Cleveland Clinic put every employee through one day and called them caregivers

A family can know the outcome data and still go somewhere else. The procedure is not the only thing they are deciding on. They are also deciding whether the place will treat them as a person while the work is done, and a ranking does not answer that.

Toby Cosgrove's chapter, hosted by Cleveland Clinic, is his account of being asked in public. In 2006 a student at Harvard Business School said her father had needed mitral valve surgery. The family knew the clinic's results and still chose another hospital, because they had heard there was no empathy. She asked, "Dr. Cosgrove, do you teach empathy at Cleveland Clinic?" He had no real answer. Patients First was already under way. It did not yet mean they taught empathy. Ten days later, in Saudi Arabia, King Fahd heard a new hospital dedicated to the body, the spirit and the soul of the patient. Cosgrove writes that the king was in tears, and many in the audience with him.

He offers his own training as the exhibit. While he learned heart surgery, up to 20 percent of patients could die on the table, and that rate took his attention. Outcomes, he argues, are half the story. From 2006 the clinic made experience a strategic priority, opened an Office of Patient Experience and appointed a first chief experience officer. Patients First then meant the whole encounter: physical comfort and educational, emotional and spiritual needs.

The proof that moved was a privilege. Parking by the front door went from doctors to patients. One complaint, as he records it, was "What is this, patients first and doctors last?" A great surgeon, the chapter says, is technically good and treats the person well. Published satisfaction scores were also being tied to Medicare reimbursement.

Other rules moved with the parking. Patients could see their records and were told so. Visiting hours ended, except in intensive care while staff were with the patient. Diane von Furstenberg replaced the open-back gown. Redcoats, who direct people or stay with someone after bad news, were expanded. HUSH set quiet hours from 9 pm to 7 am.

James Merlino, chief experience officer, describes a spill by an elevator in 2009. He fetched towels and found colleagues walking over it. His father had died at the clinic of a complication. The medicine, Merlino says, was excellent. The treatment by staff was not, and he had not meant to work there. In 2011 all 43,000 employees went offline for Communicate with H.E.A.R.T. The chapter expands the letters as Hear, Empathize, Apologize, Respond and Thank. A finance chief sat with a perfusionist, a surgeon, a lab tech and a housekeeper, and each person left with a caregiver badge. From 2008, engagement and patient ratings rose and complaints fell. No figure is given.

Patients were in the drafting as well. More than 15 Voice of the Patient Advisory Councils review policies while they can still change, and a panel of more than 4,000 was asked questions once or twice a month. Code Lavender answers an emotional emergency. Ninety-five percent of the calls came from caregivers.

1. Move one privilege clinicians hold, where people can see it. Parking at the door went to patients, and a doctor objected in so many words.

2. Put non-clinical jobs in the same session as the surgeons. The 2011 day took all 43,000 people offline, and a finance chief sat with a housekeeper. The spill is the scene that day is for.

3. Write the behaviour for the minute a complaint starts. The letters include an apology and a response. A welcome script does not tell a ward what to do once something has gone wrong.

4. Let people who have been the patient see the draft. More than 15 councils review policies, and more than 4,000 people are asked regularly. That is a patient in the room before the rule is signed.

A customer experience session is a place to take one live complaint, the rule that produced it and the person who can change that rule, and rewrite the rule with someone who has been on the receiving end of it.