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Sun 4 Feb 2007 12:00 AM

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Medical marvel

Dr Delos ‘Toby’ Cosgrove is one of the world’s finest heart surgeons, Vietnam war hero, author and CEO of health service pioneers the Cleveland Clinic. He tells Edward Poultney about his plans for the Gulf.

Despite having just flown in from the World Economic Forum at Davos in Switzerland to give a speech to delegates at this year’s Arab Health expo in Dubai, Dr Delos ‘Toby’ Cosgrove is full of energy as he walks down the long corridor to greet me with a wide smile.

As the CEO and president of America’s third-largest hospital trust group, the Cleveland Clinic, in addition to being a world-renowned heart surgeon, Cosgrove is as sharp as one of his scalpels and full of enthusiasm for what he terms the “quality revolution” that the Cleveland Clinic is pioneering in the US, and now in the GCC through the planned development of the Cleveland Clinic Abu Dhabi.

Contrary to the majority of the hospitals and health centres currently running in the region, the Cleveland Clinic Abu Dhabi is going to be run along similar lines to the US arm of the group as a not-for-profit health and research centre where the financial surplus will be fed back into training, recruitment and other facilities, freeing the hospital from some of the financial constraints that affect other centres. “We’re run by a trust rather than shareholders, so there is no pressure to work on maximising profits,” explains Cosgrove. This would also seem to clarify why he is not worried about competition from the region’s existing hospitals and healthcare centres: “It’s not a question of competition; it’s just trying to get the best quality of care possible, that’s why we put everything back into the group.”

The Cleveland Clinic group's move to bring its own brand of multi-speciality overseas for the first time will still set it apart from the rest of the medical facilities currently available in the Gulf. “This is the first academic medical centre to have diversified out of the US as a full-scale hospital,” says Cosgrove. “Groups have expanded within the country and we have sites in various states, but this is the first one outside of the country.” The project is being developed in conjunction with the UAE capital’s Mubadala Development, which will run the construction and facilities side of the project while Cleveland Clinic will concentrate on the medical side. The clinic is scheduled to open in 2010.

When asked why the group selected Abu Dhabi as the first site for the expansion programme, Cosgrove is sanguine. “We had approaches from over 80 different locations but we chose this one because we felt that we would be able to uphold our quality standards. The facilities and technology available are completely up-to-date and we have immediate access to everything that we need.” He continues: “The hospital will be a world-class tertiary facility and the staff will be continuously trained to reflect our commitment to quality care.”

And just like that the conversation turns back to Cosgrove’s central topic, that of quality. Cleveland Clinic prides itself on its mantra of a threefold quality of care: medical treatment, physical facilities and emotional experience. “That’s what makes the difference for patients — the total package. All of those will help with their recovery,” he says.

The Vietnam war veteran knows what he’s talking about when it comes to treatment — he has performed over 20,000 heart operations, authored 450 scientific publications, and holds more than 20 medical patents. As well as running a group of 34,000 employees, 12 community hospitals, 13 family health centres and five surgical centres with annual revenues of over US$4bn, he still finds time to perform hundreds of heart surgeries every year, as well as pioneer new ground-breaking techniques.

Furthermore, the group has been doing some pioneering of its own — catching on to the spread of internet technology. The e-Clinic was launched last year and allows patients to go online and gain access to secondary opinions from the group’s expert physicians and doctors. Cosgrove explains: “There is a demand for a variety of locally-based and overseas patient services, and we’re continually developing ways to make healthcare more easily available to patients.”

Cleveland Clinic also makes use of ‘virtual consultations’, whereby web cameras are used to allow the doctor and patient to see and talk to each other remotely. A technician or nurse sits with the patient and places the stethoscope, ENT cameras, heart monitors, or other equipment according to what the doctor requires for diagnosis, and the hi-speed connection allows the physician to hear and see in ‘real time’. A separate screen gives the doctor access to the patient’s medical records to see previous diagnoses and update the current developments. “This has huge implications for patient care,” clarifies a spokesperson for the group, “especially in areas where there aren’t enough experts for every healthcare centre, and financially it will help hospitals because they won’t need to keep a specialist on the premises if he is only needed in a couple of cases a year. Patients can now have access to the best opinions without needing to travel.”

