Hello, everyone. We're glad you can be here today. Before we kick off this webcast, just a couple of housekeeping items. On the right side of your screen, you will see a chat box where you can share any of your thoughts and reactions to today's presentation. If you'd like, go ahead and type in where you're joining us from today. Over there, you will also find a Q&A box where you can send us any questions you may have for our presenters. We'll do our best to address all of them at the end of the webcast. On the left side of your screen, you'll see a resources section with other relevant content or events you might be interested in. The slides are not available for download today, but you will find all of the information in the January Insight that's located at the top of that resources section. I'd also like to point out that we have a webcast on Thursday of this week about consumer trust and how AI is rewriting the patient decision journey. Our experts will cover online reviews, reputation, patient choice, and how you can manage some of that disruption that AI is bringing. We're going to get started here. I'm going to turn it over to Sarah Fryda and Jason Messerli. You can find their bios in the top left corner of your screen, but I'll let them take it away. Thanks, Matthew. Hi, and thanks for joining us today. I hope you're staying warm wherever you are located. We are so excited to talk with you all today about using NPS to improve HCAHPS. During our call today, we'll be starting with the challenge when HCAHPS and data collected through patient feedback platforms gives us conflicting information. We will move from there to discussing the consequences of not paying attention to either metric. We'll talk about how timely feedback drives improvement. We'll show a brief proof point, and then we'll discuss how to use data sets together, the two data sets together, to improve the patient experience. Let's talk first about the challenge that arises when HCAHPS results and patient feedback platform results don't appear to be telling the same story. So first, we know that NPS and HCAHPS are strongly related, which we'll show here in the next couple of slides. But we also know that managing data coming from two different systems, a lot of the times with differing metrics, can paint a seemingly different picture, which can create uncertainty and decrease confidence in your organization's plan for measuring patient experience. But both HCAHPS and patient feedback are really necessary and actually do support each other. And we also know that not effectively using one source over the other can have real impacts both financially as well as on patient experience scores. So when we look at our database and we trend our inpatient NPS with HCAHPS metrics as reported by CMS, we can see that the trend lines are very similar, and we can actually predict what future CMS HCAHPS scores will be. So this is one way we can see that there is a real underlying relationship between the two measures over time. And when we're looking at just one point in time, we can see that hospitals that perform well on HCAHPS also perform well on NPS, while lower performers tend to score lower on both metrics. And we're only displaying the HCAHPS 'would recommend' and overall rating questions here, but this holds true for every dimension on the HCAHPS survey and NPS, which we outline further in our insight. So what are some things that might make the data appear to be disconnected? Jason? Thanks, Sarah. I think the first aspect that I typically see is that we're looking at a short-term trend. This happens really commonly in organizations that are trying to improve at a rapid pace. Really one of those things where it's indicative of how they're typically looking at the data. If I'm trying to track and trend progress over time, I want to look and see progress quickly. Looking at month-by-month trends, looking at quarter-by-quarter trends can often leave me with a little bit of a difficulty seeing true performance over time. Now, what I mean by this is I recently spoke with a CMO of a large health system, and I showed him a year-over-year trend where they were actually doing very well. They performed very well. They improved every single year for the past five years without fail, which is no small feat. But the response was the thing that shocked me the most, right? He said, "I had no idea we were improving like this." That's really indicative of this monthly view you see here, right? The flavor of the month, the ebbs and flows, the peaks and valleys, whatever you want to call them, they can sometimes make us short-sighted to if we are actually improving. Is our impact actually being seen and felt by those we serve? By seeing longer trends, as Sarah noted earlier, we can also see that we are improving. And we can start to see some of those improvements over time that are having a broad impact on our organization. Sometimes it's merely that perspective that needs to be provided in order to ensure that we're not switching our focus every six months to something new, but instead tweaking what we're already doing because it is having the desired impact. An example of this would be, again, the rolling 12-month trend benefit