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How Cleveland Clinic Delivers One Million Same-Day Appointments

By Stewart Gandolf, Chief Executive Officer
Paul G Matsen

Paul Matsen Cleveland Clinic

[Healthcare Success Leadership Podcast Series] What does it take to upset longstanding “tradition” in healthcare delivery and to provide patients with quick, convenient access to care via same day appointments and other innovative approaches. Cleveland Clinic’s Chief Marketing and Communications Officer Paul Matsen, and Stewart Gandolf, CEO of Healthcare Success discuss the process of change, top-tier leadership, a culture of innovation and the benefits to patients and the organization.

In healthcare delivery today, “same-day appointments” is a fascinating, but highly elusive, concept. Patients say they want the convenience. Best practices favor a “patient first” experience. Marketing advisors regularly recommend faster and easier access to care. Providers and office managers cringe.

But relatively few provider organizations of any size—from large medical systems to individual practices—have been willing or able to actually deliver the seemingly impossible dream of same-day access to health care.

Many healthcare organizations steadfastly cling to the old, traditional means and methods. The model for access to healthcare and healthcare delivery is an assembly line to the benefit of the doctors and the staff. Whatever is efficient for the hospital or provider practice is what’s best, and the patient’s point of view doesn’t really matter.

In our podcast conversation today, Cleveland Clinic’s Paul Matsen, and Healthcare Success CEO Stewart Gandolf, discuss how the organization applied its culture of innovation to achieve an organizational change that truly put the needs of patients first.

STEWART GANDOLF: Same-day appointments are a complex and difficult challenge for any organization, especially for a busy hospital system. How and why did this concept come about at Cleveland Clinic?

PAUL MATSEN: The concept originated out of an issue that Cleveland Clinic was known for specialty and complex care. Today, we operate an integrated healthcare system—from primary care to home care—with 150 locations.

But there was a lingering perception that Cleveland Clinic was a difficult place to get appointments and a difficult place to be seen. We wanted to shatter that perception. Our CEO, Dr. Toby Cosgrove conceived the idea of offering same day appointments.

In his experience, some patients were, at that time, being offered appointments 30 to 45 days later. But the critical issue was that patients often know best when they need to be seen, and Cleveland Clinic needed to create new forms of patient access to care.

STEWART GANDOLF: In healthcare, the old model is that it is an assembly line to the benefit of the doctors and the staff. So whatever is efficient for us is what we’re going to do, and the patient’s point of view doesn’t really matter.

When you say “patients first,” it’s more than a slogan. The Cleveland Clinic is building a culture, and you’re committed to it. Patients First is simple, but exponentially more difficult in institutions with many moving parts. Any parting thoughts for our podcast listeners?

PAUL MATSEN: I would close with two things. One is that a culture of innovation is critical for any part of the organization, whether it’s clinical, technology or marketing. We all need to be continually testing and investing in new ideas. Never be afraid to pilot something before you roll it out. And you really have to have a culture where innovation is truly supported and recognized… where people are willing to take some risks, and sometimes fail. At the Cleveland Clinic, we are especially proud of the culture that we have here.

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Paul G. Matsen, Chief Marketing and Communications Officer – Mr. Matsen is responsible for all marketing and communications programs at Cleveland Clinic including brand development, key clinical line marketing, digital marketing and corporate communications. Mr. Matsen was formerly Executive Vice President and Chief Marketing Officer at Delta Airlines. He is a graduate of Rutgers University, NJ.

Additional highlights from this insightful podcast interview...

SG: Having spoken with Dr. Jim Merlino regarding the Cleveland Clinic patient experience programs, we know that the CEO endorsement and organizational leadership backing was vital to success. But, even with top-down buy-in, no doubt there were obstacles to overcome.

PM: This was a totally new concept to everyone, and access in healthcare delivery is challenging. There is demand for services; there is demand for individual physicians; and there is demand for individual locations. So there were two key things in the way we approached this.

First, we piloted the program for some time before we rolled it out through our marketing program. Each clinical area figured out what worked best for their schedule and their practice area. This took some time, but they were able to share best practices. Ultimately, every area of organization was able to solve it.

Second, we have a centralized call center that handles all of out outpatient scheduling. And when you have access to all physician schedules, it gave us the ability to provide that customer service experience of offer patients more immediate appointments at a location somewhere in the Cleveland Clinic system.

It was a great example of an organization adapting rapidly to a new concept. It took some time, but today, people would say that it was transformative and highly successful.

SG: Knowing administrators and doctors as I do, I assume that, at the beginning, some people were more enthusiastic about this idea than others. How did you get them on board?

