Physician-Focused Improvement in Patient Satisfaction at the Cleveland Clinic

Rosemary Frei, MSc

November 2013, Vol 4, No 9 - Patient Communication

Phoenix, AZ—The degree of patient satisfaction with healthcare is becoming paramount in the new era of value-based care, according to James Merlino, MD, Chief Experience Officer, and Associate Chief of Staff, Patient Experience Office, Cleveland Clinic Health System (CCHS), OH, who discussed high-value healthcare at the American Medical Group Association 2013 Institute for Quality Leadership conference.

Dr Merlino said that the proliferation of ratings by government agencies and internet sites of physicians’ outcomes, behavior, and interactions with patients is here to stay, and institutions would therefore do well to understand the importance of positive patient interactions.

“Hospital leaders need to ‘create the burning platform’ and to inform physicians that they will be increasingly held accountable for their actions around outcomes, behavior, complaint, and patient-experience metrics, and provide them with information on how to be successful at the human side of healthcare,” Dr Merlino told Value-Based Cancer Care. “At our organization, we expect physicians to develop good relationships with patients and communicate well with both patients and other members of the healthcare team, primarily nurses.”

A 12-member Physician Conduct Committee is in place at the Cleveland Clinic. The committee “conducts comprehensive and fair evaluations of reported incidents” of disruptive behavior, said Robert W. Coulton, Jr, MD, MBA, Executive Director of the CCHS’s Office of Professional State Affairs. It “encourages employees to come forward with concerns,” but it is “not intended to restrict healthy criticism [that has] the intention of improving patient care,” Dr Coulton noted.

A total of 80 complaints have been filed in the 3 years since the committee was set up; 35% did not reach the level of an incident. Having the committee in place has been “viewed as overwhelmingly positive by both physician staff and employees,” Dr Coulton said.

Communicating with Patients
A very effective way members of the CCHS have staved off a proliferation of complaints has been an emphasis on communication-skills training, explained Adrienne Boissy, MD, MA, Medical Director, Center of Excellence in Healthcare Communication, CCHS. Approximately half of the responses to the question on the Hospital Consumer Assessment of Healthcare Providers and Systems are negative comments, whereas 43% are positive, and 8% are mixed, noted Dr Boissy.

It has also been documented that physicians who are given only “fair” or “poor”/“very poor” ratings by patients are disproportionately sued and lose those cases in court.

“Just because a clinician knows that he or she cares or is trying to be caring, it doesn’t matter,” Dr Boissy told Value-Based Cancer Care. “What matters is his or her ability to communicate this verbally and whether the patient walks away feeling it.”

The Center of Excellence in Health­care Communication has been using a 4-pronged program since 2011 to help physicians achieve this, including a communication course for groups of 10 to 12 physicians, one-on-one coaching, faculty development, and research on other ways to optimize provider–patient communication.

Immediately after this 4-pronged approach was implemented, the CCHS’s outpatient surveys and physician-communication ratings by the Centers for Medicare & Medicaid Services skyrocketed, and the CCHS now stands above many other major hospitals in the country, concluded Dr Boissy.
“Everyone can change something, and in aggregate, this makes a significant difference,” she said.