Chapters Transcript Video Fire Side Chat All right, I'm gonna go ahead and start off our keynote section of today's uh conference. This is an exciting new format you saw we started out with cases. We thought that would be a neat change, very relevant for the clinician. And when we approach our next speaker, speaker, uh Doctor Toby Cosgrove, he invited us to think about doing this next section as a fireside chat. So we surveyed the division and got a number of questions together that I'd like to ask him to address and we'll open up the floor for questions should time allow at the end. But there's a lot of exciting questions I've received from many of you. Um Doctor Toby Cos Cosgrove needs no introduction. He's the former CEO and current executive advisor of the Cleveland Clinic. He's a member of the board of directors of the Cleveland Clinic, Abu Dhabi. He worked for Google Cloud and currently is an advisor for several health care organizations as an expert on health issues. He's a frequent commentator in both the national and the international media as CEO and president of the Cleveland Clinic from 2004 through 2017. He led that $8 billion organization to new heights of achievement and efficiency. In his role as executive advisor. He's currently working with the Cleveland Clinic, leadership on strategies for national and international growth. He graduated from Williams College and the University of Virginia School of Medicine. He trained at Massachusetts General Hospital and Brooks General Hospital in London in 1967. He was a surgeon in the US Air Force where he earned a bronze star. He joined the Cleveland Clinic in 1975 and chaired the department of thoracic and cardiovascular surgery. From 1989 through 2004. He performed over 22,000 operations and earned an international reputation in valve repair. He holds 30 patents for medical innovations. As CEO from 2004 through 2017, he reorganized services, improved outcomes and patient experience and strengthened the finances of that organization. He's a member of the National Academy of Medicine. He's a fellow of the National Academy of innovators in 2016. He was the fortune business person of the year. Number 14, three successive presidents of the United States have consulted him on issues in health care. I would thank Mrs Linda Kaufman for helping coordinate getting him here if he said no, we were gonna ask the next busiest person. We thought Taylor Swift to come join us. But fortunately, he said, yes, I'm gonna ask Linda to stand up for a second and also Alan Parrott with the uh Sana Board, the director of that board and Mike Cooper, where's Mike Mike? This group is helping do a lot of exciting things including the development of a cardiology fellowship here. That's something up and coming and very exciting. And so without further ado, thank you to Doctor Toby Crosgrove for coming and joining us today. So he's gonna do most of the talking but pulling together the questions from this group. The first question I have for you is what makes the care that patients receive at the clinic, the Cleveland Clinic Foundation so special. And how did you do such a great job developing your teams there? Well, first of all, let me just say that I think that uh the person here, Linda Kaufman has probably done as much for cardiac care uh in uh both Cleveland and uh here uh as anyone and Linda, I I most appreciative. So, thank you very much. Uh Well, first of all, let me just say that it's a great pleasure to be here. And uh thank you very much for the invitation. Uh I uh tell you, I think I'll tell you a little bit about how we're organized, which is fairly unique for a health care organization. Uh We're not for profit. Uh We are physician led. Uh We, all the docs at the Cleveland Clinic are salaried straight salary, no bonuses, just straight salary. We all have one year contracts and annual reviews. I had uh, 44 1 year contracts and it made me a little nervous every year, uh, when that time came around. But, uh, it is unique and I don't think there's another hospital organization quite like that. Uh One of the things that, that, uh we did was, uh, when I became c thinking about becoming CEO I asked myself a question. Really? Why are we all here? Why do we get a salary every day? Why do we have a hospital? Why do we have clinics? Um And why do we have medical schools? Why do we research? Really? Only one reason? And that's for patients. Uh So we decided our mantra was going to be patients first and that was our sort of our North star and every decision, uh, came from that, the second uh thing that, uh, made us, uh, reorganize, I guess is we've decided that if you stop and think most hospitals are organized around doctors, um, it's sort of the guilt system. There's a department of surgery, department of medicine, et cetera. Uh, and I had had the experience over time of being a cardiac surgeon, sharing a waiting room with the cardiologist and the cardiologist at the other side of the waiting room. Now, we had everything and I was in the Department of surgery and they were in the Department of medicine and I had everything in common with them. We looked after the same problems, we