Creating Enchantment with Referring Physicians - Cleveland Clinic - Gelb


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Physician experience management requires an understanding of functional and emotional needs, key activities and touchpoints. This case study highlights the successes at Cleveland Clinic in creating an exceptional physician experience.

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Creating Enchantment with Referring Physicians - Cleveland Clinic - Gelb

  1. 1. Creating Enchantmentwith Referring PhysiciansForum For Healthcare Strategists
  2. 2. Agenda1. Introduction2. Approach3. Insights4. Strategy5. Lessons LearnedPAGE 2
  4. 4. Cleveland Clinic • 26 Medical Institutes • 9 Regional Hospitals • 6 Family Health Centers • 1 affiliate hospital • 4,600 beds system-wide • Nonprofit, multi-specialty academic medical center supports more than 1.5 million visits and 45,000 admissions annually • Physician-founded and ledPAGE 4
  5. 5. Situation Overview• Cleveland Clinic is a healthcare leader in service excellence culture• Its focus on “Patients First” and its commitment to an excellent patient experience drive all caregivers• By applying a similar focus to the referring physician experience, Cleveland Clinic can build better relationships with referring physicians, ultimately benefitting the patients they sendPAGE 5
  6. 6. Cleveland Clinic:Physician Relations Center Grow referral volume by providing excellent service to Referring Physicians, office staff, and their patients.Long Term Objectives MeasureImprove referring physician/ office satisfaction Net Promoter ScoreGrow referral volume YOY growth Referrals % total volumeEnsure timely patient-specific communication Days > patient event*Engage employees in team success EEI GallupIn 2012, Cleveland Clinic needed to create a foundation to achieve these objectives by dedicatingpeople, establishing processes, and improving technology. *Pt event time may differ by specialtyPAGE 6
  7. 7. Gelb:The Basis of InsightsWe work with other nationally-recognized Institutions:• 5 “Honor Roll” institutions Barnes-Jewish Hospital• 3 out of the top 5 cancer programs Cleveland Clinic Cincinnati Children’s Hospital Duke Medicine• 2 out of the top 4 pediatric hospitals Froedtert Health Mayo Clinic MD Anderson Cancer CenterNational Benchmarking Studies: Memorial Sloan Kettering Menninger Clinic• Patient experience management Texas Children’s Hospital The Ohio State University• Marketing practices University of Chicago University of Colorado• Physician relations programs University of Michigan• International programsPAGE 7
  8. 8. ObjectivesCleveland Clinic sought to obtain insight on the experience of referring physicians, aswell as guidance to building stronger relationships with these groups.As the referring physician strategy is being designed and implemented, there was adesire to translate such into experiences delivered in the initial areas of focus.Specific objectives include:• Understand of the needs of referring physicians• Assess performance against those needs• Evaluate the referral decision-making process, including your reputation and knowledge about the scope of your programs• Design and implement strategies to positively impact the experience, promote loyalty and increase volume of referrals from physicians within the target marketPAGE 8
  9. 9. 2.0APPROACH
  10. 10. Philosophy EXPERIENCE Culture and your brand promise are linked through the experience delivered. Leaders translate customer expectations to the organization and reinforce desired employee behaviors. Cultural Transformational Brand This alignment creates an exceptionalAlignment Leadership Promise experience and a sustainable competitive advantage. EXPECTED BEHAVIORS We call this desired state enchantment.PAGE 10
  11. 11. Scope IMPACT DESIGN ANALYZE • Dashboards to • Define the ideal monitor progress DISCOVER experience • Personas FRAME • Create action plans • Qualitative • Day in the Life with leaders and Research staff• Kick off Meeting • Touchpoint • Quantitative assessment • Touchpoint Assessment prioritization• Document key insights • Decision Factor Analysis • Develop implementation plansPAGE 11
  12. 12. The Experience Map Transition of Awareness Need Scheduling Treatment Care• Perceptions of • Evaluation and • Initial contact with • Coordination of care • Discharge summary Cleveland Clinic selection of Cleveland Clinic with Cleveland • Coordination of treatment providers Clinic specialist• Knowledge about • Timing and ease of on-going care Cleveland Clinic • Discussion with process • Progress notes and • Ongoing patient patients (diagnosis, methods of• Marketing or • Resources for care/support referral options) communication educational patients and their • Call-backs for resources from • Preparing patients families • Family feedback assistance Cleveland Clinic for what to expect about their clinical experience• Ideal relationship with Cleveland Clinic• Cleveland Clinic • Front Desk Staff • Faculty/Medical Staff • Faculty/Medical Staff • Faculty/Medical Faculty/Staff • Faculty/Medical Staff • Support Staff • Support Staff Staff• Patients and their • Support Staff Families Primary Experience Stewards Key Touchpoints
