Service Fanatics

by James Merlino

  We’re in an industry where our brand is defined by how well we care for people, and every little thing counts. A pilot once told me that everything on a flight checklist is there because it cost someone’s life. Just achieving Six Sigma quality is not enough to ensure a successful experience. When considering enterprise-wide hospital metrics, one bad event out of 1,000 doesn’t seem like a big deal to us as leaders, but that one event could have had dramatic consequences for an individual patient and his or her family, friends, and everyone around them. Minor errors lead to catastrophic events, and bad judgment or behaviors create experiences for individuals that they will never forget and from which they may never recover.

  Our collective goal is simple: deliver the best possible experience to our patients—or as Ryan points out, reduce patient suffering. It’s the right thing to do, it’s how we would want to be taken care of, and it’s how we would want our families to be treated. Success will not come quickly or easily, but will be achieved with leadership, strategy, focus, and determination. We must strive to do right—all of the time. We would accept nothing less for ourselves or our families; therefore, we should offer nothing less to the people we serve.

  Epilogue

  We Have a Responsibility to Lead

  Many of Cleveland Clinic’s best ideas come from studying the best practices of others, so one of our early goals was to help shape the emerging field of patient experience by sharing what we were learning and doing. We’re both active listeners and sharers of information. We believe in bringing people together to network, exchange ideas, and learn, helping all to improve what we’re doing for patients. But this is more than that. This is a movement.

  In 2010 we established an annual Patient Experience: Empathy & Innovation Summit. When I convene it every year, I remind attendees that I’m just like them, someone working hard on the front lines to improve the experience for patients. I commit to helping them, and I ask them to help me by sharing information, exchanging ideas, and networking to advance our collective goal of improving the patient experience together. Attendance since our first year has grown to over 2,100 people representing 49 states and 39 countries, making this the largest independent summit of its kind in the world. We have attracted partners to help drive this very important change, including the American Hospital Association, the American Medical Group Association, the Association of Academic Health Centers, the Society of Hospital Medicine, and the University Health Systems Consortium. We’re bringing together our collective thought leadership to drive more dialogue, and we’re sharing what we know to help our colleagues improve.

  The agendas reflect a diverse set of topics. Andrew C. Taylor, executive chairman of Enterprise Holdings, Inc., parent company of Alamo Rent-A-Car, Enterprise Rent-A-Car, and National Car Rental, opened the first summit with a passionate speech about the importance of customer service and the need to keep customers at the center of everything in business. Son of legendary founder Jack Taylor, our speaker credited Enterprise’s customer-centric strategy as key to the company’s enduring success. Coming from a well-regarded business leader in a very successful consumer organization, Taylor’s remarks were tremendous reinforcement of the principles we believe important and transferable in healthcare.

  Every year a sentinel event is the CEO panel composed of top hospital leaders from across the United States. Participants, in addition to Cosgrove, have included Kurt Newman of Children’s National Health System, Marc Boom of Houston Methodist Hospital, David Feinberg of UCLA Health System, Michael Dowling of North Shore–Long Island Jewish Health System, Charles Sorenson of Intermountain Healthcare, and Robert Pryor of Baylor Scott & White Health. It’s a robust, hour-long discussion about leadership, culture, and the patient experience. They share their insights, challenge each other, and take questions from the audience.

  We’ve had an impressive array of speakers from a variety of different fields in and around healthcare delivery. Gerard van Grinsven, president and CEO of Cancer Treatment Centers of America, who came from The Ritz-Carlton Hotel Company, shared how management is helping to improve the emotional connectivity of patients with the organization. David Schlanger, CEO of WebMD, discussed enhancing the patient experience by helping consumers become more educated, better engaged, and more tightly connected to their health.

  General Electric, an early sponsor, twice set up a kiva, a giant round room with whiteboards for walls. GE Healthcare’s global design team, led by Bob Schwartz, invited attendees to illustrate their ideas on the walls. The kiva became a think tank on ways to improve the patient experience and impact care. GE also sponsored a speaker who shared innovative efforts to redesign the appearance of CT scanners at Children’s Hospital of Pittsburgh to make them more kid-friendly. Each CT suite features a theme, such as pirate island adventure, in which the scanner is painted like a pirate ship and the room made to resemble a tropical island. Technicians and nurses play their roles using themed scripts to enhance the experience. Some may believe this is merely window dressing, but data collected by the medical center reveals that children’s pain and anxiety levels decrease when they are imaged in these suites.

  Every summit has speakers with amazing stories and vital impact, and it has become a success beyond anything we imagined. The hunger for knowledge and sharing shown at the summits demonstrated to us early on the need to keep people engaged in the topic year-round. We also believed that patients needed to be included in the conversation. As such, we founded the Association for Patient Experience (AfPE), www.patient-experience.org/Home.aspx, in 2010. This is an independent, nonprofit 501(c)(3) organization whose mission is “to improve the patient experience by providing healthcare providers; patients and their families; and others with information, education, networking opportunities, and related resources focused on best practices.” We wanted the association to be free of commercial bias and not aligned with any business interests so that people would feel comfortable exchanging ideas and information. Membership is free, and thousands receive its newsletter, representing healthcare-aligned organizations worldwide.

