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

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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.