We care for patients as if they are family with the vision of being the undisputed best place to receive care anywhere. As we continued to face daunting challenges in the second year of the COVID-19 pandemic, our culture of safety supported our commitments to providing a safe workplace for caregivers and a safe environment of care for our patients. Cleveland Clinic is a trusted healthcare leader. We're recognized in the U.S. and throughout the world for our expertise and care. We promote continuous improvement related to safety and quality by transparently reporting performance metrics, benchmarking with industry peers and encouraging caregivers to champion safety and speak up regarding concerns.
Culture of Safety
Quality & Safety is one of our core values and caregiver behaviors associated with this value include ensuring the highest standards and excellent outcomes through effective interactions, decision-making and actions. We embed Quality & Safety in our daily operations by establishing and upholding comprehensive safety policies and standard operating procedures, providing extensive safety training to our caregivers and using a Safety Event Reporting System (SERS). Cleveland Clinic’s online SERS enables all caregivers to report a near miss, process problem or a patient event.
Our caregivers have developed a Patient Safety Program with the goal of providing the safest possible environment for those in our care. One way we measure performance is through Leapfrog Group’s semi-annual safety grades. The grades represent up to 28 national performance measures from the Centers for Medicare & Medicaid Service (CMS), the Leapfrog Hospital Survey and information from other supplemental data sources.
In December 2021, five of our hospitals, in addition to Ashtabula County Medical Center, received an “A” grade:
- South Pointe.
To promote a culture of safety, we ask all caregivers to:
- Make a personal commitment to safety.
- Be accountable for clear and complete communication.
- Support a questioning attitude.
We encourage our caregivers to recognize Safety Champions—or colleagues that promote a culture of safety—by sending them a Patient Safety award through our online Caregiver Celebrations platform. Safety Champions make safety a top priority every day with every patient, and demonstrate leadership in identifying creative ways to make our facilities and care safer. Highly regarded by patients and/or colleagues for modeling safe practices, Safety Champions work to mitigate potential harm, speak up with concerns and collaborate with others to drive improvement.
Caregivers Stand UP for Safety
Cleveland Clinic’s Universal Protocol (UP) is a required process for all caregivers to follow to support our commitment to providing consistently exceptional and safe care. Through this process, caregivers ensure each patient’s identity, scheduled procedure and procedural site are correct. This practice protects both our patients and caregivers during every procedure we perform—in operating rooms, procedural areas, at bedsides and in medical office settings.
Checklists are used across the healthcare industry and are a crucial component of any procedure. 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. In addition to our Tiered Safety Checklist for all operating rooms and procedural areas, in 2021 we introduced a new Universal Protocol Safety Checklist for Office-Based and Bedside Procedures. Informed by caregiver feedback, this streamlined and thorough checklist applies to every procedure in the office and bedside setting at Ohio and Florida locations that require informed consent, and supports our commitment to safe and empathetic care.
Active team participation is essential for the Universal Protocol to be effective in 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 a collective agreement to do so. In 2021, groups from across our facilities came together to reset expectations around how we use the Universal Protocol Safety Checklist and shared reasons why this tool is so important in preventing errors. In July, 9,035 Surgical Services caregivers showed support for our safety culture by pausing to “Stand UP for Safety” before their morning procedures.
Tiered daily huddles
Tiered huddles are brief, 15-minute conversations that provide caregivers with a safe environment to share concerns and identify solutions that ensure patient quality and safety. These huddles are a clear, consistent and efficient method to support caregivers with daily challenges, and also serve as a venue for sharing best practices, accomplishments and ideas. Our huddles start with our care teams and escalate to Executive Leadership, with caregivers throughout all tier levels working together to resolve issues. By meeting daily, our tiered huddles also provide leaders with an opportunity to follow up with caregivers on actions taken related to their concerns in a timely manner.
Quality of Care
Our caregivers are dedicated to consistent excellence and precision across our services for our patients and one another. As a high-reliability organization, we continually strive to create processes and foster a culture to radically reduce system failures. We promote high reliability by supporting each other to prevent harm, using evidence-based behaviors and following our three guiding principles of listen, learn and lead:
- Listen: Caregivers must actively listen to one another and address concerns when colleagues speak up to raise an issue.
- Learn: We improve as an organization when caregivers share successes, seek best practices and acknowledge and learn from mistakes together.