looked after the same patients. I had nothing in common with the colorectal surgeons or neurosurgeons and we wore gloves most of the time in the operating room. But um we didn't have anything in common for disease systems. So we reorganized ourselves around uh patients problems. We took the neurosurgeons and neurologists and, and the psychiatrists and put them in the neurologic institute. We took the cardiologist and the cardiac surgeons and, and the vascular surgeons and put them in the heart and vascular institute. Uh We put uh the plastic surgeons in with the dermatologist. And so essentially what we try to do is organized around uh patients problems. And um I, I think there's a couple of reasons for doing that. First of all, uh innovation happens at the borders of different disciplines. And so when you may see um the, the card, your cardiology friend at the coffee pot and you say, you know, I'm doing Mrs Jones and I don't know what the hell to do with her and what do you think? And so you think about new ways, new approaches that combine your um various expertise. And I think that that innovate, that stimulates innovation and thinking around patients uh problems. And the second thing it does is it takes away the competition. Uh once you're in the same group, you're no longer saying, oh, I don't think this patient needs an operation or we can clip the mitral valve instead, it's really Ok. What's the right thing to do for the patient? Because it financially doesn't make any difference to you. It's about doing the right thing for the patient. So that was, uh, the, one of the first, uh, things I did you can imagine. Interestingly. Um, a lot of people said, well, doesn't everybody push back about that? Wasn't there a lot of fighting? Interesting? There wasn't. Um, and the second thing, nobody ever came to me and said, this is a terrible idea. Toby, we gotta go back. Um So we did the whole change at the institution in about a year's time basically because I think if you say you're gonna do something and you don't do it, it becomes the flavor of the day and then we'll just wait till he goes away or we forget he, if he forgets about it and doesn't do it. So we did a bang. The, the couple of other things happened along the way that were kind of uh interesting. Um I had an experience um at the Harvard Business School. Uh I've never been in a business school before. I, in fact, when I became CEO I didn't know those parentheses on P and L si didn't know those were bad. Um That, that was I, I was incredibly naive. Um And um so anyhow, so when I had a friend at the Harvard Business School by the name of Michael Poer, and I called him up and I said, help. What's the CEO do? And he said, well, you know, I'll help you. So, he wrote a bunch of case studies about the Cleveland Clinic. And for the first one that he did, um, he invited me to come up for the, uh, for the presentation. So this, they have these sort of horseshoe shaped, uh, auditoriums and the students got the case right away and then I'm supposed to answer questions. Well, I'm very nervous and I'm, I'm about halfway through and a girl in the second row on the left hand side raises her hand and says, Doctor Cosgrove, my father had micro valve prolapse and we know that you've done more of those operations than anybody else in the country. But Doctor Cosgrove, we didn't come to you because we heard you don't have empathy. Doctor Cosgrove, do you teach empathy? I, I have no idea what I said after that. Uh, uh, um, and so I began to make me think about this a little bit. I mean, I don't have to get hit on the head too many times before I realize that I had to think about something. Um, and, um, so about, um, two weeks later, I'm in Saudi Arabia and uh we are partnering with a hospital over there and the CEO of the hospital is, uh opening up the, the session and he says, and this hospital is dedicated to the body and the spirit and the soul of the patient. I'm going yada, yada ya. Um, and I look over and here's the king of Saudi Arabia and the crown prince and they're both weeping, tears are coming right down their cheeks. And I'm saying who, you know, maybe, you know, this is my second clue. Uh So I'm thinking about, ok, what are, um, what's, what's this about? Um, and I'm thinking, ok, what do patients want when they come to the hospital? And um we've said they, they want three things. They want a great clinical experience, they really want a great physical experience and they want an emotional experience. So we begin, I began to think about this. We had worked like crazy on the clinical experience and that's what everybody does. Um Yeah, but we hadn't really thought about the other two. Very hard. So uh we did a bunch of things. The first thing that we did is we cleaned up the hospital, all that stuff that's in the halls and the file cabinets and uh and you know, all the equipment that's in the halls and we thought about, we'd look at the architecture and uh we tried to hide the equipment behind walls. Um And actually, um how many of you have ever put on a patient, Johnny, how many I expect most of you have at one time? That's probably the most humiliating thing you