Cleveland Clinic

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Cleveland Clinic logo.png
Cleveland Clinic.jpg
Geography
Location 9500 Euclid Avenue, Cleveland, Ohio 44195, United States
Organization
Care system Private
Hospital type Academic
Affiliated university

Case Western Reserve University School of Medicine

Cleveland Clinic Lerner College of Medicine
Services
Beds 1440
History
Founded 1921
Links
Website www.clevelandclinic.org
Lists Hospitals in the United States

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 135 different countries.[4] It is one of the five largest group practices in America.[5]

Locations[edit]

Cleveland Clinic's main campus consists of 41 buildings on 160-acres near University Circle, in Fairfax, Cleveland.[6] 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.[7]

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

History[edit]

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.[9] Dr. Weed died in 1891.[10] 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.[11] In 1897, they moved their practice to the Osborn Building on Prospect Avenue in downtown Cleveland.[9][12] They employed two additional surgeons, a radiologist, a medical illustrator, and clerical help, and practiced from this office until 1920.[13] Crile, Lower and Bunts all became professors at Cleveland medical schools, and each would be elected president of the Academy of Medicine.[14]

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.[15][16] Dr. Bunts and Dr. Lower also served in the Rouen hospital.[13] Dr. Lower later wrote of his admiration for the "teamwork and efficient organization" of military medicine.[17] In his autobiography, Dr. Crile reports that while in France, the three doctors discussed starting a new medical center in Cleveland upon their return.[16][18] In 1919, they took on a fourth partner, John Phillips, MD, formed a non-profit corporation, and leased land at the corner of East 93rd Street and Euclid Avenue in Cleveland.[13] The institution was granted a state charter in 1921.[13]

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.[19] William Benson Mayo, MD, of the Mayo Clinic, delivered the main address.[18][20] On February 28, 1921, Cleveland Clinic opened its doors to the public and registered 42 patients.[14] 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.[13] A fifth house was acquired as a residence for patients with diabetes receiving insulin treatments.[13][21] 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.[22] A research laboratory was constructed in 1928.[23]

Disaster and Recovery

On May 15, 1929, nitrocellulose x-ray films stored in the basement of the outpatient building ignited.[13][24][25] 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.[13][24] 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.[24]

Philanthropist Samuel Mather formed a committee of 36 community leaders to help Cleveland Clinic reestablish Cleveland Clinic in temporary quarters across the street.[13][24][26] Patient care services resumed five days later.[13] The 1921 building was completely renovated, and a new three story clinic building, with a new main entrance, was added in 1931.[13][24] Dr. Crile and Dr. Lower leveraged their personal $75,000 insurance policies to address financial issues arising from the disaster and the onset of the Great Depression (Dr. Bunts died in 1928).[13] Employees took voluntary pay cuts of 10 percent (1932) and 25 percent (1933).[17][27] All debts were repaid by 1941.[13]

The years 1941-1989

Dr. Crile and Dr. Lower relinquished their administrative duties in 1941.[22] The organization grew from 216 employees to 739 employees between 1931 and 1941.[13] 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 battle of Guadalcanal.[13][28] Patient volume at Cleveland Clinic tripled between 1937 and 1947.[13]

Growth of Specialization

In the 1920s, Cleveland Clinic’s medical specialties included general surgery, medicine, radiation therapy, endocrinology, ophthalmology, orthopaedic surgery, urology, and neurological surgery. Gastroenterology emerged from a physician interest in gastrointestinal imaging; anesthesiology branched off, then separated from the Division of Surgery; orthpaedics gave birth to vascular surgery; colorectal surgery, gynecology and plastic surgery were later sub-divisions of general surgery.[13] The first pediatric department opened in 1951, and obstetrics in 1955.[22] Clinical laboratories and anatomic pathology left their respective homes in medicine and surgery to form their own division, Pathology and Laboratory Medicine, in 1958.[13]

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] 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.[13]

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.[29] Within each division were departments (Department of Infectious Disease, Department of Cell Biology, etc.).[29] 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.[29] In 2007, Cleveland Clinic reorganized patient care services around disease and organ-system-based institutes.[29][30][31]

