Fireside Chat: Dr. Toby Cosgrove, CEO, Cleveland Clinic & Steven Krein, CEO, StartUp Health

What is not easy is getting up and condensing down your life’s work in two minutes. Making sure that you tell people just enough to whet their appetite and give them a sense of your commitment and passion. As I described to you before it takes massive amounts of batteries. Massive amounts of energy. And, the idea of finding partners and finding people who are as committed as you are, is one of, if not the most difficult job of entrepreneurs today. As I mentioned earlier, four years ago at Health Datapalooza I got to meet Dr. Toby Cosgrove. Dr. Cosgrove blessed us with his incredible generous wisdom and insights into what the entrepreneurs were embarking on. An incredible, incredible task. But the most important task of their life. As I described to you batteries included and what it sounds like, what it reads like, what it is described like. There is nobody I can think could harness the energy of such a massive organization and be himself batteries included. Energy providing. Partners to us at StartUp Health, the entrepreneurs in our global army. As I mentioned this is our fourth straight year in a row presenting a sample of the great work that the entrepreneurs are doing. I’d like you to join me in welcoming Dr. Toby Cosgrove, the CEO of Cleveland Clinic. An incredible surgeon, a friend, and without a doubt the most batteries included physician, clinician, and CEO that I know. Dr. Cosgrove. Thank you. So, welcome to your Summit. Well, it’s great to be here and nice to have you here as well. It’s great to be back and, you know, we always have a chance to to connect for a few minutes and I’m in awe of the most highly registered number of attendees coming to your Summit, but as I’ve been talking to people over the last couple of days about being here, there’s progress being made here at the clinic. What would you hope everybody would get over the next couple of days? Just a feeling when they get on the plane to leave or get in the car to drive home. How do you think they should feel on Wednesday afternoon? I think they ought to feel incredibly stimulated by the ideas they’ve been exposed to, and the fact that we actually are an organization that tries to push the health innovations and healthcare, and not only that, it is a great test bed for new ideas. So, we were here two years ago. We had our last fireside chat during our showcase and we talked about innovation, we showed innovation. What’s the biggest difference here at the clinic from two years ago? I’m going to broaden it out to both at the clinic, but also healthcare overall? Well, first of all, you know, we’re going through an enormous change in health care right now. We’re now feeling the impetus to change from volume to value. We’re also feeling the financial constraints that are going on across healthcare in general. I think that that has been enormous impetus for healthcare to change. We are not going to be able to deliver the quality and the volume of healthcare that we’re going to be asked to do unless we begin to change the way we do it. So, we are looking constantly at new ways to deliver great care, even better care, with fewer people involved, with better technology, and frankly we have got to depend on technology to do this. One of the pieces of data that I ran across the other day, and this absolutely shocked me, was the doubling time in healthcare knowledge. By 2020 the total amount of knowledge in healthcare will double every 73 days. How on earth are we going to keep up with that without more technology? Particularly AI. Are you happy with the amount of progress that’s been made? You know, I’m constantly unhappy. You constantly want to go faster and you need to do it better and, you know, we’re never going to be good moving as fast as we would like to move. I think that that’s the sort of dissatisfaction with the status quo that you always have to have in order to drive an organization. What’s the hardest part? What’s the hardest part of, kind of, pushing through this? I know we had a chance to talk backstage a little bit about your role as CEO. I talked earlier about, you know, organizations that need the right mindset. But, what’s the hardest thing on a daily basis?Well, the hardest thing I think is change. The hardest part about change is the people involved in changing. I think, on the one hand, you got patients who are now not used to having care given to them in a different way. You stop and think about what’s going to happen. The people that are going to look after you in the future, where you’re going to be looked after, how you’re going to get looked after, and the diseases you’re going to be looked after are all going to change. And, it’s hard for patients to get their heads around that. It’s equally difficult for the providers to get their heads around that, because they have spent, in many cases, 20 years getting trained or getting used to, or perfecting what they do and to ask them to say look, we ‘d like to have you do it a different way is a major change in your mindset. Right now we’re kind of got a foot in each boat. Where you’ve got the volume boat and the value boat and the financial incentives