Question:
Clevand case study.: Refer to the pdf (cleveland case study Final.pdf) and use academic articles greater that 2005
Format essay. 1500 words, minimum 15 references with apa formation. Must be done on this document and not converted to pdf. Need a Turnitin report.
1. What do you consider were the three main changes that the Cleveland Clinic made to improve the value of its services to patients? (500)
2. What was wrong with the previous way services were delivered by the Clinic? (500)
3. What tangible patient benefits were achieved by this transformation? How did these changes help the Clinic to measure the true cost of medical services it was providing? (500)
Further study guides in a form of powerpoint and voice on value is given for reference.
Question: Clevand case study. Refer to the pdf (cleveland case study Final.pdf) and use academic articles greater that 2005 Format essay. 1500 words, minimum 15 references with apa formation. Must be done on this document and not converted to pdf. Need a Turnitin report. 1. What do you consider were the three main changes that the Cleveland Clinic made to improve the value of its services to patients? (500) 2. What was wrong with the previous way services were delivered by the Clinic? (500) 3. What tangible patient benefits were achieved by this transformation? How did these changes help the Clinic to measure the true cost of medical services it was providing? (500) cleveland case study copy.pdf 9-709-473 R E V : J U N E 7 , 2 0 1 9 HBS Professor Michael E. Porter and Professor Elizabeth O. Teisberg (Geisel School of Medicine at Dartmouth) prepared this case. It was reviewed and approved before publication by a company designate. Funding for the development of this case was provided by Harvard Business School and not by the company. HBS cases are developed solely as the basis for class discussion. Cases are not intended to serve as endorsements, sources of primary data, or illustrations of effective or ineffective management. Copyright © 2009, 2010, 2012, 2013, 2015, 2016, 2018, 2019 President and Fellows of Harvard College. To order copies or request permission to reproduce materials, call 1-800-545-7685, write Harvard Business School Publishing, Boston, MA 02163, or go to www.hbsp.harvard.edu. This publication may not be digitized, photocopied, or otherwise reproduced, posted, or transmitted, without the permission of Harvard Business School. M I C H A E L E . P O R T E R E L I Z A B E T H O . T E I S B E R G Cleveland Clinic: Transformation and Growth 2015 What we are undertaking would in many ways transform the world of medicine. — Dr. Delos Cosgrove, CEO Cleveland Clinic was a multi-specialty health care system based in Cleveland, Ohio, renowned for patient care and innovation. The Clinic treated patients from all 50 states and 147 countries. Overall, 72% of the Clinic’s 6.4 million patients came from northeast Ohio; 15% from elsewhere in Ohio, about 13% from other states, and 0.2% were international.1 International patients accounted for 1.7% of patients seen at the main campus. As of mid-2015, the Cleveland Clinic Health System had 43,000 employees including 3,200 staff physicians, 10,965 nurses, and 1,710 affiliated community physicians. In addition to the main campus, the System included ten community hospitals in northeastern Ohio, 18 family health and ambulatory surgery centers, and 59 primary care offices located near Cleveland (Exhibit 1). The Clinic also had facilities or affiliates in ten other states, Toronto, Canada, and Abu Dhabi. Telemedical second opinions and virtual visits for patients were offered throughout the U.S. In 2014, total operating revenues for the health system were $6.7 billion, with $466 million in operating income (Exhibit 2).2 Charity care at cost represented about $211 million. The Clinic had significant revenue from philanthropic giving, and its investment portfolio stood at $6.5 billion. For decades, the Clinic had been highly ranked among U.S. hospitals. In 2015, U.S. News and World Report ranked the Clinic fifth overall, with 13 specialties ranking in the top ten in the nation. The Clinic’s Heart and Vascular Institute had ranked number one continuously for 21 straight years. The Clinic’s rank increased to second in 2016. Delos M. Cosgrove, M.D., had become the Clinic’s CEO in October 2004. His first act was to adopt Patients First as the goal for the entire organization. Over the ensuing decade, he set out to restructure care delivery and expand geographically. In 2007, the Clinic pioneered public reporting of outcomes across all practices. It also began reorganizing all services into institutes structured around diseases or organ systems, rather than around the traditional medical and surgical departments. In 2013, a Clinical Enterprise Management team was formed to unify clinical leadership and drive rationalization and standardization to create One Cleveland Clinic. Care pathways for 106 frequently-treated patient conditions had been developed, and the Clinic was beginning to roll out dedicated multidisciplinary care teams in these areas. While some physicians initially had been skeptical of the effort to transform For the exclusive use of S. Amir, 2021. This document is authorized for use only by Shabin Amir in 92603 Managing Quality, Risk and Cost in Health Care 2021 taught by JOANNE TRAVAGLIA, University of Technology Sydney from Jun 2021 to Dec 2021. 