“QUALITY IS NEVER AN ACCIDENT. IT IS ALWAYS THE RESULT … · THE CLEVELAND CLINIC 2003 ANNUAL REPORT DEFINING QUALITY THE CLEVELAND CLINIC FOUNDATION 9500 Euclid Avenue, Cleveland,

DEFINING QUALITYT H E C L E V E L A N D C L I N I C 2 0 0 3 A N N U A L R E P O RT

THE CLEVELAND CLINICFOUNDATION

9500 Euclid Avenue, Cleveland, Ohio 44195

Please visit our Web site at www.clevelandclinic.org

“QUALITY IS NEVER AN ACCIDENT.IT IS ALWAYS THE RESULT OF INTELLIGENT EFFORT.”

C O V E R Q U O T E : John Ruskin

Quality Measures Web Site – The Cleveland Clinic’s qualityefforts are on national display on our Quality MeasuresWeb site. Designed to educate and inform patient-consumers on how to choose a quality health careprovider, the Web site presents objective information onstandards and outcomes in specific medical specialties.Since its launch, the frequently updated site has beenvisited by tens of thousands of consumers from acrossthe nation.

Quality Indicator Guides – The Cleveland Clinic publishesa comprehensive series of patient-friendly guides tohelp patients choose a doctor or hospital for their care.These educational guides include specific Clinic-relateddata for many diseases and conditions, and the sixcriteria recommended by the Clinic for choosing ahealth care provider: credentials; participation inresearch and education; experience; patient satisfaction;range of services; and outcomes. These guides can befound on the Clinic’s Quality Measures Web site.

Leapfrog Initiative – The Cleveland Clinic is participatingin a national patient safety initiative designed to focusattention on three practices proven to reduce prevent-able medical errors: evidence-based hospital referral,intensive care unit physician staffing and computerphysician order entry. This voluntary safety initiative isspearheaded by The Leapfrog Group, a national organi-zation founded by The Business Roundtable, which ismade up of Fortune 500 CEOs, The Robert WoodJohnson Foundation and others. The Leapfrog Group willuse its Hospital Patient Safety Survey to identify facilitiesthat provide the highest standards of care and mostinnovative treatments to ensure patient safety andimprove outcomes. Such facilities will be designatedby The Leapfrog Group as preferred caregivers.

M E A S U R I N G Q U A L I T Y

www.clevelandclinic.org /quality

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“THE STRENGTH, MISSION AND REPUTATION OF THE CLEVELAND CLINIC ARE

BASED ON INTELLECTUAL CAPITAL – OUR SKILL, EXPERIENCE AND DEDICATION.

THESE INTANGIBLE CHARACTERISTICS ARE HARD TO MEASURE, AND, YET, THEY

AMOUNT TO THE PRINCIPAL INVESTMENT IN THE FUTURE OF HEALTH CARE.”

FLOYD D. LOOP, M.D.

Chairman and CEO, The Cleveland Clinic

As a medical, scientific and

educational institution, The Cleveland Clinic is

committed to the validity of controlled studies,

quantifiable data and repeatable outcomes.

The pursuit of quality at The Cleveland Clinic

is a matter of benchmarking, survey analysis

and measurable results. At the same time, The

Cleveland Clinic is a deeply human enterprise,

with a workforce that is as diverse in talent,

culture and personality as it is united in the

pursuit of patient care that goes far beyond the

bounds of the merely acceptable. The people

of The Cleveland Clinic are its human capital

and most valuable asset. They hold the future

of medicine in their hands, and the best of

them are making quality the focus of their

professional lives.

D E F I N I N G Q U A L I T Y

The following pages introduce a sample of individuals who exemplify

The Cleveland Clinic’s devotion to quality. They pursue quality by

leadership in quality improvement initiatives, and personify excellence

through their dedication to patient care, research and education.

T H E C L E V E L A N D C L I N I C 2 0 0 3 A N N U A L R E P O RT 2 // 3


“Too often, children who are seriously ill do not receive competent, compassionate andconsistent care that meets their physical, emotional and spiritual needs.” (Source: Report from the Institute of Medicine of the National Academies of Science)

J O A N N E M . H I L D E N , M . D .

C H A I R , P E D I AT R I C H E M AT O L O G Y A N D O N C O L O G Y

M E D I C A L D I R E C T O R , P E D I AT R I C PA L L I AT I V E C A R E

Q U A L I T Y I S C O M P A S S I O N

Joanne Hilden, M.D., by developing a Pediatric Palliative Careservice at The Children’s Hospital at The Cleveland Clinic,assures that children with serious and complex illnesses receivethe highest quality care, whatever their condition or ultimateoutcome.The Children’s Hospital has a high rate of success withchildren’s cancer and other complex conditions. Approximately80 percent of pediatric cancers are curable. “Cures come after along medical journey,” says Dr. Hilden. “Complex illness canoverwhelm children and parents.They need excellent control ofpain and other difficult symptoms, and to be well-served withinformation.That is our working definition of palliative care.”

