At Cleveland Clinic, Patient Experience is Not Just About Patient Satisfaction

By Stewart Gandolf, Chief Executive Officer

James Merlino, MD

[Podcast] For a large healthcare system or any hospital for that matter, success with “patient experience” is far deeper than “making the patient happy.” Take it from Cleveland Clinic, the first healthcare organization in the United States to appoint a Chief Experience Officer. “It’s not just about satisfaction. This is about how we deliver quality care.”

What’s more, the prestigious Cleveland Clinic will gladly explain how they see patient experience. “The way we all get better is by sharing information,” Dr. James Merlino told us in this insightful conversation with Lonnie Hirsch. “We like to share what we’re doing, and we encourage others to share with the group so that we can all improve.”

(More about the importance of sharing, and the 4^th Annual Cleveland Clinic Patient Experience: Empathy and Innovation Summit, follows below and in our recorded conversation with Dr. Merlino.)

“Our challenge is similar to a lot of challenges that a lot of healthcare organizations across the United States have, Dr. Merlino said. “Cleveland Clinic is a 91-year-old organization, and you can imagine that, as a healthcare organization, it is steeped in its traditions. So you’re talking about taking a legacy organization and developing a patient-centered culture.

“What does the patient experience mean and how does it affect everyone in the organization? One of the things we’ve done successfully is to define it. At Cleveland Clinic, patient experience is not about patient satisfaction. In our organization we prioritize the patient experience as:

Number One: Delivering safe care;

Number Two: Delivering high quality care;

Number Three: Providing optimal experience and satisfaction; and

Number Four: Driving value and efficiency.

“So why is it important to prioritize like this? It’s because you don’t want to get into a situation where you are pushing people to improve the patient experience and they push back saying, ‘So you want me to pay more attention to making patients happy than my quality [of care].’

“[The answer is] it’s not about making patients happy over quality. It’s about safe care first, high quality care, and then satisfaction and experience. We want people to understand how it’s prioritized.”

Dr. Merlino, he goes on to explain: “Where major initiatives like [patient experience] often fail is when organizations can’t execute. So you have to have an ability to execute on the strategy.

“In our organization, the way we execute on improving the patient experience is to focus on:

Processes and things that we can implement that make a difference;
Aligning our people around a culture of service excellence;
Impacting patients to make them better partners so they can help us deliver better care.

“By defining it and by articulating an execution strategy, we've been able to overcome a lot of the challenges we've seen in the organization.”

Listen to the interview for more about Patient Experience at Cleveland Clinic…

Chief Experience Officer Dr. James Merlino is also a practicing staff colorectal surgeon in Cleveland Clinic’s Digestive Disease Institute. In the following podcast interview, he provides a brief background—as well as some of the challenges and solutions—in the strategic initiative of creating a patient- and family centered environment.

He also explains how the concept is infused in the organization's culture, how patient experience is measured, physician communications training, and the success that Cleveland Clinic has achieved. Throughout our talk, it’s apparent that the organization is passionate about patient experience and achieving patient satisfaction.

For Dr. Merlino and Cleveland Clinic, a vitally important task is to share the knowledge and information among other facilities and providers. One means to do this is via the 4th annual Cleveland Clinic Patient Experience: Empathy and Innovation Summit to be held in Cleveland from May 19-21.

“This is the largest, non-aligned, independent patient experience summit in the world, so we’re proud of that,” Dr. Merlino told us. “Last year we had 874 people attend from outside the Clinic that represented 38 states and 24 countries. It’s a broad spectrum of healthcare leaders who are responsible for improving the patient experience in their organization.

“What we try to do is to bring topics [to the agenda] that will help people improve. We want our speakers to come in and talk about what they’re doing, how they did it, how others can do it, and why they think it will be successful.

“Patient experience impacts all of us, and the only way healthcare organizations can get better is to share their information so we can all improve together.”

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James Merlino, MD, is the Chief Experience Officer of the Cleveland Clinic Health System, and is a practicing staff colorectal surgeon in the Digestive Disease Institute. He is also the founder and current president of the Association for Patient Experience. As a member of the Clinic’s executive team, he leads initiatives to improve the patient experience across the Cleveland Clinic Health System.

