Bon Secours Baltimore Health System has been called a facility “in the worst of America’s healthcare system,” serving the same areas depicted in the HBO crime drama “The Wire” and near the site of riots in 2015.

Patients didn’t think highly of it either.

“It was often referred to as ‘Bon SeKiller,’” said the health system’s COO and chief nursing executive, Shelly Buck, DNP, MBA.

Presenting at the American College of Healthcare Executives (ACHE) Congress in Chicago, Buck said changing the culture within the hospital was a daunting task, but also a necessary one, as the hospital put at least $500,000 at risk each year with poor patient satisfaction scores.

Previous efforts, from having department compete on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores or even putting balloons in patient rooms, have failed. One of the biggest issues, according to Bon Secours quality commission chair Anthony Stankowski, DHA, was the board members and executives didn’t seem understand those scores or were dismissive of the dissatisfied patients.

“This is one [comment] that was deeply insulting, and it came from a board member: ‘Our community doesn’t understand excellence,’” Stankowski said.

So instead of having the board define an exact strategy for improving the patient experience, Bon Secours had the executives set broad goals, but left much of the implementation into hospital operations to the nursing staff.

Nurses would undertake hourly rounds to check on patients, along with a “bedside shift report,” where nurses would talk with patients during shift change. Improving communication with patients made them feel like staff members better understood their needs—and the survey scores went up.

“As a nurse, we want to be perceived as competent,” Buck said. “As a healthcare provider, physician or anyone, you want to be perceived as competent, because when the patient believes you’re competent, they believe there’s quality care being delivered and that high quality of care makes them feel safe. The combination of the two leads to your higher top box ratings in HCAHPS.”

The new procedures also brought multiple staff members together on daily interdisciplinary rounds. The entire care team would visit patients together, which Bucks said fostered better communication and improved consistency in their care.

Leaders and administrators had responsibilities, too. Both clinical and non-clinical leaders, all the way up to the CEO, would “round to influence,” observing and engaging the lower-level clinical staff during work hours.

This newly learned information would eventually get back up to the Bon Secours board, with patient experience stories being presented at their meetings.

The outcomes from these new efforts, Stankowski said, have been “good, but not great” on the HCAHPS scores, but it has helped all levels of the hospital to realign perceptions about how patient satisfaction can be improved.

“It’s critically important that the staff realize that the patient experience is not just about making the patients happy,” he said. “The patient experience is to make sure we meet our mission, and our mission, as Shelley said, to bring good help to those in need.”