communication skills, 115, 123, 153, 181–188, 192–194, 221, 224
complexity of questions, 59
early numbers at Cleveland Clinic, 24
goals for, 122
hospital quiet-at-night domain, 147, 205, 221
hospital reimbursement linked to, 47, 146–147
hospital unit scores, 140–144
leadership role in changing, 39–40, 140–148
limitations of, 122–124
nurse hourly rounding, 144–146, 153
online engagement model on being a patient, 207–208
physician complaints concerning, 182–183
physician education concerning importance of, 105–109, 115
pragmatic issues, 133–134
role in patient feedback, 122–125
service navigators, 149–152
teamwork and, 183–184
Healthcare Development Holding Co., 235
Healthgrades, 110–111
HealthLeaders Magazine, 32–33, 226
HealthLeaders Media survey, 29, 47
Heart & Vascular Institute (Cleveland Clinic), 145–146
Help Us Sustain Healing (HUSH) protocol, 147
Henderson, J. Michael, 43, 68
Hillcrest Medical Center (Tulsa, Oklahoma), 211–212
Home Health Care Assessment of Healthcare Providers and Systems (HHCAHPS), 122
Hong Kong Hospital Authority, 236
Horn, Roy, 219–220
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). See HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores
Hospital Value-Based Purchasing Program (HVBP), 26, 106–107, 122, 182–183
Houston Methodist Hospital, 29–30, 35, 82–83, 134–135, 230
Hsieh, Tony, 71
Human resources
employee wellness initiative, 30, 77
reward/recognition programs, 42, 73, 82, 83, 105
strategic talent management approach to, 71, 72–73
Hundorfean, Cynthia, 214
Iannotti, Joseph, 38–39
Ideas for Tomorrow lecture series, 23–24
Institute for Patient- and Family-Centered Care, 206
Intercontinental Hotels Group, 82
Janssen BioTech, Inc., 219
Johnson & Johnson, 219, 237
Johnston, Robert, 159
Joint Commission, 75–76, 94, 205–206
Journal of Patient Experience, 232
Journal of the American Medical Association, 180
Kaawach, Wael, 235
Keep Memory Alive Foundation, 219
KeyCorp, 218
King Saud Medical City (Riyadh, Saudi Arabia), 31–32
Klein, Eric, 191
Kotter, John P., 24
Leadership
executive/leadership rounds, 39–43, 50, 126–127, 148, 160, 212
personal learnings of CXO, 212–218
physician role in, 103–118.See also Chief experience officer (CXO); Chief quality officer (CQO); Cosgrove, Delos M. “Toby”; Physicians
style of, 35–37, 40, 215–218
Leapfrog Group, 59–60
Learning map, 83–86, 89, 91
Lee, Thomas H., 103, 105
Lee, Wang-Jun, 235–236
Lerner College of Medicine (Cleveland Clinic), 188
Leung, P. Y., 236
Lim, Jenn, 71
Longworth, David L., 180–181, 236
Lou Ruvo Center for Brain Health (Cleveland Clinic; Las Vegas), 219–220
Lower, William E., 15
Lutheran Hospital (Cleveland), 39–40
Luxor Las Vegas, 23
Lytle, Bruce, 184–185
Manning, Harley, 24, 52
Massachusetts Health Quality Partners, 111
Matsen, Paul, 92
McKinsey & Company, 71
Medicaid. See Centers for Medicare and Medicaid Services (CMS)
Medicare. See Centers for Medicare and Medicaid Services (CMS)
Medication delivery, 49, 134, 201, 203–204, 223, 231
Medicine Institute (Cleveland Clinic), 180–181, 236
Medoff Barnett, Kara, 31, 171
Medtronic, Inc., 33
Mellen Center for Multiple Sclerosis (Cleveland Clinic), 187–188
Methodist Hospital (Houston), 29–30, 35, 82–83, 134–135, 230
MetroHealth Medical Center, 7, 8, 9–10, 19, 127–128
MGM Resorts International, 21–23
Miller, Thomas J., 234
Mirage Hotel & Casino (Las Vegas), 21–23, 27, 56, 219–220
Mooney, Beth E., 218
Mubadala Healthcare, 234
Mylod, Deirdre, 202
Myongji Hospital (South Korea), 235–236
“Mystery shopping,” 167
National Car Rental, 230
National Quality Forum, 122
Newman, Kurt, 230, 234
Noise complaints, 133, 147, 205, 221
North Shore-Long Island Jewish Health System, 230
Nurko, Saul, 188–189
Nurses. See Communication skillsof nurses
Obama, Barack, 233
Office of Learning and Performance Development (Cleveland Clinic), 87
Office of Patient Experience (Cleveland Clinic), 11, 33–37, 87, 140
Ohio Department of Health, 108–109
Ohio State Medical Association, 134
Ombudsman/Patient Relations Department (Cleveland Clinic), 168–170
OM Group, Inc., 68
Organizational culture, 65–80
alignment around common goals, 75–80
caregiver role for all employees, 73–75, 77–80, 157–159,166–167, 216
challenges of defining, 67–71
modifying, 66–67, 69–80.See also Cleveland Clinic Experience program
owning change at all levels, 37–39
Patients First approach in. See Patients First approach
problems with, 1–7, 31, 33–34, 66–67, 98–103, 112–113, 216, 220–221
strategic talent management in, 71, 72–73
Orthopaedic and Rheumatologic Institute (Cleveland Clinic), 38–39