can do. Uh your cheeks flapping in the breeze as you walk down the hall. So we got Diane Van Furstenberg to design a wrap gown to cover your backside. Um And, and we, we did a lot of things about the physical aspect of it. And then the, the next aspect is we started to think about the emotional experience um and how you could uh manage that. And um so we took all of the uh 40,000 employees at the time offline and mixed them up, put them around round tables, uh And there'd be a neurosurgeon next to a bus driver, next to a nurse. Um, and we talked about the Cleveland Clinic experience. Um And, uh, when we left there, everybody got a button that said I'm a caregiver and we referred to everybody at the Cleveland Clinic, whether you're chief of surgery or you're driving the bus and cleaning the room as a caregiver. And that put together a team effort. And one of the things that we started to see with that is as far as patient satisfaction when we started, we were one of the last in the country and we went from about last about first after about five years and the, and the employee engagement did the same sort of thing and went zipping up as we, um, came together as a team. Uh And so it has been uh a very unique experience about uh where we put our priorities and how we figured out how we're gonna train people. So that's a little bit about uh our organization, which is I think uh different uh than it was a number of years ago. That's fantastic. There's a lot of good guidance for us and every hospital is working on big initiatives to improve those different areas. That's great guidance in your career to date. You've worn a lot of different hats. One of the questions everyone's curious to hear is given your involvement in artificial intelligence and Google in these different areas. What do you see coming in this next generation in both cardiology and medicine in general with artificial intelligence? Um When I uh stepped down from the Cleveland Clinic, I um had an opportunity to go and work for Google. And the reason I picked Google was I went to see um deep mind in London. Uh deep mind. I don't know if you recently followed it at all and they have uh managed to look at all the different uh shapes of proteins uh through artificial intelligence. I was incredibly impressed. Uh And then uh more recently, um I've been involved uh with the, the individual who put together uh open A I with Microsoft um and uh a guy by the Craig Mundy. Um and um the potential for this is enormous. Uh And the reason that I am excited about it is is I travel around the country, I see hospitals really have uh and health care in general. Three main issues. The first issue is financial if you look around the country, about, uh, half of the hospitals in the country are running in the red. Uh, the average margin for hospital for operations right now is 2%. Um, and it, it has been secondary to inflation. Um, the cost of pharmaceuticals last year went up 13%. Uh, the cost of uh, supplies went up 12%. You recently saw that Medicare is going to increase uh their funding for next year. 2.9%. Uh The, the math just doesn't add up. Um And, um, so the second major issue that I see is uh workforce shortage. Uh, there are two thou 2 million unfilled jobs uh, in health care across the country. 500,000 of those are nurses. Uh, let's, um, primary care physicians. There's 50,000 uh shortage of uh primary care physicians. Um, that means that almost 60 million people in the United States do not have a primary care physician. Um, and, uh, the third issue, um, in is a major one around the explosion and knowledge. Um, there are 1.8 million medical articles written a year. I don't know how you probably are all speed readers, but I couldn't keep up with that myself. Uh And the total amount of knowledge is now doubling every 73 days, you know, uh, when the Cleveland Clinic was founded 100 years ago, the, um, the total amount of knowledge doubled every 100 years. Now it's doubling every 73 days. I mean, explosion of knowledge and just think about what you're seeing in cardiology. Um and every other specialty just to give you an example, you know, it used to be that when I started in uh as a cardiac surgeon, I operated on everything in the chest lungs, esophagus, aorta, heart valves, the coronaries, the whole thing. And ultimately, the knowledge got so great that just my expertise just got shrunk, shrunk, shrunk. So I was doing mostly just valve surgery. Um, and I think that's been true, but we can't keep up anymore, just slicing the bread and having a specialist for the right little finger. Um, you know, it's, it's gotten to be too much. So, what, how are we going to manage the, this explosion and knowledge? Well, um, to me, um, artificial intelligence, uh, is the answer to that. Um, so let's take a moment at a time. Uh, think about, um, cost right now. Um, you know, how are we going to, um, the, the 60% of the cost of running a hospital are people. Um, and, um, that the administrative aspect of health care has grown over the last 50 years, 3000%. Um, there's just more and more administrators. Um, and, uh, you know, we're paying administrators as opposed to caregivers, a