When it comes to NHRMC, the headline news over the last two weeks has been hospital safety and quality grades, which have once again been disappointingly mediocre, at best.
The national nonprofit Leapfrog, which acts as a watchdog issuing safety and quality ratings every six months, gave NHRMC a C for the fourth time in two years. And the Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services, upgraded NHRMC from two to three out of five stars for hospital quality and safety — but downgraded the hospital’s patient survey ranking from three to two stars.
For the past two years, this has been the story: Novant NHRMC gets poor or middling rankings, acknowledges that they’re bad, but argues that the rankings are based on old data and the current conditions are far better.
That dissonance is amplified by the steady stream of stories, from staff, patients, and families, about bad experiences at NHRMC, ranging from avoidable nuisances to disturbing claims of negligence and neglect. There are entire Facebook pages dedicated to them, but they also crop up in the comment section, and in the phone calls, messages, and emails that we get as journalists. This week, perhaps prompted by recent news coverage, I got more than the usual notes about long wait times in the emergency department, high staff-to-patient ratios, hospital beds in hallways, and sanitary concerns. Protestors outside the hospital on Saturday, there to demand improvements, shared similar stories, as they have at past rallies and public meetings.
As I often remind people, bad things happen at hospitals, even the best hospitals, so no single anecdote is proof that ‘things are bad.’ But many anecdotes, against the backdrop of flagging safety and quality ratings, make it harder for the public to trust Novant’s claims that ‘things are getting better’ — even if that’s true.
In last week’s newsletter, I called it Groundhog Day, which seems to be the cultural touchstone for a lot of people, including Jon Martell, a retired doctor and hospital administrator who founded the non-profit Cape Fear Five Star Projectto push for reforms and improvements at NHRMC after a near-death experience at the hospital in 2024 (which he recounted on The Newsroom). Martell, whose organization planned Saturday's protest, referred to the film in an interview with StarNews to describe the hospital’s recurring low ratings.
Even NHRMC President Laurie Whalin referenced it.
“Some of the headlines last week, with the Leapfrog coming out, was that nothing has changed with the hospital. And I’m sure you feel like it’s Groundhog Day when we sit here,” she told me on Thursday morning, sitting in her office at NHRMC.
I was, once again, there to meet with her and Dr. Heather Davis, Novant’s chief clinical officer, for a conversation that we’ve had several times before over the last couple of years. It was, I’ll note, an interview Novant proactively solicited, a positive sign that the healthcare company has taken the rankings increasingly seriously — even though they point to the ‘data lag’ issue, where CMS reporting (also used by Leapfrog) can reach back up to four years.
“We won't defend or deny any of these results. They 100% are what they are, you know, but it's not who we are today,” Whalin said. “The real-time data that we monitor on literally a daily basis has shown significant improvement over the last one to two years.”
This time around, I wanted to dig a little deeper into that data, for better or worse, to look at exactly what the lag means, and how many more Groundhog Days we’re in for — will we see six more months of disappointing ratings or, like Bill Murray’s Phil Connors, will we find our way out of this depressing loop?
Escaping the past
In some cases, the lag really does give a backward-facing view of things at NHRMC.
Take what’s called the Medicare PSI 90, a composite of ‘patient safety indicators’ (Leapfrog uses ten of them), used to create both the CMS and Leapfrog ratings. For the spring Leapfrog ratings, these were based on reports from July 2022 through the end of June 2024 (and last fall, they were based on reporting that was a year older than that). The reporting data for the “death rate among surgical inpatients with serious conditions” metric covers the same two-year time period.
That includes some of the worst pandemic-era conditions at the hospital, with over 100 beds closed and a staff shortage of 400 nurses. CMS had just threatened to terminate the hospital’s Medicare contracts if things didn’t improve, which would have been catastrophic. It also includes administrative turmoil, with the reported sacking of then-president Shelbourn Stevens and the departure of his interim replacement not long after.
We’ve heard arguments from current and former staff that Novant could have done a better job handling the issues during this time, and I certainly think some of those are fair. But, clearly, there were some aggravating factors. And, while past administrations may have tried to put a good face on the situation, Whalin and her team have not tried to sugarcoat how bad things were.