Dr. Hilden seeks seamless coordination of care between doctorsand departments,matched by communication among the medicalstaff, the ill children and their parents. “Information is critical tothe parents of a seriously ill child,” she says.“We need to synthe-size medical information from many different sources, and funnelit to parents and children in a clear, simple and effective way.”

Dr. Hilden and her team do not believe that palliative care andcurative treatments are mutually exclusive.“Palliative care duringcurative treatments, meeting standards that assure that pain and

other symptoms in children are treated by the safest, most com-passionate and effective means possible, can mean that childrendo better and live longer.This type of care is more than simplythe prevention and relief of pain symptoms. It involves emotion-al support, respect for families’ choices and values, and helpingpeople make difficult decisions.”

Dr. Hilden’s interest in the field began, she says,“because I saw anunmet need. I had the privilege of working with children and theirparents at the bedside and with parent advocate groups at thenational level. I listened. Children who are very ill, and their fami-lies, need care that meets both their physical and emotional needs.”

Dr. Hilden has helped develop guidelines for pediatric palliativecare as part of a committee formed by the Institute of Medicineof the National Academies of Science, and authored the book,Shelter from the Storm: Caring for a Child with a Life-ThreateningCondition, published in 2003.

“We need to offer world-class care to all our patients, whatevertheir age or stage of their illness.”

I S AW A N U N M E T


C L A I R E Y O U N G , R . N . , M . B . A .

C H I E F N U R S I N G O F F I C E R


Claire Young, R.N., M.B.A., is prepared to build on a legacy ofnursing quality constructed over more than 80 years at TheCleveland Clinic. As the new chief nursing officer and chair,Division of Nursing, Ms. Young oversees more than 3,500employees – nurses, patient care nursing assistants, clinical nursespecialists and advanced practice nurses. She has experience inquality, having previously served as director of The ClevelandClinic’s Office of Quality Management. “Quality paints every-thing we do,” she says.“It colors the entire patient care process.”

From the earliest days of The Cleveland Clinic, nurses haveplayed a crucial role at every stage of institutional developmentand have been key participants in every medical advance. In 2003,the Cleveland Clinic Division of Nursing was honored withMagnet Status for Nursing Excellence by the American NursesCredentialing Center of the American Nurses Association. Only72 hospitals nationwide have achieved this coveted status.Cleveland Clinic Chairman and CEO Floyd D. Loop, M.D., said

the award “exemplifies the skills of our nursing division across theorganization, and shows our patients that we have the highestqualified, most compassionate nurses in the world.”

Working with the momentum of Magnet Status, Ms.Young isplanning quality improvements that will bring greater unity andeffectiveness to all areas of nursing at The Cleveland Clinic:inpatient, outpatient, research and regional medical practices.

“The Cleveland Clinic is the best place in the country to be a nurse,” says Ms. Young, who came to The Cleveland Clinic from the Texas Medical Center.“When I first came to the Clinic,I was thoroughly impressed with what was happening here inhealth care. The talent is unbelievable and leadership is highlysupportive. I look around and think, ‘the sky’s the limit.’”

sky’sT H E

T H E L I M I T

Q U A L I T Y I S N U R S I N G

It has been repeatedly proven that high quality nursing care reduces the rate of complications and length of stay in a hospital. A 2001 Department of Health and HumanServices study proved that nurse staffing has a direct correlation with decreasedlength of stay and other positive indicators. However, there is a widening gap betweenthe supply and demand for nurses that is changing the profession, and creating newopportunities as well as challenges for nurses everywhere. (Source: American Nurses Association)


D AV I D A . K VA N C Z , M . S . , R . P H . , FA S H P

C H I E F P H A R M A C Y O F F I C E R


L E A D E R S I N M E D I C AT I O N C U R E A N D Q U A L I T Y ”“ W E WA N T T O B E

L E A D E R S I N M E D I C AT I O N C U R E A N D Q U A L I T YTrueW E W A N T T O B E

It is projected that costs of $76 billion a year are attributable to medication misuse.Since the 1999 Institute of Medicine report on the prevalence of medical errorsnationwide, many hospitals have reviewed and strengthened their safety procedures.In pharmacy and medication use, new processes and procedures are reducingpotential errors, and making hospital care safer than ever. (Source: National Institutes of Health)

David Kvancz, M.S., R.Ph., FASHP, oversees one of the largesthospital pharmaceutical services in the world. About 95 percentof The Cleveland Clinic’s yearly total of roughly 52,000 inpatients receive at least one dose of medication daily – withone being delivered every 4.9 seconds. Mr. Kvancz is responsiblefor their effective distribution and safe use. In addition to the fullrange of the expected quality, safety and effectiveness effortsbeing implemented by Pharmacy at The Cleveland Clinic, thedepartment is expanding a new practice model that promisesadditional improvement across the board. Called the ClinicalStaff Pharmacist Practice Model, it assures that pharmacists areinvolved in every stage of the medication-use process.

