Our goal is to achieve the highest level of safety and effectiveness for all who come to us for care. Cleveland Clinic fosters an environment where all caregivers are encouraged to speak up regarding safety concerns and are supported when they do so. In addition to tracking and responding to trends in patient safety and quality of care data, our caregivers engage with patients through a variety of communication channels to ensure their feedback is incorporated in our ongoing efforts to provide the best care.
Culture of Safety
Quality & Safety is one of our core values and is embedded in our daily operations. To this end, we provide caregivers extensive safety training, use a Safety Event Reporting System (SERS) and have adopted comprehensive safety policies and standard operating procedures. Cleveland Clinic’s online SERS allows any employee to report a near miss, process problem or a patient event. Our Quality and Safety Institute is committed to best practices in quality, treatment outcomes and quality performance. The Institute is made up of the following departments:
- Clinical Risk Management
- Environmental Safety
- Infection Control
- Quality Data Registries
- Quality Improvement
- Radiation Safety
Our caregivers have developed a Patient Safety Program with the goal of providing the safest possible environment for those in our care. The 2019 Fall Leapfrog Group Safety Grades reflect our efforts and our best performance yet. Leapfrog Group releases semi-annual safety grades associated with patient safety performance and practices. These grades represent a composite score of data from a voluntary, self-reported survey, as well as several publicly reported metrics—many of which align with our Enterprise Quality priorities.
Eleven of our hospitals, in addition to Ashtabula County Medical Center, received an “A” in the most recently published grades:
- Akron General Hospital
- Avon Hospital
- Euclid Hospital
- Fairview Hospital
- Hillcrest Hospital
- Lutheran Hospital
- Main campus
- Marymount Hospital
- South Pointe Hospital
- Union Hospital
- Weston Hospital
From fall 2018 to fall 2019, 87% of our hospitals improved their scores. Moving forward, opportunities to improve include leveraging Leapfrog to facilitate hospital integration.
We acknowledge that it can take courage for caregivers to speak up about safety events and concerns. In 2019, we created the Speak Up Award to recognize those who show courage to do the right thing for patient and caregiver safety. We also encouraged caregivers to recognize “Safety Champions” across the health system with a Patient Safety honor by submitting a nomination through our online Caregiver Celebrations platform. “Safety Champions” are caregivers that have identified or anticipated potential risks and voiced their concerns to prevent harm, and who work together to develop and share solutions. Their confidence to speak up has eliminated variability, defined best practices, improved environmental factors and standardized processes, and we want to ensure they are celebrated.
Universal Protocol / Safety Checklist
Cleveland Clinic developed a Universal Protocol to prevent serious safety events during every procedure we perform—in the operating room, procedural area, at the bedside and in the medical office setting. This is a required process for caregivers to ensure that a patient’s identity, scheduled procedure and procedural site are correct.
To support the Universal Protocol, we require caregivers to use a standardized Safety Checklist. It guides teams with step-by-step scripting for sign-in, time-out and sign-out, ensuring that all teams have the same discussion for procedures.
Effectiveness of the Universal Protocol is dependent upon active team participation of every procedure from start to finish. We foster an environment where caregivers can speak up and be heard when there are safety concerns, and teams only proceed when there is collective agreement to do so.
Tiered Daily Huddles
Every day, our caregivers participate in patient safety huddles across our system. These brief, focused conservations start with bedside caregivers communicating patient safety concerns to their managers. Teams that cannot immediately address concerns can escalate this information to senior teams—tier by tier—within hours to executive leadership. Through these huddles, caregivers make Cleveland Clinic a safer place to receive care. Additionally, they create open lines of communication where caregivers can share lessons learned, accomplishments and ideas, and enable leaders to report back to caregivers regarding actions taken.
Quality of Care
At Cleveland Clinic, we strive to not only provide the best quality care, but to define it by being at the vanguard of innovation in healthcare. In 2019, we continued to enhance our quality of care by strengthening communication among our caregivers and patients and fostering a culture where every caregiver is capable, empowered and expected to make improvements every day.
Cleveland Clinic puts patients first. We believe patients should always be involved in planning their care and deciding the next steps of their treatment. We are committed to improving teamwork, communication, quality, safety and length of stay, which is why we introduced plan-of-care visits in 2019. Pioneered at Hillcrest Hospital and since implemented across the enterprise, a plan-of-care visit is a conversation among the patient, doctor, nurse and other caregivers. The purpose is to create a treatment plan with patients and their families included as part of the team. These visits are enabling patients to go home sooner, enhancing teamwork and promoting relationship-centered communication.
