Since their initial rollout in 2019, plan of care visits — which bring nurses and providers to the patient's bedside together — have become characteristic of the way care is delivered and managed across Cleveland Clinic. They've become so beneficial that the system has done away with chasing other experience scores, such as patients' likelihood to recommend.
"It's been a total disruptor to how we do business at the Clinic in the best imaginable way," Judith Welsh, MD, enterprise associate chief experience officer and academic emergency physician at Cleveland Clinic, told Becker's. "You can't walk on a Cleveland Clinic campus anywhere in the organization … and find people who don't know what plan of care visits are. … It's our culture and it's our way."
The structure of these visits aims to ensure everyone has a clear understanding of the care plan and what milestones would need to be met before discharge. They're different from traditional multidisciplinary rounds in that they don't solely focus on the physicians' goals and updates.
The visits start with providers first asking patients what's most important to them and what their biggest concerns are. Providers then ask the nurse for their updates and concerns, and physicians hold their agenda until the end, Dr. Welsh said. "[Physicians] then share responses to concerns and issues and updates to 'what are we waiting for,' 'what conflicts are we having,' 'what medications are we changing,'" she explained. The last step is a "teach back," where the provider confirms appropriate understanding of the plan of care by asking patients how they will describe their care plan with their family.
They've since become Cleveland Clinic's main patient experience metric, with the system embedding two custom questions in their HCAHPS survey to track how frequently the visits occur and how helpful patients find them. An internal regression analysis showed that when these patients perceive these visits happen at least half of the days of their stay, most other important metrics — teamwork, nursing communication, physician communication and likelihood to recommend — also improved.
"We very intentionally stopped chasing scores over the last year or so," Dr. Welsh said. "Our CEO has added [plan of care visits] to his scorecard, so we're not chasing likelihood to recommend, or doctor communication or nurse communication at that CEO level. Plan of care visits are [CEO] Tom Mihaljevic's patient experience metric."
The plan of care visit is used for inpatient hospital visits every day across Cleveland Clinic, though the structure can be used in any type of visit, Dr. Welsh said, adding that as an emergency physician, she does these visits with her patients and staff as well.
Plan of care visits have been especially beneficial amid workforce shortages and staff burnout, which both complicate effective communication and collaboration, Dr. Welsh said. The visits save nurses and providers time by preventing misunderstanding and unnecessary pages throughout the day.
"It's not just something we do for the patients," she said. "We find that on the units where plan of care visits are done really well, everybody's super engaged and they love them because they see the benefit in [the visits] for themselves."