"There’s a revolution going on right now.
On the frontiers of medicine, some doctors have
developed an approach for treating people that is
more effective, more humane, and more affordable."
Delos M. Cosgrove, MD, CEO & President
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The Cleveland Clinic Way
Lessons in Excellence from One of the World's Leading Healthcare Organizations
Cleveland Clinic experienced another successful year in 2013. We saw more patients and welcomed more new patients than at any time in our history. All indicators of our financial health rose significantly. The world looks to us as a model of quality, efficiency and service.
But healthcare is changing. The nation is moving from a fee-for-service approach to one that rewards outcomes, efficiency, quality and population health. We can expect a more complex regulatory environment, lower reimbursements and continuing uncertainty.
For many, this is a time of anxiety. At Cleveland Clinic, it is a time for action. We are leveraging our resources, expanding our networks, and building on a vast and growing knowledge base. We are preparing to address the great challenge of our time — to invent the healthcare system for the 21st century.
Cleveland Clinic is well-positioned to lead in this endeavor. We are committed to clinical excellence. We have a unique, patient-centered organization. We have the will and momentum to effect change.
Yesterday we pioneered for today. Today we pioneer for tomorrow. The current crisis is our opportunity to create a better healthcare system. All you can ask for in life is an opportunity. We have that opportunity now. We will create ready access, drive superior quality and make healthcare more affordable. We will “act as a unit” to give every patient the best outcome and experience. That is the future of healthcare. That is the Cleveland Clinic way.
Sincerely,
Delos M. Cosgrove, MD
CEO and President
Robert E. Rich Jr.
Director and Chairman of the Board
What is the Cleveland Clinic Way?
The Cleveland Clinic Way, by Toby Cosgrove, MD: Book Trailer
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Ninety-two years ago, four physicians founded a new medical center in Cleveland. It was a nonprofit group practice where doctors from many specialties could collaborate for efficiency and better patient care. Their mission was “to care for the sick, investigate their problems and educate those who serve.”
Integration
Today, Cleveland Clinic is a main campus, eight community hospitals and more than 75 outpatient locations (including 16 family health centers) in northern Ohio, and facilities in Florida, Nevada, Toronto and Abu Dhabi. Our locations are linked by health information technology and critical care transport, getting patients to the right facility, at the right time, for the right care. Our integrated structure enables us to control costs, measure and improve quality, and provide access to high-quality healthcare ser vices across a broad regional system.
Collaboration
All Cleveland Clinic staff physicians receive a salary with no bonuses or other financial incentives. The hospital and physicians share a financial interest in controlling costs. Physicians get no financial benefit from ordering unnecessary tests or using expensive devices.
Patient Focus
Cleveland Clinic is organized into patient-centered institutes based on single diseases or organ systems. Each institute combines medical and surgical services at the same location under the same leadership to improve patient care and experience.
Quality Improvement
Each institute is required to establish benchmarks and measure and improve quality. Institutes are also required to publish annual outcomes books showing volumes, results, innovations, publications and other information relevant to patients and referring physicians.
Information Technology
Cleveland Clinic integrates its far-flung system with an extensive electronic medical records system. This system includes participating community physicians and patients, who are able to access test results and portions of their medical record remotely via the Internet.
Value
Cleveland Clinic’s model of medicine has made it possible for us to achieve cost savings on a vast scale over the past several years. We were able to mobilize physicians and employees into hundreds of teams to address specific expenses. These teams cut costs from the operating room to the storeroom with a minimum of intramural friction. Our mantra is “Patients First.” Our motto is “To Act as a Unit.” Our goal is to give every patient the best outcome and experience. That’s the Cleveland Clinic way.
“Do I really need another test?”
The Cleveland Clinic Way
The Group Practice Model
Cleveland Clinic’s caregivers work as a team to lower costs and improve outcomes.
Cleveland Clinic is a nonprofit group practice. Our doctors work on one-year contracts. They are paid a salary. Every caregiver — from the greeter to the gastroenterologist — is on the same team. We all share the same mission, vision and values. That’s the Cleveland Clinic way.