you can see here, looking across NPS, HCAHPS Would Recommend, HCAHPS Rate Hospital. This is why it really matters looking at a broader time frame. When I can see over time that I'm actually trending downward or upward, and I should say this is one client example. This is not our overall database. You can start to notice that they're all going in the same direction. They see similar trends, similar upticks, and similar downticks over time as well. These long-term relationships are much better representations of our performance over time. Really, they do help to get rid of some of the noise that some of these data points do not go together or they're trending in different directions when, in fact, they are telling the same story. It's just that a short-term trend might blind us to this fact. Sarah, I know you're going to talk a little bit about how we can actually avoid some of these pitfalls and some of the consequences of not paying attention to either metric. I'll kick it back over to you. Sure. So let's talk about some of the consequences of not paying attention to either metric. Some organizations struggle with analysis paralysis when their experience doesn't line up perfectly with when their experience data doesn't line up perfectly with HCAHPS. When multiple sources tell slightly different stories, teams can hesitate, delay decisions, miss opportunities for improvement. There's also a laser focus on HCAHPS because it is public, it's highly scrutinized, and it's directly tied to reimbursement. So as a reminder, performance on the HCAHPS survey accounts for a quarter of a hospital's total performance score under the CMS Value-Based Purchasing Program, and hospitals can lose or earn back up to 2% of Medicare inpatient payments. The stakes are real. Underperforming or not fully participating in HCAHPS can lead to financial loss. Hospitals that don't understand the true drivers of experience not only miss insights, they also leave substantial revenue unclaimed from the national incentive pool. Jason, why does getting feedback quickly matter so much for performance? Well, it matters for a few different reasons. I think first and foremost, it determines a great deal on who we're getting feedback from and the way we reach out. I'm going to go back, Sarah, because I think it's really important that we hit on this. The demographic aspect of feedback is really critical here. When we think about HCAHPS in its entirety since the beginning of time with HCAHPS, there's been a largely homogenous respondent group, right? The majority of responses that we see in HCAHPS come from those age 65 and over. In fact, the research here that you see shows roughly 63% of all responses for HCAHPS from all of our partners nationwide come from those that are 65 and over. Now, that in and of itself doesn't mean a whole lot, but when we start to cross that and cross-reference that with our more contemporary outreach, we see a much more representative sample. Now, the 63% you see in our database is actually more pronounced in some cases as well when we look at individual client examples. I've had reviews that I've done for clients recently where that number has climbed to 70%, 75%, and even one example where 80% of all feedback that client was receiving for HCAHPS came via that 65 and over age group. Now, this leads us to think, well, that age group is markedly different than their younger cohorts. We know that. We know they're more medically complex. We know they have more comorbidities. They're more likely to have other deficiencies, whether it be cognitive, sensory, etc., alongside. And so some of the things that we measure with HCAHPS become increasingly difficult to move if that is the only population we're predominantly getting feedback from. So administration really matters, the way in which we gather that feedback, to get a very representative sample to ensure that we're moving the needle. One client example I can think of where this really helped us is they were really improving when it came to contemporary outreach, but they'd kind of hit a plateau when it came to HCAHPS, probably a situation many of our listeners today can relate to. What we looked at was that they actually had the most loyal patients were their older population, those 65 and over. And really, that population would recommend them every day of the week, right? But what became really apparent was the same exact things were driving that likelihood to recommend among all generations. It was care coordination, and it was interpersonal communication, right? Communication with nurses, most likely. And what that actually ended up doing is we were able to see that the younger generations did not have any difficulty with the communication aspects, but they were less loyal. Whereas we had the most loyal folks that were responding to HCAHPS predominantly that were very loyal, but they said that they struggled with more of those communication aspects. So it gives us an indicator to say, well, these are the folks we need to spend more time with. We need to look at things like, do they have someone in the room accompanying them? Are they asking questions? Are we confirming understanding? All of those aspects really play a critical role in how