Talk:Cleveland Clinic

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Departed Faculty

It is notable that three top-level heart researchers have recently been let go from this well-respected research institution. The article currently reads as a puff piece without any depth of information. I tried very hard to make the addition from a neutral point of view but would welcome suggestions on holding the article to the highest standard of neutrality. Chicagolive (talk) 15:35, 6 August 2009 (UTC)

Facts and Figures

This article may need a bit of a cleanup. It has figures without citation ($2.7 billion endowment...where did this number come from?) and broken links among the references, including my favorite reference #5: "Story Not Found". No kidding.

Does this deserve the cleanup tag, or can someone who is familiar with the Clinic address some of the issues with the article?

User:Saerko —Preceding undated comment was added at 15:01, 8 January 2009 (UTC).

Historical Information

I think the article should be expanded in order to allow more of the historical actions of the Cleveland Clinic, which could include pictures like this 1. Anyone agree with me?

File:CCF-Logo.jpg

The Cleveland Clinin Foundation logo as of 2006 and before. Now outdated. Previously used on the Cleveland Clinic page.

IBHMC 01:43, 8 December 2006 (UTC)

This section ends by claiming that Cleveland Clinic "is currently the second-largest medical group practice in the world, after the Mayo Clinic." The Wikipedia article titled "Group medical practice in the United States" actually lists it as larger than Mayo Clinic, but also lists two even larger group practices in the United States, let alone what might exist in the rest of the world.

So apart from the fact that "currently" is not historical information, the statement seems to be of very questionable veracity. (It is quite possible that at one time in the past it may have been the second largest in the world.)

RayTrimble (talk) 09:18, 1 March 2010 (UTC)

I can't find a good, public/free, online, secondary source which provides the Cleveland Clinic's size rank relative to other similar organizations. I did find this from 2009 which doesn't even put Cleveland in the top 20: http://www.darkdaily.com/large-medical-groups-are-best-positioned-to-provide-integrated-care-113#axzz28Gf2Kqx5

The Grumpy Hacker (talk) 20:40, 3 October 2012 (UTC)

Respected Doctors

I added a few resprected doctors that I am aware of. However, I'm sure there are more at a hospital as large as the Clinic. If anyone knows of more, feel free to add. 69.40.240.140 23:52, 8 January 2007 (UTC)

Notable visitors

Is there a reason why the citations for this section don't work? 2,3-DPG 21:09, 1 June 2007 (UTC)

This seems to have been renamed notable patients, and goes on to list The Prince Charles of Wales. Yet searching only reveals evidence of a 1970s visit to the hospital - i can't see anything about him attending as a patient. The citation does not suggest he received treatment, only that he visited. I haven't checked the others, but it's possible that more than one of these was a visitor, not a patient. — Preceding unsigned comment added by 75.75.4.251 (talk) 03:07, 2 July 2014 (UTC)

Trauma center question

Can anyone confirm that the Cleveland Clinic's Emergency Department is a Level-II trauma center, as it says in the article? As far as I know, the ER at the Main Campus is not accredited as a trauma center. The only trauma centers in the Clinic system are Huron Hospital, Hillcrest Hospital and Fairview Hospital.

I'll look... Spencer^T♦C 00:05, 21 April 2008 (UTC)

Affiliation with Case Western Reserve University

We need to clarify what is meant by affiliation. Case Western's teaching hospital is Case Western University Hospital, the Cleveland Clinic's largest local competitor. The connection between the university and the Cleveland Clinic is that medical students can rotate at the hospital. 2,3-DPG (talk) 21:14, 13 February 2010 (UTC)

LeBron James

I think all cleveland sports players go to the Cleveland Clinic. LeBron, to me, would only be notable if he came back to the Clinic now that he's no longer playing in cleveland. Dizzizz (talk) 04:00, 28 October 2010 (UTC)

I agree. Furthermore, I do not believe notables being treated at any hospital is merits any distinction for the hospital.

Why is so much content being blanked?

I will need to keep rolling back the edits that blank so much comment unless the anonymous user is better able to explain its deletion. Without an edit summary that makes sense, it appears to resemble vandalism.

  Bfpage |leave a message  18:45, 16 May 2015 (UTC)

More Independent Sources

Cleveland Clinic “Reputation” needs some “clarification to provide readers accurate and unbiased information.

1. The National Ranking Chart is based upon three references 4, 5, 6. "5" and "6" references are from US News and World Reports. Reference “4”, a Time Magazine reference, quotes rankings from US News and World Reports.

2. US News Rankings are not unbiased nor independent. Hospitals pay US News large sums to use the US News Rankings and logo. Cleveland Clinic is one of the largest payers for licensing fees to US News for this marketing tool.

http://www.healthcarecommunication.com/Main/Articles/Should_hospitals_pay_to_promote_a_US_News_World_Re_10577.aspx

3. The references to independent ratings (no quid pro quo payment) should be included under reputation.

CMS data for Hospital Acquired Conditions (HACs) gave Cleveland Clinic a score of 8.7 (1-10 possible with 10 being the worst) placing Cleveland Clinic in the bottom 7% of all hospitals.

Ref: http://cdn.kaiserhealthnews.org/attachments/HACPenaltyChart.pdf

Leapfrog Group awarded Cleveland Clinic with the first ever “D” rating for patient safety.

