Cleveland Clinic: Difference between revisions

	File:Cleveland Clinic logo.png
	The Main Entrance of Cleveland Clinic on Euclid Avenue. Cleveland Clinic's Miller Family Pavilion and main entrance on Euclid Avenue.
Geography
Location	9500 Euclid Avenue, Cleveland, Ohio 44195, United States
Organization
Care system	Private
Type	Academic
Affiliated university	Case Western Reserve University School of Medicine Cleveland Clinic Lerner College of Medicine
Services
Beds	1440
History
Opened	1921
Links
Website	www.clevelandclinic.org
Lists	Hospitals in the United States

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Revision as of 13:45, 17 October 2015

Cleveland Clinic is an academic medical center providing patient care services supported by research and education in a nonprofit group practice setting.^[1]^[2]^[3] Cleveland Clinic’s 3,150 staff physicians and scientists work in 130 medical specialties and subspecialties.^[4] In 2014, Cleveland Clinic had 5.5 million outpatient visits, 53,337 acute admissions, 25,727 surgeries and 112,042 emergency department visits at all its facilities. Cleveland Clinic treats patients from 50 states and 100 different countries.^[5]^[6] It is one of the five largest group practices in America.^[7]

Patient Care Services

Cleveland Clinic offers patient care services in these major categories:^[8]

Cardiology
Cardiac Surgery
Urology
Cancer Treatment
Nephrology
Neurology
Neurological Surgery
Orthopedic Surgery
Rheumatology
Gastroenterology
Gastrointestinal Surgery
Colon and Rectal Surgery
Gynecology
General Surgery
Pulmonology
Ear, Nose and Throat
Ophthalmology
Psychiatry and Psychology
Geriatrics
Bariatric Surgery
Dermatology
Plastic Surgery
Pediatrics

Within the categories above, Cleveland Clinic also offers these services:^[8]

• Acupuncture • Addiction Medicine • Addiction Psychiatry • Adolescent Medicine • Allergy Treatment • Child & Adolescent Psychiatry • Child Neurology • Cardiac Electrophysiology • Congenital Cardiac Surgery • Critical Care - Pediatric Critical Care Medicine • Diabetes Treatment • Diagnostic Radiology • Emergency Medicine • Endovascular Surgical Neuroradiology • Epilepsy Surgery • Family Medicine • General Practice • Medical Genetics • Gynecologic Oncology • Hand Surgery • Hematology • Hepatology • Holistic Medicine • Hospice & Palliative Medicine • Immunology • Infectious Disease • Internal Medicine • Interventional Cardiology • Neonatal-Perinatal Medicine • Neurodevelopmental Disabilities • Vascular Neurology • Neuroradiology • Neurotology • Nuclear Medicine •Nuclear Radiology • Obstetrics • Occupational Medicine • Optometry • Oral & Maxillofacial Surgery • Spinal Surgery • Pediatric Orthopedic Surgery • Sports Medicine • Osteopathic Manipulative Medicine • Pain Management • Pediatric Allergy/Immunology • Pediatric Anesthesiology • Pediatric Cardiology • Pediatric Emergency Medicine • Pediatric Endocrinology • Pediatric Gastroenterology • Pediatric Hematology-Oncology • Pediatric Infectious Disease • Pediatric Nephrology • Pediatric Neurological Surgery • Pediatric Pulmonology • Pediatric Rehabilitation Medicine • Pediatric Rheumatology • Pediatric Sports Medicine • Pediatric Surgery • Pediatric Urology • Physical Medicine & Rehabilitation • Public Health & General Preventive Medicine • Pulmonary Critical Care Medicine • Radiation Oncology • Fertility Treatments • Sleep Medicine • Surgical Oncology • Transplant Surgery • Vascular & Interventional Radiology • Vascular Medicine

Locations

Cleveland Clinic's main campus consists of 41 buildings on 160-acres near University Circle, in Fairfax, Cleveland.^[9] Cleveland Clinic operates 18 family health and ambulatory surgery centers in surrounding communities, a multispecialty hospital and family health center in Weston, Florida, an outpatient clinic in Toronto, Ontario.^[10]

The Cleveland Clinic health system has 9 regional hospitals, 18 family health centers, and hospital, clinics and offices in Florida, Nevada, Canada and Abu Dhabi:

Main Campus, Cleveland, Ohio
Cleveland Clinic Children's Hospital is located within the main campus; there is a nearby rehabilitation center in Cleveland's Buckeye-Shaker neighborhood.
Euclid Hospital, Euclid, Ohio
Fairview Hospital, Cleveland, Ohio
Hillcrest Hospital, Mayfield Heights, Ohio
Lakewood Hospital, Lakewood, Ohio
Lutheran Hospital, Cleveland, Ohio
Marymount Hospital, Garfield Heights, Ohio
Medina Hospital, Medina, Ohio
South Pointe Hospital, Warrensville Heights, Ohio
Cleveland Clinic Florida, Weston, Florida
Cleveland Clinic Florida - West Palm Beach, Florida
Lou Ruvo Center for Brain Health, Las Vegas, Nevada
Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates^[11]

In September, 2015, Cleveland Clinic announced that it would exercise its option to take full control of the Akron General Health System, in which it has had minority ownership since 2014. State and federal approval is pending.^[12]

Same-Day Appointments

In 2012, Cleveland Clinic began offering same-day appointments to those who call the Cleveland Clinic general appointment number before noon. Cleveland Clinic CEO Delos M. Cosgrove reports that Cleveland Clinic saw more than a million same-day visits in 2014.^[13]^[14]^[15]

History

Early Beginnings

Cleveland Clinic grew out of the surgical practice of Frank J. Weed, MD, at 16 Church Street on the near west side of Cleveland.^[16] Dr. Weed died in 1891.^[17] 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.^[18] In 1897, they moved their practice to the Osborn Building on Prospect Avenue in downtown Cleveland.^[16]^[19] Crile, Lower and Bunts all became professors at Cleveland medical schools, and each would be elected president of the Academy of Medicine.^[20]

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.^[21]^[22] 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.^[23] In his autobiography, Dr. Crile reports that while in France, the three doctors discussed starting a new medical center in Cleveland upon their return.^[22]^[24]

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.^[25] William Benson Mayo, MD, of the Mayo Clinic, delivered the main address.^[24]^[26] On February 28, 1921, Cleveland Clinic opened its doors to the public and registered 42 patients.^[20] 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.^[27] A fifth house was acquired as a residence for patients with diabetes receiving insulin treatments.^[27]^[28] To meet rising patient volume, a 184-bed hospital was built in 1924, located at East 90th Street and Carnegie Avenue.^[1] A power plant, laundry, and ice plant were also built.^[27]^[29] A research laboratory was constructed in 1928.^[27]^[30]

Disaster and Recovery

On May 15, 1929, nitrocellulose x-ray films stored in the basement of the outpatient building ignited.^[31]^[32]^[33] 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.^[32] 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.^[32]

Philanthropist Samuel Mather formed a committee of 36 community leaders to help Cleveland Clinic reestablish itself in temporary quarters across the street.^[32]^[34]^[35] Patient care services resumed five days later.^[34] The 1921 building was completely renovated, and a new three story clinic building, with a new main entrance, was added in 1931.^[32] All debts were repaid by 1941.^[36]

The years 1941-1989

Dr. Crile and Dr. Lower relinquished their administrative duties in 1941.^[29] 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.^[37]

Growth of Specialization

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^[3]^[36] 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.^[29]^[39]

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.^[40] Within each division were departments (Department of Infectious Disease, Department of Cell Biology, etc.).^[40] 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.^[40] In 2007, Cleveland Clinic reorganized patient care services around disease and organ-system-based institutes.^[40]^[41]^[42]

Growing Facilities

Cleveland Clinic built new operating rooms in the early 1970s to accommodate the growth of cardiac surgery. ^[29] 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).^[29] A pathology and laboratory medicine building was constructed on Carnegie Avenue in 1980.^[40]

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,^[43].

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.) ^[44]^[45]^[46]^[47]

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.^[3]^[48]

Other Cleveland Clinic programs and facilities dating from 1998-2004 include the Sherwin Research Building, Children’s Hospital, Cleveland Clinic Innovations,^[49] 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. ^[50]^[51]

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.^[3]^[52]

Dr. Loop launched a capital campaign in 1997 with a $16 million lead gift from the Norma and Al Lerner and family.^[53] This campaign raised $191 million to build the Lerner Research Institute, Cole Eye Institute, and Taussig Cancer Center.^[3] 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.^[54] A $44 million Center for Genomics Research^[55] was completed in 2004, along with a new parking garage across the street from the 1921 building.^[1]^[56] 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.^[3]

2004 to present

Appointed CEO and president in 2004, Dr. Cosgrove^[57] 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.^[58]^[59]

Cleveland Clinic made all its properties smoke-free in July 2005, and stopped hiring smokers in 2007.^[60] 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.^[61] An Office of Patient Experience was established at Cleveland Clinic in 2005, administered by a chief experience officer.^[13]