“We believe that the pharmacist must be part of the patient careteam,” says Mr. Kvancz. “In areas where the new model is beingused, clinical staff pharmacists round with key physicians and target specific risk factors and outcomes.They assure that the drugtherapy being ordered provides the best clinical outcomes, leastrisk and most appropriate cost. In additional areas, advanced degreeclinical pharmacist specialists round with key physicians to consulton medication-use issues concerning individual patients.”

A study co-authored by members of the Cleveland ClinicPharmacy team concluded that the Clinical Staff PharmacistPractice Model has the potential to minimize risks, decrease costsand improve outcomes associated with drug therapy. This practice model was recognized with the Abbott National HospitalPharmacy Quality Award in 2000 and the American Society ofHealth-System Pharmacists Achievement for ProfessionalPractice of Pharmacy in Health Systems award in 2002.

“We intend to strengthen the clinical outcomes focus of our practice, working closely with physicians and nurses,” says Mr.Kvancz. Further expansion of the Clinical Staff PharmacistPractice Model to all patient care areas will occur during thenext two to three years, as new automated drug preparation,dispensing and information systems are installed at TheCleveland Clinic. “Our goal is that our people, systems andservices be recognized within our profession at the same level as Cleveland Clinic medical, surgical and nursing are recognizedwithin theirs.”

Q U A L I T Y I S S A F E T Y

T H E C L E V E L A N D C L I N I C 2 0 0 3 A N N U A L R E P O RT 1 0 // 1 1

“Now that a draft of the human genome map is complete,research is focusing on the function of each gene and the rolethat faulty genes play in disease. This will lead to improved diagnosis of diseases and a new approach to disease therapy.Researchers will create new classes of drugs based on genesequencing and structure. These drugs, because they are targeted to specific sites in the body, will have fewer of the side effects common in many of today’s medicines. Othermedications will be customized for an individual’s genetic profile.” (Source: National Human Genome Research Institute)

One of the biggest medical stories of the year came out of the Cleveland Clinic Center forCardiovascular Genetics, directed by Qing Wang, Ph.D. Dr.Wang and Eric Topol, M.D., chairman ofCardiovascular Medicine, became the first scientists in history to identify a specific gene as a cause of human coronary artery disease. This medical first could lead to better screening and life-savingtreatment for patients who have a family history of heart disease.

Although the discovery was covered widely in newspapers and national television news, Dr. Wangsays the most critical media attention was the publication of his and Dr.Topol’s paper in the journalScience, and its highlighting in perspective articles there and in Nature Reviews Genetics, Circulation,Discovery Medicine, and Clinical Genetics.“Publication in prestigious journals like Science is an importantvalidation of quality in the academic field,” says Dr.Wang. Other validation, according to Dr.Wang,includes outside grants, which he has from the National Institutes of Health, the Doris DukeCharitable Foundation and the American Heart Association.

A native of China, where he continues to maintain scientific and educational ties, Dr.Wang came toThe Cleveland Clinic in 1999 with an already significant record of achievements in genetics, includingthe discoveries of three genes for long QT syndrome and the first gene for idiopathic ventricular fibrillation (Brugada syndrome), a lethal cardiac arrhythmia.

“Working together with Dr.Topol was the key to finding the gene for familial heart disease,” says Dr.Wang. “It began with the clinical expertise of his department, which interwove directly with thework we perform in the lab and led to the breakthrough discovery.”

Currently, Dr.Wang is anticipating publication of an important paper on the genetics of angiogenesis(the growth of new blood vessels). He continues to work on projects involving the genetics of coronaryartery disease and myocardial infarction, and cardiac arrhythmia and sudden death. He also is expandinginto the genetics of atrial fibrillation and neurological disease.

P U B L I C AT I O N H A S A H U G E

Q U A L I T Y I S R E S E A R C H

Effect

L E A D E R S I N M E D I C AT I O N C U R E A N D Q U A L I T Y ”“ W E WA N T T O B E

Q I N G W A N G , P H . D .

D I R E C T O R , C E N T E R F O RC A R D I O VA S C U L A R G E N E T I C S


L I N D S E Y C . H E N S O N , M . D . , P H . D .

V I C E D E A N F O R E D U C AT I O N F O R T H EC L E V E L A N D C L I N I C L E R N E R C O L L E G E O FM E D I C I N E , C A S E S C H O O L O F M E D I C I N E

P R O F E S S O R O F A N E S T H E S I O L O G Y A N D S TA F F,D E PA RT M E N T O F G E N E R A L A N E S T H E S I O L O G Y,T H E C L E V E L A N D C L I N I C

Q U A L I T Y I S E D U C A T I O N


Lindsey Henson, M.D., Ph.D., is the first person to hold appoint-ments as a physician at The Cleveland Clinic and in the Dean’sOffice at Case Western Reserve University School of Medicine.She is emblematic of the remarkable partnership that has beenforged between these two institutions to create the ClevelandClinic Lerner College of Medicine of Case Western ReserveUniversity, a new program dedicated to training medical studentsto become physician investigators. Its goal is to meet the pressingpublic need for skilled medical research that can be quicklytranslated into patient care.

