By Adrienne Boissy, MD, MA
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“To dwell inside a well-functioning machine is to be largely unaware of its functioning.”
– Siddhartha Mukherjee
When you’re part of a large healthcare system that operates efficiently every day, it’s easy to overlook the inner workings. If the lights are on, linens are fresh and shuttles are operating, it’s just another day.
But the performance of a hospital’s front line, such as food service and transportation caregivers, can make or break a patient’s experience. Recently, Cleveland Clinic’s executive leaders not only witnessed it firsthand, but also lived it.
Every month we bring leaders together to round on the units and talk to front-line workers and patients about issues affecting them. During November’s rounds, instead of standing around like outsiders, observing and taking notes, leaders got their hands dirty.
Nearly 100 executives partnered with caregivers in patient transport, facilities, police and security, linens/laundry, cafeteria and other areas. They donned the uniforms and spent an hour shadowing their counterparts.
Walking in caregivers’ shoes
I was matched with Johnny, a member of the lift team who has worked at Cleveland Clinic for over 35 years. Johnny is a big guy, a football coach. On his shirt collar he wears a small, handcrafted barbell pin — a gift from a previous patient that he lifted every day during a long hospitalization.
During my time with Johnny, he was paged to do a lift in ICU. As we walked to the patient’s bedside, every person we passed knew Johnny and exchanged greetings. He knew their names, families and relevant life events.
When we arrived in ICU, Johnny greeted the patient and his wife with respect. He delicately repositioned the patient’s lines so they wouldn’t get tangled during the move. Then, while explaining everything he was doing, every step, he tenderly lifted the patient from the bed and gently set him in the bedside chair.
I was so touched by the care and empathy that Johnny had for the patient and family, that tears welled up in my eyes. I quickly turned away to try to figure out why I was crying. I was supposed to be lifting! In truth, I was overwhelmed. The softness of his voice, the wife’s gratitude for his presence, and the purity of kindness to another so vulnerable were completely unexpected yet beautifully human.
I thought lifting patients was a job, but after rounding with Johnny, I realized how much he cared for patients and formed relationships with them day after day, lift after lift.
I wasn’t the only one affected. After the rounds, other leaders wrote notes to their front-line caregivers about what the experience had meant to them and what they had learned. One thanked a shuttle driver for giving patients not only safe transportation but reassurance. Another shared how caregivers cleaned rooms with compassion by leaving notes and towel creations for patients. Another celebrated food service caregivers for their innovation in getting food to the right place at the right time — because food heals.
We all walked away with a deeper appreciation of others.
Refresh your rounds
Keeping leadership rounds fresh and stimulating is no small challenge.
We can go out and talk to people to see how things are going, and they may tell us that everything is great. But is it really? How do we get the meaningful input we desperately want?
Shadowing front-line workers is one answer.
Too often, discussions of quality, safety and experience occur in staff meetings, boardrooms and break rooms. In today’s complex environment, this isn’t enough. Leaders, patients and board members should participate in executive leadership rounds because:
Time and attention spans are short. Busy executives can get a taste of real-life experience in a manageable timeframe. You can’t understand everything in one hour of shadowing, but it’s enough to pique curiosity, gain appreciation and kindle an opportunity to learn more.
Front-line caregivers are fantastic teachers. When walking in another person’s shoes, listening to why they do what they do, and standing beside them as they do it, you gather insights that never could have come from presentations or graphs. Shadowing helped our leaders to slow down, be present and experience what it means to provide great care here. On rounds one day, I asked an environmental service caregiver what he did. He replied, “I take care of my patients.” That’s purpose over task!
Partnership is power. With more than 50,000 caregivers at Cleveland Clinic, our leaders can’t know everything, nor do they have all the solutions. We all want patients to have exceptional experiences, but better processes and technology will only go so far. Exceptional patient experiences still are created largely by exceptional front-line caregivers. Finding new ways to celebrate them and giving our time to them is always time well spent.
Sending leaders to work on the front lines will become a regular practice at Cleveland Clinic. I encourage other healthcare leaders to do the same: Eat the food that gets delivered to your patients. Put on a gown for a while. Be a sous chef in the kitchen. Sit in your own waiting rooms.
In the end, it’s about deepening empathy — for patients and for each other.
Johnny taught me that.
Dr. Boissy is Chief Experience Officer at Cleveland Clinic.