The Cleveland Clinic Way: A book review by Bob Morris

Cleveland ClinicThe Cleveland Clinic Way: Lessons in Excellence from One of the World’s Leading Health Care Organizations
Toby Cosgrove, M.D.
McGraw-Hill (2014)

How and why group practices can provide much better – and much less expensive — healthcare

There are valuable business (i.e. leadership and management) lessons to be learned from the information, insights, and counsel provided by Toby Cosgrove, M.D. and CEO of the Cleveland Clinic. These are among the questions he addresses: “How can the performance of an entity as large and complex as a hospital be improved, given that there are so many different professionals coming together to get the job done? How can doctors, nurses, technicians, and other support staff improve, for instance, the care that lung transplant patients receive so that they recover more quickly and stay in intensive care for fewer days? How can the many teams within a hospital uniformly sterilize surgical instruments so that patients sustain fewer serious infections? How can teams of professionals — each with different training and perspectives — improve their care of women during labor and delivery to minimize the number of risky procedures (for example, cesarean sections) that these women undergo?”

One of the keys to the effectiveness of healthcare provision at the Cleveland Clinic is the group practice model, one that was essentially born and continuously improved at the Mayo Clinic (co-founded by William and Charles Mayo in Rochester, Minnesota, in 1889) and the Cleveland Clinic (co-founded by George Crile Sr., Frank Bunts, William Lower, and John Phillips) in 1921. During the First World War, Dr. Crile and his colleagues set up military hospitals not far from the front. “They were impressed by the military approach to medicine, which was so different from the private practice model that dominated civilian medicine. Military medicine was collective.” More to the point, it was collaborative and collegial. “Everyone shared the same mission, and all were focused on the patient and making the patient better.” That, in essence, soon became the “Cleveland Clinic Way.”

Cosgrove has much of value to say about eight trends that will define the future of medicine. In fact, they will probably define the future, period. He explains WHY or HOW

1. Group practices will provide better — and cheaper — healthcare
2. Collaborative medicine is more effective
3. Big Data will be harnessed to improve the quality of healthcare as well as lower costs
4. Cooperative practices can be the wellspring of innovation
5. Empathy is crucial to better patient outcomes
6. Wellness of both mind and body depends on healthcare, not sickcare
7. How healthcare is best provided in different settings for greater comfort and value
8. How tailor-made healthcare treats a person rather than a disease

Directly or indirectly, these trends will sustain patient-driven healthcare with its focus on the quality of patient experience. These are among the dozens of passages of greatest interest and value to me, listed also to suggest the scope of Cosgrove’s coverage:

o Origins of the Group Practice Model and the Cleveland Clinic (Pages 4-6)
o The Power of Collaboration (29-30)
o The Teamwork Incubator (31-34)
o Working Together in Institutes (38-44)
o The Wondrous New Face of Medicine (50-52)
o Electronic Medical Records Offer Significant Advantages (57-61)
o Big Data Drive Medical Research and Improve Healthcare Outcomes (65-70)
o Improving Performance at All Levels (73-76)
o Innovation and Its Enemies (83-84)
o Innovation at the Margins (90-94)
o Bringing Innovation to Market (94-100)
o Navigating the Cultural Sea Change (112-116)
o Improving Caregiver-Patient Communication (120-123)
o Bad Habits Cost More Than Money (135-138)
o Changing Tines, Changing Care (155-157)
o Toward Better Integration (161-167)
o How Personalized Care Works (176-178)

Cosgrove provides a substantial value-added benefit: mini-commentaries that provide valuable supplementary information about the Cleveland Clinic way (in practice) within the context of the narrative. Their subjects: “Teams Tamer Seizures” (48-49), “Call Today for an Appointment Today” (124-125), and “A System Open to Anyone” (162-164).

When concluding this remarkable book, Cosgrove observes, “Healthcare professionals, policy makers, patients, and citizens together can lead the way to improved healthcare delivery in this country. I’ve written this book in the hope of creating a movement of individuals who realize what is at stake and what is possible and are committed to leading the way. Count yourself as a member of this movement. Speak out about healthcare. Break new ground. Make new connections. Be a pioneer.” Years ago, Margaret Mead observed, “Never doubt that a small group of thoughtful, committed, citizens can change the world. Indeed, it is the only thing that ever has.” The Mayo Brothers and their associates did that 1889 and Dr. Crile and his colleagues did that in 1921. I agree with Toby Cosgrove: “Now it’s our turn.”

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