More than 600 undergraduates applied for the 32 available spotsin the College of Medicine’s first class (entering July 2004).WhileThe Cleveland Clinic already has one of the largest post-graduatemedical training programs in the country and hosts medical stu-dents from other schools, the College of Medicine’s students will“energize The Cleveland Clinic in a new way,” says Dr. Henson.“The presence of these bright, eager young people, studying a

medical curriculum built from the ground up by ClevelandClinic staff members, will be professionally and intellectuallystimulating.”

As vice dean, Dr. Henson is responsible for the academic, financialand operational affairs of the College of Medicine as a componentof the Case School of Medicine and works with other deans andfaculty for Case’s existing M.D. program to coordinate planning,particularly in the clinical curriculum. She is inspired by theoverwhelming enthusiasm of Cleveland Clinic personnel for thenew College of Medicine, and the immense amount of time andlabor they have devoted to making it a reality. “So many peoplewho go into medicine long to give something back,” she reflects.“Given the opportunity to share their wisdom and knowledgewith those who will be the medical leaders of tomorrow,Cleveland Clinic scientists and physicians have devoted countlesshours to creating one of the most innovative medical educationprograms in America.They are amazing.”

A N D I N Q U I S I T I V E S T U D E N T S ”

creative“ W E A R E E N R O L L I N G R E M A R K A B LY

While physician scientists have traditionally moved discoveries from bench to bedside,they are becoming an “endangered species.” It is believed that the number activetoday is only half of the number needed. Even though promising new ideas continue tobe produced in the basic sciences, the lack of physicians with the training to do patientresearch has resulted in an inability to turn scientific discoveries into patient cures.(Source: The Wall Street Journal)


Doing it right the first time is important to Joseph Hahn, M.D.,and Chris Coburn of CCF Innovations (CCFI).“We are devel-oping serious products that need to work under the most stressfulconditions – products that we ourselves can take with confidenceto our patients,” says Dr. Hahn.

Confidence is high at CCFI, where Dr. Hahn, Mr. Coburn andtheir colleagues work hard to enhance research and technologydevelopment for patient care, and to generate income forresearch by bringing Cleveland Clinic innovations to market. In2003, CCFI had record performance in almost every categoryand hosted a high-profile innovation conference, attended by theleading names in the biotechnology industry.

As CCFI’s administrative team, Dr. Hahn and Mr. Coburn bringa wealth of experience to their jobs. Dr. Hahn, a neurosurgeon,inventor and M.B.A.,was the longest serving chairman of surgeryin the history of The Cleveland Clinic (1987–2003), leading a

division with more than 220 surgeons and six departments rankedamong the 10 best in the country. Chris Coburn was a vice president and general manager at Battelle, Ohio’s first Science andTechnology Advisor; held staff positions at the National Institutesof Health and NASA; and has written, consulted and lectured ontechnology commercialization around the world.

“There are no casual decisions in business today,” says Mr.Coburn. “Every investment, every grant comes under intenseanalysis.We’re trying to subtract the risk for the investor. That’sthe definition of quality in entrepreneurship.”

Dr. Hahn believes that The Cleveland Clinic’s human capital,its hard work and record of successful innovation will continueto attract funding. “Innovation at The Cleveland Clinic keepschugging along like a train on the tracks,” he says. “Investorswant to be part of that tradition of excellence.They know thatwith The Cleveland Clinic, they are investing in a winner.”

J O S E P H H A H N , M . D .

C H A I R M A N , C C F I N N O VAT I O N S

C H R I S T O P H E R C O B U R N

E X E C U T I V E D I R E C T O R , C C FI N N O VAT I O N S

Q U A L I T Y I S E N T R E P R E N E U R S H I P

“Technology offers Ohio a path for manufacturing modernization and growth, as well asspurring new technology firms and industries from its research base. Technology can leadto faster business growth, higher wages and a larger multiplier effect for the economy.” (Source: Battelle Memorial Institute Report, April 2002)

“ W E A R E DedicatedT O G E T T I N G I T R I G H T T H E F I R S T T I M E ”


Peter Cavanagh, Ph.D., brings multifaceted expertise to his newposition as the Virginia Lois Kennedy chairman of BiomedicalEngineering at The Cleveland Clinic. As a researcher, he is headof the Bone Loss Team for NASA’s National Space BiomedicalResearch Institute. His clinical interest is in foot complications ofdiabetes. His department – the largest in the Lerner ResearchInstitute – also is multifaceted, with 25 principal investigatorsleading a group of more than 250 researchers working in the areasof biomechanics, biomedical devices, bioMEMS and nanotech-nology, cardiovascular bioengineering, imaging, neural control,orthopaedic biology and bioengineering, wound healing and tissue engineering.

