September 21, 2017

Patient Experience Front and Centre: A Perspective from the Cleveland Clinic

At the Cleveland Clinic whether you clean rooms, volunteer at the information desk or perform cardiac surgery you’re known by one term – caregiver. At the recent OHA Health Care Leadership Summit, President and CEO Dr. Toby Cosgrove explained how focusing on the patient experience has transformed care and united employees across the organization. 

As an experienced cardiac surgeon at the Cleveland Clinic, Dr. Toby Cosgrove remembers the first time he realized that there’s more to the patient experience than a successful surgery. “I walked into a patient’s room flush with a sense of accomplishment knowing that a heart surgery had gone well,” he says. Instead he was met with looks of disappointment from the patient’s family. “When they looked under the bed the family had discovered dust bunnies and an empty IV bag,” he says.

It was a sobering come down for the surgeon and now as President and CEO of the esteemed organization, the example he uses to drive home the point that the patient experience is as much about the big, important stuff as the little, seemingly inconsequential details.

UHN President and CEO Dr. Peter Pisters engaged Dr. Cosgrove in a ‘fireside chat’ as part of this year’s OHA Health Care Leadership Summit. The audience, comprised of board members and senior hospital leadership from across the province, was keen on learning how the Cleveland Clinic has challenged its staff to put the patient experience at the centre of everything they do.

As a sign of just how far we’ve moved in the traditional doctor-patient relationship, Cosgrove says the emotional interaction people have with their doctor is a big determinant of where they decide to have their surgery. “We’re really being judged on three qualities – clinical outcomes, the physical experience and the emotional experience,” he says. The leaders at Cleveland realized they were not doing well on the final two.

The CEO’s first move was to hire the hospital’s first Chief Experience Officer and establish an Office of Patient Experience. It was also the first major academic centre to make the patient experience a strategic goal.

The latest flavour of the day

Instilling the patient experience deep in the heart of the organization’s values has Cosgrove admits “been a long, interesting journey” and not without a few missteps along the way. “We went through discussions with staff about what the patient experience means to them and then handed out buttons that said Patients First,” says Cosgrove. “People were pretty cynical and dismissed it as the latest flavour of the day.”

Undeterred, he kept going. When Cosgrove announced that everyone working or volunteering in the organization needed to be referred to as a caregiver, it didn’t go over very well. But, the impact of that small semantic shift was seismic – it drove up both staff engagement scores and patient experience scores. “It sent the message that we are a team with everyone included,” he says.

Pisters probed Cosgrove on how the goal of having a better patient experience plays out in practice. “What’s one of the most embarrassing experiences a patient has to endure?” asks Cosgrove. “Putting on a patient gown.” They turned to one of the fashion world’s most respected authorities – Diane von Furstenberg. She designed a wrap-around gown, a stylish and still functional solution.

They believe the patient experience starts the moment you walk in the front door – and they’re ready for you. Volunteers with red coats are a conspicuous and comforting presence throughout the hospital. A visiting contingent from IBM jokingly referred to themselves as the ‘IBM 13’, not because that’s how many of them there were but because they were stopped and asked if they needed help 13 times!

Where have we failed?

With so much riding on this big strategic goal, the Clinic puts a lot of emphasis on installing the right leaders. Cosgrove turns the idea of successful leadership on its head by first asking, “Where have we failed?” When things don’t work out he says it often comes down to what those leaders don’t have: emotional intelligence. “We’re able to set the pattern by whom you select for leadership roles and who the organization rejects over time,” he says. “How you control yourself and how you interact with others is judged as highly as your CV.”

When asked by an audience member how to actually teach EI, Cosgrove admits those qualities probably can’t be taught and essentially “it comes down to fit”.

Still, they leave as little as possible to chance, dedicating enormous resources and energy to cultivating the organization’s leaders. Very early in the job of CEO, Cosgrove had to put together a succession plan and that extends across the organization – every department has a succession plan and makes training a high priority. “We’re always looking at high potential people across the organization and giving them stretch experiences,” he says. Right now there are 300 leadership opportunities.

Even when everything is driving towards the concept of ‘team’, there are going to be holdouts. Pisters asked how the Clinic brought along the group traditionally most opposed to joining in – physicians.

Cosgrove admits that convincing physicians to be part of the collective when they are naturally more independent can be challenging. Being a non-profit organization definitely helps. “All of our 3,600 physicians – the largest physician population after the Mayo Clinic – are salaried with annual performance reviews,” he says. “There is no incentive for them to do more tests or more surgeries.”

This creates an entirely different set of motivations and ensures everyone is aligned around the same goal – “Doing it for the patient and realizing we can’t do it alone,” he says. As a sign of their commitment to turning physicians into team players the Clinic is now building a new health education complex.

They also employ a very powerful tool in transforming physician behaviour – metrics. “Every physician’s name is on our website with reviews and comments,” says Cosgrove. This very public form of measurement is just one of hundreds of data points the hospital is using for quality improvement in patient care and outcomes. “We spend huge amounts on reporting the data, studying the data, and learning from the data,” he says.

The Cleveland Clinic is no exception amongst healthcare organizations in being obsessed with the explosion of data in healthcare – a statistic Cosgrove says is doubling every 73 days. Their latest venture is a collaboration with one of the world’s most powerful AI platforms – IBM’s Watson.

Both Cosgrove and Pisters are moving on from their current positions and admit they’re part of ‘an old guard’ of physician leaders. “Leadership training, MBAs...I had none of that,” says Cosgrove. He’s grateful for being in the front row of an industry undergoing profound change. “Technology is enabling treatment anywhere, anytime,” he says. “We know that in the future hospitals are not going to be the centres of care anymore.”

Technology has transformed healthcare but has in no way altered its raison d’être. “We’re all in this business because we want to help people,” says Cosgrove. Putting the needs of patients first is a legacy both leaders are proud of. “At one point early in this job,” says Cosgrove, “I was speaking to an audience of business students and something one of them said stopped me in my tracks – she said, ‘Dr. Cosgrove, you don’t teach empathy’. With Patients First, I hope we’ve changed that.”