In good hands

Cleveland Clinic has delivered world-class treatments since 1921, and is currently ranked as one of the top US hospitals. Founded by a group of physicians with the mission to take ‘better care of the sick, investigate their problems, and further the education of those who serve’, the clinic was, even back in those days, a pioneer in the healthcare industry. Today, continuing this good work, the organization remains at the forefront of innovation, supported by its unique culture of research and education.

In his role as CEO, Toby Cosgrove is responsible for overseeing progress in the area of innovation and continuing the clinic’s legacy of achievements. Millions of patients have benefited from the state-of-the-art technology and professional care given by the organization’s staff. Having joined the clinic in 1975 as a Cardiac Surgeon, Cosgrove progressed to become Chairman of the Department of Cardiac Surgery and has been in his current role as CEO since 2004.

During his career at the hospital, Cosgrove can recall many milestones in the clinic’s history. Of these, one of the biggest transformations has been the expansion from a one-hospital system to a healthcare system with ten hospitals in two states, facilities in three foreign countries, 37,000 employees, a budget which has grown from $750 million budget to $5 billion over the last 15 years, and 4200 beds under management at the moment. “Evaluation of the organization and its growth has been one of the major events that would characterize us,” he says.

The organizational structure has undergone a dramatic shakeup over the years. In the past, healthcare organizations, and particularly academic healthcare organizations, have been organized around professional groups, as Cosgrove explains: “There were departments of surgery, medicine, anesthesia and many more, all of which were very profession-centric. We have just completed the reorganization to become a more patient-centric organization. We have brought together the people who deal with a particular organ system or a particular disease process into one organization. For example, the Neurologic Institute will have neurologists, neurosurgeons and psychiatrists all in the same organization. This is going to give better focus around the patient and ultimately improve the service.”

According to Cosgrove, excellent communication is one of the crucial characteristics of success. To achieve this, he strives to be as transparent a CEO as possible, and has introduced effective communication systems throughout the organization. “Since we are in so many locations and we have such a big employee number, the first thing we did was to introduce a televised address to the entire organization four times a year,” he outlines. “These focus on events of the day and any issues that we’re trying to emphasize. The idea is to ensure that everybody receives the same message.”

Considering the size of the organization, hospital management is a complex and challenging task. However, Cosgrove highlights how ‘putting patients first’ is foremost on the agenda and every decision is geared around ensuring and providing an excellent service. “There wouldn’t be any hospitals, any clinics, or jobs if it were not for the patient, so I think that the most important thing is to keep the organization focused on its principal mission.”

This focus on patients has resulted in the clinic being rated one of America’s top three hospitals by US News and World Report, while the clinic’s heart program has been ranked number one in the country for the 12th consecutive year. The clinic has the biggest cardiovascular surgical program in the country, with some 4000 cases a year, and it continues to grow its patient facilities to keep up with the demand.

Cleveland Clinic is incredibly proud of these achievements, as Cosgrove elaborates, “We attain these high levels by prioritizing patient needs and constantly refining our processes. In cardiovascular surgery, we’ve put in an enormous effort to examine our results and to continue improving them by measuring them as we go forward. As a consequence, they get better and better. Each time we find a problem, we dive deeply into it and try to analyze why we had the problem in the first place and improve on that. It was a constant series of very small refinements that ultimately resulted in a better and better product.”

Bright ideas
Innovation plays a key role at the clinic and has done ever since the inauguration of the organization. The founders of the clinic were very innovative individuals and even after 85 years this spirit is still going strong. This is demonstrated in the annual ‘Innovator of the Year’ award, which recognizes achievements and awards a cash prize to the winner.

Last year’s winner was Ali Rezai, Director of Cleveland Clinic’s Center for Neurological Restoration who was recognized for his contributions in neurosurgery, technology development and the development of novel clinical applications of deep brain stimulation (DBS). “Innovation is one of our hot buttons,” enthuses Cosgrove. “It’s really baked into our woodwork. Our organization is one that is founded on an innovative governance structure. We have set up a system that allows physicians to take their ideas, help commercialize them and bring them to marketplace to help patients. This has been very helpful in getting new products and new ideas to the marketplace.”

One of the most exciting innovations is in the area of neurostimulation and is known as deep brain stimulation (DBS) This involves putting pacemakers into people’s brains to treat many ailments, ranging from depression and drug addiction to comas and Parkinson’s disease. In fact, this procedure is working wonders for people with debilitating movement disorders such as Parkinson’s disease, tremors and dystonia and physicians at the organization believe it has the potential to improve a range of other conditions.

