Cleveland Clinic: State of the Clinic 2019


Ladies and Gentlemen, please welcome Cleveland Clinic’s CEO and President, Dr. Tom Mihaljevic. [Applause] Thank you very much. Good morning. And welcome to the State of the Clinic. I would like to thank you for being here today. And I would also like to thank those who are joining us from around the country and around the world. I’d especially like to thank our guests, our elected officials and community leaders who took the time to come. Over the past year, I traveled to many of our locations and met with thousands of caregivers. You moved me, you taught me, and you inspired me. So I would like to thank you very much. In 2018, we’ve introduced a new ethical framework – treat patients and fellow caregivers as family and Cleveland Clinic as your home – a framework that you warmly embraced. If we do this, we do the right thing. Every time. We also introduced four care priorities – Care for Patients, care for our Caregivers, Organization and the Community. Each priority supports the others. With all of that, you made 2018 another great year. Here’s a look at what we’ve accomplished together. ♪ The Cleveland Clinic consistently ranks among the best hospitals in the nation. U.S. News and World Report has named the Clinic #1 in Urology and Cardiology for the 24th year in a row. It’s wonderful that Cleveland Clinic is on the cutting edge of all this. They’re there to find the problem and to fix it so that you have a quality of life again. ♪ It’s a team approach, it’s everybody coming together and being able to work together collaboratively. ♪ Cleveland Clinic pumped 17.8 billion dollars into Ohio’s economy. Just within the last few months we’ve added over 100 new jobs. It really speaks to the Cleveland Clinic’s commitment to our community. By combining quality care with education, compassion, and self-reliance we can ultimately decrease the cost of medical care and improve the health of our community. I had a seed of opening a clinic where we could provide culturally competent and bilingual services to this community. I would never have dreamt that, that was possible but philanthropy helped put it in life. ♪ Velosano is becoming a movement, 100% of all our donations go to research. We can take those ideas and develop the next therapy. ♪ Cleveland Clinic well known for expanding its footprint here in northeast Ohio with this new medical school as well as all over the world. ♪ The model of care that Cleveland Clinic offers doesn’t exist in our country. I think Cleveland Clinic London will be a game changer. ♪ As our reputation in Florida has grown so has the demand for our services from all around the world. The new Cleveland Clinic Lakewood Family Health center will be open for business. ♪ They’ll have access to urgent care. They’ll have access to level one trauma. Union hospital is now a full member of our health system. ♪ That’s why the new Cleveland Clinic Children’s center is so amazing. It’s where little matters. We’re here for his last chemo treatment. [bell rings] They took the best care of him. I don’t think he would be here with out them. ♪ It’s incredible what they can do these days. The Cleveland Clinic developing one of the only bionic arms in the entire world. We’ve taken out their nerves after the amputation and redirected them to new muscle and skin sites. So now here on my chest, I feel my hand. I truly believe that research can transform healthcare. ♪ If we identify it, we treat it, we can make a huge impact on the quality of life of MS patients. The Cleveland Clinic thinks they have a cancer breakthrough. A blood test that can pick up the disease years before a person actually get sick. Our hope is this will allows us to detect these potentially lethal cancers at a much earlier stage when they’re far easier to cure. The Lou Ruvo Center for Brain Health is leading the way in research for dementia across the country. So many great things are happening in the research side of our field and we have the opportunity to bring it straight to our patients. ♪ When you’ve got very motivated talented people working collectively to try to do the best thing for the patient, it’s a formula that’s hard to beat. They don’t worry about problems, they think of solutions. That’s what the Cleveland Clinic is about. ♪ [Applause] The accomplishments of 2018 were absolutely remarkable, but we know they did not come easy. Because nothing worth doing is easy. We developed through effort and through change. And this is what made Cleveland Clinic great for 98 years. And it will allow us to thrive in the future as well. Cleveland Clinic today is a healthy organization, at the top of our field, in the most exciting time in healthcare. We have the opportunity to lead as never before. To do this, we need a clear vision and we need a clear strategy. In the last year’s State of the Clinic, I said we would build a plan, and we would build a plan together. We convened hundreds of leaders, caregivers and board members last year to develop a vision and strategy for our organization. Our vision is to become the best place for healthcare anywhere, and the best place to work in healthcare. Our strategy is this – We will stay true to who we are – working as a team with the patient at the center of everything we do. We cannot ever change this. This will never change. We