The group practice model means Cleveland Clinic’s doctors have no financial incentive to order unnecessary treatments or tests.
“The other hospital told me I was too old for surgery.”
The Cleveland Clinic Way
Multispecialty Care
Cleveland Clinic’s caregivers collaborate to treat thousands of patients turned away elsewhere.
Cleveland Clinic recruits the best doctors from around the country and around the world. They represent more than 130 specialties and subspecialties. Working together in patient-centered institutes, they treat more of the sickest patients than any comparable hospital in America. That’s the Cleveland Clinic way.
Cleveland Clinic treats many patients other hospitals would consider too old, sick or frail for certain treatments.
“Wait. I can check my medical record now.”
The Cleveland Clinic Way
Information Technology
Cleveland Clinic’s patients and caregivers can access patients’ medical records anywhere.
Cleveland Clinic’s comprehensive electronic medical records system links patients, caregivers and facilities in a seamless web of secure, accessible information. We are leading the application of big data to lower costs and improve population health. That’s the Cleveland Clinic way.
Patients can check their medical records on their smartphones, tablets or home computers, wherever they are.
“I’m back on the road to independence.”
The Cleveland Clinic Way
Driving Innovation
Cleveland Clinic moves new ideas into new businesses.
Cleveland Clinic’s caregivers are continually refining, adapting and inventing new software, devices and techniques for better patient care. Cleveland Clinic Innovations speeds the patenting, testing and commercializing of bright ideas. Patients everywhere benefit. That’s the Cleveland Clinic way.
Cleveland Clinic is the first civilian user of the CAREN (Computer Assisted Rehabilitation Environment) system to improve balance and gait in neurologically impaired patients.
“Thank you for answering all my questions.”
The Cleveland Clinic Way
Patient Experience
Cleveland Clinic practices and teaches empathy.
Cleveland Clinic is transforming the patient experience. Our Office of Patient Experience works to improve everything from the patient gown to quiet at night to healing services for the spirit and emotions. Patient satisfaction scores are up — but we’re working to make them even better. That’s the Cleveland Clinic way.
Cleveland Clinic’s doctors and other caregivers are offered special training to strengthen their listening and communications skills.
“I turned sixty and needed to make a change.”
The Cleveland Clinic Way
Wellness
Cleveland Clinic promotes “well care,” not “sick care.”
Caring for the sick is good. Preventing sickness is even better. Cleveland Clinic has developed protocols to keep patients with chronic disease out of the hospital. Our Wellness Institute has programs for patients, caregivers and the community. Lower costs by promoting wellness. That’s the Cleveland Clinic way.
Cleveland Clinic’s Wellness Institute offers lifestyle programs to lose weight, improve health and boost outlook on life.
“I got her an appointment today.”
The Cleveland Clinic Way
An Integrated System
Cleveland Clinic is an integrated healthcare delivery system with local, national and international reach.
Cleveland Clinic encompasses locations in Ohio, Florida, Nevada, Canada and Abu Dhabi. Linked by health information technology, shared protocols and critical care transport, we offer the right care, at the right place, at the right time. That’s the Cleveland Clinic way.
As an integrated system, Cleveland Clinic is able to offer same-day appointments — more than a million were booked in 2013 alone.
“Will I get sick like mommy?”
The Cleveland Clinic Way
Personalized Healthcare
Cleveland Clinic incorporates family history, genetic profile and personal preference into your care.
Cleveland Clinic is tailoring healthcare to individuals and families. Our Genomic Medicine Institute offers genetic assessment and counseling. Our doctors work to align medications with individual genetic profiles. We are making patients active partners in their own care. That’s the Cleveland Clinic way.
Children at risk of inheriting familial disease syndromes can reduce their risk through genetic counseling at Cleveland Clinic’s Genomic Medicine Institute.
