In late 2017, my reporting partner Kathleen McGrory got a tip that there might be problems at the heart surgery unit at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.

It ended up turning into a series called Heartbroken, one of the most difficult projects we have ever worked on.

We spent most of 2018 knocking our heads against one reporting challenge after the other. Medical professionals were too afraid to speak against a Johns Hopkins hospital. There was no paper trail from medical malpractice lawsuits. The hospital wouldn’t provide any details about the problems. And there was no available method to calculate how well the heart unit was performing.

We almost gave up a few times.

Instead, after months of work, we were able to show that children in 2017 died after heart surgery at three times the state and national average rates. Frontline workers in the hospital’s Heart Institute had raised concerns as early as 2015, but were mostly disregarded until it was too late.

Kat has already written about how we got the story for the USC Annenberg Center for Health Journalism. Her piece includes how we found Heart Institute patients, analyzed state admissions data, and connected with insiders.

Behind all of that reporting, we also created a set of guidelines to keep us from giving up on the story along the way. We didn’t always follow them perfectly, but keeping them in mind helped us get through this marathon.

Here are our tips for surviving a grueling, long-term reporting effort.

1. Keep in touch with editors (or mentors)

We had at least one reporting problem every day. A source stopped responding to phone calls. A research paper raised questions about the validity of our data analysis. A day of nonstop door-knocking led to absolutely nothing.

Almost immediately after each one, Kat and I called or texted our editor, Adam Playford. He was our go-to support structure for getting through the daily grind (on top of being a hell of an investigations editor). His ability to dissect problems and come up with next steps was vital. Without him, it was too easy to get bogged down by problem after problem as they went on for months.

That’s not because Kat and I are incapable of problem-solving. Outside eyes are just especially helpful during these projects. Typically, we were working through several different tasks at any given time. Whenever one of them slowed us down, it halted progress on all of them. Adam kept us on track and at full speed.

It’s incredibly important to have someone to talk to on a regular basis. If an editor isn’t that person, build a group of trustworthy coworkers, friends, or mentors.

2. Maintain a weekly list of achievable tasks

When we set out to report Heartbroken, every item on our to-do list would end up taking months of work. Initially, that was extremely discouraging. Weeks would pass and it felt like we weren’t getting anywhere. Things would seem impossible and we’d want to move on.

We quickly realized we needed a way to constantly keep us focused on discrete tasks. Adam started tracking weekly goals in a document and we met every Tuesday to update and discuss. Our lists had four categories: last week recap, this week’s priorities, tasks we’re pushing off, and big-picture goals.

Some weeks were good. In one, we met multiple patients’ families, found obscure public records, connected with experts, and made large progress on data analyses. And even though others were slower, we were always pushing the reporting forward.

The list was not about our editor keeping tabs on us; it was a way to measure our own progress as reporters. By the end of the year, we had a document that outlined the work we did for almost every week. We were even able to go back to the list when we wrote the story, making sure we weren’t forgetting about any important reporting.

3. Voice concerns early and often

Concerns popped up in our minds throughout our reporting: Is the data accurate? Are the sources right? Is the story fair?

When we had problems with anything, we generally voiced them to the rest of the team as quickly as possible. Concerns like these can fester if left unaddressed. But talking about them early will actually make stories and reporting stronger.

While working on our earlier stories about a case where a newborn was discharged after surgery with a needle in her chest, an expert source said something surprising to me. A needle is sometimes left behind if a surgeon determines that it is unsafe to continue searching for them and that is completely okay, she told me.

I immediately had tunnel vision. I thought this was no longer a newsworthy medical mistake and that I had misunderstood the facts. We got on the phone as a team and discussed. My team reminded me that the baby’s parents had no idea the needle was left behind, a serious violation of state law. The hospital’s CEO had also told us there was a second needle case, and the heart program had “challenges.” We quoted the expert to show that mistakes will happen in medicine. But we also showed they need to be properly reported to patients and their families.

We would later report that this breach of trust was part of a trend. The state found that the needle case was never reported to regulators, another violation of state law. And after our November investigation, a Johns Hopkins internal review found 13 other Heart Institute cases were not properly reported to the state.

4. Be open and transparent with readers

When we started reporting Heartbroken, one of our main concerns was the data analysis.

One of the surgeons we wrote about, Dr. Jeffrey Jacobs, was also the national expert on pediatric heart surgery data. When other news outlets covered the topic, he was almost always quoted. Jacobs had co-authored multiple papers that were critical of analyses based on publicly available state admissions data. He preferred using internal clinical data to measure the quality of a heart surgery program.

But when the hospital wouldn’t share its internal data, we decided to use the publicly available data anyway. The entire time we knew we’d need to publish a thorough and transparent methodology. We searched for every possible contention with the analysis by reading peer-reviewed research and having background conversations with top experts. Then, we addressed those contentions directly in our write-up.

In the end, everything we learned was in our data analysis methodology. The Python code and the outputted data was published on GitHub (our agreement with the state prevented us from publishing the input data).

Most doctors and data experts we spoke to after we published knew that we’d done our homework. The few that raised concerns were pointed directly to the appropriate section in the methodology.

5. Treat writing as an iterative practice

We write a lot of drafts. The November investigation had about 20 separate ones. Even the data analysis methodology had at least 10.

Our writing process is almost like iterative software development. We don’t try to get it completely right on the first draft or the first five drafts. Instead we go through quicker drafts and learn from them. It’s much easier to find reporting holes and overarching themes when the reporting is put into words.

Then, it’s all about improving the previous draft and writing a new one until the story is ready. Along the way, drafts will take hard turns and entire sections will be scrapped, and the final story will be all the better because of it.

6. Trust the process

This is one of the first pieces of advice I got when I joined the Tampa Bay Times and it has stuck with me ever since. Trust these guidelines and trust the process they establish.

There are many moments throughout a long reporting effort when a reporter is going to have doubts. They can be set off by a bad day, a fight with a colleague, or seemingly nothing. But they will come and you’ll feel like the story isn’t going in the right direction or there’s just too much work to do to get the full story or the story just isn’t good.

The doubts can set you completely off course. If your concerns are voiced, the only thing left is to have faith in the reporting and editing process. Keep reporting, keep filing drafts, and keep improving the story. The process has worked before, and it’ll work again.

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