will care for patients and families across their lifetimes. With care that is going to be proactive and supported with the very best of digital technology. We will grow, and double the number of patients we serve over the next 5 years. Everything we do and everyplace we are, will bear the unmistakable stamp of One Cleveland Clinic – with the same quality and experience at every location. This is the Cleveland Clinic way. Our strategy is fully aligned with the care priorities we’ve established. Let’s take a look at each of these “Four Cares” in turn. As I mentioned, Our vision for Cleveland Clinic is to become the best place for care anywhere. It is truly the reason why all of us are here today. Teamwork has been the essence of Cleveland Clinic since 1921. For almost 100 years, our motto has been “to act as a unit.” In other words, to act as a team. And I have to warn you upfront, that you’re going to hear me say the words “team” or “teamwork” 34 times in the next 25 minutes. And the reason for it is because we are the ultimate team play in healthcare. In 2018, we brought this to a new level with a transformative innovation called tiered daily huddles. Now for all of you in the audience, I know that this is not a new term. Because every day for the past year, every day 25,000 caregivers take part in the huddle process across Cleveland Clinic. Here’s how it works. ♪ Marymount? We have zero potential serious safety events. We have one environmental safety issue. No staffing issues. The tiered huddle process is one of my favorite things of the day. ♪ It starts at the unit level and it works its way to the executive level. Information flows in all directions across teams to the next level of leadership and then back out to our caregivers. It helps us understand where we need to address issues that have come up from both safety and quality. His falls risk was adjusted and safety measures put into place. We talk about caregiver safety. Caregiver Experience issues at main campus this morning we did have an RN. We can escalate any issue problems or barriers that we’re having and get a quick resolution to them. After the very first huddle, I was like, yes this is, this is awesome and this is what we need to do. We’ve developed a standard list of questions so it’s very helpful to be able to gain that feedback right away. As leaders, we are expected to ask these questions, caregivers are expected to tell us what’s happening so that they can do their job better. Our nursing caregivers they’re kind of amazed, that issues they bring up, then they’ll get answers back or resources back in a timely manner. They have really brought us together as a stronger team and better relationships with other departments because things are getting resolved a lot quicker. ♪ The tiered daily huddles allow us to track the vital signs of our complex and global enterprise – improving quality, efficiency, and most importantly – patient safety. Safety is our non-negotiable priority. It is the foundation of the trust that we establish between us and our patients. We all know that trust is gained in drops and lost in buckets. Last year we set a goal to reduce serious safety events – and we did just that. But we have to do better. Our goal for serious safety events is zero. It means to eliminate them. How do we get there? We have to speak up, but we also have to respect, and hold each other accountable for patient care. Because silence is the enemy of safety. Cleveland Clinic supports a culture where every caregiver can speak up, without fear, on all matters of patient safety. Today, I’m announcing a new “Speak Up Award” for individuals and teams who bring safety issues to light. We are all equally committed to superior patient care experience as well. So how do we accomplish that? By now, I believe you guessed it. By teamwork. We launched another innovation called multidisciplinary team rounding. These are not your ordinary rounds. They bring the entire care team together- and, they include patients and their families. Team of teams are the foundation for our future care model – highly functioning teams will be the patient’s proactive health partner, striving to keep people well, not just to be there for them when they become sick, and then over the course of a lifetime. We all know that great things happen when great people work together. For example, our face transplant. Half the population of the planet got a first-hand look at our team of teams last year. There were more than three billion impressions- not million, but billion impressions- for National Geographic’s cover story on Cleveland Clinic’s landmark face transplant. It is a remarkable story about a remarkable young patient. ♪ I’m Joanna Connors and I wrote and reported the National Geographic story about the face transplant at the Cleveland Clinic. I started on the story more than a year before the actual transplant and I knew how many departments within the clinic were treating her. What an intricate web of professionals, of physicians, but also non-physicians were taking care of Katie. I mean the level of compassion and care that I saw was just striking to me. I’ll be your social worker during this process. What kept occurring to me is that whole cliché, it takes a village to raise a child. I started seeing the clinic as a village and it was taking a village to help Katie. ♪ I didn’t lie to you, this is going to happen. It’s happening now. I’m so excited. ♪ I love you. The precision of getting that OR ready. I was really struck by this thought I, it was almost like awe, there are so many brilliant people here. But not just brilliant, they are compassionate and they’re dedicated. And this is not for their glory, they care about Katie, and they felt reverence, was just game changing for me in the way I see the clinic. [Applause] ♪ That spirit prevails of we’re going to all work together, in a unique way, I think here‪.