Cleveland Clinic's Office of Caregiver Experience Improves Outcomes

Added on Oct 24, 2019

Cleveland Clinic’s Office of Caregiver Experience Improves Provider and Patient Outcomes
By Audrey Doyle

When Dr. Tom Mihaljevic became president and CEO of Cleveland Clinic in January 2018, he vowed to continue the patient experience work of his predecessor, Dr. Toby Cosgrove, and make the clinic the best place to receive health care.

To deliver on his promise, Dr. Mihaljevic established the Office of Caregiver Experience (OCE), whose mission is to make the clinic the best place to work in health care.

According to Joy Jones, OCE executive director, Dr. Mihaljevic established the department—reportedly the first of its kind in the industry—in recognition of the strong, positive relationship between the caregiver and patient experiences. “They go hand in hand. Caregivers can’t provide safe, high-quality, patient-centered care if they can’t find purpose or meaning in their work, don’t feel physically or psychologically safe, are suffering from stress or burnout, or are experiencing other difficulties that affect their well-being,” Jones said.

To that end, the OCE uses input from clinical and nonclinical staff to develop programs, tools, and other resources intended to improve the caregiver experience in four key areas: organizational culture; the physical work environment; the availability of tools and technology that promote teamwork, health, safety, and well-being; and the ability to grow, belong, and be well both on and off the job. Members of Cleveland Clinic’s Office of Patient Experience and Quality & Patient Safety Institute consult with the OCE team to ensure that all of its programs help support the caregiver experience while resulting in better patient care.

Although the seven-person team came together less than two years ago, their efforts have already produced meaningful improvements in caregiver engagement, caregivers’ perceptions of patient and workplace safety, and patient experience. Notably, from 2017 to 2019, the system raised its rank from the 76th to the 77th percentile for caregiver engagement overall and from the 74th to the 81st percentile for nurse engagement in particular. In addition, caregiver turnover is on a downward trend systemwide.

Listening to the Voice of the Caregiver

Just as the voice of the patient is the foundation for successful patient experience improvement efforts, the voice of the caregiver—or, in this case, the 60,000+ caregivers in Cleveland Clinic’s 10 regional hospitals and more than 150 outpatient locations—has been the foundation for the OCE’s caregiver experience improvement efforts. The team gathered those voices in a few different ways.

They began by studying the clinic’s most recent Press Ganey engagement surveys and Leapfrog culture of safety surveys. This helped them identify systemwide drivers of engagement, determine engagement levels across the caregiver population, and understand caregivers’ feelings regarding their physical and psychological safety.

To learn what caregivers wanted, the team spent six months in 2018 conducting a listening tour of 21 Cleveland Clinic facilities. To ensure that they would gather actionable information during the tour, they asked caregivers for their input on the clinic’s performance in the following areas, which the OCE refers to as the “four pillars” that form the foundation for a positive caregiver experience.

  • Culture: We provide a caring culture so our caregivers can find purpose and meaning in their work.
  • Physical Environment: We provide an environment where our caregivers feel safe so they have the comfort to be themselves and do their best work.
  • Tools & Technology: We ensure that our caregivers have access to tools and technology that foster teamwork and promote their health, safety, and well-being.
  • My Experience: We provide opportunities for our caregivers to create, shape, and build their own unique experience where they feel like they belong, can learn and grow, and are supported to do their best and be well.

At each stop on the tour, caregivers gave feedback on what they thought already worked well and what they felt they needed for an optimal experience. Those who couldn’t attend the tour in person could participate online. In total, approximately 11,000 caregivers participated, more than double the number the team expected.

In addition to the surveys and listening tour, the team also reviewed video from recent town hall meetings to gather further feedback on what caregivers were thinking and feeling, and what they said they needed or wanted.

According to Jones, the surveys, town halls, and listening tour indicated that caregivers strongly believed in the purpose of their work and in the organization’s mission, vision, and values. They also brought to light some caregiver needs the OCE team is now addressing through a variety of programs and resources.

For example, the team learned that caregivers wanted their leaders to recognize when they’re feeling stressed, so they partnered with the Caring for Caregivers team in the clinic’s Human Resources department to create a leader tool called iCare Conversations. This one-page infographic, which is also available as a pocket card, lists the behavioral and physical signs of caregiver stress and the differences between inherent and external stress, explains how to have a meaningful conversation with a caregiver who is exhibiting signs of stress, and recommends ways to show care and concern and determine next steps.

“This tool coaches our leaders on how to ask pointed questions without being intrusive, and has given us lots of valuable information about our caregivers at the bedside,” said Jones. “High amounts of stress are one of the realities of working in health care, and it’s important for leaders to be cognizant of caregiver anxiety and burnout and how to sensitively broach a conversation about it.” According to Terri Muldrow-Hines, OCE director of operations, the team is currently reviewing additional topics to address in the iCare Conversations format.

