prioritizes clarity in its reporting. Feedback data is continuously updated and rendered into dashboard reports, which give leaders up-to-the-minute visibility on the state of their organization. It’s not just data—it’s insight.



With Real-time’s data-collection capacity in hand, leaders at SRC devised a methodology that would help them broaden the reach of their services.

The organization had a number of Advanced Practice Providers (APPs) in its ranks who would be more than capable of managing patient caseloads independently. Allowing APPs to do so would lighten the MD caseload considerably, and instantly multiply the organization’s capacity to serve new patients.

But SRC’s leaders were uncertain about patients’ feelings on the matter. Would patients feel underserved if they saw an APP instead of an MD? Put another way, would the type of provider affect patient satisfaction?

To answer that question, leaders turned to Real-time.


SRC’s experience team focused their investigation on new patients, aged 8–17 years old, who presented with scoliosis or related spinal concerns. Using Real-time feedback, they were able to field verified feedback ratings from 527 patients and use them to determine which features correlated with Net Promoter Score (NPS).

The resulting data revealed two important trends:

  1. There was no significant correlation between NPS and provider type. Encounters with APPs led to an average NPS of 80.0, while encounters with MDs produced an average of 80.7. This meant that patients were equally likely to be satisfied by an encounter with an APP or an MD—at least for their initial consultations.
  2. The strongest correlate for a low NPS score had nothing to do with the provider type, or with the care setting. Instead, it had to do with patient presentation. The most significant associating factor with a low NPS score was chronic back pain in adolescent patients.


Both of these findings enabled SRC’s leaders to re-evaluate their strategy for managing new patients.

First, the data clearly showed that the patient experience would not be jeopardized by allowing APPs to manage new cases. Seeing this, SRC empowered its APPs to operate in “side-by-side” clinics with its MDs, and the new solution was the best of both worlds—the APPs were able to independently see patients, but they still had MDs close by for consultations.

With this structure in place, SRC was able to increase its throughput while maintaining the standard of excellence that its patients had come to expect.

A second innovation arising from this data focused on adolescents with back pain. In response to the data, SRC has designed a pilot for specialized back-pain clinics, tailored to the needs of adolescents. Though still in early phases of development, leaders are confident that the organization and patients alike will benefit from the extra attention shown to this population.

“We took the information from Realtime and operationalized it. Now our APPs have more independence in their clinic, and they continue to see a very large number of new patient referrals for adolescent scoliosis.”

Lori Karol, MD, Chief Quality Officer, Scottish Rite for Children


The COVID-19 pandemic, unfortunately, curbed these programs before they would have the chance to rise to their potential. SRC leaders, however, expect to restore both of these
projects when normal service delivery resumes.

In the meantime, they’re finding new applications for Real-time’s robust feedback data. Leaders are now using it to investigate SRC’s efforts at telehealth, ensuring stability of care in the era of social distancing.

That’s an illustration of how Real-time spans service lines, informing a comprehensive vision of the care experience. Endlessly customizable, the Real-time solution can be rapidly adjusted to suit any emergent strategic need. That flexibility is part of Real-time’s power— and it’s why Real-time continues to be a vital source of strategic intelligence for leadership at SRC.

“I would encourage anybody who is using [Real-time] to think about how that information can improve their efficiency, can improve satisfaction
scores. Because you can use Realtime in so many ways. It’s very powerful data.”

Lori Karol, MD, Chief Quality Officer, Scottish Rite for Children

For more on employee engagement solutions from NRC Health,
call 800.388.4264 or visit nrchealth.com/demo.