Ref: http://www.healthleadersmedia.com/page-1/LED-286906/Leapfrogs-New-Safety-Report-Card-Alarms-Hospitals%29

In August 2012, Consumer Reports rated Cleveland Clinic 98th among 105 rated hospitals in the State of Ohio for overall patient safety, with a score of 39 out of 100 possible points. Nationwide, the top 10 hospitals in this survey received scores of 68 to 72, and the bottom 10 hospitals received scores of 16-25.

Ref: http://www.leapfroggroup.org/media/file/CRHospitalSafetyRatings.pdf

4. Modern Healthcare singled out Cleveland Clinic for the egregious safety violations, harm to patients, and cover-up during the CMS investigations. The Medicare/Medicaid reimbursement termination track is not based upon a the “immediate jeopardy” violation (imposed because of six unreported operating room fires in which three patients were burned, also not reported) but on violations of Conditions and Standards repeatedly during nearly a dozen CMS Surveys.

The documents in link below are the cover letters attached to each CMS Survey Form 2567 describing the survey findings shown in the Modern Healthcare article. These cover letters are the ONLY documents of CMS issuing to the Cleveland Clinic notice of termination date of Medicare/Medicaid reimbursement.

Ref: https://drive.google.com/file/d/0B6FohU_aOdk5WXEyZjBfTlJpaWs/view?usp=sharing

Patient 32 (talk) 14:21, 4 June 2015 (UTC)

Hello. There has been discussion among Jytdog and Slimvirgin and me at Jytdog's talk page. As a courtesy I am signalling them here, and either they can comment or I can solicit other review for the proposals below. We had talked about how Wikipedia responds to people who have ongoing disputes off-Wikipedia with organizations and who wish to edit Wikipedia articles about that organization. I think we came to consensus that Wikipedia policy and practice is that anyone is welcome to propose changes on an article's talk page and on the talk page, content can be reviewed for its merit without undue examination of the proposer. Historically, Wikipedia has sought to avoid hosting biased contributions, particularly from editors with a conflict of interest. Patient 32 has reported bad experiences with this hospital. I have some amount of conflict in this because I am employed by Consumer Reports, which rated this hospital. I would say more if asked, but moving on, I would like to address the content proposals.

I formatted the references you presented into citations. I also appended all but the last reference to some of the statements you made. See here -

• Hospitals, including Cleveland Clinic pay U.S. News & World Report large sums of money to use the US News Rankings and logo.
• A Kaiser Family Foundation review of data from the Centers for Medicare and Medicaid Services considered the number of patients who got hospital acquired conditions from many hospitals. In this review, Cleveland Clinic got a score of 8.7 (1-10 possible with 10 being the worst) placing Cleveland Clinic in the bottom 7% of all hospitals.
• In August 2012, Consumer Reports rated Cleveland Clinic 98th among 105 rated hospitals in the State of Ohio for overall patient safety, with a score of 39 out of 100 possible points. Nationwide, the top 10 hospitals in this survey received scores of 68 to 72, and the bottom 10 hospitals received scores of 16-25
• Leapfrog Group awarded Cleveland Clinic with the first ever “D” rating for patient safety. In this rating scheme, The D and F grades "represent the most hazardous environments for patients in need of care."

I did not format the last source because as a WP:PRIMARY source, it alone cannot be used as a source for including information into Wikipedia. I understand that you may have a journalist's reporting of this letter, and if you provide that, then that may be eligible for referencing on Wikipedia.

In my opinion, your suggestion is a good faith attempt to suggest sources and claims which can be summarized and referenced on Wikipedia. Let's see what others think of these statements. Blue Rasberry (talk) 20:20, 10 June 2015 (UTC)

In reference to only the last source (https://drive.google.com/file/d/0B6FohU_aOdk5WXEyZjBfTlJpaWs/view?usp=sharing) which requires outside references to subject documents, I offer the following references:

Reference to termination notice to the Cleveland Clinic is made in several articles:

1. The violations were all reported to Cosgrove. According to the report he was cited for systemic management failure after not informing patients that a robot would be used in procedures. http://www.washingtonpost.com/blogs/post-politics/wp/2014/06/07/ceo-of-cleveland-clinic-withdraws-name-from-consideration-as-va-secretary/

2. Last year, the Cleveland Clinic was cited for 23 health and safety issues. Plus, it received two letters warning that reimbursements for Medicare patients would be stopped if corrective action wasn't taken within days. http://www.ideastream.org/news/cleveland-clinic-cited-federal-safety-violations

3. A three-month Modern Healthcare analysis of hundreds of pages of federal inspection reports reveals the 1,268-bed hospital spent 19 months on “termination track” with Medicare between 2010 and 2013 as a result of more than a dozen inspections and follow-up visits triggered by patient complaints. http://www.modernhealthcare.com/article/20140607/MAGAZINE/306079939/cleveland-clinic-cases-highlight-safety-oversight-flaws?utm_source=frontpage&utm_medium=newsitem309&utm_campaign=carousel-traffic

4. The chief quality officer of the Cleveland Clinic Health System says he was startled the first time he read a formal threat from Medicare saying the government might cut off the funding for the system's flagship hospital for management failures that limited the hospital's capacity to render safe and adequate care. “The first time I got one of those, I said, 'Oh my God, what's all this about?'” Dr. Michael Henderson, the system's top quality executive, said in an interview with northeast Ohio's National Public Radio affiliate, WCPN. Over time, though, Henderson came to learn that such language in Medicare's termination warnings is just a part of "the standard forms" following hospital inspections with adverse findings. The Cleveland Clinic declined to make Henderson or any other executive available for interviews for Modern Healthcare's June 9 cover story, "Cleveland Clinic cases highlight flaws in safety oversight." The story reported that Medicare's only recourse for failing hospitals is to cut them out of the program, which officials are loath to do. The result, experts say, is that some hospitals end up cited repeatedly for the same types of violations, even after claiming to have resolved the problems. Medicare threatened the Cleveland Clinic with termination at least four times between 2010 and 2013, CMS documents say. http://www.modernhealthcare.com/article/20140613/BLOG/306139998/medicare-termination-really