Pain management, 49, 134, 203–204, 223, 231
Patient complaints and grievances, 126–127, 168–170, 215
Patient experience, 45–63. See also Cleveland Clinic Experience program; Patients First approach
challenges of defining, 45–49
Cleveland Clinic definition in 360 continuum, 54–63, 71, 104, 225
communication skills in, 58–60, 115, 123, 153, 178–181
efficiency of processes and operations in, 151–152
“elephant” parable for, 47, 53, 151–152
feedback on. See Patient feedback
finding early partners to support, 145–146, 152
global focus on, 233–237
importance of, 109–110
metrics in, 152–154
operationalizing improvements in, 60–63, 211–227
patient perceptions of, 50–52, 53–54. See also HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores
Patients First approach. See Patients First approach
problems of, 1–9, 31, 103–108, 177–178
professional definitions of, 52–54
service excellence in meeting expectations, 159–161
3Ps of, 61–62, 138
Patient experience “360” concept, 54–63, 71, 104, 225
Patient Experience: Empathy & Innovation Summits, 191–192, 202, 219, 229–232, 237, 238
Patient feedback, 119–136
on access and same-day appointments, 36
asking patients for information, 131–132
CAHPS instruments in, 122.See also HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores
challenges of, 119–120
on communication, 178–181
lack of interest in being a patient, 129–130<
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learning what patient needs, 119–120
limitations of, 122–124, 130–131, 133–134
listening to patients, 225
patient advisory councils, 132
patient-centeredness and, 120–121
patient need for information, 127–129
patient surveys and, 122–123, 124–125, 134, 135, 178–181
pragmatic issues in, 133–134
proxy measures for, 123–127
verbatims and anecdotal data in, 130–131, 134–135, 172–174, 197–198, 215
Patient gowns, 30–31
Patient involvement, 197–210
expectations for bedside nurse call button response, 3, 204, 207, 208
expectations for noise control, 133, 147, 205, 221
expectations for pain management, 49, 134, 203–204, 223, 231
expectations for visiting hours, 133, 205–207
reasonableness of, 168–170, 204–207, 215
teaching people to be patients, 202, 207–209
Patient Protection and Affordable Care Act (2010), 26, 47
Patient proxies
environmental cleanliness, 50, 126, 147–148, 152, 221, 223
physician-nurse communications, 125–126
recognizing needs of individual, 50–51, 125
“Patients: Afraid and Vulnerable” (video), 174
Patients First approach, 13–28. See also Cleveland Clinic Experience program; Patient experience
as “burning platform” and strategic priority, 24–26, 38
caregiver role for all employees, 73–75, 77–80, 157–159,166–167, 216
Cleveland Clinic as pioneer in, 26–28
as Cleveland Clinic founding principle, 14
components of, 57–59
employees first approach versus, 18–19, 99
global spread of, 233–237
hospital chief executive officer (CEO) in. See Cosgrove, Delos M. “Toby”
hospital chief experience officer (CXO) in. See Chief experience officer (CXO)
implementation challenges, 137–155
internal campaign for implementing, 16–17
introduction of, 15, 25, 26
as motto of new CEO, 10–12, 15–17
organizational alignment around, 17–19, 27–28
organizational integration effort, 139–140
patient feedback and, 119–136
projects to improve HCAHPS scores, 140–148
as reason for existence, 19–24
tactical implementation of, 137–155
in transforming Cleveland Clinic, 21
Patrnchak, Joseph, 72–73, 75, 78
Peabody, Francis Weld, 13
Peacock, William M., III, 166
PepsiCo, 84
PERT, 217
Physicians, 97–118
accountability for care delivery, 105–112
communication skills of. See Communication skills of physicians
empathy and medical school training, 7–9
key skills of, 13
leadership in transforming patient experience, 103–118
opinion leaders/early adopters, 90–92, 114, 184–185
organizational culture challenges concerning, 1–7, 31, 33–34, 66–67, 98–103, 112–116, 216
participation in Cleveland Clinic Experience program, 86–92, 93–94, 105–118
power issues of, 6–7, 98–103, 112–116
in private practice, 181, 192–194
referrals of, 10
responsibilities of, 97–98, 103
teamwork of, 30, 65–67, 112–116
transparency of information concerning, 35–36, 106–112, 115, 153, 181–186
Porter, Michael E., 15
Press Ganey Associates, Inc., 103, 218–219, 231–232
Press-Ganey Institute for Innovation, 202
Production and Operations Management Society, 60–61
Pryor, Robert, 230
Qubaisi, Saif Bader Al, 235
Radboud University Medical Center (Netherlands), 25, 70
Raman, Ananth, 138, 211
Rand Corporation, 122
