In tables of eight to 10 people, including a facilitator, Merlino and his staff talked to the randomly assigned groups about patient experience using theoretical situations and a visual learning map, encouraging them to develop a collegial atmosphere. It cost $11 million to do the project, says Merlino, but it was well worth it.
"It was a leveling experience that got everyone to realize that patient experience isn't the responsibility of one group," he says.
Rather, it is a team effort, and the organization succeeds or fails on patient experience as a team.
"A highly engaged workforce is a big driver of satisfaction," he says. "We needed a culture of engaged and satisfied caregivers. If we don't get that, we don't get to any other level. Any Fortune 100 company understands that."
And patient experience is a journey that never ends, he says.
While Merlino says Cleveland Clinic is "nowhere near where we want to be," its patient satisfaction scores, after 2009, when this intensive training was initiated, jumped 15% in one year, from 2010 to 2011.
"We attribute it to our work on this program," Merlino says.
But a one-day retreat for employees wasn't going to get the job done in and of itself, Merlino realized. Sustainability was critical, so patient experience measurement and metrics needed to be implemented by the management staff, a group 2,200 strong, and they needed to know it was one of the most critical factors by which their performance would be judged going forward. And it had to have full support from Toby Cosgrove, MD, Cleveland Clinic's CEO.
"The top person has to say it's critical," Merlino says. "If you don't have that, you're not successful."
Those 2,200 managers underwent two sessions to discuss measurement protocols, accountability, engagement, and developing unity of purpose.
"These managers sustain it," says Merlino. "Managers must be razor-focused on the goals; you have to give them mechanisms to track them and you have to hold them accountable. They will then hold their employees accountable. Toby drives it to the executive leadership team, we drive it to our management, and management drives it to the employees. In a way, what we're doing is enforcing basic management techniques. It's not rocket science."