A Modern Approach within a Culture of History and Tradition

On the Road with Walter Reed National Military Medical Center – May 2018

by Tiffany Christensen

My Lyft driver picked me up from Ronald Reagan National Airport and, before we left the parking lot, asked me why I was going to Walter Reed National Military Medical Center. I gave him the simplest answer I could think of; “I’m going to learn more about how they care for their patients and families.”

“They only care for Veterans there, right?” he replied.

I smiled because I had once believed Walter Reed Bethesda only cared for active duty soldiers injured on the field. Interesting how this iconic healthcare facility is so well-known and yet not very well understood. I shared what I had come to learn. “No, they care for active duty, veterans and their beneficiaries.”

With that, he dropped me at the front of the campus where I waited for my escort to take me through the gates, past the armed guards.

Walking through the front doors of Walter Reed Bethesda, I couldn’t help but feel the history of the building and think about the thousands of military patients and families who had walked in those doors since the early 1900’s. In fact, there is a room directly attached to the front lobby that looks like a mini-museum with historic documents and photos, adding facts and dates to a palpable sense of the past. I also immediately noticed the clothing of the people working at Walter Reed Bethesda. Most of the clinical staff bustling around me were wearing boots and camouflage suits with colors correlating to their branch of the military. For a civilian like myself, this was an interesting departure from the familiar site of clinicians in scrubs and leaders in suits.

Underneath that superficial observation, I quickly became aware that I was surrounded by a culture steeped in tradition which includes a commitment to respecting the rank of those around you. This culture of respect is noticeable in the way people speak to each other (“Sir” and “Ma’am” are proper ways to address superiors) and in the way they regard patients and families. Just as there was a calling to serve their country, the men and women working in Walter Reed Bethesda clearly feel a duty to serve those who serve our country. While I was there, I had the opportunity to visit the oncology floor and talk with several nurses. I was both moved and inspired by the way they spoke about their patients with deep reverence and compassion.

Just like any other healthcare organization, Walter Reed Bethesda has challenges. The nature of the military is such that people are often called to different duties often in different parts of the world, making consistency challenging. Walter Reed Bethesda, for example, changes CEOs every few years. To add to the transitory nature, Walter Reed Bethesda as an institution is also in transition. In 2011, Walter Reed Army Medical Center integrated with the National Naval Medical Center in Bethesda, forming what’s now known as Walter Reed National Military Medical Center. In 2013, this evolution continued with another organizational redesign now known as National Capital Region Medical Directorate. With this transition comes a new structure and the inclusion of all branches of the military. The merging of these branches means a merging of cultures and leaders. Anyone who has gone through a re-org knows very well that, even under the best of circumstances, these kinds of changes bring unique challenges.

What makes this “On the Road” extraordinary is Walter Reed Bethesda’s willingness to take a bold, modern step into improving experience amidst all of this tradition, history and change, Walter Reed Bethesda is the first military hospital to formally build an Office of Experience. In July of 2017, the NCR Directorate added “Director of Experience” to the Board which already included a 12 other “Directors” including Nursing, Medicine, Surgery, Behavioral Health, Dentistry and Education. This was a huge step forward and a big leap of faith.

At the helm of the Office of Experience is Dr. Catherine Kimball-Eayrs. Dr. Kimball-Eayrs is a Colonel and a Pediatrician. She now works closely with her deputy to improve experience across Walter Reed Bethesda. Dr. Kimball-Eayrs is clearly passionate about her work and states that this department is purposefully named “The Office of Experience” as a result of seeing the need to improve experience for staff as much as patients. The impetus for the office, in fact, was a recognition that focusing solely on patient experience without considering staff experience had lead some staff to feel frustrated and resentful. At that time, staff did not feel as though they had an opportunity to be heard and were not getting the attention they needed.

After looking at civilian models across the United States, Kimball-Eayrs developed a strategy for piloting this work based on the practices at similarly sized academic medical centers. Today, Kimball-Eayrs strives to build a culture and a system in which every project, choice and change must:

1. Recognize who is impacted
2. Ensure those who are/will be impacted have a voice that is heard

Like any organization, there was some resistance to this approach early on but Dr. Kimball-Eayrs has been pleased to see that people are “easily convinced” that this work is both needed and worthwhile. One of the first programs that helped to shape this opinion was implementation of Leadership Rounding. In this model, leaders at the Director level round once a week on staff and/or patients in whatever area they choose to visit. On several occasions, this rounding strategy helped to uncover tensions between staff on various units and, as a result, the Rounding Director was able to address the issue that day and on an on-going basis. Had it not been for the rounding practice, these concerns would likely not surfaced until months later when the work culture survey was administered.

Today, there is an ongoing effort to perfect the questions asked while rounding but there is no lack of enthusiasm or any lingering concerns about the time it takes to round. The practice had the desired outcome; to give the frontline a voice and has proven itself to be a good use of time and energy.

The Office of Experience is relatively new at Walter Reed Bethesda and there are big plans for the future including additional opportunities to partner with patients and families as advisors, better strategic alignment with the office of patient/visitor relations and for deepening the breadth of resiliency work across the system. What is equally exciting is the example Walter Reed Bethesda is setting for other Military Healthcare facilities. Dr. Kimball-Eayrs has already received requests from different parts of the country to discuss her model so this may, over time, become a standard for military health organizations. It was an honor for The Beryl Institute to be given a window into this exciting new breakthrough in the space of improving experience!