Pioneers of Patient Experience: An Interview with Cleveland Clinic’s Chief Experience Officer

Cleveland Clinic has always been a pioneer in healthcare, so it comes as no surprise that they are blazing the way in the patient experience movement. They were one of the first academic institutions to create an Office of Patient Experience, and the very first to appoint a Chief Experience Officer. They also host one of the very few patient experience conferences in the world. We recently had the pleasure of talking with Dr. James I. Merlino, Chief Experience Officer at Cleveland Clinic about the rise and domination of the patient experience.

Tell me a little about the history of your patient experience initiative. How did this focus come to be and when did it really take off and turn into a whole department?

It really started when our CEO (Dr. Toby Cosgrove) took over the hospital in 2005. When he became CEO, one of the first things he implemented, within the first month, was the “Patients First” initiative. With the “Patients First” initiative, it really started to center on the issues of the care around the care. I was actually a fellow in training here and I remember walking down a hall with a co- fellow and joking, because it was like, ok, patients first- when do we not put patients first? That’s kind of a stupid slogan. We’re burned out fellows; it’s before work hour restrictions. But when I left the clinic, I was partly in private practice, and you learn very quickly in private practice what that message of “patients first” means. To be successful in private practice, it’s not about how good your medicine is; it’s about how good your relationships are. So when I came back to the clinic, it resonated that that’s what the message is. So every day we try to really reinforce to our caregivers that you need to practice good medicine, that’s the foundation; but if you don’t take care of the patients and their families, that’s not a good way to practice.

After that, Toby was speaking to Harvard Business School about the clinic model. There was a young MBA student sitting in the front row and she raised her hand, “Dr. Cosgrove, my father is a physician, fairly wealthy, lives in Virginia, and he needed mitrovalve surgery.” Now, Toby, at the height of his practice was probably the world leader in mitrovalve surgery- he actually pioneered mitrovalve repair. She said, “We know that you’re the number one heart center in the world and you’re a famous heart surgeon, but we chose not to come to Cleveland Clinic and went to Mayo instead because you don’t teach empathy to your doctors.” He was floored, silent. You talk to Robert Porter who was teaching the class and knows Toby well and he’s never seen him like this. Toby came back and said, “You know what? We need to do more. It’s not good enough to just talk about it, it’s not good enough just to have the “Patients First” initiative; we must have more of a focus.” That’s when he launched the Office of Patient Experience and hired a Chief Experience Officer.

Many institutions collect patient experience data but have a hard time translating it into effective change. How has Cleveland Clinic been so successful at it?

It’s hard, and it’s very difficult to find success, as you’ve pointed out. We basically look at it on two levels. One, it’s about processes that work well in getting the data to people who can use it to make changes. So we have a very sophisticated business dashboard and we collect patient survey data and are able to get very granular with it to drive it down to the unit level and actually on the physician side, we can drive individual physician scores. Getting the data to them, educating them about the process helps them understand how they’re being evaluated and helps to drive performance improvement at the local level.

Now the other part of it is having people who care, because at the end of the day, if you don’t have the mindset to deliver great service, you’re not going to be successful. So as part of our effort to kind of change the culture, we’ve implemented a “Cleveland Clinic Experience” initiative. Last November we started taking every employee off line for half a day about mission, vision and values of the organization, about expected service behaviors (in other words, how we think you should perform and behave with a patient or customer), how you do service recovery, and then at the end of the exercise, we ask each employee to hold themselves accountable to one of the values in the job that they do every day. We do it in groups of 500, where we put them in the ballroom around a table of 8 with a facilitator and a learning map to discuss those points. As of today (March 8), we will have put 30,500 employees through that. What that does is drive engagement, aligns a culture- which it’s very difficult to align a culture but it really starts to get to that issue. Making sure that everyone is on the same track, they all have the mindset that this is about the patient and this is how we expect you to behave. Everybody goes through it: doctors, nurses, the entire executive team. Our chief legal counsel likes to joke that he was sitting next to a janitor on one side, a thoracic surgeon on the other side and a nurse across from him. That’s what it does: it’s about leveling the playing field. Everybody is the same. We’re all here for patients.

It seems Cleveland Clinic has thought of everything from the patient perspective; a great example is your focus on health literacy. Talk a little about your health literacy initiative and how it came to be a priority.