lot of that administrative stuff ought to be able to be taken care of, uh, by a, I think about making an appointments uh, billing and the Cleveland Clinic has 3500 people that work in revenue cycle. Just putting out a bill, 1000 people work in call centers just making appointments that we ought to be able to take that amount of money and put it into nursing and care for, uh, patients as opposed to the administrative aspect of things which would, uh, help the finances of health care enormously. Um, then let's look at um, the workforce shortage. Um, we, we need to depend upon technology to reduce the, the work. For example, um, think about nursing, there's now a button about the size of a 50 cent piece that you can stick on your chest. Um, that will give you a continuous readout of all the vital signs. Think about the number of hours that a nurse walks around, uh taking blood pressure and vi and respiratory rate and gets it maybe every six or eight hours and then has to record it. Um That's a tremendous amount of uh work that needs to be uh done by technology. Um And not only do you instead of getting uh vital signs every eight hours or six hours or four hours or get them constantly think about the things that you could pick up earlier that would uh reduce that sort of problems for you. And the, and the other issue that, uh I see about the explosion and knowledge is that there's so much new knowledge that the time between something is a proven technology and its standard of care across the country is now 13 years. So, think about the fact that probably half the patients aren't getting the latest, uh, capabilities. Um, and it's just if you don't learn it in medical school or your residency, probably not gonna practice it. So, um, now you ought to be able to have instant ca, uh, updates on anything that any new sort of information, uh simply by going to, um, you know, Google or Open A I, by the way, I, I just came back from California about two weeks ago and I was at, at open A I and they gave me a preview of what chap uh GP T 5.0 is gonna look like? Wow. Um They, they said ask a, you know, complicated question in health care and it was there in about two seconds. So the help that we're gonna get is going to be amazing. By the way, how many of you use chat right now? About half of you. Um, I it's, it's, it's amazing. Um And what it does, II I, you know, most of the questions you sent me, uh I had to look up and get help from Chad the answer. I love that you, you've given us the lens of the A I side you point out and, and it's something that's on everyone's mind here in this era of shortages of clinicians and staff that's affecting so many top institutions and the cost constraints affecting medical systems across the country. What short term and long term strategies in addition to A, I, do you see as being a solution to this problem? Yeah, I think, you know, one of the things we're gonna have to do well, so let me go back to my military experience in Vietnam. I learned a lot there. Um, I ran 100 bed hospital there. There were, um, and we had two docs, about 15 or 20 nurses and a squadron of uh techs. And during that time, um we moved 22,000 sick and wounded through that facility in the course of a year. And the techs did all kinds of things. They took x rays, they moved patients, they did all uh a tremendous amount of work, um that, um, you know, generally would be put on nurses. Um And uh currently, and I think what we need to do is we need to uh have people increasingly practice at the top of their license. For example, when II, I arrived at the Cleveland Clinic, um the, uh we always had a P A uh in the operating room who took the vein sewed up the legs. Um, you know, they actually kept the residents on the straight and narrow, um because they were there every day and knew how things ought to happen. Um And they just were amazingly, uh uh uh solidifying and standardizing, uh, the care and I'd never seen that before and they did a much better job than I did as a resident harvesting, uh, veins or whatever they were doing. Uh, so they were, so now, uh, for every doc at the Cleveland Clinic we have, uh, one, physician extender and I think it's probably gonna move to 1 to 1 and, uh, I think the same sort of thing, so much of the work of nurses ought to be able to be over, taken over by tech. And um, that's gonna require some licensing issues. Um But certainly it would make life a hell of a lot easier for a lot of people that makes a lot of sense. Um, on that front of life insurance and, and issues like that. Um How can he, we, we as health care professionals focus so much on our individual patients. What do you see coming in? He public health policy and how can we help shape that or help move that in a positive direction? Yeah. Um One of the things that I've seen is that now the social determinants of health care in Cleveland by zip code, there's a 20 year difference in life expectancy and the same is, and I was just talking to people in Boston. It's 25 years in Boston difference in life expectancy. Uh de and it depends upon, you know, uh where you're born in terms of your food, your family's income, your housing, your