patient-doctor relationship Positive Change

Patients First: Innovative Ideas from the Cleveland Clinic

Patients First
Patients First at the Cleveland Clinic

In one of the grand lobbies of one of America’s top hospitals is the slogan, “Patients First.”

Last month, I toured the sprawling state-of-the-art main campus of the Cleveland Clinic with medical colleagues from B.C. Founded in 1921, it is a non-profit organization and the second largest group medical practice in the U.S. (after the Mayo Clinic). Each of its 3000 physicians are salaried but hired on one-year contracts. Every physician is subject to an annual professional review to hold everyone accountable to the goals of the organization.

The motto, “Patients First” represents a commitment to each patient. This refers not only to the highest standard of clinical care (“Every life deserves world class care.”) but patient-centred values encompassing their physical, emotional and spiritual experiences in healthcare.

Our tour was sponsored by the Practice Support Program which has been bringing evidence-based, quality improvement innovations to the physicians of British Columbia. The triple aims of the program are to (1) improve the healthcare experience (for both patients and providers), (2) improve patient outcomes (quality and safety) and (3) be sustainable. 

On our two-day tour, I was able to see first hand how the Cleveland Clinic had created a more patient-centred organization. These included the HUSH (Help Us Support Healing) campaign to create a quiet hospital environment at nighttime, the Ask 3/Teach 3 program to ensure that patients are given clear education about their medications, purposeful hourly nurse rounding on each patient, and the No Pass Zone policy (No employees should walk by a room with an unanswered call bell without checking in on the patient – even if it is not their patient).

Click to access OPE-Newsletter-5-26-10.pdf

The Cleveland Clinic knows that these practices have improved patients’ experiences. As with most American hospitals, patients are surveyed after they leave the hospital. I wonder how our clinics and hospitals would fare if we imported this practice?

Included in the Practice Support Programs I am teaching my colleagues are patient surveys. This can help us assess how we’re doing from our patients’ perspective, where we need improvement and whether practice changes have made a significant difference.

In upcoming posts, I’ll elaborate on these and other innovative ideas that may be coming soon to a hospital or clinic near you.




Balance Exercise Healthy Living patient-doctor relationship Screening Tests

How Do You Think About Your Health?

Superman at the Cleveland Airport

I have been a doctor for almost all of my adult life, but long before that, I was a patient.

In grade 6, I missed three weeks of school when I was hospitalized with rheumatoid arthritis, and during my childhood, I had more medical appointments than most of my patients and more blood tests than any of them.

I learned never to take my health for granted, I learned not to define myself by a diagnosis or illness, and from the nurses and doctors of Burnaby Hospital who looked after me as a whole person and not just the disease, I discovered my vocation.

It’s human nature to grumble about appearances at different stages in our lives – a blemish in our teens, wrinkles and grey hair as we age, our height or our weight. These concerns fade into insignificance in contrast to the seriously ill or those who would be happy just to feel normal and not in pain.

How we think about health informs how we approach our lives.

How do you define health?

Is it youth? Is it the absence of illness? Is it when everything in your body, your emotions and your mind are in perfect order?

If that were the case, few of us would be healthy and none of us would stay that way.

When I gave public talks for the Canadian Diabetes Association, I learned of the organization’s preference never to refer to people with diabetes as diabetics. So easy it is for health care providers and patients themselves to label them with a condition that they may have.

For some, that labeling is limiting. It can bring a negative focus to their healthcare and how they see themselves.

This negative approach to health is endemic. Almost all medical visits are problem-based. Most people only see the doctor because of infections, distress or other symptoms of illness. The minority comes for preventive care. Even fewer are proactive.

As a family physician, when patients have made appointments to address their problems, I’m usually the one to remind them of things they should be checking – for example, an annual blood pressure measurement for most adults, diabetes testing over age 40, stool tests for hidden blood over 50, prostate exams for men over 50, and pap smears and mammograms for women.

Although accidents can happen and we cannot avoid every illness, we can all live longer, healthier lives with a positive approach to health. Preventive care includes healthy and safe living, with attention to a good, balanced diet, a variety of regular physical activity and eliminating unnecessary risks (such as smoking, unsafe driving, recreational drugs and alcohol abuse).

Secondary preventive practices include the early detection of potentially life-limiting conditions while they are treatable. Screening tests can detect early signs of cervical, prostate, breast and colon cancer long before a person has any symptoms.

In the next few weeks, I will be reviewing the preventive and proactive practices you need to know in order to take control of your health. You may come to think of your health – and your life – in a more active and positive way.