Empathy is an International Concept

Podcast Transcript

Steph Bayer: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast, exploring empathy and patient experience. I'm your host, Steph Bayer, Senior Director of the office of Patient Experience here at the Cleveland Clinic in Cleveland, Ohio. Today, I'm pleased to have James Gutierrez here. Jim, welcome to Studies in Empathy.

James Gutierrez: Hey Steph, it's great to be here. Greetings from London.

Steph Bayer: Jim's an internal medicine physician. He currently serves as the Chief of Quality, Safety, and Patient Experience at Cleveland Clinic London. This year, Cleveland Clinic London opened its doors to its first outpatient center. Cleveland Clinic London's first inpatient hospital is expected to open early next year. Jim's provided care at Cleveland Clinic for over 20 years. He formally has served as a department chair, President of Cleveland Clinic Medicare ACO, and is a member of our Board of Governors. Boy, you're busy. It's such an honor to have you make time today, and especially given the time difference. So, thank you so much.

James Gutierrez: No, it's my pleasure. It's great to continue to be connected with you and the team back in Cleveland, Steph.

Steph Bayer: So, I just read a bio, but tell me a little bit about it in your words and what your journey was like to get to your current role in London.

James Gutierrez: Absolutely. So, I'm Northeast, Ohio, born and bred and raised. I'm from Youngstown, Ohio, originally, and came to Cleveland for college, initially, and then went to medical school there. Did some training on the East Coast and then came back to work in Cleveland, and have been in Cleveland since, at least up until I came to London. I joined Cleveland Clinic, I think I had had couple years of experience before coming to the clinic, but I joined in the mid-nineties right around the time when they were starting to expand into the community and open up the Family Health Centers. So, the opportunity to be part of a large organization like the clinic, but still practice in my local community was really attractive to me. So, that was really super. Early on in my career, pretty much as soon as I joined, I was asked to get involved with the quality efforts in what was then called Regional Medical Practice. So, the clinic's efforts in the community.

James Gutierrez: I think I learned that quality as well as safety and patient experience, those are great areas for young doctors or other people in healthcare to kind of develop leadership skills and get to know an organization. Because patient experience, quality, and safety, they all cut across really all aspects of the organization. So, it was great for me because it allowed me you to build relationships with people on main campus and at other family health centers, and really get to know the organization well, and also become known a bit more outside of just my practice. That eventually led to me becoming the Chair of what was then the Department of Community Internal Medicine when it was first formed. I had that role until I came to London in 2018. During my time in primary care, both practicing and as a Department Chair I got involved in the early efforts around population health at Cleveland Clinic, which was really exciting. Really looking at how do you start to not only address the issues for patients who you are seeing every day, but really how do you start to look at a population of patients and do things a bit differently to make sure that you're trying to identify and interrupt health problems before they get to the point where you need to go see a doctor?

James Gutierrez: I had some involvement through that with the forming of our Accountable Care Organization, which is an effort in our Medicare population to improve the quality of care as well as lower the cost of care. I was really blessed in 2018 to be asked to join our team in London as the Chief of Quality, Safety, and Patient Experience and be part of the team that's really looking to bring this project to life. As you said, we opened up our outpatient facility in September, so we're seven or eight or nine weeks into this now, and it's really exciting to be caring for patients. We'll be opening the hospital here, which is going to be a huge milestone for us and for Cleveland Clinic at the end of January, 2022. So, it's a really busy time, but it's really exciting being part of a team that's bringing Cleveland Clinic's model and our ethos to the United Kingdom.

Steph Bayer: I didn't realize you were over there in 2018.

James Gutierrez: Mm-hmm (affirmative).

Steph Bayer: Boy, before we even had the building ready you were there.

James Gutierrez: Yeah, well, it was interesting, Steph, when a number of us came over, the project had been going on for two or three years already, it goes back to 2015 or earlier when they started to first envision Cleveland Clinic London and look for a site and everything. When I got here, we had the site. It basically was three walls and a massive hole in the ground where they took an existing building and gutted it and have built it back up. COVID, I think put a bit of a wrench in plans in terms of throwing us off our timelines. But that said, I think it was a tremendous bonding and learning experience for all of us here, going through a pandemic together, kind of working virtually, supporting each other. And I think it's given us a different perspective on empathy and patient care as well because it clearly starts with how caregivers treat one another.

Steph Bayer: Isn't that the truth? Let's explore that a little bit. Just in the last seven or eight weeks you've gotten to see patients. Prior to that, it was just the team building during a pandemic. I like that you said you learned empathy and how we treat each other. Can you talk about how leaders like you build empathy in a new location like London?

