Fluent Essays

Assignment 1: Executive Memo You are the CEO of a Healthcare organization. The patient satisfaction data, as measured by the Press-Ganey survey, shows most patients who have received care at your hospital would not recommend the facility to friends and family, and the patients’ overall rating of the organization is mediocre at best. Your top focus as CEO is to build a superior patient experience. Your Assignment: Based on your reading of the Service Fanatics textbook, including the best practices shared in the book, draft a 2-to-3-page Executive Memo, to be distributed to all staff and members of your organization.  Be sure your memo includes the following: 1. Clear and concise outline of the strategy for improving the patient experience 2. Tactics to be used to drive the strategy 3. Description of how all staff can participate in putting “Patients First” 4. Call to Action, with a Statement about how success will be measured Your assignment must follow these formatting requirements: • Typed, double-spaced, using Times New Roman font (size 12) with one-inch margins on all sides. • In place of a Cover page, provide the following Headings on Page 1 of your memo: · TO: Insert Professor’s Name · FROM: Insert Your Name · DATE: Insert Assignment’s Due Date · RE: It’s All About the Patient, Assignment 1 Note: The Headings page is not included in the required assignment page length. PLEASE FOLLOW THE GRADING RUBRIC AND FORMATTING INSTRUCTIONS GIVEN. NO PLAGIARISM, NO EXCEPTIONS. Praise for Service Fanatics “Service Fanatics will become the gold standard on patient- centered care. Cleveland Clinic in all its glory, like many of the rest of us in healthcare, had lost its way with compassion and empathy. Dr. James Merlino in his role as the Clinic’s Chief Experience Officer, along with CEO Toby Cosgrove and the rest of the healers at Cleveland Clinic, changed that by putting Patients First. Merlino’s description of this journey is at times painful, raw, and brutally honest. Service Fanatics and its author exude passion, humility, integrity, and caring. It will make any organization better and is a must-read for everyone in healthcare.” —David T. Feinberg, MD, president of UCLA Health System and CEO of UCLA Hospital System “Merlino gives a behind-the-scenes account of how Cleveland Clinic, traditionally known for medical excellence, transformed itself to put equal focus on the patient experience. It’s a fascinating story on its own merits, but it’s also the story of the future of healthcare. For all healthcare leaders who are (or those who soon will be) leading a similar transformation, this book will be an indispensable guide to the journey ahead.” —Dan Heath, coauthor of the New York Times bestsellers Made to Stick, Switch, and Decisive “This book is a candid recounting of Cleveland Clinic’s rocky, flawed journey toward creating world-class patient experience. James Merlino is painfully honest about the failures and mistakes along the way, even as he lays out a practical road map for change. This combination of candor, pragmatism, and hope is why Merlino has emerged as one of the most respected healthcare leaders in the country. Service Fanatics is invaluable for any hospital administrator determined to transform patient experience.” —Leah Binder, president and CEO of The Leapfrog Group “Driven by his experience as a family member, patient, and physician, Jim’s passion has created a movement to refocus the healthcare system’s design, process, and culture on the patient. With his colleagues at Cleveland Clinic, he has championed the effort to once again center care around the patient and has engaged healthcare leaders across the industry to embrace transparency in the spirit of improvement. Jim’s commitment to his patients and empathy for their journey resonates on every page of this book. When we reflect on the major transformation of the industry, history will show that Jim Merlino and Cleveland Clinic were at the forefront of returning our healthcare system to the patient and helping us return to the noble cause that drew us all to careers in healthcare.” —Pat Ryan, CEO of Press Ganey “It’s an important work by the leading voice in patient experience. It’s also a gripping personal narrative that changed my perspective on every doctor-patient interaction I’ve had in my life. … Service Fanatics is upfront about just how hard it is to change a culture so that it becomes truly customer-centric—then tells you how you can do it anyway. Merlino describes the challenges at Cleveland Clinic with an unsentimental eye, and he also provides detailed descriptions of what the leadership team did to overcome those challenges. … All in all, Service Fanatics is a great read that’s also making me smarter about patient experience. If only all business books could bring those two elements together.” —Harley Manning, Forrester.com “It is one thing for a leader to establish an organization-wide priority and quite another to achieve it. To many, Cleveland Clinic’s rapid improvement in patient satisfaction scores appears nearly miraculous. Dr. Merlino’s book offers a compelling and candid tale of how an already great hospital engaged its 43,000 employees