The clinic’s doctors are also subject to strict checks and regular reviews — whereas most hospitals place staff on 10 to 15-year contracts, the group maximises quality levels by renewing contracts on an annual basis, a practice that will continue at Cleveland Clinic Abu Dhabi. “We’ll be bringing in professionals from North America on a rotation system to the hospital and we’ve had enormous interest from regional medical students who would like to train at the centre and possibly in the States,” says Cosgrove. Nor does he foresee any problem with possible culture clashes arising from the group’s move into the Middle East healthcare market: “We currently treat patients from all over the world, from over 80 different nationalities, from different religions and cultural backgrounds. We have translators, and our staff receive cultural awareness training.”

The contract for Cleveland Clinic Abu Dhabi is for 15 years, during which time the group will place its resources back into training local and regional staff and supervisors to the rigorous quality standards it prides itself on. As Cosgrove elaborates, “15 years is the usual timeline for effectively transferring standards,” and training and education will continue throughout each employee’s rotation.

The global healthcare sector is a constantly expanding business, with turnovers running into billions of dollars annually, but with all the money generated from medical care it comes as somewhat of a surprise that advertising is not a major consideration for the group, with little or no media or television campaigns.

Yet the clinic relies mostly on word-of-mouth and referrals from doctors; especially as it is considered the foremost heart care centre in America. “If I operate on 700 patients in a year, 600 of those will have been referred to us by fellow doctors,” Cosgrove says. And the others? “Over the internet mostly, off their own steam.”

Nor is he worried that patient numbers will suffer from a lack of awareness in the Gulf. “It might be slow to start with but the number of professionals in the industry is quite small so we expect word to spread once the Abu Dhabi centre opens.” With the amount of emphasis placed on quality of treatment and world-class services, there’s no doubt that Cleveland Clinic Abu Dhabi will soon be in rude health.

Cleveland’s calling

Cleveland Clinic is one of the top three hospitals in the United States, and 11 of its specialities rank among the nation’s Top 10, according to last year's US News & World Report “America’s Best Hospitals” survey 2006.

The report ranked Cleveland Clinic’s heart programme as No. 1 in the country for the 12th consecutive year and the clinic is ranked among the United States’ best in all 16 specialities.

Complete 2006 rankings for the Cleveland Clinic are: cancer, 13; heart and heart surgery, 1; digestive disease, 2; endocrinology, 7; gynecology, 8; kidney disease, 3; neurology and neurosurgery, 5; ophthalmology, 14; orthopedics, 5; otolaryngology, 7; pediatrics, 20; psychiatry, 20; pulmonary, 7; rehabilitation, 22; rheumatology, 4; and urology, 2.

Cleveland Clinic is a not-for-profit multi-speciality academic medical centre that integrates clinical and hospital care with research and education. It was founded in 1921 with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation.

Approximately 1500 full-time salaried physicians at Cleveland Clinic and Cleveland Clinic Florida represent more than 100 medical specialities and sub-specialities. In 2005, there were 2.9 million outpatient visits to Cleveland Clinic. Patients came from more than 80 countries.

Cleveland Clinic and Abu Dhabi’s Mubadala Development signed an agreement late last year to establish a pre-eminent world-class hospital in Abu Dhabi to be known as Cleveland Clinic Abu Dhabi.

Under the terms of the 15-year agreement, Cleveland Clinic will establish, develop and operate a world-class speciality hospital in Abu Dhabi, using the Cleveland Clinic systems, procedures, guidelines and standards. The hospital will incorporate Cleveland Clinic’s medical group model, providing a spectrum of speciality services.

The site of the new hospital will be on Al Suwwa Island, located close to the Mina Zayed Port, and across from Abu Dhabi Mall. It is scheduled to be operational in 2010.

"We’re continually developing ways to make healthcare more easily available to patients."
"Patients can now have access to the best opinions without needing to travel."

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