“I've set out publicly our operational challenges during that ‘22 and into ‘23 time period,” she said.
Whalin has been at the hospital for a long time, way before Novant purchased it from New Hanover County, so she has a long-term perspective, including on those difficult years.
Because of the four-year lag — and the two-year reporting window — NHRMC has essentially been dragging around this nightmare period since spring 2024, the last rating cycle where the hospital got a B grade before the rating slipped to a C.
It also means that the understandable public outcry, specifically the question of ‘what Novant intends to do about’ each new poor score lands in kind of an awkward way, Dr. Davis told me.
“We've been asked this question about, ‘okay, Leapfrog’s come out, are you going to do anything with that data? Are you going to change anything from your review of that data?’ And the answer is, ‘we looked at that data two years ago, or three to four years ago, because that's when it's from,” Davis said. “The data from ‘22 to ‘24 is data we've already evaluated, and that is what has informed our improvements, our process, our resource, our change in protocols, and that's what's leading to the ‘25 — ’26 improvements.”
Whalin and Davis noted, for example, significant and sustained improvements in reducing hospital infections that do show up in Leapfrog ratings. That data is much more recent, from mid-2024 to mid 2025, during a period of time when former president Ernie Bovio (who has since returned to UNC Health) and then Whalin were at the helm of NHRMC.
But not all of the more recent data is unproblematic.
More recent issues
Several other metrics, based on data from 2024 and 2025, are still below the top-tier ratings to which Novant says it aspires.
Those include patient experience issues like ‘doctor communication,’ ‘information about medicines,’ and ‘discharge information.’ It also includes a key safety metric, surgical site infection following colon surgery, which Leapfrog has rated NHRMC as below average for years.
In terms of the communications-based issues, Whalin noted: “That has been one of our major focus areas in ‘25, and it started toward the end of ‘24.”
Whalin said the hospital launched a task force, working with nursing and physician leadership.
“They've done lots of things, just in how they communicate with each other, how we communicate as a team, bedside handoff, patient progressive rounds [multidisciplinary meetings to assess a patient’s treatment],” she said. “I mean, our physicians even have little markers where they write on the whiteboard, so the patients now see their plan. They have a ‘commit to sit program,’” which, as the name implies, encourages healthcare workers to sit with patients and talk to them.
Whalin said over the course of 2025, doctor communication went from the 33rd percentile among hospitals to the 71st percentile. Over the same time period, nurse communication went from the 29th percentile ot the 83rd percentile. And, because those metrics have a more up-to-date reporting period, they should be captured in the near future, Whalin said.
The hospital also launched a task force for colon surgery infections, where unlike the other four infection metrics tracked by Leapfrog, it’s been harder to move the needle. Whalin said the multidisciplinary team, led by physicians with nursing and infection prevention specialists, who review cases and work on implementing ways to improve outcomes — that is, to see fewer infections.
Notably, due to the sheer volume of patients and the severity of their conditions — because NHRMC is the primary trauma center for southeastern NC — there will be some infections. Leapfrog doesn’t measure against an absolute zero, it measures against an average, with higher safety scores for hospitals that have fewer-than-average incidents. Overall, NHRMC saw an additional 30% reduction in hospital-acquired infections – and Whalin said she was confident the hospital would stay on that trajectory, including with colon surgery infections.
The second-best time
Whalin and Davis touted the recent improvement to three stars from CMS. But when I asked about the downgraded CMS’ patient survey score, which dropped from three to two stars earlier this year, they had less to say.
Whalin said she wasn’t sure what the time period for the survey was.
“We’ve asked our patient experience team to look at that,” she said. “My assumption is that has a time period before a lot of this work and these improvements.”
The CMS site doesn’t exactly make it easy to find the reporting period and, like Whalin, I initially struggled to track it down. But, going through a list of all 172 data sets, there are three surveys, all using a rolling one-year reporting window, updated every quarter (which explains why the survey star rating was updated before the overall safety and quality rating, which is annual). The most recent reporting period for the surveys is July 2024 through June 2025.
Whalin pivoted to discussing Novant’s partnership with Press Ganey, a company that focuses on improving healthcare performance, on what they’re calling the “nursing bundle,” a comprehensive approach to improving patient experience.
