James Merlino: Part 1 of an interview by Bob Morris

MerlinoJames Merlino, MD, has been the Chief Experience Officer of the Cleveland Clinic health system, as well as a practicing staff colorectal surgeon in the Digestive Disease Institute. He is the founder and current president of the Association for Patient Experience. As a member of the Clinic’s executive team, he led initiatives to improve the patient experience across the Cleveland Clinic Health System. In addition he also led efforts to improve physician-patient communication, patient access, and referring physician relations. Partnering with key members of the Clinic leadership team, he helped to improve communication with physicians and employees, and to drive employee engagement strategies. He speaks to boards, c-suite leaders and physicians around the world on the important issues of culture, patient experience, and leading change. Dr. Merlino was named to HealthLeaders magazine’s 2013 list of “20 people who make healthcare better” and is a recognized world leader in the emerging field of patient experience. Dr. Merlino’s wife, Amy, is a maternal-fetal medicine specialist at Cleveland Clinic.

His book, Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way, was published by McGraw-Hill (2014). In January (2015), he transitioned from the Clinic to Press Ganey at which he serves as president and Chief Medical Officer of its strategic consulting operations.

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Morris: Before discussing Service Fanatics, a few general questions. First, who has had the greatest influence on your personal growth? How so?

Merlino: My personal growth was certainly aided by a lot of people – probably by many in ways today I can’t even appreciate. But as an adult and more recently, Dr. Feza Remzi had a significant impact on me. He is chair of colorectal surgery at Cleveland Clinic and my “clinical” boss. From Remzi, I learned the importance of relationships with people and how this greatly enhances patient care. He is one of the most compassionate and passionate people I have ever met. I would watch him interact with patients – gain their trust, take care of them, care for them as a human, and I wanted to mimic who he was. Doctors are taught to be objective and dispassionate; Remzi teaches people that it’s ok not to be dispassionate, and develop good relationships with people who have entrusted you with their lives!

Morris: The greatest impact on your professional development? How so?

Merlino: Dr. Toby Cosgrove used to tell me that the best leadership development comes from people you admire as leaders and mimicking those traits. For me, there were three people that significantly influenced my professional growth:

Ananth Raman is UPS Foundation Professor of Business Logistics at Harvard Business School. Ananth and I became friends shortly after I became Chief Experience Officer at Cleveland Clinic. Ananth taught me the meaning of execution – that at the end of the day, you could talk about strategy all you wanted but if you cannot translate that to operational execution, the strategy is irrelevant. As I said in the book, execution has defined our success because we did more than talk about patient experience, we fixed it. That is the most meaningful.

Beth Mooney is Chairman and CEO of Key Bank. Beth was the Chair of the Board level Safety, Quality and Patient Experience Committee of Cleveland Clinic. She was with me from the beginning and taught me a very important concept that I still use to this day: When taking over something new, apply three rules. First, benchmark what you are doing to understand how it functions. Second, apply early enhancements to gain short-term success, and finally differentiate it for long-term growth and value. Beth also taught me the concept of “progressive incrementalism,” meaning that as long as you are moving forward, you are having success. She is a great leader who has taught me how to be a professional and operate at a completely different level.

Finally, Dr. Toby Cosgrove taught me many things, but from him I really learned how to step out of the tactical side of leadership and management, and step into the strategic side. He taught me about having a vision, about not being afraid to challenge the status quo, and about recognizing that success comes from truly thinking outside the box and not being afraid to take risks. I also learned how to lead – more specifically how to translate vision into executable strategy.

Morris: Years ago, was there a turning point (if not an epiphany) that set you on the career course you continue to follow? Please explain.

Merlino: Clearly it was the experience my Father had at Cleveland Clinic in 2004. He was diagnosed with bladder cancer while I was a fellow in colorectal surgery at the Clinic. Naturally, working at Cleveland Clinic, I wanted him to come here so that he could get the best care. He was admitted for an ambulatory procedure and he had a complication that caused him to be admitted to the hospital for seven days. At the end of that hospital stay, he had a cardiac arrest in the hospital and died. I believe he died in our hospital believing it was the worst place in the world. If he had the opportunity to rate his experience, the Clinic would have failed.

This is the first time I had really been on the other side of healthcare – I had not been a patient before and no one close to me had been seriously ill. Being on the other side of healthcare changes you if you haven’t been there before – especially if you work in the medical profession. It was an unreal experience that defines who I am today as a physician. This single event launched me on this movement to change the world of healthcare and drive toward greater patient-centeredness. This forms the basis of chapter one of my book.