- Lead: Caregivers model our high safety and quality standards by holding themselves, each other and our organization accountable; embracing and implementing new best practices and actively using our model for continuous improvement.
Our commitment to a Just Culture supports high reliability by fostering an environment in which caregivers encourage and support one another in coming forward to acknowledge and address mistakes. At Cleveland Clinic, having a Just Culture means:
- Increasing psychological safety for our caregivers to speak up and report errors by supporting them when they do so and providing a fair and just process to address issues.
- Identifying and addressing system failures instead of focusing on individual failures.
- Holding ourselves accountable when the variation is driven by individual decisions that deviate from our standards.
A Just Culture gives us the opportunity to learn, improve the care we deliver and prevent potential errors. To support our caregivers, our Patient Safety & Quality team developed a Just Culture Decision Tree in 2021 to guide our caregivers in identifying events, gaps and variations in expected outcomes, and taking appropriate actions to address them.
To elevate the voices of patients and caregivers, organizational leaders conduct monthly rounding on our units in collaboration with quality, safety, and continuous improvement.
Leadership rounding includes participants from members of the Executive Team and their Direct Reports, Nursing Leaders, Institute Administrators, Physicians, Non-Physician Leaders, Cleveland Clinic Board Members and Healthcare Partners. Goals of leadership rounding include:
- Supporting and improving patient care.
- Increasing caregiver engagement.
- Improving the patient and caregiver experience.
- Identifying and improving environmental conditions.
- Recognizing caregivers for outstanding care and service.
- Engaging members of the Board of Directors and the Board of Trustees.
This process also enables us to identify and resolve individual and systemic issues while providing meaningful leadership visibility for patients and caregivers.
The pandemic continued to cause disruptions in 2021, contributing to burnout and staffing challenges. Our Continuous Improvement (CI) team has provided support to caregivers during this unprecedented time by equipping them with tools and training to manage resources more efficiently and increase productivity.
Our CI team has specialists in every hospital and clinical institute in Ohio and Florida to support cultural transformation. Our goal is to build a culture in which every caregiver is empowered and expected to make improvements every day. In addition to providing project management support, our CI specialists serve as coaches to build CI capabilities among teams and leaders so they can apply these skills to future projects.
Actions we promote among our caregivers to drive continuous improvement include:
- Seeking improvement every day.
- Making problems visible.
- Getting to the root cause.
- Testing and implementing countermeasures.
- Standardizing and sharing solutions.
We promote values and behaviors to drive growth and change through our Cleveland Clinic Improvement Model (CCIM).The model encourages a collaborative and focused approach to developing new resources and best practices for standardization across the enterprise.
Cleveland Clinic Medicare ACO (CCMACO)
An Accountable Care Organization (ACO) is a group of doctors, hospitals and other healthcare providers who voluntarily work together to provide high-quality care to the Medicare patients they serve. Coordinated care helps to ensure that patients, especially those with chronic conditions, receive appropriate and timely services while avoiding duplicative interventions and medical errors.
Our primary goal is to ensure patients receive the right care, at the right time and in the right place. Through our ACO, we connect our patients to our primary and specialty care teams; proactively manage their care across all settings including while at home, in a hospital or in a skilled nursing facility; and offer value-based programs to support patient transitions in care, their management of chronic disease and optimization of their medical therapy. Through these programs, we hope to enhance the number of days patients are able to spend at home feeling well and to enable the receipt of care in line with patient values. We understand the importance of individualized, patient-centered treatment plans, and strive to tailor our services to patient goals.
In 2022, CCMACO entered into a new five-year program as part of the Medicare Shared Savings Program—‘MSSP Enhanced’—that provides greater incentives for ensuring that we deliver high-quality patient outcomes while reducing the total costs of care. At the same time, we also began participating in the Primary Care First Program. This new program builds on the concept of a ‘patient-centered medical home’ in primary care, aimed at delivering comprehensive, coordinated and easily accessible medical services to all of our patients.
CCMACO succeeds by providing patients with the highest quality care. Below is a list of measures that reflect our most recent performance.
For more information about our ACO and most recent quality performance results, please visit our Cleveland Clinic Medicare ACO webpage.