to become even better. By detailing every step with candor and eloquence, this book explains precisely how the hospital achieved its gains—and, in so doing, offers invaluable lessons not only for healthcare leaders but also for anyone interested in how to achieve meaningful progress across any organization.” —Barbara R. Snyder, president of Case Western Reserve University “Anyone involved in healthcare will treasure Dr. Jim Merlino’s book because it provides a candid, poignant look at patient care from both provider and patient perspectives. The stories and lessons around empathy and compassion are inspirational and help us think more clearly about the importance of the overall patient experience.” —Kurt Newman, MD, president and CEO of Children’s National Health System “In this warts-and-all account, Jim Merlino describes how he and his Cleveland Clinic colleagues transformed a culture focused almost exclusively on clinical excellence into one that fully embraced the need to deliver a caring and empathic experience for people. In so doing, Merlino has created a comprehensive and methodical playbook for other http://www.forrester.com/ healthcare organizations seeking to fulfill the same paramount objective: putting patients first.” —Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation “The art and science of caring for others is remarkably highlighted in Dr. Merlino’s splendid Service Fanatics. This is a must-read for all leaders or aspiring leaders in the business of delivering professional services. Dr. Merlino and his Cleveland Clinic colleagues get i t!” —Marc Byrnes, chairman of Oswald Companies “Cleveland Clinic is a great example of what healthcare should embody—full service to each and every patient. I’ve seen what their work and commitment have done, with a very important member of my family, my brother, and it’s fantastic. Every medical venue should emulate their facilities as well as their superb and comprehensive services. Keep up the great work.” —Donald J. Trump Copyright © 2015 by James Merlino. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 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Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. For my father, who showed me the other side To Amy, for her unwavering support To Toby and Joe, for never saying no and never doubting Contents Foreword Preface Acknowledgments Chapter 1 Transformed by the Patient Experience Chapter 2 Patients First as True North Chapter 3 Leading for Change Chapter 4 Describing the Elephant: Defining the Patient Experience and Strategy Chapter 5 Culture Is Critical Chapter 6 Cultural Alignment: The Cleveland Clinic Experience Chapter 7 Physician Involvement Is Vital Chapter 8 Want to Know What Patients Think? Ask! Chapter 9 Execution Is Everything Chapter 10 Healthcare Requires Service Excellence Chapter 11 Doctors Need to Communicate Better Chapter 12 Making Patients Our Partners Chapter 13 Getting It Done Has Defined Our Success Epilogue: We Have a Responsibility to Lead Notes Index I Foreword I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel. —MAYA ANGELOU n 2004, acclaimed heart surgeon Dr. Delos “Toby” M. Cosgrove became the CEO of Cleveland Clinic, an institution known for innovation and excellence in patient outcomes. As he transitioned from surgery to strategy, he was invited to speak to Harvard Business School students about the Cleveland Clinic model of care. During that address, he was challenged by a student who asked whether he taught empathy for patients at Cleveland Clinic. It is a story that Toby has shared over the years as a defining moment in his strategic thinking. Patients go home from the Clinic “well,” but do they feel well cared for? The seed and the stake were planted for Patients First, Cleveland Clinic’s defining purpose. I am on the board of the Clinic, and Toby asked me to translate my business credentials in customer experience to help the Clinic with the patient experience by chairing a board-level committee on patient safety, quality, and experience and to work with the new chief experience officer, Dr. Jim Merlino. In my role as then vice chairman of community banking at KeyBank, I had embarked on a similar journey—to differentiate through the customer experience by putting the customer at the center of everything we do. Jim Merlino is a rising star, whose passion for the patient is rooted in an experience with his ailing father, where he found himself on the “other side” of medical practices and outcomes. In the early days, Jim and I would meet to discuss ways to institutionalize the Clinic’s nascent efforts in patient experience. The principles I had developed in banking on how to drive change and customer experience were relevant, but being involved in Cleveland Clinic’s transformation around the patient opened my eyes and upped my game as well. And in the process of working together, Jim and I became friends. Jim had no clear starting point and no clear definition of success. There were no playbooks or manuals on what to do. He launched a methodical internal and external process to learn best practices from a variety of industries, as well as understand and determine what success