‬ It made me jealous, actually because I thought, these people are really helping people. What a wonderful thing to go home and say, “this was a tough day, but man, I really helped people today.” My big regret is that you can’t name everyone in the story. ♪ I wish I could have because everyone should be proud of the outcome of this. ♪ [Applause] Today’s care relieves today’s suffering, and research and education enable us to create the care for tomorrow. Patient care, research and education are interdependent and mutually supporting. We cannot have one without having the other. Nothing we do this year will benefit the future of healthcare more than the opening of the Health Education Campus. This milestone project is being developed with our colleagues from Case Western Reserve University. And the beautiful building, the Sheila and Eric Samson Pavilion, will open this summer. It will teach healthcare professionals to be members of interdisciplinary teams and promote lifelong learning. The Health Education Campus will shift the center of gravity of medical education closer than ever to Cleveland, Ohio. Teamwork has brought us success in patient care and education – and it is no surprise that teamwork is also bringing us success in research. The Lerner Research Institute earns one of the highest percentages of team-based NIH grants in the United States. And here are a few examples: The collaboration between our Heart & Vascular Institute and Lerner Research Institute are analyzing the genetics of atrial fibrillation. The Musculoskeletal Research Center is leading the national trial on a new reconstructive knee surgery. Beyond the NIH – we are investing in team-based research ourselves through a future immuno-oncology center that will take cancer care to a new level of genetic precision. These research projects exemplify “team of teams” that will translate benefits directly into better patient care. Our vision is to become the best place to work in healthcare. Because we cannot have a superb care for our patients without having the best possible place to work in healthcare. And we will do so by taking care of each other like family. We have a big family – 66,000 strong. We had our first and largest family reunion, we called Family Day, at Progressive Field. Thank you for making this a huge success. Last year, I promised that we would create an Office of Caregiver Experience, the first suh office in healthcare. Today, the office is fully staffed and bursting with energy. Over the past year, they conducted more than 11,000 interviews, and we’re already making the changes you’ve asked for. We extended the onboarding period for new caregivers. We are the first medical system in Ohio to raise our minimum wage to $15 an hour. We’re strengthening our already best-in-class career development for all current caregivers. Most importantly, we’re focusing on addressing caregiver burnout and promoting resilience. Burnout is a serious problem in the healthcare industry. Individuals struggle to cope with the complexity of healthcare by themselves. We are approaching burnout by leveraging technology, teamwork, and improving wellness. We have hired scribes and deployed voice recognition to make documentation for our providers more seamless. And that will give them more time to dedicate to patient care. We expanded the care teams by doubling the number of advanced practice providers in the last four years. And we are offering more and more opportunities for you to enhance your personal wellness and wellbeing. One of the best ways to address burnout is to develop engaged caregivers, who have a sense of meaning and purpose in their work. Engaged caregivers can answer three simple questions- What is my job and purpose? How do I contribute to my team and the organization? How will I grow and develop? I would encourage each and every on of you to work with your supervisors and your team to develop the answers to those questions, and a plan that will inspire you and motivate you. We all have one thing in common, a glue that holds us together, our secret sauce of Cleveland Clinic – which is Cleveland Clinic culture. Culture is deliberate, we define it and live it. We are all equally responsible for it. Cleveland Clinic has a rich culture of inclusion. We do not tolerate discrimination in race, religion, nationality, culture, age, sexual orientation & identity, or veteran status. We firmly believe that our diversity is our strength. By 2024, we will have leadership that fully reflects the diversity of those they lead. Now I’d like to speak about an important yet silent threat. There is a national epidemic of violence against healthcare workers, especially in emergency departments. Cleveland Clinic is no exception. Last year alone, nearly 30,000 weapons were confiscated from patients and visitors. 