we can get feedback, how we can use that feedback, and learn from both data sets, right, to be very impactful. Now, to go back to really some of this, how do we actually act on this information? I gave you one example there where we can learn from both data sets. The other thing we need to consider, though, is getting really timely feedback does a lot of things for us. Sure, it illuminates things we need to improve, and that's really important to coach people and help make them better, but it also helps us highlight the behaviors we want to see and showcase those very quickly as well. So I always challenge every organization that if you don't have as rigid a program for positive recognition as you do for performance improvement, then we should probably look at those programs and make sure that it aligns. If your grievance process is much more rigid than the way you recognize folks, well, that probably sends a certain message as well that we're going to pay a lot more attention to those things that we need to improve upon, right, rather than those that we need to recognize and model the behaviors for. So timely feedback allows me to recognize my employees, right? Remind them why they got into this work in general, which is super critical, especially with all of the challenges many of you are facing with staffing issues, with strikes some folks I know have had in the last year. It's really important that we have a mechanism to recognize those folks and stem some of that employee burnout, reduce employee churn, right, at the bedside, which we know is critical to great patient care. It also allows us to use this as an early signal. So understanding, again, from those that we are treating today that are in a younger age bracket, what is most important to them versus their elderly counterparts, being able to garner loyalty long-term today so we have the opportunity to treat them tomorrow, right? And I think that's a really critical piece we don't think about all the time is that helping someone stay within a certain system is going to be really critical to health outcomes, right? When I have every aspect of someone's care and I've been treating them for the last 20 years, I probably know a lot more about them than if they fragment their care and they go to 5 different places. So it's really critical. And then it allows us to have much more rapid feedback cycles of improvement. So we can implement something. We can see if it's working within a matter of days and weeks instead of months and quarters. We can make sure that we make the necessary tweaks or modifications if we need to as well. And that ultimately helps inform long-term strategy too that impacts HCAHPS down the road as well. So there's a lot of things that go into that timely feedback. And certainly, not least of those is the impact of service recovery as well. I can't talk about patient experience without talking about the importance of service recovery. Closing that loop very quickly with patients, you can see the data there. The impact on HCAHPS rate hospital and HCAHPS would recommend for 24- or 48-hour resolution is really critical. You see some of the drop-off from 24- 48. Then after the fact, many organizations look at it, and the data tells us once we get beyond that 3- 4 days, many situations are unrecoverable. HCAHPS is not really a mechanism that allows us to garner feedback as quickly in many cases to resolve those situations. So that's why it's really important to act on service recovery because we know the data tells us if someone has an issue, we do effective service recovery, they might actually be more loyal than if they never had anything go wrong in the first place. They know should the worst happen, they are going to be taken care of. And it's also really important to focus in on things we know are going to be impactful. So focusing in on one or two metrics that we know are going to be important, and in particular, the behaviors that underlie those metrics, right? The behaviors that are going to drive those things. So I give the example a lot of you might have two questions that seemingly aren't the exact same question, but the behaviors that drive them are probably very, very similar, if not exactly the same. The example I would say would be courtesy and respect of nurses and confidence and trust in nurses. Two different questions, right? But things that we're going to do to build confidence and trust are probably the same sort of things, the behaviors we're going to emphasize to treat them with courtesy and respect, right? And that's going to build trust in the long run as well. So think about those behaviors as you go into your own improvement journeys. What behaviors are going to drive metrics, not the other way around? Because it's not a set it and forget it, to borrow the Ronco slogan, right? Set it, forget it type of situation for behavioral change. It's one of those things where we need to continually revisit it and make it simple as to how you need to target this the next time you are interacting with a patient. Now, we're a research company. This isn't just hearsay. We've obviously looked very closely at this. And Sarah's going to talk about some proof points around that and how we can