Transforming Ambulatory Care: Session Recap from NGPX 2025 Keynote with Miranda Merriman and Aida Honovich

2025, NGPX. KEYNOTE: Transforming Ambulatory Care Through Experience-Led Innovation

Announcer: now what I, who I'm, I would love to invite my new Inova friends to the stage we have Miranda Merriman, and Aida Honovich. Come on up. Come on. We're so excited we got to have dinner together last night and it was just an honor to meet both of you, and I'm super excited for you to share.

Please join me in welcoming them.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: There's the click. Thank you. All right. Good morning everyone. I'm Miranda Merriman. I'm the system director over ambulatory patient experience and patient relations of a Nova Health System. We're in 30 minutes outside of DC if Fairfax, Virginia, that's where we call the mothership hospital is.

And then we have five total hospitals and almost 300 clinics. Our scope of expertise and what we get to focus on is that the clinic side. Today we're gonna talk about what we did to transform care through our clinics. So first I wanna talk a little bit about who Inova is, and when I pass Aida, she'll get a chance to introduce herself.

But who is Inova? And when we think about this piece, we have pretty buildings of course, and we have a large spread across four counties. But who we are is really. Goes down to our people, but it also gets to the numbers, right? So we always call it looking at a novetta glance. We have a little over 25,000 employees across those five hospitals and those almost 300 clinics.

We do quite a significant amount of community care. You can see $434 million goes out to our community each well last year. And then with that, all five of our hospitals are magnet. We are all five grade A. Leapfrog and we are all five, five star hospitals at this time, right? So when we look at that, we're a great place to work.

We have a really incredible support team, and we're lucky to have what we have When we break those numbers down to the ambulatory side, what we see is that gets a little bit smaller, right? We get a little bit of smaller footprint. We have almost 5,000 team members. We have 2300 medical staff.

And then with that. All of our clinics and all of our divisions are separated by service line. So if you think about it, we have a primary care service line. We have a medicine service line, surgery service line and it goes on and on, right? For 10 service lines. And so we help to spread our work based off of that service line level.

Everybody has a mandate. Everybody has priorities, right? These are our priorities. We really focus on our team at Inova. Access is huge for us. We wanna make sure that our patients have access at the right time, right place for the right reasons, and we're really honing in on how we can transform the care.

For our patients in the way that they need us each and every day. And part of that comes through making sure that the value is in each and every encounter that we have with our patients. We like to call it in the med practice world value in the visit. And we are also growing across Northern Virginia.

We're building two hospitals right now that are set to open in 2028. One of the hospitals will be replaced. So it's a net new of one, even though it's two hospitals being built. We're here to talk to you about this journey. We put our data at the front because we figured we would help you to understand why this was important to us.

I started at Inova in October of 2022 and have been there since then. And when I started we had a lot of mistrust in patient experience world. In med practice, and so the goal was how do we get our teams to trust us and the work that we're bringing to them and make a difference. And as you can see, we've done a pretty decent job of that.

So we are quite proud of the work that we've done and with this, we used to measure likelihood to recommend, but this year we switched to staff work well together. I like to call it the sweet metric, SWWT, the Sweet Metric. And so with the sweet metric, we are continuing to see that growth. And this is the trajectory that we're hoping to also launch into our hospitals, which is what we started in June of this year.

So how did we get here? Of course, data helps us, right? We have to narrow our focus with data. If you have almost 300 clinics, you need to be able to be focused. I have three team members on my team. Aida is one of those team members. Julie and Allison are my other team members. And with that we focus quarterly, we come together, we do a retreat, and we look at our data.

So we pull a quadrant analysis twice a year. That is based off of a year's worth of data. And when we look at the quadrant analysis, we then measure that against our current performance. Each clinic, each and every one of those almost 300 clinics. We're just looking to see who's falling into the quadrant and where is our promise, where's our promise?

Sample size comes into this quite significantly. I cannot send team members when I have three team members to a clinic who has 26 surveys, right? I can send somebody to a clinic that has 900 surveys and to put it into perspective of how many surveys we get each month. It's about 15,000 surveys a month.

A month. So just let your brain wrap around that for a moment, because that's a lot of data. We are data rich, which is wonderful, and that allows us to really focus our key drivers, our current performance, our quadrant. All of those beautiful comments that we get right to be able to figure out where we need to go next.

And so our strategy is really focused across all of these elements that you see here. And we separate it from the in-person and the virtual visit experiences because those are two very different experiences and the statistically significant amount of data that we have allows us to keep this focus.

Did I miss anything, Aida?

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: I think you're good.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: Okay. All right, so one of the strategies that we put into place in order to help the degradation in our data was we closed our survey window at 15 days. What we noticed before that is that the comments were coming in and the patients didn't know who they were taking the survey for, even though it says it at the top, but they didn't know who they were taking the survey for.

And if they don't know who they're taking the survey for, then I don't know who to focus on to make a difference. I had the hunch, we had our data analyst team run the data and sure enough, at that 15 day mark, I didn't know it was gonna be 15 days. I just knew it was gonna come back at something.