would look like for Cleveland Clinic. It takes leadership to set the tone and to set aspirational goals for an institution. Together, Toby and Jim created the processes for organizational change and required and empowered all the employees of the Clinic—from physicians to service workers—to become caregivers. With no guidebook on how to take Patients First from aspirational goal to operational reality, the Clinic embarked on a journey of trial and error, success and failure, until the aspiration became a strategy and tactics were developed that allowed the Clinic to implement world-class patient experience. Service Fanatics is a testament to Jim’s passion and work, but also to Toby Cosgrove and Cleveland Clinic. A senior leader of another hospital once said, “We can’t all be Cleveland Clinic.” To which Jim responds, “Yes, you can.” Service Fanatics shows you how. It is the road map, rich with stories and examples, as well as tools and insights to operationalize the patient experience. Improving the patient experience is not only the right thing to do; it is an imperative in the changing world of regulation and law in American healthcare. But its message and content transcend healthcare. Service Fanatics provides pragmatic lessons and actionable takeaways for business professionals in many industries—mine included. In an era of content overload, it is a compelling and valuable read. Beth E. Mooney Chairman and CEO KeyCorp D Preface ana Bernstein is a smart, energetic, beautiful 25- year-old woman out to conquer the world. She enchants everyone she meets. Dana is also an expert in understanding the world of healthcare: expert not because she’s on the provider or delivery side of healthcare, but expert because she’s lived on the patient side since she was three. In the past 22 years, Dana has had more interactions with doctors and nurses, more admissions to hospitals, and more procedures than most people have in a lifetime. What gives Dana her expert credentials is a battle with Crohn’s disease, 1 one of the two major bowel diseases characterized by inflammation, or in layman’s terms, significant irritation and erosion of the bowel lining and walls. It’s a disease in which the body’s immune system essentially attacks its own organs. An estimated 1.4 million in the United States suffer from inflammatory bowel disease. 2 Not many are familiar with it, and there is no known cause or cure. Crohn’s disease represents a terrifying spectrum of possibilities. Some can live their entire lives with only very minor manifestations of it, while others develop significant, frequently recurrent, episodes involving the constant use of medications, multiple surgical procedures, and potential loss of the entire intestine, necessitating a small bowel transplant. Crohn’s can affect any part of the intestinal tract and can lead to significant problems in just about every major organ system. Dana lives at the extreme end of the spectrum. Since her diagnosis, she’s had multiple operations and innumerable hospital admissions and procedures. If you sat and talked with her, you’d believe she’s no different from anyone else her age. But if she shared her struggle with Crohn’s, you’d learn that she has little of her intestines left, uses an ostomy, and receives daily nutritional support through a catheter threaded into her chest. Dana also struggles with managing chronic pain caused by extensive inflammation and the significant scarring from multiple surgeries. She’s facing the possibility of a small bowel transplant, which is a daunting procedure. It will put her life in jeopardy, and she’ll need more than just expert medical care to get through it. By her own admission, Dana is not an undemanding patient. Aside from the complexities of her disease, she is very much the captain of her body. She and her mother, Cari Marshall, probably know as much about Crohn’s disease as many of the physicians who’ve provided Dana’s care, and Cari has dedicated her life to helping Dana fight her disease. Dana is an activated patient who’s not afraid to be her own advocate. She and her mother don’t just want information to make a decision; they want to be involved in how and why decisions are made. But Dana also wants something more, and that’s the reason she travels 2,000 miles for healthcare, while there may be experts who could treat her closer to home in Las Vegas. Dana wants her physician to be someone not only who is at the top of his field, but who brings compassion and humility to his work. She found that combination in Dr. Feza Remzi, chair of the Department of Colorectal Surgery at Cleveland Clinic. In Dana’s words, “I know I’m a tough patient, but I’ve been through a lot and know what works for me and what doesn’t. I often feel when I challenge doctors, they don’t want to engage and have a serious conversation with me about what’s going on.” She believes that Remzi cares for her as a patient, but also treats her like a friend. “He cares for me—I can feel it in the way he talks to me and the way he treats me,” she says. “He actually yells at me sometimes, but that shows he cares.” Does considering a patient a friend cloud a doctor’s judgment and objectivity? “Absolutely not!” explains Remzi. “I’m her physician and surgeon first, but is it too much for me to care for her as a person?” Remzi explains how this brings more to the table: “If caregivers feel personally engaged, they will be sharper and more in the moment.” As a physician, he knows the boundaries. “I’ll never compromise what’s right for her care, but I’ll always see myself as her partner and advocate in helping her to conquer this terrible disease. We are friends in the foxhole together. I have her back, and she helps me be a better doctor—she keeps me sharp.” 