Be Well: The Clinic Way

Cleveland Clinic Chief Executive Dr. Toby Cosgrove
Cleveland Clinic Chief Executive Dr. Toby Cosgrove

Why was this book written?

"The book has been in the works for about two years and there was a lot of bad news about health care, you know health care is broken, it's a disaster, it's dysfunctional, etc. And actually, health care in the United States at its best is the best health care in the world," Cosgrove says.

The book is 200 pages, it reads fairly quickly. Was making a quick how-to book intentional?

"Yes, this is a book that is essentially written around using patient stories as illustrations of a point. It was not written as a heavy book on policy. It was written more as a book that could be easily read and accessible to a wide variety of people."

Is there a particular patient story that sticks out in your mind?

"Oh, gee there are, there are lots of patient stories. You see stories from pregnant women who had aortic dissections who were flown here. And the baby delivered and then the aorta repaired and now, 20 years later they both continue to do well. The point being made that it brought together an integrated team of obstetricians and anesthesiologists and cardiologists and cardiac surgeons all working simultaneously together as a team. And the point really is about integrated care."

Now, the book is entitled the Cleveland Clinic Way. Can you summarize what that way is and how it's different than other hospitals?

"We are a group practice of some 3200 physicians, and we govern ourselves. We are physician led. All of us here are salaried without incentive pay. We have annual professional reviews and one-year contracts. And those are some of the things that set the tone. Most hospitals either employ physicians or have physicians come in and use those facilities.

But in fact we are organized in a little different way. And I think that that allows us to work more effectively as teams. And we're also not incented to do more or less for a patient because we are getting the exactly the same amount of pay regardless."

In 2009 President Barack Obama visited the Cleveland Clinic and during a news conference there he said he considers the health system a role model. What exactly do you think it was that put the Cleveland Clinic in the national spotlight during that period?

"One of the things that did it was a study done by Dartmouth and published in what's called in the Dartmouth Atlas and they looked at the cost of people in the last 18 months of life across the country. And it turns out that the Cleveland Clinic and the Mayo Clinic were the lowest cost for major organizations institutions in those last 18 months of life. Essentially suggesting that not only did they have higher quality but they were not doing excessive testing or excessive procedures on patients simply because the incentive was not there to do that."

One of the conversations that started around the time Barack Obama came and has been re-ignited itself several times since then is this question of whether the the Cleveland Clinics way of operating can be replicated at other facilities. Do you think it can be replicated?

"Yeah, well, if you look at what's going on across the United States, I think people are becoming closer and closer to what the Clinic's model is. We are an integrated system of hospitals and doctors and if you look at it there is a consolidation going on in hospitals across the United States now. Sixty-five percent of the hospitals are part of a system and now 58 percent of doctors are employed by hospitals. So they are becoming closer and closer to the model in which we have. So clearly some of things we were fortunate enough to inherit are becoming part of the general scene across the country."

I do want to know, will we be seeing another book from you about the evolution from surgeon to hospital to hospital leader.

Cosgove laughs and adds: "That's not currently planned."

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