education, uh et cetera. And you know, that is beyond the scope of uh health care providers generally. Um And you know what you um we're, we're not paid trained uh equipped to manage feeding people and housing people and et cetera. So, um I think we need to incorporate a lot of uh other organizations to help us manage that. Let me give you an example. It turns out that the zip code that I live in has the highest incidence of lead poisoning in the country and it comes from lead paint. Um And so um United Way in Cleveland put on a big campaign to begin to help um get rid of the lead paint. The Cleveland Clinic uh gave $50 million to the United Way to help them do that. Um And um you know, we're beginning to attack it in that way, but for the Cleveland Clinic to just do it by itself, I think, you know, I, I can't imagine we would have the, the capabilities to do that. But do you stop and think about the importance of lead poisoning just for a minute. It damages your mental development. Therefore, you don't do so well in school, you don't get as good an education, you don't get as good job, you don't get as good as income you don't live in as good a house. Um And so all these things fit together, it's gonna be a societal approach to it. I mean, yes, there are things that we can do through value based care. Um But the the bigger issues go beyond that in terms of the social determinants, I think that makes sense. And you bring up the topic of value based care. A lot of the questions ultimately came into the idea of we live in a fee for service environment. There's been a lot of discussions about the future of health care reimbursement as we move away from fee for service to value based care. Share with us your thoughts on where that's headed and, and what, what's the right answer and how do we adapt to it? Well, I stroke my long white beard and tell you what the right answer is. Um, first of all, we're now in year 13 of, uh, the attempt to get the value based care, uh, it turns out that 60% of the payments in the United States are now value based, uh and it is increasing uh rather rapidly. Um, and that's where, you know, you have affordable care organizations, et cetera. Um I think it's gonna continue. Um, it is very, um, geographically, uh advanced in southern California. It's almost all value based care uh in New York City. Um, they've not heard the word value based care yet. Um, but it all there are pockets uh all over the place and, but no question, the government is, uh, putting increasingly, uh pressure on moving to value based care and you're going to see it. Um, Medicare, I think by, uh, 2030 is, uh, going to be almost exclusively value based care in one form or another. So there are a lot of, a lot of areas that I think that you can make substantial progress in it. Um, for example, orthopedic procedures. Um, you, you see now, uh, what we've seen is fixed base payment for a hip or a uh a knee. And you've seen orthopods respond by figuring out, ok, if we do it uh in a prescribed way, uh on everybody, we will reduce the uh blood utilization, the time in the hospital, the complications, et cetera. And they've gone from putting everybody in rehab for a month afterwards to um send, doing the rehab and getting up walking around that day and sending them home the next day. Um Those, those sort of things I think do wind up uh saving money. Uh I don't not sure that everything is gonna save money. Um, but, um, you know, it is certainly the direction that the country is headed. Um, a number of questions got around the concept of uh as health care providers, we're taking care of older sicker, frailer patients. We have more advanced medical technology to deliver that obviously has cost implications. But sometimes I think we've struggled with how to get our patients involved in doing the things they need to, whether it's through cardiac rehab programs or other issues like that. The top one question in particular was around, uh, incentivizing patients to keep themselves healthy by pay. What, what other ways can we impact our patients, uh, partnership in taking care of themselves? What, what have you seen in that area? Yeah, I think, you know, let me go back if I could because one of the things that I think is gonna be AAA nice opportunity, um, is surprisingly everybody now or more and more people are going and finding the answers online and, um, whether you're using propensity or you're using, uh, you've got your new iphone that's got A I on it. Um, or uh whether you, um, and people are getting reminders, um, recently, uh I saw um, a couple of things that I think are going to be front and center, um, and they're called agents, um coming out of A I and everybody's gonna have their own agent and your agent may remind you that, did you take your medication? Um D did, are you sure that you, um, got uh your exercise today? Um And uh these, um, and, you know, I, I don't know if you're familiar with agents, but agents are essentially things that uh on artificial intelligence can answer questions for you and remind you of things. And uh for example, you, you may say, you know, I, I'd, I'd like to go to New York tomorrow and it'll