Raising the nation's 'guts quotient' — 5 thoughts on the future of healthcare from Cleveland Clinic CEO Dr. Toby Cosgrove

When Delos "Toby" Cosgrove, MD, president and CEO of Cleveland Clinic, was a high school junior, his father took him to visit a family friend who was a college professor.

"Naturally, the conversation turned into, 'What do we need to do to get Toby into college,'" Dr. Cosgrove told the audience during a keynote at Becker's Hospital Review's 8th Annual Meeting in Chicago. Rhoda Weiss, PhD, speaker, author, consultant and co-chair of the meeting, moderated the conversation. The professor said he was not interested in Dr. Cosgrove's IQ, but rather his GQ —  a term that neither Dr. Cosgrove nor his father had heard before.

"It's 'guts quotient.' In retrospect, that turned out to be a really important thing for me," he added. Guts refers to one's perseverance or grit in the face of setbacks or in anticipation of challenges.

Dr. Cosgrove went on after college and medical school to serve as chief of U.S. Air Force Casualty Staging flight in Da Nang, Republic of Vietnam. He joined Cleveland Clinic in 1975 as a cardiac surgeon and has served as CEO of the system since January 2004.

Dr. Cosgrove, who today leads an $8 billion health system with facilities across the U.S., Abu Dabi and soon in London, said it has been his GQ that has driven his ability to propel his career and the Cleveland Clinic forward. Despite the uncertain future of health reform, the rest of the industry must cultivate higher GQ to not only survive, but to thrive in a changing healthcare landscape.

Here are five thoughts from Dr. Cosgrove on how to succeed in the future of healthcare.

1. Teach clinicians to be team players. "I realized some time ago that doctors are not trained to be team players," said Dr. Cosgrove, "yet none of us has the individual power of the doctors who used to go to patients' houses with a black bag and deliver the cure alone. Healthcare today is dependent on a huge number of players."

Team-based, highly coordinated care is a central component of Cleveland Clinic's care delivery strategy. Physicians, nurses, dentists, physician assistants and other providers often come together in one building for team training. The health system's leadership also evolved its physician-based departments into disease-based institutes to facilitate greater collaboration between formerly disparate groups of clinicians.

Dr. Cosgrove said it also occurred to him that every staff member of the health system has a role on the care team. "Everyone from the bus drivers and cafeteria workers to the chief of staff and neurosurgeons are caregivers," he said. Calling each individual a "caregiver" has had innumerable positive effects on the system's culture, morale and employee satisfaction.

2. Invest in IT. Health systems must invest in sophisticated IT systems if they want to keep up with the explosion of knowledge going on in healthcare right now, said Dr. Cosgrove.

"When the Cleveland Clinic was formed in 1921, the total amount of knowledge doubled every 150 years," he said. "Now the total amount of knowledge is doubling every 73 days. There are 5,600 medical journals turning out 900,000 articles every year. And one human genome has 3 billion data points. So I think we are going to be very dependent on IT going forward to help us manage this explosion of knowledge."

Cleveland Clinic has partnered with both IBM Watson and Microsoft to support staff and medical education. Both technology systems promise to revolutionize the way data is stored, processed and optimized to support education and clinical decision making. With Microsoft's augmented reality technology, medical students can use holograms of human bodies and organs instead of cadavers, which, "if anything, would benefit the social lives of first-year medical students so they don't have to constantly smell like formaldehyde," Dr. Cosgrove said.

3. Make population health management a strategic priority — for patients and staff. The momentum behind population health management efforts to mitigate the cost of chronic disease management under value-based care and lower reimbursements has surged in recent years. Dr. Cosgrove emphasizes that these efforts must be targeted at staff in addition to patients.

By the time Dr. Cosgrove became Cleveland Clinic's CEO, he "had a long time to observe the ravages of smoking," he explained. He saw the physical effects of smoking firsthand as a cardiac surgeon, and lost his father, a smoker, to emphysema. That, combined with the fact that smoking is the most preventable cause of cancer, spurred Dr. Cosgrove to implement a hiring ban on smokers in 2007. If a candidate tests positive for nicotine, he or she must complete smoking cessation treatment before being offered a position. Smoking is not permitted anywhere on the health system's campus.

He is equally committed to lowering the rates of obesity, the effects of which cost the national healthcare system billions of dollars per year. "We give a lot of lip service to population health and wellness, but it's important to actually make it a part of the culture," said Dr. Cosgrove. 

4. Deliver care in the most cost-effective settings. "There is little question we're over-bedded in the U.S.," said Dr. Cosgrove. "In the last 20 years, we've gone from 1 million beds to 800,000 beds across the country, and we're still at an average of 65 percent occupancy." The increasing rate of outpatient procedures combined with shorter lengths of stay is going to lead to even higher over-bedding in the U.S., he added.

Consolidation enables hospitals to focus on their most successful service lines, pare down superfluous or underutilized services and provide care in the most cost-effective settings, said Dr. Cosgrove. "Not every hospital has to do the most technical things," he said. "Community hospitals can do deliveries and handle emergencies," while academic medical centers, which have higher overhead costs and specialize in more complex care, can take the more difficult cases.

There are two aspects that are integral to the success of greater partnerships and consolidation between facilities, Dr. Cosgrove noted: interoperability between disparate EMRs and efficient transportation.

5. Do not underestimate the devastation of the opioid epidemic. "This is one of the great tragedies of our time and not many people realize how bad it is," said Dr. Cosgrove. "I recently visited the Vietnam memorial in Washington. There are 53,000 names on that memorial. Last year there were 53,000 deaths caused by drug overdoses. We have a Vietnam War going on in our country every day."

Dr. Cosgrove said the Vietnam War ultimately ended due to highly negative public opinion. "People saw the body bags every night on the evening news. Everyone understood it. But not everyone understands the magnitude of the issue right now and it's getting worse." Increasing public awareness of the problem, combined with improving the approach to combat it by medical professionals and law enforcement, are the first steps the U.S. must take to control the epidemic of opioid abuse.

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