3 Remzi provides Dana with medical advice and treatment, but he also helps guide her and her family through the right decisions. Dana’s mother describes Remzi as one of the most compassionate and caring people she has ever met, saying, “His empathy is real!” The family’s trust and confidence in Remzi’s medical ability is bolstered by his concern for Dana as a person, not just as a patient. Is it truly possible to expect both high professional competency and compassionate care with a human connection? I had the honor of being a guest speaker at an advanced executive leadership course at Harvard Business School when we discussed this very question as part of a Cleveland Clinic case study. We were considering the patient experience, how it factored into the treatment of patients and whether there could be a financial return on investment to help drive these concepts across an organization. I posed a dilemma to the students: You’re a patient needing heart surgery and have the choice of two surgeons. One is absolutely the best in the world by every measurable objective outcome, but she is mean and doesn’t communicate well with patients or their families. She’s a true technocrat who has no empathy or humanism. Your other choice is a surgeon renowned for compassion and empathy, but his outcomes, while within the standard of care, by reputation are not quite as good as the other surgeon’s. Whom would you want to do your surgery? Interestingly, the students were about equally divided in their choice. Some said they didn’t care whether the surgeon ever talked to them, as long as the operation was a success with a great outcome. Others took what I call the more “humanistic” perspective: they wanted someone to care for them as a person as well as perform a competent operation, arguing that if the compassionate surgeon’s outcomes were within the standard of care, that was good enough. As a surgeon who has seen excellent, marginal, and poor surgeons up close, I used to believe that technical proficiency was the most important element of surgical care and that if I ever needed an operation, I would surely choose technical prowess over everything else, including whether the doctor talked to me. I have seen very nice and empathetic but technically challenged surgeons navigate terrible complications and avert liability by building strong connections with patients and families. This illustrates a fact that’s often revealed in malpractice litigation: Doctors don’t get sued because they are incompetent. They get sued because they don’t communicate or build relationships with patients and families. I wonder how the Harvard students would have responded if my colleague Shannon Philips, Cleveland Clinic’s quality and safety officer, had first educated them about the culture of safety. Technically proficient but disruptive physicians actually create an environment that is unsafe and stifle other caregivers from stepping forward to protect patients. These physicians can actually have worse outcomes because they foster a culture of fear. I suspect the students who favored the technocrat might have reconsidered. Being on the other side of healthcare, both as a patient and as a family member of a patient, changed my beliefs about what I want from a physician. Patients deserve—and should demand—a physician who is medically competent as well as empathetic and compassionate. I also believe that as healthcare leaders responsible for safeguarding quality medical delivery, we should work hard to ensure that we provide both. Brian Bolwell, chair of Cleveland Clinic Taussig Cancer Institute, is, like Remzi, among the smartest physicians I know, and also a caring and compassionate human being. I was in his office one day, and he seemed subdued. I asked what was wrong, and he said, “A young woman I took care of for a long time just died. It’s impossible not to be sad.” She was not merely a patient to him; he knew about her life, shared a journey with her, and cared about her. If I am ever diagnosed with a terrible disease, I want physicians like Remzi and Bolwell to care for me. I want to have a connection with the persons treating me. I want to know that they care about me personally, that they are as invested in my recovery as I am. Yes, I demand that they be competent and objective, but I want to know that they will be there with me and for me. I don’t want some brilliant technocrat to just perform a procedure and walk away without an afterthought as to how I will get back to my life. I want my doctors to know something about me as a person, listen to what I think, and understand that outside the hospital I have a life, a