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Top Novant officials presented to the New Hanover County Board of Commissioners, riding high on what is probably the most significant announcement the healthcare company has made since buying NHRMC — $1 billion in new investments in the hospital. They also addressed Novant’s efforts to address concerns about staffing, patient safety, and quality of care.
Novant’s officials aren’t just responding to concerns voiced by the public and elected officials — although there has been plenty of that — or the dismal safety and quality ratings from the Centers for Medicare and Medicaid Services, a federal agency that rates both safety and patient experience, and Leapfrog, a national nonprofit watchdog for hospital quality.
They’re also speaking to conditions of the asset purchase agreement (APA), the legal contract that transferred ownership of NHRMC to Novant. The APA includes promises of significant capital investments — to the tune of $3.1 billion — and efforts to stay in the top 10% for patient satisfaction.
It’s worth noting that, in some cases, Novant discusses both its hospital operation and its network of physicians and clinics in the same breath. And, while NHRMC has faced some criticism, Novant’s physician network — known as Physician Quality Partners, the coastal region’s Accountable Care Organization — has been ranked number one in the nation, an impressive distinction.
The presentation was kicked off by Ernie Bovio, the president of Novant’s coastal region. Bovio came to Novant from UNC Health in early 2024 and brought some stability to NHRMC, which had seen repeated leadership turnover. He was followed by Dr. Heather Davis, Novant’s chief clinical officer, and finally NHRMC President Laurie Whalin, a longtime NHRMC employee who has seen, and been fairly candid about, the hospital’s highs and lows.
Staffing
Many of the key issues over the last five years have revolved around staffing and morale.
Bovio acknowledged that the first two years of ownership were “crisis management” due to Covid. Indeed, it’s hard to imagine launching any major capital projects while the world was shutting down — especially when the public outcry was directed at the deteriorating conditions in the hospital, not the lack of new capital projects.
A major part of that was NHRMC’s use of traveling nurses — which was both necessary to keep the hospital running and, conversely, debilitating for morale. In the fall of 2022, former hospital CEO John Gizdic, who has since become a top Novant exec, called the situation “unsustainable.”
Novant pumped millions of dollars into the problem. Bovio said investments and pay raises for staff since 2020 have totalled around $330 million, not including benefits, continuing education, and other resources. Currently, Bovio said NHRMC has reduced its nurse turnover rate from 26% in 2021 to 9.5% last year. The hospital has hired hundreds of new nurses, as opposed to short-term contract positions, and it’s brought in 180 more physicians and advanced practice professionals to the region. Bovio told commissioners Novant is fully staffing all of its beds and clinical locations – although we’ve heard from critics, including current and former staff, that those staff levels, and the experience level of those on staff, could be improved.
A hospital can be fully staffed and still have serious issues, including morale, engagement, and patient experience — all problems we’ve heard about, especially during NHRMC’s darkest days in 2022.
Following up on Bovio’s remarks, Davis told commissioners that there’s been improvement on those fronts. Davis noted that “team member engagement” is up from 69% in 2021 to 76% last year. The improvement takes NHRMC from the 37th percentile to the 62nd percentile. Novant officials have said their goal is to hit the top quartile and decile (i.e., the top 25% and 10% of all hospitals nationwide) on a wide range of safety, quality, and patient experience measures.
I followed up with Novant to ask what, exactly, ‘engagement’ meant. A spokesperson told me it “reflects the level of commitment and connection team members feel toward the organization and their work. This score is based on our annual survey, which is open to all team members for a month. Individual responses are anonymous, and the survey is administered by a third-party partner.” Notably, the spokesperson said the improvements they’ve seen are for the Coastal Region as a whole, not just NHRMC’s main hospital tower facility.
According to Press Ganey, a company that focuses on improving healthcare performance, hospitals across the country are seeing an uptick in these measures.
“After years of unrelenting pressure, the healthcare workforce is finally showing us something we haven’t seen in quite some time: a real, measurable rebound in both employee and physician engagement,” the company announced late last month.
Press Ganey also noted that, “even with the encouraging improvements we’re seeing, the risks tied to disengagement haven’t faded,” reporting that 29% of disengaged employees left their jobs between 2024 and 2025. For employees who felt “neutral,” it was 19%.
Patient experience
A growing, stable, and increasingly engaged staff is an unalloyed good — but it’s only part of the equation. A good patient experience is obviously the goal of healthcare. And bad patient experiences have led to public protests and pressure on elected officials to get Novant to improve.
Notably, the low scores Novant NHRMC has received from the Centers for Medicare and Medicaid Services (CMS) aren’t as bad when it comes to patient experience. Self-reported data from patients give Novant a three-star rating compared to a more data-driven two-star rating for safety (more on that, in a minute).