Transcription:

Healthcare Success:	Our guest today is Dr. James Merlino. Dr. Merlino is the Chief Experience Officer of the Cleveland Clinic Health System and is a practicing staff colorectal surgeon in the Digestive Disease Institute. Dr. Merlino is also Founder and President of the Association for Patient Experience, and as a member of the clinic's executive team, Dr. Merlino leads initiatives to improve the patient experience across the Cleveland Clinic Health System. Welcome, Dr. Merlino, and thanks for being with us today.
Dr. Merlino:	Thank you, Lonnie. It's my pleasure to be here.
Healthcare Success:	Great. I wanted to start by asking when and why Cleveland Clinic established this role of chief experience officer and then how you came to be in that role.
Dr. Merlino:	The role was established in 2008 when our CEO, Dr. Toby Cosgrove, assumed the leadership of the Cleveland Clinic. One of his key initiatives originally was to take the organization back to more of a patient and family-centric environment. He started to implement a lot of tactics and messaging, and he made patient experience a strategic priority. He felt that he wasn't getting significant traction at the Cleveland Clinic, so he wanted to take it to the next level. The Cleveland Clinic became the first healthcare organization in the United States to actually appoint a chief experience office and to open or develop an office of patient experience. What he did was actually model this after a lot of large industries in the United States today with their chief customer service or chief customer officer model. I took over the role in July of 2009. I had trained at the clinic and went somewhere else to practice. I moved my practice here in January of 2009. The role became open and my CV was put in and I interviewed with Dr. Cosgrove and members of the executive team, and ultimately, was appointed chief experience officer.
Healthcare Success:	Well, great. Thanks for that background. What are your responsibilities as chief experience officer, meaning what type of activity do you handle directly and what do you delegate to others?
Dr. Merlino:	Lonnie, my number one priority is to keep the organization focused on what's important, which is the patient, and to make sure that everything we do has the patient at the center of all of our initiatives. On a day-to-day basis, I have a team of project mangers who drive and implement best practices that impact the patient experience. I have a team of individuals that design and deploy service excellence standards for all of our 43,000 caregivers. The dirty side of patient experience is I handle the complaints which actually is helpful because it allows us to see light on things that we should be working on to improve so it actually is a plus.
	I also oversee referring physician relations because, frankly, our patients are our number one customers, but physicians who send patients to our system are our second customers. We want to make sure that we're providing them with a good experience, making sure that they get information back timely, that their patients get access and that we're servicing their patients because, ultimately, they become our patients as well.
Healthcare Success:	That makes complete sense. Tell me, what are some of the challenges in establishing an optimal patient experience across an organization as large as Cleveland Clinic Health System?
Dr. Merlino:	That's a great question because I think that our challenge is similar to a lot of similar challenges that healthcare organizations across the United States have. Cleveland Clinic is a 91-year-old organization and you can imagine in the fact that it's a healthcare organization that it's very seeped in its traditions. You're talking about taking an organization that's a legacy organization and essentially developing it to a patient-centered culture where, in fact, the patient is not always right. Some of our challenges have been really messaging.
	What does the patient experience mean and how does it affect everybody in the organization? One of the things that we've done I think very successfully is really defining it. At Cleveland Clinic, patient experience is not about patient satisfaction. In our organization, we prioritize the patient experience as 1) Delivering safe care; 2) Delivering high quality care; 3) Providing optimal experience and satisfaction; 4) Driving value.
	Why is it important to prioritize like this? Well, you don't want to get into a situation where you're pushing on people to improve the patient experience and they push back on you and say, "Well, so you want me to pay more attention to making patients happy than my quality." The way we get around that is say, "No, it's not about making patients happy over quality. It's about safe care first, high quality care, then satisfaction and experience." We want people to understand how it's prioritized, and I think we have been very successful with that, and that's helped us get over the challenge of really getting people to understand how it's defined.
	The next biggest challenge is it's great to have a strategic priority like patient experience, but where major initiatives like this fail is often organizations can't execute, so you have to have an ability to execute on the strategy. In our organization, the way we execute on improving the patient experience is to focus on processes, things that we can implement that make a difference, aligning our organization and our people around culture of service excellence, and impacting our patients, trying to make patients better partners so that they can help us deliver better care. I think that by defining it and by articulating an execution strategy, we've been able to really overcome a lot of the challenges that we've seen in the organization.
Healthcare Success:	That's great, but how do you measure patient experience, at least in your organization?
