Cosgrove presents Cleveland Clinic model

On Friday, Delos M. (Toby) Cosgrove ’62, CEO of the world-famous Cleveland Clinic, delivered a lecture titled “Developing a Health Care System for the 21st Century” to an audience on the Massachusetts College of Liberal Arts (MCLA) campus.

Cosgrove began his lecture by assessing the state of the current healthcare legislation, which he described as having three goals: improving quality, providing access and decreasing costs. Of these, Cosgrove said, only the question of access has been addressed satisfactorily by the current legislation. As the Cleveland Clinic and the similarly lauded Mayo Clinic have both succeeded in addressing the other two goals – high quality and low cost – Cosgrove offered the cornerstones of his Clinic’s philosophy as a model for healthcare reform across the country.

Chief among these goals, Cosgrove said, is quality, an elusive concept that hasn’t traditionally lent itself to quantification in the medical sphere. The Cleveland Clinic has addressed this issue by methodically recording outcome measures for each of its specialty centers, resulting in outcomes books that are distributed both internally and externally.

“We’re in the process of taking the art of medicine and making it a science,” Cosgrove said. Several other hospitals have followed suit and have published outcomes books of their own. “[Now,] we are competing not on reputation, but on quality,” he said.

The second cornerstone of the Cleveland Clinic’s philosophy is innovation. Cosgrove quoted economist Elizabeth Teisberg: “[Innovation is] the only long-term solution to high quality, affordable health care.” Next, he gave a number of examples of innovation in action at the Clinic, including the invention of the first dialysis machine, made out of a Maytag washing machine and sausage casings. The Clinic awards innovation with the $50,000 Mason Sones Award and constantly writes new patents.

“Healthcare has changed from an individual practice to a team event,” Cosgrove continued, emphasizing teamwork, the third cornerstone of the Cleveland Clinic. At the Clinic, an average of 18 non-physicians support each physician on staff. According to Cosgrove, having such a team allows each member to master a precise set of skills.

The reorganization of departments of surgery and medicine at the Clinic has also emphasized teamwork. While most hospitals keep surgeons and physicians in separate departments regardless of the medical issues that they specialize in, the Clinic organizes its institutes around organs or disease systems. The Neurological Institute, for example, places neurosurgeons, psychiatrists and neurologists together to better address patients’ needs from all angles of a disease.

Service is the final cornerstone of the Cleveland Clinic’s philosophy. As Cosgrove explained, the quality of care at the Clinic has increased to the point where it can address the clinical, physical and emotional quality of the patient experience. “Now that the patients know they’re going to have a successful heart surgery, they want a quality experience in the hospital,” he said. The measures taken by the Clinic include the institution of patient greeters, redesigned patient gowns to avoid embarrassing wardrobe malfunctions, open visiting hours, massage and pet therapy, open medical records and a prayer room. Cosgrove suggested a new interpretation of the healthcare experience: “No longer are these individuals staff and employees – they’re caregivers.”

Cosgrove believes that the Cleveland Clinic’s success with these principles has important implications for the future of healthcare. Healthcare constitutes one-sixth of the U.S. economy, and this percentage will only increase as more people, especially the elderly, enter the system and new treatments are developed. To counteract this expansion, the incentives to produce value in healthcare – the greatest quality for the minimum cost – must be changed. “The insurance companies are not the only villain here,” Cosgrove said, citing the need for patients, drug companies, insurance companies and hospitals to take the initiative to reform the system.

After that, Cosgrove cited smoking and obesity as two burdens on the healthcare system that are largely in the hands of patients. “Right now, the public has no responsibility for their own health,” he said. Cosgrove has been known for his strong views on the agency of patients, and his policies have reflected a drive to make patients assume that responsibility. The Cleveland Clinic has offered free programs in weight loss and smoking cessation to the counties that it serves and, more radically, the Clinic has also stopped hiring smokers.

In conclusion, Cosgrove noted that although the model of the Clinic has contributed in its own way to healthcare reform, an economically feasible and high-quality healthcare system will require the cooperation and ingenuity of all involved.

Cosgrove’s lecture was a part of the Four College Issues Forum, a collaboration formed in 2008 with the aim of bringing together students and faculty from Southern Vermont College, Bennington College, MCLA and Williams to contemplate critical issues of the moment.