utilize this information effectively. Thanks, Jason. So what we're seeing across the data is pretty clear. Organizations that consistently use real-time feedback, close the loop quickly, and focus their improvement strategies, like Jason talked about, are the same organizations improving faster and more reliably on HCAHPS. So when we compare NRC Health customer performance on HCAHPS from 2022, which was the lowest scoring period of the pandemic, to 2024, the results stand out. Hospitals that partnered with NRC Health improved at a higher rate across all 10 HCAHPS dimensions, as you can see on this chart. The biggest improvements showing up in the dimensions of Staff Responsiveness, Overall Hospital Rating, and Hospital Quietness. So what we're talking about today isn't just theoretical. It shows that when we have teams that have continuous insight, take action quickly, and reinforce the right behaviors, experience performance doesn't just recover. It accelerates. The takeaway from this is that using patient feedback effectively doesn't just improve experience in the moment. It positions organizations to sustain improvement, strengthen outcomes, and capture the full financial and reputational value tied to HCAHPS. Let's shift into what this really means for performance. There is no shortage of data. I think we can all agree on that. Hospitals that struggle do so because it's hard to know how to use their data with confidence. When organizations treat NPS and HCAHPS as competing measures, they lose clarity and momentum. But when these metrics are recognized as connected signals, one offering immediate, actionable insight and the other serving as standardized high-stakes benchmark, they become far more powerful together. What the evidence shows us is that nearly immediate patient feedback reflects the same underlying behaviors that drive HCAHPS. When teams act on that feedback consistently, the improvements they make for all patients ultimately show up in their publicly reported scores and reimbursement. So the real opportunity isn't just choosing the right metric. It's using timely data at the right moments to guide action, accelerate improvement, and turn measurement into meaningful progress. It looks like we do have some time for questions. So you can put those in the Q&A box on the right side of your screen, and Jason and I will do the best we can to answer all your questions. Great. Thank you both. That was so good. We do have a few popping in here. Just a reminder to everybody, you can find that Q&A box on the right side of your screen. Excuse me. We have a question here. It says, "Value-based purchasing equally weighs each domain. Should I focus on all HCAHPS domains when it comes to my strategy or improvement work? Yeah, I can answer that. So it's very tempting, right? And I've worked with many organizations over time that when we talk about every domain being equally weighted, it's really tempting to have a work group for every one of those, right? Or a plan, improvement plan for every single domain. And the reality is that you only have so many resources, so much time, so many FTE hours that you can devote to this, right? That focus on what matters most to your patients is going to have the most impact. So I always advise organizations that instead of trying to have these separate teams that are trying to run in the same direction, maybe they're all going to the same location, but if you think of an interstate, they're all taking different exits to get there. That's one of those situations where it's probably more impactful to pick what's most important, what's highly correlated to overall rating or would recommend, and choose those. Typically, what we've seen is that that's nursing communication metrics, right? Because they have other impacts, right? They do the most explaining. They listen the most. They help with discharge instruction the most, right? Nurses are going to have the most time spent with a patient of any role, most likely. It makes sense that it would have a broader impact. Now, in 2025, I will say one of the really prevalent trends that I saw in client data was that the new metrics under care coordination were coming to the top a lot. When I say a lot, I'm saying 85%-90% of the time, I would find at least one of those questions was one of the top correlates, right? That really is telling for me because it's probably more of a self-fulfilling prophecy than anything that it's always probably been something that patients struggle with is coordinating care, understanding what all these rules do, what they're all telling me, what I need to do when I leave here. It's complex, right? At the end of the day, that's one of the things that I think can be improved, right? Especially for patients that we're talking about in those older age brackets. I mentioned the folks that are unaccompanied. I honestly like to look at marital status when I look at a lot of client data because it's really telling sometimes those that are married or have a life partner tend to score much better than all those that have a status of single, divorced, separated, widowed, right? Because they're more likely, on average, to have somebody with them or accompany them, right? And they have