Rappaport, Felix, 21–23
Recognition/reward programs, 42, 73, 82, 83, 105
Red Coat greeters/navigators, 158
Referrals, 10
Relationship: Establishment, Development, and Engagement (REDE) Model of Communication, 190, 191
Relative-value-unit (RVU) performance, 184
Remzi, Feza, 5, 10–12
Respond with H.E.A.R.T. program, 92, 165–167
Reward/recognition programs, 42, 73, 82, 83, 105
Rice, Thomas, 191
Risk-taking, 216–218
Ritz-Carlton Hotel Company, 72, 74, 158–159, 163, 230
Roizen, Michael, 30
Root, Inc., 84–86, 89
Ruvo, Larry, 219–220
Ryan, Pat, 218–219, 220, 226, 231–232
Samsom, Melvin, 25, 70
Saudi Arabia, 234–235
Scaminace, Joseph M., 68
Schein, Edgar, 70
Schlanger, David, 230
Schwartz, Bob, 230–231
Service excellence, 157–175
accountability in, 167–168
apologies in, 160–163
with challenging patients, 168–170
checklist of best practices, 164
clinical excellence versus, 14, 159
Communicate with H.E.A.R.T., 94, 163–167
communication skills of physicians in. See Communication skills of physicians
defined, 159
empathy in, 160–163, 170–174
impact of service failure, 160–163, 168
meeting patient expectations, 159–161
nature of, 158–161
service recovery and, 160–163
Service navigators, 149–152
Sheil, Eileen, 42
Shop for H.E.A.R.T. program, 167
Siegel, Alan, 20
Siegelvision, 20
Siegfried & Roy, 219–220
Siemens AG Healthcare Sector, 234
Silos, 142–144
Six Sigma quality, 226
Sloan School of Management, MIT, 70
Society of Hospital Medicine, 229–230
Solomon, Micah, 158, 232
Sorenson, Charles, 230
Southern Wines & Spirits of Nevada, 219–220
South Korea, 235–236
S.T.A.R.T. with Heart program, 164–167
Stein, Terry, 189
Stover, Reggie, 84
Sydell and Arnold Miller Family Heart & Vascular Institute (Cleveland Clinic), 30, 158, 184–185
Taylor, Andrew C., 230
Taylor, David, 188–189
Taylor, Jack, 230
TEDMED, 197
3Ps of patient experience, 61–62, 138
Transparency
HCAHPS measures of communication skills, 106–108, 115, 181–186
hospital reimbursement and, 47, 106–107, 111
physician engagement and, 110–112
physician score distribution, 35–36, 106–108, 115, 153, 181–186
Trump, Donald, 20–21
Trump International Hotel & Tower (Chicago), 20–21
UCLA Health System, 29–30, 41–42, 230
UCLA Hospital System, 37
United Arab Emirates, 67, 68, 166, 234, 235
U.S. News & World Report, 14, 24, 221–225
University Health Systems Consortium (UHC), 221, 229–230
Velez, V. J., 188–189
Vernon, Thomas, 84, 90
Veterans’ Administration (VA), 233
Visiting hours, 133, 205–207
Vogt, David, 188–189
Voice of the Patient Advisory Councils (VPACs), 132
Walt Disney Company, 19–20, 22, 27, 74, 163
Walt Disney World Resort (Orlando), 19–20, 22
Warwick Business School, 159
Watermark Consulting, 17–18
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WebMD, 230
Welch, Jack, 15
West, Renee, 23
Windover, Amy, 188–189, 193
Zabell, Donna J., 84, 86, 90
Zappos, 71
Zeroske, Joanne, 203–204
About the Author
James Merlino, MD, is the Chief Experience Officer of Cleveland Clinic Health System and is a practicing staff colorectal surgeon. He is the founder and current president of the Association for Patient Experience. He leads initiatives to improve the patient experience, physician-patient communication, patient access, and referring physician relations across the Cleveland Clinic Health System. He speaks to boards, physicians, and other healthcare leaders throughout the world on the importance of aligning healthcare culture around the patient and delivering on strategies to improve the patient experience. He has authored several articles and is widely quoted in publications. His work and comments have appeared in Harvard Business Review, Forbes, the Wall Street Journal, and Yahoo Finance, among many other outlets. In 2013, HealthLeaders magazine named him one of “20 People Who Make Healthcare Better.”
Dr. Merlino received his undergraduate degree in business administration at Baldwin-Wallace College and his medical degree from Case Western Reserve University School of Medicine. He completed his residency training in general surgery at University Hospitals of Cleveland, and his fellowship in colorectal surgery at Cleveland Clinic. During his residency, he took a two-year research sabbatical to complete an AHRQ-funded research fellowship in health services research. Dr. Merlino is certified by the American Board of Colon and Rectal Surgery and the American Board of General Surgery. His wife, Amy, is a maternal-fetal medicine specialist at Cleveland Clinic.
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