Cleveland Clinic's 4 radical approaches to care integration, patient satisfaction

With a historical reputation for being the best, Cleveland Clinic has applied some unconventional methods to its care integration model that boosts patient satisfaction.

Both President Obama and Gov. Romney mentioned the Clinic as an exemplary innovator in the presidential debate.

"I really think our model is our secret sauce," Cleveland Clinic CEO Delos "Toby" Cosgrove said in a Business Insider interview about the recent shout-outs. Based on the idea of "Patients first"--the slogan the Clinic adopted since Cosgrove took the helm--the system has restructured the entire organization.

1. Get rid of departments  
The Clinic restructured the entire system, eliminating the surgical department and the department of medicine, rethinking organization based on patient needs.

For example, if a patient has a headache, he can go to one neurologic institute, with the specialists physically located near each other. The institutes are more efficient and less costly, according to the CEO.  

"In one year, we changed the whole organization," Cosgrove said. "It's all by institutes."

2. Evaluate everyone every year
No physician is tenured at the Clinic. All the employees are salaried and have one-year contracts, including Cosgrove, who has had 37 one-year contracts. The idea is modeled after every other industry, in which employees receive a performance evaluation every year--notably absent in healthcare.  

"You got privileges at a hospital, and they were yours for life," Cosgrove noted. "In the annual professional review, we go over all individual contributions to the organization, and that contributes to our decisions about what we do about salary or whether we reappoint or don't."

 Such annual assessments mean physicians are not compelled to provide unnecessary services.

"We have no financial incentives to do more or less," the CEO told Business Insider.

3. Get a price gun
The Clinic also started to label supplies, letting providers know how much everything they used cost.

"We also put a price tag on supplies in the operating room," Cosgrove said. "In the past, if a doctor thought he needed a suture, he would just grab it, open it, and throw it away. Now, they see the price."  

The urologists looked at prostatectomies, paying attention to the cost of the sutures, how many instruments they had on the table and how long the patients stayed in the recovery room. Taking these cost-conscious actions resulted in a 25 percent reduction in actual costs, according to Cosgrove.

4. Learn from Mickey Mouse
"'Patients First' isn't just a slogan at Cleveland Clinic; it's our guiding principle," Cosgrove previously told FierceHealthcare. "That is where we get our satisfaction and our motivation."

The Patients First campaign is a $11 million patient experience strategy that incorporates methods from Disney and InterContinental Hotels, The Plain Dealer reported.

Each of the 43,000 employees, including Cosgrove, goes through three hours of Cleveland Clinic Experience training and learns about maintaining eye contact, actively listening and apologizing to patients for when something goes wrong.

Each employee recognizes their role in the patient experience. For instance, the training imparts that everyone--administrative assistant or executive--smile, open doors and pick up trash.

The Clinic instills that everyone is a caregiver, according to James Merlino, chief experience officer and FierceHealthcare advisory board member.

"It doesn't matter if you are in the basement, turning on the lights. In this organization, you are contributing to the mission: You're helping to care for patients," Merlino told the Plain Dealer.

Such training has helped the Clinic achieve an 80 percent satisfaction rate for patients who rated the hospital as a 9 or 10 overall in 2011.

For more information:
- here's the Business Insider article
- read the Plain Dealer article

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