Healthcare Collaboration: The Experience at One Hospital

At Cleveland Clinic, a patient was asked to keep a journal of all the caregivers she saw over her five-day stay. She noted eight doctors, 60 nurses and so many others she lost track. The journal didn’t even track staff from non-clinical areas — food services, parking or billing. A May 2013 Harvard Business Review article by James I. Merlino and Ananth Raman reported on the Cleveland Clinic’s effort to get everyone in the organization to start thinking like a caregiver.

In 2010, all 43,000 employees at Cleveland Clinic participated in a mandated half-day exercise that cost $11 million. Eight to ten people were randomly assembled to meet with a trained facilitator. They shared stories about what they did and how they could do it better. They were trained in basic behaviors: introducing themselves to patients and other staff members, actively listening, building rapport by learning something personal about patients, and thanking them. A few physicians asked to be excused. Their request was refused. Non-physician staff realized they, too, impacted the patient experience and physicians who had been skeptical found the exercise worthwhile.

Cleveland Clinic undertook more action aimed at improving service including improving care coordination. A unit with the worst scores in a Centers for Medicare and Medicaid Services (CMS) satisfaction survey was chosen for a pilot. Several problems were discovered. For example, the case manager and social worker, the two employees critical to a smooth patient discharge process, didn’t like each other and rarely communicated. Weekly meetings forced communication among caregivers, even those they didn’t like. As a result of efforts like this, the unit CMS survey score went from one of the lowest in the organization to the highest — in less than a month.

According to CMS, the overall patient satisfaction for Cleveland Clinic has risen from 55% in 2008 to 92% in 2012 (approximately 4,600 hospitals were surveyed).

For more on healthcare collaboration, see Lessons in Healthcare Collaboration and Tools for Engaging Physicians.