The Cleveland Clinic Experience
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- Duane Todd
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1 The Cleveland Clinic Experience Patient Experience Summit La Crosse, Wisconsin James Merlino, MD Chief Experience Officer
2 Mr. Jones
3 Our Culture
4
5 Care for the sick Investigate their problems Educate those who serve
6 To act as a unit.
7 Feb 28, 1921
8 Cleveland Clinic Integrated Health System - Main campus 1200 beds - 10 regional hospitals - 18 Family Health Centers - Florida, Canada, Las Vegas, Abu Dhabi, and Egypt Revenue $6 Billion 42,000 Employees
9 4
10 85 Year Model Group Practice - Doctor ownership - Physician Leadership Non-profit No incentives / No Bonus Employed physicians - One year contracts Innovation / Volume Clinical Excellence
11 2005 New Leadership What was the key to our success, would not be the key to our future..
12 Patients First.
13 Providing the highest quality patient experience is a primary goal of the Cleveland Clinic Organization. -Delos Toby Cosgrove, MD, CEO
14 Why is this important Right thing to do The way we would want to be treated - Patient centered care - Family centered care Patient s want it their Quality Who we are as an enterprise Government
15 Harvard
16 Our Risk # 4 USNWR th percentile CMS Patients came for expertise didn t like us
17 Experience?
18 My patient. Avg risk Rectal Cancer 5 day LOS - 8 Staff Physicians - 18 Departments - 60 nurses (RNs) - Residents / Fellows - RPN / PA / Housekeepers / Meal / PSRs / Nutritionists / Phlebotomists / Physical Therapists / Radiology techs / Front desk / Service Navigators / Financial Counselors What about the family?
19 The 360 Before During After Manage the 360 Continuum
20 Patient Experience Journey Pre-entrance Perception Pre-patient Entrance Patient Experience Post Experience Culture of Service Process People Patients
21 Strategic Plan Improve Patient Experience Leverage culture change Advance service and service recovery Develop consistent PE presence Advance holistic healing opportunities Engage patients Become the industry leader Advance research
22 Goal: Improve Enterprise Patient Experience Metrics (Process)
23 Improve Patient Experience Focus: HCAHPS (PE brand) Communication and Education Full transparency Key stake holder partners - Staff / Com. Docs / Nurses / Others Service Excellence training HCAHPS Domain focused teams
24 Improve Patient Experience Domain Focused Teams Reputation Doctor Communication Environment Nurse Communication Responsiveness Pain Management Medication Communication Discharge
25 Improve Patient Experience Domain Focused Teams Clinical project manager Consolidated efforts Best practice driven Metrics - Process metric - Outcome metric
26 Environment Quiet at Night
27 Elements of the Protocol HUSH Champions Patient expectations flier HUSH Posters Announcement at 9:00pm Doors closed as appropriate Hallway lights dimmed Staff are counseled about noise Floor auditing
28 Quiet at Night Weston 82.0% 90 th
29 Responsiveness Nurse Communication Emphasis on Hourly Rounding Front line staff education & input Metrics - Process - Outcome Manager accountability - Audits
30 Did a Nurse Visit Every 2 Hrs % Response Always Usually Sometimes Never
31 Always Rounded Nurse Always Visited Q2 Hrs Rate Hosp Rec Hosp Nurse Comm Respnse Pain Med DC
32 Usually Rounded Nurse Usually Visited Q2 Hrs Rate Hosp Rec Hosp Nurse Respnse Pain Med DC Comm
33 Sometimes Rounded Nurse Sometimes Visited Q2 Hrs Rate Hosp Rec Hosp Nurse Comm Respnse Pain Med DC
34 Never Rounded Rate Hosp Nurse Never Visited Q2 Hrs Rec Hosp Nurse Respnse Pain Med DC Comm
35 Top 20 Units: Nurse Rounds Every 2 Hours % Always G070 J073 July 2010 January 2011 N size limited to > 60 returned surveys per unit J061 H081 G081 H060 J081 J052 J072 H051 J071 H070 H050 H071 G090 H080 M063 G100 G101 G080 Survey Audit
36 Nursing Plan Orientation and on-boarding Nursing HCAHPS education brochure Service excellence training Standardize unit reporting Regular manager meetings Process auditing and feedback Unit mystery shopping