30,000 weapons. We are taking strong measures to protect our caregivers. We’ve increased police presence, we added panic buttons to badges, we put metal detectors at every emergency room entrance, and created an app for our caregivers to request a police escort to our parking areas. We are committed to protect each other, just as we protect our patients, and just as we protect and care for the organization and its resources. And we have to take care of our organization just as if it were our home. Because we know we work for a unique enterprise with a very important mission. I can stand before you and say with healthy confidence that every country in the world wishes it had a Cleveland Clinic. And every patient in the world would come to Cleveland Clinic if they could. We should all be very proud of this. You made Cleveland Clinic a haven for the sick. We bring hope for millions. And this is why access to Cleveland Clinic here is a critical issue for us. Last year, we cared for over 2 million patients – more than ever before. Despite adding more facilities and more caregivers, we barely, barely, made a dent in the demand for our services. We can’t take this demand for granted. It is our moral obligation to open our doors as wide as possible for those in need. Just imagine if your mother, sister, or loved one were sick, you would not want them to wait two weeks or two months to be seen. You would want them to be cared for today. This is what it means to treat patients as family. At the same time, we face the same economic challenges as the rest of healthcare. The cost of care delivery continues to rise, and reimbursement continues to decline. We have to fight to keep costs low and through that, care affordable for our patients. We will do this by studying and improving processes of care delivery through our new Healthcare Delivery Science Center, and also simultaneously to deployment of continuous improvement. These continuous improvement efforts help us get better in every aspect of the care we provide. Because we need to do well to be able to do good – to be able to reinvest in our mission of patient care, education, and research. This is what it means to take care of our organization as our home. Responsible stewardship will allow us to grow. And we will grow both physically and digitally. We’ll invest in our home base and our core infrastructure here in Ohio by prioritizing investments in the Neurological Institute, Cole Eye Institute, Fairview Hospital and the Mentor community. In Florida we continue to invest in new facilities, adding over 6,000 new caregivers, and welcoming our dear friends from Indian River and Martin Health into our family. In Abu Dhabi, we continue to grow at an unprecedented pace and are expanding into new venture into cancer care. Our family of caregivers is growing rapidly in London. Cleveland Clinic London is scheduled to open in 2021, our centennial. Digital technology will transform the way we deliver care and allow us to grow beyond the walls of our buildings. Telemedicine is our most exciting and our fastest growing service – increasing 70% over the last year alone. This service makes Cleveland Clinic care available to patients in every corner of the world. Digital innovation is taking place in every domain. We’re putting patient photos in the electronic medical record to reduce misidentification. Through remote monitoring, we’re allowing more patients to recover at home. We’ve added new protections to prevent overdose and addiction to controlled substances, the largest public health challenge today. Artificial intelligence and machine learning is already helping us to keep patients at home and out of the hospital. Risk calculators identify patients who are about to leave the hospital but they are at risk of readmission – so that we can better coordinate their care and keep them healthy and keep them at home. And this new technology is making care safer, more personal, and more local. Through physical and digital growth, we will double the number of patients we serve over the next five years. Growth brings us into new communities. And we are committed to the wellbeing of every community we serve. Here in Ohio, we’ve been at the same corner for 98 years. We are an anchor institution – adding 17.8 billion dollars to the local economy, and more than 906 million dollars in community benefit. As a healthcare organization, we are obviously passionate about wellness, and we’d like to see Cleveland become the healthiest city in the United States. We’re focusing on two pressing issues – opioid addiction and infant mortality – and we’re working alongside our partners in the community to make improvments in those areas. And as you know, we also hire from our communities and are a major job provider wherever we are. We’ve joined with schools, colleges and universities to train students to work in healthcare careers. We have dozens of programs with more than 8,000 students. The Aspire Nurse Scholars Program provides high school students with exposure to careers in nursing. Here’s one Aspire graduate who’s now working with us here on our main campus – I decided to be a nurse when I was about nine years old. The Aspire Nurse Scholars program is very amazing, they teach us things we should actually be learning