  13. 13. Goal: Evolve into Operational Integration Source: Gelb Benchmarking StudyPAGE 13
  14. 14. 3.0INSIGHTS
  15. 15. Overview 3 EXPERIENCE Cultural Transformational Brand 2 Alignment Leadership Promise 1 EXPECTED BEHAVIORSPAGE 15
  16. 16. While Cleveland Clinic has a strong brand… 1Physicians form perceptions over a career based on training, CME, and patientcare. Therefore, experience management goes beyond the referral process.Cleveland Clinic has a leading reputation, on par with other nationally-recognized hospitals such as Mayo Clinic and Johns Hopkins.You also hold the top Net Promoter Score (NPS) in the competitive set(including local options).Advocacy is driven principally by clinical excellence.We found that most physicians (200 mi. radius) have referred patients toCleveland Clinic in the past year, and recommend it most frequently.Outreach isn’t a problem - Current referrers and lapsed/non-referrers agree thatCleveland Clinic has the best physician outreach of any hospital tested.PAGE 16
  17. 17. Cleveland Clinic’s NPS is the highest among its 1 competitive set, overshadowing locals Likelihood to Recommend 13% 13% 20% 20% 20% 20% 27% 27% 26% 26% 34% Detractors (6-0) Detractors (6-0) 23% 34% 23% 21% 60% 54% 54% 63% 21% 24% 24% 60% 63% 23% 23% 33% 33% 30% 30% Neutrals (8-7) Neutrals (8-7) 64% 64% 59% 56% 20% 27% 27% 59% 56% 50% 50% 20% 24% 41% 41% 36% 24% 36% 20% 20% 19% 19% 13% Promoters (10-9) 13% Promoters (10-9)Cleveland Mayo Clinic JohnsCleveland Mayo Clinic Johns Mass. Mass. University University UPMC UPMC SUMMA SUMMA Metro Metro Akron Akron Clinic Clinic Hopkins Hopkins General General Hospitals Hospitals Health Health General General 13% 20% 20% 27% 26% 34% Detractors (6-0) 23% 54% 21% 24% Net Promoter Score (NPS) 60% 63% 23% 33% 30% Neutrals (8-7) 51 39 35 23 16 NPS 64% 59% 56% 50% 1 20% 27% 24% 41% 36% -41 20% -35 19% -51 13% Promoters (10-9) Cleveland Mayo Clinic Johns Mass. University UPMC SUMMA Metro Akron Cleveland Mayo Clinic Hopkins Clinic Johns General Mass. Hospitals University UPMC SUMMA Health Metro General Akron Clinic Hopkins General Hospitals Health GeneralQ14.1, 0-to-10 scale with10 being “Extremely Likely” and 0 being “Not At All Likely”Net Promoter is a registered trademark of Satmetrix Systems, Inc., Bain & Company and Fred Reichheld N= 281-346 PAGE 17
  18. 18. Leadership in clinical outcomes key strengths 1 “World Class Care” Confidence in treatment for complex or rare cases Their patients report being satisfied with care We discovered Quality or quantity of Top Physicians strengths as a Top physicians with experience in complex cases source for Providing Cutting Edge Technology growth in Offers the best, newest technology and treatments referral volume Satisfaction with Outcomes Satisfaction with Conferences and CME Provides opportunities for networkingPAGE 18
  19. 19. Due largely to these clinical strengths, share of 1referrals modest and increasing • Cleveland Clinic is the most common first-choice referral location for every specialty and procedure surveyed • Among physicians referring any patients to Cleveland Clinic, it receives an average of x% of their referral volume, modest, but more than any other hospital • Responding doctors say they have increased in the past year the share of patient referral volume they send to Cleveland Clinic, and that they intend to increase that share again in the coming year • Better communication is seen as a hospital’s key to earning more referral volume, and the top service concepts tested both relate to faster and easier communication of patient informationPAGE 19
  20. 20. However, the physician experience delivered needs to 2move beyond clinical excellence for sustained growthDespite excellent evaluations, referring physicians indicate several areas wherethe emotional attachment to Cleveland Clinic is in need of improvement.Meeting emotional needs is critical in building trust and overcoming perceptionsof competitiveness.Furthermore, misalignment between current experience and their needs hasled to dissatisfaction among some physicians and their referralcoordinators/patients.Given the differences between PCP and Specialist needs, the experienceneeds to be designed to accommodate such (e.g., communications).Building more welcoming and inclusive relationships with referring physicianswill complement your leading capabilities.PAGE 20
