James Merlino: Part 2 of an interview by Bob Morris


MerlinoJames Merlino, MD, has been the Chief Experience Officer of the Cleveland Clinic health system, as well as a practicing staff colorectal surgeon in the Digestive Disease Institute. He is the founder and current president of the Association for Patient Experience. As a member of the Clinic’s executive team, he led initiatives to improve the patient experience across the Cleveland Clinic Health System. In addition he also led efforts to improve physician-patient communication, patient access, and referring physician relations. Partnering with key members of the Clinic leadership team, he helped to improve communication with physicians and employees, and to drive employee engagement strategies. He speaks to boards, c-suite leaders and physicians around the world on the important issues of culture, patient experience, and leading change. Dr. Merlino was named to HealthLeaders magazine’s 2013 list of “20 people who make healthcare better” and is a recognized world leader in the emerging field of patient experience. Dr. Merlino’s wife, Amy, is a maternal-fetal medicine specialist at Cleveland Clinic.

His book, Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way, was published by McGraw-Hill (2014). In January (2015), he transitioned from the Clinic to Press Ganey at which he serves as president and Chief Medical Officer of its strategic consulting operations.

Here is an excerpt from Part 2 of my interview of Jim. To read all of Part 2, please click here.

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Morris: When and why did you decide to write Service Fanatics?

Merlino: I want to change the world of health care. We need to be more patient-centric, there needs to be greater compassion, humanism, and empathy in what we do. All of us – the multitude of professionals who deliver care – need to work better together. These are the challenges that need attention and I want to help address them. At Cleveland Clinic under Toby Cosgrove’s leadership, we have started to do all of these things. I wanted to share our story and my experiences in hopes of either igniting this work in others, validating the work others are doing, or just providing words of encouragement to people who are also working on this. The book is also a form of a how-to. For those who have not started and need some guidance, I think the book provides it.

Morris: Were there any head-snapping revelations while writing it? Please explain. Merlino: Yes, we learned a lot. Reflecting over the last 5-10 years of the journey is one thing, but when you sit down and write about it and then read what you wrote, you realize that there was a lot of hard work done by a lot of people and we actually accomplished a lot! People – leaders are so caught up in the day-to-day of operations that sometimes I think we fail to really appreciate the work that gets done.

Morris: To what extent (if any) does the book in final form differ significantly from what you originally envisioned?

Merlino: Originally, I think we designed it to be more of an historical account of our work, but what we decided — over time — was make it more of a “how to book” for both providers, but also for patients. I wanted each chapter to stand alone, meaning that you could read one chapter or a collection of chapters and take away something that is useable in your organization. For patients and the consumer, I think the book provides an in-depth examination of issues that increases understanding of some of the complexities of healthcare delivery. The book also gives them information on what they should expect – or deserve — with their care provision.

Morris: To what extent (if any) was writing this book influenced by Toby Cosgrove’s book, The Cleveland Clinic Way?

Merlino: I helped Toby with writing his book. I was one of a few people who had the honor of reviewing the entire manuscript and offering a critique. Toby’s work, but more importantly his book project, inspired me to work harder to tell the patient experience story. One chapter deals with patient experience – Service Fanatics offered an opportunity to take a chapter of the book and expand it into a completely independent dialogue about a single topic. Morris: To what extent has your MD training proven to be more relevant to your current duties and responsibilities than would training for an MBA?

Merlino: Being a physician who practices medicine gives me real-life experience on the front lines of healthcare – it makes the translation of the strategy of what we are doing easier and more practical because I know how it will affect front-line caregivers and ultimately our patients. Having an MBA certainly provides you with a set of tools to be an effective manager or leader, but in healthcare, working on the front lines is critical to a complete understanding of the business. I equate it to something similar I have heard about military officers: unless you have served on the front lines of battle, you really don’t know what it means to fight or the consequences of your decisions.

Morris: I have frequently heard it said that a hospital is among the unhealthiest environments, especially for those who are already ill. Your own thoughts about that?

Merlino: Hospitals are both unhealthy and unsafe, and I think one of the greatest ironies in medical care is that we encourage people to leave hospitals as soon as their circumstances permit. Many patients think we are “kicking them out” to cut costs and that we “don’t care.” The reality is we DO care and that is why we want them to be discharged as soon as it is appropriate. Patients are at risk for hospital acquired infections and other complications in the hospital – the longer they stay, the higher the risk. Because of the nature of the business – complicated patients with multiple diseases and a variety of different combinations of treatment options, there is also inherent extreme variability in what we do. This variability creates an environment where safety is at risk. We need to do more to drive toward greater standards and higher reliability in our culture to make hospitals safer.

Morris: My own opinion is that those who comprise an organization’s workforce must first become “fanatics” before attempting to create “fanatics” among its customers, patients, clients, guests, etc. What do you think?

Merlino: I want the work force to be passionate – I think passion drives the fanaticism, which subsequently leads to better performance and outcomes. I think there is no better field to ignite people’s passion than healthcare. The idea of helping a fellow human being at the time of their greatest need, I think, is a tremendously motivating opportunity for us to become a fanatic about what we do. I want every healthcare worker to come to what they do every day with their passion ignited to serve the patients entrusted to their care. I want them to be able to answer my question “Why are you doing this?” And, I want those answers to be something about taking care of people. If not, they probably should not be in healthcare.

Morris: What specifically can be done to improve the quality of workplace experience for those who cook the food and scrub pots and pans in the kitchens, empty waste baskets and haul trash, clean the rest rooms, and complete all the other unglamorous but essential tasks?

Merlino: As I explain in my book, at Cleveland Clinic, everyone is a caregiver. It does not matter what your role is in the organization – if you work for us, you are part of supporting the mission of Cleveland Clinic. This is an immensely important, critically important point because we want everyone aligned around why they come to work every day, which is to help support the care of patients. The caregivers in our organization who never see a patient are as important as the ones who do. Think about it on its most basic level: you can’t run a hospital without those who provide food or maintenance services. So they are just as important in the ecosystem of healthcare as are surgeons, nurses, anesthesiologists, and others who have direct contact with patients and their loved ones. The first step in starting that journey is to help them realize how essential they are to fulfilling the mission of the organization.

Morris: As I indicate in my review of the book for various Amazon websites, there are dozens of passages throughout your narrative that caught my eye. Here are several. Please respond. First, Cleveland Clinic: Challenges of organizational culture (Pages 1-7, 33-34, 66-67, 98-103, 112-113, and 220-221) Of all the challenges, which proved most difficult? Why? Is it an ongoing challenge?

Merlino: For decades, Cleveland Clinic — like most other large, academic health systems – had become very “legacy based.” The organization was highly successful for a lot of reasons so there were many who wondered why we needed to change anything. We were internationally prominent, patients came to us, and doctors sent patients to us – what’s the issue? The challenge was convincing people that the patient experience is important and something different from what we were doing – that we needed to focus on it; to get better at really treating things beyond just the disease. We need to treat the patient holistically, and provide for the spiritual and emotional dimensions of the journey as well as the medical side. Getting people to recognize that was the hardest challenge of the culture. Now jump ahead 6 years and I will tell you that it has become one of our greatest achievements. Today, everyone knows the patient experience is critical and a priority of the organization and everyone “owns” it.

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To read all of Part 2, please click here.

To read Part 1 of my interview of Jim, please click here.

Jim cordially invites you to check out the resources at these websites:

Press Ganey link

Amazon Service Fanatics link

Institute for Innovation link

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