Each one of the articles above refers to the CMS notification letters sent to the Cleveland Clinic found in this shared link. Patient 32 (talk) 15:36, 16 June 2015 (UTC)

Comment: I am responsible for previously removing the content based on both US News and World Reports and the other rankings. All of the facts laid out above appear proper. However, that said, and apologies for a long statement here, but I think there are several aspects to mention.

• The USNWR-based data was redacted because I believe that the problems with that system of rankings are not confined to the payment by hospitals to use the US News award badge, something that I understand is entirely non-obligatory, but more significantly extend to appreciable questions of methodology. My policy-based rationale for non-inclusion was that I question whether USNWR rankings are really WP:RS. However, upon reflection, the purist approach of removing the USNWR content is perhaps going to be a Sisyphean uphill battle on behalf of WP:RS policy. What I have now done is keep the rankings that were added back in, and contextualize them by stating some of the limitations, particularly those self-acknowledged by USNWR.
• The other rankings were removed because WP:UNDUE seemed to apply if the USNWR rankings are redacted. It seemed to fail WP:NPOV if one methodology was accepted and another was turned back. In my opinion, none of these models can be rigorously scientifically objective because in essence simpler acuity is being compared to more complex. The data never reflects random assignments (of similar comparator test groups), and the results of multivariate acuity score correction models are capriciously sensitive to modeling assumptions, and thus methodologically suspect. I've added these rankings back, on the grounds of "if USNWR is in, the other similar quality type of data is in too", and I added sourced contextualization as to how, for example, a D is "not good but isn't the very worst either". (For example, it overreaches to say it was "the first ever D rating". It WAS one of 121 D ratings in the first Leapfrog ranking that used D and F rather than a withheld score, and as dark as that is, it's not exactly the same.)
• In the CMS content, I think the present article text is a mildly disengaged, neutral, but accurate summarizing paraphrase, that points to the sources, but does not degenerate into blow by blow metaphrase literalism of every minutely nuanced complexity, big and small. In my opinion (but then I wrote it up !) it is WP:NPOV presently. I would expect that over time the CMS situation will be in evolution, in that I would imagine the concerns are subject to a plan of corrective action, and moreover the 19 months is not rolling on up at this juncture.
• The Advocacy issues that have been under discussion elsewhere engender my sympathy. They are separate from this commentary and the edits made.

In summary, I would have preferred that both the USNWR and other rankings both be omitted for the policy based reasons I've given, but the content is perhaps more reflective of a mid-road view now. I've made the explained edits, and I am done with this, and I will let others take it up from here forward. FeatherPluma (talk) 04:25, 21 June 2015 (UTC) and subsequently modified. FeatherPluma (==Affiliation with Case Western Reserve University== 10:10, 23 June 2015 (UTC)

New First Paragraph with Additional Data

A new paragraph has been inserted to provide a more substantial introduction to the organization. I work for Cleveland Clinic and am voluntarily fixing up this page to make it as useful as possible to Wikipedia users. There will be more to come. I am a Wikipedia editorial neophyte and look forward to the help of other editors and the those who have already given this page such thoughtful consideration.HealthMonitor (==Affiliation with Cleveland Clinic== August 25, 2015)

Thanks for stopping in. I noticed that you are citing a book self-published by Cleveland Clinic - o Act as a Unit: The story of the Cleveland Clinic. Because it is self-published, its content probably falls under self-published sources guidelines, so be mindful that Wikipedia usually disallows information from these kinds of sources. I appreciate your bringing this source and its content here - some of it is a great foundation for presenting basic information about the organization.

If you have any questions about using Wikipedia then feel free to ping me. Also, consider saying hello at WikiProject Medicine where most of the health editors meet. Blue Rasberry (talk) 20:24, 28 August 2015 (UTC)

Blue Rasberry: I'm in a quandary regarding "To Act as a Unit". Most of the information sourced to that book is available in other publications or websites, but they all cite "To Act as a Unit" as their primary source. I have access to the sources from which "To Act as a Unit" was derived, but that would mean citing unpublished archival material, or even less accessible published sources. What do you think? HealthMonitor —Preceding undated comment added 03:26, 29 August 2015 (UTC)

These things may not be relevant - the issue is that Wikipedia should be a summary of what reliable sources have said on a topic. "Reliable sources" is Wikipedia jargon and means something specific - in this case, it means sources which are not written/published/funded by Cleveland Clinic for the purpose of Cleveland Clinic promoting itself. Wikipedia takes the position that when information only appears in self published sources (which are not "reliable"), that information should not appear in Wikipedia, because it disrupts neutral point of view.

Since most information about any given organization is self published, and never appears in other sources, that also means that most information about any given organization is not appropriate for Wikipedia. The line which makes information appropriate for inclusion is when someone not paid by an organization published the information. So if independent writing has not covered a topic, then that topic should not be included in Wikipedia, even if the topic is fundamental to the organization's own self-published branding.