  21. 21. “Enchantment” attitudes in need of improvement 2 Physicians’ Perceptions of Their Relationship with Cleveland Clinic 41% I tend to forgive Cleveland Clinic of occasional missteps 47% 32% I feel included & welcomed at Cleveland Clinic 23% Positive Attitudes 26% I go out of my way to recommend Cleveland Clinic 22% 23% Current Referrers (n= 244-274) Im a better practitioner because of Cleveland Clinic 24% Lapsed Referrers (n= 30-37) 20% Cleveland Clinic is interested in my success 15% 41% The success of Cleveland Clinic has made it arrogant 51% Negative Attitudes 41% I only refer to Cleveland Clinic out of necessity 50% 38% Cleveland Clinic feels cold and impersonal 50% 37% Draws attention to a statistically Cleveland Clinic feels like a competitor significant difference 33%Q26, percentages represent “Strongly Agree” or “Agree” PAGE 21
  22. 22. Barrier: Misalignment of process with needs 3 Private Practice to Private Practice referrals Confidence in treatment for complex or rare cases Their patients report being satisfied with care We discovered Managing the referring physician experience strategic • Aligning processes and culture to meet the differing needs of PCP’s and Specialists challenges to (functional needs) overcome • Building relationships to meet emotional needs (lapsed) • Motivating physicians to refer and become champions of Cleveland ClinicPAGE 22
  23. 23. Significant gaps exist in how you communicate and 3using desired forms of communication Usage and awareness of the DrConnect system is low, in the single digit percentages among referring physicians Of the 12 service offerings tested as concepts, the two most motivating to referring physicians were both related to easing and expediting patient communications.PAGE 23
  24. 24. Current referrers like to do business by phone, fax 3 or email, but are not with Cleveland Clinic Follow-Up Dr Communication Phone Fax Email Mail EMS/EPIC Connect Methods, Method Method Method Method Method Method Current Desired Desired Desired Desired Desired Used Used Used Used Used Used with Method Method Method Method Method Referrers with CC with CC with CC with CC with CC CC Acceptance of 27% 17% 28% 18% 11% 5% 11% 15% 12% 6% 5% Patient Notification of 8% 5% 36% 19% 14% 5% 16% 25% 14% 8% 7% Seeing Patient Lab & Test 3% 0% 41% 23% 11% 4% 22% 25% 17% 12% 9% Results Progress 3% 1% 36% 21% 14% 4% 25% 27% 17% 12% 9% Reports Complications 34% 6% 24% 14% 8% 4% 13% 17% 14% 8% 5% Expiration of 41% 6% 21% 11% 8% 3% 14% 14% 10% 8% 3% Patient Discharge 1% 0% 39% 20% 13% 4% 27% 31% 17% 11% 8% Summary Follow-Up Care 5% 6% 35% 18% 11% 5% 26% 36% 18% 9% 8% N= 277-353Contrasting Q10 vs. Q19 PAGE 24
  25. 25. Persona: Primary Care Providers 3 “My patient’s satisfaction with care directly impacts the success of my practice. When my patients are happy, they stay with me and refer me to their friends and family. Primary Care Provider When I refer a patient, my reputation is at stake.”GOALS BEHAVIORS NEEDS• Grow their patient base • Many of their patients require a • Feel confident that their patient will• Strengthen reputation through referral to a specialist or sub- receive the same level of care they excellent care for their patients specialist provide• Build lasting relationships with their • Private practice PCP’s will often • Timely appointments to ease patients refer to private practice specialists patient anxiety • Employed PCP’s refer to their • Referral process that does not tax institution their resources and staff • Refer locally for less complicated • Stay informed about their patient’s cases, believing their patients want treatment and care, indirectly convenience responsible for “outcomes” • Make appointments for their patients PAGE 25
  26. 26. Persona: Specialists 3 “I am an expert in my specialty. Almost every case I refer is complex. For rare cases or those that require special technology, I need a physician at the top of their field with very specific expertise- distance to travel is insignificant.” SpecialistGOALS BEHAVIORS NEEDS• Grow their patient base • Refers to sub-specialist for • Ability to identify physicians based• Strengthen reputation through complex cases on expertise excellent care for their patients • More often than not, they do not • Knowledge of• Building lasting relationships with make the referral appointment for technique/technology available Primary Care Physicians the patient but they provide • Knowledge of physician’s contact information reputation • Do not typically see patient after • Indirectly facilities “outcomes” the referral but requires closure for • Manage their referral process risk management purposes PAGE 26
  27. 27. Assessment1. Our referral volume is rooted in clinical excellence2. However, local competitors can and do attract share by managing the referring physician experience better3. Our physician experience management is neither deliberate nor consistent4. Interestingly, the farther away the physician, the more strongly they advocate for us5. And once the physicians are “lapsed,” they are unlikely to come backPAGE 27