“We’ve brought them in as a special focus this year, around what we call the nursing bundle,” Whalin said, which includes more communication between nurses and the patient and their families, involving patients in shift hand-offs, so issues don’t get lost in the shuffle, and more rounding, where nurses proactively visit patients. She described it as a best practice, inspired by lean management techniques that let frontline workers make incremental improvements based on feedback rather than a strictly top-down approach.
Whalin said that while some nurses were doing this work already, the goal was to make it a universal practice.
“We had it in pockets, but it wasn’t hard-wired,” Whalin said. “We want these embedded in our culture so that you see it everywhere, every time, and it's not, ‘okay, they do a great job of it [in some departments], but maybe it's hit or miss over here.’”
According to Whalin, this approach is being rolled out right now. I asked, if this was a best practice, why wasn’t it implemented earlier — say in 2024, when Novant’s new management team said (or at least implied heavily) it was righting the ship?
“That’s a great question. Great question. I don't know that I have a great answer for it,” Whalin said. “I think as we started to focus on our team, and we said, ‘Okay, first we've got to focus on our leadership team, and what do we need to do?’ And my focus was, get the right team in place, get the right structure. We felt that it was important to make sure our leaders knew how to engage their staff before rolling something like this out.”
You’ve probably heard the saying: the best time to take action was yesterday, the second-best time is today. It’s more than an inspirational fridge-magnet quote, urging you to get to the gym. In government and other administrative roles, the fear of criticism for past inaction often prevents a response going forward, as it seems like a tacit admission. It’s a variation on the sunk-cost fallacy that can freeze organizations. It’s worth noting, again, that there were protestors out in front of the hospital this weekend, demanding that Novant ‘do something.’ I have to at least acknowledge that they are, and if late rather than never, then that’s the story, but it’s preferable to Novant doing nothing.
Whalin and Davis said, again, they were confident the work’s benefits would show up in scores soon enough. Davis also added that the approach of bringing nurses into the process, instead of just giving them marching orders, so to speak, had benefitted morale. Whalin noted that in 2025, turnover for nursing staff was less than 10% – considerably lower than the industry average, which is closer to 18% or higher, depending on department or specialization.
“When people feel part of the work, they feel like their voice is valued, and they're really helping to define what ‘good’ looks like, and to be recognized when those improvements happen, they're the ones who are driving it,” she said.
Whalin briefly paused to go back to the question of why this was being rolled out now, and said she wanted to make sure there was no blame on nurses.
“I do want to go back and just go on record [...] there's no blame there, that's completely us and creating the environment, and saying this is the expectation, and then giving them the environment to be able to achieve that. And so that's leadership. I just want to make sure it doesn't come across that nurses were not doing best practices or what they're supposed to be doing,” Whalin said.
I told Whalin it was my understanding nurses were doing everything they could, and she and Davis agreed with that.
Dashboard confessional
In the years after Novant bought NHRMC, which coincided with the Covid-19 pandemic, we heard plenty of concerning stories — in some cases from friends and families who were hospitalized.
The public became increasingly frustrated, demanding to know what was going on at the hospital. This culminated in 2022, when WWAY published a story, based on anonymous sources, claiming that a woman had died while awaiting admission to the emergency department — and that the state was investigating. It was a journalistic gamble, to be sure, but it felt like a dam of frustration had broken. And, WWAY was right, a woman had died, an investigation was launched, and ultimately the federal government put the hospital on notice.
Things have improved dramatically since then, though using NHRMC’s infamous nadir as a benchmark is admittedly a low bar.
Perhaps ironically, the situation has been inverted. Because of lagging data, real-time conditions in 2021 and 2022 were terrible, but the scores, pulled from the prosperous pre-pandemic ‘best of times’ during the county-owned years, were relatively good. Now, officials say current conditions are great, but the scores are down, dampened by data from ‘the worst of times.’
The constant is the public’s desire to know what’s really going on.
Last November, during another Groundhog Day interview, I asked Whalin, ‘if Novant has real-time data that’s more accurate and up to date than CMS or Leapfrog, why not publish it for the public to see?’ And she told me that Novant had a ‘microsite’ dashboard getting ready to roll out by the end of the year, which would have exactly that kind of data, as well as emergency room wait times.