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.^[62]^[63] These Outcomes books are available in print and online for the reference of referring physicians and the public.^[64] 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.^[65]^[66]

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.^[67]^[68]

The Zielony Institute for Nursing Excellence oversees practice and education for 12,000 inpatient, outpatient, rehabilitation and home care nurses.^[69]^[70]

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.^[71] 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.^[72]^[73] The Tomsich Pathology Laboratories opened on Carnegie Avenue and East 101st Street in 2012.^[74] Cleveland Clinic Florida opened offices in West Palm Beach, and dedicated the Egil and Pauline Braathen Center for neurology and cancer services in 2015.^[75]^[76] 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.^[77] 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.^[78]

In January 2015, Cleveland Clinic announced the closure of Lakewood Hospital in Lakewood, Ohio.^[79] 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.^[80]

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.^[81]

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.^[82]^[83]

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. ^[84] 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.^[84]^[85]^[86]

Model of Medicine

Not for Profit Group Practice

Cleveland Clinic is a nonprofit organization and group medical practice in the United States.^[87]^[88] 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).^[89]

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.^[67] 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.^[90] 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.^[67]^[68]

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.^[68]

An Integrated System All Cleveland Clinic facilities and locations share the same rules, practices and protocols.^[88] 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.^[42] 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.^[88]^[91]

Research

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.^[1]

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.^[92] Cleveland Clinic's Case Mix Index is 2.338595, according to the most recently posted CMS data.^[93] 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.^[94]

Finances and Economic Impact

Cleveland Clinic had a margin above costs of $249 million on $6.45 billion of revenue in 2013^[95]According to data analyzed by American Hospital Directory, its annual gross total patient revenues of $9.14 billion were the second largest in the US in 2011.^[96] 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.^[97]

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^ New York Times, Cleveland Clinic Discloses Doctor Industry Ties retrieved from http://www.nytimes.com/2008/12/03/business/03clinic.html?hp on August 28, 2015
^ Washington Post, In Yelp era, medicine joins the ratings game June 4, 2015, front page
^ ^a ^b ^c Annals of Translational Medicine, The Cleveland Clinic:a distinctive model of American medicine retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4200609/ August 28, 2015
^ ^a ^b ^c New York Times, Approaching Illness as a Team, December 25, 2012, retrieved from http://www.nytimes.com/2012/12/25/opinion/approaching-illness-as-a-team-at-the-cleveland-clinic.html, on August 28, 2015
^ Crain’s Cleveland Business, Cleveland Clinci Receives Donation for its Nursing Institute, November 12, 2009, retrieved from http://www.crainscleveland.com/article/20091112/FREE/911129984/cleveland-clinic-receives-donation-for-its-nursing-institute on August 28, 2015
^ http://www.medscape.com/viewarticle/751637 retrieved on August 28, 2015
^ http://www.torontolife.com/style/toronto-health-and-beauty/2014/02/26/best-private-medical-clinics-toronto/
^ http://articles.latimes.com/2010/may/19/entertainment/la-et-gehry-vegas-20100519
^ s://www.bluffton.edu/~sullivanm/nevada/lasvegas/gehry/brain.html
^ http://www.perspectusarch.com/work/projects/cleveland_clinic_pathology_lab.shtml
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^ http://touch.sun-sentinel.com/#section/-1/article/p2p-83033338/
^ http://www.cleveland.com/architecture/index.ssf/2014/09/cleveland_clinic_breaks_ground.html
^ http://www.cleveland.com/architecture/index.ssf/2014/12/cleveland_planning_commission.html
^ Plain Dealer, Lakewood Hospital to Close for Family Health Center, January 20, 2015, retrieved from http://www.cleveland.com/lakewood/index.ssf/2015/01/lakewood_hospital_to_close_in.html, on September 26, 2015
^ Dill, Jessica (September 21, 2015). "Kucinich: 'Secret plan' was developed to close, demolish Lakewood Hospital". Fox 8 Cleveland. Retrieved September 21, 2015.
^ Plain Dealer, Problems Revealed at Local Lab September 26, 2015, retrieved from http://www.cleveland.com/healthfit/index.ssf/2015/09/sloppiness_lax_oversight_revealed_at_cleveland_clinics_marymount_lab_overhaul_includes_firings.html, on September 26, 2015
^ Cleveland Clinic Champions Diversity and Inclusion, Global Cleveland, retrieved from http://globalcleveland.org/newsletters/334-cleveland-clinic-champions-diversity-and-inclusion, on September 11, 2015
^ Modern Healthcare, They're coming to America ...; ... for care as some facilities recruit foreign patients October 1, 2007
^ ^a ^b Cleveland Clinic Begins Recruitment for new Abu Dhabi Hospital, Plain Dealer, April 16, 2013. Retrieved from http://www.cleveland.com/healthfit/index.ssf/2013/04/cleveland_clinic_begins_recrui.html on August 28, 2015
^ http://www.thenational.ae/uae/health/inside-cleveland-clinic-abu-dhabi-5500-doctors-apply-for-175-positions
^ https://www.mubadala.com/en/what-we-do/healthcare/cleveland-clinic-abu-dhabi
^ http://www.cleveland.com/healthfit/index.ssf/2013/12/charity_care_community_benefit.html
^ ^a ^b ^c The Cleveland Clinic Way by Toby Cosgrove, McGraw-Hill Education, 2014, p.5
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External links