“We are committed to investigation, innovation and the transla-tion of scientific discoveries into practical applications thatenhance patient care,” says Dr. Cavanagh. He expects the qualityof his department to be gauged by specific attributes, includingpeer-reviewed funding; scientific results in respected journals;translation of scientific results into patient care; participation in

the international scientific community; and being sought forauthoritative consultation by industry, government and the media.

“I hope to lead in quality by example,” he says.“Our departmentis where science, education and technology transfer come togetherfor the advancement of knowledge and the good of the patient.Our work must stand up to the highest level of comparison withour peers at any academic organization.”

Impressed by the openness of The Cleveland Clinic leadership tonew ideas, Dr. Cavanagh notes that “people here are remarkablycollaborative.”

One of Dr. Cavanagh’s other goals is to build The ClevelandClinic’s Diabetic Foot Care Program, which he heads, into oneof the nation’s leading centers. Collaboration will be key, as hecreates clinical and research programs to minimize the impact ofthe disease on African-Americans, who suffer from the disease indisproportionate numbers.

ExampleI H O P E T O L E A D I N Q U A L I T Y B Y

Q U A L I T Y I S I N N O V A T I O N

“In the next 25 years, advances in electronics, optics, materials and miniaturization willaccelerate development of more sophisticated devices for diagnosis and therapy, suchas imaging and virtual surgery. The emerging new field of bioengineering – engineeringbased in the science of molecular cell biology – will greatly expand the scope of biomedical engineering to tackle challenges in molecular and genomic medicine.”(Source: The Journal of the American Medical Association)


P E T E R C AVA N A G H , P H . D .

C H A I R M A N , B I O M E D I C A L E N G I N E E R I N G


“As we review infections over the years ... we conclude that aconstant appraisal of preventive measures, dissemination ofresults, and insistence on accountability are the best methods ofattaining the ‘irreducible minimum,’ given the current state oftechnology and our understanding of immune function.” (Source: Floyd D. Loop, M.D., et al, The Annals of Thoracic Surgery, July 1990)

Q U A L I T Y C A R E I SEssential

Quality means paying attention to every detail of care. For LarsSvensson, M.D., Ph.D., who performs enormously complex cardiovascular surgeries, that plays out in efforts to minimize post-surgical complications – including those that involve the incisionitself. “Quality is a tradition here,” says Dr. Svensson. “We are constantly looking for ways to improve safety, effectiveness and cost.As far back as the 1980s, Dr. Floyd Loop was demonstrating thatcontrol of post-surgical complications was a factor in controlling thecost of patient care.When you develop a reputation for developinghigher quality care, you also begin to get more complex referrals.”

Director of the Center for Aortic Surgery,Marfan and ConnectiveTissue Disorder Clinics at the Cleveland Clinic Heart Center,Dr. Svensson has contributed to advances in protecting the brainfrom stroke; the use of cryogenic methods to reduce neurocogni-tive deficit after complex cardiovascular surgery; and protectingthe spinal cord and kidneys during major aortic surgery.

“When operating on the descending thoracic aorta, there is adanger of reduced blood flow to the spinal cord causing paralysis,”says Dr. Svensson.“At one time, the incidence of this in the highestrisk group was as high as 41 percent.We have been able to reducethe risk to 3.8 percent.This is very gratifying.”

Dr. Svensson has made important contributions to the develop-ment of minimally invasive cardiac surgery, including reoperations.His studies also have established the most effective means ofreducing wound infection after surgery.

“A reputation for quality can help you recruit the best physiciansto your institution,” he says. “It also helps to attract educatedpatients. So many patients now are using the Internet to researchdoctors and hospitals. When they see that you have written agreat deal on a disease process, and have passion and enthusiasmfor the subject, they know that you will give them superior care.”

L A R S S V E N S S O N , M . D . , P H . D .

D I R E C T O R , C E N T E R F O R A O RT I C S U R G E R Y, M A R FA NA N D C O N N E C T I V E T I S S U E D I S O R D E R C L I N I C S

S TA F F S U R G E O N , T H O R A C I C A N D C A R D I O VA S C U L A RS U R G E R Y

Q U A L I T Y I S P R E V E N T I N G C O M P L I C A T I O N S

W A LT E R M A U R E R , M . D .

A S S O C I AT E C H I E F O F S TA F F, O F F I C E S O F Q U A L I T Y A N D A C C R E D I TAT I O N

D E B O R A H N A D Z A M , P H . D . , R . N . , F. A . A . N .

