Service Fanatics

by James Merlino

  Praise for Service Fanatics

  “Service Fanatics will become the gold standard on patient-centered care. Cleveland Clinic in all its glory, like many of the rest of us in healthcare, had lost its way with compassion and empathy. Dr. James Merlino in his role as the Clinic’s Chief Experience Officer, along with CEO Toby Cosgrove and the rest of the healers at Cleveland Clinic, changed that by putting Patients First. Merlino’s description of this journey is at times painful, raw, and brutally honest. Service Fanatics and its author exude passion, humility, integrity, and caring. It will make any organization better and is a must-read for everyone in healthcare.”

  —David T. Feinberg, MD, president of

  UCLA Health System and

  CEO of UCLA Hospital System

  “Merlino gives a behind-the-scenes account of how Cleveland Clinic, traditionally known for medical excellence, transformed itself to put equal focus on the patient experience. It’s a fascinating story on its own merits, but it’s also the story of the future of healthcare. For all healthcare leaders who are (or those who soon will be) leading a similar transformation, this book will be an indispensable guide to the journey ahead.”

  —Dan Heath, coauthor of the

  New York Times bestsellers

  Made to Stick, Switch, and Decisive

  “This book is a candid recounting of Cleveland Clinic’s rocky, flawed journey toward creating world-class patient experience. James Merlino is painfully honest about the failures and mistakes along the way, even as he lays out a practical road map for change. This combination of candor, pragmatism, and hope is why Merlino has emerged as one of the most respected healthcare leaders in the country. Service Fanatics is invaluable for any hospital administrator determined to transform patient experience.”

  —Leah Binder, president and CEO

  of The Leapfrog Group

  “Driven by his experience as a family member, patient, and physician, Jim’s passion has created a movement to refocus the healthcare system’s design, process, and culture on the patient. With his colleagues at Cleveland Clinic, he has championed the effort to once again center care around the patient and has engaged healthcare leaders across the industry to embrace transparency in the spirit of improvement. Jim’s commitment to his patients and empathy for their journey resonates on every page of this book. When we reflect on the major transformation of the industry, history will show that Jim Merlino and Cleveland Clinic were at the forefront of returning our healthcare system to the patient and helping us return to the noble cause that drew us all to careers in healthcare.”

  —Pat Ryan, CEO of Press Ganey

  “It’s an important work by the leading voice in patient experience. It’s also a gripping personal narrative that changed my perspective on every doctor-patient interaction I’ve had in my life. … Service Fanatics is upfront about just how hard it is to change a culture so that it becomes truly customer-centric—then tells you how you can do it anyway. Merlino describes the challenges at Cleveland Clinic with an unsentimental eye, and he also provides detailed descriptions of what the leadership team did to overcome those challenges. … All in all, Service Fanatics is a great read that’s also making me smarter about patient experience. If only all business books could bring those two elements together.”

  —Harley Manning, Forrester.com

  “It is one thing for a leader to establish an organization-wide priority and quite another to achieve it. To many, Cleveland Clinic’s rapid improvement in patient satisfaction scores appears nearly miraculous. Dr. Merlino’s book offers a compelling and candid tale of how an already great hospital engaged its 43,000 employees to become even better. By detailing every step with candor and eloquence, this book explains precisely how the hospital achieved its gains—and, in so doing, offers invaluable lessons not only for healthcare leaders but also for anyone interested in how to achieve meaningful progress across any organization.”

  —Barbara R. Snyder, president of

  Case Western Reserve University

  “Anyone involved in healthcare will treasure Dr. Jim Merlino’s book because it provides a candid, poignant look at patient care from both provider and patient perspectives. The stories and lessons around empathy and compassion are inspirational and help us think more clearly about the importance of the overall patient experience.”

  —Kurt Newman, MD, president and CEO

  of Children’s National Health System

  “In this warts-and-all account, Jim Merlino describes how he and his Cleveland Clinic colleagues transformed a culture focused almost exclusively on clinical excellence into one that fully embraced the need to deliver a caring and empathic experience for people. In so doing, Merlino has created a comprehensive and methodical playbook for other healthcare organizations seeking to fulfill the same paramount objective: putting patients first.”