James Gutierrez: Yeah, I think it was a challenge as well as a great opportunity, Steph, because it's rare to have the opportunity to build a culture and a facility from the ground up. Even in the US, when we open a new hospital, we're still kind of building it with the support of the other Cleveland Clinic Health System hospital's teams, caregivers, et cetera, come over. So, this was really building from scratch. We developed, early on, what we call our Cleveland Clinic London purpose statement, which is compassionate caregivers transforming health and care for the world. That really became our mantra in a lot of ways. We had a slide that calls that purpose statement out, along with Cleveland Clinics values and our care priorities at Cleveland Clinic, which as you know, are our patients, our caregivers, our community in the organization.

James Gutierrez: And every meeting, we start with reiterating that slide to keep reminding people why we're here in London, what we're bringing, and it's not us bringing it from the US. It's building it together, taking what's the best from the US and what we've developed over a hundred years at Cleveland Clinic, and melding that with the best of UK healthcare. We spend a lot of time with our caregivers from day one, helping them to be aware of Cleveland Clinic's values. Through purpose slide, we talk about quality and safety and empathy and teamwork and inclusion and the other values, again, over and over and over again. We show the empathy video, which no matter how many times we see the Cleveland Clinic empathy video, it has so much meaning for us. All of our caregivers see that on day one of their orientation. All of our caregivers are receiving or have received heart training. So, they really understand that basic Cleveland Clinic model for empathic interactions, either with patients or with each other. Then we just keep reiterating that Patients First motto, that ethos, because as you know, it's much more than a motto, right? It really is the way we make decisions at Cleveland Clinic. I think it's been great to see a whole new group of caregivers in another country embrace those values and that patient's first ethos. 

Steph Bayer: I want to reflect back a few things I heard because I think it's worth repeating. As you're building empathy, you talked about reinforcing and starting your meetings with a purpose statement and talking about how to build purpose. I just read this book just this weekend. So, here's a business plug for a non-related Cleveland Clinic book. It was called The Power of a Moment by the Heath brothers, and essentially, they said that they did business studies on people that are motivated by their individual passion, the passion to serve, or people that are motivated when there's a higher purpose to the work. They actually found better long term, sustained performance when you can ingrain a purpose in the work. Passion moves an individual forward, but purpose moves all individuals forward. And the idea that to build this empathy culture you started even before patients on that purpose. Congratulations.

James Gutierrez: Well, that's great. And thanks for sharing that book recommendation, it sounds terrific. It brings to mind something we've- I think we were just talking about here yesterday with our executive team in London. We're obviously in a very busy time now because we're seeing patients in one facility, and we're in a huge scurry to get everything ready to open up a brand new hospital. Clearly, our caregivers are working very hard. I think what we were talking about is I think there's good evidence like probably what cited in that book to suggest that if you really want to keep people engaged in their work, keep them from getting burned out, it's not as much making sure they're not working too hard or working too many hours. It's all about making sure that they can continue to see that meaning and purpose in their work. Because if you really feel like you're not just doing a job, but you're working with a team to achieve something that's bigger than any of the individual pieces, that really helps to maintain motivation.

Steph Bayer: It really does. And empathy is hard, as a concept, but when you embed it as a purpose, it's a little bit more digestible. So, you've lived in London for a few years now, what new perspective, from being in London, have you gained as it relates to empathy?

James Gutierrez: That's a great question. Working in London has been just a fantastic experience for me, really transformative. One of the things that's really impressed me, perhaps what's impressed me the most, is really getting a closer view of the National Health Service here, the NHS. The NHS was formed after the war, and it was really it built on the premise that everybody should have access to high quality healthcare. So, everybody without any out of pocket payment can access NHS services, and it's rightly regarded as a national treasure here. Following that, I'm really impressed with the passion I see from the nurses, the doctors, the other care givers here who still work or have worked in the National Health Service. Clearly, they're doing it, not for the money, as much as it's a calling for them. It's something that's part of the national ethos.

James Gutierrez: And empathy, clearly, it's a common language between here and the UK, and they're clearly doing it to support the people of this country. And they're bringing that really with them to their work here at Cleveland Clinic London. So, I think rather than us being a Greenfield here where we had to totally start from scratch, we are really taking a lot of that passion, that empathy, and that real skill from our UK providers, and really melding them with some of the things that really we've developed and that make our model special around delivering empathic care. I think Cleveland Clinic London really is going to be a fantastic blend of the best of the US and the best of the UK.

Steph Bayer: I love that perspective, and I love that empathy is a commonality that crosses upon there. What is a surprise to you though? What, being in London, have you found to be the biggest surprise?

