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HL20: James Merlino, MD, FACS, FASCRS—A Passion for Patient Experience

 |  By jfellows@healthleadersmedia.com  
   November 22, 2013

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of James Merlino, MD, FACS, FASCRS.

This profile was published in the December, 2013 issue of HealthLeaders magazine.

"We spend hours and hours and lots of money on how to be at the top of our game in healthcare—nurses and physicians are doing continuing education, learning how medicine is evolving—but we spend nearly zero time on how we deliver that care."

Today, James Merlino, MD, FACS, FASCRS, is a go-to leader for hospitals and health systems looking for advice on how to improve their patients' experiences. In addition to his position as chief experience officer for the Cleveland Clinic, he also serves as president and founder of the board for the Association for Patient Experience, an independent nonprofit organization that grew out of discussions at the first Patient Experience Summit sponsored by Cleveland Clinic in 2010 and was established to support healthcare professionals, patients, and their families by improving the patient experience.

He has been at the helm of rethinking and redefining patient experience for the nonprofit academic medical center since 2009. But, initially, it was a job he didn't want, in a hospital he never wanted to step foot in again.

In the summer of 2005, Merlino walked out of the Cleveland Clinic after finishing his fellowship believing the world-renowned hospital was "the worst place in the world for patients." Six months earlier, Merlino's father had died there after a five-day stay related to an ambulatory procedure for bladder cancer. Merlino vowed never to return. Not because of the clinical care—complications that arose with his father's surgery were "nobody's fault," he says; rather, he was upset with the way his father was treated.

"The nurses didn't consistently round on him. His doctor didn't round on him. The communication with the family was terrible," says Merlino, who struggled with the decision to leave because he trained for his specialty in colorectal surgery at the hospital and considered it an honor to be there.

The experience on the other side of healthcare opened his eyes wide. Those five days, he says, redefined how he thought about taking care of patients.

"What I recognized pretty quickly was that we ignored the human side. We ignored the patient. We ignored the family," he says. "We spend hours and hours and lots of money on how to be at the top of our game in healthcare—nurses and physicians are doing continuing education, learning how medicine is evolving—but we spend nearly zero time on how we deliver that care."

Merlino says he returned to the Cleveland Clinic after a five-year hiatus because CEO Delos "Toby" Cosgrove, MD, assumed his title in 2005 and put a renewed focus on patient experience. Merlino says he and Cosgrove were unsure what patient experience meant, but they were both dedicated to making it a priority, something Merlino says is a must to move the needle at any hospital.

"There has to be passion around it," Cosgrove says of improving patient experience. "It's got to be a strategic priority. You have to put it front and center of everything you do in the organization. In terms of who leads it, it's got to come from the top person. It's not a nursing problem; it's not an operations problem. Anything you're doing to develop the culture has to be led by the top people otherwise it won't get the billing it deserves."

Leadership may be in charge of driving home the point that patient experience is core to the strategy at Cleveland Clinic, but Merlino is also quick to point out that it is a shared responsibility among every employee. He says he learned early on in Cleveland Clinic's patient experience journey that aligning staff was central to carrying out his vision of putting patients first. When a 43-year old patient, who was getting ready to leave after an uncomplicated surgery, showed Merlino the journal she'd kept while at the hospital, he was shocked to see how many different people had helped care for her during the five days since when was admitted.

"At the end of this hospital stay, eight physicians had signed the journal, 60 nurses, and so many other people … and she forgot to have three people sign the journal," he says. "What it said to me, in a very, critical stage of this career, was that it's not just the doctor or the nurse, it's everybody. If everybody's not aligned in thinking what we're doing and how they're interfacing with that human being, then we're not going to be successful at delivering what we're supposed to be doing, which is high-quality care."

Merlino believes communication is the fundamental building block of a patient experience that, if it is positive, will have a ripple effect in hospital safety, quality, experience, and value. The multipronged approach defines the Cleveland Clinic's "Patients First" initiative, a personal mission for Merlino, who says helping patients have a good experience is beyond "more smiling" by physicians or gimmicks that attempt to make a patient happier. To Merlino, high quality and safety flow from solid communication with everyone involved in the healthcare of a patient.

"When nurses communicate better at the bedside, medication errors are reduced, falls are reduced, pressure ulcers are reduced," he says. "Those are safety issues. When physicians communicate better with patients and nurses, compliance with treatment goes up and coordination of care improves. That's quality."

Intuitively, hospital leaders know that better communication will lead to better results, but Merlino says staff, including leadership, is tasked so heavily that it is easy to lose perspective, especially in a hospital with a lot of patients. He's not endorsing smaller hospitals, but rather a different approach to who is working in healthcare.

"I think that 90% of people who work in healthcare are there for the right reasons," he says. "I think there's probably a percentage who want to do the right thing, but don't know how to do it, and there's a small percentage of people who don't belong here."

Cutting out the small group of healthcare workers who hinder healthcare efforts is no small task, but identifying deficiencies through training and development around service excellence can help he says.

The other component of patient experience Merlino emphasizes is empathy and compassion for the caregivers, not just the patients. That idea is expressed in an emotional four-minute video Cleveland Clinic produced for its 2012 State of the Clinic Address. With only background music playing, patients, doctors, nurses, and family members are shown moving throughout a hospital setting with just a few words describing them and their situation. For example, the words, "He has been dreading this appointment. Fears he waited too long," appear next to an elderly man in wheelchair. In another scene, a physician leans against an elevator wall with the words, "Recently Divorced." The video is effective at illustrating the humanity that can get lost between caregivers and patients. It's been downloaded nearly a million times.

"It just reminds me of why this is important," says Merlino. "You have to pay attention to little things because at the end of the day, they're human beings. They come to us at their most vulnerable, terrifying time in their life. We need to deliver care in a much more compassionate way."

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Jacqueline Fellows is a contributing writer at HealthLeaders Media.

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