Sunday, December 9, 2012

Restructure the Clinic?

Cleveland Clinic's 4 radical approaches to care integration, patient satisfaction

With a historical reputation for being the best, Cleveland Clinic has applied some unconventional methods to its care integration model that boosts patient satisfaction.

Both President Obama and Gov. Romney mentioned the Clinic as an exemplary innovator in the presidential debate.

"I really think our model is our secret sauce," Cleveland Clinic CEO Delos "Toby" Cosgrove said in a Business Insider interview about the recent shout-outs. Based on the idea of "Patients first"--the slogan the Clinic adopted since Cosgrove took the helm--the system has restructured the entire organization.

1. Get rid of departments
The Clinic restructured the entire system, eliminating the surgical department and the department of medicine, rethinking organization based on patient needs.

For example, if a patient has a headache, he can go to one neurologic institute, with the specialists physically located near each other. The institutes are more efficient and less costly, according to the CEO.

"In one year, we changed the whole organization," Cosgrove said. "It's all by institutes."
2. Evaluate everyone every year
No physician is tenured at the Clinic. All the employees are salaried and have one-year contracts, including Cosgrove, who has had 37 one-year contracts. The idea is modeled after every other industry, in which employees receive a performance evaluation every year--notably absent in healthcare.

"You got privileges at a hospital, and they were yours for life," Cosgrove noted. "In the annual professional review, we go over all individual contributions to the organization, and that contributes to our decisions about what we do about salary or whether we reappoint or don't."

 Such annual assessments mean physicians are not compelled to provide unnecessary services.
"We have no financial incentives to do more or less," the CEO told Business Insider.

Read more: Cleveland Clinic's 4 radical approaches to care integration, patient satisfaction - FierceHealthcare

 My Opinion:
I feel like the slogan "patients first" is rather cliched.  It's like how businesses always say they try to put "customers first."  Perhaps another, more catchy saying would help the clinic.  I also don't understand how eliminating departments becomes less costly.  Sure, maybe specialists are easier to seek out, but regardless of whether it's less costly or not, the patient is still probably paying lots of money to go see the same doctors.  The evaluations are interesting - but the CEO doesn't mention that any patients are allowed to have their say.  It would also be interesting to see the statistics for these reviews - are some doctors actually let go, and if not, are there any that have their salaries reduced?  Feel free to comment.

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