The worst and best out of Cleveland

This week, named Cleveland, Ohio, the most miserable city in the United States. The article explains that the city achieved this dubious honor “thanks to its high unemployment, high taxes, lousy weather, corruption by public officials and crummy sports teams (Cavaliers of the NBA excepted).”

I will not attempt here to defend the city, but some good things do seem to come out of Cleveland. The Cleveland Clinic is one of them. In a recent Fortune magazine article, Geoff Colvin interviews Dr. Delos Cosgrove, its CEO, on what allows the hospital to be both among the highest-rated hospital in the country – most notably for cardiac care – yet display great efficiency and cost control discipline.

Dr. Cosgrove shares many best practices in the interview: doctors are salaried and receive a yearly review, the Clinic is physician-led, and it works to provide a hassle-free experience for the doctors who work there, among others. But what really caught my attention was the dialogue, triggered by an insightful question by Colvin, on how patients at the Cleveland Clinic are allowed to look at their own charts. Here is the exchange:

Geoff Colvin: You do something at the Cleveland Clinic that I’ve never heard of elsewhere – you let patients look at their own charts. What led you to do that, and what have the effects been?

Dr. Cosgrove: I thought, “If I’m in the hospital, I want to know what those guys are writing about me.” Why should it be the hospital’s chart, as opposed to the patient’s chart? It’s really about the patient. So I said, “Why can’t we do this?” So we did.

We have an electronic thing called MyChart, where you can go on the Internet and read your record. Few other hospitals around the country have done it. But we think it’s the patients’ information. It’s about them. We’re working for them. Why shouldn’t they have the data?

Geoff Colvin: Inside the organization what were the fears about this?

Dr. Cosgrove: The fears were that patients would get information they weren’t ready for – diagnosis of cancer, for example, or psychiatric information. So we put filters on that; the doctor has a week to get to the patient and let them know about this sort of thing. But what happened was doctors then improved their communication with patients, and patients got the information better, and it worked well all the way around.

What is most intriguing about this practice is the transparency it conveys about the care being provided, and the attention placed on the quality of the patient’s experience that it highlights. This little exchange exemplifies the value created for both sides when a company decides to make itself into a glass house. Fears of misinterpretations and anxiety about misuse of the data by laypeople are common. Over time, though, both sides work out the process through which the data should be shared, and both sides end up with a better experience and a reduced cost and risk.  Transparency is the mother of co-creation.

And there may be hope for Cleveland after all.

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