Back to the book - the book can clarify details, but since the book was published by Cleveland Clinic as a promotional tool, the article should not cover information only found in the book and not in independent sources.

What do you think? Is the book promotional? Who funded its creation and publishing? The details which other writers outside the clinic have covered based on the book are appropriate for inclusion. Blue Rasberry (talk) 11:12, 29 August 2015 (UTC)

Bluerasberry: I understand what you're saying. I'm going to go over the points that cite "To Act as a Unit" and find other sources. In defense of "To Act as a Unit", though, while it was published by the organization, it is not promotional,. It includes historical material that does not necessarily make Cleveland Clinic look good. It's a very sober and dry account. But I'll try and replace it going forward. HealthMonitor (talk) 13:54, 29 August 2015 (UTC)HealthMonitor

HealthMonitor Dual sourcing is nice too - the book, and also some independent commentator which either cite the book or which says the same thing.

There are a handful of clinics in the world which have a documented history like the one you have in this book. It is dry, but the very existence of a work like that is promotional, especially when it is funded in-house, and especially in the absence of external publications. If you want to establish the book's credibility, then bring some information from the book which covers a scandal in Cleveland Clinic's history. If there is nothing like that in the book, then either Cleveland Clinic has never had a scandal, or whomever wrote the book was influenced to adhere to an agenda. Group Health Cooperative produced one of these histories also - I worked with that text for weeks but ultimately could not reconcile it with criticism and had doubts about several parts of it. It was published by a historical society, but it still had ties to the organization. Thanks for being thoughtful about this - your contributions here are great. Blue Rasberry (talk) 14:23, 29 August 2015 (UTC)

Bluerasberry: Thanks for the advice. There is in fact a lot of material from the book that is unflattering enough to establish its credibility. There is still a lot to add to this article. Thanks again. — Preceding unsigned comment added by HealthMonitor (talk • contribs) 21:28, 29 August 2015 (UTC)

Rankings

The Rankings section was taken out, both the U.S. News and the Leapfrog and CMS, for promoting apples and oranges comparisons. Johns Hopkins' Wikipedia page does not include its U.S. News rankings.HealthMonitor (==Affiliation with Cleveland Clinic== August 28, 2015)

HealthMonitor Can you say more about why you think US News, Leapfrog, and CMS are not reliable sources for reviewing the services provided by Cleveland Clinic? Wikipedia tries to summarize the best available sources. What about these makes them unreliable? Blue Rasberry (talk) 20:18, 28 August 2015 (UTC)

Bluerasberry: Thanks for your reply. US News, Leapfrog and CMS are all reliable in their own way. But I was worried that they were being presented as competitive yardsticks, when really they measure different things. It seemed like some kind of argument was starting up. The validity and comparability of hospital rankings is a huge subject and could easily be an article in its own right. HealthMonitor —Preceding undated comment added 03:16, 29 August 2015 (UTC)

HealthMonitor Fortunately Wikipedia does not concern itself with validity of information - it only judges sources by reliable source criteria. There is supposed to be a summary of the coverage which reflects the weight of the publications. I agree that the weight and presentation of the ratings was problematic, and it might be good to remove everything that was there. But I am not ready to say that the sources were invalid, or that the publishers were not authorities in their field. Some of the information there did have standing as expert point of view, whatever criticism there may be of the experts.

Was there anything there that you found salvageable? I will look again, but I thought I would get your opinion first. All of those organizations have some esteem as reviewers of hospitals, and their reviews are the best that have been provided. Do you know of better reviews of the clinic? Blue Rasberry (talk) 11:16, 29 August 2015 (UTC)

Bluerasberry: There is no question that the sources are valid. It would be possible to post many third party evaluations that make the Clinic look good. But one of my goals in revising the Cleveland Clinic site was to remove anything that might seem promotional or puffy. In the same way, someone could post many evaluations that put the Clinic in an unfavorable light. Both positive and negative would be based on selective data. So it might be best to set the whole question aside, or address the issue of hospital rankings in a separate article.HealthMonitor (talk) 12:43, 29 August 2015 (UTC)HealthMonitor

Thanks. No hurry for any of this and you are doing great. Blue Rasberry (talk) 14:24, 29 August 2015 (UTC)

Beautiful images - uncertain copyright status

An employee of the organization just added some beautiful facility images with uncertain copyright status. I am discussing this on that person's userpage at User_talk:HealthMonitor#About_those_images. Blue Rasberry (talk) 15:37, 16 September 2015 (UTC)

Reversion?

Elvey: May I ask, why the reversion? — Preceding unsigned comment added by HealthMonitor (talk • contribs) 01:36, 13 October 2015 (UTC)

Why do you ask I question I already answered in my edit summary? Did you not read it?--Elvey^(t•c) 08:22, 13 October 2015 (UTC)

Elvey: Thanks for your reply. I have removed all references to books, publications and websites controlled by the subject of the article. All facts are referenced by third parties. I have posted a request for edits below. I hope this has been done properly. HealthMonitor — Preceding unsigned comment added by HealthMonitor (talk • contribs) 17:02, 13 October 2015‎

Elvey deleted 40kb of content and HealthMonitor dropped a changed version of those 40kb of content here on this talk page. I reverted both of these changes. Let's all talk before making big changes.

