Cleveland Clinic & Patients First

1. Value for patients seems to always have been at the heart (no pun intended) of Cleveland Clinic’s objectives. It began almost 100 years based on the principles of cooperation, compassion and innovation. Everything they’ve done since then has seemingly kept this in mind and they also implemented strategies for perpetual growth. One example of this involved becoming the most frequent provider coronary artery bypass operations (1970’s) while at the same time becoming the first patient outcome registry where they would contact patients, at home, post-surgery to see how they were doing. This commitment to quality continued through the early 2000’s when they adopted a focus on evidence-based practices (who would have thought). This also coincidentally aligned with their goals of growth in helping to provide compliance for reasons of accreditation.

The year 2004 also showed to be a pivotal moment in the company with their development of the motto “Patients First”. At the heart of this was creating an atmosphere of multi-disciplinary teams amongst all the different medical disciplines in the Clinic, “upsetting traditional organizational hierarchies”. Different institutes were created under the umbrella of Cleveland Clinic with this multi-disciplinary approach at the heart of it. The idea of evidence-base approach continued in this as the Clinic’s head, Dr. Delos Cosgrove, implemented measurements for improving “structures, processes and outcomes”. The Clinic also invested heavily in information technology to help in these measurements and allow patients full transparency of their medical records.

2. Measurable results showing that the policies Cleveland Clinic have in place are having success. They improved in overall satisfaction from the 55th percentile in 2008 to the 92nd percentile in 2012. Components of this include an increase in room cleanliness from the 4th percentile in 2008 to the 71st percentile in 2012, as well as drastic improvements in nurses’ communication, doctors’ communication, communication about medication, pain management, staff responsiveness and discharge information; all respectively from 2008 to 2012.

3. I have a dose of skepticism (healthy, I hope) regarding the transformation to “patient first”. As the health care industry has a strong component of capitalism at its core with a willingness to participate in already questionable lobbying engagements, the entities that are changing to this motto would just be following along the lines of the “customer first” in any normal service industry. I suppose though any consideration of the patient (or customer) is better than none. Initially, I was put off in knowing that Cleveland Clinic doctors were still making equivalent compensations to that of their equals in other clinics, hospitals, etc. If their overall plan was to keep costs as low as possible for the customer, why are compensating at such an amount.  Unfortunately, the inefficiencies in the healthcare market have led to exorbitant costs in medicine, procedure, equipment, etc. which probably forces Cleveland Clinic into having to pay such salaries.  If they don’t, they wouldn’t be able to attract the doctors to provide the necessary care to their patients. Hearing that they charge at Medicare rates provided some balance. If more clinics adopted such a non-profit approach as the Cleveland Clinic, that might represent progress for me. 

However, as long as for-profit systems exist in health care, it will continual to be an uphill climb against patients receiving the short end of the stick in terms of costs, no matter how its dressed up. Cutting into such inefficiencies and costs, it does give hope to hear of technologies such as Blockchain that could revolutionize how EHR’s are kept, among other processes in the healthcare industry. Additionally, hearing of how discussion boards allowing common patients to communicate, (e.g., e-patient Dave) also give hope. Like any change, or revolution, it has to come from the people. Hearing the voices we’ve heard thus far into the semester provides hope that systemic issues in healthcare can be ransacked, reversed, reinvented, reformed, and given an appropriate Rx.