Synopsis: From the HBR article and the Case Study, the CEO at the Cleveland Clinic, Dr. Delos "Toby" Cosgrove’s central message to employees had been Patients First!, which demanded relentless focus on measurable quality.
“This included constant attention to patient safety, respect for the patient’s dignity, excellence in housekeeping services and facilities, and genuine concern for the patient’s emotional wellbeing and care experience.”Dr. James Merlino became Chief Experience Officer in 2009. Merlino defined the patient experience as "everyone and everything people encountered from the time they decided to go to the Clinic until they were discharged.” He worked to make patient experience insights more tangible by asking the question: “How can processes and metrics drive improvements in the patient experience.” As you read the case, consider the following: (You can write it as a paragraph and include any issues that stood out for you as you read the case. These questions are mostly to serve as prompts for your thinking.)
- What is the Cleveland Clinic’s overall strategy for improving value for patients?
- Are there examples of what Cleveland Clinic are doing well, or areas where they may still need improvement?
- What do you think of other efforts linked in the class schedule, or examples of your own, that make you feel like there is a “patient first” transformation in place or are you skeptical? Explain.
It is very impressive that the Cleveland clinic was both able to recognize the need to improve customer satisfaction, as well as actually affect the satisfaction ratings so positively in a short amount of time. One of the first ideas that struck me was when the article mentioned that “Merlino got everyone in the enterprise – including physicians who thought that only medical outcomes mattered – to recognize that patient dissatisfaction was a significant issue and that all employees, even administrators and janitors, were 'caregivers' who should play a role in fixing it”. The thought struck me: can patient experiences be bad simply because the doctor doesn't realize how they may seem to patients, or that they are unaware of the additional steps it takes to make a patient happy? In addition to getting all parts of the clinic working together to create a better customer experience, I also think that the clinic's idea to “communicate intensively with prospective patients to set realistic expectations for what their time in the hospital would be like” is a fantastic way to get a better understanding of what a patient may expect and how the clinic can meet that.
ReplyDeleteWhile I think it is wonderful that the Cleveland Clinic strives to be at the top of both medical excellence as well as customer experience, I'm left wondering how realistic their methods are for clinics who are looking to make the same changes. The clinic already boasted some of the best doctors in the country, and was able to create an entirely new department with over 100 employees and large budget in order to improve and maintain customer satisfaction. This seems extremely unrealistic for other clinics to mimic, so then how do others look to make the same improvements?
I agree with you regarding other hospitals/clinics enforcing the same principles of putting patient's experience first, as the budget mentioned in those articles for the program was huge. However, as there will already a model out there, it could be cheaper for others to follow the path and copy a lot of the decisions that were made by the Cleveland Clinic, therefore cutting back on some of the costs behind data gathering. While every clinic is different, patient's opinion about clinics/hospitals seem to often be based on a similar core of issues.
DeleteAs of 2014 the U.S. health care system has made an effort in the transformation from volume to value. Dr. Cosgrove at the Cleveland Clinic has emphasized the importance of value for patients. By recognizing the “non-professional staff” as Caregivers, employees are engaged more than ever in fulfilling the mission, vision, values, patient experience and service standards of the Clinic. As a result of this emphasis on value, in 2014 patient satisfaction had improved and patient complaints dropped measurably.
ReplyDeleteStrategies in improving value for patients
1) Identifying problems: Put in place systems to track and analyze patients’ attitudes and complaints and to determine and address the root causes of problems
2) Establishing processes and norms: creates “best practices” department to identify, implement, promote and monitor approaches
3) Engaging and motivating employees
In terms delivering a great patient experience Cleveland Clinic is doing well. One of the biggest challenges the Clinic had to face in this transformation was redirecting employees toward a patient-centric mentality. Improving doctor, nurse and medication communication saw an upward trend as well. It appears that the Clinic has a solid system that identifies areas that need to be improved. Because Cleveland Clinic has accepted the change, in many ways it has learned to be an autonomous self-improving healthcare system. But I share the same skepticism as Kelly. I’m having a hard time imaging other clinics adopting the same transformation.
I’ve had negative experiences with my personal healthcare treatment which has made me skeptical of this type of transformation. I have always associated quality and high-value with higher costs but in healthcare that may not always be true
Overall, the Cleveland Clinic is doing very well in their efforts to maximize the patient experience, even in ways that don't necessarily involve the patients themselves. One strategy that stuck out to me, other than the methods mentioned above by Kelly and Luis, was efforts made by Cleveland Clinic's CFO (Steve Glass) to analyze the costs of care by several different lines of service. By simply raising awareness and identifying what the cost of care is, he was able to greatly inform himself and his physicians. With this knowledge, plenty of money and supplies can be saved and used when needed, allowing Cleveland Clinic to better focus their care on patients and save money at the same time.
ReplyDeleteOne area Cleveland Clinic appears to be doing very well in is keeping a robust electronic medical record system for all patients of all types. With this, both patients and physicians had access to the same information, allowing for consistency and ease of access to a large amount of information from a reliable and secure portal that was able to be updated in real time. Such a system is not easily attainable as we start to really dig deep into the digital age of information.
Overall, like a lot of people, I still remain a bit skeptical that there will be a widespread and quick transition to this "patient first" transformation. I mean, in general I'm usually skeptical of everything, even through I personally have never experienced poor care from a doctor or clinic aside from having to wait incredibly long times in a waiting room or exam room. Hopefully more doctors, physicians, and clinics follow the example set by Cleveland Clinic, but I'm doubtful there will be any sort of quick and radical transformation happening across the country any time soon.