have not changed significantly enough to move us to the value equation completely. So, the whole country is in the process of making this enormous change. This is the biggest change that’s happened in healthcare in a century. Can you repeat that again for everybody, because I think that’s, you know, that is such a critical statement to be made by the CEO of the Cleveland Clinic. Yeah, this is the biggest change, I think, that’s happened in healthcare in a century and it is the biggest industry in the United States and it affects one hundred percent of the people. I mean how much more changed could you ask for? Well, you don’t just sit here in Cleveland. You travel the world, you have you had a chance to not just visit, but play in a different sandbox around the world. What’s different about what’s happening here in the U.S. vs what’s happening in different regions around the world? Well, first of all, I think the whole world is under increasing pressure on how you look after people, with more and more things you can do for people, older populations, and the financial pressure that this massive demand for healthcare has put upon them. If you look at what’s going on right now much of the world which has been government-run health care is now moving towards private. In the United States were going the opposite direction. I think what that says is that nobody’s happy with the situation they’ve got. They’re looking for something different and so we see this. It’s interesting, in the United States we’re really worried about being eighteen percent of the GDP for healthcare costs. In Abu Dhabi they’re really worried about the fact that it’s four percent of the GDP there. But, everybody is concerned about the growing costs of healthcare and so everybody’s looking for a different solution and we are trying to figure out how we can bring more efficiency to healthcare delivery and also at the same time try to put more more emphasis on keeping people well. That really hasn’t taken off yet. Are you seeing innovation come from just within India? Iknow you see it externally, but do you think the clinic has has been able to harness the power of entrepreneurs and others, or is the kind of mindset right now really develop here, and how does that play with what you are doing in Abu Dhab? We see innovation happening all over the world. You see it in Europe, you see it in Asia, you see it all over the United States. The biggest issue that I have is trying to keep your finger on the pulse of what’s going on all over the place. I am constantly worried that there’s some major change that’s going to sneak up on me from behind I don’t see coming and just change everything. So, I don’t know how many startups that there are. Just in California in healthcare there must be well over a hundred. Yeah. We’re tracking 7500 digital health and wellness startups globally right now and growing everyday. But, I think that’s the interesting part. The innovations that you see now are not the innovations that you saw 10 years ago. 10 years ago you saw devices and pharmaceuticals. Now you’re seeing all digital. How are you approaching it here in Cleveland Clinic? How are you approaching the filtering or the view of, you know, both external and internal innovation? We are concentrating on, right now, on what we are trying to bring out of the Cleveland Clinic. We’re a little overwhelmed right now with trying to manage all those ideas. We’re constantly looking for things that would come from outside that we can participate in. I think Explorys was a great example of that. Which came in and essentially built on the strength of the Cleveland Clinic. We participated in it hard and we’re delighted to see it go on and be purchased by IBM. When you think about, when you take your CEO hat and you put on your physician hat, which I know you wear as well. Being a doctor today. Coming out of med school. How do you, how would you view the career, the choices that you need to make, the mindset that you need to be successful coming out today for young physicians and clinicians? Well, I think one of the major things that changed is the difference between how I was trained and how the reality of delivering care is now. We were trained all as individuals. I laughingly tell the story about one day that I was, the Chief Resident was leaving and leaving me in charge of the service and he said, “Toby if anything comes up that you can’t handle, handle it.” I remember calling me as a sign of weakness. So, we were essentially trained to take care of everything and without calling for help. So, as a general surgeon we used to think of ourselves as, we looked after the skin and its contents. Now, you know, healthcare knowledge has gotten so great and it’s so complicated you need teams. So, teams, we were not trained to be teams, players. Teamwork is not a natural act of doctors. So, one of the things we’re doing now is we’ve got a new health education complex with Case Western Reserve which is bringing together medical school, dental school, nursing school, and PA schools and everybody will be trained together and cross fertilized back and forth, so the first time that you meet is not going to be on the ward where everybody’s an individual trained