Morris: To what extent has your formal education been invaluable to what you have accomplished in life thus far?

Merlino: As a physician, we are taught that learning and education never stop –they are lifelong. I think education comes in various forms: formal, informal, and most importantly, experiential. All of this defines who we are and gives us if you will our abilities to function as leaders. I believe all of those pieces constitute formal education – it is invaluable to who we are and how well we perform.

Morris: What do you know now about the business world that you wish you knew when you went to work full-time for the first time? Why?

Merlino: The importance of culture! You frequently hear the phrase “culture eats strategy for lunch!” This is something that they don’t teach you in school and few leaders appreciate. Cultural influences come at you from two different directions. There is the organizational culture that you must understand if you are to impact significant strategic initiatives. If the “people” are on board, you can achieve anything. Vice versa if they are not – you will not achieve anything.

Similarly, organizational leadership culture is important as well. I have participated as a leader in many organizations where the leadership culture was just mean – ugly, where jealousy, competitiveness, and destructive inter-personal relationships absolutely stymied progress. There should always be healthy tension and candid debate, but leadership teams need to practice communication, relationship building, emotional intelligence, and be aligned around shared, common purpose to achieve organizational success. Senior leaders, presidents, chief executive officers, others need to ensure they are fostering the right environment for leadership otherwise all of that ugliness will trickle through the organization.

Morris: From which non-business book have you learned the most valuable lessons about business? Please explain.

Merlino: That book is Thinking in Time: the Uses of History for Decision Makers by Richard E. Neustadt. The book teaches people to use history as a benchmark for decision-making. Countless mistakes are often replicated because people do not know or understand historical nuances or consequences. This applies to all types of decision-making in both business and government, and is especially relevant in healthcare.

Morris: Here are two of my favorite quotations.Your response? First from Richard Dawkins: “Yesterday’s dangerous idea is today’s orthodoxy and tomorrow’s cliché.” Your response?

Merlino: It’s a great metaphor for thinking outside the box! Things that people thought not possible when they were proposed and blown off become enormously successful. There are a lot of ideas that never succeed – but we all know the crazy ideas that did – who would have thought 30 years ago that people would pay $4 For a cup of coffee – but today, we have 20,000 Starbucks stores around the world. A group of prospective investors once remarked that “Google” was the “balloon company.” The point is, don’t rush to pooh-pooh something you don’t understand or aren’t willing to try and understand – it could be something that changes the world.

Morris: From Thomas Edison: “Vision without execution is hallucination.”

Merlino: This is something my mentor, Ananth Raman at Harvard Business School, would tell me all the time: “Jim, no one will disagree the patient experience is important. The more important question is, how will you fix it? How will you execute?” The ability to execute defines success – make no mistake!

Morris: In your opinion, why do so many C-level executives seem to have such a difficult time delegating work to others?

Merlino: Good C-suite executives rise to the top because they can execute. Good execution at the operational level requires us to have a solid handle on details – that doesn’t mean operators don’t delegate, it just means that they have a strong line of site to the front lines because they know that is where operational success is driven. As people move into the c-suite, they hold on to their operational persona and likely feel the need to do more. But success in the c-suite comes from our ability to be more strategic and trust that we have selected highly qualified people to take our places.

Morris: Most change initiatives either fail or fall far short of original (perhaps unrealistic) expectations. More often than not, resistance is cultural in nature, the result of what James O’Toole so aptly characterizes as “the ideology of comfort and the tyranny of custom.”

Here’s my question: How best to avoid or overcome such resistance?

Merlino: I really dislike the word “change.” When I talk about improving the culture, I prefer to say “develop” or “evolve.” I recognize that this is a play on words that essentially mean the same thing. If I walk into a room and say: “we are here to change the organization,” it sends shock waves through the group. If I walk into a room and say: “your success to date has come from who you are and where you have been, to be successful in the future, we need to get to X, let’s talk about how we evolve the organization to that point,” that is a very different statement. They both are saying the same thing, but one will enlist help from the front lines to get there. Successful organizational “change” must come from the people – find the early adopters. So, recruit them with common purpose, recognize that it will take time, and plow forward.

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Jim cordially invites you to check out the resources at these websites:

Press Ganey link

Amazon Service Fanatics link

Institute for Innovation link

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