Davis also told commissioners that 81% of the time, patients say that doctors and nurses are communicating well with them. Davis said that put them above 63% of hospitals nationwide, citing Press Ganey’s patient experience database. Davis didn’t specify if this score was for NHRMC or Novant’s broader coastal region.
It went unsaid, but that does mean that one in five has an experience where there was bad communication. With hundreds of thousands of patients annually, that’s a lot of potentially bad experiences. It’s also, like the engagement metric, short of where Novant has said it would like to be, falling below the top quartile by a dozen percentage points.
Davis said Novant was continuing to improve and was proud of its work so far, but didn’t give a sense of what that improvement had looked like, so I followed up on this as well.
A spokesperson told me they’ve seen improvement in doctor and nurse communication, noting that an uptick of even a few points can increase Novant’s comparative rankings against peer institutions.
In 2023, the communication scores were 77% for nurses and 79.4% for doctors; that's several points higher than the 2022 scores, which were 74.3% for nurses and 75.2% for doctors, according to Novant.
“Increased scores can be attributed to intentional efforts, such as interdisciplinary rounding, where the entire care team joins the patient to discuss the plans together to support information sharing and continuity of care,” the spokesperson wrote.
A note on infographic tomfoolery
I need to take a quick moment here to point out some of Novant’s graphics, showing improvement in team member engagement and patient experience.
Now, both of these graphics, as I’ve written above, represent basically good news – albeit with more work to do if Novant wants to get into the top quarter or the top 10% of hospitals nationwide. But they're also the kind of thing that drives data journalists nuts – misrepresentations that are sloppy at best and deliberately misleading at worst.
The first is the engagement graphic. This is a classic case of what’s called a ‘truncated y-axis.’ Because it doesn’t start at zero, the vertical axis inflates the difference between the two numbers. In fact, this chart visually suggests engagement has more than doubled.
Truncated Y-axis graphs are a common mistake in data visualizations. They’re also deliberately used to mislead people by advertising and consulting firms, all the time.
Here’s what a more honest and clear representation would look like:
Now the second graphic, about communication.
This isn’t a specific type of data visualization error as much as it is both vague and wrong. The graphic, I think it's fair to say, strongly implies that the quality of communication is up 81% — which is not true. Based on the past data points provided by Novant, it’s up a few percentage points, or about 8% (based on communication, averaging doctors and nurses, being somewhere around 75% in 2022, that would represent an 8% improvement over three years).
In either case, there wasn’t an 81% improvement. You could argue that the graphic indicates the percentage of good communication is up to 81%, but that’s a stretch — and, what’s more, without showing a timeframe or what the score is up from, it’s even harder to think that’s what the sign is representing.
Yes, I acknowledge this is petty and potentially pedantic. But this is a multi-billion dollar company, explaining to our elected officials what they’re doing with the hospital they bought from us with the promise that it would be a world-class facility. They should be as clear and honest as possible and avoid the temptation to spin the data (especially if that data is already trending in the right direction).
I wish commissioners had pushed Novant on these points, just to hold their feet to the public fire a little, but I also acknowledge that the presentation zipped by pretty briskly, and they were asked to absorb a lot of facts and figures in just a few minutes. Hopefully, they retained more than just the graphics, and perhaps they’ll follow up.
Ok, moving on — to some better graphics.
Safety improvements
Davis explained to commissioners some of the key safety data points where NHRMC has improved, including infections, where Novant can show clear year-over-year improvement. These make up a significant portion of both CMS and Leapfrog scores, and Novant has done a lot of work to improve them. More importantly, they represent real harm to people that's been avoided, meaning patients who are in less pain and go home quicker.
Novant has also made improvements on what are known as patient safety indicators, which are often aggregated into a single score, like the one used by CMS (and in turn, by Leapfrog).
As Novant officials have said in the past, CMS and Leapfrog data for these safety factors can lag anywhere from six months to five years or more. That means, in some data sets, disastrous conditions during the height of the pandemic continue to pull down aggregate scores released in 2024 and 2025. There are also safety issues with more recent datasets that cover Bovio and Whalin's time in leadership, and on those fronts, officials have said they're still working on improvements.
Novant’s presentation featured what they called “real-time” data, which is not currently available to the public. Officials said last year that a public-facing dashboard would be available by the end of 2025, but it hasn’t gone online yet. In late January, a Novant spokesperson told me it was still being worked on.
