Cleveland Clinic shares its patient experience secret

For the fourth consecutive year, the renowned Cleveland Clinic participated in the annual Cayman Islands Healthcare Conference in November, but most of the 700 attendees did not see the presentation they gave during their visit.  

Instead, the Clinic’s representatives spoke to a specific audience the day before the conference began. 

“We were asked to do a special presentation on patient experience for [Cayman’s Health Services Authority],” said Dr. James Merlino, the chief experience officer of the Cleveland Clinic and author of the book “Service Fanatics.” 

Only a decade ago, the words “patient experience” had little meaning in terms of a healthcare delivery strategy and even if they did, few would have wanted to hear what the Cleveland Clinic had to say on the subject. Although it’s always been known for the quality of its clinical outcomes, the Cleveland Clinic at one time ranked among the lowest in the United States in terms of the manner in which its doctors and other staff delivered those clinical successes. 

Rob Stall, the executive director of Cleveland Clinic’s international operations who joined Dr. Merlino on his visit to Grand Cayman, said that the attitude of staff basically was “we know what’s best for you; take it.” 

“That’s not what patients want,” he said. 


‘Patients First’  

The staff attitude at the Cleveland Clinic changed as a result of a ‘Patients First’ strategy directive by its CEO, Dr. Toby Cosgrove, who took over the helm of the institution in 2004 and noticed that the hospital had lost its patient-centricity, Dr. Merlino said. Moving forward with the idea that the patient is the most important person in the organization, Dr. Cosgrove coined the term “patients first” and created a clear-cut purpose for all of the hospital’s employees, starting with the people who clean the floors and going right up to the specialist doctors. 

“Everybody knew the reason they came to work was the patients, and he made the “patients first” initiative a strategic priority,” said Dr. Merlino. 



Successfully implementing the patients first strategy required a significant culture change within the organization, and that required buy-in from the employees. The Cleveland Clinic has eight hospitals and 15 community health centers in northeast Ohio, as well as clinics or hospitals in Florida, Toronto, Las Vegas and Abu Dhabi, and the idea was to have all 43,000 of its employees, including 3,200 physicians, on the same page. This required a major investment in training. 

A four-hour group training session called “The Cleveland Clinic Experience” was developed, and all employees were required to attend. To encourage engagement in the training sessions, and thus increase the likelihood of learning retention, the groups were kept small and a visual training aid, dubbed a “learning map,” was developed to stimulate the dialogue in the small groups. 

In order for the attendees to understand that what was being asked of them was a company-wide initiative, the groups were structured so that the occupations of the employees were mixed up, Mr. Stall said. 

“Physicians were sitting with people who clean, sitting with security officers, sitting with nurses,” he said. 

Dr. Merlino said there were early adopters of the initiative who accepted it right away, but there were also those who resisted. 

“One of the things that helped was everyone had to do [the training],” he said, adding that healthcare delivery today is “inherently team-based,” which also helped win over the resisters.  

To demonstrate that the initiative wasn’t only a one-off training session, the Cleveland Clinic also established a strategy to increase employee engagement at all times.  

One aspect of the employee engagement strategy is “leadership rounds,” in which managers and executives from many different departments walk around the hospital to visit with patients and talk to staff to get a better sense of how the hospital is operating and the perceptions of those on the front lines. 

The Cleveland Clinic was also the first major healthcare organization to establish the chief experience officer position in order to bring about a cohesive approach to the patient experience strategy. Dr. Merlino became the second chief experience officer at Cleveland Clinic in 2009, and he was the one who was effectively given the responsibility of executing a strategy which, at that point, existed only on paper. 

The measurable results of implementing the “Patients First” initiative show that in just six years the Cleveland Clinic went from having some of the lowest patient experience rankings in the country to some of the highest. The overall ranking of its main campus in Cleveland has gone from the 34th percentile in 2008 to the 92nd percentile in 2014; nurse communication rose from the 16th percentile to the 79th percentile during the same period; and cleanliness increased from a dismal 5th percentile to 80th percentile over those six years. 

However, Dr. Merlino said, the improvement he is most proud of is in doctor communication, which went from the 14th percentile to the 67th percentile at the main campus between 2008 and May 2014. 

Because patients come from all over the world to seek care at the Cleveland Clinic, Dr. Merlino has stressed that every employee is an ambassador for the clinic, so when patients have good experiences, they will go home and tell others, something that is good for the organization. 

“In addition to that, it’s the right thing to do,” 

Cayman connection  

Although it has participated in the Healthcare Conference here since 2011, the Cleveland Clinic has had an association with the Cayman Islands and its hospitals and physicians for many years. That association includes referrals from local doctors and advice. 

Dr. Merlino said the aim is to create partnerships with the doctors here, not take patients away from them. 

“We don’t want them to send people to us for things they can do here,” he said.  

Over the years, many Cayman Islands residents have traveled to the Cleveland Clinic, particularly the one in Weston, Florida. In his book “Service Fanatics,” Dr. Merlino writes about one such patient, the mother of current Health Minister Osbourne Bodden. He writes that when he came for the 2013 conference, he was invited to speak about patient experience at a small dinner with a group of businessmen, including Mr. Bodden. During the dinner, he wrote, Mr. Bodden told him about how some years ago his mother, fearing she had cancer, went to the Cleveland Clinic for diagnostic tests. Understanding his mother’s fear, Mr. Bodden asked the doctor to approach the subject gingerly when breaking the news about the diagnosis. Instead, the doctor blurted out, “You have cancer, and we have to start treatment immediately.” 

Mr. Bodden told Dr. Merlino that after that, his mother left the hospital and never came back, seeking treatment in Cuba, where she felt the doctors treated her more like a person. 

Dr. Merlino said that the “Patients First” strategy is designed to make sure that all employees of the Cleveland Clinic keep sight of the fact that they’re dealing with people and families. 

“‘Patients First’ is more than just words,” he said. “What ‘patients first’ means is that you’re a caregiver.” 

Dr. Merlino said he stresses to staff that the manner in which healthcare is delivered affects everybody, and that everyone is going to be patient one day. 

“We’re all in this together,” he said. “Frankly, that should have been the focus on healthcare a long time ago.”