Service Fanatics

by James Merlino

  At the Canadian Conference on Physician Leadership, hosted in conjunction with the Canadian Medical Association and the Canadian Society of Physician Executives, I gave a keynote on the importance of patient experience for the delivery of high-value care. Canada is a model for integrated healthcare delivery, home to some of the best physicians and medical care in the world. At the conference many physicians came up to me and said it is absolutely time that we also become the model for patient-centered care. Louis Hugo Francescutti, president of the Canadian Medical Association, himself a renowned international speaker on culture, agreed that Canadian Healthcare’s challenge, like everyone else’s, is to get every caregiver aligned around the patient.

  I have the honor of knowing some of the most important leaders in healthcare, and I’ve had the privilege of addressing hospitals, medical societies, physician groups, and boards across the world. Even when I am with leaders from businesses unrelated to healthcare, the themes are the same: the need for customer centricity is paramount. It’s remarkable for me to see and hear about other people’s work. I have a requirement: when I travel on patient experience business, I must bring back at least one idea to help us; otherwise the trip was a failure. We must learn from each other, share information, and, together, improve what we do for patients.

  The need to drive toward more patient-centeredness and implement patient experience strategies is not unique to my organization, your organization, or the United States. It resonates around the world because it’s the right thing to do, and it impacts organizational effectiveness across a variety of areas, including safety and quality.

  An incident that now reminds me every day why this is important occurred at the patient experience summit held just shy of my fifth anniversary in the CXO role. Johnson & Johnson, our presenting sponsor, erected a “caring wall.” It was a place where patients and caregivers shared stories and insights about what’s important, and a professional illustrator sketched out visual representations of their thoughts. There were many images that represented empathy, storytelling, love, and care. But the one that resonated most, the one that speaks to the “why,” was the illustration that it “could be my mother, father, child, me” (Figure E.1). Do we really need any other visual?

  Figure E.1 Caring wall.

  Cosgrove recently remarked to me, “One of the most important things I’ve done in my career is to define why we’re here—for patients.”4 He introduced Patients First to begin the journey of aligning Cleveland Clinic. We were fortunate to start our journey before the patient experience became a national healthcare priority, which is garnering increasing attention not just from regulatory agencies but from employers, payers, and patients around the world.

  This is your opportunity to lead. This movement is critical to how you deliver care. Join us!

  Notes

  Preface

  1. Bruce G. Wolff, James W. Fleshman, David E. Beck, John H. Pemberton, and Steven D. Wexner, eds., The ASCRS Textbook of Colon and Rectal Surgery, 1st ed. (New York: Springer Science + Business Media, LLC, 2007), 584–600.

  2. “Inflammatory Bowel Disease (IBD),” The Centers for Disease Control and Prevention, accessed March 24, 2014, www.cdc.gov/ibd/.

  3. Dana Bernstein and Feza Remzi (Chair, Department of Colorectal Surgery, Cleveland Clinic), in multiple discussions with the author over the period January–April 2014.

  Chapter 2

  1. Sherwin B. Nuland, Doctors: The Biography of Medicine (New York: Alfred P. Knopf, 1988), xv.

  2. Toby Cosgrove (Chairman and CEO, Cleveland Clinic), in discussion with the author, October 21, 2013.

  3. Delos “Toby” Cosgrove, The Cleveland Clinic Way (New York: McGraw-Hill, 2013), 116.

  4. Cosgrove, in discussion with the author, October 21, 2013.

  5. Jon Picoult, “The Watermark Consulting 2013 Customer Experience ROI Study,” WaterRemarks (blog), April 2, 2013, www.watermarkconsult.net/blog/2013/04/02/the-watermark-consulting-2013-customer-experience-roi-study/.

  6. Megan Burns, Harley Manning, Allison Stone, and Jason Knott, The Customer Experience Index, 2013 (Cambridge, MA: Forrester Research, 2013).

  7. “Culture & Diversity,” Disney Careers, accessed June 24, 2014, http://disneycareers.com/en/working-here/culture-diversity/.

  8. Alan Siegel (CEO of Siegelvision), in discussion with the author, July 7, 2014.

  9. John T. Chambers (Chairman and CEO, Cisco Systems), in discussion with Cleveland Clinic executive leadership team, March 8, 2012.

  10. Harley Manning, “Outside In” (lecture, 3rd Annual Patient Experience: Empathy & Innovation Summit, Cleveland, OH, May 20–22, 2012).

  11. The metaphor dates back to a 1988 quote from a crew member on a burning oil-drilling platform in the North Sea and has been adopted by organizational change experts for decades in discussing motivation for change. Daryl Conner, “The Real Story of the Burning Platform,” Change Thinking (blog), August 15, 2012, www.connerpartners.com/frameworks-and-processes/the-real-story-of-the-burning-platform.