D I R E C T O R , O F F I C E O F Q U A L I T Y A N D T H E Q U A L I T Y I N S T I T U T E

Q U A L I T Y I S D A T A


“Advances in the science of quality measurement, in health information systems, and inour understanding of how to effect change in clinical practice present unprecedentedopportunities for improvement. Quality measurement and reporting is a powerfulmechanism to drive quality improvement. Health care consumers, purchasers andproviders all have an interest in building capacity for quality improvement and measure-ment. Consumers and purchasers need reliable, comparative data to buy value in healthcare and to generate market demand for quality. Providers also need comparativedata to design improvement programs and compare their performance againstregional and national benchmarks.” (Source: National Quality Forum)

In many areas of life, quality is in the eye of the beholder. But atThe Cleveland Clinic, data rule. Over the past several years,TheCleveland Clinic has increased its data gathering activities inareas ranging from clinical outcomes to patient satisfaction, all forthe purpose of measuring and improving quality. Many of theseactivities are initiated and overseen by Walter Maurer, M.D.,associate chief of staff, Offices of Quality and Accreditation.“Medicine as a whole has shied away from the public reportingof data,” says Dr. Maurer. “We want to reverse that trend by collecting and releasing data that are relevant to quality issues.”

Deborah Nadzam, Ph.D., R.N., F.A.A.N., facilitates this process asdirector of the Office of Quality and The Quality Institute.“Qualityis very definable in terms of our function,” she says.“It is evidence-based care, provided in an environment that is safe and comfortablefor patients, and which meets or exceeds their expectations.”

Under the auspices of Chief of Staff Robert Kay,M.D.,Dr.Maurerand Dr. Nadzam (along with Eileen Pomieko, director of theOffice of Accreditation) are making The Cleveland Clinic and theCleveland Clinic Health System national models of quality man-agement.“Quality begins with asking questions,” says Dr. Maurer.“Did we make the patient better? Is the patient satisfied? How dowe stack up against government standards and safety regulations?Are we meeting the needs of payors? Are we putting enoughresources behind data collection representative of quality of care?”

“People who work in quality have to be quality,” says Dr.Nadzam.“They need to be teachers.They have to be able to pulla system apart and analyze it. They need to be collegial andencourage collaboration.”

“Defining quality is the future of this institution,” adds Dr.Maurer.

Q U A L I T Y B E G I N S W I T H A S K I N G

Questions”“


E R I C A . K L E I N , M . D .

S E C T I O N H E A D , U R O L O G I C O N C O L O G YA N D P R O F E S S O R O F S U R G E R Y,G L I C K M A N U R O L O G I C A L I N S T I T U T E

W E A R E D O I N G T H E M O S T A D V A N C E Dwork


“Urologists remain high on the list of in-demand medical specialists in the UnitedStates, and their services are even moresought after than in previous years …A recently published study … concludesthat an aging American population willincrease demand for surgical proceduresby as much as 50% by the year 2020.Urologic surgeries are expected to increaseby more than one-third by 2020.” (Source: Urology Times)

The Cleveland Clinic Glickman Urological Institute is America’slargest urological practice. It is also one of the most highlyregarded. “It personifies all the attributes of quality in patientcare,” says Eric Klein, M.D., who has been a member of thedepartment since 1981.

“Quality means putting the patient’s best interests first,” says Dr.Klein.“It is doing the appropriate evaluation and medical or sur-gical management, getting it right the first time and keeping thepatient informed every step of the way.”

Defining the State of the Art is the Urological Institute’s motto.“We are doing the most advanced work in many areas,” says Dr.Klein. “Our physicians and researchers aren’t simply reacting towhat other people think is appropriate.We are establishing prece-dents for others to follow.”

Quality at the Urological Institute is reflected in its award-win-ning clinical research, number of publications, enormous patientvolume and outstanding graduate medical education (rankednumber one at The Cleveland Clinic two years in a row).

“The salaried staff model at The Cleveland Clinic also contributesto our culture of excellence,” says Dr. Klein.“There is no incentivefor us to provide anything but the most appropriate care for eachpatient, and we are glad to refer a patient to colleagues that wouldbenefit the patient most.”The Urological Institute, he observes, isthe most subspecialized department in the world, yet anothermeasure of quality.

For the past 14 years, urology at The Cleveland Clinic has rankedin the top five in U.S.News & World Report’s annual “America’sBest Hospitals” survey and is currently ranked in the top two. Dr.Klein credits former chairman Ralph Straffon, M.D., currentchairman Andrew Novick, M.D., and outstanding colleagues, pastand present, with “setting a tone of excellence that remains thestandard for everything the department does.”

Q U A L I T Y I S E S T A B L I S H I N G P R E C E D E N T S

D AV I D L . B R O N S O N , M . D .

C H A I R M A N , D I V I S I O N O F R E G I O N A LM E D I C A L P R A C T I C E

J A M E S F. G U T I E R R E Z , M . D .