I think most people want Novant to succeed, and journalists aren’t looking to pillory the institution (we’d prefer it to be a very high-quality hospital, even if that makes it a very boring story). We want to trust Novant, but without data, it’s hard to verify. And it’s hard to know what to make of the horror stories shared on social media. In the absence of data, it’s unclear if they’re unfortunate outliers or indicative of ongoing systemic issues.
Capital investment
Batting cleanup, Whalin laid out Novant’s plans for the coming five years for the commissioners.
The biggest news is a massive $1 billion investment, including a new heart and vascular tower on NHRMC’s main South 17th Street campus paired with a new outpatient medical office. The plan also includes a new and expanded rehabilitation hospital on NHRMC’s Wrightsville Avenue campus — and a reconfiguration of the existing hospital tower’s first two floors. It’s the largest single project ever commissioned by Novant, Whalin said.
There are some procedural and regulatory hoops to jump through, including the state’s certificate of need (CON) process. Explaining the history, value, and drawbacks of the CON system could fill several other columns. Basically, the CON law was designed in the 1970s to require approval from the state’s Department of Health and Human Services before a healthcare company could make major expansions to services, add new facilities, or purchase major new equipment. In theory, CON laws prevent hospitals from concentrating their resources in major metro areas to compete for customers, which in turn pushes hospitals to provide services in more rural areas. Critics say the CON law hasn’t delivered on its promise to rural communities, while also preventing competition in more urban areas that could drive down prices. (And some free market critics also just say the government should butt out.)
According to Novant, the rehab hospital on Wrightsville has already received state approval, and the outpatient medical office won’t require it. But Novant will need the state's green light for the heart and vascular tower on South 17th Street.
As Bovio noted, this plan significantly increases Novant’s total investment in the region. Initially, Novant had promised $600 million in “routine capital expenditures” over a ten-year period (with an automatic five-year extension available). But the larger promise was $2.5 billion. As Bovio told commissioners, there was no timeline or due date included in the sale contract, but Novant is now considerably closer to delivering on that figure. Whalin said Novant has now committed close to $2 billion, including the recent announcement.
There are $200 million in projects already completed, including numerous clinical and office spaces, and the Neuro Institute Tower, recently renamed for Deloris P. Jordan, mother of Michael Jordan, who recently donated $10 million to Novant. A seperate $10 million donation allowed Novant to open two clinics, located near Creekwood and Houston Moore, designed to serve patients even if they don't have health insurance.
There are also $400 million in ongoing projects, perhaps most importantly, the Scotts Hill Medical Center. Despite significant cost increases due to inflation and other factors, the nearly $300-million facility is on track to open this year. Breaking a little news, Whalin told commissioners the official opening date is now set for June 16 — it’s the first new hospital to open in the county in nearly 60 years, Whalin said.
Whalin said the Scotts Hill facility would “alleviate constraints” on the main campus emergency department, which has been the epicenter of many concerns we’ve heard about hygiene, overcrowding, quality of care, and more. She also noted that while Novant has worked to reduce the wait time for an inpatient bed from 16 hours in early 2025 to seven and a half hours, the Scotts Hill opening would help further address that.
Bill of health?
Almost three years ago, my colleague Kevin Maurer and I checked in on Novant’s progress. At the time, in the summer of 2023, things were pretty rocky.
The hospital was still reeling from a tragic death in the emergency department, which put NHRMC in “immediate jeopardy” with CMS, a “situation in which the provider's noncompliance with one or more requirements of participation has caused or is likely to cause serious injury, harm, impairment, or death to a resident," according to the federal agency.
And Novant was hemorrhaging money trying to keep staffing up. Then-President Shelbourn Stevens told us NHRMC was operating at a loss.
Morale was in the gutter, and it was clear there were questions about leadership all the way to the top. In fact, Stevens, whom we interviewed extensively for the piece, was fired shortly before we published.
Even a die-hard cynic would be hard-pressed to say Novant hasn’t improved conditions at NHRMC. Sure, you have to take Novant's starry-eyed goals for 2030 with a grain of salt, but we're a long way from wondering if the feds are going to shutter the place by cutting off Medicare contracts.
And, a few infographics aside, Novant officials have gotten better at acknowledging that there is more work to do — something both Davis and Whalin reiterated. The commissioners said several times that Novant’s willingness to admit where they weren’t hitting the mark was appreciated — and several commissioners noted that when they ‘pick up the phone,’ Bovio, Whalin, and others always answer.
Critics and skeptics have noted that heart and vascular services are extremely profitable — and questioned whether Novant has an eye on improving patient quality or just the bottom line. I think, from the conversations I’ve heard, that they can pay attention to both. But, whereas the $1 billion investment gets a splashy day or two in the news cycle, the struggle to improve quality — and win back public trust — will take much longer.