Clinical & Research Achievements
Gut Flora Studies Generate More Surprises
Stanley Hazen, MD, PhD, of Cleveland Clinic’s Lerner Research Institute and Miller Family Heart & Vascular Institute, has discovered that carnitine and choline, natural components of red meat, egg yolk and high-fat dairy products, are converted by bacteria in the gut into a substance that promotes atherosclerosis and coronary artery disease.
Dr. Hazen found that when intestinal bacteria digest the common food substance lecithin (which contains choline) or carnitine, they produce an organic compound called TMAO (trimethylamine N-oxide), and that TMAO levels in the blood are an accurate marker for cardiovascular disease. Dr. Hazen found that TMAO is a byproduct of the digestion of meat, eggs and other animal-based foods, which accelerated heart disease in an animal model. Expanding on these findings, Dr. Hazen’s lab is learning even more surprising facts about gut flora and heart disease.
(The American Heart Association and American Stroke Association have named Dr. Hazen’s discovery of the link between gut flora and cardiovascular disease one of the Top 10 major advances in cardiovascular and stroke science for 2013.)
Gut Flora Studies Generate More Surprises
Clinical & Research Achievements
Pioneering Pediatric Multivisceral Transplant
A 4-year-old boy with a rare genetic disorder was transplanted with a new liver, intestine, pancreas and duodenum, by a team led by Kareem Abu- Elmagd, MD, PhD, Director of Cleveland Clinic’s Transplant Center. It was the first pediatric multivisceral transplant to be performed at Cleveland Clinic and the first in the world to treat Martinez-Frias/Mitchell-Riley syndrome. Medical care was provided by a team from pediatric gastroenterology in Cleveland Clinic Children’s.
The 15-hour surgery was successful; the patient has been discharged and has excellent graft function. His diabetes has been cured, and he enjoys an unrestricted oral diet with no need for intravenous nutrition. This unprecedented case involved collaboration among surgeons, pediatric dietitians, nutritionists, transplant coordinators and other caregivers.
Dr. Abu-Elmagd has been instrumental in the development and clinical introduction of multivisceral transplantation since 1991.
“I’m certain he won’t have recurring disease with the new organs. I want to see the boy healthy, to have a normal life and to go back home to enjoy his family and siblings.”
– Kareem Abu-Elmagd, MD, PhD, Director of the Transplant Center
Clinical & Research Achievements
Epilepsy Surgery First
One of the major forms of epilepsy, focal epilepsy, can be cured by surgical removal of a portion of the brain. The challenge is to identify the correct portion to be removed with the minimum risk to the patient. Stephen E. Jones, MD, PhD, and Jorge Gonzalez-Martinez, MD, PhD, of the Neurological Institute, developed a novel method to identify the correct portion of the brain by combining two leadingedge technologies — intracranial electrode implantation and functional MRI (fMRI) — in the operative environment. They were first in the world to successfully use this technique, which maps neural activity in the brain in real time. It will allow neurosurgeons to better identify regions of the brain responsible for causing focal epilepsy. This will improve surgical outcomes and benefit thousands of patients.
Presented at: 51st Annual Meeting and The Foundation of the American Society of Neuroradiology Symposium 2013
(Winner: 2013 outstanding presentation award in general neuroradiology)
Epilepsy Surgery First
Clinical & Research Achievements
New Method of Complex Nasal Reconstruction
Michael Fritz, MD, and surgeons from Cleveland Clinic’s Head & Neck Institute have pioneered a new technique for the reconstruction of complex nasal lining defects using the free vascularized anterolateral thigh fascia lata flap. The skin was used to replace nasal lining in five patients with total or subtotal rhinectomy defects. No flap failure or lining loss was observed, and harvest site morbidity was negligible. Patients achieved satisfactory nasal form and patent nasal airways without requiring revisions.
Potential advantages offered by this technique compared with more established methods include (1) single-stage replacement of nasal lining, structure and skin coverage; (2) fewer additional stages of reconstruction to achieve functional and aesthetic results; (3) thin lining to allow for optimal airway contour; (4) less harvest site morbidity; and (5) development of composite soft tissue, cutaneous and/or muscle flaps to repair adjacent defects.