Growing Facilities

Cleveland Clinic built new operating rooms in the early 1970s to accommodate the growth of cardiac surgery.[13][22] 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).[22] A pathology and laboratory medicine building was constructed on Carnegie Avenue in 1980.[13]

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.[13] Completed in 1985, the Century Project consisted of a 14-story outpatient building (now known as the Crile Building), designed by Cesar Pelli,[32] a two-block long pedestrian bridge (Skyway), a 1,500 car parking garage, and two new hospital wings bringing the total bed count to 1,200.[13]

Becoming a system.

Dr. Loop was appointed chairman of the Board of Governors in 1989. The following statistics show Cleveland Clinic’s growth during his administration, which ended in 2004. Outpatient visits went from 720,000 a year in 1989, to more than 2.9 million in 2004. Surgical cases multiplied by a factor of seven. Cleveland Clinic’s total assets went from $865 million to more than $5 billion.[33][34]

Emergency Department visits on the main campus rose from 17,000 a year to 61,000 after the opening of the Maria and Sam Miller Emergency Services Building in 1994. This building included 24 new operating rooms. The professional staff (salaried doctors) went from 700 to more than 1,800. The employee count grew from 8,000 to 32,000.[33][34]

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.) [35][36][37][38]

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][39]

Other Cleveland Clinic programs and facilities dating from 1998-2004 include the Sherwin Research Building, Children’s Hospital, Cleveland Clinic Innovations,[40] 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.[13][41][42]

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][43]

Dr. Loop launched a capital campaign in 1997 with a 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.[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.[44] A $44 million Center for Genomics Research[45] was completed in 2004, along with a new parking garage across the street from the 1921 building.[1][46]

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[47] 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.[48][49]

Cleveland Clinic made all its properties smoke-free in July 2005, and stopped hiring smokers in 2007.[50] 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.[51] An Office of Patient Experience was established at Cleveland Clinic in 2005, administered by a chief experience officer.[52]

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.[53][54] These Outcomes books are available in print and online for the reference of referring physicians and the public.[55] 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.[56][57]

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.[58][59]

The Zielony Institute for Nursing Excellence oversees practice and education for 12,000 inpatient, outpatient, rehabilitation and home care nurses.[60][61]

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.[62] 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 architct Frank Gehry.[63][64] The Tomsich Pathology Laboratories opened on Carnegie Avenue and East 101st Street in 2012.[65] Cleveland Clinic Florida opened offices in West Palm Beach, and dedicated the Egil and Pauline Braathen Center for neurology and cancer services in 2015.[66][67] 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.[68] Also being planned is a new Health Education Campus to house the Cleveland Clinic Lerner College of Medicine of the CWRU school of Medicine, the CWRU School of Medicine, CWRU School of Dental Medicine, CWRU School of Nursing, and allied health education programs. The Foster + Partners-designed building is currently under construction across from Cleveland Clinic’s main entrance on Euclid Avenue.[69]

Same-Day Appointments

In 2012, Cleveland Clinic began offering same-day appointments to those who call the Cleveland Clinic general appointment number before noon. CEO Dr. Cosgrove reports that Cleveland Clinic saw more than a million same-day visits in 2014.[52][70][71]

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.[72][73] 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.[73][74][75]

Model of Medicine[edit]

Cleveland Clinic is a nonprofit organization and group medical practice in the United States.[76][77] No part of the net-income or assets of Cleveland Clinic are distributed to its members, trustees, officers, or other persons. There are shareholders or partnership interests.[13] 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).[78] 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.[58] 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.[79] 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.[58][59] 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.[59] All Cleveland Clinic facilities and locations share the same rules, practices and protocols.[77] 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.[31] 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.[77][80]

Research[edit]

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]

Finances[edit]

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.[81]

See also[edit]

References[edit]