  28. 28. SummaryTo become partners in patient care,we must transform our processes and our people todemonstrate an environment of mutual respectPAGE 28
  29. 29. 4.0STRATEGY
  30. 30. Imperatives (and links to our workshops)1. Streamline the referral process (COORDINATION)2. Establish a focus on how services are delivered (CARE)3. Address the unique patient-specific communication needs of PCPs and Specialists (ALL)4. Overcome attitudes that we are a competitor (COMMUNICATIONS)5. Redefine the role of physician relations and outreach (ACTION)PAGE 30
  31. 31. Action Planning (Workshops for Each) Care Communication Coordination Referrers Patients Generating Awareness Scheduling/TransferEmotional Needs Experience Outreach Managing Patient CareFunctional Needs Resources Marketing AccessibilityPAGE 31
  32. 32. Sample AgendaDay 1: Day 2:8:00 – 8:15 Introductions 8:00 – 10:30 Communication8:15 – 8:45 Research Review 10:30 – 11:00 Quick Hits / Wrap up8:45 – 11:00 Care 11:00 – 11:15 Break 11:15 – 12:15 Lunch / Comm Planning11:00 – 12:30 Quick Hits / Lunch 12:15 – 2:15 Implementation12:30 – 3:45 Coordination 2:15 – 2:45 Wrap up3:45 – 4:15 Quick Hits / Wrap Up PAGE 32
  33. 33. Structure: Experience DesignNeed Scheduling First Visit Treatment Follow-up Ideal Outcomes Best Opportunities for Improvement Expected Behaviors Process Mapping Message Mapping Implementation PlanPAGE 33
  34. 34. “It takes only a few minutes to complete the Scheduling referral process at Cleveland Clinic” Expected Behaviors Success MeasuresGet your patient to the appropriate physician(s) the first Number of transferstimeContinually strive for timely access for your patients First / third available Monitor escalations of appt schedulingWork with physicians to resolve dissatisfaction with Phys satisfactionappointment availabilityProvide clear instructions at time of scheduling in Utilization of materials/website downloadsaddition to referral guide ComplianceCreate options when available – appointment times, Number of options presented at time oftreatment plans, how to connect with our institutes first callAsk the patient and physician to whom communication Recorded in profile during first call, EPICshould be made (at multiple points) and captureAcknowledge to referrer that appointment has been Compliance and record that notice wasmade sent /communicated PAGE 34
  35. 35. Process PrioritizationProcess Urgency Impact (H-M-L) (H-M-L)Referring physician feedback and service recovery H MReferral appointment escalation (expedited appointments) H MFollow-up patient-specific communications (trigger, calls, H Hdocumentation, outcomes)Process for letting phys know his patient has chosen CCF M MProcess for consulting the referring physician for internal referral M MEnterprise collaboration for messaging and promotion with L Mreferring physicians PAGE 35
  36. 36. Coordination Improvements (Quick Hits)Move Excel documentation of escalation to Systematic Report Alerts for AgingAppointment Requests, plus automatic escalationPrioritize Referring Physicians and Staff appointment requests, rather thanhave requests fall into a generic queueSimplify the scheduling process questions or cleave scheduling fromregistrationTrend reporting by Physician Relations to the InstitutesStructure and streamline webmail routing to ensure capture and tracking of allEducate Institutes that Physician Relations is a shared resource and canprovide value to allPAGE 36
  37. 37. Message Mapping How they see us today How we want them to see us How we will convince them Positioning Concept Aligned Messages Decision Drivers Primary Differentiating Attitudes to Overcome Messages Touchpoint Prioritization Attitudes to Reinforce Reasons to Believe Action Plan Lasting ImpressionsPAGE 37
  38. 38. “Institute” enables you to expand your clinicalMessage Map - Pilot expertise. When you refer your patients to us, we will provide cutting edge clinical care with superior treatment outcomes in an efficient and truly collaborative pre and post treatment environment . “One Stop Collaborative Care” • Hotline referral access • Process steps (define – must be simple) We make it easy for you to refer • Hospitalists • Confirmation of all referrals (must deliver) • Testimonials from referring physicians • Scheduling within X days (same day?) We ensure two-way communication • Timely sharing of patient treatment information (must deliver) • Pre and post treatment consultations (must deliver) • You will get your patient back (percentages of patients returned) • Testimonials from referring physicians We offer specialized and • X% get back to referring physician within x (time) after procedure innovative treatment befitting an • Forefront of clinical care (advances in their area) academic medical center • Sub specialty expertise (# of physicians) • Scientific and clinical firsts along with CME offerings (#) • Patient testimonials and case studies We extend your clinical expertise • Clinical collaboration • Superior patient treatment outcomes • Referring physician and patient testimonials • CME/Grand Grounds opportunities PAGE 38
