HealthCare Model for the 21 st Century Institute for Healthcare Improvement National Forum CCHS Mission Care for the sick Dr. Frank E. Bunts Dr. George W. Crile Investigate their problems Educate those who serve Dr. William E. Lower Dr. John Phillips
Professional Staff 3,500 3,000 # 2,500 2,000 1,500 1,000 500 0 2003 2005 2007 2009 2011 2013 Caregivers 45,000 40,000 # 35,000 30,000 25,000 2003 2005 2007 2009 2011 2013
Cleveland Clinic NEO Family Health Centers Brunswick CCHS NEO Hospitals
2.5 Average Severity 2.0 1.5 1.0 0.5 0 Cleveland Clinic UCLA Mayo Mass Gen John Hopkins
Cleveland Clinic Florida Cleveland Clinic Lou Ruvo Center for Brain Health
Cleveland Clinic Canada Sheikh Khalifa Medical City
Cleveland Clinic Abu Dhabi 6.4 Million Patients FHC FHC R.E. Jacobs Health Center Elyria Family Health Center FHC Lorain Family Health And Surgery Center FHC Lou Ruvo Center for Brain Health Las Vegas, Nevada FHC Westlake Family Health Center H Fairview Hospital FHC H Lakewood Hospital FHC Lakewood Family Health Center FHC H Lutheran Hospital FHC Independence Family Health Center Strongsville Family Health and Surgery Center Brunswick Family Health Center Euclid Hospital Cleveland Clinic H H Marymount Hospital FHC Wooster Family Health Center H H S.T.J. Health Center Hillcrest Hospital H South Pointe Hospital H Medina Hospital Ashtabula County Medical Center Cleveland Clinic FHC Toronto Willoughby Hills Family Health Center HC FHC FHC Solon Family Health Center FHC Chagrin Falls Family Health Center FHC Beachwood Family Health and Surgery Center FHC Twinsburg Family Health Center H Cleveland Clinic Florida
Transport Team Hospital Transfers 25,000 20,000 # 15,000 10,000 5,000 0 2005 2006 2007 2008 2009 2010 2011 2012
"There are decades where nothing happens; and there are weeks where decades happen." Lenin Engagement An "engaged employee" is one who is fully involved in, and enthusiastic about their work, and thus will act in a way that furthers their organization's interests. Wikipedia
Physician Engagement 100 90 99 % tile 80 70 60 50 2008 2010 2012 Organization Structure Not for Profit Group Practice Physician Leadership Salaried Annual Professional Review 1 Year Contract
Organization of Care Delivery Profession Oriented - Division of Surgery Patient Oriented - Heart and Vascular Institute
Heart & Vascular Institute Cardiac Surgery Cardiology Vascular Surgery Vascular Medicine Miller Pavilion
Communication CEO Meetings - Weekly Institute Staff - Weekly Admin Departments - Monthly Institute Chair Dinners - Monthly Hospital - Monthly Community - Quarterly Connections - Quarterly Staff Meetings - Quarterly Institute Scorecard - Executive Forums Communication Intranet sites
Communication Social Media Communications Weekly e-newsletters
Transparency Physician HCAHPS Scores
Professional Staff Leadership Roles 300 272 # 200 100 2004 2013 Leading in Healthcare Course 100 80 N=397 # 60 40 20 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
600 500 Cleveland Clinic Academy Staff Attendees # 400 300 200 100 2006 2007 2008 2009 2010 2011 2012 2013 CC Experience
Caregiver Engagement 100 80 %ile 60 87 40 20 0 2008 2009 2010 2011 2012 2013
HCAHPS Before & After Course Completion 50 40 Pre Post 30 %ile 20 10 0 Domain Explain Listen Respect Doctor Communication 100 80 60 Mayo Mass Gen Johns Hopkins UCLA CC 50th 40 20 0 2008 2009 2010 2011 2012
