Preface

Terri McCort was expecting a baby.¹ She was already five days overdue. As she sat down for dinner, she felt an unusual pain at the base of her throat. She didn't know it, but she was in mortal danger. Deep inside her chest, the largest blood vessel in her body, the aorta, was beginning to tear itself apart. If left untreated, it would rupture massively, gushing blood like an open fire hydrant. Terri and her unborn baby would die.

Terri was hard to ignore as she burst through the doors of her local emergency room. She was tall and long-armed like Abraham Lincoln. And, as has been speculated about Lincoln, Terri has Marfan syndrome, a genetic disease of the connective tissue that can render the aorta fatally fragile. The disease had already killed her father and three brothers. Now it seemed like it was Terri's turn.

Fortunately, the caregivers at Terri's southern Ohio hospital knew exactly what to do in the case of a complex emergency that was unlike anything they'd ever seen: they called Cleveland Clinic.

A helicopter arrived and flew Terri to Cleveland Clinic's advanced care facilities. With her condition worsening by the minute, a multispecialty team that included a surgeon, a cardiologist, and an obstetrician went to work. They stabilized her and assessed her condition. She was rushed to an operating room, where her aorta was clamped and she was placed on a heart-lung machine. The obstetrician stepped in and performed an emergency cesarean to deliver a beautiful baby boy.

As Terri's baby was being examined, the heart and vascular team surrounded the table. Aortic rescue can be dangerous. It includes some of the most complex procedures in all of cardiovascular surgery. Few specialists anywhere have experience in the full range of techniques required. Terri's team of surgeons, anesthesiologists, technicians, and nurses went to work. They knew that it would be a long night, but they were determined that Terri would live to see her newborn son the next day.

If Terri's local hospital hadn't sent her to Cleveland Clinic, she probably wouldn't have made it through the night. "We were racing against the clock," said one of the surgeons. But Terri got to see her son the next day, and after nine days in the hospital, she was able to go home. She spent the next four months recovering, but eventually she went back to work as an inspector at a basket factory. Her son, Seth, is now in his early twenties. A "typical young man," in Terri's words, he enjoys computers and spending time with his girlfriend. He also has Marfan syndrome and goes for annual checks of his aorta.

Terri's case exemplifies the virtues of a unique model of medicine—a system in which caregivers work as a team, doctors purely practice medicine, and the patient comes first. Unlike the majority of American physicians, those at Cleveland Clinic and a few other institutions aren't free agents who are affiliated with a specific hospital. They are employees of the same organization that owns the hospital, and they practice as an integrated group—behind-the-scenes facts that make a huge difference. In Terri's case, top experts in a dozen fields were able to scramble in the middle of the night to pull off a complex and unusual medical intervention. It was a seamless collaboration and the kind of "everyday miracle" that has captured the attention of everyone from the president of the United States to the New Yorker.

We all know that American healthcare is supposed to be a mess. Yet on the frontiers of medicine, Cleveland Clinic has developed an approach to treating people that is more effective, more humane, and, surprisingly, more affordable. By reorganizing doctors and other caregivers so that they work together better and by reorienting medical institutions in ways that embrace and enhance collaboration, innovation, patient experience, and wellness, we could solve all kinds of problems—including financial ones—that are driving our ominous healthcare "crisis." We could help individuals live longer, healthier lives without bankrupting the nation. We could launch a technology revolution that would save lives. We could make visits to the hospital more pleasant and emotionally healing experiences. And we could help doctors engage with patients and with one another as people and enjoy the practice of medicine again.

As CEO of Cleveland Clinic, I lead a multibillion-dollar enterprise that has outposts around the world. But I wasn't born a CEO. I spent most of my career in the medical trenches as a cardiac surgeon, performing more than 22,000 operations, including the world's first minimally invasive valve surgery. Instruments and techniques that I invented are used in operating rooms everywhere. I know the sights, sounds, and smells of the operating room. I know what it takes to build a small, tight-knit team for surgery and what it's like to organize an entire system of hospitals. I also know the human side of healthcare. I've felt the thrill of saving a life—not once, but hundreds, even thousands of times. And I understand what it's like to lose a patient and then have to face the family in the waiting room.

I love my patients and I love being a doctor, but I've never felt like a medical insider. I finished at the bottom of my class in medical school, and I was strongly advised not to go into cardiac surgery. I didn't know it at the time, but I had an undiagnosed learning disability: dyslexia. Over the course of my career, this condition has proved to be a blessing in disguise. Because of the limitations it imposed, I never fell prey to the herd mentality. I had to forge my own way of learning about and understanding what went on around me. That informs how I lead Cleveland Clinic.

Across America, people have been asking, "What's wrong with the healthcare system? How do we fix it? What is the best model of healthcare for these times?"

It's clear that some parts of American healthcare are dysfunctional. Other parts seem to work very well. Among the latter are large, not-for-profit group practices such as Cleveland Clinic. The national media have taken note and produced features and articles. President Barack Obama praised Cleveland Clinic and similar organizations on national television and visited us to find out more about how we operate. The level of interest in this organization and its methods has remained high over the years. People would like to know more about Cleveland Clinic and what we do differently.

The Cleveland Clinic Way arose out of the ongoing national debate on healthcare reform. Our purpose is to share the good news about American healthcare and show how Cleveland Clinic and similar organizations are shaping the future of medicine. This book draws upon my speeches, writings, blog posts, and published Cleveland Clinic communications to provide the most comprehensive and accurate account possible of the subject matter and the organization. Cleveland Clinic has kindly allowed me to quote verbatim and without attribution from authorized publications and corporate communications. The final product is a combination of my thoughts and the wisdom of Cleveland Clinic caregivers, past and present.

It's a positive vision of healthcare compared with the ones that we usually see. And it's a vision that I hope will shift not only how we as medical professionals talk about medicine but how we practice it—and how we lead our healthcare organizations, empowering citizens to make more informed decisions about their health and reigniting pride in American medicine and American innovation.

The Cleveland Clinic Way isn't about the complexities of the health insurance debate. It doesn't take a stand on the specifics of recent healthcare legislation, nor does it talk about how individual doctors should treat individual diseases. Rather, it's an overview of how our dominant system of practicing medicine can be overhauled for the better, giving a look at a healthcare revolution that is already under way at Cleveland Clinic—and is one that we need to further and hasten. Ultimately, I hope you'll find it an inspiring book about how real doctors could intervene in new ways to better the lives of real people.

People like Terri McCort. People like you.