Hospitals can deploy all the navigators they like to help patients traverse the vast and, at times, confusing health care system. But in the end, they need to fix the broken elements of the patient experience rather than bring in more employees to cover them up.

That was one of the key lessons learned by Chief Experience Officer James Merlino, M.D., during his almost six years with the Cleveland Clinic. The nine-hospital industry giant eventually scrapped its navigator program, finding that, even though the workers helped to smooth out the visit, they didn't improve satisfaction scores. Patients were displeased that navigators were needed because doctors weren't rounding or nurses weren't visiting the bedside.

I recently sat down with Merlino, one of the first such chief experience officers hired by a hospital, to pick his brain. He's departing from the clinic at the end of this year to take on a role as president and chief medical officer of the strategic consulting division at Press Ganey. Merlino hopes he can spread his message to a wider audience in the new role. Last year, he also wrote a book on the topic, Service Fanatics: How to Build Superior Patient Experience the Cleveland Clinic Way.

"You can't layer things on to fix this," Merlino says. "You can find best practices and implement them, but at the end of the day, it's also about finding processes that are broken and fixing them. If your doctors aren't rounding, they need to round. If they don't communicate well, you need to teach them. If nurses aren't going to the bedside, you need to get them there, because that's what really makes the difference. You can't create a workaround for every problem."

When Merlino first joined the Cleveland Clinic, patient satisfaction scores were among the lowest found in the HCAHPS survey in 2009. But in just a few years, the clinic has pulled a 180, with scores in the top 8 percent of the 4,600 or so hospitals polled in the HCAHPS survey. Improvements include everything from adopting same-day appointment scheduling, to investing in art and architecture to create a more calming environment, to training all 43,000 employees to operate with a patient-first mindset.

Merlino says one of the biggest challenges is changing the culture. Six years ago, if you walked down a hallway at a Cleveland Clinic hospital and asked employees what they do, each one would give a different answer. Nowadays, every response would be centered on serving patients. Getting to that mindset is no easy task when some folks in the field still think the patient experience is just a feel-good, unimportant topic, and he calls the transformation one of his biggest accomplishments.

"That's one of the things we are really fighting with — this is not a warm and fuzzy concept. It's not about smiling. This is about how we deliver health care," he says. "It's getting everyone aligned around the idea that we're here for patients because you're fighting decades of legacy."

Merlino is spending his last few months at the Cleveland Clinic tying up loose ends and helping the organization to find a successor. Leaving the well-regarded system is going to be tough, but he's looking forward to spreading the word nationally.

"[Press Ganey] is a great platform to really take how we think about driving patient-centeredness and to help hospitals across the United States achieve it. So, I'm very excited about that opportunity," he says.

What is your hospital doing to help improve each patient's experience? Share your thoughts in the comment section and, for further reading on the topic, check out this fold-out story I wrote last year in H&HN, which includes more on Merlino and the Cleveland Clinic's experience strategy.