Cleveland Clinic's Cosgrove: Congress Needs to Improve Quality of Healthcare

A renowned heart surgeon says that failure is an important part of leadership.

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What innovations have you implemented at the Cleveland Clinic that could be adopted in other healthcare systems?

One of the things that works in our favor at Cleveland Clinic is that we are all salaried employees—we have no financial incentives in terms of delivering more care or less care. Second, we have quality control around our physicians. They all have one-year contracts and annual professional review. That's probably our best quality control.

Another thing is that we have reorganized ourselves around patients and patients' problems. Traditionally, you have a department of surgery, but the only thing [the doctors have] in common is that we all wear gloves. Now we have a heart and vascular institute that has cardiologists, cardiovascular surgeons, and vascular surgeons all in the same location. If you have a headache, you may not know if you need a psychiatrist, a neurologist, or a neurosurgeon, but they're all there. That gives the patient the advantage of a multidisciplinary approach to their problem. It also allows the [care providers] to come together and think about innovative approaches. As the borders between surgery and medicine begin to become less clear, it's obviously an advantage to have both specialties in the same organization, so they can work together.

Our country faces great challenges in the next decade. How can we develop leaders equipped to meet those challenges? And how do you meet those challenges?

Doctors traditionally have not had schools for leadership, but leadership is not something that is inherent; you learn it and you work with it. It's important that you get opportunities early on to lead and develop those capabilities, and get coaching. I was very fortunate. Early on in the military, I was given command of a 100-bed hospital in Vietnam, which gave me my first real taste of leadership. I had other opportunities as I progressed up the ladder in the Cleveland Clinic, particularly as chairman of the department of thoracic and cardiovascular surgery, which was a very large organization with big responsibilities. I actively tried to learn leadership; it was work both scholarly and practical.

Did you have mentors in developing your leadership skills?

I did. I had multiple mentors. I looked a lot outside the business of medicine. I got some great mentoring by Michael Porter at the Harvard Business School, and I sought out people in other industries as well.

Do you learn from your mistakes?

I have been very good at making mistakes. Just by my background—I am dyslexic, so I've had lots of scholastic failures along the way. Over time, I learned that failure was not such a bad thing. Failure was only bad if you didn't recover from it. I am perfectly willing to try new things, make a mistake, try to learn from it and then push on. To be afraid of failure is a self-limiting event. I have about 30 patents, and most of those came from mistakes I have made and things that didn't work until I got it right.

For instance, patients were having strokes during cardiac surgery. We found that the way we returned the blood to the patient brought the blood back in in a very jetlike fashion, which knocked little atherosclerotic plaques off. That disaster for the patients led to going back to see how we could do it better. We developed a catheter that sprayed the blood back into patients rather that jetting it back in. That reduced the incidence of stroke by about 30 percent.

So, lots and lots and lots of mistakes.

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