37 Doctor Communication Physician leadership Score transparency Complaint transparency Verbatim analytics Task force - How do we teach improvement? Communication Champions - Peer physician coaches Communication guide House staff
38 ID NAME N DOC COMM Respect Listen Explain RATING RECOM MEND
39 DDI Physicians Doctor communication vs. Hospital rating g y DOC COMM Good doctor Bad hospital rating Natl Avg = 64% Natl Avg = 80% Low Communication Low Rating Low Reputation Poor Doctor Communication High Hospital Rating Rating 'n' of DDI Physicians with > 5 '0 9 surveys returned = 5 6
40 Verbatim Analysis Dr Access 25% Others 4% Coordination 25% Compassion / Respect 12% Listening 10% / Interns Residents 5% Explain 19%
41 Coordination Coordination 25% The Clinic is too big! Dr. skill is excellent, but they don t communicate between themselves. Each Dr. tells me a different thing. There is no one Dr. in charge to review orders from all of the other Dr. s. You must develop a method of Dr. in charge. Respect: Usually Listen: Usually Explain: Usually This team runs like a well oiled machine. Communication between staff members is key and was demonstrated positively every day. I couldn t have been more satisfied w/ my stay or care. CC is my recommendation to anyone in need of the best medical care. Thank you. Respect: Always Listen: Always Explain: Always
42 Goal: Leverage Culture Change (People)
43 Enterprise Goals Patient Safety Indicators Readmission Rates Core Measures HCAHPS Hospital Acquired Infections Engagement Scores Safety Patient Experience Quality Employee Experience (Culture)
44 Can a Culture be Changed?
45 Current State
46 Culture Patients Employees Doctors Caregivers Nurses
47 Patients First. Safety Quality Patient experience Value
48 Our Initiative We are culture centric Designed by us! Focus groups across the organization Consultants How to sustain?
49 Path to Culture Change Communication is critical Message must be razor focused Managers / leaders are foundation Talent Management Lifecycle No one excluded Zero Tolerance
50 Cleveland Clinic Experience
51 Cleveland Clinic Experience Learning Map Staff Managers Everyone else Owners You Role are of Mission, the Respected Leader vision, values H Must Reinforce Lead Patient Serving by example Experience Leader - Model Teach Engagement Expected Behaviors O Accountability Service Recovery O Responsible to Sustain the Change Recognizing you! K Why we are all Caregivers All Caregivers T H E E X P E R I E N C E
52 Process Flows Staff Employees Managers Leading the Way Exploring the Cleveland Clinic (Learning Map) Coaching for Outstanding Performance
53 Leverage the Culture Cleveland Clinic Experience Mission, Vision, and Values Desired service behaviors Service recovery (HEART) Serving Leader Link us to our values
54 Why a Learning Map Visual representation of ideas Tool to drive content How We Learn (Interactive) - 10 % of what they read - 50 % of what they see - 90 % Hands-on / Interact / Discuss
55
56
57
58
59
60 In Regards to the Experience Where are you right now? Before After
61 By the numbers. 41,000 Completed Las Vegas, Weston, Toronto CCAD / SKMC 174,000 Employee hours 28,000 manager hours 92% average satisfaction metric
62 Sustainability Hospital wide Leadership Rounding Patient Partnerships Cleveland Clinic Experience Engagement / Accountability Processes Manager Competency New Employee Orientation Constant Reinforcement
63 Goal: Engage Patients (People)
64 Hospitals
65 Patient s role?
66 Listening to the Patient s needs Complementary services for patients - Massage - Reiki - Healing touch - Spiritual care - Aromatherapy
67 Managing Patient Concerns Top 5 issues resolved at the bedside: - Communication - Lost Belongings - Staff Responsiveness - Cleanliness - Pain Control
68 Listening to patients to improve Voice of the Patient Advisory Council Suggest Guide Discuss
69 Reasonable Expectations Private rooms A Quiet Environment We push information - What is the patient responsibility? Understanding their care Personal responsibility How long should they stay?
