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Watertown native, Cleveland Clinic CEO, authors book on how to make health care more efficient


Watertown native Dr. Delos M. “Toby” Cosgrove III has developed skills as a world-renowned heart surgeon. And as a manager he has developed skills that are helping to change health care in this country. He shares his vision in a new book.

Dr. Cosgrove is president and chief executive officer of the Cleveland Clinic. The 1958 graduate of Watertown High School has authored “The Cleveland Clinic Way: Lessons in Excellence From One of the Leading Healthcare Organizations.”

Against the backdrop of real patient sories, the book explores eight trends that can make health care in America more efficient, as proven by Cleveland Clinic’s own experience in implementing the practices.

The Cleveland Clinic is one of the largest and most respected hospitals in the country. It comprises eight community hospitals, 18 family health and ambulatory surgery centers, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Toronto and Cleveland Clinic Abu Dhabi.

The nonprofit Cleveland Clinic is a physician-led group practice. Its physicians are all on one-year contracts and paid an annual salary that is based on “quality metrics,” outcomes and research and not on the number of tests or procedures performed.

Dr. Cosgrove said this model encourages collaboration across disciplines and eliminates barriers to sharing information. He also says it allows Cleveland Clinic caregivers to put patients first by removing all incentives to do anything other than what is clinically best for each patient.

“Health care has long been a cottage industry in the United States with private practitioners and independent hospitals,” said Dr. Cosgrove, 73, in a phone interview from Florida, where he stopped as part of a tour to promote his book. “So there’s never really been a system of health care across the United States. It’s been sort of every community relies upon members of the community to support it.”

As an example of that community approach, Dr. Cosgrove recalled the experiences of his father, attorney Delos M. Cosgrove Jr.

“He was born in the House of the Good Samaritan, had his appendix taken out there, had his children there and ultimately died there,” Dr. Cosgrove said. “Health care doesn’t work that way anymore. It’s gotten too sophisticated. No hospital can be all things to all people. So you have to begin to put together a system.”

Dr. Cosgrove said 60 percent of hospitals in the nation are part of such a collaborative system, which makes them more financially efficient and also more efficient in services offered.

He said his book grew out of the national debate about health care.

“Many, many health care organizations have come to us and wanted to know more about our model,” he said of the Cleveland Clinic. “So we thought it was worthwhile to describe some of the things we’ve done. There’s so much criticism of the health care system in the United States. But at its best, it’s the best in the world.”

Among those who have lauded the Cleveland Clinic have been President Barack Obama.

Dr. Cosgrove was asked if he thought the president’s signature legislation, the Affordable Care Act, is the right approach to fixing the country’s health care system.

“I think the best way to put it is that we knew we had to change,” he said. “The financial pressures of health care costs had been so high in the United States that it was starting to eat into all other social programs.”

He said the country’s spending on health care is at 18 percent of gross domestic product, the highest in the world. That’s approximately $8,000 per person per year. The White House has said that slowing the growth rate of health care costs will prevent disastrous increases in the federal budget deficit.

“It’s starting to affect businesses, it’s starting to eat into the budget for every state and starting to influence how much money (we spend) on education and other programs,” Dr. Cosgrove said. “So we really have to get the costs of health care under control. Whether the Affordable Care Act is going to manage that or not remains to be seen.”

Dr. Cosgrove’s book is designed mainly for health care and business executives. He has divided it into eight chapters that he hopes will empower readers:

n “Group Practices Provide Better — and Cheaper — Care”

n “Collaborative Care is More Effective”

n “Care Should be Monitored and Recorded for Quality”

n “Twenty-First-Century Care Should Be Innovative”

n “Care Should Be a Healing Experience for Body and Mind”

n “Wellness Depends on Healthcare, Not Sickcare”

n “Care Should Take Place in Different Settings for Comfort and Value”

n “Care Should be Tailor Made for You”

Dr. Cosgrove has performed more than 22,000 operations and has earned an international reputation for expertise in all areas of cardiac surgery, especially valve repair. He has 30 patents filed for medical and clinical products used in surgery.

Dr. Cosgrove, who finished in the bottom of his class at University of Virginia Medical School, credits his learning disability, dyslexia, with giving him an innovative way of thinking. Dyslexia is a reading disability that occurs when the brain does not properly recognize and process certain symbols.

Dr. Cosgrove said he didn’t know he was dyslexic until he was 34.

“I thought I was sort of stupid,” he said. “School was a tremendous struggle for me. It took me a long time to do my homework in high school. I really struggled with French in college.”

But he began to realize that he seemed to think differently about problems than other people did.

“I realized this when I was a consultant in a company that made heart valves in the United States,” Dr. Cosgrove said. “There were about five of us. They would present a problem and everybody would go around the table giving their thoughts, and my thoughts would be completely different than anybody else’s.”

Those different ideas, he said, led to his patents’ and other successes.

“It turns out it’s a real advantage,” Dr. Cosgrove said of his dyslexia. “If you don’t get your self-esteem destroyed as you go through school, I think it can be a tremendous advantage.”

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