  12. “The 8-Step Process for Leading Change,” Kotter International, accessed January 21, 2013, http://www.kotterinternational.com/our-principles/changesteps.

  13. Melvin Samsom (Chairman of the Executive Board, Radboud University Nijmegen Medical Center) and Lucien Engelen (Director, REshape & Innovation Center, Radboud University Nijmegen Medical Center), in discussion with the author, November 2013.

  Chapter 3

  1. “CEO Report: Optimism on the Upswing,” 12, HealthLeaders Media, January 2013.

  2. “Patient Experience Beyond HCAHPS: Care Coordination and Cultural Transformation,” HealthLeaders Media Council Special Report, August 2013.

  3. Delos “Toby” Cosgrove, The Cleveland Clinic Way (New York: McGraw-Hill, 2013), 109.

  4. A story recounted by Cosgrove and Medoff Barnett at the 1st Annual Patient Experience: Empathy & Innovation Summit. May 25, 2010.

  5. Paul Hagen, “The Rise of the Chief Customer Officer,” Paul Hagen’s Blog, Forrester Research Inc., January 24, 2011, http://blogs.forrester.com/paul_hagen/11-01-24-the_rise_of_the_chief_customer_officer.

  6. John Commins, “Experience the Patient,” HealthLeaders magazine, June 2012, accessed online February 1, 2014, www.healthleadersmedia.com/content/MAG-281208/Experience-the-Patient.

  7. Anthony Cirillo, “The New CEO—Chief Experience Officer,” HealthLeaders News, March 28, 2007, accessed online February 2, 2014, www.healthleadersmedia.com/content/88259/topic/WS_HLM2_HOM/The-New-CEOChief-Experience-Officer.html##.

  8. Marc Boom (President and CEO, Methodist Houston), in discussion with the author, September 2013.

  9. David T. Feinberg, CEO panel discussion, 4th Annual Patient Experience: Empathy & Innovation Summit, May 20, 2013.

  10. Steven Glass (Chief Financial Officer, Cleveland Clinic), in discussion with the author, March 27, 2012

  11. J. Michael Henderson (Chief Quality Officer, Cleveland Clinic), in discussion with the author, April 1, 2014.

  Chapter 4

  1. “Blind Men and an Elephant,” Wikipedia, last modified January 15, 2014, accessed January 22, 2014, http://en.wikipedia.org/wiki/Blind_men_and_an_elephant.

  2. Jacqueline Fellows, “New Approaches to Patient Experience,” HealthLeaders magazine, August 13, 2013, www.healthleadersmedia.com/content/MAG-295064/New-Approaches-to-Patient-Experience.

  3. Jennifer Robison, “What Is the Patient Experience?,” Gallup Business Journal, September 30, 2010, accessed January 22, 2013, http://businessjournal.gallup.com/content/143258/patient-experience.aspx.

  4. Kai Falkenberg, “Why Rating Your Doctor Is Bad for Your Health,” Forbes, January 2, 2014, accessed January 22, 2014, www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/.

  5. Harley Manning (Vice President and Research Director Serving Customer Experience Professionals, Forrester Research), presentation at the 3rd Annual Patient Experience Summit, Cleveland, OH, May 21, 2012.

&nb
sp; 6. Merriam-Webster’s Collegiate Dictionary, accessed January 23, 2014, www.merriam-webster.com/dictionary/experience.

  7. Amy Fiern, David Betts, and Toni Tribble, “The Patient Experience: Strategies and Approaches for Providers to Achieve and Maintain a Competitive Advantage,” accessed January 23, 2014, www.deloitte.com/assets/Dcom-UnitedStates/Local%20Assets/Documents/us_lshc_ThePatientExperience_072809.pdf.

  8. Robison, “What Is the Patient Experience?”

  9. “Defining Patient Experience,” The Beryl Institute, accessed January 23, 2014, www.berylinstitute.org/?page=definingpatientexp.

  10. D. A. Redelmeier, J. Katz, and D. Kahneman, “Memories of Colonoscopy: A Randomized Trial,” Pain 104 (July 2003): 187–194.

  11. Jennifer Woodward. “Effects of Rounding on Patient Satisfaction and Patient Safety on a Medical-Surgical Unit,” Clinical Nurse Specialist, 23, no. 4 (2009): 200-206.

  12. Leah Binder, “The Courage and Triumph of the Patient,” Forbes Pharma and Healthcare (blog), December 11, 2013, www.forbes.com/sites/leahbinder/2013/12/11/the-courage-and-triumph-of-the-patient/.