family, and friends. Why is this important? I want my doctors and other caregivers invested personally in my outcome. Empathetic care that transcends the human condition is what I aim to provide to my patients and is the standard we should all expect for ourselves as patients. A personal investment in empathy and compassion by all caregivers is the foundation of the future for healthcare. We must align our organizations and people around patients and how we deliver care to them. A focus on the patient experience has become a differentiator for Cleveland Clinic. Dana travels 2,000 miles for high-quality care and high-quality caring at our institution. Our alignment around the patient impacts everything we do, not only improving patient satisfaction, but ultimately enhancing our delivery of safe, high-quality care and high value. Any healthcare system in the world can and should adopt putting patients first as its primary purpose. When we began our patient experience journey, there was no textbook or playbook telling us how to start. The healthcare scholarship doesn’t often consider the competency of how to deliver care. Trial and error became our modus operandi. We created our own strategies and tactics, adopted some from others, and applied lessons from businesses outside healthcare. Our approach has been based on living the challenges at the front lines of a diversified and heterogeneous healthcare system with incredible patient needs and demands. Our physician champions, including me, still see patients. Our nurse champions are at the patients’ bedside. This frontline involvement and commitment is one of the reasons we’ve been successful. You cannot fix the patient experience from a 50,000-foot strategic perspective; most of the work must be operationalized at the patient touch points and carried out by frontline caregivers. From a practical standpoint, improvement required us to frame a strategy concisely and then focus on key elements that allowed us to implement it. Everything patients—and their families—see, do, and touch is considered by us as the patient experience. This book focuses on how to think about the patient experience, how to define it, and the factors we feel are critical to enhance it. Improving patient-centeredness also impacts how we deliver safety and quality. These are important not just for patients, but for caregivers as well. In the subsequent chapters, I describe how Cleveland Clinic’s leadership determined to make the patient experience a priority, defined it, and set a strategy for improving it. I discuss the foundational elements of culture, physician involvement, and understanding patients. I share our execution successes and failures, including how we organize, recruit, train, and measure for service excellence; how Cleveland Clinic has evolved its culture and aligned its workforce around Patients First; and how we improved the critical element of physician communication. I convey my beliefs and experiences regarding cutting-edge issues such as making patients our partners in ensuring a quality experience and sharing approaches with caregivers worldwide so that patients everywhere can hope to receive better care. I have written about Cleveland Clinic’s journey because we have made a difference and our approach is working. It is just one of many possible approaches, and you may find that it can help your organization. And just as we have learned from a variety of different businesses outside of healthcare, I believe that our strategy and many tactics hold lessons for other businesses as well. Aligning a workforce around the customer is applicable to any business that has customers, which is every business. No doubt some reading this book will look at parts of our organization and say that our approach is not functioning as well as we think. Improving the patient experience is hard work, and we still have a lot to do. But just as Cleveland Clinic historically has had relentless focus on medical excellence, there’s no question that we now pair that with a relentless focus on improving the patient experience. We have gone from being among the lowest-rated hospitals in the country for patient experience metrics to among the highest. This book is not meant to be a comprehensive resource for every patient experience tool available or a technical manual of all that we do. I discuss our strategy and many of our tactics, and I describe some of the roadblocks we encountered. If you peer under the hood of our organization, we look like most other healthcare systems—perhaps even like yours. We have the same needs and challenges, and we all face an uncertain future. There are some elements unique to our journey that have granted us unusual success. Cleveland Clinic’s appetite for innovation allowed this program to gain hold and flourish, giving us a head start. But at the time we began, external pressures were not as intense. Today, the forces pushing hospitals to get better are much stronger, so this should help others gain the foothold they need to climb the path of improvement. It’s my hope that you will find something in this book that can help your organization. Perhaps the book will reinforce that you are on