  If AfPE is the link to frontline caregivers and patients, the Institute for Innovation is the patient experience link back to large healthcare organizations. There is a huge knowledge gap in healthcare delivery. Currently, we simply don’t have the ability to bring together large amounts of hospital data from a wide variety of sources to understand complicated patient problems and improve hospital processes. When Pat Ryan took over Press Ganey, he wanted to start a nonprofit research institute to benefit the greater healthcare community. The new institute’s purpose would be to bring together health systems to share information, fill in the research gaps, and solve common problems. I was excited by the prospect, as no one except the government was trying to do this. Could we look at millions of patient data points from multiple systems and answer questions, such as what drives readmission, how do you increase patient treatment compliance, and how do you manage a patient’s experience? Such information could substantially impact the way we deliver healthcare worldwide.

  I agreed to participate as a founding board member but wanted to make certain that information the institute discovered would be available to frontline caregivers from any organization seeking to improve patient care. Ryan agreed, and we determined that the AfPE would be an important distribution channel for the findings and best practices. The association would manage dissemination to any hospital or caregiver needing the information to help improve patient care. It is an exciting collaboration that promises to drive research and push results to the people who need it most.

  At the 4th Annual Patient Experience Summit, the AfPE was the first to introduce a peer-reviewed journal exclusively dedicated to improving how we deliver care to patients, the Journal of Patient Experience. The cover story in the inaugural issue recounts a physician’s harrowing emergency department experience with her dying teenage daughter and highlights the interconnectedness between patients, providers, and healthcare
organizations. A feature article by Micah Solomon, “Finding the Heart of [Hospital]ity: Patient Satisfaction and the Healthcare Experience,” discusses parallels between delivering hospitality and a great patient experience. With its expanding editorial board of leading academicians, this journal will help advance patient experience scholarship.

  There will be a new health education center on the grounds of Cleveland Clinic. It is a wonderful new partnership with Case Western Reserve University (CWRU), my medical school alma mater. It’s the first center in the world where nursing, dental, social work, and medical students learn together. When I was in medical school, we never attended classes or worked with nursing students. Imagine the possibilities! If we’re to promote the culture we need for developing high-performing teams and high reliability in the delivery of healthcare, this is the place to do it.

  CWRU is a pioneer in the field of interprofessionalism for improving care delivery. Cleveland Clinic is a leader in the patient experience, with programs like its physician communication training; a separate program was designed and developed for midlevel providers and nurses. Imagine a scenario in which the basics of interprofessionalism are taught in undergraduate academic programs, with that same model carried through postgraduate medical education and early nursing career development and then becoming the operational standard for delivery of care in the hospital setting and the maintenance of health. The opportunity to transform the delivery of care and the patient experience will be incredible!

  President Obama has previously referred to Cleveland Clinic as “one of the best healthcare systems in the world.” He honored the Clinic and Dr. Cosgrove by asking him to consider becoming Secretary of Veterans Affairs in hopes that he would transform the VA health system in a similar way to how he has transformed Cleveland Clinic. The VA health system is not unlike any other healthcare system in the United States. Everyday, caregivers walk into the doors of VA facilities around the country determined to work hard and do what is right for our veterans—we must never lose sight of that. Are they perfect at what they do? Of course not, and no one is! Are there processes that can be improved? Can the culture be better aligned around the patient? Absolutely! It is an organization that delivers high-quality care to our nation’s heroes, but it needs to realign its focus on wrapping that care around more patient-centeredness. Imagine if the Veterans Administration adopted a “Veterans First” initiative; aligned its work force around serving its most important customer, veterans; defined its focus as safety, quality, and satisfaction; and attacked other things we know are important to delivering on an exceptional patient experience such as patient access. The Veterans system would achieve a patient-centered care delivery model like any other model healthcare system in the world.

  Patient Experience Is Global

  Just as the Hippocratic oath binds physicians worldwide in commitment to ethical and moral treatment of the patient, a focus on the patient experience—the obligation to keep the patient at the center of everything we do—similarly binds global healthcare organizations and leaders. Healthcare providers around the world experience the same joys and possess the same challenges and opportunities that we do. Not surprisingly, they want to provide safe, high-quality care for their citizens, and they want it delivered with compassion, empathy, and humanity.

  Cleveland Clinic’s “Empathy: The Human Connection to Patient Care” video has been viewed in more than 200 countries, and I have personally shown it to healthcare professionals from Canada, China, Ghana, Mexico, the Netherlands, Nigeria, Saudi Arabia, South Korea, Turkey, United Arab Emirates, the United Kingdom, and the West Indies. I study people’s faces while they watch the video, and reactions are startlingly similar: silence and visible emotion, including the shedding of tears. These universal reactions are not coincidental. The video has real meaning; it makes a tangible connection to their professional calling.

