"We made it more abstract. The idea being, let's just tell our people that anything that affects the patient outside the delivery of medical care is patient experience."
Not that they don't strive to do well on metrics like HCAHPS and other patient experience measures, but Merlino says he wants to avoid a "teaching to the test" mentality that may result from an exclusive focus on how the hospital system performs on measures that might affect reimbursement.
Rather, a more holistic approach is needed to fully incorporate the core idea of patient experience—that one bad experience can ruin the whole effort. By focusing exclusively on measures that are on the HCAHPS survey, essentially, you're missing both the ethical obligation to do best for the patient at all times, as well as the potential long-term benefits of patient loyalty.
"One bad interaction can define the impression," he says. "This is well documented in retail and other service businesses."
So how does one begin to incorporate accountability and responsibility for a patient's experience throughout the institution?
In stages, he says.
HCAHPS' focusing role
At the beginning, despite his misgivings, Merlino did focus on HCAHPS scores. He explains: "We chose HCAHPS initially not because we're chasing numbers, but because it was the only thing that had leverage. If you don't do it well, you will be penalized financially. We had started on this journey for the right reason before HCAHPS, but needed something to focus on."
But more important was to get the message to everyone who works in the hospital that each of them is responsible for patient experience.
"You can talk to anyone at our main campus and ask them about patient experience. They will say it's important and they are part of it," Merlino says.
Merlino says Cleveland Clinic faced an interesting challenge culturally, because it had always been thought of as an organization founded by doctors, for doctors. Instead, it's for patients, Merlino says, and the rest of the employees, whether they regularly encounter patients or not, have at least as important a role to play in patient experience.
Cleveland Clinic took a big risk to deliver that message to the entire staff of 42,000 employees by taking them offline over a period of months in small group sessions that lasted a half day. Everyone spent valuable time, from neurosurgeons to housekeeping staff, discussing why it was important, how everyone is in this together, and service excellence standards and how to improve.