1. An organizational structure is referred to as "the formalized patterns of interactions that link a firm's tasks, technologies and people. Structures help to ensure that resources are used effectively in accomplishing an organization's mission. Structure provides a means of balancing two conflicting forces: a need for the division of tasks into meaningful groupings and the need to integrate such groups in order to ensure efficiency and effectiveness" (Dess et.al, 2009, p. 28). The Cleveland Clinic has organized its medical network into what is known as an integrated practice unit, which allows the doctors to "pool their wisdom and expertise for the benefit of the patient and the community" ("Cleveland Clinic: Facts & Figures," 2013). It could be said that the integrated practice unit at Cleveland Clinic is a strategic business unit structure, which "makes the task of planning and control by the corporate office more management [and allows for more] decentralization of authority in order for the businesses to react more quickly to important changes" (Dess et.al, 2009, p. 34).
There were distinct reasons why the Cleveland Clinic was able to implement this structure successfully. The Cleveland Clinic was run by CEO Dr. Delos Cosgrove, who understood the clinic's philosophy was that quality was the first priority and that outcomes of potential medical developments within the organization would enable learning and improve the medical expertise of those working there. Dr. Cosgrove also believed that transparency. Dr. Cosgrove understood that "while the [clinic] could not be the best at everything, the more you put out there, the more credibility you have" (Porter, 2012, p. 21). These were two reasons why the structure at the Cleveland Clinic was successfully implemented.
2. Clinics, hospitals and medical facilities such as the Cleveland Clinic often are the vanguard of using outcome measures versus process measures. Outcome measures "provide an integrative assessment of quality reflective of multiple care processes across the continuum of care" ("Physician Consortium," 2011). Ways in which outcome measures are often opted for instead of process measures is due to the quality that is reflective of the impact of the multiple processes route; the validation that is provided from the outcome measurement data and intermediate measurements can be taken before the final outcome. Hospitals often find it difficult to input these types of measures due to the risk associated with them as process measures require less adjustment for illness than outcome measures. With outcome measures there are additional need for data to be collected regarding the diseases where with process measures that is not the case. A third reason is the need for updating of modeling procedures that are used (Rubin et.al, 2001; "Physician Consortium," 2011). These three reasons allowed Cleveland to be on the forefront of outcome measures.
3. The Cleveland Clinic has successfully used its metrics to drive continuous improvement by better understanding its costs measurement processes and enabling more transparency. Most hospitals are measured by procedure, but at Cleveland, an outcome process was adopted to better assess the charges and costs associated with a full care cycle rather than the day by day procedural costs. "Understanding the cycle costs for services required deep involvement of physicians with insight into the process of care" (Porter, 2012, p. 40). Transparency was also adopted. Clinic leaders continually met with teams and shared information about the varying services and costs changes that would ultimately affect the outcomes of how the doctors performed their skills on the patients.
4. Cleveland Clinic believes in the experience of each and every patient. Insights into the experience of the patient are very important to each and every doctor working at the clinic; therefore, the clinic in 2007 became the first to "appoint a Chief Experience Officer that would encourage doctors and nurses to ask patients what else they could do for them while they were there?" (Porter, 2012). Patients are also educated about their health history. These insights were gathered into the outcome measures data that was collected. Gallup also began tracking the assessment of the clinic by the employees and patients with the intention to engaging management and letting them know whether this tangible process was a success or not in care coordination and patient transitioning.
5. In an effort to make things better, companies and organizations often do too much. There are risks to growth. As with all successes, there are downsides that can occur. These risks often include poor communications and lack of commitment from those within the organization. These risks can cause breakdowns in the growth of an organization (Dess et al., 2009). Cleveland then should focus on ensuring that there are no breakdowns in the communication engagement of their staff. With the many expansion efforts that Cleveland undertook over the course of their years in business, sometimes there can be too much expansion and/or innovation. Cleveland will also have to make sure that what caused them to be effective in the first place: commitment from all of the staff is kept. Employees have to feel valued in their jobs and fulfilled on certain levels. While Cleveland Clinic cannot do everything per se, they have to continue to value their employees and the different types of techniques and methods that are proposed to create better experiences for the patients.
Cleveland Clinic: Facts & figures [Facts & Figures Sheet]. (2013). Retrieved from http://my.clevelandclinic.org/Documents/About-Cleveland-Clinic/overview/cleveland-clinic-facts-and-figures.pdf
Dess, G. G., Lumpkin, G. T., & Eisner, A. (2009). Strategic Management: Creating Competitive Advantages (5th ed.). McGraw-Hill/Irwin.
Physician Consortium for Performance Improvement [Recommendations Report]. (2011). Retrieved from http://www.ama-assn.org/resources/doc/cqi/pcpi-outcome-measures-framework.pdf
Porter, M. J. (2012). Cleveland Clinic: Growth Strategy 2012. Harvard Business School Business Policy Working Papers Collection, 19-41.
Rubin, H. R., Pronovost, P., & Diette, G. B. (2001). The advantages and disadvantages of process-based measures of health care quality. International Journal for Quality in Health Care, 13(6), 469-474.