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INTRODUCTION
The Cleveland Clinic was founded in 1921 as a multi-specialty group practice staffed and run by four physicians who had served in a military hospital in France during World War I. The four men—Drs. Crile, Lower, Bunts, and Philips—were inspired by a vision of a healthcare system in which physicians “acted as a unit,” collaborating in ways that departed radically from the back-then norm of fiercely independent and competitive physicians and practices. In so doing, the Cleveland Clinic challenged the status quo of physicians as “heroic lone healers.”1
Over the next 101 years, the collaborative vision that gave rise to the Clinic evolved into a nonprofit healthcare system made up of 22 hospitals and 275 outpatient facilities around the globe, including Cleveland Clinic hospitals in Abu Dhabi and London. The Main Campus in Cleveland today has some 1300 hospital beds where patients are treated by over 3000 physicians supported by 40,000 other caregivers, including 11,000 nurses. In aggregate, the Clinic now employs over 77,000 caregivers worldwide—a group that includes more than 5500 physicians and scientists, 3500 advanced practice providers, 2000 trainees, and 15,000 nurses. In 2022, this group of 77,000 treated 3.4 million patients with distinction.2 The Cleveland Clinic has consistently been ranked as a top hospital in US News and World Reportrankings, with many top-ranked specialties. For example, the Clinic has been ranked #1 in the category of Cardiology and Heart & Vascular Surgery in all 29 years the rankings have been undertaken.
The stellar rankings and performance of the Clinic have also received national recognition, perhaps most memorably during President Obama’s much-publicized trip to Cleveland in 2012, when the Clinic’s practices and accomplishments were held up as a model for American healthcare. The Clinic’s reputation owes importantly to its ongoing commitment to continuous improvement in carrying out its three-part mission of “caring for life, researching for health, and educating those who serve.” One such improvement was a fundamental and innovative transformation of the Clinic’s organizational structure, or “org chart,” in 2008.
Until 2008, the Clinic was organized, like most hospitals (and colleges and their medical schools), into separate “departments” corresponding to their special areas of expertise—departments of Surgery, Internal Medicine, Neurology, and so forth. This departmental organization is a traditional structure that reflects the guild-like nature of medical training, and the bond of common experience shared by physicians working in the same specialties. Departments (or divisions) are further broken down into medical subspecialties such as Cardiology, Nephrology, Rheumatology, and Gastroenterology, and the surgical specialties of Cardiovascular Surgery, Urology, Orthopedics, and other disease-oriented surgical disciplines.
This traditional structure of guild-based departments was completely revamped in 2008 under the direction of the Clinic’s then-CEO and President, Dr. Toby Cosgrove. After joining the Clinic in 1975 and becoming chairman of its Department of Thoracic and Cardiovascular Surgery in 1989, Cosgrove was appointed CEO in 2004 (a position he held until his retirement in 2017). Early in 2008—and just weeks before one of the present writers joined the Clinic as head of its Cardiac Electrophysiology section—all the departments were reorganized and replaced by 22 new “Institutes” dedicated to serving the Clinic’s three-part mission of patient care, medical research, and continuing education of caregivers.