  1. ^ a b c d Encyclopedia of Cleveland History, http://ech.cwru.edu/ech-cgi/article.pl?id=CCF1, accessed August 25, 2015
  2. ^ Crain’s Cleveland Business, Hospitals & Hospital Systems, Special Section, p. H12, August 3, 1998
  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
  4. ^ a b Cleveland Clinic. (2014). 2014 State of the Clinic Annual Report, p.1. Retrieved from http://my.clevelandclinic.org/ccf/media/Files/About-Cleveland-Clinic/overview/state-of-the-clinic-2014.pdf, August 25, 2015
  5. ^ Modern Healthcare, Largest Group Practices, October 2, 2014. Retrieved from http://www.modernhealthcare.com/article/20141004/DATA/500032755, August 26, 2015
  6. ^ 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
  7. ^ www.clevelandcliniccanada.com
  8. ^ Bell J. Cleveland Clinic Abu Dhabi opens its doors for first patients. The National, UAE. March 17, 2015. [1]
  9. ^ a b 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
  10. ^ Shock, Physiological Surgery and George Crile, Peter C. English, Greenwood Press, 1980, p. 62
  11. ^ 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
  12. ^ Retrieved from http://www.whonamedit.com/doctor.cfm/1959.html, August 25, 2015
  13. ^ a b c d e f g h i j k l m n o p q r s t u v w x y To Act as a Unit: The story of the Cleveland Clinic, John D. Clough, MD, editor, 2004, retrieved from http://www.clevelandclinic.org/act/TAAAU.pdf, on August 25, 2015
  14. ^ a b Creating Cleveland Clinicby Brad Clifton and Jessica Carmosino, retrieved from http://clevelandhistorical.org/items/show/603, on August 29, 2015
  15. ^ The Lakeside Unit: Cleveland Medicine in World War Ihttp://lakesideunit.com, retrieved August 29, 2015
  16. ^ a b George Crile, George Crile, An Autobiography, edited by Grace Crile, 2 Vol. (Philadelphia and New York: Lippincott, 1947),274-80.
  17. ^ a b 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
  18. ^ a b Hospital Built Upon Service, Milwaukee Journal, May 16, 1929, page 2. Retrieved from https://news.google.com/newspapers?nid=1499&dat=19290516&id=H5pQAAAAIBAJ&sjid=wCEEAAAAIBAJ&pg=5944,1367390&hl=en, on August 26, 2015
  19. ^ Retrieved from http://blog.cleveland.com/medical/2008/09/07CGCLINICTIME.pdf, August 26, 2015
  20. ^ The Emergence of the Egaltarian OrganizationHuman Relations August 1986 vol. 39 no. 8 683-724
  21. ^ Ohio Memory, Madeleine Bebout and the Nurses at Oxley Homes Photograph, caption. Retrieved from https://server16007.contentdm.oclc.org/cdm4/item_viewer.php?CISOROOT=/p267401coll36&CISOPTR=14140&CISOBOX=1&REC=2, on August 26, 2015
  22. ^ a b c d e Pathfinders of the Heart, the History of Cardiology at Cleveland Clinic, William C. Sheldon, Xlibris, 2008, p.60
  23. ^ Cleveland: The Making of a City, William Ganson Rose, 1950, Kent State University Press, p.1011
  24. ^ a b c d e They Died Crawling: And other Tales of Cleveland Woe, John Stark Bellamy III, Gray & Company, 1995, pp218-232
  25. ^ Time Magazine, May 27, 1929, pp. 15-16
  26. ^ Reading Times, May 17, 1929, p2
  27. ^ Without Whose Aid, Nursing and Cleveland Clinic, Diane Ewart Grabowski, Cleveland Clinic Foundation,1996, p.91
  28. ^ The Way it Was. 1907-1987, Sex, Surgery, Treasure & Travel, George Crile, Jr., Kent State University Press, 1992, p.222
  29. ^ a b c d Harvard Business School, Cleveland Clinic:Growth Strategy 2014, Michael Porter and Elizabeth Teisberg, December 29, 2014, pp.4-5, retrieved from , on August 26, 2015