And at the 15 day mark, you can see the nice little squiggles. So those nice little squiggles let me know that my data is very much getting degraded over time. So when we cut that survey window off, everybody was really panicked. They were like, Miranda, we're gonna lose our sample size. And I'm like, I don't think we will.

And we didn't. It grew by 3000 surveys a month.

Announcer: Wow.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: So that has allowed us to really hyperfocus in the areas that matter. And we also do a little bit of, I'll scratch your back, you scratch mine with our teams. When you're building trust with. These teams who did not have trust before, there's ways in which you can do that.

One of those ways is really getting down deep and figuring out what are those, we talked about it yesterday, pebbles in their shoes, right? What is it? And one of the pebbles in their shoes is we just moved four providers from one clinic to the other clinic. There's this massive disruption and you expect us to perform at the same level as we did before.

If we have massive moves happening, we pause the survey. If we have a clinic under construction, which we have right now in Alston, our clinic in Alston is going through a MA major renovation. Guess what? They forgot to tell us about it. I can't help you if you don't tell me. And I can't know where all the construction's happening all the time, right?

300 clinics. I have a pretty good eye. I don't know all of them. And so with that, what we saw all of a sudden is their comet started saying, oh my goodness, I can't even hardly get into the clinic. There's so much construction. So then one of our performance advisors, Allison, was like, what's going on in this clinic?

So then we find out that they're under construction. They forgot to tell us we didn't get 'em paused. Now it's impacting their data. So we were able to get them paused now, but these are the ways in which you can build trust and make a difference. If you pause those surveys, it helps them to have some breathing room so that they don't feel like everything is always about the data.

The data. It's about the people. We care about them, they care about us. Alright? So when we align our strategy. The innovative approach we take is really focused on these key three things. We talked about the strategy, we talked about some of the collaboration, but Aida is gonna talk a lot about our presence and that's the part we're most proud of.

Alright,

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: you Miranda,

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: welcome. Tell who you are.

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: Good morning everyone. My name is Aida Honovich and I have the pleasure of working with Miranda. It's been the best two years of my career. We've, we have a lot of fun. You can imagine. Just, she shines so bright. And she's, thank you. She is the reason why you saw that big curve go up.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: Team effort, promise,

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: team effort. We have a great team. I can't say that enough. So when we looked at our quadrants and we looked at our data, we said, all right, what do we do? So we reached out to our teams and we said, help us help you. And how do we do that? One team Inova is big on one team.

We are one team. Mindset and collaboration. That's where that grows the most. So what do we do? Anyone hear about immersion rounding? Anyone do it? So immersion rounding in our organization looks a little different. We go and sit at their table in their clinic. We say, tell us what's going on. Tell us your gaps.

We look at opportunities and we look at recognition. We take best practices and we learn from them. We sit at their table and then we get invited back a lot. They always want us to come back. We form that relationship. We're able to offer real time coaching and support. To those team members, those leaders, the providers, when we're in those clinics.

And sometimes we spent three months in that clinic, depending on how big it's, and other times it might just be a few weeks.

Announcer: Yep.

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: Depending on what their needs really are. And so the key to this is it's not one size fits all. Every single clinic has their own reality and we adapt to that reality and that drives.

The resources and the things we provide them, depending on what their clinic specialty is and what their needs are. We have, as Miranda mentioned, many clinics. We live in a very diverse population, so every clinic has their own needs and opportunities, and we learn from that. And that true elbow to elbow collaboration really drives this.

So once we immerse. We identify their gaps, their opportunities, their best practices, and recognize what they do best. We moved in, we moved into action, so we figured out that patient experience is something that everyone wants to be a part of, but really don't know how and where are the resources? Is it just when we show up?

So we developed a webpage that is on our internal website for patient experience, specifically in the ambulatory side. Yeah, and that's where all of our tools and resources, huddle guides, you name it, is on there. It took forever, but it's really worth it. It did take

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: forever.

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: We created a patient experience education series that was truly driven by our team members.

It wasn't something we bought from some vendor, no offense to those vendors, but we looked at what is. Our team at Inova need, where are those gaps? And that's where we developed our Caring Connections course, which is really rooted in our values and our mission service recovery, leading the response and how we lead and recover patients while they're in the clinic and not go home and send us a survey three days later.

And then we find out they were unhappy. Leadership reminders, right? Leadership has a big role here. So we work a lot with our leaders and make sure that they're on board. We do an annual patient experience ramp up. We're getting ready to start one Right now it's called the 12 days of collaboration, and so it's like a fun way to end the year and get everyone excited so that we don't hit that January low and we don't drop.

So just reminding everybody of. Of that since we're all so busy during the holidays. And we do compassion carts, visits. We make sure that we hit every single site at least once a year and we go in, we bring goodies and. Our teams approach us. They wanna tell us what's working well, what they've done, what they've accomplished.

They're really excited. We show up to their celebrations. We have the Peach and Daisy awards that we do for our team members, and we go in and we cheer them on. So it's really a true team effort. And then what is the impact here? So we empower our teams by doing this consistent patient experience focus.