separately in silos, but in fact, they’re going to be more like team players. That is going to continue because there’s so much knowledge and so much capabilities. You know, the average cardiac surgical patient going through the Cleveland Clinic interacts with a hundred and twenty different individuals. That’s a big team. So, I would say the difference now is you’ve got to be a team player and you’ve got to be ready to change with the technology as the technology changes. Always learning. Always learning. Always learning. When you think about, and I’m just gonna swing back to the startups and the entrepreneurs. You know, I think there’s not an entrepreneur out there that wouldn’t love to figure out how to commercialize and validate and partner with the Cleveland Clinic. You built an incredible reputation for your internal innovation. Coming back to this external innovation thing, how might you look at the next five years and how perhaps the Cleveland Clinic could be just fantastic partners and almost a partner of choice for entrepreneurs and startups that are really just trying to get in and be a build some validation and data to prove what they have works? Well, absolutely. What I want to do is create the ground, where you can plant the seeds of innovation, regardless of where they come from, and see if they grow. We have a wonderful potential for this and the fact that, first of all, we have a big organization with lots of patients. We have a mindset about innovation that we need to continue to get better. We have multiple different locations to grow it in. One of the big opportunities we have, quite frankly right now, is Abu Dhabi. We have a American hospital run by American doctors with a Cleveland Clinic mindset to it and this is a great place for people to test various things that are going to ultimately have to go to the FDA. So, we’re seeing more and more companies come to us and say, “Gee, instead of going to India or someplace, could we come to Cleveland Clinic and have that same IRB approach to looking after testing something?” Do you feel like the organization’s set up for that? Right now, here? The organization is not set up for it now, but we’re working hard to set it up for it and we’re bringing new people with a new mindset about how we continue to bring people in from the outside to try and look at new technologies. So, one of the single biggest breakthroughs I mentioned to everybody earlier, is that what we’ve discovered is it’s not about the capital, or the customers, or even just the team. It’s actually about the whole mindset of everybody involved. Mindset plays such a critical role for entrepreneurial innovation. No question. Talk to me a little bit about your mindset and how you think about approaching what you do everyday in the face of this wave of technological innovation and disruption? Well, I’m thinking back about when I started as a cardiac surgeon. You know, I was constantly looking for ways we can do something better. Whether it was new instruments, or new approaches, or new technologies, or new valves, or the new incisions, or whatever we could. You know, one of the things I found that I was very good at, is failing. I have a whole drawer full of things that I developed that never made it out of my bottom drawer. Some of them were ideas that happened really before people were ready for them. I remember one was, we developed two umbrellas that you put on the end of a catheter and open on either side of it and put them together and the company that I was working with came to me and said well, we don’t think anyone’s ever going to treat the heart with a catheter. The time wasn’t right for it. But, you know, you have to keep having that mindset about, ok, how can we do it better? What is it that doesn’t work? If you keep, eventually you’ll find something that is, that’s the point. Do you think that, besides being almost trained and educated to not fail, the mindset of a clinician being one of which is almost the total opposite of entrepreneurial mindedness? Well, that’s it that’s an interesting thing about doctors. I mean, you stop and think about how we were trained. We weren’t selected because we’re great creative writers or artists. We were selected and got into medical school because we could understand how to memorize things, etc. Then we went through our medical school just memorizing one thing after another and then we were taught to do things the way the Chief Resident told us to do it, and then he was told how to do it by the junior attending, and he was told by the chief of whatever it was. So, we became not imaginative or creative, neither selected are trained that way. Plus the fact that we were learned that you didn’t want to take chances with people’s lives. So, it is very difficult for people to get into the entrepreneurial spirit and accept failure after you’ve had that sort of background. So, you have to understand that healthcare move slowly. In fact, it’s 13 years from the time an idea is proven to be successful to the time its standard practice. So, we’re very slow-moving organization because I think those two things. One, not trained for risk, not trained entrepreneurially, and two, because we’re dealing with patients lives. So, it’s