Is the Cleveland Clinic Replicable?
Great institutional cultures can accomplish great things. But in some ways, that’s a problem for the rest of us. It’s natural to want to emulate the achievements of Cleveland Clinic in our policies. But you can’t make a culture out of rules. Culture is an organic outgrowth of an organization’s history, it’s people, its successes and failures. It cannot be ordered from the top, or nurtured by simply altering the financial incentives. Cosgrove speaks of maintaining the institution’s culture in much the way that he talks of maintaining their electronic health records system: a constant process of checking in, re-evaluating, and upgrading.
We can salary doctors and order them to care as much as the Cleveland Clinic doctors and administrators do about continual improvement. We can mandate checklists and appointment follow ups and staffing levels. But we can’t make them be the Cleveland Clinic.
More from Megan McArdle on Cleveland Clinic’s salaried physicians.
I think a pragmatic and efficient way to alter culture is through overall competition. Would you contend that it would be impossible to reach the Cleavaland Clinic’s level of productivity and efficiency if other institutions were constantly trying to compete to get to that level?
Excellent post.
“Culture is an organic outgrowth of an organization’s history, it’s people, its successes and failures. It cannot be ordered from the top, or nurtured by simply altering the financial incentives”
These are difficult things to duplicate. I think the policies that helped contribute to the organizations history is the goal.
I don’t think the solution is to implement policies to replicate any type of culture of efficiency. It’s a matter of instilling a model, such as the Cleveland Clinic, and have others not just try to follow the model but to out-do it.
I agree that nurturing the right culture is organic, something that can’t be brought about by way of policies. However, I would also add that with the right policies and financial structure in place, we can attract the right human capital. And the right human capital can produce more than just the “culture.”
I should worry more about attracting the right human capital, and have an effective policy framework in place. These will function like the foundation from which an effective and diverse culture can grow.
I agree with Andrew’s comment, it is very insightful.
It seems like hospitals should do what works for them — absolutely. But if something works elsewhere it may be worth trying, with a few tweaks.
The approach that Cleveland Clinic is taking is fantastic. If a similar concept could be applied in other institutions, I’m sure there would be great outcomes. It’s not so much about being exactly like other successful insitutions, but about learning what’s working for them and perhaps trying to adopt a similar system, but not necessarily the same, that might benefit everyone else.
Very interesting post John!
This is a very appealing idea, and it’s very worth looking into. However, as we have seen several times in our own system, what works for some may not work for others.
I’m sure Cleveland Clinic can be replicated. But the true puzzle is figuring how to provide the appropriate incentive for other health care systems to do so. Profit, loss and fear of being put out of business is the best way I can think of.
I would like to point out that the two pioneer hospital groups she references in this article – Kaiser and Cleveland Clinic – are both using Epic’s EHR.
Kudos to you, Epic.