It’s a very difficult problem. Let me back up and say some of our challenges are around patient expectations, because when you look at the environment today, it’s like a triangle squeezing hospitals. You have increasing regulation, so from the patient experience standpoint, there’s a focus on HCAPS and the link of satisfaction to reimbursement. On the other corner of the triangle you have decreasing overall resources. Everybody is cutting back on reimbursements and people are stressed. Then the third corner of the triangle, you have patient expectations, which are increasing: everybody wants to spend more time with their doctor, they want private rooms. How do you reconcile that? So I think one of the ways you do it is you go to patient engagement and literacy. What that does is makes patients understand that we’re going to take good care of you and we’re going to do everything we can to provide good service and to drive your perception, but at the end of the day, we’re partners in your care and you’re 50% of that partnership. As part of that partnership, we’re going to ask you for certain expectations. We’re going to treat your pain, but you need to really understand how you can help us better treat your pain by telling us what’s working, what’s not working. We’re going to communicate with you and tell you what the plan is and make sure your care is coordinated, but you have a communication obligation as well and we’re going to teach you on how to drive communication bedside so that you’re better protected and the interaction with your care team is better. Make sure that you ask questions, that you write things down, make sure you pick a communications coach in your family to kind of bet here with you when the team is rounding so when the team walks out of the room, someone else was there, heard everything and can reinforce it if you don’t remember. It’s about placing some of the burden of care on the patient and their family and making them realize it’s not unidirectional, it’s bidirectional and they have to participate.

So we have several initiatives here around that. One is driving more information to patients on their expectations. We’re piloting a program where they watch an online video module before they come to the hospital. It doesn’t talk about procedure education; it talks about expectations in the hospital. We think this is a very important leverage point for this issue.

We deal a lot with employee engagement and how it affects the patient experience. It’s something you’re institute has been stressing for a long while. How have you seen your employee engagement initiatives impact the quality of patient experience?

Absolutely. So in 2009 at our Strategic Planning Retreat, we stood up in front of the entire leadership of our clinic organization and said, look: until we recognize that we have a culture of engaged and satisfied caregivers, we will never achieve our goals around safety, quality and patient experience, but ultimately we will never achieve our goals around our enterprise. It’s like the example of the spill on the floor. 18 months ago, outside one of our elevator banks, there was a spill on the floor. I saw it as I came out of my office and walked to the cafeteria to get towels and as I’m about to put the towels over the spill, I see all of these employees kind of walk over the spill. That is about at its core level: being engaged to protect the safety of our visitors because people can fall. How many people stopped to do something about that? Not many. So until you get to this kind of culture where everybody owns everything, so if you’re walking down the hall, I don’t care if you’re a heart surgeon or a brain surgeon, if someone wants to know where the bathroom is, you help them. That’s engagement. You’re interested in the organization and doing everything you can to help patients and their families. So we’re trying to drive that very strongly. We’re now measuring engagement with Gallup, we’re doing the “Cleveland Clinic Experience” initiative, our managers are held accountable for engagement plans; it is a critical part of what we do.

This May you will host your second annual Patient Experience: Empathy and Innovation Summit. What did you take away from last year’s summit and what do you expect of 2011’s?

What I took away was that there is a huge need for this discussion. People are just sponges for information on how to improve the patient experience. There’s a huge amount of energy around the topic because hospitals are starting to realize it’s important. This year, we tried to expand the momentum, getting more people involved. We don’t make money on the summit. We’ve kept the registration costs low to attract a wide audience. We’re expecting a great turnout. At last year’s summit, we founded the Association for Patient Experience which is an organization off of the clinic platform. We had 250 people sign up.

We’re looking to expand that as well because we feel very strongly that solutions to how patients should be treated belong in the public domain for healthcare workers to share as best practices. So we look forward to the summit to help us launch that as well.

Many doctors and healthcare professionals think their time is better spent focusing on things besides measuring, discussing and eventually improving patient experience. What would you say to those professionals?

There’s the old adage, “Well, Doctor Smith is kind of mean to people but he’s a great surgeon” In today’s environment, you can’t be mean to people. Being a great surgeon is really about treating people well and also being technically proficient. And that’s what we should strive for. There’s a lot of doctors who are skeptical. I say, “Look, if you don’t want to believe that doing it because it’s the right thing to do is the right reason, then put yourself in the patient’s position and ask yourself if you were sitting in that bed, how would you want to be treated? And if you don’t want to believe that reason, then accept that this is a reality that the government and peers have latched onto service quality and patient experience is essential and will now be linked to public reporting and imbursement. You can choose if it’s the right thing to do because it’s your patient or you can choose because the government says it’s the right thing to do. Regardless of your motivation, you have to accept that it’s now part of our reality.”

Submit a Comment

(e)merge © 2012   |