someone else to ask those additional questions too. So long answer short, or long answer there, I know to answer that question, but there's a lot of different things we can look at. And I think picking one metric that's going to really drive it and focusing on behaviors that are going to have a broad impact is really a critical piece. Great. Thank you. Another one here. What would be one top recommendation for encouraging managers to address service alerts or help with service recovery more quickly? In other words, ways to show the value so they don't just see it as another task. I think that, sorry, sorry, I can take this one. I'll take another one. I take another one. I think this is a really difficult situation when there's already so many different things on managers' plate, right? Or on nurses' plates in general, right? Especially if I'm a nurse manager. I do think it's important that we balance the positive with the negative. And so one of the things that we do very effectively as a partner is we do have compliments reports. We have positive reinforcement that you can share on a regular basis. And if we have a ratio where it's a 3:1 positive to negative, 4:1 positive to coaching ratio, right? I think that really helps when you have to have that discussion around coaching to say, "Hey, this will help you be more effective. You're doing nine out of ten things really, really well." I think it's also really critical to position it as not an additional thing. Whenever you're rolling out an initiative, whenever you're talking about improvement strategies, if we position it as an additional thing, there's nothing probably that will get nurses and staff to tune out more quickly. But I do think that positioning it as, "This is how we do what we do, and this is how we're effective in it," has been much more successful for organizations that have taken that approach. But it is difficult, right? And some people are better at it than others. It's also getting out of the whole day-to-day of, "I used to do your role, and I know how to do your role better." Simon Sinek, if any of you have heard him, I'll quote him real quick. He says, "In leadership, you're not in charge. You're responsible for those in your charge." And I think that's a really critical perspective as well that sometimes the main challenge is getting out of the day-to-day that I know how to do better than you and instead helping you be the best version of yourself in this role. And so, yeah, all strategies I've seen be successful, but yeah, the ratio of positive to negative, I think, is probably one of the more impactful ones, and then making it not something additional. So hopefully that helps. Another person asks us, "What if my contemporary outreach has been going up consistently, but my HCAHPS has remained stagnant? Larry, are we recording that one question too? Yeah. Yeah, yeah, I can. So I've seen this as well in individual client examples. Certainly something that can happen. I would encourage you to look at the makeup of your respondent groups, right? Just for no other reason than to understand who's actually responding to each. That can be a simple thing of breaking it down by age, breaking it down by gender. Sometimes what you'll notice, it could be language as well, that you'll have a group, a cohort group that we're really underperforming with or maybe is vastly underrepresented. I gave the example earlier of that client I worked with where there was 80% of their population that was responding to HCAHPS for 65 and over. It's a really quick check for them to say then, "Okay, what do our inpatient volumes truly look like? Do we have 80% of our inpatient volumes that are 65 and over?" If that's the case, maybe that's an accurate representation. Who knows? Chances are, and what I've seen happen in practice a lot of times is that there's one method of feedback, typically HCAHPS, that's becoming very specialized, right? So if I have 80%+ of 65 and over respondents, well, I mentioned this already, that's going to be a really difficult population to move the needle with, right? They're probably more medically complex. They have more comorbidities. They're really going to have more difficulty transitioning home. They have more medications probably than an average 35- 40-year-old. So there's a lot of things that come into play, but I would encourage you to look at your demographics and see what does the makeup look like. And then we can start to infer certain things or we can start to look at other indicators to see should there be changes, right? I had another organization that said we really need to augment our HCAHPS and incorporate another modality to see if it captures more representative feedback as well. So they added Web, right? And that's an option in 2025 that wasn't there before. And it might not markedly change the feedback you get from every generation, but it might bring in a whole new group of people that wouldn't have responded to your current mode. For instance, the client I'm speaking about, they didn't see a bump in Millennials or Gen X, right? But they saw a bump in several different age groups. That meant really that they were getting more feedback from individuals across the spectrum that were