James Gutierrez: Mm-hmm (affirmative). That is a great question because I think there's been a lot of surprises, including the fact that there's a big difference between UK English and US English. So, I think my colleagues and I have really had to learn a new way of speaking. We joke that whether it's on emails or in conversations with people, like you in Cleveland, we've learned to toggle back forth in how we talk, not with an accent, but just the words we use. I think though the other surprise, and this has really been gratifying, is seeing people in another culture and in another country really connect with Cleveland Clinic's values and Cleveland Clinic's model. I think when you grow up an organization, like I have, it's easy to take it for granted because it's the only organization you've ever been in, and everybody- sometimes you can kind of, "Oh yeah, the values. We're going to talk about the values again," but to come to another country and see people really say, "I love the way you do that" or "I love the way you not only have your values, but live your values," that has been a real pleasant surprise. And I think it really has been the best part of being part of this project.

Steph Bayer: That's great. I'm going to switch gears a little bit and ask you about our patients. Now, as Cleveland Clinic London is opening, how are you listening to and communicating with patients, even before we see our first hospital patient, or even before we had our outpatient clinic open?

James Gutierrez: One of the things I learned in my Patient Experience Leadership role here is that there already is a strong tradition in the UK of not only getting patients' feedback or input about decisions, but actually, truly engaging in co-creation. So, it's certainly something that we have strived for at Cleveland Clinic, but it 100% resonates and aligns with what they do here in the UK. Just like in Cleveland, we have our Healthcare Partners Program where we have patient panels and patients engaged in committees and really in leadership in the organization. That's not only a practice here, but it's an expectation. So, we have the challenge of how do you do that when you don't have patients, as a brand new healthcare provider? The fortunate thing though is even though we're not seeing patients at Cleveland Clinic London, our doctors, who are called consultants here, they're coming to us from the National Health Service.

James Gutierrez: Many of them have their own private practices as well, and so they have their own patient panels. So, we were able to go and kind of assemble a panel of patients from their practices to really be our initial nuclear patient panel. Just as we were gearing up to start that panel, COVID hit and we all were working remotely. So, we had to really pivot from doing that in person to doing it virtually, which actually patients like, because they don't have to travel into Central London... 

Steph Bayer: That's a good point.

James Gutierrez: ... at dinnertime, so it's worked really well. Our Patient Experience Manager here, Michelle, has really done a great job of managing that panel, really making sure that we're bringing to them real issues, kind of sharing with them either this is something we're planning, how does it sound? Or this is something we want to do, how do you think we could best do it? It's really helped us to get a jumpstart. The exciting thing, now, is now that we have pay patients, we're actually starting to recruit real patients, and we found that many of our patients are really happy to help us out as we're really starting to take our first steps as a provider in the UK.

Steph Bayer: Someone said to me recently that patients- We spent a lot of money in healthcare on consultants. I don't mean the doctor consultants that I now know you call, but in consultancy groups. Patients are free consultants, if we find ways to incorporate that voice. So, that's wonderful that's an expectation and that you've done that from the get go, even with the pandemic.

James Gutierrez: Yeah, absolutely. It's been great that we have because, probably not surprisingly with this being a different country and a different culture and a different health system, not everything that we do in Cleveland, that we've developed as a best practice in terms of patient experience, resonates with the people in the UK. And certain things that we're not doing in Cleveland or maybe have stopped doing because we didn't feel it was effective, definitely is here. So, it really challenges our preconceptions about how to do things here. It really helps to make sure that what we come up with is our model for healthcare and for the delivery of patient experience can really be appropriate for the actual patients we're going to be serving.

Steph Bayer: Yeah, and isn't that patients first, looking to the patients we're serving and not the model that we think they need? So, with the pandemic, has that impacted in a way that you could talk about how Cleveland Clinical London's being received by patients?

James Gutierrez: Yeah, well, I think based on what we've seen in the US, as well as the UK, clearly COVID has had a tremendous impact on health systems all over the world. I think the biggest impact here in the UK, because the National Health Service covers everybody and it has a very tight budget, especially compared to what we're used to spending in the US, even in the best of times, the NHS here pretty much is operating near capacity in most areas. So, with COVID it really stretched the resources of the system, and a lot of care had to be deferred because of COVID filling up the hospitals. There were three or four major waves of COVID here in the UK, and each one of those kind of bumped up against the capacity. So, a lot of elective care, joint replacement surgeries, hernias, cataract surgeries, a lot of cancer care, and a lot of even screening care, routine health maintenance stuff was deferred.

James Gutierrez: So, there's an estimate that, conservatively, there's over 5 million people here in the UK who are currently on waiting lists for care that might be six, 12, or even 24 months long.  

Steph Bayer: Wow.