  39. 39. Linking Action Plan to InitiativesThe action plan organizing specific tactics into areas of maturity (e.g., basic,performance, enhancement).To better organize these tactics, we have bundled such into initiatives.Each initiative includes similar tactics and are meant to run somewhat concurrently.Over time, each initiative will lead you to higher levels of maturity, but this will likelyhappen faster in some areas.Current thinking is to launch these initiatives initially with our pilotInitiatives:•Provide Services to Institutes•Monitor Referring Physician Activities•Align Around “One” Cleveland Clinic•Demonstrate ValuePAGE 39
  40. 40. Initiative #4:Demonstrate ValueMarket information standard report (annual?)•SDI information•Competitive intelligence reportsLead strategic conversations with Institutes•Organize physician advisory boards•Align with calendar of outreach, publications, marketingActivity recording/reporting•Call center activities•Referral volumes (overall, based on campaigns)•Satisfaction interventions and retention rates•Liaison activitiesPAGE 40
  41. 41. Need Scheduling First Visit Treatment Follow-upKey ActivitiesPotential patient calls call Pain Points • Calls not returnedcenter for additional • Provided incorrect informationinformation • Need to repeat their “story”Internal Processes How can CRM support/improve process? Are we improving? Information Needs • What is currently collected, needs migrated • What needs to be collected Assessing, Monitoring and Tracking Staff Pain Points • How should that information be organized • Surveys • Incomplete records • Key Metrics • Information needs • Reports and Trends • High volume of calls PAGE 41
  42. 42. 5.0LESSONS LEARNED
  43. 43. Results to DateWe’ve formalized our role within the enterprise • Newly formed Physician Liaison group linked to Enterprise objectives • One number to call for all Referring Physician needs – 300+ calls per day fielded by agents dedicated to service excellence • Improved visibility to referral patterns and trends for Institutes via dashboard reporting • More timely patient-specific communication – Reduced turnaround time from 72hrs to 48hrsPAGE 43
  44. 44. Key Prescriptions for Your InstitutionsEnlist the support of an executive champion earlyIdentify potential internal partners for collaborationUse a formalized approach to engage referring physiciansand document their feedbackEnsure the process is holisticValidate data integrity – improve where neededDemonstrate resultsPAGE 44
  45. 45. Contact UsJennifer FragapaneDirector, Referring Physician CenterCleveland Clinic216.444.3281John McKeeverExecutive Vice PresidentGelb, An Endeavor Management Company800-846-4051 officejmckeever@endeavormgmt.comPAGE 45
  46. 46. Endeavor Management is a strategic transformation and management consulting firm that leads clients to achieve real value from their initiatives. Endeavor serves as a catalyst by providing the energy to maintain the dual perspective of running the business while changing the business through the application of key leadership principles an-d business strategy. The firm’s 40 year heritage has produced a substantial portfolio of proven methodologies, enabling Endeavor consultants to deliver top-tier transformational strategies, operational excellence, organizational change management, leadership development and decision support. Endeavor’s deep operational insight and broad industry experience enables our team to quickly understand the dynamics of client companies and markets. In 2012, Gelb Consulting became an Endeavor Management Company. With our Gelb experience (founded in 1965) ,we offer clients in-depth insights in the healthcare industry and unique capabilities that focus their marketing initiatives by fully understanding and shaping the customer experience through proven strategic frameworks to guide marketing strategies, build trusted brands, deliver exceptional customer experiences and launch new products. Endeavor strives to collaborate effectively at all levels of the client organization to deliver targeted outcomes and achieve real results. Our collaborative approach also enables clients to build capabilities within2700 Post Oak Blvd., Suite 1400 their own organizations to sustain enduring relationships. For moreHouston, TX 77056 information, visit and 713.877.8130www.endeavormgmt.comPAGE 46