Toby Cosgrove reveals the secret to Cleveland Clinic's care delivery transformation

Despite its challenges with hand-hygiene compliance and doctor-patient communication, Cleveland Clinic has had tremendous success with accountable care and improving patient safety and care access, according to CEO Toby Cosgrove, M.D., who spoke Friday at the sixth annual National ACO Summit in the District of Columbia.

The clinic launched its accountable care organization this year, integrating primary and specialty care, which "yields quality, safety and affordability," he said. The ACO, which includes about 5,000 quality physicians covering 60,000 Medicare patients, has already shown promising results, he said, with all quality measures above the 50th percentile.

Part of the secret of the organization's success is its use of distinct measures for all of its goals, Cosgrove said, from emergency department wait times to employee weight loss under its wellness program. "Physicians are an incredibly data-driven group," he said, "and if you want to make a change, you present the data and that makes the case for you."

For example, Cleveland Clinic is committed to improving care access so that patients can see a provider "anytime, anywhere"  whether in a hospital, ER or walk-in clinic. Using the "split-flow" model--a variation on triage in which nurses redirect patients to one of two areas depending on the severity of their conditions--the clinic's average ED wait times are down to 13 minutes, Cosgrove said. The clinic also makes same-day appointments for 98 percent of people who request one. 

Cosgrove is also proud of the organization's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores, which improved across all campuses, In five years, he said, the clinic went from last place to first in HCAHPS scores for hospitals with more than 1,000 beds. 

But Cosgrove admits that the organization still has its challenges. For example, he said, lack of doctor communication remains the most common patient complaint, leading the clinic to implement mandatory communication courses.

And, he lamented that he "cannot believe I can't get everyone to wash their hands every time." To improve hand-hygiene compliance, he said, the organization has added electronic hand-washing alert systems at the door of each patient room. It also implemented the "snap system," which encourages employees to snap their fingers to remind one another to wash their hands. 

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