The dashboard didn’t meet its year-end deadline, and when it was announced, during Novant’s five-year update presentation to county commissioners in February, it was underwhelming. I had gripes about the ways the infographics were presented, which I felt were misleading. I also noted a more general issue, which was that the ‘dashboard’ was a static .pdf – drawn from data from the past year, which, while closer to the present than some CMS datasets, is not how anyone I know would define ‘real time.’ It hasn't been updated since it was published.
The dashboard is a work in progress, Whalin said, conceding that she had “probably rushed it” out after committing to releasing it.
“I was like, ‘We've committed to this, right? We've set out publicly. We're going to put data out there. We need to put data out there.’ And so we worked with our web designers to try to get something out there so that we could live up to our commitment of starting to be transparent. So that's what we started with. And the goal was always to, one, add additional metrics, and then two, have an update on it quarterly, and so that was our goal and commitment,” Whalin said.
While not exactly ‘real-time,’ quarterly data would be more timely than even the most recent CMS or Leapfrog data. Whalin said that level of accuracy is what the public deserves and accepted that, in some cases, it could show things like an occasional spike in, say, hospital-acquired infection.
Whalin was very graceful about my critiques, joking that “we saw you had some notes.”
But, more seriously, she admitted, “We heard your feedback on very fair points on the axes and how we represent the data, and making sure that it meets some standard definitions, and that the typical person that would look at a graph and it makes sense in terms of the scale, the range, the axes, all that other stuff. So we've taken that feedback, and we're in the process of currently updating it, and it should be done by the end of the month.”
It was my turn to joke, saying “I don’t want to do this to you again,” by publishing a deadline, but Whalin, checking with a spokesperson, confirmed Novant could commit to an update by the end of May.
Whalin acknowledged that the dashboard probably still won’t be exactly what I would want or imagine. And, to be fair, I acknowledged that my expectations weren’t grounded in any experience running a hospital.
I will say, having been gaslit and bullshitted by more than my fair share of officials over the years, Whalin’s proactive willingness to invite the press in, take their criticisms in stride, and even occasionally admit the need to course correct, deserves respect.
No end-zone dance, yet
Novant frequently points to the accolades it's won as a counterbalance to less-than-flattering ratings from CMS or Leapfrog. And it has won some prestigious awards, including being named one of the top five pediatric facilities in the country by Vizient, a private, for-profit healthcare improvement company, multiple awards and top rankings for hip and knee replacement services, and high marks from the American College of Cardiology.
Whalin and Davis noted these are not ‘pay to play’ awards, and often they don’t know they’re going to be named until they get a press release goes out.
But these awards are often for one component part of the hospital, and they focus on recognizing excellence, not concerns or flaws. There’s also a certain public cynicism about an industry award versus a rating by an independent nonprofit or the federal government. I think for these reasons these awards don’t have the same psychological purchase.
There’s something about the grades and stars, perhaps because they are so concise and easy to articulate — yes, at the expense of nuance — that has become the core of the conversation about hospital quality.
The public hears that NHRMC is a C-rated, two-star hospital and feels an understandable frustration. That would probably be true for any community, but there is an added layer of pressure here in New Hanover County, where elected officials made the controversial decision to sell the publicly-owned hospital. During that process, county commissioners and members of the Partnership Advisory Group, which helped steer the sale process, repeatedly pointed to promises of delivering ‘exceptional,’ ‘world-class,’ and ‘cutting-edge’ healthcare. And, it’s worth noting, the sales agreement included contractual promises by Novant to make best efforts to be in the upper echelon of patient satisfaction – which, it's fair to say, is a benchmark they haven't hit.
All about to say, even when Novant got a B rating, the public dissatisfaction was neither unreasonable nor unfounded.
Acknowledging it might be an unfair question, I asked Whalin and Davis if there was a way to generate a Leapfrog or CMS-style rating based on the conditions right now, this week, what would it be?