Elvey - good call in demanding an explanation from HealthMonitor. Obviously this person has a relationship with Cleveland Clinic because they say on their talk page that they work there. Healthmonitor - thanks for coming to Wikipedia and making a good faith effort to comply with the rules. We all are aware that Wikipedia has a troubled history of being attacked by public relations staff of every organization on earth, and that the volunteers tire quickly of arguing with paid employees who have an agenda and push against Wikipedia rules. I would like to give my personal opinion that HealthMonitor has made an attempt to comply with Wikipedia rules, and has been in good communication with this talk page, and has responded well to criticism in the past.

Elvey - can you elaborate on your complaint that "Revert edits which consist of undisclosed paid/sponsored advocacy. Disclosure within an article is not allowed by Wikipedia policy; authorship attribution is normally limited to edit histories. Undisclosed paid promo. content violates FTC regulations", which you wrote in the edit summary? Can you point out 1-2 specific things which conflict with Wikipedia rules? Are you really asserting that this content is problematic in entirety, or do you see some particular problems?

I could criticize this content also. I like to see references after every sentence per Wikipedia's verifiability rules, and I like for all references to go to reliable sources (meaning not self-published by Cleveland Clinic), but among the content which I think needs development I see also some things that I like.

May I ask for a little deeper criticism? It is not efficient to bat around 40kb of text, and I wonder if we can focus on specific problems as we examine this. Blue Rasberry (talk) 19:46, 13 October 2015 (UTC)

I don't dispute that HealthMonitor has made an attempt to comply with Wikipedia rules, however, undisclosed paid promo. content violates FTC regulations and thereby conflicts with Wikipedia rules. (What part of "Revert edits which consist of undisclosed paid/sponsored advocacy. Disclosure within an article is not allowed by Wikipedia policy; authorship attribution is normally limited to edit histories. Undisclosed paid promo. content violates FTC regulations" DO you understand?) I would certainly be open to offering deeper criticism - however first the criticism I already offered ought be responded to more substantively. Until then, you're edit warring by reverting and more importantly, you need to be aware that adding undisclosed paid promo. content that violates FTC regulations and thereby conflicts with Wikipedia rules - even if it's you adding the content by reverting my revert. I ask that you reconsider and undo your revert while discussion continues. I see you saw my comment on User_talk:HealthMonitor where I've already offered deeper criticism.

Contributions that violate US law are not welcome here. For information on how to contribute to Wikipedia when you have a conflict of interest, see the conflict of interest guideline and frequently asked questions for organizations. In particular, HealthMonitor has failed to

• avoid editing or creating articles related to this organization. And Bluerasberry has edited to perpetuate edits that fail to do that!
• exercise great caution so that not to violate Wikipedia's content policies.

Finally: All contributors must not contribute content that violates conflict of interest laws (just as all contributors must respect copyright). The Unfair Commercial Practices Directive is valid throughout the European Union. In a German court decision in 2012 (that also relied on the directive) regarding Wikipedia: "The court held that when a company edits a Wikipedia article, the resulting text falsely creates the impression that the edit has no business-related purpose. By implication, the judges found that the average reader of Wikipedia articles expects to find objective and neutral information" rather than content written by a paid advocate such as yourself. That is a very very important condition, comparable to the FTC Guide" that consumers are likely to believe reflects the opinions, beliefs, findings, or experience of a party other than the sponsoring advertiser”. This expectation by consumers of neutral information on Wikipedia, requires that companies not write "their" WP articles for PR/marketing purposes. It is essential to achieve consensus on the conflict between this content that I removed and FTC Guide and policy. Understood? --Elvey^(t•c) 20:27, 13 October 2015 (UTC)

Elvey: Please point out where the content was not factual or poorly sourced, and I will be happy to correct or remove those sentences. — Preceding unsigned comment added by HealthMonitor (talk • contribs) 23:13, 13 October 2015 (UTC)

Elvey

1. It is against site policy to attempt to apply law to Wikimedia guidelines. Talking about the FTC ruling is out of bounds. Wikipedia:Wikilawyering and Wikipedia:No legal threats say more about this. If you do have a legal concern then site guidelines are to escalate it to the Wikimedia legal team immediately, which I would help you do, but I hope we can come to agreement to not talk about what is legal or illegal. So far as I understand, the options are leaving this part out or contacting WMF legal. Do you see other options?
2. We can talk about Wikipedia conflict of interest rules. You called healthmonitor's edits "Undisclosed paid promo", but this person has disclosed their work affiliation on his user page and all over this talk page. In my opinion they are complying with disclosure policy beyond what the Wikipedia community expects. This person has been responsive to feedback for weeks in a way that I have rarely see as compared to problem contributors listed at WP:COIN. Beyond disclosure on the user page and this talk page, what more do you request? Also - this person is not an official representative of the organization. They are presenting themselves as someone with a work affiliation who is a fan of the organization, which is different than being an official PR spokesperson. Healthmonitor has been very human in conversation and not at all like the usual uncompromising corporate brick wall.
3. Assuming that we put aside discussing legal issues, and assuming that we can keep compliance with disclosure guidelines, what do you have to say about the content? I have already critiqued a bit of it as it was slowly developed. Healthmonitor kept some things and removed others. All of the changes can be discussed, but to do this I would like to get to a point where we confirm that the user is acting in compliance so that the content can be considered for what it is. How can we examine the content? Do you want it copied here to the talk page and considered piecewise? Should we consider it from the edit history? I do not intend to burden you with reviewing the content, especially when you have doubts about it, but if there is a review process, I want it to happen in a way that makes you feel safe in a process which has Wikimedia community support. How would you feel about considering the content by section, and my seeking feedback from WP:COIN, WP:HOSPITAL, and maybe WP:MED? Blue Rasberry (talk) 11:48, 14 October 2015 (UTC)

