Quality Care An Interview with Toby Cosgrove, M.D., President and Chief Executive Offi cer, Cleveland Clinic EDITORS’ NOTE Dr. Toby Cosgrove What makes Cleveland Clinic so disease. Hospitals will increasingly be utilized only received his medical degree from special and what has been the key for addressing really complex issues. More and the University of Virginia School of to its success? more things are being looked after as outpatients Medicine in Charlottesville and We have to go back to our model, and short-term stay, so the nature of hospitals is completed his clinical training at which incorporates 3,600 physicians in a changing. There are fewer beds in the United States Massachusetts General Hospital, group practice. We are all salaried and right now. There has been a 20 percent reduction Boston Children’s Hospital, and we have one-year contracts, annual pro- in the total number of hospital beds in the U.S. Brook General Hospital in London. fessional reviews, and are physician-led. because people are spending less time in the hos- His undergraduate work was at This has been the case throughout pital and are utilizing more outpatient care. Williams College. He was a surgeon the long history of the institution. There seems to be a move toward con- in the U.S. Air Force and served in Is top talent still coming into solidation into larger health systems. Is that Da Nang, Republic of Vietnam as medicine? what is happening and will small, community the Chief of U.S. Air Force Casualty Toby Cosgrove There is no question that top talent hospitals survive? Staging Flight. He was awarded the still comes into medicine. There are still Increasingly, the trend is to be part of a system, Bronze Star and the Republic of Vietnam more people applying to medical school than they and that’s how it should be because not all facilities Commendation Medal. Joining Cleveland Clinic can accept. should attempt to be all things to all people. in 1975, Dr. Cosgrove was named Chairman of One of the reasons Cleveland Clinic attracts The community hospitals will look after the the Department of Thoracic and Cardiovascular people is that we allow them to practice medicine. things they do well, and complicated things will Surgery in 1989. Dr. Cosgrove has addressed the As a cardiac surgeon, I spent all of my time oper- move on to bigger systems. Senate Health, Education, Labor and Pensions ating – I didn’t have to do things like contracts or The fact that we have systems working Committees, in Washington, D.C. He is the recip- hire secretaries or send bills. I just looked after together provides effi ciency, reduces the rate of ient of Cleveland Clinic’s Master Clinician patients, and that is one of the real attractions of competition, and delivers better care. Award, Innovator of the Year Award, and Lerner being a doctor here. When it comes to the upcoming 100th Humanitarian Award. Dr. Cosgrove topped Are you concerned about technology anniversary of the institution, there is a cam- Inside Business’ “Power 100” listing for Northeast impacting the doctor/patient relationship? paign to secure continued investment. Ohio and is highly ranked among Modern I worry about this a great deal. Technology How important is that investment and which Healthcare’s “100 most powerful people in health- has come into healthcare in a major way, and there areas will you focus on? care” and “most powerful physician executives.” are four things that are impacting the physicians We’ve continued to invest in our organization and causing major issues, particularly in regard to at a pretty substantial rate. We just completed INSTITUTION BRIEF Based in Cleveland, Ohio, satisfaction and burnout. a brand new cancer center that required about a Cleveland Clinic (my.clevelandclinic.org) is a First, doctors now have to become part of a $170 million investment to bring together all of the nonprofi t multispecialty academic medical cen- team – they are no longer solo practitioners that capabilities in one facility. ter that integrates clinical and hospital care with have total autonomy. We have continued to grow outpatient facili- research and education. It was founded in 1921 The second thing is that the Affordable Care ties, everything from urgent care to family health by four renowned physicians with a vision of pro- Act has brought all sorts of quality metrics and mea- centers to bring care as close to people as possible viding outstanding patient care based upon the surements into a physician’s daily business. This is and make our access to care more affordable and principles of cooperation, compassion, and inno- new for them and has changed how we get paid, easier to reach. vation. Cleveland Clinic has pioneered many etc., and has enormously changed the business We have continued to educate, and we have a medical breakthroughs, including coronary of delivering care. huge investment going with Case Western Reserve artery bypass surgery and the fi rst face transplant Third is the electronic medical record, which around our new health education campus, which in the United States. U.S. News & World Report requires physicians to document at a level that they will be a $500 million investment. consistently names Cleveland Clinic as one of the had never been required to do before. We do about a quarter of a billion dollars nation’s best hospitals in its annual “America’s The fourth thing is the explosion in informa- worth of research funding each year, and that really Best Hospitals” survey. More than 3,600 full-time tion. The total amount of knowledge in healthcare speaks to the future of our organization. salaried physicians and researchers and 11,000 is doubling every 73 days, which is an incredible Right now, we’re in a major process of mov- nurses represent 120 medical specialties and burden just to keep up. ing toward an increasing digital health world, and subspecialties. The Cleveland Clinic health sys- This has led to burnout among physicians – that will be a big investment for us as well. tem includes a main campus near downtown the incidence rate is that 50 percent of physicians How critical is Cleveland Clinic’s impact Cleveland and more than 75 Northern Ohio out- demonstrate burnout. This is a real concern. on the city of Cleveland? patient locations, including 16 full-service Family What will the hospital of the future look The impact of the clinic on the city has grown Health Centers, Cleveland Clinic Florida, the like, and is there a transformation taking place to a $13 billion economic impact annually. We’re Lou Ruvo Center for Brain Health in Las Vegas, of what a hospital will be? the biggest employer that Cleveland has ever had, Cleveland Clinic Canada and, currently under Increasingly, there is less and less acute dis- and we’re continuing to see the city show tremen- construction, Cleveland Clinic Abu Dhabi. ease in hospitals, and it’s more about chronic dous vibrancy.• 56 LEADERS POSTED WITH PERMISSION. COPYRIGHT © 2017 LEADERS MAGAZINE, INC. VOLUME 40, NUMBER 3.