C H A I R M A N , R E G I O N A L M E D I C A LP R A C T I C E Q U A L I T Y C O U N C I L


A new report indicates that “the nation’s health care system is riddled with ‘qualitygaps’ that prevent millions of Americans from receiving ‘best practice’ care … Theobserved ‘quality gaps’ were not equally prevalent throughout the system – amonghealth plans that measure and report on their performance, clinical quality was higherand showed strong gains.” (Source: “State of Health Care Quality” Report, National Committee for Quality Assurance)

Q U A L I T Y I S C O N S I S T E N C Y

“Quality means consistently meeting the highest standards forpatient experience and patient care,” says David Bronson, M.D.,chairman of Regional Medical Practice, a network of familyhealth and surgery centers across Northeast Ohio. Dr. Bronsonoversaw an important quality milestone in 2003 when his divisionbecame the first at The Cleveland Clinic to switch over to thecompletely integrated electronic patient record.

“The electronic record reduces errors, enhances privacy andallows internists, primary care physicians and specialists to sharepatient information with other physician specialists withouttouching a piece of paper,” says Dr. Bronson.

Electronic record keeping makes it possible to do quality assess-ment at a level of detail never before achieved in medicine. It has been a powerful tool for internist James Gutierrez, M.D.,appointed by Dr. Bronson to chair Regional Medical Practice’sQuality Council – a group of physicians, nurses and administratorswho meet monthly to monitor and improve medical quality efforts.

“Our primary focus so far has been a project to assess how ourphysicians are meeting standardized measures for preventive care

targeted by the National Committee for Quality Assurance,” saysDr. Gutierrez. “The goal is to assure that all physicians are providing preventive care at a level that exceeds these nationalbenchmarks.”

Dr. Gutierrez and his colleagues sample physician records to assessthe rate at which patients are participating in key preventivemeasures, including mammography, colorectal cancer screening,adult and pediatric immunizations, cholesterol screening, smokingcessation and bone density testing.

Over the past three years, the performance of Regional MedicalPractice physicians has exceeded national benchmarks, withsteady improvement over time in most areas. They consistentlyperform at the highest level compared to other physicians locallyand statewide.

Says Dr.Bronson,“We really are a group practice extending acrossthe region, operating as part of a major academic medical center.That combination assures ongoing high quality for all patients.”

“ W E R E A L LY A R E A groupP R A C T I C E ”


“Treatment of common childhood eye diseases should begin much earlier than standard practice. One childhood eye disease, strabismus, is an abnormality in whichchildren cannot align their eyes properly or fuse the images from the two eyes.Children with this condition – which affects at least 30,000 babies each year – typically stop using one of their eyes to avoid double vision. This results in deprivedsensory input to that eye.” (Source: Society for Neuroscience)

“There can be no compromise in providing the most precise diagnosis and appropriate,compassionate therapy for any patient,” says Elias Traboulsi, M.D. “We must offer the bestcare for all patients, no matter where they come from and whatever their background.”

One of 60 physicians and scientists at the Cleveland Clinic Cole Eye Institute, Dr.Traboulsitreats both adults and children with strabismus (eyes that focus separately, rather than as a singleimage), and has expertise in a vast range of other disorders, especially genetic diseases thataffect the eye. He is president of the International Society for Genetic Eye Disease, publishesscientific papers and textbook chapters, and trains residents. He also is involved in communityoutreach as a director of a program called Vision First.A mobile computerized screening lab thattravels to schools in the Cleveland Municipal School District,Vision First provides compre-hensive, free screenings to pupils enrolled in pre-kindergarten, kindergarten and first grade.

Conceived by Hilel Lewis, M.D., chairman of the Cole Eye Institute,Vision First checks forclarity of vision and for signs of cataracts, amblyopia (lazy eye) and strabismus. Students whofail any portion of this detailed evaluation immediately receive a full eye examination, alsoat no cost. A colorful bus equipped with diagnostic technology travels to the schools, andeye professionals (Rhoda Wilson, technician; and Heather Hasley, O.D., optometrist) usuallyscreen about 50 to 70 children a day. “Vision First detects and treats problems early.This ensures a better quality of life. If the children need a complete eye examination, it is provided on site by one of our staff optometrists,” says Dr.Traboulsi.

Vision First is close to Dr. Traboulsi’s professional and personal heart. “I do this because Ineed to do it,” he says.“It is a very rewarding experience just to be with the children and tobe able to assure that they are getting the care they need.”

Q U A L I T Y I S U N C O M P R O M I S I N G C A R E

E L I A S T R A B O U L S I , M . D .