a hard row to hoe to understand that physicians are not necessarily the most entrepreneurial risk takers that happened. So, how do you view then, in light of that, how do you view, or what would you recommend to entrepreneurs? What would be your advice to entrepreneurs today that are working daily to reimagine, transform, improve, save, create? Okay. First of all you’ve got to find a leader who is interested in doing this. Really, leadership of an organization is vital for that particular thing. Then you have to find someone within the organization who is going to champion that product, or that device, or that idea. Once you get someone who has the energy and the excitement and is supported with from leadership then I think you got a winner. Is there a conduit to that today? If you’re an entrepreneur is it knock doors and try to find someone or is there actually a path to navigating? Well, from, you know, one of the things that I think about the Cleveland Clinic is, you stop and look at how is Cleveland Clinic, which is in the second poorest city in the United States, managed to grow the point where it has grown? And, has grown only around innovation and the fact that we were trying to push the boundaries of whatever it was we were pushing. So, the organization has a long history going right from its founders, and from the idea of how we are organized around a group practice, of being an entrepreneurial organization. Also, you know, tolerating and accepting and embracing people with different sorts of ideas. That, I think, is part of an organization’s DNA and I think that it is vastly important that we continue to foster that. So, the organization is ready for it. Then you have to find the individual within the organization who is going to pick up a particular project and run with it. What would you love to see the Summit look like five years from now? You know, when we started this I was flabbergasted when three or four hundred people showed up the first time. Now I look out at this and I’m just saying oh my gosh this is incredible and, you know, I only see each year it has grown. Each year it’s gotten more exciting. Each year there’s been more things added onto it and we’ve outgrown the space that we’re in originally and are now here. I’m looking forward to the day when we outgrow here. Pretty big space. It is pretty big space, but more crowded than ever before. The Cleveland Clinic brand. Brands are so important today. Credibility, believability, reputation. It’s often an overlooked part of a company, a business, a startup, an organization. Philosophically, what’s your view on the brand? Clearly, it was a brand when you joined 40 years ago, but today it’s a completely different global grand that’s known by so many people in the industry, but also patients. Philosophy? Yeah, I think one of the important things about the brand is the the importance of transparency. We are absolutely believers in transparency, both internally and externally. One of the things we do internally is we are very transparent about what the results are amongst our physicians. Frankly, we share that with them in rank order by name, so the docs understand where they at where they stand. Then also, we’re transparent about the outside. We want to share our results and compare them whenever we can with the benchmarks across the country. I think that that light, if you will, is tremendous for the understanding about who we are and why we are and the fact that that we’re not trying to hide anything. Do you feel, do you feel there’s more to do? You’ve done incredible work of the last 12 years a CEO. What’s next here? Well, there’s all kinds of things next. I think, you know, we’re in the process of in expanding our global reach. We’re going to London. We’re expanding what we’re doing here in Cleveland with a new Cancer Center due to open in another three months or another six months. We’re excited about what’s going on with our health education. We’re opening a new hospital in 21 days on the west side. We are having all kinds of relationships with other hospitals across the country and the fact I think it is important that you have really major partnerships, because we’re no longer in the area where it’s a cottage industry. Every industry in the United States is consolidated. I mean, if you look at airlines and look at supermarkets, and bookstores, and law firms, and accounting firms, consulting firms. They’ve gotten big and the reason they’ve gotten big is you’ve got so much support for an organization whether it’s IT or HR, or whatever it is, that to reproduce it over, and over, and over again is not efficient. So, we are going to get bigger. Other healthcare organizations are going to grow. So that there are systems. And frankly, not all hospitals should be all things to all people. The high technical things that are done in small numbers you’ve gotta concentrate, so you get really good at them. The community services ought to be in the community. There’s no reason to have OB not being out in the community. So, we’re looking at systems and I am incredibly excited about the future of the organization. I think it is in a better position now than it ever has been and the opportunities for us are enormous. Who