CDelos M. (Toby) Cosgrove, M.D., Cleveland Clinic

Dr. Toby Cosgrove

A Leading Model of Care Delivery

Editors’ Note

Dr. Toby 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. His undergraduate work was at Williams College. He was a surgeon in the U.S. Air Force and served in Da Nang, Republic of Vietnam as the Chief of U.S. Air Force Casualty Staging Flight. He was awarded the Bronze Star and the Republic of Vietnam Commendation Medal. Joining Cleveland Clinic in 1975, Dr. Cosgrove was named Chairman of the Department of Thoracic and Cardiovascular surgery in 1989. Dr. Cosgrove has addressed the Senate Health, Education, Labor and Pensions Committee, in Washington, D.C. He is the recipient of Cleveland Clinic’s Master Clinician Award, Innovator of the Year Award, and Lerner Humanitarian Award. Dr. Cosgrove topped Inside Business’ “Power 100” listing for Northeast Ohio, and is highly ranked among Modern Healthcare’s “100 most powerful people in healthcare” and “most powerful physician executives.”

Clinic Brief

Based in Cleveland, Ohio, Cleveland Clinic (my.clevelandclinic.org) is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. It was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion, and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. More than 3,000 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. The Cleveland Clinic health system includes a main campus near downtown Cleveland and more than 75 Northern Ohio outpatient locations, including 16 full-service Family Health Centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and, currently under construction, Cleveland Clinic Abu Dhabi.

What is it that has made Cleveland Clinic a consistent leader?

Our model of care delivery. We are a group practice that governs itself and builds and owns the buildings, and we decide the direction we’re going to go. We’re physician-led; we’re all salaried; and there are no incentives. The salary means there is no financial incentive for the doctors to do more or less – only what the patient needs.

We also have one-year contracts and annual professional reviews, which is an opportunity to give feedback to the physicians and get them to give us their feedback on how we run the organization.

We have grown the model and the practice enormously since I joined it as a physician 37 years ago, when we had about 140 doctors; we’re now at 3,200.

How broad are the areas of specialty, and what are you known for?

There’s nothing we don’t cover. We have about 130 specialties and subspecialties. We’re probably best known for heart and vascular for which we have been number one with U.S. News & World Report for the past 19 years; and we have the largest cardiac surgical service in the country by a factor of about two.

Also, we’re number two in urology; number two in GI; number two in neuro; and 14 of our specialties are in the U.S. News & World Report top 10.

Is there enough of an emphasis on prevention today?

The short answer to that is, no. The reason is that 40 percent of the premature deaths in the U.S. are caused by three things: smoking, obesity, and lack of exercise.

The major crisis in the U.S. now is around the cost of health care, and there are only two ways we’re going to reduce the cost – one is by having a more efficient delivery system, and you’re seeing that now with a lot of consolidation beginning to take advantage of scale, particularly around back office and to avoid duplication. The second of those is to decrease the burden of disease in the U.S., and I particularly point to obesity in that circumstance when 10 percent of the health care costs in the U.S. are secondary to obesity. The problem is getting worse and we can’t control health care costs in the U.S. unless we can control that epidemic.

What needs to be done to get on that healthy path?

Ultimately, it will fall to industry to make inroads. We have offered free Weight Watchers, free Curves, free access to our gyms, free yoga; we have changed the food that is served in the hospital and gotten rid of foods with trans-fat; taken the sugar drinks out of vending machines; labeled the caloric count of the food in the cafeteria – we have lost 415,000 pounds so far.

Are metrics in place to help ensure that you’re reaching those service standard goals?

That is vitally important. The quality in health care is the clinical outcome, the physical experience, and the emotional experience.

Unfortunately, most lay people cannot judge the quality of the clinical experience, although we have been very transparent about it; so we have metrics for the physical and emotional experience.

We started by redesigning our hospital gowns – Diane von Furstenberg helped with that. We have a wrap gown now that completely covers.

We’ve looked at the architecture, how we bring natural light into the rooms, how we put art on the walls as both an orienting and enlivening experience for the patients. We also have greeters to help patients get around.

We took all 43,000 of our employees offline for half a day and talked about the Cleveland Clinic experience, and every one of them got a badge that said, “I’m a Caregiver.” This includes doctors as well as people who work on the loading docks, because it’s a team effort and everyone on the team has to be involved.

We have dogs that are walked through the hospital, both the pediatric wards and the palliative care wards in particular, to comfort patients.

We regularly measure patient satisfaction. The employee engagement and patient satisfaction parallel each other.

What type of community outreach do you engage in?

We’re the largest employer that Cleveland has ever had. We need a viable community for us to succeed.

We have looked at our obligations to the community and defined three of them: the first is to provide great health care; the second is to be a great employer; and the third is to stimulate education in any way we can so that we have an educated populace for the knowledge economy as we move forward.

We are also supportive of building a new convention center and Global Center for Health Innovation in Cleveland, which will be a tremendous economic stimulus.