  —Susan Dentzer, senior policy adviser to

  the Robert Wood Johnson Foundation

  “The art and science of caring for others is remarkably highlighted in Dr. Merlino’s splendid Service Fanatics. This is a must-read for all leaders or aspiring leaders in the business of delivering professional services. Dr. Merlino and his Cleveland Clinic colleagues get i t!”

  —Marc Byrnes, chairman

  of Oswald Companies

  “Cleveland Clinic is a great example of what healthcare should embody—full service to each and every patient. I’ve seen what their work and commitment have done, with a very important member of my family, my brother, and it’s fantastic. Every medical venue should emulate their facilities as well as their superb and comprehensive services. Keep up the great work.”

  —Donald J. Trump

  Copyright © 2015 by James Merlino. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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  For my father, who showed me the other side

  To Amy, for her unwavering support

  To Toby and Joe, for never saying no and never doubting

  Contents

  Foreword

  Preface

  Acknowledgments

  Chapter 1

  Transformed by the Patient Experience

  Chapter 2

  Patients First as True North

  Chapter 3

  Leading for Change

  Chapter 4

  Describing the Elephant: Defining the Patient Experience and Strategy

  Chapter 5

  Culture Is Critical

  Chapter 6

  Cultural Alignment: The Cleveland Clinic Experience

  Chapter 7

  Physician Involvement Is Vital

  Chapter 8

  Want to Know What Patients Think? Ask!

  Chapter 9

  Execution Is Everything

  Chapter 10

  Healthcare Requires Service Excellence

  Chapter 11

  Doctors Need to Communicate Better

  Chapter 12

  Making Patients Our Partners

  Chapter 13

  Getting It Done Has Defined Our Success

  Epilogue: We Have a Responsibility to Lead

  Notes

  Index

  Foreword

  I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.

  —MAYA ANGELOU

  In 2004, acclaimed heart surgeon Dr. Delos “Toby” M. Cosgrove became the CEO of Cleveland Clinic, an institution known for innovation and excellence in patient outcomes. As he transitioned from surgery to strategy, he was invited to speak to Harvard Business School students about the Cleveland Clinic model of care. During that address, he was challenged by a student who asked whether he taught empathy for patients at Cleveland Clinic. It is a story that Toby has shared over the years as a defining moment in his strategic thinking. Patients go home from the Clinic “well,” but do they feel well cared for? The seed and the stake were planted for Patients First, Cleveland Clinic’s defining purpose.

  I am on the board of the Clinic, and Toby asked me to translate my business credentials in customer experience to help the Clinic with the patient experience by chairing a board-level committee on patient safety, quality, and experience and to work with the new chief experience officer, Dr. Jim Merlino. In my role as then vice chairman of community banking at KeyBank, I had embarked on a similar journey—to differentiate through the customer experience by putting the customer at the center of everything we do.

  Jim Merlino is a rising star, whose passion for the patient is rooted in an experience with his ailing father, where he found himself on the “other side” of medical practices and outcomes. In the early days, Jim and I would meet to discuss ways to institutionalize the Clinic’s nascent efforts in patient experience. The principles I had developed in banking on how to drive change and customer experience were relevant, but being involved in Cleveland Clinic’s transformation around the patient opened my eyes and upped my game as well. And in the process of working together, Jim and I became friends.

  Jim had no clear starting point and no clear definition of success. There were no playbooks or manuals on what to do. He launched a methodical internal and external process to learn best practices from a variety of industries, as well as understand and determine what success would look like for Cleveland Clinic.

  It takes leadership to set the tone and to set aspirational goals for an institution. Together, Toby and Jim created the processes for organizational change and required and empowered all the employees of the Clinic—from physicians to service workers—to become caregivers. With no guidebook on how to take Patients First from aspirational goal to operational reality, the Clinic embarked on a journey of trial and error, success and failure, until the aspiration became a strategy and tactics were developed that allowed the Clinic to implement world-class patient experience. Service Fanatics is a testament to Jim’s passion and work, but also to Toby Cosgrove and Cleveland Clinic.