in college. I would come in so like energetic because I’m doing something I love. I’m actually suppose to start working as a PCNA, a patient care nursing assistant at the Cleveland Clinic main campus and I start school in the fall. Honesty, I’m just filled with so much joy, it just feels so good knowing that the Aspire program has had my back and has had their hand in helping me create my future. [Applause] Thank You [Applause] She’s so excited, you can feel it in the video. I mean this is the phenomenal impact that we can create for young people in our communities. It’s very, very moving. You know, our caregivers are very committed to our community. Many participate in community service and would like to do even more. So we’re launching a new volunteer initiative that we call Community Service Time Off. We’re giving Cleveland Clinic caregivers an opportunity to volunteer on paid time with designated agencies. I have to tell you a story. A few months ago, my team and I spent time volunteering at the Cleveland Food Bank. And it was a great and a very, very rewarding experience for all of us. In particular for myself, because they were teasing me that I could dust off my surgical skills for packing lunches for students. And I could tell you, we were, by far, the fastest sandwich packers in Northeast Ohio. Hands down. You never know what your surgery training is going to be good for. So, on a serious note, We want every community we serve to be the healthiest community possible. We live in extraordinary times. Today, Cleveland Clinic is the most exciting organization in the noblest profession – healthcare. We are the beacon of hope for millions. The world looks to us for innovative solutions to the greatest challenges in healthcare. Our collective power is especially clear in the most complex cases – patients who would have no hope anyplace else. And here’s an example. ♪ Before all this happened he was very healthy. He turned 18 on November 5th. Two days later he said he didn’t feel good, our whole world changed after that. He had, had kind of a rough course coming in. He had to be intubated, had a breathing tube put in because this big kind of football size mass in his chest was pushing on his airway. The tumor wasn’t shrinking fast enough. He couldn’t get oxygen into his lungs. Drastic action had to be taken and he was placed on ECMO, which is essentially like a heart lung bypass machine. We talked about what is the feasibility of doing radiation therapy on ECMO? And there was no reports of this ever being done before. We started having conversations about, “OK how the heck do we actually make this work?” And then the conversation turned to, “you know, how do we even get him there?” We’ve never taken a patient from here all the way over there while on ECMO. So now I need to figure out the team that could get him there. They prepared the route and made decisions on, is it even physically possible? Thankfully they had done that because then the decision was we need it and we need it now. And that’s when everybody pulled together quickly. We saw everybody prepare and, and check and double check. It was probably 20 to 25 people that helped. The entire Skyway was blocked off for us on the real run. We were from his bed space into Taussig in about 15, 20 minutes. Three people, maximum taking shallow breaths could fit in that elevator. Everybody else had to go down the stairs. I remember being very scared, but I remember feeling confident because I saw so many people working together. ♪ He really made progress with the therapy that we gave him. That gave us quite a lot of hope moving forward. There was this big scarred down tumor there but it had responded to the therapy. What made things work was the ability of different teams to communicate with each other and share ideas and work collaboratively together. We could pull all this team together, get him there and back and then all the other patients never felt a change in their care. You know, we’re still in the middle of his story. I know he can do it and I know the doctors here aren’t going to give up. He’s got a long journey, but boy he’s come through a lot. He just doesn’t give up and that’s where, where we’re at. ♪ [Applause] The team that cares for Shayne and that transported Shayne to the Taussig Cancer Center for radiation treatment is here today. I’d like to ask them to stand and be recognized. [Applause] Thank you. Thank you very much. Shayne’s journey is not over, and neither is ours. We will be here for Shayne and his family every step of the way. And we will be here for each other as we embark on our future journey. Because there is absolutely nothing we can’t accomplish if we work together. The months and years ahead are full of challenges and full of promise. Working as a team, we will achieve our vision – for Cleveland Clinic to become the best place for care anywhere, and the best place to work in healthcare. There is nowhere I’d rather be than right here, right now, with you, to build this great future. I’m truly honored and humbled to serve as your CEO and President. Many thanks to all of you for coming today. Thank you for all that you do for our patients, each other, our organization, and our community. And I wish you a great day. Thank you very much. [Applause]

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