Sunday, September 1, 2013

Urban Healing

Cleveland's famed clinic (formally CCF, for Cleveland Clinic Foundation) is a city within a city.  The ever-expanding non-profit institution owns miles of buildings downtown (a total 43,000 employes worldwide) and is the second largest private employer in Ohio after Walmart. The 167 acre property includes three hotels, subsidized transport, and  a system of regional healthcare centers that reach to Florida, Nevada, and a new billion-dollar outpost rising in Abu Dhabi. The latest planned expansion is a new medical education center on 11 acres carved out of the middle of its main urban campus, a cooperative effort with Case Western - the separate medical institution nearby - being designed by  London architect Norman Foster.

 This 4th largest medical center in the US ranked first in cardiology by US News & World Report  operates in military mode, doing battle with morbidity and mortality along with  shifting local and national political priorities. No more than 16 people are in charge atop a descending pyramid of responsible others. Doctors are paid salaries, just like generals. No wonder an efficiency-minded President Obama  endorsed the place as a model of the future in an early visit trumpeting the Affordable Care Act, now the law of the land. They really do seem to be trying to implement cost controls and "change the culture" to emphasize teamwork i.e. improve cooperation and reduce redundancies in patient care, the major contributor at present to US escalating healthcare costs. (Upward of 18 percent of the country's annual budget at present.)

"We don't use human assets as well as we could," confesses one of the staff  orthopedic surgeon. "Everyone can improve." Physicians will find their jobs changed, he warns.

 Among many innovations to be found at this empire of healing is the existence of a second CEO known as Chief Experience Officer. The experienced guide on a recent tour titled him "chief empathy officer," a job currently held by a staff surgeon. As in patients' experience, emphasizing - upping the ante on relationships while on hospital grounds.  A nice trick since surgeons not famously empathic professionals. Alas, we had no chance to meet either this sanctified leader nor any patients, though one experienced staff surgeon spoke hopefully of "patients having their own ownership in the outcome." Of what exactly? Their health, yes. Also - timely note - of implementation of the ACA that is going to find thousands, if not millions, more patients at their door. 

 Though as an aside, I must add an anecdote passed on to me that shows the outreach effort can be catching on many levels: a grateful royal personage in residence at the swank VIP rooms for months, having various organs transplanted  would have free pizza delivered weekly to CCF employes. (Probably not all 43,000.) Apocryphal? Perhaps, but that is just the sort of story suited to the institution's legend.  It helps to report that my source (then visiting a friend's hospitalized sister) was Cleveland-born and announced herself as a staffer for a key member of the US Senate. CFF President and heart surgeon Toby Cosgrove himself turned up to offer her a tour of robotics in use.

Surprise # 2: anyone ailing is welcome at CCF. Whoever you are or wherever you live, you are guaranteed to be given an appointment to be seen the day you call. (No further detail supplied by clinic's public relations professionals but it's likely that follow-through will be a little more complicated, depending on your gripe and your location.) All part of the much-touted empathic program no doubt. Try it - and see for yourself. Call 1-888-223-CARE.

Facts and figures and VIP names roll on in great numbers about the place on Wikipedia, a virtual honor roll of celebrity. Those lucky - wealthy - folks can claim a top drawer suite with commanding views and enough electronics to run a business from their bed.  On the other hand, the clinic says it had 150 million charity cases in 2012.

Part of the healing process includes visual therapy, to judge by what is on all the walls: a fulltime PhD art curator on staff takes care of acquisitions that enhance pristine soft blue-gray opaque glass paneling on the halls. Would that military quarters -see CCF's origins 91 years ago - 

Big Brother or Big Daddy definitely is in charge here: an anesthesiologist who confessed at the recent Chautauqua Institution's theme week on healthcare that he is a reformed soda pop (Dr. Pepper) addict manages the institution's wellness program seeking to improve the health of every employe. Anyone not coming up to speed doesn't last long at CCF.  Smokers and fatties don't get hired. Get with the program or else. Try meditation, leaner diets, and exercise  (10,000 steps a day) according to Dr. Mike Roizen, known fondly and familiarly as the clinic's energizer bunny. (He got  his friend, TV's Dr. Oz, to help  cure him.)

The main entrance is a curving wall of windows behind a round constantly moving water feature that is said to promote a feeling of security. The doors open onto white and off=white public areas - a strategically designed welcoming space. The lighting is worthy of theater,  carefully executed to emphasize the grandeur of CCF's calling.  Pedestrian skyways link various parts of the immediate campus - with institutes organized into "diseases and body parts" -  show videos in constant motion. Little if anything is stagnant here; a piece of stray paper dropped on the ground would probably disappear on the spot out of sheer shame. Dr. Toby would almost certainly be on it, if not.

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