  30. ^ Crain’s Cleveland Business, In name of streamlined care, Clinic forms 26 institutes, November 05, 2007, retrieved from http://www.crainscleveland.com/print/article/20071105/FREE/311050037/in-name-of-streamlined-care-clinic-forms-26-institutes, August 26, 2015
  31. ^ a b Newsweek, What Health Reform can Learn from Cleveland Clinic, November 26, 2009, retrieved from http://www.newsweek.com/what-health-reform-can-learn-cleveland-clinic-76971, on August 26, 2015
  32. ^ retrieved from http://pcparch.com/project/crile-clinic, on August 26, 2015
  33. ^ a b Cleveland Clinic Foundation, 1990 Annual Report, page 42
  34. ^ a b Cleveland Clinic, 2004 Annual Report, p. 46, retrieved from http://www.clevelandclinic.org/ReproductiveResearchCenter/docs/annualreport_2004.pdf, on August 28, 2015
  35. ^ Center for Studying Health System Change, retrieved from http://www.hschange.com/CONTENT/214/clev-04.html?PRINT=1, on August 28, 2015
  36. ^ Note, Can Cleveland Clinic Health System Be Trusted: Whether a Proposed Merger or Acquisition by Cleveland Clinic Health System Will Substantially Impair the Competitive Health Care Market in Northeast Ohio Resulting in a Violation of Federal Antitrust Statutes, 17 J.L. & Health 137 (2002-2003), p. 159, retrieved from http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1135&context=jlh, on August 28, 2015
  37. ^ retrieved from http://www.cleveland.com/healthfit/index.ssf/2014/08/cleveland_clinic_to_put_100_mi.html, on August 28, 1015
  38. ^ retrieved from, http://www.ohio.com/lifestyle/powell/akron-general-cleveland-clinic-ceos-say-affiliation-better-than-expected-1.586407, on August 28, 2015
  39. ^ Building Health-Care Empires;As The Cleveland Clinic and University Hospitals Expand, They Cement Their Places As The Area's Health-Care Leaders, Plain Dealer, November 16, 1997, p. 1H
  40. ^ Retrieved from, http://www.cleveland.com/business/index.ssf/2010/10/chris_coburn_development_pioneer_guides_cleveland_clinics_technology_initiative.html, on August 28, 2015
  41. ^ Dr. Floyd Loop, heart surgeon who led Cleveland Clinic to preeminence, has died retrieved from http://www.cleveland.com/metro/index.ssf/2015/06/do_not_publish_dr_floyd_loop_h.html, on August 28, 2015
  42. ^ How Cleveland Clinic Tackles EHR Implementationretrieved from, http://profitable-practice.softwareadvice.com/how-cleveland-clinic-tackles-ehr-implementation-0713/, on August 28, 2015
  43. ^ City & Shore Magazine, Cleveland Clinic Florida Celebrating 25 Years, p. 40, retrieved from https://my.clevelandclinic.org/ccf/media/files/Florida/News/city-shore-25-anniversary-0913.pdf
  44. ^ Retrieved from, http://www.cleveland19.com/story/827385/lerner-donates-100-million-to-clinic, on August 28, 2015
  45. ^ Retrieved from http://kaczarch.com/labresearch/cleveland-clinic-center-for-genomics-research on August 28, 2015
  46. ^ Retrieved from, http://www.karpinskieng.com/ProjectPortfolio/1/148/0 on August 28, 2015
  47. ^ Becker’s Hospital Review, 10 Things to Know about Cleveland Clinic CEO Dr. Toby Cosgrove, retrieved from http://www.beckershospitalreview.com/hospital-management-administration/10-things-to-know-about-cleveland-clinic-ceo-dr-toby-cosgrove.html on August 28, 2015
  48. ^ Cleveland Clinic’s New Look More than just a Pretty Face retrieved from http://www.cleveland.com/medical/index.ssf/2008/09/cleveland_clinics_new_look_mor.html on August 28, 2015
  49. ^ Retrieved from http://www.nbbj.com/work/the-cleveland-clinic-foundation-miller-pavilion-and-glickman-tower/, August 29, 2015