I share your interests/concerns regarding the electronic system put into place by the Cleveland Clinic. I think on principle, it can really save time for the staff who can spend more time focusing on their tasks rather than having to answer patients and families concerns several times an hour. I think it would work a long way towards improving patient's experience.
DeleteHowever, I agree that the system seems very difficult to set up and ensure the privacy of medical records. I'm also wondering whether it could lead to the 'reverse' situation than intended, meaning that the staff could then dissociate itself from communication with clients and direct any request to the electronic system.
I find the Cleveland’s Clinic determination to improve patient’s satisfaction admirable. Going to the hospital is most often a very scary experience, whether you are the patient or accompanying the patient. From a patient perspective, having a “good experience” at a clinic is not only reassuring, it also creates an incentive for people to return and recommend it to others. Studies have also demonstrated that a patient going into surgery with a positive mindset is rather likely to have a faster and easier recovery after the surgery than a patient heading to surgery with a negative state of mind. From the Clinic’s perspective, projecting an image of efficiency and sense of welcoming can attract patients from all over the world.
ReplyDeleteThe Clinic’s main strategy for improvement appears to be listening to patient’s opinions, and rely on their experience to make the necessary changes. It also believes in deep cooperation between all employees of the hospital, from custodial teams to surgeons. I also appreciated their will to personalize ‘their service’, and ensure that patients knew who were caring for them. However, a few points concerned me. First, I have to admit that obtaining opinions is great to determine patterns, but it is important to remember that the opinions generally come from a public non familiar with the specificities of medicine, therefore their concerns might sometimes be misplaced (for instance, Merlino and Raman mentioned in “Health Care’s Service Fanatics” how some patients complain about the hospital not being quiet at night, while the authors argue the need for doctors and nurses to regularly check on patients and ensure that everything is going as planned. My other concern was the fact that in my opinion, the main aspect of hospitals in general that could be improved upon is communication towards patient. Not every detail can be explained as it would be extremely time-consuming and could scare the patient beyond reasonable worries. However, patients, family members and friends often feel as if the doctors are too busy for them and patients are seen as numbers rather than people. I felt that an interesting initiative could be to create some type of workshop for the staff clinic and general public to meet and exchange points of views directly.
From my personal experience, I had the unfortunate experience of suffering from food poisoning during my first semester at the University of Arizona. The hospital kept refusing to admit me until I found a doctor to personally walk me into the ER. This experience leads me to see the initiative from the Cleveland Clinic as extremely promising, and I am looking forward to seeing more hospitals adopt a similar attitude.
What is the Cleveland Clinic’s overall strategy for improving value for patients?
ReplyDeleteIt was good to see the Cleveland clinic step up their game in the healthcare industry by putting their patient first. No one wants to stay in the hospital, they want to get in and get out to feel better, thus having/providing future patients (new and old).
Are there examples of what Cleveland Clinic are doing well, or areas where they may still need improvement?
In the area of Avenues of Growth, the Cleveland clinic looked at what worked in the last decade and decided that “The Clinic could build, buy or partner, and needed to define paths that aligned financial success with medical success. (Page 12)” Building relationships is what made the process easy for patients that require heart and vascular affiliate programs and held account for all surgery cases. Another view pointed out by Will, like the VA, the Cleveland clinic allowed both patients and doctors to have the same information and through an easy portal median.
What do you think of other efforts linked in the class schedule, or examples of your own, that make you feel like there is a “patient first” transformation in place or are you skeptical? Explain.
I never been admitted to the hospital (knock on wood), but when my son was born, they took three hours to get a wheel chair to our room to discharge us. “WE Can’t WALK OUT??!!!”. To this day we still receive medical statements/charges because the hospital did not input our insurance information. Anything that involves healthcare, I still remind skeptical.
Cleveland clinic has been one of the best healthcare institutes though with certain skepticism. One one hand Cleveland clinic has prioritized patient first in their healthcare service which was one of a kind. In most institutes higher authorities are outside the loop in the intricacies of healthcare treatment, but here the CEO himself too the initiative to change things. He realized it was not about just performance outcomes the the experience that really counts for a patient. He made sure it seeped through the entire institute from ground up that patient experience matters equally along with medical outcomes. By making patients an active part of the loop and dynamically improving the institute by dedicated teams, Cleveland clinic to newer heights.
ReplyDeleteHowever the wikipedia page of Cleveland clinic did have mixed responses for the ranking of the clinic. This is mainly because even though their emphasis was patient first it doesn't seem like it was safety first which is equally important. Certain surveys also ranked it one of the worse environments for patient in need for care. (The wiki page is worth a read).
Cleveland does have a good track record when it comes to healthcare services where funds and medical breakthrough technologies are successfully implemented. (https://health.clevelandclinic.org/2015/11/cleveland-clinic-is-first-u-s-to-offer-clinical-trial-of-uterus-transplant/ and http://www.modernhealthcare.com/article/20160510/NEWS/160519998)
Patient first transformation even though essential for improving the healthcare system of the country is going to take a long time to be adopted. Especially with a strong influence of the fee for service model and influential insurance companies, it is going to be a daunting task to care of patients equally as revenue.
Hi Dr.Suzie,
DeleteI realized my response on the date of the submission wasn't published and so I have re-written the same.
Any idea why it wasn't published? You should check, by refreshing the page. Easy to see it. Blogging isn't any different than posting assignments; best to check.
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