not getting captured before with the current modes they were using, right? They weren't getting feedback from a group. In other words, the question becomes, "Well, who do we have that we're not getting feedback from today? And where are our blind spots, right?" I hope that's helpful. That's what I would do to start, right? To try to figure that out if I were in your shoes and what I've done with some other partners as well. Great question. All right. We have another one here. I think Sarah might be equipped to answer this one. "We are a small hospital and don't have enough volume to support collecting feedback outside of HCAHPS. What else can we do? Yeah, that's a great one. Not all hospitals have enough sample size to utilize real-time to its full capacity. Some might also struggle with low sample sizes. If you're not able to use real-time at all for your inpatient population because you're sampling all of your patients for HCAHPS, one of the things that I highly recommend is using real-time to evaluate your emergency department experience. So if you're like most hospitals, there's a significant amount of volume of your inpatients that are coming directly from the ED. And how they are treated in the ED does impact their experience and how they score on the HCAHPS survey. So I know we have some data that shows that patients who are admitted through the ED typically score their inpatient experience lower or their answers on the HCAHPS survey. They typically score those lower than those who have a planned stay. So one way you can really impact HCAHPS is by using real-time to evaluate those emergency department experiences. Even though those patients from real-time aren't going to be getting the HCAHPS survey, if you're able to improve the ED experience for all patients, then some of that will carry over into your inpatient areas. I know I saw a question here in the chat about low sample sizes for HCAHPS. My recommendation there would be if you have low sample sizes, sorry, low sample sizes for real-time in the inpatient side. If you are struggling with that, I mean, you can still evaluate your data. Obviously, taking the scores with a grain of salt if you have low n sizes, but really maximizing the service recovery portion of that, being able to take action on the feedback that you do get from there. So some of that rich comment data will be really helpful to your organization. And again, it will still have an impact on your HCAHPS scores because, again, if you're using the information that you're collecting there to really change the patient experience for all patients, then you will see some of that impact on HCAHPS. Great. Thank you so much. Here's one from Amy. "Thank you for the presentation," she says. "What sampling strategy do you recommend when implementing NPS to ensure ample returns for HCAHPS submission? All right, Sarah, do you want me to take that one or do you want to? As I'm here. Sure. Go ahead. Take that one. Okay. So typically, that would be largely dependent on your volume, right? And so if you are a smaller organization, if you have enough volume that you need to allocate it all to HCAHPS, well, then that limits our options for more contemporary feedback. If you have enough volume that you can still do HCAHPS sampling and get to at least the minimum, right, for CMS and still do some additional outreach outside of that, then I think that it would be largely dependent on what you're used to doing. So whenever an organization comes to me with that, I look at what they've been doing consistently, right, in the past. So we don't markedly change what you're doing, how many people you're reaching out to, the data you're collecting with that. I usually recommend at least 150% of the minimum. So we're going over and above that minimum 300 for HCAHPS. But we're still then maximizing all the feedback we can get via more contemporary means to do that. Now, you can go either way with that. I have organizations that are successful with both of that, but you're going to have to swing the door one way or another is the way I look at it. It's almost like a kitchen door right in a restaurant, right? It's going to go all the way this way or all the way that way. And you can meet in the middle, but it's one of those where it has to be aligned priorities. Because what I've seen happen is that if you have organizations that want to use HCAHPS for unit-level data and they want significant data at each unit level for HCAHPS and they want to be able to stand behind that data, that tells you you need probably a lot more HCAHPS data than not, right? If you're going to use them in tandem with one another and you want to be able to use really contemporary data like we're talking about today in a real-time experience portal, then you probably don't need as much HCAHPS, right? You can utilize that data in real-time to make informed decisions and help drive both. So again, it's a case-by-case basis, but I think it's largely dependent on your goals as an organization and your volumes. So those would be the two factors for me. Awesome. We have a question here from Janet. She tells you excellent content. "They're working to implement a system service recovery awareness where all leaders are