Once the pacemaker is implemented in the brain, it works by emitting finely tuned pulses of energy. As a result, symptoms are relieved and the cell damage and destruction normally associated with traditional brain surgery is avoided. If a patient’s condition worsens, the pacemakers can be reprogrammed to adjust to any change. Surgeons at the clinic can target precisely, with one millimeter accuracy, where confused or abnormal nerve signals are generated. This accuracy means that the pacemaker’s tiny electrode can be perfectly positioned. Although the process cannot cure it has been credited with drastically improving the quality of life for patients in contrast to other therapies they might have tried.

The clinic’s Heart and Vascular Institute also has a long history of innovation, beginning with the invention of coronary angiography in 1958; then in 1968 the first coronary artery bypass operation took place. The institute continues to apply new techniques and technologies to help advance the treatment of heart conditions, including percutaneous aortic valve replacement, a new treatment being investigated for patients with severe symptomatic aortic stenosis.

Another new technology that has been making a big impact is an advanced ultrasound technology developed by a team of Cleveland Clinic scientists which is being used to  help predict heart attacks in patients. The technology is able to do this by determining where dangerous plaques are developing within their coronary arteries.

Money talks
Funding is one of the biggest challenges facing the industry in this area of research. The current funding situation for research is looking bleak. Cosgrove agrees that the slow erosion of funding from the NIH is an ongoing concern for the industry. At present, one-third of funding for research comes from federal sources, and the rest comes from venture capitalists and industry. The clinic has taken a proactive approach and has looked to a number of sources to meet its future needs, so that it is not dependant on NIH funding

“Industry and philanthropy are our two major sources of funding,” explains Cosgrove. “From these, we have developed a significant flow of funds that have helped us grow our research funding over the last several years.”

The clinic isn’t alone in taking these kinds of measures. In fact, Cosgrove believes that funding from other sources will become an inevitability for similar organizations if they want to continue with their research interests. “It will be to the detriment of the country if we don’t continue with research. Healthcare in the bigger picture is a major export from the United States, whether it be products, technology, knowledge or any of the education that we provide for the world. To step back from this would be a major long-term step backwards for the country.”

In the future, the organization aims to concentrate its efforts in a number of areas, including innovations in nerosciences, better diagnostic techniques and even including redesigning the pajamas patients wear at the hospital to make them more friendly. “People are working on their particular areas, some of which will be fruitful, some of which will not; but we are continuing to explore many different areas.”

Another focus will be the opportunities for the organization abroad. The clinic has had inquiries from 60 or 70 countries who are keen for them to provide healthcare facilities. The organization currently has a facility in Toronto, and there are plans for another in Vienna.

In Abu Dhabi, the clinic is building a 360-bed hospital in collaboration with the government, which is scheduled to be operational in 2010 and will include a multi-specialty tertiary center and adjacent clinic. The facility will use the most up-to-date IT systems, offer state-of-the-art diagnostic and treatment capabilities and utilize advanced technologies in surgery, imaging, telemedicine and electronic medical records.

 “We see new international activities as both an opportunity and an obligation,” explains Cosgrove. “We feel we have an obligation to share the expertise which we have assembled here with other locations. It is an opportunity for us to use our intellectual capital and help both ourselves and other people.”

Dr. Delos M. (Toby) Cosgrove is President and CEO of Cleveland Clinic. As CEO, he presides over a $4.6 billion healthcare system comprised of the Cleveland Clinic, nine community hospitals, 14 family health and ambulatory surgery centers, Cleveland Clinic Florida, Cleveland Clinic Toronto and the developing Cleveland Clinic Abu Dhabi.

Dr. Cosgrove received his medical degree from the University of Virginia School of Medicine in Charlottesville and completed his clinical training at Massachusetts General Hospital, Boston Children’s Hospital and Brook General Hospital in London.

Innovations at Cleveland Clinic

Many major medical breakthroughs that have happened at Cleveland Clinic:

• Isolation of serotonin, a key factor in hypertension (1940s)
• Development of ‘no-touch’ colorectal surgery (1950s)
• First coronary angiography (1958)
• Development and refinement of coronary bypass surgery (1967)
• First minimally invasive aortic heart valve surgery (1996)
• First successful larynx transplant (1999)
• Discovery of first gene linked to juvenile macular degeneration (2000)
• Discovery of first gene linked to coronary artery disease (2003)