Cleveland Clinic to open in London
2021 will see something unusual, the opening of a new private hospital in London which is part of an American non-profit system. The Cleveland Clinic started in Ohio, and now has facilities in Florida, Nevada, Canada and the United Arab Emirates. The American spoke with Dr. Brian Donley, Cleveland Clinic London's CEO about what the new hospital will bring to Americans in the UK.
By Michael Burland
Published on May 31, 2019
clevelandcliniclondon.uk

Dr. Donley, the Cleveland Clinic is well known in the United States, but it's a new name in Britain. Can you give us some background?

The Cleveland Clinic started in 1921 when four doctors came together after World War I. They had worked together successfully in the war, putting their combined efforts into the best interests of the soldiers and thought, 'why don't we do that at home?' Instead of individual practice they came together as a group in 1921. That's the start of the Cleveland Clinic. Fast forward 98 years later, that group of four doctors has grown to 3,600, but from a governance standpoint we continue to be a group of doctors that run a health system, not a health system that has a group of doctors. That's one of four key things that we think about as we come to London: we are physician-led and we think that's important because it brings the patient's perspective into the decision making. The other key points are that the Cleveland Clinic enterprise is a non-profit, so all of our money gets reinvested back into patient care, research and education. Organisations that focus on research and education get better outcomes for their patients. They also attract great talent, because great talent wants to be at the forefront of innovation. Those four key parts that we bring with us form the core of our culture.

Three other words that are important for the Cleveland Clinic are teamwork, transparency and innovation. We are proud of what we've accomplished in the United States over 98 years, proud of our reputation of being the number one Heart Center in the United States for the last 24 years straight, but we know that if we're going to be great for the next hundred years we need to continue to learn and innovate. By coming to London we can do that and continue to get improve for the benefit of our patients.

We want to bring the best of what we've done in Cleveland, but also integrate with the best of UK healthcare. We're opening up this 185 bed hospital, which will be a full service hospital but concentrating on heart and vascular (cardiac surgery and cardiology), colorectal surgery and gastroenterology (digestive diseases), orthopaedics and neurosciences (neurosurgery and neurology). Those four are great strengths of ours. We will not focus on women's health and paediatrics, but patients will have all kinds of needs so we'll offer comprehensive care through affiliations with other UK healthcare groups.

How will patients pay for their care?

We will enter the private healthcare market here, where some patients will have private medical insurance, some will self-pay, and a number of international patients will be sponsored by their government.

Most overseas Americans have insurance, but if they don't will you link up with any insurance groups here?

We'll develop relationships with the main insurers for people who need it.

Have you thought ahead about how many Americans you'll have, as a percentage of patients?

We'll be open to care for UK citizens, of course, but certainly for Americans who will be very familiar with our brand. We have a strong international brand too. You know, we will be the first clinical academically-oriented center from the US here in the UK, with a research and education focus. London will allow us to be a globally integrated healthcare system for the world, all connected with one electronic medical record. We believe it will be the most technologically capable hospital in the UK.

Some of our readers are here for maybe three or four years and then move on, so you'll be able to help them as they travel around the world?

Yes, I think that as the world becomes more global, we're here with a long-term vision. We're planning to open in London the first quarter of 2021, which happens to coincide almost exactly with our centennial.

What will you offer that existing private healthcare facilities don't in this country?

There are good offerings that exist around London, but I think that we offer a model of care that's been focused, back to our founding, on teamwork. We're designed to work as teams, and transparency – both internal and external transparency – has been a part of us for a long time, which drives us to be better. Examples of that are we have published our outcomes, for up to 20 years, and they're available for everyone to see on our website. In Cleveland we get patient satisfaction evaluations and publish the outcomes of those on our website, they're available for everyone to see. Our non-profit culture with a focus on research and education is distinguishable. Again, we concentrate on advancement because our patients get better outcomes.

It sounds like a virtuous circle, the patients get better outcomes, you get better doctors.

That's exactly right. And it's an enjoyable place to work!