do you admire? Well, you know, you learn things from all kinds of different people and you learne some good things and you learn some things that you don’t want to do. So, I am constantly looking for the best things that I can pick from various individuals all over the place. I think probably growing up as I learned more about things I didn’t want to do and the things I didn’t want to practice, but I’ve always gone places to try and learn things from other people. So, you admire the way somebody does something and you admire the way somebody else does something and you try to bring them together and in both in your organization and yourself personally. Who do you admire? Well, you know, I think one thing we have to say is this gentleman that’s about to come talk to us. I think you have to say admire him enormously, in the energy that he is brought to the Cancer Moonshot. It is only through force of his office and personal energy that he’s gotten as far and brought us as far as we have and I think you have to take your hat off to him. An enormous contribution. So, that’s a great lead into the Vice President Biden who’s about to come on stage and give the keynote. Why do you think now is the right time for his Moonshot? The Moonshot and why and we’re going to hear from him but I want to know, you’ve been with him in a couple different places over the last year and watch him deliver the keynote you spent time with him personally. Tell me why you think now. I think now with what we’re seeing is a tremendous series of things that are coming together going to help us. First of all big data. Enormous opportunity. The ability to communicate as well as we have through all the devices and social media and in internet enormous. The explosion that’s happening in genomics. The understanding increasingly of the causes and the prevention that are all coming together. I think they’re this is a wonderful time for medicine in general and certainly these forces are going to expedite all of our cures. I mean when I go back to the fact that the total amount of knowledge is doubling every 73 days. You know we’ve got to have new ways to handle that data and now is our opportunity and now we can begin to apply it to cancer. Do you believe that we can end cancer as we know it? I think we’re going to get worse we’re seeing more and more cancer now being turned into a chronic disease and some cancers are curable no question about that bigger percentage all the time. Do I think we will totally end it in most of our lifetimes? No I don’t think so. But I think it will change in the from being a death sentence if you will to something that is manageable and treatable and turned in many cases into a chronic disease. Vice President Biden’s coming out to talk to us and and you’ve heard him say so many times how the passion and the moment and the energy that we need to harness globally is so important. What for you is the most important part of where you sit today the legacy you want to leave and the feeling you want to leave people with about Toby Cosgrove? You know, I don’t think
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about my legacy at all. Seriously, I don’t. I talked about, I think, about the organization. I say this often and I absolutely mean it. Cleveland Clinic made me I did not make the Cleveland Clinic and I’m very very fortunate to have the opportunity that I had to be here and participate the way I have been. Well Dr. Cosgrove four years ago, a little over four years ago, we first met in Washington. Yeah, I remember well. You invited just a little over a dozen of our companies to Cleveland Clinic and as we’ve grown each year I can’t tell you how much we’ve appreciated the red carpet being rolled out. The chance to launch your Summit every year is one of the highlights of our year. Our friendship with you and your wife and the way all the leaders here at the clinic have embraced entrepreneurs is really a model to be followed. We look forward to doing more work together and more importantly coming back a year from now, not just with more progress but a defined way that entrepreneurs and startups can really bring their solutions here and we can work together to change healthcare. As I say always batteries included. Dr. Cosgrove always a pleasure. Thank you so much for letting me to sit down with you today. Thank you. Thank you. So there’s going to be a little bit of a set change here. I think that you’re going to see a little logo up there for the Vice President. It’s going to be a few minutes but I want to once again thank you all for giving us a chance to inspire. To hopefully connect link arms and if I leave you with one thing today, it’s the notion of be batteries included. Remember a meeting, a talk, a conversation can lead and help entrepreneurs in ways you can’t even begin to imagine. Ladies and gentlemen please give the health transformers another round of applause. Dr. Toby Cosgrove Susan and a great team at Cleveland Clinic innovations for putting this wonderful event together. And we will be right back thank you very much have a wonderful Summit and I look forward to meeting you in the next couple of days. Take care.

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