Restore

Would anyone object to the restoration of the article as it stood on (I believe) October 13, 2015? That was a version that was shorn of any references that sourced books, magazines, or websites controlled by the subject of the article, in response to editor Elvey's comments. HealthMonitor —Preceding undated comment added 14:17, 15 October 2015 (UTC)

In this edit at the conflict of interest noticeboard discussion, Slimvirgin advised using {{edit request}} to propose changes. SV said "the best way forward is to break the rewrite down into individual edit requests", which I am doing below. Can anyone who has criticism for these sections please speak up? Blue Rasberry (talk) 00:08, 19 October 2015 (UTC)

Propose to add this content from HealthMonitor Blue Rasberry (talk) 00:08, 19 October 2015 (UTC)

History

Early Beginnings

George Washington Crile, MD, one of the four founders of Cleveland Clinic.

Cleveland Clinic grew out of the surgical practice of Frank J. Weed, MD, at 16 Church Street on the near west side of Cleveland. Dr. Weed died in 1891. The practice was purchased by his two assistants, Frank E. Bunts, MD, and George Washington Crile, MD. In 1892, they brought Dr. Crile’s cousin, William E. Lower, MD, into the practice. In 1897, they moved their practice to the Osborn Building on Prospect Avenue in downtown Cleveland. Crile, Lower and Bunts all became professors at Cleveland medical schools, and each would be elected president of the Academy of Medicine.

Dr. Crile organized the American military hospital in Paris in 1915, and later led the United States Army Base Hospital No. 4, in Rouen, France. It was the first contingent of the United States Army to see active duty in Europe during the First World War. Dr. Bunts and Dr. Lower also served in the Rouen hospital. Dr. Lower later wrote of his admiration for the "teamwork and efficient organization" of military medicine. In his autobiography, Dr. Crile reports that while in France, the three doctors discussed starting a new medical center in Cleveland upon their return.

Propose to add this content from HealthMonitor Blue Rasberry (talk) 00:08, 19 October 2015 (UTC)

First years of operation.

A four-story outpatient building was constructed on the purchased land. Cleveland Clinic was dedicated at a private ceremony on February 26, 1921. William Benson Mayo, MD, of the Mayo Clinic, delivered the main address. On February 28, 1921, Cleveland Clinic opened its doors to the public and registered 42 patients. In April 1921, Cleveland Clinic had 60 employees, including 14 physicians, four nurses, a telephone operator, six cleaners, 22 clerical workers, an art department, and an unknown number of laboratory technicians. In 1922, the founders purchased four private homes nearby for hospitalization, radiation treatment, and administration. A fifth house was acquired as a residence for patients with diabetes receiving insulin treatments. To meet rising patient volume, a 184-bed hospital was built in 1924, located at East 90th Street and Carnegie Avenue. A power plant, laundry, and ice plant were also built. A research laboratory was constructed in 1928.

Propose to add this content from HealthMonitor Blue Rasberry (talk) 00:08, 19 October 2015 (UTC)

Disaster and Recovery

On May 15, 1929, nitrocellulose x-ray films stored in the basement of the outpatient building ignited. An explosion sent a cloud of toxic oxides of nitrogen and carbon though the building. One hundred and twenty-three people lost their lives, including founder Dr. Phillips. A dozen investigating agencies were not able to determine a single cause for the Cleveland Clinic fire of 1929. Cleveland Clinic’s own inquiry narrowed the possible causes down to three: spontaneous combustion caused by heat; a discarded cigarette or match; contact with an extension cord light hung over a stack of films.

Philanthropist Samuel Mather formed a committee of 36 community leaders to help Cleveland Clinic reestablish itself in temporary quarters across the street. Patient care services resumed five days later. The 1921 building was completely renovated, and a new three story clinic building, with a new main entrance, was added in 1931. All debts were repaid by 1941.

Propose to add this content from HealthMonitor Blue Rasberry (talk) 00:08, 19 October 2015 (UTC)

The years 1941-1989

Dr. Crile and Dr. Lower relinquished their administrative duties in 1941. In 1942, Cleveland Clinic’s Naval Reserve Unit, which included George Crile, Jr., MD, son of one of the founders, established a mobile hospital in New Zealand to treat wounded from the Guadalcanal Campaign.

Growth of Specialization

Cine-coronary angiography was developed at Cleveland Clinic by F. Mason Sones, MD, in the late 1950s.

Leadership

In 1954, Cleveland Clinic formally adopted governance by a physician-led Board of Governors. The nine physician governors are elected by the physician staff. They work with the CEO and lay administrators to formulate and carry out policy, overseen by a board of directors and board of trustees This is a list of the chairman of the Board of Governors, and their terms of office:

• Fay Lefevre, MD, 1954-1968
• Carle E. Wasmuth, MD, 1968-1973
• William S. Kiser, MD, 1973-1989
• Floyd D. Loop, MD, 1989-2004
• Delos M. Cosgrove, MD, 2004–present.

Organization

Up until 2007, Cleveland Clinic's the largest organizational unit was the division, with the hierarchy being: division > department > section. There was a Division of Medicine, Division of Surgery, Division of Anesthesiology, etc. Within each division were departments (Department of Infectious Disease, Department of Cell Biology, etc.). Within each department were sections, (Section of Headache and Facial Pain, Section of Metastatic Disease, etc.). Divisions and departments were led by chairs, and section were led by heads. In 2007, Cleveland Clinic reorganized patient care services around disease and organ-system-based institutes.

