Chapter 3: Leading for Change

Introduction

Cleveland Clinic has made significant improvements in the patient experience, not because there is a CXO or an Office of Patient Experience, but because our president and CEO owns the patient experience as a strategic initiative. Our success in transformation occurred because the top person in the organization led the way.

When I confer with senior hospital leaders having responsibility for managing the patient experience, I often find their CEOs have little hand in leading or messaging it. Others tell me the CEO occasionally says it’s important, but holds no one accountable for improvement. This is confirmed in a HealthLeaders Media survey finding that 48 percent of hospital leaders think the patient experience is a top strategic priority,¹ but only 15 percent identify the CEO as owner of the initiative.² Patient experience improvement is often seen as “just another thing we have to do,” with responsibility relegated to nursing, quality, or hospital operations.

Disparity between what top leaders say about the patient experience and where it resides organizationally is a key reason why there isn’t sufficient traction to drive meaningful change. Improving the patient experience is all-encompassing; it requires every person and every process to be aligned around the patient. No one in the organization can singly achieve that alignment unless the top person is leading the charge. Because everything the patient experience encompasses is inherently comprehensive, only the top leader can effectively impact such a broad scope. In organizations where the CEO owns the patient experience, including Cleveland Clinic, Children’s National Medical Center, Houston Methodist, and UCLA Health System, among others, you quickly recognize the impact of senior leadership.

At the beginning of Cleveland Clinic’s efforts to improve the patient experience, Cosgrove set the strategy, as well as managed the change. Within a couple of years of becoming CEO, he launched a variety of major initiatives to help improve patient-centered care.

For example, Cleveland Clinic became the first U.S. healthcare system to change the way medicine was organized. Traditional academic medicine is structured around major departments, such as the Department of Surgery or the Department of Medicine. All subspecialties related to surgery or medicine were within these departments.

While surgeons and medical specialists in many of the major service lines, such as cardiac and digestive diseases, were already very good at working closely together, Cleveland Clinic was founded on the model of physicians working together as a unit. Cosgrove felt very strongly that formalizing this model and integrating it across the organization for all specialties would greatly enhance patient care. So our radical institute model was born. The entire enterprise was reorganized around new institutes, a significant restructuring of how care is delivered and how patients interact with the system.

There are no longer departments of medicine or surgery; there are institutes organized around disease and organ systems. The Sydell ...