H E A D , P E D I AT R I C O P H T H A L M O L O G Y A N D A D U LT S T R A B I S M U S

D I R E C T O R , C E N T E R F O R G E N E T I C E Y E D I S E A S E S , C O L E E Y E I N S T I T U T E

C A R E F O R A L L ”Best“ W E M U S T P R O V I D E T H E

No organization can pursue quality as diligently

as The Cleveland Clinic without being noticed. The Cleveland

Clinic stands out among hospitals for the recognition it has received

from those who have made quality their mission. Listed below are

some of the honors awarded to The Cleveland Clinic in 2003. We

are proud of these honors, not for their own sake, but as validations

of the quality of care we provide to patients who come to The

Cleveland Clinic from throughout the world.

“AMERICA’S BEST HOSPITALS” (U.S.News & World Report)The Cleveland Clinic has been ranked one of the fiveleading hospitals in America every year for more thana decade in U.S.News & World Report’s prestigious“America’s Best Hospitals” survey. In 2003, TheCleveland Clinic ranked number one in America forcardiac care for the ninth consecutive year, and one of America’s top 10 in Gastroenterology, Geriatrics,Nephrology, Neurology and Neurosurgery, Orthopaedics,Otolaryngology, Rheumatology and Urology. In all, TheCleveland Clinic ranked among the nation’s best in all17 specialties surveyed by this magazine.

MAGNET STATUS (American Nurses Credentialing Center)America’s most sought-after indicator of nursing excel-lence, Magnet Status was awarded to Cleveland Clinicnursing in 2003. Independent studies of Magnet Statushospitals have shown that patients average shorterlengths of stay and have higher rates of satisfactionwith their care.

TOP 100 HOSPITALS (Solucient)The Cleveland Clinic is a seven-time winner of thisnational benchmark survey that recognizes medicaland operational excellence.

AMERICA’S TOP DOCTORSSeventy Cleveland Clinic physicians were named in the2003 edition of this directory. The Cleveland Clinic wasone of the best-represented hospitals in the directory.

CONSUMER CHOICE AWARD (National Research Corp.)The Cleveland Clinic was named the preferred hospitalin its region, based on a survey of consumers whowere selected at random and asked their perception of which hospital has the best doctors, nurses, imageand reputation, and overall quality.

ERNEST A. CODMAN AWARD(Joint Commission on Accreditation of Healthcare Organizations)The Cleveland Clinic and the hospitals of theCleveland Clinic Health System were named a 2003winner of the seventh annual Ernest A. Codman Awardin the category of stroke quality improvement. Thisaward recognizes excellence in the use of outcomesmeasurement by health care organizations to achieveimprovements in the quality and safety of health care.

R E C O G N I Z I N G Q U A L I T Y

T H E C L E V E L A N D C L I N I C 2 0 0 3 A N N U A L R E P O RT 2 8 //

C O V E R Q U O T E : John Ruskin

Quality Measures Web Site – The Cleveland Clinic’s qualityefforts are on national display on our Quality MeasuresWeb site. Designed to educate and inform patient-consumers on how to choose a quality health careprovider, the Web site presents objective information onstandards and outcomes in specific medical specialties.Since its launch, the frequently updated site has beenvisited by tens of thousands of consumers from acrossthe nation.

Quality Indicator Guides – The Cleveland Clinic publishesa comprehensive series of patient-friendly guides tohelp patients choose a doctor or hospital for their care.These educational guides include specific Clinic-relateddata for many diseases and conditions, and the sixcriteria recommended by the Clinic for choosing ahealth care provider: credentials; participation inresearch and education; experience; patient satisfaction;range of services; and outcomes. These guides can befound on the Clinic’s Quality Measures Web site.

Leapfrog Initiative – The Cleveland Clinic is participatingin a national patient safety initiative designed to focusattention on three practices proven to reduce prevent-able medical errors: evidence-based hospital referral,intensive care unit physician staffing and computerphysician order entry. This voluntary safety initiative isspearheaded by The Leapfrog Group, a national organi-zation founded by The Business Roundtable, which ismade up of Fortune 500 CEOs, The Robert WoodJohnson Foundation and others. The Leapfrog Group willuse its Hospital Patient Safety Survey to identify facilitiesthat provide the highest standards of care and mostinnovative treatments to ensure patient safety andimprove outcomes. Such facilities will be designatedby The Leapfrog Group as preferred caregivers.

M E A S U R I N G Q U A L I T Y

www.clevelandclinic.org /quality

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DEFINING QUALITYT H E C L E V E L A N D C L I N I C 2 0 0 3 A N N U A L R E P O RT

THE CLEVELAND CLINICFOUNDATION

9500 Euclid Avenue, Cleveland, Ohio 44195

Please visit our Web site at www.clevelandclinic.org

“QUALITY IS NEVER AN ACCIDENT.IT IS ALWAYS THE RESULT OF INTELLIGENT EFFORT.”

Documents

“QUALITY IS NEVER AN ACCIDENT. IT IS ALWAYS THE RESULT … · THE CLEVELAND CLINIC 2003 ANNUAL REPORT DEFINING QUALITY THE CLEVELAND CLINIC FOUNDATION 9500 Euclid Avenue, Cleveland,