  Chapter 5

  1. John D. Clough, To Act as a Unit: The Story of the Cleveland Clinic (Cleveland, OH: Cleveland Clinic Press, 2005), 1-47.

  2. A. Marc Harrison (Chief Executive Officer of Cleveland Clinic Abu Dhabi), in discussion with the author, August 2, 2014.

  3. Joseph Scaminace (CEO OM Group, Inc.), in conversation with the author, August 2009.

  4. Michael Watkins, “Organizational Immunology,” Harvard Business Review (blog), June 11, 2007, http://blogs.hbr.org/2007/06/organizational-immunology-part-1/.

  5. Melvin Samsom (Chairman of the Executive Board, Radboud University Nijmegen Medical Center), in discussion with the author, November 2013.

  6. Paul Hagen, Harley Manning, and Jennifer Peterson, How to Build a Customer-Centric Culture (Cambridge, MA: Forrester Research, 2010), 4.

  7. Edgar H. Schein, Organizational Culture and Leadership, 4th ed. (San Francisco: Jossey-Bass, 2010).

  8. Elizabeth G. Chambers, Mark Foulon, Helen Handfield-Jones, Steven M. Hankin, and Edward G. Michaels III, “The War for Talent,” McKinsey Quarterly 3 (1998): 44–57.

  9. Wikipedia, s.v. “talent management,” last modified October 2, 2013, http://en.wikipedia.org/wiki/talent_management#cite_note-war-2.

  10. Jenn Lim, keynote at 5th Annual Patient Experience: Empathy & Innovation Summit, May 19, 2014.

  11. “Careers at The Ritz-Carlton,” The Ritz-Carlton, accessed February 12, 2014, www.marriott.com/ritz-carlton-careers/default.mi.

  12. The Joint Commission, National Patient Safety Goals (2010), accessed February 12, 2014, www.jointcommission.org/assets/1/18/hap_2010_npsg.pdf.

  Chapter 6

  1. James I. Merlino, “Conversations with the CEO: Dr. Marc Boom of Houston Methodist,” Association for Patient Experience, September 30, 2013, www.patient-experience.org/Education-Research/Articles/Conversations-with-the-CEO-Dr-Marc-Boom-of-Houston.aspx.

  2. The I CARE concept was developed in 2004 in an emergency medical services Ethics and Values course taught by educator Chris Le Baudour, who challenged students to identify personal core values. In a brainstorming session, the people in the class distilled their individual lists to the now-famous five. Le Baudour subsequently collaborated with colleague Chris Nollette, PhD, to sort the values into the recognized I CARE acronym, a framework widely used in healthcare and other settings. “The I CARE Story,” I CARE, accessed February 15, 2014,www.icarevalues.org/story.

  3. Adapted from Dr. William Glasser’s work on retention rates.

  4. Lead reviewer, Joint Commission, debrief with Clinic executive team, October 21, 2010.

  Chapter 7

  1. Association of American Medical Colleges, Medical Student Education: Debt, Costs, and Loan Repayment Fact Card, October 2013, accessed March 19, 2014, www.aamc.org/download/152968/data/debtfactcard.pdf.

  2. Althea Chang, “The Most and Least Trusted Occupations,” Yahoo Finance (blog), August 9, 2013, http://finance.yahoo.com/blogs/big-data-download/most-least-trusted-occupations-160721749.html.

  3. “Honesty/Ethics in Professions,” Gallup, Inc., December 5–8, 2013, accessed March 19, 2014, www.gallup.com/poll/1654/honesty-ethics-professions.aspx.

  4. “Doctor Contests Revocation of Hospital Privileges,” Associated Press, January 22, 2014.

  5. Zack Budryk, “Hospital Bullies Pose a Danger to Patient Safety,” Fierce Healthcare (blog), February 3, 2014, www.fiercehealthcare.com/story/hospital-bullies-pose-danger-patient-safety/2014-02-03.

  6. Ibid.

  7. Thomas H. Lee, “Turning Doctors into Leaders,” Harvard Business Review, April 2010, 50–58.

  8. Thomas H. Lee and Toby Cosgrove, “Engaging Doctors in the Health Care Revolution,” Harvard Business Review, June 2014, 3–9.

  9. Ibid.

  10. “How Does Your Doctor Compare?,” Consumer Reports Health: Special Report for Massachusetts Residents, May 31, 2012.

  Chapter 8

  1. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century (Washington, DC: National Academies Press, 2001).

  2. “The CAHPS Program,” Agency for Healthcare Research and Quality, accessed July 9, 2014, https://cahps.ahrq.gov/about-cahps/cahps-program/index.html.