Cleveland Clinic is committed to transparently reporting measures of patient safety, quality and satisfaction, and setting targets for improvement with the aim of enhancing patient outcomes and experiences. We provide patient data in our annual State of the Clinic report and participate in the following reporting initiatives:
- 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.
These reporting initiatives enable stakeholders to benchmark our progress alongside industry peers, and also drive improvement and best practice sharing across the industry.
Data privacy and security
Protecting information is an important part of Cleveland Clinic’s commitment to providing the highest level care. In the digital age, a patient’s information is an extension of themselves, and we view it as our responsibility to treat that information with the same respect we give every patient. In 2020 and 2021, a number of U.S. hospitals had their operations shut down in ransomware attacks. The heightened threat prompted the federal government to issue an unprecedented cyberattack warning to healthcare organizations.
At Cleveland Clinic, we have a comprehensive Cybersecurity program designed to ensure a safe and trusted environment for the care we provide and the business we conduct. For years, Cleveland Clinic has invested in cybersecurity tools to secure information, keep our systems resilient and withstand evolving cyberattacks. Cleveland Clinic’s Cybersecurity team is continuously improving the security of our systems, especially during times of global crisis, such as the COVID-19 pandemic. The team also actively engages caregivers by providing ongoing updates and training, including an intranet site with resources and alerts, annual compliance training and an ongoing phishing email campaign to train our caregivers to identify and report suspicious emails. In response to increased numbers of caregivers working remotely, our Cybersecurity team enhanced policies and standard operating procedures to address the evolving threats, empowering caregivers to protect our digital assets when working remotely.
2021 patient data
All data covers the enterprise, with the exception of Cleveland Clinic Abu Dhabi (a Mubadala Health Partner) and Cleveland Clinic London (hospital opened in March 2022), unless otherwise noted. For more information on Cleveland Clinic Abu Dhabi, please view their State of the Clinic report.
The serious safety event rate measures how many potentially harmful events occur in relation to the number of patients we serve. This rate allows us to monitor progress toward our goal of being the safest place to receive care. We perform a root cause analysis on all serious safety events and share improvements and lessons throughout the enterprise to decrease the potential for the same event happening in other locations. By empowering and expecting caregivers to speak up when safety is at risk, we continued to maintain a low series safety event rate in 2021.
Excludes Lodi due to low volumes
We continued to focus on reducing preventable readmissions by enhancing care coordination in 2021 through plan-of-care visits. In these collaborative visits, our caregiver teams coordinate discharge planning with patients to reduce readmissions and keep patients healthy at home. We are committed to further expanding use of plan-of-care visits in 2022.
Excludes Lodi due to low volumes
Hospital-acquired infections can result in sepsis, a potentially fatal immune response. Reducing hospital-acquired infections is a priority for Cleveland Clinic, but in 2021, mortality from sepsis was higher than our target. Sepsis requires early diagnosis and treatment, and we are focusing on improving our capabilities to diagnose sepsis quickly by:
- Introducing emergency response teams dedicated to identifying sepsis early and working with bedside teams to swiftly manage it.
- Using artificial intelligence to help detect potential cases sooner to enable rapid treatment.
Hand hygiene is an important everyday safety habit, and an important measure to reduce the spread of COVID-19. To remind caregivers to practice good hand hygiene, we added signage to restrooms and infographics to screensavers. Additionally, Cleveland Clinic uses external observers to track hand hygiene across the enterprise to improve compliance.
Uncontrolled diabetes and controlled hypertension are two important population health measures. In 2021, our Quality Team continued to actively work on and make improvements related to these conditions for our ACO.
Benchmarking source: Press Ganey Medical Practice Benchmarks (ratings/scores reported at the 50th percentile rank Jan 2021 - Dec 2021)
We have identified care accessibility as an opportunity for improvement, and are invested in delivering our care in more ways and more places. Learn more about how we are transforming care access to make it easier and more equitable to use our services.
Benchmarking source: October 2022 Public Report January-December 2021 Discharges. Patients’ perception of plan-of-care visit (POCV) frequency is an internal measure and does not have a national benchmark.
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. To provide a better patient experience, we are increasing our focus on delivering empathetic care uniformly across all our locations, and increasing the frequency of plan-of-care visits.
We expanded the number of facilities included in our rate of complaints and grievances from main campus to the enterprise. We will work on reducing our rate of complaints and grievances through ongoing efforts to enhance the patient experience.