The team also learned that caregivers wanted to know more about the resources, benefits, and personal and job growth opportunities Cleveland Clinic provides. To address this, they launched a periodic event called Thrive Where You Are. Each event is targeted at a specific employee group, such as support services or nursing. Before an event, the team surveys the intended group to determine where they need assistance regarding their health, their ability to grow and develop in their position, their sense of empowerment, and their financial well-being. At the event, the group receives targeted materials that explain how Cleveland Clinic can help them thrive in those areas.

Emergent and acute care services are also available at the event, so caregivers struggling with food, transportation, child care, mental health, and similar concerns can get immediate support. Then the team works with Caring for Caregivers to connect them with longer-term services and programs.

The fact that Thrive Where You Are addresses such matters is a major strength of the program, Jones said. “Usually, caring for the caregiver pertains to the job; once the caregiver leaves the facility, they’re on their own,” she said. “But during the listening tour, we asked caregivers how happy they are at work and how happy they are at home, and we found they were only 3 points happier at home than at work. It’s important that we get a full picture of our caregivers’ lives both within and outside the walls of the facility, because if they can’t feed their kids at night, if they don’t have a safe and reliable way to get to work, if they’re struggling with depression—they can’t be great caregivers, and nothing we say or do for them at work will matter.”

In addition to these issues, the OCE team also discovered that caregivers liked being shown gratitude for their work and felt this didn’t happen often enough. To remedy this, last year they launched a peer-to-peer program called Gifts of Gratitude. For three days in December, caregivers visited one of several Gratitude Stations located in a conference room on the clinic’s main campus and emailed their colleagues a scripted message to express their appreciation and thanks for exhibiting one or more of the following behaviors:

  • “Responsible Boldness,” for demonstrating a focus on quality and innovation
  • “Team Spirit,” for demonstrating a focus on teamwork, compassion, and inclusion
  • “Culture Care-ier,” for demonstrating a focus on caring for patients, colleagues, and the Cleveland Clinic community and resources
  • “Authentic Impact,” for demonstrating a focus on integrity, trust, and respect
The program was extremely successful. “I thought we’d get 2,500 people, but 6,700 people attended,” Jones said, adding that, in total, 25,000 messages were sent and received across the enterprise. The OCE also hosted six 1- and 2-day events at regional hospitals that drew approximately 300 visitors per day and participation from more than 4,200 caregivers overall. This December the OCE plans to host its second Gifts of Gratitude event, this time with the theme “Advancing a Culture of C.A.R.E.” (C.A.R.E. stands for Communication, Accountability, Respect, and Evolving.) The program was extremely successful. “I thought we’d get 2,500 people, but 6,700 people attended,” Jones said, adding that, in total, 25,000 messages were sent and received across the enterprise. The OCE also hosted six 1- and 2-day events at regional hospitals that drew approximately 300 visitors per day and participation from more than 4,200 caregivers overall. This December the OCE plans to host its second Gifts of Gratitude event, this time with the theme “Advancing a Culture of C.A.R.E.” (C.A.R.E. stands for Communication, Accountability, Respect, and Evolving.)

Continuing the Journey toward an Optimal Caregiver Experience

In the past two years, the OCE team has responded to caregiver feedback in numerous ways. But, like patient experience, providing an optimal caregiver experience is a continuous journey, and to that end, the team is in the process of developing and refining a number of additional strategies.

For instance, to track how caregiver experience is driving patient experience, they’re piloting a process to align the organization’s engagement survey data with HCAHPS patient experience survey data through Press Ganey Critical Metrics Maps, which incorporate into a single view current and historical metrics related to employee engagement and patient experience. This will enable leaders to visually assess the organization and its work units, compare work-unit performance, identify inconsistencies across metrics, and track progress over time.

In addition, through a partnership with the Harvard T.H. Chan School of Public Health and Harvard Business School, the team developed and added 14 culture-related questions focusing on teamwork, communication, and psychological safety to its most recent engagement survey to get a baseline culture read across the organization. They administered the revised survey in May and will use the resultant data to devise caregiver experience improvement plans specific to the needs of the clinic’s institutes, divisions, and hospitals.

The team also recently began a “Culture and the Caregiver Experience” executive briefing series. Their first guest was Harvard Business School’s Novartis Professor of Leadership and Management, Dr. Amy Edmondson, whose seminal work promotes psychological safety as the most important factor for team effectiveness. Over the next several months, the OCE will develop tools that leaders can use to ensure a psychologically and physically safe environment for caregivers. An additional leader tool, an upcoming webinar series called “The Five Strategies for Enhancing Caregiver Well-Being,” will highlight the role that leaders play in helping caregivers be and feel well.

According to Jones, the OCE team continues to listen to caregivers’ voices through ongoing engagement surveys, safety surveys, and town halls. In addition, through a strategy dubbed OCE Connect, they visit two facilities per week to connect with caregivers throughout the system.

“By listening and responding to caregivers’ needs, we’re taking care of the people who take care of our patients,” Jones said. “And in the process, we’re making the clinic the best place to receive health care by making it the best place to work in health care.”