  3. “HCAHPS: Patients’ Perspectives of Care Survey,” Centers for Medicare & Medicaid Services, accessed February 4, 2014, www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html.

  4. Ibid.

  5. J. A. O’Malley, A. M. Zaslavsky, R. D. Hays, K. A. Hepner, et al., “Exploratory Factor Analysis of the CAHPS Hospital Pilot Survey Responses Across and Within Medical, Surgical, and Obstetric Services,” Health Services Research 40, no. 6 (2005): 2078–2088.

  6. M. N. Elliot, D. E. Kanouse, C. A. Edwards, and L. H. Hibourne, “Components of Care Vary in Importance for Overall Patient-Reported Experience by Type of Hospitalization.,” Medical Care 47, no. 8 (2009): 842–848.

  7. “Patient-Mix Coefficients for July 2014 Publicly Reported HCAHPS Results,” www.hcahpsonline.org/files/Coefficients_for_July_2014_Public_Reporting_03-18-2014.pdf.

  8. D. M. Clarke, I. H. Minas, and G.W. Stuart, “The Prevalence of Psychiatric Morbidity in General Hospital Patients.,” Aust NZJ Psychiatry 25 (1991): 322–329.

  Chapter 9

  1. Wikipedia, s.v. “best practices,” last modified January 21, 2014, http://en.wikipedia.org/wiki/Best_practice.

  2. Margo A. Halm, “Hourly Rounds: What Does the Evidence Indicate?,” American Journal of Critical Care (November 2009): 5814, doi:10.4037/ajcc2009350.

  Chapter 10

  1. Micah Solomon, “Improving the Patient Experience: Why Hospitals Consulting Other Hospitals Won’t Fix Healthcare,” Forbes, June 20, 2014.

  2. Robert Johnston, “Towards a Better Understanding of Service Excellence,” Managing Service Quality 14, no. 2/3 (2004): 129–133.

  3. Wikipedia, s.v. “service excellence—healthcare,” last modified January 27, 2014, http://en.wikipedia.org/wiki/Service_Excellence_%E2%80%93_Health_Care.

  4. Adapted from Paul R. Timm, Customer Service: Career Success Through Customer Satisfaction (Upper Saddle River, NJ: Prentice-Hall, 2001), 59.

  5. AboutFace, http://aboutfacecorp.com/services/customer-experience-serivces/cx-products/service-recovery-index/.

  6. Myron D. Fottler, Robert C. Ford, and Cherrill P. Heaton, Achieving Service Excellence: Strategies for Healthcare (Chicago: Health Administration Press, 2009), 359–382.

  7. Daniel Goleman, Emotional Intelligence (New York: Bantam, 1995).

  8. Every Life Has a Story … If We Only Bother to Read It, CFA Properties, Inc., accessed February 19, 2014, www.cathyfamily.com/resources/videos/every-life-has-a-story.aspx.

  Chapter 11

  1. Osbourne Bodden (Minister of Health, Cayman Islands), in discussion with the author, October 16, 2013.

  2. M. K. Mar
vel, R. M. Epstein, K. Flowers, and H. B. Beckman, “Soliciting the Patient’s Agenda: Have We Improved?,” Journal of the American Medical Association 281, no. 3 (January 20, 1999): 283–287, www.ncbi.nlm.nih.gov/pubmed/9918487.

  3. David L. Longworth, MD (Associate Chief of Staff for Professional Staff Affairs, Cleveland Clinic), in discussion with the author.

  4. The State of New York pioneered a similar approach when developing its Cardiac Surgery Reporting System. Since 1989, the state has collected and publicly released cardiac surgery outcome data. Open-heart surgeons and surgery programs with poor outcomes were forced to improve or cease operations, to the ultimate benefit of patients. See “Adult Cardiac Surgery in New York State,” New York State Department of Health, accessed February 9, 2014, www.health.ny.gov/statistics/diseases/cardiovascular/.

  5. A relative value unit (RVU) is a measure of value used in the Medicare reimbursement formula for physician services. See “The Medicare Physician Payment Schedule,” American Medical Association, accessed February 9, 2014, www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-medicare-physician-payment-schedule.page.

  6. James I. Merlino and Robert W. Coulton, “Enhancing Physician Communication with Patients at Cleveland Clinic,” Group Practice Journal 61, no. 2 (February 2012): 24–32.

  7. Richard M. Frankel and Terry Stein, “Getting the Most out of the Clinical Encounter: The Four Habits Model,” The Permanente Journal 3, no. 3 (Fall 1999): 79–88, http://xnet.kp.org/permanentejournal/fall99pj/habits.html.