Cleveland Clinic

[encyc-1] Encyclopedia of Cleveland History, http://ech.cwru.edu/ech-cgi/article.pl?id=CCF1, accessed August 25, 2015

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[kastor-3] ^ ^a ^b ^c ^d ^e ^f Specialty Care in the Era of Managed Care, John A. Kastor, MD, The Johns Hopkins University Press, 2005, p.2

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[7] Modern Healthcare, Largest Group Practices, October 2, 2014. Retrieved from http://www.modernhealthcare.com/article/20141004/DATA/500032755, August 26, 2015

[WebMD-8] ttp://doctor.webmd.com/hospital/cleveland-clinic-cleveland-oh-8f66968f-baee-4a78-8961-ba6e201d0f9b-overview?d=3.51, retrieved on September 15, 2015

[9] Steven Litt for The Plain Dealer. January 22, 2012 Cleveland Clinic's new master plan envisions bigger, greener campus with ample room to grow for decades

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[Bell2015-11] Bell J. Cleveland Clinic Abu Dhabi opens its doors for first patients. The National, UAE. March 17, 2015. [1]

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[lifeandtimes-16] Journal of Postgraduate Medical Education, The Life and Times of George Washington Crile, RA Kazi, 2003, Volume, 49 , Issue 3, pp. 289-290. Retrieved from http://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume=49;issue=3;spage=289;epage=290;aulast=Kazi, August 25, 2015

[17] Shock, Physiological Surgery and George Crile, Peter C. English, Greenwood Press, 1980, p. 62

[18] The history of urology in Cleveland, Ohio, KP Sajadi and HB, Goldman, Urology. 2010 Dec;76(6):1293-7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20810152, August 25, 2015

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[urology-23] Surgery, Subspecialization and Science: A History of Urology at the Cleveland Clinic, 1921-2000, Mark D. Bowles and Virginia P. Dawson, Cleveland Clinic Foundation, History Enterprises, Inc., 2000, p. 19

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[timeline-25] Retrieved from http://blog.cleveland.com/medical/2008/09/07CGCLINICTIME.pdf, August 26, 2015

[egaltarian-26] The Emergence of the Egaltarian OrganizationHuman Relations August 1986 vol. 39 no. 8 683-724

[rowland-27] The Cleveland Clinic Foundation, by Amy Rowland, William Feather, 1938

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[sheldon-29] Pathfinders of the Heart, the History of Cardiology at Cleveland Clinic, William C. Sheldon, Xlibris, 2008, p.60

[rose-30] Cleveland: The Making of a City, William Ganson Rose, 1950, Kent State University Press, p.1011

[canton-31] The Repository (Canton)A Deadly Combo; X-ray films burn noxious fumes at Cleveland Clinic, July 14, 2014

[bellamy-32] They Died Crawling: And other Tales of Cleveland Woe, John Stark Bellamy III, Gray & Company, 1995, pp218-232

[time-33] Time Magazine, May 27, 1929, pp. 15-16

[pddisaster-34] Plain Dealer123 Die in Clinic Disaster; Poison Gas Seeps into System; Explosion Rocks Building, August 23, 1998

[35] Reading Times, May 17, 1929, p2

[profiles-36] Profiles in Performance: Business Intelligence Journeys and the Roadmap for Change, Howard Dresner, Wiley & Sons, 2010, p. 57

[barney-37] The Way it Was. 1907-1987, Sex, Surgery, Treasure & Travel, George Crile, Jr., Kent State University Press, 1992, p.222

[38] Hall, Robert J. (1985). "In Memoriam: F. Mason Sones, Jr., M.D". Texas Heart Institute Journal 12 (4): 356–358. PMC 341889

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