  Cleveland Clinic, in partnership with Mubadala Healthcare, is establishing Cleveland Clinic Abu Dhabi. The 23-acre facility, the largest healthcare build in the world, is designed to bring world-class, Western-style medicine to the Middle East. Marc Harrison, my friend and colleague, is the CEO. He will tell you that the entire facility is designed with the patient and family at the center of operations. Harrison grew up in Cleveland Clinic’s culture and is transporting every piece of this culture some 8,000 miles away to deliver a similar experience. It will become a model for global healthcare delivery and the patient and family experience.

  A few years ago, I chaired a patient experience track for the Arab Health Congress Leaders in Healthcare Conference. Arab Health Congress is the world’s largest healthcare conference organizer, and its Leaders series highlights important industry topics. Thomas J. Miller, CEO of customer solutions for Siemens AG Healthcare Sector, delivered the opening address on the critical role technology will play in patient-centered care advances. Newman of Children’s National Health System in Washington, D.C., and Harrison of Cleveland Clinic Abu Dhabi traded discussion points about aligning doctors with the idea of putting patients first and fostering the right culture to deliver effective, safe, and high-quality healthcare. This was one of the first international sessions exclusively dedicated to the patient experience and was one of the best attended of the conference.

  The former Saudi Arabia minister of health, Abdullah bin Abdulaziz Al-Rabeeah, adopted the Patients First motto for his organization. In his words, “‘Patients First’ is essentially meant to convey a message to all health practitioners in the kingdom … on the crucial importance of pursuing … this course of action.”1 His successor, the interim minister of health, Adel Fakieh, has made improving the patient experience a top strategic priority. The brand of patient experience is slightly different, as the kingdom uses the phrase “patient rights and relations.” But the goals are collective—ensuring that patients and their families have respectful, dignified, and empathetic healthcare—and our challenges are similar: getting everyone in healthcare to understand and align around that.

  Cleveland Clinic also partnered with the Ministry of Health to hold a patient rights and relations conference in Yanbu, Saudi Arabia, attended by some 400 ministry officials. Assisting with the conference was Wael Kaawach, a Harvard University–trained orthopedic surgeon and CEO of Healthcare Development Holding Co., a large healthcare operations consortium in Saudi Arabia. His commitment to patient-centeredness is fueled by the desire to improve the care of people in his country. Kaawach reminds me that culture is a critical element in illness and must be factored into the experience. “Muslims receive illness and death with patience and prayers. They consider an illness as atonement for their sins,” he says.2 In addition to compassion and empathy, he stressed that in his culture caregivers must demonstrate mercy. Kaawach’s passion for the topic and his desire to lead change are driven by more than just a commitment to his people. He is a cancer survivor who has experienced the other side of the healthcare system he is endeavoring to fix. Kaawach represents a common worldwide thread. Efforts to improve the patient experience are typically driven by the individual passion of people on the front lines that have experienced the challenges of patient-centeredness firsthand.

  At an Abu Dhabi Health Services Company (SEHA) leadership retreat, chairman and managing director Saif Bader Al Qubaisi stood on stage, recognizing and thanking various leaders for their dedication and organizational commitment. He acknowledged to the roomful of caregivers, “What you do is very hard work.” The leadership at SEHA is currently leading a transformation effort to center the entire organization around the patient and drive employee engagement.

  Wang-Jun Lee, chairman and CEO of Myongji Hospital and publisher of the Korean Doctors’ Weekly in South Korea, has invested heavily in the patient experience. Myongji Hospital’s new cancer center has infusion suites that overlook manicured gardens. Leveraging technology, cancer patients receiving linear accelerator therapy employ a card that activates preselected treatment room music, aromatherapy, light
therapy, and images supplied by the patient. All of this investment and technology is for one purpose: to improve the patient experience. Similar interest in the patient experience is thriving at Seoul’s Samsung Medical Center and Severance Hospital of Yonsei University Medical Center.

  David L. Longworth, chairman of Cleveland Clinic’s Medicine Institute, and I opened a leadership development conference sponsored by General Electric Corporation in Istanbul, Turkey, attended by government and hospital leaders throughout the Middle East and Africa. We challenged participants to think about the patient experience in their countries, asking them to discuss barriers and ways to improve. At the report-out, the energy was electric. Every group agreed with the core tenets: patients first, strategic priority, and leadership. Attendees never before exposed to patient experience concepts became converts. After our session, one of the leaders from an African healthcare facility collared me and said, “You have described who we are and our problems. We have not connected our people—our employees—to the patients, and we need to do this.” Months after the talk, every government and hospital represented in the audience is seeking Cleveland Clinic’s guidance on transforming its organization to improve the patient experience.

  At the opening of one of the annual Hong Kong Hospital Authority conventions, CEO P. Y. Leung discussed that when delivering healthcare in the future, “care, not cure,” is what will be important.3 He reviewed one of the authority’s strategic pillars, person-centered care. Throughout the conference, there were discussions of teamwork, safety, and culture.