INTERVIEW VIEW Interview INTER A Leading Model of Care Delivery An Interview with Delos M. (Toby) Cosgrove, M.D., President and Chief Executive Offi cer, Cleveland Clinic What is it that has made Cleveland Clinic a Curves, free access to our gyms, free yoga; we consistent leader? have changed the food that is served in the hos- Our model of care delivery. We are a group pital and gotten rid of foods with trans-fat; taken practice that governs itself and builds and owns the sugar drinks out of vending machines; labeled the buildings, and we decide the direction we’re the caloric count of the food in the cafeteria – we going to go. We’re physician-led; we’re all sala- have lost 415,000 pounds so far. Dr. Toby Cosgrove ried; and there are no incentives. The salary means Are metrics in place to help ensure that there is no fi nancial incentive for the doctors to do you’re reaching those service standard EDITORS’ NOTE Dr. Toby Cosgrove received his med- more or less – only what the patient needs. goals? ical degree from the University of Virginia School of We also have one-year contracts and an- That is vitally important. The quality in Medicine in Charlottesville and completed his clinical nual professional reviews, which is an opportu- health care is the clinical outcome, the physical training at Massachusetts General Hospital, Boston nity to give feedback to the physicians and get experience, and the emotional experience. Children’s Hospital, and Brook General Hospital in them to give us their feedback on how we run the Unfortunately, most lay people cannot London. His undergraduate work was at Williams organization. judge the quality of the clinical experience, al- College. He was a surgeon in the U.S. Air Force and We have grown the model and the practice though we have been very transparent about it; served in Da Nang, Republic of Vietnam as the Chief enormously since I joined it as a physician 37 so we have metrics for the physical and emo- of U.S. Air Force Casualty Staging Flight. He was years ago, when we had about 140 doctors; we’re tional experience. awarded the Bronze Star and the Republic of Vietnam now at 3,200. We started by redesigning our hospital Commendation Medal. Joining Cleveland Clinic in How broad are the areas of specialty, gowns – Diane von Furstenberg helped with that. 1975, Dr. Cosgrove was named Chairman of the and what are you known for? We have a wrap gown now that completely covers. Department of Thoracic and Cardiovascular sur- There’s nothing we don’t cover. We have We’ve looked at the architecture, how we gery in 1989. Dr. Cosgrove has addressed the Senate about 130 specialties and subspecialties. We’re bring natural light into the rooms, how we put art Health, Education, Labor and Pensions Committee, probably best known for heart and vascular for on the walls as both an orienting and enlivening in Washington, D.C. He is the recipient of Cleveland which we have been number one with U.S. News & experience for the patients. We also have greeters Clinic’s Master Clinician Award, Innovator of the World Report for the past 19 years; and we have to help patients get around. Year Award, and Lerner Humanitarian Award. Dr. the largest cardiac surgical service in the country We took all 43,000 of our employees offl ine Cosgrove topped Inside Business’ “Power 100” list- by a factor of about two. for half a day and talked about the Cleveland ing for Northeast Ohio, and is highly ranked among Also, we’re number two in urology; number Clinic experience, and every one of them got a Modern Healthcare’s “100 most powerful people in two in GI; number two in neuro; and 14 of our badge that said, “I’m a Caregiver.” This includes healthcare” and “most powerful physician executives.” specialties are in the U.S. News & World Report top doctors as well as people who work on the 10. loading docks, because it’s a team effort and ev- CLINIC BRIEF Based in Cleveland, Ohio, Cleveland Is there enough of an emphasis on pre- eryone on the team has to be involved. Clinic (my.clevelandclinic.org) is a nonprofi t multi- vention today? We have dogs that are walked through the specialty academic medical center that integrates The short answer to that is, no. The reason hospital, both the pediatric wards and the pallia- clinical and hospital care with research and educa- is that 40 percent of the premature deaths in the tive care wards in particular, to comfort patients. tion. It was founded in 1921 by four renowned U.S. are caused by three things: smoking, obesity, We regularly measure patient satisfaction. physicians with a vision of providing outstanding pa- and lack of exercise. The employee engagement and patient satisfac- tient care based upon the principles of coopera- The major crisis in the U.S. now is around the tion parallel each other. tion, compassion, and innovation. Cleveland Clinic cost of health care, and there are only two ways What type of community outreach do has pioneered many medical breakthroughs, includ- we’re going to reduce the cost – one is by having you engage in? ing coronary artery bypass surgery and the fi rst face a more effi cient delivery system, and you’re seeing We’re the largest employer that Cleveland transplant in the United States. U.S. News & World that now with a lot of consolidation beginning to has ever had. We need a viable community for us Report consistently names Cleveland Clinic as one of take advantage of scale, particularly around back to succeed. the nation’s best hospitals in its annual “America’s offi ce and to avoid duplication. The second of those We have looked at our obligations to the Best Hospitals” survey. More than 3,000 full-time sal- is to decrease the burden of disease in the U.S., and community and defi ned three of them: the fi rst aried physicians and researchers and 11,000 nurses I particularly point to obesity in that circumstance is to provide great health care; the second is to represent 120 medical specialties and subspecialties. when 10 percent of the health care costs in the U.S. be a great employer; and the third is to stimulate The Cleveland Clinic health system includes a main are secondary to obesity. The problem is getting education in any way we can so that we have an campus near downtown Cleveland and more than worse and we can’t control health care costs in the educated populace for the knowledge economy 75 Northern Ohio outpatient locations, including 16 U.S. unless we can control that epidemic. as we move forward. full-service Family Health Centers, Cleveland Clinic What needs to be done to get on that We are also supportive of building a new Florida, the Lou Ruvo Center for Brain Health in Las healthy path? convention center and Global Center for Health Vegas, Cleveland Clinic Canada, and, currently un- Ultimately, it will fall to industry to make in- Innovation in Cleveland, which will be a tremen- der construction, Cleveland Clinic Abu Dhabi. roads. We have offered free Weight Watchers, free dous economic stimulus.• VOLUME 37, NUMBER 1 POSTED WITH PERMISSION. COPYRIGHT © 2014 LEADERS MAGAZINE, INC. LEADERS 31.