4 Things Cleveland Clinic CEO Dr. Toby Cosgrove Could Bring to the VA

 Toby Cosgrove, MD, president and CEO of Cleveland Clinic since 2004, is reportedly in consideration to become the next secretary of the Department of Veterans Affairs.

VA Secretary Eric Shinseki announced his resignation last week amid criticism of VA management across the country after patient safety issues in Phoenix made national headlines in April and May. Three people familiar with the matter said the White House has approached Dr. Cosgrove about the position, and one of them said Dr. Cosgrove is "seriously considering" accepting, according to the Wall Street Journal report.

Here are four reasons his appointment would make a great deal of sense.

1. He has a no-excuses mentality about patient wait times. In 2008, under Dr. Cosgrove's leadership, Cleveland Clinic instituted a same-day appointment policy. Since then, all patients who call the Clinic are asked if they want to be seen immediately. Roughly one million of Cleveland Clinic's 5.5 million patient visits now occur on the same day the patient calls.

The policy was devised after an event with a patient troubled Cleveland Clinic's physician leaders. As Dr. Cosgrove wrote in a recent article for Harvard Business Review:

"A patient called the Cleveland Clinic's urology department seeking an appointment because he was having trouble urinating. He was given the next available slot — two weeks away. A few hours later he arrived in the emergency department with acute urinary retention. Doctors quickly solved the problem, but the patient suffered greatly in the hours before treatment.

The physician leaders discussed the case, and one asked, 'Do we want to be the type of organization that doesn’t even try to figure out if patients should be seen right away?' In that light, the existing appointment system seemed intolerable."

Given the bevy of accolades and recognition Cleveland Clinic has received over the years, it's easy to assume healthcare's poster child has long been immune to problems around access to care. Phone calls to Cleveland Clinic weren't always greeted with the question, "Would you like to be seen today?" That is something Dr. Cosgrove charged and oversaw. The anecdote above suggests he has the ability to not only adjust but completely overhaul a system when things go wrong, even with one patient.  

2. He would bring an unprecedented level of transparency to the VA. As a writer for Forbes, David Whelan called Cleveland Clinic and asked to speak to the system's chief transparency officer. He soon found himself on the phone with Dr. Cosgrove.

Dr. Cosgrove has earned the title for good reason: He developed the concept of Cleveland Clinic's Outcomes Books, which make performance and outcomes data for its clinical institutes publicly available. Dr. Cosgrove developed the concept almost 30 years ago when he was chief of cardiac surgery at the Clinic, in which he'd hold meetings to share complication and mortality rates and hold surgeons accountable. That practice carried on to the C-suite, and the books have been publicly available on Cleveland Clinic's website each year since 2005.

The books detail departments' outcomes, good and bad. "If you doubt this is radical, go to your local hospital's Web site," wrote Mr. Whelan. "See if it publishes how many patients died during heart surgery last year."

The system's transparency is unique from the consumerism angle, but it has internal benefits, too. The droves of annual data let Cleveland Clinic drive improvements and measure progress year over year. James Weinstein, DO, president and CEO of Dartmouth-Hitchcock in Lebanon, N.H., told public radio outlet WKSU: "I think there's a tremendous opportunity to use [Cleveland Clinic's information sharing] to look at the value and outcomes of care for our veterans and I'd like to see much more transparency in that reporting. I think Toby would be an advocate for that."

3. He has the necessary perspectives. Dr. Cosgrove is a former heart surgeon and veteran, leaving him with the valuable ability to identify with physicians and veterans alike. 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.

Although Mr. Shinseki, a disabled Vietnam veteran himself, was beloved by many in Washington, some lawmakers said he lacked political and media savvy. Dr. Cosgrove has some political ties already, but not too many, which may be just want people want at this time. He consulted with the Obama administration about the Patient Protection and Affordable Care Act, but he has also been candid about some of the law's downsides. Dr. Cosgrove was also elected to the independent Institute of Medicine in 2013, making him one of approximately 1,750 members to advise Congress on a range of health matters, such as stem cell therapy, Medicare spending, post-deployment needs of veterans and more.

4. He's a relentless worker. Dr. Cosgrove has been described by many as a workhorse, and his work ethic would be a good match for the systemic cultural problems described at the VA. Bob Kocher, a former White House adviser on health policy who now does venture capital healthcare investments, wrote in an email to the Washington Post: "Toby only knows how to do healthcare at a very high level of quality and will not sleep until he instills a similar ethos into the culture at the VA."

Even as CEO, Dr. Cosgrove is still involved in Cleveland Clinic's collection of patient outcomes data, and attends meetings with staff on how to improve things like CAUTI rates or other unsatisfactory performance issues. He holds more than 30 patents for innovation, and when he was still performing heart surgeries, he'd average more than 13 per week, clocking in for about 700 for the year. Dr. Cosgrove also learned he was dyslexic at age 32, but he has come to attribute much of his creativity and innovation to the condition. He told the Plain Dealer in 2004: "We're not very good at the scholastic stuff, but we see other things that are different. And that's a big advantage."

Want to keep reading about Dr. Cosgrove? Here are another 10 things to know.


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