70 Patient as Partner One that is united with another in an activity of common interest
71 What it means to partner As important as me Engagement (pay attention) - Safety - Medications - Other Ask questions Communicate / research Assign an advocate More than just customer
72 Can Expectations be a tool?
73 Caregiver Role Given: Quality of care Discuss what to expect Define their role as a patient How to communicate What Quiet means The limitations of pain management How caregivers respond What partnership means
74 Clinic Pilot? Communication Medication mgt Pain Management Quiet Cleanliness Responsiveness
75 HCAHPS Doctor Communication Viewed Emmi Program Did Not View Emmi Program 90 th Percentile 80 % (% Always)
76 HCAHPS Medication Communication Viewed Emmi Program Did Not View Emmi Program 90 th Percentile 80 % (% Always)
77 HCAHPS Night Viewed Emmi Program Did Not View Emmi Program 90 th Percentile 80 % (% Always)
78 HCAHPS Room Cleanliness Viewed Emmi Program Did Not View Emmi Program 90 th Percentile 80 % (% Always)
79 HCAHPS Staff Response Viewed Emmi Program Did Not View Emmi Program 90 th Percentile 80 % (% Always)
80 Are we Improving?
81 Rate Hospital % 9 or Mayo Mass Gen Johns Hopkins UCLA CC Natn'l Avg Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 Q2 09 Q1 10 Q3 09 Q YTD CMS Reported Scores
82 Hospital Recommendation 100 % Yes Definitely Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 Mayo Mass Gen Johns Hopkins UCLA CC Natn'l Avg Q2 09 Q1 10 Q3 09 Q YTD CMS Reported Scores
83 Nurse Communication % Always Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 CMS Reported Scores Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 09 Q1 10 Q3 09 Q YTD
84 Doctor Communication 100 % Always Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 CMS Reported Scores Q2 09 Q1 10 Q3 09 Q YTD
85 Meds Communication % Always Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 CMS Reported Scores Q2 09 Q1 10 Q3 09 Q YTD
86 Pain Management % Always Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 CMS Reported Scores Q2 09 Q1 10 Q3 09 Q YTD
87 Cleanliness % Always Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 Q2 09 Q1 10 Q3 09 Q YTD CMS Reported Scores
88 Discharge Instructions and Care 100 % Yes Q2 07 Q1 08 Q3 07 Q2 08 Q4 07 Q3 08 Q1 08 Q4 08 Q2 08 Q1 09 Q3 08 Q2 09 Q4 08 Q3 09 Q1 09 Q4 09 CMS Reported Scores Mayo (2) Mass Gen (5) Johns Hopkins (1) UCLA (3) CC (4) Natn'l Avg Q2 09 Q1 10 Q3 09 Q YTD
89 Patient and Employee Experience CCHS 10,000 9,000 8,000 7,000 Percentile ,000 5,000 4,000 Complaints ,000 2,000 1, Gallup Engagement HCAHPS Rating HCAHPS Recommend Complaints
90 Goal: Research
91 Sickest Patients in the US Medicare Severity of Illness Case Mix Value Series1 Series2 Barnes CC (4) UCSF (7) Mayo (2) Johns Hopkins (1) UCLA Penn Duke Brigham Mass Hospital NY
92 50 % of Patients 3 or 4 Severity Length of Stay Severity of Illness Classification
93 Staff Responsiveness by SOI 65% 60% 55% 50% 57% 52% 49% 45% 40% 35% 42%
94 Doctor Communication by SOI 85% 80% 75% 80% 77% 75% 70% 70% 65% 60%
95 Always Rounded Nurse Always Visited Q2 Hrs Rate Hosp Rec Hosp Nurse Comm Respnse Pain Med DC
96 Nurse Always Rounded by Severity SOI 1 SOI 2 SOI 3 SOI 4 % Always or Yes 90th Natn'l Percentile RN Comm DR Comm Pain mgmt Staff Response Night HCAHPS Domain Measures Med Comm
97 Isolation and HCAHPS 100 Main Campus Isolation Patients 80 % 'Always' MD Communication RN Comm Staff Response Pain Mgmt
98 Depression and HCAHPS % Top Box Rating Recommend Dr Communication Nrs Communication 0 No Depression Mild Depression Severe Depression
99 Doctor Communication by Bed Size 100 Nat'l 90th Percentile Max Avg 80 % Always
100 Summary Experience is Right True North Transparency is an important lever Reimbursement link is perverse Metrics that hospitals control Limit of Patient-Centeredness All hospitals are not the same - Robust adjustment is necessary
101 Facilitate Sharing.
102 Mr. Jones
103
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