Published in: JAMA Facial Plastic Surgery
New Method of Complex Nasal Reconstruction
Clinical & Research Achievements
Unparalleled Focus on Concussion
Cleveland Clinic’s Concussion Center — directed by Jay Alberts, PhD — in collaboration with departments and institutes across the organization, has launched an unparalleled effort to improve the prevention, diagnosis and management of concussion. Elemenets include the evidence-based, EMR-integrated Concussion Care Path and the refinement and distribution of Cleveland Clinic’s Concussion (C3) App using proprietary Cleveland Clinic intellectual property. Active research includes the Boxing Biomechanics Study, a Federal Aviation Administration-funded study of loss of consciousness, and development of the Intelligent Mouthguard to gather real-time data in fights – among other studies.
These efforts bring together Cleveland Clinic clinicians and researchers from several institutes in an unprecedented push to address concussion. National attention for these efforts this year was capped by the announcement of “The Trust” — a collaboration among Cleveland Clinic, the NFL Players Association and two universities to care for and improve the brain health of retired NFL players.
Unparalleled Focus on Concussion
Clinical & Research Achievements
Collaboration Finds Autism Marker
Autism spectrum disorders can be difficult to diagnose, creating a demand for measurable biological or biochemical markers of the disease. A collaboration between Charis Eng, MD, PhD, Chair of the Genomic Medicine Institute, and Thomas Frazier II, PhD, Director of Cleveland Clinic Children’s Center for Autism, has found high levels of a specific amino acid — aspartic acid — in the urine of individuals identified with autism spectrum disorders. They also identified elevated or reduced levels of other specific amino acids in the subjects’ blood plasma. The results of this study suggest that urine analyses and blood work could prove to be simple, costeffective diagnostic tests for autism.
Published in: European Journal of Human Genetics
Collaboration Finds Autism Marker
Clinical & Research Achievements
World’s First Robotic Natural Orifice Surgery
Surgeons led by Jihad Kaouk, MD, of Cleveland Clinic’s Glickman Urological & Kidney Institute, have performed the first robotic living-donor nephrectomy using a natural orifice. This surgery marks the first-ever clinical application of robotics for natural orifice surgery. The kidney was removed transvaginally from a 61-year-old living donor using a da Vinci® Si Surgical System.
This clinical achievement builds on knowledge gained through the team’s pioneering laparoscopic transvaginal living-donor nephrectomy of 2009. The patient had an uneventful discharge after 48 hours in the hospital. The recipient of the donor organ had no postsurgical infection.
Published in: Urology
World’s First Robotic Natural Orifice Surgery
Clinical & Research Achievements
Unexpected Risk of LVAD Thrombosis
The HeartMate II® left ventricular assist device (LVAD) is a mechanical pump capable of taking over some or most of the function of the left ventricle of a severely failing heart. It has been approved by the FDA as a bridge to transplant or long-term support for heart failure patients who don’t qualify for transplant. Randall Starling, MD, MPH, and colleagues from Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute detected an apparent increase in the rate of thrombosis (blood clots) in patients using the HeartMate II, as compared with preapproval clinical trial results and initial experience. Collaborating with teams from Duke University and Washington University, they reported that the rate of pump thrombosis related to the device has been increasing and is associated with substantially poor outcomes. As a result of this finding, other centers are examining the rate of pump thrombosis, and additional collaborative research is underway to identify patients at risk and potential causes of this life-threatening complication. The potential use of this heart pump in less ill patients is now under close scrutiny based on this research.
Published in: New England Journal of Medicine
Unexpected Risk of LVAD Thrombosis
We are partners in a great enterprise of patient care, research and
education.
Our mantra is “patients first.” Our motto is “to act as a unit.” We are never satisfied. Always striving. Always innovating. Determined to give every patient the best outcome and the best experience.
That’s the Cleveland Clinic way.