Dr. Merlino:	Well, there's lots of surveys that you can do to measure how well you're doing in patient experience. The six areas that most healthcare organizations measure patient experience are in the emergency department, in the ambulatory environment, in the inpatient environment, home healthcare, psychiatric services and pediatrics. We measure all of those areas, but what we really pay attention to is our HCAPs or inpatient. The reason we chose to do that is because, number one, it was the most visible patient experience metric. It was the first one to be out there and it's what the government has been talking about. Secondly, it's publicly reported and it's linked to reimbursement now. It was easy to create a soap box of change around it. When we started to talk about patient experience, we really needed to let people know what we're going to be focusing on, and we needed to give them metrics that they could focus on, so HCAPs, the inpatient metric, was the natural choice, and that's why we chose to focus on HCAPs.
	We also theorize, and I think correctly, that if we can improve the inpatient environment, the tactics that we would use and the strategies that we would use to improve inpatient satisfaction would trickle into the other areas because at the end of the day, one of the most important features of improving patient experience on the inpatient environment is how our caregivers communicate with patients. If you can improvement that on the inpatient environment, you will also drive improvements on that, in the ambulatory, the emergency department and the other areas.
Healthcare Success:	How do you coach that communications process, again across a large organization with so many providers?
Dr. Merlino:	Here at Cleveland Clinic, we're very transparent about the data, so the first step is to let people know where they stand, and we do that on an individual level for physicians, and we do it on a department and unit level for the nursing units. The second thing we do is once we have been transparent with the data, we take our best practices and we apply it to the areas. For physicians, as an example, we developed a physician communication training program where we can actually give our physicians tactics to help them become better communicators. We also trained up 18 physician coaches that work with our medical staff and help them to delivery better communication practices with patients.
Healthcare Success:	Wow, that's impressive. I assume it's paying off for you.
Dr. Merlino:	Well, it's funny you say that. It is and it's interesting because we benchmark our organization's scores against many groups and for large academic medical centers, we are a leader in how well our physicians and nurses communicate with patients. That's not where we used to be, so we're very proud of that.
Healthcare Success:	Let me ask you a slightly different question. In your experience, what's the most important aspect of optimal patient experience that most organizations overlook or mishandle?
Dr. Merlino:	The first thing is I think it's important that organizations recognize what I said before about the definition. It's not about making patients happy. This is about how we deliver care. If you just kind of pick apart the HCAP survey, which is the CMS required survey, you recognize quickly that three of the big domains, how well nurses communicate, how well physicians communicate and how well all of us communicate about medications. It's about communication, and so that's not just about making patients happy.
	If you improve the way nurses communicate with patients at the bedside, you decrease medication errors, not impact safety. If you improve the way physicians communicate with patients and family, you improve compliance and that drives quality. Yes, by the way, if we communicate better, patients are more satisfied. However, if you hit all three, you're now driving value and efficiency. That's the most important aspect that I think people overlook, that it's not about satisfaction. This is about how we deliver care.
	We are very good every year as physicians at making sure we're on top of our practice game by doing more education and CME. Nobody practices how to deliver that care better. In other words, how do you improve the encounter with the patient, how do you make the encounter more efficient? That's what patient experience is about.
Healthcare Success:	I have one more question because I know your fourth annual Cleveland Clinic patient experience summit is going to be held the middle of May this year in Cleveland. I just wanted to ask you, what types of people attend this summit and what kind of topics do you cover?
Dr. Merlino:	Thanks for asking about the summit. We're very pleased with the success that we've had with it. First of all let me tell you, this is the largest nonaligned independent patient experience summit in the world, so we're very, very proud of that. When I say nonaligned and independent, we don't make money on this. We are a provider that puts this on for other providers because I think that the way we all get better is to share information. We like to share what we're doing and we encourage others to share with the group so that we can all improve.
	Last year at third annual summit, we had 874 people attend from outside the clinic that represented 38 states and 24 countries. It's a broad spectrum of healthcare leaders that are responsible for improving the patient experience in their organization. We've been very careful to listen to the people that attend and use that information to shape the agenda.
	What we try to do is bring topics that will help people improve. We want our speakers to come in, talk about what they're doing how they did it, how others can do it and why they think it'll be successful. We really want this to be an exchange of information. We pay very close attention to the timely topics around patient experience. How do you improve HCAP score? How do you engage physicians to be focused on this? How do you impact culture to develop your people around these concepts? I think because we've listened to the people that have attended in the past and used that information to shape the agenda, we continue to make this a very successful event.
Healthcare Success:	It sounds very exciting. Thanks for sharing that. Thanks for your time today. It's been a great insight, I believe, for our listeners as it relates to even how to define patient experience as well as how to execute. As you said, if you fail on the execution, it's just a good idea it didn't happen. I really appreciate your time. Good luck with your summit and thanks for being with us today.
Dr. Merlino:	Lonnie, thank you for including Cleveland Clinic in your healthcare success strategies podcast. The patient experience affects all of us, and the only way that healthcare organizations can get better is to share their information.