the right path and provide you with a reassuring pat on the back. My goal is simple. If you deliver healthcare, you must think about how to align your organization around the patient. In such an environment, Remzi, Bolwell, and millions of other caregivers throughout the world can deliver high professional competency and compassionate care with a human connection. It is what patients like Dana Bernstein … Assignment 1: Executive Memo Due Sunday, midnight of Week 3 You are the CEO of a Healthcare organization. The patient satisfaction data, as measured by the Press-Ganey survey, shows most patients who have received care at your hospital would not recommend the facility to friends and family, and the patients’ overall rating of the organization is mediocre at best. Your top focus as CEO is to build a superior patient experience. Your Assignment: Based on your reading of the Service Fanatics textbook, including the best practices shared in the book, draft a 2-to-3-page Executive Memo, to be distributed to all staff and members of your organization. Be sure your memo includes the following: 1. Clear and concise outline of the strategy for improving the patient experience 2. Tactics to be used to drive the strategy 3. Description of how all staff can participate in putting “Patients First” 4. Call to Action, with a Statement about how success will be measured Your assignment must follow these formatting requirements: • Typed, double-spaced, using Times New Roman font (size 12) with one-inch margins on all sides. • In place of a Cover page, provide the following Headings on Page 1 of your memo: · TO: Insert Professor’s Name · FROM: Insert Your Name · DATE: Insert Assignment’s Due Date · RE: It’s All About the Patient, Assignment 1 Note: The Headings page is not included in the required assignment page length. RUBRIC - Assignment 1: Executive Memo Criteria Unsatisfactory Low Pass Pass High Pass Honors 1. Articulate a clear and concise strategy for improving the patient experience. Weight: 20% Does not articulate a strategy for improving patient experience. Does not justify the strategy. Not at all clear and concise. Partially articulates a strategy for improving patient experience. Partially justified the strategy. Not fully clear and concise. Satisfactorily articulates a strategy for improving patient experience. Satisfactorily justified the strategy. Clear and concise. Presents a well-articulated strategy for improving patient experience. Justifies the strategy. Very clear and concise. Thoroughly articulates a strategy for improving patient experience and thoroughly justifies the strategy. Excellent level of clarity and conciseness. 2. Describe strategic tactics for improving the patient experience. Weight: 20% Does not describe the strategic tactics for improving the patient experience. Partially describes the strategic tactics for improving the patient experience. Satisfactorily describes the strategic tactics for improving the patient experience. Describes well the strategic tactics for improving the patient experience. Clear and concise. Thoroughly and succinctly describes the strategic tactics for improving the patient experience. Clear and concise 3. Provide a statement about how all staff can participate in putting “Patients First”. Weight: 20% Does not provide a statement of how all staff can participate in putting “Patients First”. Partially provides a statement of how all staff can participate in putting “Patients First”. Satisfactorily provides a statement of how all staff can participate in putting “Patients First”. Well-formulated statement of how all staff can participate in putting “Patients First”. Clear and concise statement. Thoroughly and completely formulated statement of how all staff can participate in putting “Patients First”. Clear, concise, and actionable. 4. Provide a call to action, and state how success will be measured. Weight: 20% Does not provide a call to action. Missing or incomplete statement of how success will be measured. Partially provides a call to action. Partially provides a statement of how success will be measured. Satisfactorily provides a call to action. Short statement as to how success will be measured. Well-expressed call to action. Clear and concise statement about how success will be measured. Thoroughly and completely provides a call to action. Clear and concise statement of how success will be measured. 5. Clarity, Logic, Writing Mechanics, Grammar, and Formatting. Weight: 20% Multiple mechanical errors: much of the text is difficult to understand or the text does not flow; memo fails to follow formatting instructions. Mechanical errors make the text difficult for the reader to understand; text does not flow; memo includes unsupported conclusions and assertions. Some mechanical errors: text flow is satisfactory; memo is mostly clear; assertions and conclusions are generally justified and explained. Few mechanical errors; text flows well; memo clearly expresses the student’s position in a manner that logically develops the topics. Minimal minor mechanical errors; text flows very well; memo clearly expresses the student’s position in an exemplary manner that logically develops the topics.