The medical outpatient facility at 24 Portland Place, which will open in the Fall of 2020

As you're a doctor yourself, how does the relationship with your administrators work?

I would say that we partner with the administrators, we partner with nursing, we partner with finance experts, there's a multitude of individual skills that have to come together in the team to enable the best results. That is why we actually call every person that works in our organisation a caregiver, because whether you ever see a patient or not, you're critically important to the journey for that patient. We think of it more as a team partnership, not doctors employing others. Doctors have a leadership role only because that's in the best interests of the patient, to bring the patient into the center of all decision making. That even includes our architectural design. We design our buildings to bring light in, for a soothing environment for patients, and our rooms are designed with the patient's comfort and healing in mind.

This hospital will have 185 beds, and 30 of them will be ITU (Intensive Care Unit) beds on level 3 for more complex care. The issue is trying to match the patient to the right hospital and the right level of care. Some patients can be taken care of at home and never should come to a hospital, some can be taken care of in an outpatients setting where they come and go home the same day, some can be taken care of in a generalist hospital,and there are many that do an outstanding job, and then there are complex medical cases where they're probably better off in a specialist care setting like ours. I think it's a kind of ecosystem.

Will you have outpatients?

We will, yes. We are opening up an outpatient building in the Fall of 2020 on Portland Place, near Harley Street and just behind the BBC's Broadcasting House. When I came over here we had around 10 employees, we're up to about 120 now and will create jobs for 1150 over the next 21 months.

Will the British staff go over to Cleveland to sort of share things?

Yes, we've hired a doctor lead for every department, and all the UK doctors have been to Cleveland several times so that they can learn and understand what the Cleveland Clinic culture is as we bring the best of Cleveland and the best of the UK healthcare together.

On a personal note, what is your background at the Cleveland Clinic

I was an orthopaedic surgeon, then I was asked to run one of our hospitals as part of our physician leadership, then all of our hospitals in the Cleveland area. I then attended Harvard Business School to get that training, then came back as Chief of Staff and Chief of Clinical Operations, responsible for all our operations across North America, I did that for three and a half years then took over this job.

Will you be working and living in London while the new hospital is being set up?

Yes, we have three boys and we dropped our youngest off at college in the States then moved here a week later.

And have you been here before?

I am so glad you asked that question! I have been here before and that's important. About 10 years ago I was fortunate enough to be chosen for a program that's existed since 1946, where the United States picks five orthopaedic surgeons every other year to spend time working in the NHS. I spent time travelling through many different NHS systems and was able to see unbelievable doctors, great care, great innovation, and when I took that learning back to my own full-time orthopaedic practice – my area is foot and ankle – it changed my practice. It was an eye-opening experience, it broadened my thoughts, broadened my network, and it actually allowed me to be a better orthopaedic surgeon for my patients. I draw off that experience as I come here in this role now as CEO of Cleveland Clinic London, I personally know what's possible, and myself and my patients have had the benefit of that.

Once the new facility in London is up and running will you see patients?

I'll look to be clinically active, as all our physician leaders are. It's absolutely key to understanding the way everything works.

Is there anything that you enjoy in London, and anything you miss from the States?

Is there anything I enjoy? I could go on and on, we've had a wonderful experience. We enjoy the diverse conversation that exists in the individuals that you meet in this city. We love the diversity of entertainment. We really like the West End so it's amazing on a Friday for us to say 'Hey, lets go and see Come from Away!" You don't have those opportunities in Cleveland, if you want to see a show you fly to New York. We love the history and really enjoy getting to know about English history – Kew Gardens, Windsor, going to Cambridge to go punting – it's amazing. Then there's the opportunity to travel for weekend trips around Europe. Anything I've missed? We certainly miss, a little bit, the distance from our children, and then other than that we have an intense missing and a huge hole in our heart for our washer and dryer! Yeah, the size of our washer and dryer is our number one miss.

We actually like the weather too – compared to Cleveland!

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