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Growing Facilities

Cleveland Clinic built new operating rooms in the early 1970s to accommodate the growth of cardiac surgery. The Martha Holding Jennings Education Building opened in 1964, with an auditorium named for Dr. Bunts. A new hospital building (currently home to Cleveland Clinic Children’s) was opened in 1966, and a new research building went up in 1974 (demolished in 2007). A pathology and laboratory medicine building was constructed on Carnegie Avenue in 1980.

Cleveland Clinic Taussig Cancer Institute.

Dr. Kiser led the development of a strategic plan to accommodate growing patient volumes in the late 1970s. This resulted in a group of buildings known as the Century Project. Completed in 1985, the Century Project including a 14-story outpatient building (now known as the Crile Building), designed by architect Cesar Pelli,.

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Becoming a system.

Dr. Loop was appointed chairman of the Board of Governors in 1989.

In the late 1990s, Cleveland Clinic merged with nine regional hospitals: Marymount Hospital, Lakewood Hospital, Fairview Hospital, Lutheran Hospital, South Pointe Hospital, Euclid Hospital, Health Hill Hospital, and Ashtabula County Medical Center (an affiliate hospital). (Medina Hospital joined the system in 2009; Akron General Hospital became an affiliate in 2015.)

For access from local communities, Cleveland Clinic began building what are now 18 Family Health and Service Centers across the region. These facilities offer primary care, specialty services and outpatient surgery.

Other Cleveland Clinic programs and facilities dating from 1998-2004 include the Sherwin Research Building, Children’s Hospital, Cleveland Clinic Innovations, the Surgery Center, Neurological Imaging Center, Cleveland Clinic Sports Health, Intercontinental Hotel and Bank of America Conference Center. During this period also, Cleveland Clinic invested in electronic medical records system that now links all its sites.

Cleveland Clinic Florida (begun in Ft.Lauderdale in 1988) opened a medical campus in Weston, Florida, with a hospital, outpatient clinic and 24-hour emergency room. It now includes offices in West Palm Beach.

Dr. Loop launched a capital campaign in 1997 with a $16 million lead gift from the Norma and Al Lerner and family. This campaign raised $191 million to build the Lerner Research Institute, Cole Eye Institute, and Taussig Cancer Center. Another gift from the Lerner family enabled the launch of the Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University (CWRU) School of Medicine in 2004. A $44 million Center for Genomics Research was completed in 2004, along with a new parking garage across the street from the 1921 building. In 2001, Dr. Loop announced plans for a new home for heart and vascular services. The campaign to finance the project continued after his retirement in 2004.

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2004 to present

Patient drop-off roundabout and fountain at Cleveland Clinic's main entrance.

Appointed CEO and president in 2004, Dr. Cosgrove modified and oversaw the completion of the planned heart and vascular building, and a tower for urology and nephrology services. The four-million square foot Sydell and Arnold Miller Family Pavilion and Glickman Tower opened in 2008, with 16 operating rooms, 278 private patient rooms, and four ICUS. This project also included a power plant, and garage and service center on East 89th street, which is linked to the main campus through a series of underground tunnels, and served by a fleet of 82 automated guided vehicles.

Cleveland Clinic made all its properties smoke-free in July 2005, and stopped hiring smokers in 2007. In March 2007, Cleveland Clinic eliminated trans fats from patient and cafeteria meals, reduced access to sugared beverages, and offered employees incentives through its health plan to lose weight, exercise, and manage chronic disease. An Office of Patient Experience was established at Cleveland Clinic in 2005, administered by a chief experience officer.

Beginning in 2005, all Cleveland Clinic patient care services were required to publish annual reports of quality improvement statistics, volumes, outcomes, mortality and other data. These Outcomes books are available in print and online for the reference of referring physicians and the public. Physician biographies on the Cleveland Clinic website include industry relationships and potential conflicts of interest, as well as one-to-four star patient ratings and comments taken from patient surveys.

The delivery of patient care services were reorganized in 2007. The traditional divisions of Medicine and Surgery were dissolved and replaced by integrated practice units called institutes. Each institute combines the medical and surgical departments for a particular body system or disease (e.g., Heart & Vascular Institute, Digestive Disease Institute, Orthopaedic & Rheumatology Institute), under a single leadership, under the same roof.

The Zielony Institute for Nursing Excellence oversees practice and education for 12,000 inpatient, outpatient, rehabilitation and home care nurses.

Cleveland Clinic's Glickman Tower, adjoining the Miller Family Pavilion.

Cleveland Clinic Canada opened in 2008 on the 30th floor of Brookfield Place in downtown Toronto, to offer wellness screenings, sports health, and preventive services. The Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas was opened in 2009, with services from the Neurological Institute and Glickman Urological & Kidney Institute, in a building designed by architect Frank Gehry. The Tomsich Pathology Laboratories opened on Carnegie Avenue and East 101st Street in 2012. Cleveland Clinic Florida opened offices in West Palm Beach, and dedicated the Egil and Pauline Braathen Center for neurology and cancer services in 2015. Upcoming projects at Cleveland Clinic include a new 377,000 square foot seven-floor cancer treatment facility to house all outpatient cancer care on the main campus, scheduled for completion in 2017. Also being planned is a new Health Education Campus to house the Cleveland Clinic Lerner College of Medicine of the Case Western Reserve University School of Medicine, the CWRU School of Medicine, CWRU School of Dental Medicine, CWRU's Frances Payne Bolton School of Nursing, and allied health education programs. The Foster and Partners-designed building is currently under construction across from Cleveland Clinic’s main entrance on Euclid Avenue.

