Skip to main content

Toby Cosgrove on Teamwork, Leadership, and Cleveland Clinic's 'Secret Sauce'

Analysis  |  By Steven Porter  
   September 24, 2019

During his time at the helm, the health system's revenues grew to $8.5 billion annually, as it opened sites in Florida, Nevada, Canada, and the United Arab Emirates.

BOSTON – Toby Cosgrove, MD, the former Cleveland Clinic president and CEO who signed on last year as an executive advisor to Google's Cloud Healthcare and Life Sciences team, spoke candidly Monday with conference attendees about his views on healthcare leadership.

The industry's executives need to commit themselves to fostering collaboration and developing the future leaders who will replace them, Cosgrove said, during his talk at the Kyruus ATLAS symposium on access. He also shed some light on what he views as foundational to Cleveland Clinic's success.

Here's what he said about those three key topics:

1. Fostering Collaboration by Touting 'Caregivers'

Cosgrove, a cardiac surgeon, told the story of a time he operated on one of his wife's relatives. Everything went well medically, but when he relayed the positive outcome to the patient's family, they seemed angry, he said.

"'What's the matter?'" Cosgrove recalled asking the family. "And they say, 'Look under the bed.' So I get down on my hands and knees to look under the bed. And there are two things: dust bunnies and an empty IV bag."

"About 120 people touch a cardiac surgical patient on the way through the hospital, and the whole experience was ruined for that family by somebody who threw this IV bag under the bed and didn't clean up," he said.

That's the point at which he realized just how dependent the entire healthcare system is upon not just doctors and nurses but all the people who comprise the industry, including cleaners, clerical staff, suppliers, and bus drivers, Cosgrove said.

That's why the Cleveland Clinic began referring to everyone on its team as a "caregiver." That helps to affirm a collaborative environment, and it has boosted patient satisfaction and engagement, he said.

"Healthcare really is a team sport," he said.

2. Picking Leaders for Their Leadership Skills

Even when he stepped into his role as Cleveland Clinic's CEO in 2004, he didn't fully understand how important leadership is to the success of an organization, Cosgrove said.

"I totally changed my brain about this," he added. "If you have a hospital that's not doing well and you put a capable guy or gal as the head of it, the team changes in about six months. The same can be said for a nursing floor. The same can be said for a department or institute."

But hospitals and health systems frequently fail to select future leaders based on their leadership skills, he said. Too often, leaders are chosen because they succeeded in their technical work, such as being a doctor or nurse, he said.

"We simply take someone who is technically capable, and because they do a good job, we promote them," he said.

That's why the Cleveland Clinic took some cues from the U.S. military and established a leadership institute. The model calls for people to be given leadership responsibilities at a very small level. If they succeed, then they move on to the next step, then they receive additional training, and so on, Cosgrove said.

Leadership is 90% about having experience and learning if you enjoy it and have a knack for it, he said. The other 10% is the technical component of understanding it.

"We have to focus on our leaders and pick them because they're leaders, not because they're great colonoscopists," he added.

3. Flavor of Cleveland Clinic's 'Secret Sauce'

When he joined the organization in 1975, the Cleveland Clinic had just 200 doctors and one hospital, Cosgrove said. Now it has 63,000 employees, 11 hospitals, and a global reach.

During his 13-year tenure at the helm, the health system's revenues grew from $3.7 billion in 2004 to $8.5 billion in 2016, as it opened sites in Florida, Nevada, Canada, and the United Arab Emirates, with plans to open another site in the United Kingdom next year.

"If there's a secret sauce at the Cleveland Clinic, that's how its organized," Cosgrove said.

"We are physician-owned. We are not-for-profit. We're all employees," he added. "We're straight salary, with no bonuses."

"And we take the annual professional review very seriously. You're reviewed by your peers," he said.

"I've had 44 one-year contracts, and that keeps you on your toes," he added.

"I don't know another hospital organized that way."

Related: Cleveland Clinic's 5-Year Plan Looks to Double Number of Patients

Related: How Cleveland Clinic Aims to Shape Population Health

Related: Who's Afraid of Amazon and Google? Not Cleveland Clinic.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: Provided/Cleveland Clinic

Get the latest on healthcare leadership in your inbox.