709-473 Cleveland Clinic: Transformation and Growth 2015 2 the organization around value, by 2015 many of the clinicians leading these efforts described their journey as "the road to Damascus." History of Cleveland Clinic: Founding to 2004 Cleveland Clinic was founded in 1921 by four distinguished physicians whose aim was outstanding patient care provided through cooperation, compassion and innovation. Their vision of a multi- specialty group practice grew out of shared experiences in treating soldiers in France in World War I. As one of the nation’s first multi-specialty clinics, its 13 salaried physicians were called socialists by critics who favored private practices in which doctors were paid fees for services. Over the next four decades, the Clinic added physicians in a widening set of fields and expanded its Cleveland facilities. The role of research and teaching also expanded. In 1958, the future of the Clinic was transformed by the development of the coronary angiogram imaging procedure by Dr. F. Mason Sones. The discovery provided the first definitive tool for diagnosing coronary disease before a heart attack or noticeable symptoms, and led to dramatic improvements in cardiac diagnosis and treatment. Cleveland Clinic became its epicenter. In 1967, the Clinic’s Dr. Rene G. Favalaro pioneered the coronary artery bypass operation, applying bypass techniques used in kidney surgery. By 1970, one thousand of these operations had been performed at the Clinic, attracting both doctors and patients from around the world. By the mid-1970s, the Clinic was performing 3,000 coronary artery bypass operations per year, the most frequently performed surgical treatment worldwide. Cardiac surgery, cardiology, and related specialties at the Clinic began co-locating in 1970. Over time, the Departments of Cardiovascular Medicine, Thoracic and Cardiovascular Surgery, and Cardiothoracic Anesthesiology were brought together in a dedicated facility. A separate building on the Clinic campus opened in 1980, including outpatient clinics, specially outfitted operating and procedure rooms, imaging facilities, cardiac intensive care facilities, and dedicated inpatient rooms. Many discussions about improving patient care occurred informally since cardiologists and cardiac surgeons had offices on the same hallway. The cardiovascular surgery and cardiology groups established a patient outcome registry in 1972 for internal research purposes, the first in the field. The registry enabled significant improvements in care. In the late 1970s, for example, the cardiovascular surgery group began contacting patients at home after coronary artery surgery and asked how they were doing. A meaningful number of patients reported that they had contracted hepatitis. The team realized that hepatitis risk arose from the prevalent use of blood transfusions. Focus shifted to reducing blood use, with most patients getting no blood at all, and hepatitis became a rare occurrence. Using outcome information and a team approach, the Clinic pioneered a series of improvements that reduced complications and boosted success rates (Exhibit 3). Beginning in 1986, the federal government began public reporting of mortality data for cardiac surgeries. Uncomfortable with the government’s metrics, the Society of Thoracic Surgeons (STS) began working on its own measures, and compiled a national risk-adjusted database by 1989. Clinic surgeons benefited from the broader comparative data and from learning about measurement and risk adjustment. By 1990, Clinic results were widely shared within the hospital. In the late 1970s and 1980s, the Clinic’s facilities, staff, and range of specialties grew rapidly. Under CEO and kidney transplant surgeon Dr. William S. Kiser, the Clinic’s international reputation grew, For the exclusive use of S. Amir, 2021. This document is authorized for use only by Shabin Amir in 92603 Managing Quality, Risk and Cost in Health Care 2021 taught by JOANNE TRAVAGLIA, University of Technology Sydney from Jun 2021 to Dec 2021. Cleveland Clinic: Transformation and Growth 2015 709-473 3 particularly in cardiac surgery and urology. In 1982, the Clinic undertook a $182 million construction project that became the largest privately financed project in the history of American health care. The Clinic began providing care coordination services to accommodate families, provide translators and ease communications with referring doctors. In 1987, the Clinic established a kidney transplant affiliation, training and advising private surgeons who worked at a hospital in West Virginia. The Clinic’s medical staff was salaried and not tenured. Dr. Fred Loop, previous Chair of Thoracic and Cardiac surgery and CEO from 1989 to 2004, implemented annual professional reviews for every physician, a practice almost unheard of in medicine. The cardiovascular group at the Clinic had long had formal annual reviews that included patient outcomes. Loop explained that physicians needed to compare themselves every year to their own previous performance. Salaries reflected a combination of benchmarks at other academic medical centers, physician skill levels, and productivity. Although most salaries rose over time, some physicians were not renewed, some department heads were replaced, and the salary of doctors could decrease if their productivity went down. The Clinic had traditionally paid less than most academic hospitals, but by 2015 salaries were competitive. Many community physicians with privileges at Clinic-owned hospitals were also interested in shifting to a staff position to allow easier coordination of care and more regular schedules. In 1988, the Clinic built two hospitals in Florida, its first geographic expansion. Each hospital operated largely independently of the Cleveland main campus. The widely anticipated Clinton Administration health care reform proposals in the early 1990s created pressure for hospitals to