Davis demurred in a very professional, academic way, noting that it’s technically difficult because the metrics and methodology change. The Leapfrog grades, for example, are based on comparisons to average scores — and while Novant has its own internal data it’s hard to get contemporaneous data from other healthcare systems to do that kind of comparison. In other words, Novant has a good picture of what NHRMC looked like this week, but not what a thousand other hospitals looked like during the same time period.
Whalin was more confident, joking that Davis would be mad, but venturing an answer anyway.
“I would put us at an A,” Whalin said, noting they were already very close to a B this year with outdated data.
Sooner or later, the data will either bear out Whalin’s claim — or it won’t. Whalin said, “I’m going to bet on ourselves.”
To her credit, Whalin doesn’t expect that level of confidence from the public. As she’s told me before, she knows the public wants — even needs — to see an A-rated, five-star hospital before they’ll believe it.
“That's why we're not spiking the ball in the end zone right now. We're clearly saying ‘three is on the way to five,’ right? We're not sitting here saying we made it. There's no other choice but A and five-star.” Whalin said.
The official goal is to see those public-facing ratings by 2030, but Whalin and Davis both said they don’t want to wait that long. But then, even more importantly, they’ll have to maintain it.
“When we get there, we will celebrate, we will spike it in the end zone, but then we're going to maintain it,” Whalin said. “That's the other thing: getting there and maintaining it are two very different things. It’ll take a lot of hard work, but that is what we’re here for. I like high expectations, so if the community has high expectations of us, they should, and we're going to deliver on it.”
The day after Groundhog Day
Notably, 2030 is when UNC Health, the state-owned academic healthcare system, plans to open its own hospital in Wilmington, on a 62-acre property right down the road from NHRMC. If approved by the state’s certificate of need process this summer, UNC Health’s hospital promises to offer some of the same services as Novant, although it will be several times smaller than NHRMC.
UNC Health coastal regional president Ernie Bovio, fresh off a two-year stint overseeing NHRMC and the coastal region for Novant, had nothing bad to say about his former employer (in fact, he said he was proud of his time there, adding that they'd made real improvements). But he also said UNC Health's new hospital would offer much-needed “healthy competition.”
Whalin didn’t think it was really an apples-to-apples comparison.
“What I think is needed is access, and I think Novant is delivering on our plans to deliver that to the community, and making sure that we do have the high-quality physicians, the specialists, and the facilities to take care of that,” she said. “I think having a 100-bed hospital down the road probably is not going to provide that impact [...] we are the tertiary, quaternary care center, and we always will be, so the level of services will never be comparable. So to me, it's just not even comparable from that standpoint.”
That's not just bluster; Novant is planning a $1-billion investment in NHRMC, including a new heart and vascular tower on the South 17th Street campus paired with a new outpatient medical office, among other projects, pending regulatory approval. And even without that, UNC Health won't supplant Novant with its current proposal. But it could well have broader ambitions in the Cape Fear area.
In my conversation with Bovio this week, he noted that, were it not for the state's anti-competitive certificate of need law, "there would already be another health care system in Wilmington." He added that he was glad the state had reported the need for more hospital beds in the county, "so that we can get started on it," emphasis added by me. I’m not trying to put words in Bovio’s mouth, but given the rapidly growing regional population, especially in Brunswick, Columbus, and Pender counties, I don’t think it’s crazy to think we could see UNC Health try to expand in ways aimed at making them more comparable to Novant, building on a new hospital as a foothold.
That’s one possible future, in which we wake up, and it is, to our deep relief, February 3 — the day after Groundhog Day. Novant NHRMC is an A-rated, five-star hospital. UNC Health has opened the doors of its own smaller hospital. To some extent, the healthcare systems play to their strengths, but there’s some healthy competition, and also academic and research collaboration. Wait times are down, patients — and healthcare providers — have options. UNCW may even be well on its way to opening a medical school. It’s not a utopian prediction: There will be tragedies and unforeseen problems, but the public will not have the deep sense of unease that it does right now.
I could live with that as an outcome in the next few years. I think many of us could. Selfishly, I would like to stop writing the Groundhog Day story, even though I know it’s important, even though I know it’s not just about grades and stars but about people’s lives.
I look forward to writing a different story. I think I can see the contours of it now. But I don't think we're all the way there. Not yet
