Patient experience affects us all: Q&A with Cleveland Clinic CXO Dr. James Merlino

At some point in life, everyone will be a patient — and that reason alone is why improving patient experience should be the focus of hospitals and health systems nationwide.

This is something James Merlino, MD, the chief patient experience officer at Cleveland Clinic, experienced first-hand years ago when his father was hospitalized, experienced post-operative complications and later died. He opens up about it in his new book, "Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way" (McGraw-Hill Education, 2014).

In the book, which is educational but written in a conversational tone, Dr. Merlino shares how he became passionate about improving patient experience and provides real life examples from Cleveland Clinic's own patient experience transformation, led by Dr. Merlino and the Clinic's CEO, Toby Cosgrove, MD.

Here, Dr. Merlino discusses points from the book in greater detail and shares tips for other healthcare leaders hoping to make a positive impact on patient experience in their organizations.

Question: In the book, you said part of being a CXO is keeping "plenty of gasoline around to fuel the fire" of a burning platform — but how do you keep the burning platform alive even when experience scores have improved?

Dr. James Merlino: The biggest challenge we have is sustainability. There are always opportunities to improve. The way I see it, you're never perfect. There will be things that happen that aren't good for patients. So you have to keep the story in front of the leaders. Use data a lot and push it down to different levels of the organization. Use anecdotes, stories and letters from patients. Share good things, but also things that are opportunities for improvement.

It's also important to constantly remind people that we're all in this together — just because we work in healthcare doesn't mean we're different, because at the end of the day we will all be patients someday. People hear the stories and recognize that this could be them or their family member. Be relentless about keeping this in front of people.

Q: Though healthcare leaders talk a lot about improving "patient experience," we lack an encompassing definition of the term, which you address in the book. How did you work through that problem at Cleveland Clinic, and how can other systems do the same?

JM: it is very important to frame the definition around how it integrates in patient care so that people don't view patient experience as just patient satisfaction or a standalone issue. At Cleveland Clinic, we framed it so it was always about safety first. Then quality, and an environment that's patient-centered. That is the patient experience. How you operationalize that is how it impacts patients.

It's important that you have a definition that patients understand. To patients, the experience is everything, so hospitals should set the expectations for how patients should think about it. If we don't do that, patients will define it based on what they think is important. We're in a service industry where the customer is not always right, so we need to make sure they understand why things are happening. Like if we tell them to get out of bed after surgery and they don't want to, explain that they have to because it impacts quality and outcomes. If I don't have a discussion with them, they will define their experience based on that I did something they didn't like and they'll be unhappy about.

Q: That's interesting, that you have to have the patient understand the definition as well.

JM: I think it's important. People tend to forget about the role of the patient in all of this. We educate them on their illness and disease management, but not what it means to be a patient and why we do certain things. It is a critically important missed opportunity that we have to take advantage of.

Q: You wrote candidly about how some of the changes made at Cleveland Clinic weren't popular with physicians and also discussed some failed initiatives. Why did you feel it was important to include the less-successful initiatives in the book?

JM: I think that's the real world. People tend to talk and write about things that are very successful, and things that didn't go so well get pushed aside. People want to highlight what was working. But when you're teaching people how to think about doing something, especially when working on a new topic like patient experience, you have to give people examples of things that didn't go so well — painful lessons — so they can learn from it. It's honest dialogue.

Q: It seems you worked not only with leaders from other health systems but organizations from other industries as well as you worked to improve patient experience at Cleveland Clinic. What can healthcare leaders learn about patient experience from other industry leaders?

JM: I think we tend to be very siloed in healthcare, both in the industry and within an organization. But looking at others in our industry, even our competitors, is important. Things that people are doing that are good that are applicable to my environment, things you want to use. Those things should be shared and recognized as successful.

I think it's important to recognize that organizations do a lot of great things out there. We look around everywhere and ask, does that have applicability to what I do? That's something that Toby Cosgrove is notorious for, looking across all environments for opportunities that could possibly impact healthcare.

Q: Did you find your competitors were forthcoming with information and willing to talk?

JM: I think people are more than willing to share; they're flattered that you're asking. As we became much more successful at this, our willingness to share was met with open arms as well. They were surprised we were willing to talk about it. Now we have a constant trail of people through the Clinic who want to talk about patient experience. We love to share what we're doing, and we have benefitted greatly at looking at what others are doing.

Q: If you could distill all of the lessons in the book down to one key takeaway, what would it be?

JM: I think it is that at the end of the day, there's a need to be focused on this because it's the right thing to do and will impact all of us. It's important not because we work in healthcare, but it is how we and our family will be treated. It's critically important to recognize that patient experience directly impacts all of us.

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