James Gutierrez: So, there's a lot of excitement among the patient population here. We're the first new hospital to open up in Greater London in over 30 years, brand new hospital, not a new hospital that's part of an existing health system. So, I think the fact that we are coming on adding capacity at a time when the country really needs it, and a lot of the services that we'll be delivering at Cleveland Clinic London really address those areas where that backlog has been created. So, we're feeling like although we wish we could have been operational to really step up and help during the midst of those waves of COVID. At least we're going to be here to help with the recovery, and to help get patients in the country back on track from a health perspective.

Steph Bayer: That's so important.

James Gutierrez: Yeah.

Steph Bayer: I'm going to ask about your big role as well as your patient experience roles. In what quality, safety, or patient experience initiative are you most excited about with Cleveland Clinic London?

James Gutierrez: I guess I'll cheat because I can think it two, but I think the first one is we have focused a lot on developing some tools and skills to help to deliver highly reliable care here in Cleveland Clinic London. Healthcare, as you know, Steph, has been learning a lot of lessons over the last couple of decades from other industries that have kind of figured out how to deliver highly reliable services. That really simply means how do you deliver consistent quality and safety and whatever your business is despite existing in a really complex, sometimes even a chaotic environment, which certainly healthcare can be at times, right? So, industries like nuclear power, like aviation, even the military, they have really learned a lot of lessons over the years about how to do that.

James Gutierrez: Healthcare has really, in recent years, started to incorporate those lessons, and we've been able to really develop a toolkit for our caregivers to help them to deliver high reliability, regardless of whether they're seeing patients or whether they're working in other areas kind of in the back office, not with patients, but still doing important work. We're all caregivers here. A lot of that, frankly, a lot of that high reliability is built on empathy. It's about number one, having empathy for your fellow caregivers, for your fellow team members, listening and also valuing speaking up and supporting speaking up amongst teams, in between teams. And then on the patient care realm, while obviously in terms of patient experience, it again is around teaching skills to effectively communicate with patients, like the heart program, so that we're sure that we are really listening to our patients and engaging them fully in their care.

James Gutierrez: That kind of brings me to the second initiative that I'm really excited about. That's what we call, in Cleveland Clinic, the Plan of Care Rounds. Okay. Plan of Care Rounds, for the listeners, really is simply the idea that it's structured every day in the hospital, that the key members of the care team, usually at minimum a doctor and a nurse involved in that patient's care, sit down with the patient, really kind of explain what the plan is for their care, both that day and for hospital stay, and I think most importantly, make sure that they're hearing from the patient what their questions or concerns are and they're answering them. Okay. It sounds very simple, but I think, as we've learned at Cleveland Clinic, it's a challenge to do it consistently, and I think we've learned some tricks for doing that. 

James Gutierrez: We have the opportunity, here, to build that into our model from day one at the hospital. So, it's not bringing something new into a system where people's habits are ingrained, but our intent is to have that part of our way of doing things from day one. So, I'm really excited about that. I'm really also excited that, based on some of the tools that Cleveland Clinic has produced, we'll be able to kind of easily measure that and understand how often it's happening so we can be sure that it's happening. And if it's not in certain areas, we can look at how we can make sure that it is delivered.

Steph Bayer: Great answers. I love how the Plan of Care visit really is about communication and expectation setting. That is high reliability and empathy at its best. Now, I promised you no curve balls and a very...

James Gutierrez: Here it comes though, right?

Steph Bayer: Yeah, right. In a very non-empathetic way here is, if I were to check in with you five years from now, what would you say would be your measure to know that this was a successful launch, that we were serving London in the best way possible, the world in the best way possible? How do you see success in five years?

James Gutierrez: Yeah, I think, for me, a key measure of success would be that patients come to Cleveland Clinic London because it's Cleveland Clinic London, because they know that means that they're going to receive high quality care, the utmost and safe care, and also a tremendous patient experience which includes empathy. The reason that it's so important is we are in the Private Healthcare System here in the UK. And in the Private Healthcare System, patients generally select their doctor based on reputation, based on their skill. That happens in the US as well, but if we're successful, patients are going to come to us, not only because we have tremendous doctors who have great reputations, but they're going to trust that no matter which doctor they're scheduled with, when they contact Cleveland Clinic London, they're going to get consistent, empathic, high quality care. If we can do that in five years, there'll be high fives all around.

Steph Bayer: Look at that. You knocked that curve ball right out of the park. Hey, Jim, with your leadership, I'm confident that Cleveland Clinic London is going to have the highest, safe, quality experience that we can offer any patient anywhere. So, thank you for the leadership that you've been giving us and that you're continuing to offer. It's a pleasure talking to you.

James Gutierrez: Thanks Steph, for the vote of confidence. I hope we can fulfill it. I think more importantly, thanks for the opportunity to participate in this podcast. I enjoy listening to it, and it's great to be a participant.

Steph Bayer: This concludes this Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcast. Subscribe to the Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening. Join us again soon.