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Introduction

The entrance to our old executive offices was across from the elevators to the main hospital. One day I was walking in the lobby about to get on one of the elevators when I noticed a puddle on the floor. I immediately went to find something to wipe it up. As I was returning to the lobby with my paper towels, I stopped and observed all of the people that were either avoiding or stepping over the puddle. People were taking appropriate evasive action, but no one did anything to take care of it. Many were our employees—doctors, nurses, other staff—who were ignoring a problem that could have caused harm to a patient.

I’m often asked what I might have done differently along our patient experience journey. While quick to admit the trial-and-error process that’s collectively led to our success, I unequivocally respond “the culture”—turning our attention to aligning and developing it earlier. Culture in healthcare is critical!

Culture impacts safety, quality, and satisfaction, everything in healthcare—or in any organization, for that matter. Human talent is our most important asset, responsible for delivering everything we do. But it would have been difficult, having just taken over the patient experience initiative, for me to raise the specter of culture change. How could a relative neophyte challenge the culture that has made Cleveland Clinic highly successful since its foundation in 1921? It wouldn’t have been a credible first step.

Cleveland Clinic was founded by four physicians who were friends and colleagues in Cleveland, Ohio. Three of the four served together on the battlefields of Western Europe in World War I, where teams of physicians worked closely to care for patients. Back home in the United States, the practice of medicine was very competitive and independent, with no incentives for teamwork. Believing there was a better way, these men founded Cleveland Clinic “to act as a unit” in the group practice of medicine.

Over the years, while it was generally true that our physicians collaborated closely on patient care, many felt the founders’ ideal had faded as the organization grew. We started as a small, single-location, tertiary-care specialty referral center. Today we are big and growing: an enormous organization with some 43,000 people throughout the globe. We have more than 3,000 physicians and scientists. Those still here after more than a quarter century talk about how different it was when there were only 150 physicians on the medical staff. While our culture supported physician teamwork, the concept of team has been eroded by our size, and there certainly wasn’t a workforce uniformly focused on patients.

The organization also didn’t have a reputation for being particularly nice to employees or patients, confirmed by engagement and satisfaction studies at the time I assumed the role of CXO. At a recent executive leadership retreat, I asked my colleagues to select adjectives to describe ...

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