PM: There’s always resistance to change. And in healthcare, we’re going through unprecedented change in virtually every area of the enterprise. Change management is critical, and it all starts with communications and getting people to understand the “why;” why is this important.

Providing access to our model of care, providing access to our caregivers was something that we needed to dramatically improve. Ultimately, communications plays a central role. Dr. Cosgrove and I talked about this often and at length, that we could use marketing not only to educate the community about same-day appointments, but also to help drive the cultural change within Cleveland Clinic.

The campaign that we ultimately rolled out is called “the power of today.” The concept was, “yes, we offer same-day appointments, but the most important thing is the people and the programs that same-day appointments give you access to. And that’s what the power of today is all about.

We had that message delivered by Cleveland Clinic caregivers and physicians. That messaging helped drive the cultural change inside the organization, and adoption of same-day appointments outside the organization.

SG: Was it a smooth implementation or were there a lot unexpected speed bumps along the way?

PM: Of course there were bumps along the way. [In our organization] there are institutes where access is particularly challenging. In dermatology, for example, there is always greater demand for those services than we could make available.

So the key to making this innovation successful was to have each clinical area—each institute, in our case—work to solve the issues within their own area, with help from our continuous improvement teams or our clinical transformation team.

We’ve been at it for four years now, Stewart, if you can believe it. Today it runs extremely well, and now we’re moving on to the next frontiers of access.

 SG: You’re obviously helping people if you can see them sooner. I’m wondering about the results clinically and from a marketing point of view. Is there a way that you can summarize those results?

 PM: We’ll see over one million same-day appointments this year at the Cleveland Clinic. That’s almost a mind-boggling number. And there are incredible stories of patients who had been seen for a same day appointment who, as it turns out, had critical conditions that they were facing. And, being able to get same-day access to health care probably saved their lives.

Plus, the evolution of access is moving us beyond same-day appointments. We still offer them, of course, but we’re adding Access Anytime Anywhere. We’ve added 14 walk-in clinics that are open now Monday through Friday from 6AM to 9PM, and Saturday and Sunday from 8AM to 4PM. We’ll have a total of 16 by the end of the year. This creates another unscheduled opportunity for patients to come to the Cleveland Clinic.

In addition, we rolled out Express Care Online visits where we’re seeing almost a thousand of those visits per month. We’re trying to bring down the barriers to access. We believe it’s a critical part of healthcare transformation.

For the brand, it’s been fantastic. As we look at attributes across the board, one that we look at is: who offers the best combination of compassionate care and clinical excellence. We’ve seen our scores on that increase dramatically…and that is what we were after. At Cleveland Clinic, while we’re known for our world class, complex care, we’re here to serve all the medical needs of the community.

SG: That is an interesting payoff. The patient has a hard time evaluating the skills of the surgeon, but they do know if they were treated well, especially during that scary time when they are first being seen. So it sets up the relationship in a whole different way, I assume, in terms of the patient’s attitude when they come into the Cleveland Clinic.

PM: Providing access and providing choices to the patient for how and where they can be seen is a transformational change in healthcare. And virtual visits—we call it Express Care Online—walk in clinics, same-day appointments…these are all things that have been incredibly well received by patients.

They are changing the way that care is delivered. And, as a healthcare provider, we need to do these things. We need to disintermediate ourselves before competitors step in and provide these services.

It has been great for the organization, but more importantly, it has been great in terms of the care we have been able to provide to the community. The patient satisfaction levels for Express Care Online, for example, has been beyond our expectations.

SG: We work with a lot of hospitals and doctors. And what I find about Cleveland Clinic is that you are truly focused on the patient and on what works. Help me convince skeptical doctors and hospitals that they should do the same thing. What would you tell others that it’s the right thing to do?

PM: Stewart, you put your finger on it. You have to start with what’s in the best interest of the patient. At Cleveland Clinic, we talk about “Patients First.” And when you do that, you really have to listen to what patients are asking for. Patients were asking for appointments that would fit their schedule, access that lets them to use the latest technology, and they were asking for access to care on the weekends for working families and working moms and dads.

These are things that seem extremely “common sense” when you talk about it. But healthcare organizations need to challenge themselves to be innovative. And at the Cleveland Clinic, we have a culture of innovation. Be it in our patient experience organization, or in addressing access to care, or embracing electronic medical records…the Clinic has always had that mindset.

It is truly putting patients first when we think about how do we transform schedules around the needs of patients, and not necessarily around the needs of the organization.


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