owners versus deferring to a patient relations department. Any points for cultivating a culture of service-minded leaders? I think Janet also had another question, which I'm actually going to include in this answer because I love it. It was about culture of the organization as well, I think. Is that the same question, I think, from or same individual, Janet, that you submitted that? Yeah. So I think it goes to your first question that you had asked around the culture with that. The best way, and not everyone likes to hear this because it's not an easy thing to have happen, right? The best way I've seen to create a culture of accountability, of support, and I say that wholeheartedly, it's not accountability and all stick and no carrot, right? It's accountability and support is to have effective executive leadership rounding, right, and leadership rounding that occurs frequently from a supportive standpoint. So for organizations that I've seen move the needle and move it very quickly, they've had an engaged C-suite team. Many times they'll assign themselves to a unit, right? They'll round on patients. They'll round on staff as a supportive function, not to see if they're doing their job, but rather to see where they can help to understand, make things real that they're hearing day to day about the difficulty of the work environment, see if they can make improvements to that. So that has been something that if you go back years and years to David Feinberg when he was at Ronald Reagan UCLA Medical Center, that's one thing he did, right? He's spoken at TED Talks and everything about what that did for their culture and the C-suite going out and doing that. I've been the personal recipient of executive leadership rounding as a patient at a Mayo facility, and it was phenomenal, and it meant a lot to me. I was able to share certain things that I wouldn't have felt comfortable sharing with my direct caregiver necessarily, right? I think that's the first critical step. The other part about service recovery is really going to be down to what you have as an organization that you can support. Meeting you where you're at, right, would be my recommendation. If you want to do a decentralized approach where every unit manager, every nurse manager, whoever it is, is responsible for their own area and service recovery, well, there's probably a lot of training that needs to go into that. They need to also see that modeled from the top down that this is something we're going to view as important. It's part of our daily work. It's not something additional. If you're going to do a centralized approach, I've seen that be successful too, right? Where you're talking about a patient relations department or patient advocates that are doing that. There's benefits and pitfalls to both, right? If it's centralized, then I have the same people doing it all the time. I know they're good at it. I can hire for that skill. I can make sure that we are consistent with our approach. We know the exact escalation. If it's decentralized and my nurse managers or clinic managers or wherever I'm at are doing that, then it's really going to be a situation where you have varying levels of skill and some folks that are really good at it and some folks that aren't. And so it ends up being something where you need a complementary supportive function to help coach those individuals that it does not come naturally to. Because otherwise, it's going to be something that falls by the wayside if they're not comfortable doing it. So that's a long-winded answer to those two aspects. But I love the culture question because it's one of my favorite things to talk about. And yeah, I've seen it work really well with clients when they can make things real and they see it firsthand. They're visible on the floor, so. One last thought on that, though. If you're going to do a leadership rounding, executive leadership rounding, I can't stress it enough. Support. It's a supportive function, not a punitive one. I've been with leaders that have rounded, and the patient literally says. They ask, "What else can I get you?" And they say, "Some ice. Some ice would be great. Can I get some more ice in my cup?" And I've watched that leader go out and walk to the nurse and say, "They need some more ice. I'm going to go back to my leader rounds." Pick up the cup, get the ice. You are there to help support your staff. That is the biggest thing. It's a small thing, right? But that was the biggest thing in that round that I saw that just completely did away with any benefit to that person being there. They thought immediately, "They're making more work for me. They're not helping me with anything." They couldn't have gotten the ice, seriously. They're a clinician. They can check to see if they're supposed to have ice or not. They can get the ice. They can bring it back. So anyway, I'll get off my soapbox, but that's a big thing. It needs to be a supportive function. Sorry. No, that's great. Thank you so much. We do have a bunch of questions in here. I'm so glad you guys are finding this content so valuable to you. Somebody else asks, "You mentioned looking at age specifically, but I am curious what other sorts of demographic views you've found to be most impactful. Yeah. Sarah, feel free to chime in. I know you've looked at a lot of this information too, so I don't mean to speak for you. I look by gender always to start. I've seen organizations where NPS has been a 13-point difference between men and women. And the most troublesome ones are when it's a 13-point difference and women are performing lower. In other words, they're much less likely to rate you. There's statistics. 