In January 2015, Cleveland Clinic announced the closure of Lakewood Hospital in Lakewood, Ohio. The 108-year-old facility was reportedly operating at a loss between 2005 and 2015. The announcement of the closure was controversial among residents in the area with former US Representative Dennis Kucinich stating that Cleveland Clinic plotted to close and demolish the hospital. According to Kucinich, the move "would produce life-threatening transportation delays for people" and that the Cleveland Clinic manipulated its numbers to make the hospital seem like it did not make a profit. The Cleveland Clinic said it would continue to work with the Lakewood community through the closure process.

In September, 2015, the clinical laboratory at Marymount Hospital, located in Garfield Heights, Ohio, was cited for six major violations by the Centers for Medicare and Medicaid Services (CMS). More than twelve lesser violations were also noted, including deliberate falsification of results. No patients were harmed. Cleveland Clinic transferred the laboratory director to another job and terminated approximately 12 employees as a result of the findings. Cleveland Clinic is revising policies at Marymount Hospital, retraining personnel, and reviewing all laboratory operations at its community hospitals.

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National and International Patients

Cleveland Clinic treats patients from all 50 states and 90 countries. Seventy-two percent of Cleveland Clinic’s patients came from northeast Ohio, and 16 percent from other parts of Ohio. Twelve percent are from the other 49 states, and 1.7 percent are international. Cleveland Clinic Global Patient Services (GPS) provides services for patients coming for treatment from outside the United States. GPS has patient service coordinators, financial counselors, and interpreters available in 98 languages.

United Arab Emirates

Cleveland Clinic manages Shaikh Khalifa Medical City (SKMC), for with SEHA, the Abu Dhabi Health Services Company, in an arrangement dating to 2007. SKMC consists of a 586 bed acute care hospital, 14 outpatient clinics, and a 125 bed behavioral sciences center and urgent care center located within the city of Abu Dhabi. Cleveland Clinic Abu Dhabi opened in 2015. A partnership with Mubadala Healthcare of UAE, Cleveland Clinic Abu Dhabi offers medical services in 30 specialties and subspecialties in a 13 floor clinic and hospital with 364 beds (expandable to 490), on five clinical floors. It is operated on the Cleveland Clinic physician-led model of collaborative medicine.

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Model of Medicine

Not for Profit Group Practice

Cleveland Clinic caregivers crossing the main campus.

Cleveland Clinic is a nonprofit organization and group medical practice in the United States. No one owns Cleveland Clinic, and marginal revenues are reinvested in the purposes named in its articles of incorporation, including patient care, the operation of hospitals, research, education and to provide community benefit, as defined by the Internal Revenue Service (that is, programs or activities that provide treatment and promote health and healing as a response to identified community needs).

Salaried Physicians Cleveland Clinic has staff physicians in 130 specialties and subspecialties. All Cleveland Clinic staff physicians are paid a salary, and are on one year contracts. All staff physicians undergo an annual performance review (APR), plus two-a-year ongoing professional practice evaluations. Contracts are renewed and salaries are determined based on the APR. The APR assesses the physician’s benchmarked performance in patient care, education, research, professional activities, and patient satisfaction. The reviewer will also take into account the subjective qualities of leadership, collegiality, and innovation. The discussion is two-way, with physicians having an opportunity to voice concerns or request additional resources.

Patient-Centered Institutes Patient care services are carried out through 26 institutes. Institutes are integrated practice units that combine the medical and surgical departments for specific diseases or body systems under a single leadership in a single location, e.g., the Digestive Disease Institute, which contains the departments of Gastroenterology & Hepatology, General Surgery, Colorectal Surgery, a Bariatric & Metabolic Institute, Center for Human Nutrition, and Ileal Pouch Center.

An Integrated System All Cleveland Clinic facilities and locations share the same rules, practices and protocols. They are linked by a system of critical care transport that uses ambulances, jets and helicopters to transfer patients to the particular facility best equipped to treat their condition. They are also linked by a shared electronic medical records system that allows a physician at any location to access a patient’s medical record, including images, at any Cleveland Clinic site.

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Research

View of the Cleveland Clinic Lerner Research Institute.

The Cleveland Clinic Lerner Research Institute had an annual research expenditure of approximately $250 million in 2008. The Cleveland Clinic Lerner College of Medicine of Case Western Reserve University opened in 2004. Cleveland Clinic’s graduate medical education program is one of the largest in the country.

Case Mix Index

The Case Mix Index is a metric used by the Centers for Medicare and Medicaid Services (CMS) to measure the complexity and diversity of the patients and associated resources at a hospital or medical center. Cleveland Clinic's Case Mix Index is 2.338595, according to the most recently posted CMS data. This is in the upper one percent of comparable American hospitals, and indicates that Cleveland Clinic treats a significant number of patients with severe diseases and complex comorbidities.

Finances and Economic Impact

According to data analyzed by American Hospital Directory, annual gross total patient revenues of $9.14 billion were the second largest in the US in 2011. A 2013 report shows that Cleveland Clinic had an economic impact on Northeast Ohio of $12.6 billion, supporting 93,000 jobs in Northeast Ohio, and $5.9 billion in wages and benefits.