Another way we encourage open communication is through leadership rounding. Each month, leaders at all levels of the organization conduct leadership rounding, in which they speak with caregivers, patients and patients’ visitors and/or families. The purpose of these conversations is to improve our quality of care by providing direct access to leaders, and for leaders to view patient care at the point of delivery to hear the "voice of the patient" firsthand.
Cleveland Clinic Improvement Model
The Cleveland Clinic Improvement Model (CCIM) encourages caregivers at all levels of the organization to drive innovation and continuous improvement by promoting values that catalyze change, such as collaboration, candor and accountability. More than 5,000 caregivers across the Cleveland Clinic Health System provided input to develop, test and refine the Cleveland Clinic Improvement Model (CCIM), and its application enables us to continuously improve all aspects of our care:
- Patient Safety
- Patient Quality
- Patient Experience
- Caregiver Experience
Measuring our quality and safety performance is an essential component of the CCIM. Cleveland Clinic provides healthcare quality data in our annual State of the Clinic report and via the following reporting initiatives to enable stakeholders to benchmark our progress alongside industry peers:
- The Joint Commission Performance Measurement Initiative
- Centers for Medicare and Medicaid Services (CMS) Hospital Compare
- Ohio Department of Health Service Line Reporting
- National Specialty Society Databases and Registries
Additionally, through our Find a Doctor site, patients can leave reviews for our physicians and see experience ratings and comments from other patients to inform their decision making.
Accountable Care Organization
Cleveland Clinic opted to form a Medicare Accountable Care Organization (ACO) in 2015. Today, our ACO is one of the largest in the country, managing 95,000 Medicare patients across Northeast Ohio and Florida. Through our ACO, we successfully connect patients to medical homes and care teams, proactively manage their care across the continuum (including at skilled nursing facilities) and establish other value-based efforts so that patients rely less on emergency care. These efforts to coordinate care improve both the quality and affordability of services we offer our patients. To further support our commitment to population health, we launched our Cleveland Clinic Community Care (CCCC) unit in 2018. From our primary care physicians, to our hospitalists, to our paramedics and APRNs doing house calls, CCCC providers function as a team to proactively address the health needs of communities. In 2018, the most recent year for which we have available data, we monitored ten primary care ACO performance measures for improvement.
We track and transparently report measures of patient safety, quality of care and satisfaction and set targets to continuously improve the patient experience across the enterprise.
We are proud to be one of the first U.S. health systems to publicly report Serious Safety Events (SSEs), which include incorrect procedures, patient falls with injuries and other events that may harm patients. In 2019, Cleveland Clinic health system reported and disclosed 89 SSEs. Surgical SSEs are an area where our efforts to improve safety resulted in a 46% decline in 2019. Drivers of this progress included greater adherence to standard checklists and speaking up for safety.
One opportunity we have identified for improvement is to reduce the number of patients who return to the hospital soon after discharge. After five years of steadily reducing our hospital readmission rate, we saw a slight rise in the rate in 2018 and again in 2019 (from 12.9% to 13.4%). To meet this challenge, we are implementing checklists, working with community physicians and skilled care facilities, and addressing non-medical factors affecting readmissions.
Hospital-acquired infections can result in sepsis, a potentially fatal immune response. Lowering the rate of sepsis occurrence is a major goal in all inpatient settings. Knowing that every hour counts in sepsis cases, we are implementing strategies to identify and treat sepsis at every stage of care — from contact with emergency response personnel through to intensive care. Using checklists and augmented intelligence, our caregivers have achieved a reduction in sepsis mortality since 2017.
Cleveland Clinic uses external observers to track hand hygiene to decrease self-reported compliance. These individuals will make more than 6,000 observations monthly across the enterprise.
Uncontrolled diabetes is an important population health measure because individuals can experience serious health effects from elevated blood glucose levels. According to the American Diabetes Association, 34.2 million Americans—or 10.5% of the population—had diabetes in 2018. Individuals diagnosed with diabetes have, on average, 2.3 times greater healthcare costs than individuals without diabetes due to complications from the disease. To this end, we provide diabetes screenings as part of our community health fairs and wellness programs.
Medical Practice Percentile Rank
Source: Press Ganey
In 2019, Cleveland Clinic transitioned from the CG CAHPS survey instrument to our survey vendor’s standard instrument. This new survey will provide more robust national benchmarking for our outpatient satisfaction scores at our hospitals and family health centers.
The Center for Medicare and Medicaid Services along with the Agency for Healthcare Research and Quality developed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey to provide a standardized method for measuring patients’ perspectives on care they received.
The number of complaints and grievances we receive from patients continues to trend downward. In 2019, Cleveland Clinic reduced patient complaints and grievances by 11% compared to 2018.