90% of all healthcare decisions in the United States are made by women. Women make up predominantly the majority of the nursing workforce, right? I mean, there's all these things that that's a really important thing for an organization if you're missing that group, if you're not delivering on the needs of women. That's how I got plugged into the current health system I go to because my wife had our children there, right? And so for me, that's always a starting point is by looking at gender. And if there's a big gap, something to address, right? Is there a gender bias that exists? Age, marital status always. But Sarah, anything else that you've looked at that's been interesting to you? Yeah, definitely. I mean, it does vary for each hospital or health system. One thing that I know I've been approached about is differences in language. So sometimes we do see for some hospitals where there's a higher occurrence of language barriers. That's where maybe communication suffers more from the HCAHPS survey. So I always do like to look at language as well. And again, it's going to differ. It can differ for every different hospital or health system just based on the services that are offered and whatnot. But I always also like to look at language. So that's a good addition, I think, too, in addition to what Jason said. Great. Here's another one for you. "At one point, you mentioned the need to focus on behaviors, but I have different questions that show up as highest correlates when comparing data sets. What behaviors should I focus on? I think it's a really good question. I mentioned this a little bit around if you have questions that are similar, but they're not the exact same thing, are the behaviors going to have the same impact? I I think the really good organizations that I've seen that are really successful in this work is they're not so focused on the metric. They're saying to themselves, "Okay, but what behavior do I need to focus on to improve this?" So in other words, if it's explanation, right? If it's nurses explain things understandably or doctors treat you with courtesy and respect, am I really getting down to what is the thing I need to do differently as a clinician or as a nurse doctor when I go into the room with that patient? What are the specific things? Do I sit down? Do I look them in the eye? Do I not loom over them with the bed? Do I walk very fast into the room, right? Because the pace with which I walk is going to probably dictate the urgency with which they try to get their question out, right? So getting very specific with each staff member when they interact with patients, this is the role you play. These are the behaviors we are referring to when we say explain things understandably. It's not change all your explanations. It's confirm understanding. It's use teach-back. It's have them reiterate it. Give them a pad and paper or have them take out their phone and take a note, right? Use the tools at your disposal to help with retention because you need to plan that they're going to have questions, right? If we're talking about explanations in this example, right? They're going to have questions. What mechanism do I have in place then for them to answer those questions when they have them? Or what have I given them as a tool to double-check on those things when they start to question if they had it right in their head too? And this happens to everybody, right? I mean, I work in healthcare. My wife works in healthcare. She had a surgery this past year, and we didn't get everything right. We had to call back in. We had to go through an operator and talk to another person. And we finally got to somebody who could answer her question. It was a whole rigmarole. So make sure you have those things in place and confirm understanding before they leave because they're going to have those questions. So yeah, that's what I would say to that. Thanks. Awesome. Thank you so much, Jason. I know we have a few more questions in the chat here. Don't worry if you didn't get your question answered today. There are some of these that might be a little better answered one-on-one. We have the email you registered at. We're going to follow up with you, think out some good answers for you. You have not been forgotten. Thank you, everybody, so much for joining us today. Let me just put in one more plug for our webcast on Thursday this week. Check out the Pediatric Collaborative coming in March if you're a pediatric professional. Of course, we're having HUB again this year. Registration's open for HUB now. Check that out on the NRC Health events site. Thank you so much for joining us, everybody. Like I said, we'll get back to you with those answers. A link to the recording will be sent out if you want to watch this again. Thanks for joining us. We're so glad you could.