  A senior leader of another hospital once said, “We can’t all be Cleveland Clinic.” To which Jim responds, “Yes, you can.”

  Service Fanatics shows you how. It is the road map, rich with stories and examples, as well as tools and insights to operationalize the patient experience. Improving the patient experience is not only the right thing to do; it is an imperative in the changing world of regulation and law in American healthcare. But its message and content transcend healthcare. Service Fanatics provides pragmatic lessons and actionable takeaways for business professionals in many industries—mine included. In an era of content overload, it is a compelling and valuable read.

  Beth E. Mooney

  Chairman and CEO

  KeyCorp

  Preface

  Dana Bernstein is a smart, energetic, beautiful 25-year-old woman out to conquer the world. She enchants everyone she meets. Dana is also an expert in understanding the world of healthcare: expert not because she’s on the provider or delivery side of healthcare, but expert because she’s lived on the patient side since she was three. In the past 22 years, Dana has had more interactions with doctors and nurses, more admissions to hospitals, and more procedures than most people have in a lifetime.

  What gives Dana her expert credentials is a battle with Crohn’s disease,1 one of the two major bowel diseases characterized by inflammation, or in layman’s terms, significant irritation and erosion of the bowel lining and walls. It’s a disease in which the body’s immune system essentially attacks its own organs. An estimated 1.4 million in the United States suffer from inflammatory bowel disease.2 Not many are familiar with it, and there is no known cause or cure.

  Crohn’s disease represents a terrifying spectrum of possibilities. Some can live their entire lives with only very minor manifestations of it, while others develop significant, frequently recurrent, episodes involving the constant use of medications, multiple surgical procedures, and potential loss of the entire intestine, necessitating a small bowel transplant. Crohn’s can affect any part of the intestinal tract and can lead to significant problems in just about every major organ system.

  Dana lives at the extreme end of the spectrum. Since her diagnosis, she’s had multiple operations and innumerable hospital admissions and procedures. If you sat and talked with her, you’d believe she’s no different from anyone else her age. But if she shared her struggle with Crohn’s, you’d learn that she has little of her intestines left, uses an ostomy, and receives daily nutritional support through a catheter threaded into her chest. Dana also struggles with managing chronic pain caused by extensive inflammation and the significant scarring from multiple surgeries. She’s facing the possibility of a small bowel transplant, which is a daunting procedure. It will put her life in jeopardy, and she’ll need more than just expert medical care to get thr
ough it.

  By her own admission, Dana is not an undemanding patient. Aside from the complexities of her disease, she is very much the captain of her body. She and her mother, Cari Marshall, probably know as much about Crohn’s disease as many of the physicians who’ve provided Dana’s care, and Cari has dedicated her life to helping Dana fight her disease. Dana is an activated patient who’s not afraid to be her own advocate. She and her mother don’t just want information to make a decision; they want to be involved in how and why decisions are made.

  But Dana also wants something more, and that’s the reason she travels 2,000 miles for healthcare, while there may be experts who could treat her closer to home in Las Vegas. Dana wants her physician to be someone not only who is at the top of his field, but who brings compassion and humility to his work. She found that combination in Dr. Feza Remzi, chair of the Department of Colorectal Surgery at Cleveland Clinic.

  In Dana’s words, “I know I’m a tough patient, but I’ve been through a lot and know what works for me and what doesn’t. I often feel when I challenge doctors, they don’t want to engage and have a serious conversation with me about what’s going on.” She believes that Remzi cares for her as a patient, but also treats her like a friend. “He cares for me—I can feel it in the way he talks to me and the way he treats me,” she says. “He actually yells at me sometimes, but that shows he cares.”

  Does considering a patient a friend cloud a doctor’s judgment and objectivity? “Absolutely not!” explains Remzi. “I’m her physician and surgeon first, but is it too much for me to care for her as a person?” Remzi explains how this brings more to the table: “If caregivers feel personally engaged, they will be sharper and more in the moment.” As a physician, he knows the boundaries. “I’ll never compromise what’s right for her care, but I’ll always see myself as her partner and advocate in helping her to conquer this terrible disease. We are friends in the foxhole together. I have her back, and she helps me be a better doctor—she keeps me sharp.”3