All year round, not just on those days. We show up and we made it accessible, actionable, and sustainable. And I will tell you, with our Caring Connections classes, when we first rolled it out, we were nervous that no one's gonna show up. And now our, we have people on the wait list. And the reason that is, is because leaders stepped up to take those classes with the frontline team members and saw what it.

What an impact that is. And hopefully in 2026 they're all gonna be mandated, but we make 'em so fun that it doesn't feel like work. So the focus was taking us from transactions to connections, and we did that. Miranda mentioned earlier is really focusing on that teamwork, the empathy and inclusion, not just with our teams and our patients, but with each other.

So really focusing on that process improvement and how we take that and. Make it purposeful by using our best practices, our service recovery tools, and our deescalation. All right? And this gives us an opportunity to really work with those frontline leaders and our providers that really help drive the patient experience because they set the stage for their teams, right?

So we onboard every single new leader to patient experience and our providers to that mission. We deliver real time data insights. We turn that data into stories and solutions. And we listened for trends. We read all of our comments. We, as Miranda mentioned, 15,000. Surveys returned and each of, there's a, there's six sections on their survey, so time six, and we read every single comment every single month, and we have our finger on the pulse and we know what's going on, and we step up, we reach out to the teams and say, Hey, tell me about this, what's going on?

And that's where we can really do that. And then we obviously celebrate those wins and inspire that continued growth by showing up as a true partner and collaborator with our teams by joining them at their table and in their real reality. All right, I'm gonna pass it back to Miranda.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: Okay. So part of being a partner, resource and support is also helping our teams to have that trust in us by helping them to feel safe in their spaces.

Workplace violence is at an all time high, as we well know. And healthcare is one of the highest places in which someone who works in healthcare will be in a workplace violence event. With that. We have created something called the escalation management process. There is a lot on this slide, but I will help to simplify it because it's number one timing.

But number two, wanna make sure that you guys understand that the key here is that this is all about building trust with those teams. Our clinics do not have security outside the doors majority of the time, unless they happen to be in a building where there is security, which is rare, then they don't have that.

I know that you all know that people have escalations that happen. We have had nurses be told that they could kill them in elevators. We have had we have had patients show up with weapons. We have had patients do lots of different things, which I am sure happen in your areas as well. Our goal is to do deescalation first and not get to this point, but in order for us to help them.

To know that they're feeling safe and supported. We created a process around this. This was not just a process that patient experience created. Our patient relations team is part of this work. Our risk management team was part of this work. Our quality and safety teams were part of this work, and our frontline teams were part of this work.

It was sponsored and it was sponsored by our executive leadership, and it is now spread to the inpatient world because it has. Such success. The key here is that there's a three step process. A first occurrence of a patient having a vi, like a, an escalated event, not threatening to kill and not physical violence.

Those are immediate dismissals that will not happen. We will no trespass you from Inova because that's not going to be something that we can do with our teams to make them feel, make sure that we make them feel safe, right? So if somebody's receiving physical violence. We make sure that they press charges and then we also move through the no trespass process.

If somebody is being threatened with their life, it could be by phone, it could be in person, then those things do happen. My team has, lives were threatened recently because of patient relations issue. Patient no longer can come to Inova. We cannot have our teams feeling unsafe. So with that, we go through this process.

We teach our leaders how to have those conversations with the patients. You reset your patient responsibilities based on their behaviors. You make sure that you have that conversation. Conversation is key. That conversation happened. You document said conversation, and you debrief with your team to make sure that they know that you are helping to protect them.

If it happens again, second occurrence, those same things happen, but then a formal warning letter will go to the patient's home, making sure that we have documentation of that warning. And then after that warning letter goes to their home, that gets, when we have confirmation of that, we send it certified mail That gets uploaded into the record.

We know then that they have received it and we have that on record. And then if it's a third occurrence, then they will be dismissed. That is a process that has evolved over several years. It was not easy. It is not something that we love that we have to do, but it has become so relevant that we now are meeting three times a week to discuss cases.

And I would say Monday, Wednesday, Friday, when we're discussing cases, sometimes we can have five or six cases on the docket for the whole health system. And sometimes we can have done. If we have none, we cancel the meeting. Thank goodness. So with that lots of questions come with this. If you have questions about it, just reach out to me.

I'll be happy to talk about the process. But when Aida said that it was me, it is my team who does all of this work. They're incredible team. Not everyone is pictured here. We're missing a team member and one of 'em just recently promoted out of our department and we're really mad at him for that, but excited for him too.

He's the tall one in the back. That's Michael. But Anthony is the only other one I haven't talked about. He's on my patient relations team. We're missing Tanya in this picture, and then we're hiring another person for our patient relations right now. So if you live in DC. Send your application in? No.

But this summarizes all the work that we do. If you wanna take a picture of it, I can explain it later 'cause we're out of time. But I wanna make sure you understand that all of this work happens because of us focusing on teamwork, empathy and inclusion, and that strategy, that presence, and the collaboration that we do with our teams in all of these many different ways.

And we don't have time for questions, but we do. Thank you.

Aida Hozanovic , Patient Experience Performance Advisor, Inova Health System: Thank you so much.

Miranda Merriman, System Director, Ambulatory Patient Experience, Inova Health System: Yeah, thank you.