book a flight and a restaurant for you. Um So this is not, this is not pie in the sky by and by this is, this is uh reality. And I think that this is going to start to help us interact with patients. And I, I think you're, you're going to and I, the best example I saw of agent recently and those of you in the nursing home will appreciate this. Um It's called um Hippocratic A I um I don't know if you know about this or not, but what they did is they took 12,000 conversations between nurses and uh patients and trained a I to answer the questions. Uh for example, um I listened to a conversation with a little old lady who was having a colonoscopy and she wanted to know all of the things that she could eat before her colonoscopy and the A I answered all those questions for her and then she uh four times during it, she said, now what time is my appointment again? And the, the voice said it's 930 and uh it never lost its patience. You know, how many times I gotta tell you it's 930 very politely, you know, said it's 930. Um and uh so the empathy that was built into this. So, you know, you can imagine the amount of time and effort that is spent with nurses having to answer these sorts of questions or doctors having to answer these sort of questions. Um This is an agent. Um And this agent can uh represent uh you uh as you go forward and in, in an empathetic manner and not lose its patience when you get asked four times. What time is my colonoscopy? That's fantastic. I, I need one of those. Um Another question is next year. I'm gonna send my agent here. Nice. Oh, I like that. So this is a neat conference for us. It's a, it's a very multidisciplinary conference. We have multiple fields represented from cardiovascular groups to primary care. We have our technicians, our nurses, the, the whole gamut uh health care providers, younger physicians, older physicians, advanced, uh A PPS and groups. Um, looking at those are the folks in the younger part of their career, starting in a career in cardiovascular medicine and in those early years, what advice do you have? How do you succeed in this field? Um, II, I kind of give the, um, same advice every time I'm asked this question. Um, and I'll, I'll, I'll, um, give you an overview and then try and give you specifics. Um, I always say that if you exceed your job expectations, um, you'll get the next opportunity and then I think it breaks down into a number of things. Um I don't think that you necessarily in early part of your career seek the, the job that pays the most you seek the job that is gonna, uh, where you're gonna learn the most. Um The second thing is I think you, uh, need to surround yourself, uh with people, um, with the highest quality people that you can. I remember. Um, when I left my training, uh, in Boston, I had uh, a number of job offers. Um, in fact, I was unemployed for a while. It was kind of embarrassing going down and being a fully trained cardiac surgeon going down to the unemployment office uh every week. But, um, I got over that. Um, um, eventually, uh, so I look for a job that uh would stretch me. Um And that, uh would not necessarily looking for the position that had the highest income, but the job that would be the uh opportunity to uh go and many jobs just, um, you, you pick a job and you can say, ok, uh you can move from this job to another job and it will accelerate you or you can go to a job that's a dead end job. I think you always want to look for the job that has the potential to lead you to the next one. And I think the other aspect of it um is, uh you need to cultivate things that are gonna expand you into the community uh into uh other activities. So you don't get totally burned out of what you're doing. Um And finally, uh you have to learn how to be, speak publicly if you, particularly if you want to lead. Um Probably the most embarrassing thing that I ever did was go and take a public speaking course in California one time. Um And they put a camera in front of you and they stuck a microphone and ask you questions and then you had to look at yourself answering the questions. Boy, was that embarrassing? Um And uh and it's hard. Uh and it is, you have to work on it and you think those people that you see on television doing it well are naturals. They work at it. Um So, um I think those aspects of things um help you move along. And I would suggest that um particularly looking for a job where you're gonna learn and have the opportunity to go, to go further up a tree that makes a lot of sense and kind of along the same lines. I, I mentioned that one of our big excitements is starting this cardiology fellowship program. We hope to have our first fellows in 2026 and that's been community and organizational wide, a big effort having been part of such a successful program. What advice do you have for us and, and how to be successful, how to create great trainees and attract strong candidates and so forth. Well, um I think you have the opportunity to, to learn from a lot of other places that have done it before you have. And I always uh let me take a tangent on that. Um IIII I don't, first of all, I believe that there's always somebody doing something