Patient Satisfaction 100 80 %ile 60 Rank 40 76 20 0 2008 2009 2010 2011 2012 2013 Execution Quality Access Value Cost Continuous Improvement
Executing to Meet Our Goals Quality
University Hospital Consortium Quality 80 70 60 Rank 50 14 th 2013 20 th 2012 49 th 2011 80 th 2010 40 30 1 25 50 75 Rank 101 300 Patient Safety Indicators # Per Month 200 100 0 83 2010 2011 2012 2013 83
Heart Failure Readmissions 30 % 25 22% 20 15 < 20% 2010 2011 2012 2013 15.0 All Cause Readmissions % 14.0 14.4% 13.0 13% 12.0 2012 2013
12.0 Post-Op VTE # per 1,000 pts. 9.0 6.0 3.0 5.5% 9.4% 0.0 2012 2013 Hospital Acquired Infections 35 # 30 25 33 20 15 2012 17 2013
Executing to Meet Our Goals Access 50 40 Emergency Departments Door to Doctor # 30 Minutes 20 30 minutes 12.6 10 14 minutes 2010 2011 2012 2013
Nurse on Call 200,000 90 Women s Health Institute Speed of Answer 70 Move to Appt. Center 50 # Seconds 30 10 2010 2011 2012
Same Day Visits 1250 # thousands 1000 750 500 250 0 2008 2009 2010 2011 2012 MyChart 1,800,000 1,400,000 1,000,000 600,000 Auto Enrollment Oct.15 th 200,000 0 2003 2005 2007 2009 2011 2013
Executing to Meet Our Goals Lower Cost Choose Wisely Cost Campaign Cost Education Practice Change $28,437 Q1 Saving
Lab Tests Avoided # 14,000 12,000 10,000 8,0008 Thousands 6,0006 4,0004 2,0002 5,388 12,082 $1.2 Million 0 2011 Feb Apr Jun 2012 Aug Oct Dec Prostatectomy All Cases 8,000 $ per Case 7,000 6,000 5,000 23% 4,000 2009 2010 2011
Weight Management Weight Watchers Curves Shape Up & Go Fitness Centers Yoga Farmer s Markets 415,000 LBS Lost Vending Machines GO! Foods
Q1 04 Q2 04 Q3 04 Q4 04 Q1 05 Q2 05 Q3 05 Q4 05 Q1 06 Q2 06 Q3 06 Q4 06 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Q4 09 Q1 10 Q2 10 Q3 10 Q4 10 Q1 11 Q2 11 Q3 11 Q4 11 Q1 12 Q2 12 Q3 12 Q4 12** Chronic Disease Enrollment 60 59% 57 % 40 20 0 2009 2010 2011 2012 2013 Employee Health Plan PMPM Costs 420 $ 380 340 300 7.6% 2.0% 260 220 2004 2005 2006 2007 2008 2009 2010 2011 2012
Economics Inflection Point Cleveland Clinic Integrated Care Model Retail Venues Home Community - Based Organizations Care System CC Clinic Post-Acute (other) Independent Physician Offices Skilled Nursing Facilities Rehab Ambulatory D&T Hospitals Emergency
Joint Commission Patient Centered Medical Home Patient Centered Medical Home 91% Caregiver satisfaction 12% Provider explanation 12% Desired appointments 9% Time spent with provider 8% Confidence in provider
Care Path Development Cycle Guides in development 69 Guides complete 22 Paths complete 4 Paths in EMR 3 > 750 Caregivers 100 80 Total Knee Blood Utilization # 60 40 20 0 2012 2013
Headache ED Pilot 70% 60% 50% 40% 30% 20% 10% 0% Opiates Prescribed Baseline 63% Pilot 5% The Change Curve Shock Right actions and clear change communications can reduce the emotional impact of changes Acceptance Morale & Productivity Exploring Emotion Initiation of change Time
ALL AMERICANS DESERVE WORLD CLASS CARE No one cares how much you know, until they know how much you care. Theodore Roosevelt
Care Paths Reduce variation Standardization >1000 engaged caregivers Process & role redesign Appropriateness criteria Culture change Mobile App iphone and Droid Access CC physicians Referrals Transfers
Premature Mortality Medical Access 10% Behavior 40% Obesity Sedentary Life Smoking Genetics 30% Environment 5% Social 15% U.S. News 2013 Honor Roll 1 Johns Hopkins 2 3 4 5 Mass General Mayo Clinic CLEVELAND CLINIC UCLA