  50. ^ New York Times, >Hospitals Shift Smoking Ban to Smoker Ban, retrieved from http://www.nytimes.com/2011/02/11/us/11smoking.html, on August 28, 2015
  51. ^ Retrieved from http://www.cleveland.com/healthfit/index.ssf/2010/07/sugar-sweetened_food_beverages.html, on August 28, 2015
  52. ^ a b Health Care’s Service Fanatics, Harvard Business Review, May 2013, retrieved from https://hbr.org/2013/05/health-cares-service-fanatics on August 28, 2015
  53. ^ Redefining Healthcare, Michael E. Porter and Elizabeth Teisberg, HBS Press, 2006, Appendix A
  54. ^ Forbes What Business Can Learn from Cleveland Clinic retrieved from http://www.nytimes.com/2008/12/03/business/03clinic.html?hp on August 28, 2015
  55. ^ https://my.clevelandclinic.org/about-cleveland-clinic/quality-patient-safety/treatment-outcomes
  56. ^ 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
  57. ^ Washington Post, In Yelp era, medicine joins the ratings game June 4, 2015, front page
  58. ^ 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
  59. ^ 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
  60. ^ 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
  61. ^ http://www.medscape.com/viewarticle/751637 retrieved on August 28, 2015
  62. ^ http://www.torontolife.com/style/toronto-health-and-beauty/2014/02/26/best-private-medical-clinics-toronto/
  63. ^ http://articles.latimes.com/2010/may/19/entertainment/la-et-gehry-vegas-20100519
  64. ^ s://www.bluffton.edu/~sullivanm/nevada/lasvegas/gehry/brain.html
  65. ^ http://www.perspectusarch.com/work/projects/cleveland_clinic_pathology_lab.shtml
  66. ^ http://www.bizjournals.com/southflorida/blog/morning-edition/2013/03/cleveland-clinic-florida-looks-to.html
  67. ^ http://touch.sun-sentinel.com/#section/-1/article/p2p-83033338/
  68. ^ http://www.cleveland.com/architecture/index.ssf/2014/09/cleveland_clinic_breaks_ground.html
  69. ^ http://www.cleveland.com/architecture/index.ssf/2014/12/cleveland_planning_commission.html
  70. ^ Becker's Hospital Review, Call Cleveland Clinic, Get an Appointment the Same Day: How's That Possible?. Retrieved from http://www.beckershospitalreview.com/hospital-management-administration/call-cleveland-clinic-get-an-appointment-the-same-day-how-s-that-possible.html, on August 28, 2015
  71. ^ http://www.cleveland19.com/story/28262195/cleveland-clinic-ceo-addresses-changes-in-state-of-the-clinic-address
  72. ^ Cleveland Clinic2014 Annual Reportpage 34. Retrieved from http://www.clevelandclinic.org/about/2014-annual-report/images/2014-cleveland-clinic-annual-report.pdf, on August 28, 2015
  73. ^ 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
  74. ^ http://www.thenational.ae/uae/health/inside-cleveland-clinic-abu-dhabi-5500-doctors-apply-for-175-positions
  75. ^ https://www.mubadala.com/en/what-we-do/healthcare/cleveland-clinic-abu-dhabi
  76. ^ http://www.cleveland.com/healthfit/index.ssf/2013/12/charity_care_community_benefit.html
  77. ^ a b c The Cleveland Clinic Way by Toby Cosgrove, McGraw-Hill Education, 2014, p.5
  78. ^ Hospitals Building Healthier Communities retrieved from, http://community-wealth.org/sites/clone.community-wealth.org/files/downloads/ExcerptHospitalsBuildingHealthierCommunities-ClevelandClinic.pdf, August 28, 2016
  79. ^ https://www.advisory.com/daily-briefing/2012/12/10/cleveland-clinic-ceo-four-ingredients-in-our-secret-sauce
  80. ^ http://www.healthcare-informatics.com/news-item/cleveland-clinic-recognized-stage-7-ambulatory-award
  81. ^ Oh J. 100 Top Grossing Hospitals in America Becker's Hospital Review. Aug 29,2011 [2]

External links[edit]