better than I am someplace in the world. Um And I am. Um And I, so I used to as a surgeon, I used to hear that there was something going on in France or Texas or Stanford, excuse me. And I would pick up and take my notepad and go and watch the surgeon doing it. And I went to France and I went to England and I went to Germany and I went to Texas and I went to Stanford and I went to Boston and all over the place and the things that I learned changed cardiac surgery at the Cleveland Clinic and ultimately in the United States. Um And uh so probably one of my biggest failures and I used to cock that when I serve my innovation trips. Um And I thought, gosh, if I can do this, wouldn't it be great to send all the docs from the Cleveland Clinic out all over the world as spies? We'd go and learn everywhere. And I, um and uh so I said we're gonna have a program where you guys can go and learn. Uh, once a year, we'll pick up the tab, you go learn wherever you wanna go and bring it back and incorporate it. That was probably my biggest figure. I couldn't get more than 50 guys to do that. We're people. Um And I think that's a real shortcoming. Um I think, um, people, you know, there's always somebody to someplace to go learn something from. And, uh I think that's a, a great op opportunity and, and, um, let me step on my soapbox here for a second if I could. You know, I think, uh one of the other things that we need to think about in health care is leadership. Um, you know, I told you how bad I was getting when I became the CEO. Um And I think generally in health care, we pick leaders, not on the basis of um their leadership capabilities, but on the basis of their resume and their CV. Now you have to figure that docs and most of us are all trained to be technicians of one sort or another. Um You know, we may be a great colonoscopist or a great cardiac surgeon or a great neurosurgeon. It doesn't mean that we have the skills for um leadership, which is entirely different. Um in leadership, you gotta be able to communicate with people and um have a vision. Uh And so I started to think about um my successors and how I was gonna have people who are better trained and more capable than I was when I finished. And so um I began to look around at who was the best at developing leaders. And we used to think about, well, there's the mckenzie or there's the Great Banks uh or the Proctor and Gamble or Ges in the world. And they were, they, they train leaders and then I, as, the more I thought about it, I thought they're not the people who have been at the longest, the people have been at it the longest in the military. And they have a very interesting and a pretty straightforward model for doing this and, and what they do, uh is you start with a small group and you, if you do well at that, you got a bigger group to lead and if you do well at that, you get a bigger group, but in between they send you off to get the academics, you go to n war college or you go to Harvard Business School or you go to artillery school. Um And, um, and by the time those guys get those little stars on their shoulders, they're pretty damn impressive. Um And so we started that, that same sort of uh program. Um We identified initially 250 docs. Um And we would give them an increasing responsibility. Um And, uh, some of them did, well, some of them didn't do well and some of them liked it. Some of them didn't like it. Um And, um, my turns out that every year I would give the board uh on the name of five or six people who I thought could be my successor and we would, uh I would move them along and try and give them a different job and, and some did well and some didn't, some went on the list, some came off the list. Um So my successor, just to, to give you an example, I, I recruited him as a cardiac surgeon after about six years, he came to me and said, I'd like to have um a more of an administrative job. I don't want to have the same career you did. I said thanks. That's very flattering. Um um So, um we sent him to Harvard uh to get executive MB A. Um Then I sent him to the desert, he went to Abu Dhabi um as chief of staff uh for, and then he became the CEO in Abu Dhabi and now he is my successor. Um He is taller, better looking nicer uh smarter and better trained than I was. Um So, um you know, but I think we need to think about leadership uh for health care because I think we haven't done a good job. Um And I think we need to think about how we train people along those lines. That's fantastic. I'm getting the signal that uh that we've exhausted our time for today on behalf of everyone. I'm really grateful you took the time to come down and join us for today. Any last closing comments you want to make? Yeah. Well, first of all, thank you very much for your attention. I appreciate, I appreciate the invitation and thank you very much for having me and um, and uh, and entertaining me and uh listening. Appreciate it. Thank you so much. Appreciate it. Published November 13, 2024 Created by Related Presenters Deepak Talreja, M.D. Sentara Cardiology Specialists View full profile Toby Cosgrove, MD Executive Advisor, Former President and CEO, Cleveland Clinic
BROADCASTMED