Overview
We care for patients as if they are family with the vision of being the undisputed best place to receive care anywhere. Our culture of safety continues to support our commitments to providing a safe workplace for caregivers and a safe environment of care for our patients.
In 2022, Cleveland Clinic was named a top hospital by Newsweek as part of its “World’s Best Hospitals 2022” analysis and by the 2022-2023 U.S. News & World Report “Best Hospitals” rankings.
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
Safety & Quality are among our core values. Caregiver behaviors associated with this value include ensuring the highest standards and excellent outcomes through effective interactions, decision-making and actions.
We embed Safety & Quality 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. All caregivers are continually supported in utilizing our high reliability behaviors to break down barriers to psychological safety and effective communication.
Safety champions
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.
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.
Leadership rounding
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 Board members.
Leaders visit units at each hospital across the enterprise and ask caregivers and patients the same questions based on safety topics. This process also enables us to identify and resolve individual and systemic issues and educate widely on safety-related topics while providing meaningful leadership visibility for patients and caregivers.
Continuous improvement
At Cleveland Clinic, we strive for a culture where every caregiver is capable, empowered and expected to make improvements every day. We know that there is power in numbers and successful improvement efforts do not originate from leadership alone. By engaging every caregiver in this work, we create an environment where problems are opportunities that we surface and address regularly and where caregivers share ownership of challenges and successes. Continuous improvement (CI) is not a series of extra projects — it is how we do the work we have already identified as mattering most to our patients, caregivers and leaders.
Our CI team has specialists in every hospital and clinical institute in Ohio and Florida to support cultural transformation. CI specialists serve as coaches to build CI capability among teams and leaders so they can apply these skills to solve their most important problems. Over many years of learning, we have documented the best-known way to improve, which is the Cleveland Clinic Improvement Model. We organize behaviors and tools for easy adoption in this model, observable in the workplace as:
- Clear and articulable goals.
- Visually displaying goals and current performance.
- Active problem solving through implementing and testing countermeasures.
- Standardizing and sharing effective countermeasures.
The success of our organization is rooted in our strong improvement culture. Our culture is our caregivers and our caregivers are the foundation of how we do our work. We make improvements because our caregivers are capable, empowered and expected to every day.
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.
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.
Patient Data
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, as well as 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 2022, 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.
2022 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.
All of our locations track and trend events that potentially are harmful to patients and perform cause analysis to avoid replication of those events. In addition to this work, we also track the ratio of potentially harmful events to all reported safety events and call it the harm ratio. Safety science shows that understanding these “near miss” or “good catch” events can help eliminate the potential for harmful events.
We continued to focus on reducing preventable readmissions. Our analysis has shown that ensuring that patient get timely follow-up care after an admission has a large impact on their readmissions. Also, understanding and addressing social determinants of health are part of our strategy. We have efforts in both areas to ensure that patients can go home and stay home after receiving our care.
Excludes Lodi due to low volumes
Our hospital-acquired infection rates are high performing compared to other hospitals in the US in most cases. We have identified some opportunities to improve our surveillance of surgical site infections, utilization of urinary catheters and central lines, and prevention techniques. We realize that utilizing better surveillance methods than most health systems and identification of infections may affect our CMS penalties, rating scores and reputation, but believe that it is the right thing to do for our patients.
We monitor hand hygiene as part of our ongoing quality assurance program. Hand hygiene is likely one of the most critical elements to avoiding infections. We encourage all caregivers to support one another by reminding peers to perform the best hand hygiene on an ongoing basis.
Uncontrolled diabetes and controlled hypertension are two important population health measures. Cleveland Clinic is working to improve these and other population health indicators through enhanced care coordination; ensuring patients receive the appropriate care at the right time; optimizing technology and information systems; and engaging primary care specialty teams directly in the improvement work.
Benchmarking source: Press Ganey Medical Practice Benchmarks (ratings/scores reported at the 50th percentile rank Jan 2022 - Dec 2022)
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: Center for Medicare and Medicaid Services, hospital patient discharges July 2021-June 2022. 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.
Through ongoing efforts to enhance the patient experience, we work to reduce the rate of complaints and grievances across the enterprise.
