Everybody Is a Caregiver (ft. Toby Cosgrove)

You've replicated so many leaders that left and gone to other fantastic institutions as CEOs. That's always a hallmark to me of, of a great leader, someone who can replicate themselves.

I see 3 major problems with healthcare right now. 40% of the hospitals are running in the red and it's too expensive for patients. There's, uh, 2 million unfilled jobs in healthcare across the country. The explosion in knowledge, the total amount of knowledge in healthcare doubles every 73 days. Last year there were 1.8 million medical articles written. Why do I get paid? Why do we have a hospital? Why do we have a clinic? Why are we all here? For patients. And that's the only reason we're there.

Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marx.

Welcome to another edition of Digital Voices. So excited for this one because it's like one of my heroes and former boss, Dr. Toby Cosgrove. Toby, welcome to Digital Voices.

Oh, it's good to be with you, Ed.

I know, I have such great memories. That's kind of how we first met was via the Cleveland Clinic. I still remember the first time meeting you. I still remember the interview questions and some of the things that happened. You read to me a patient letter. You probably might not remember that, but While we were in the interview, you read to me a patient letter and it was quite eye-opening and fun and super interesting. And it's like, man, this is where I want to serve. And so that's how we first met. And then I enjoyed our relationship ever since then because that was like almost 10 years ago. It's been great. But Toby, before we get into all the questions we have set up for you, everyone will want to know what songs are on your playlist. Like what kind of music? What kind of music?

I'm a real retro guy. You know, I have to say my My favorite song is Emerson, Lake& Palmer with Lucky Man. And do you know that that song was written by Lake when he was 12 years old?

No.

Wow.

I did not know that. Very cool.

I listen to a lot of jazz now.

Yeah. Well, now I got Lucky Man going through my brain. It's a beautiful song, the lyrics and the music melody, everything. What about life message or mantra? Are there words that sort of guide you in how you live?

Yeah, I was heavily influenced by, obviously all of us are, by our parents. And my dad told me, look, you're supposed to leave the world a better place and be a contributor. And so, that's really sort of driven me from the get-go.

So, Toby, as we sort of get into career and leadership, before we get there, tell us about yourself. Like, what's your story? Are you a Cleveland Boy, you know, where did you grow up? All that kind of stuff.

Uh, well, I grew up in Watertown, New York, uh, which is not the end of the earth, but you can see it from there. Um, uh, it's a small town of about 30,000. I went to the local high school there and played sports and then went on to Williams College, um, where I was a disaster in almost every respect. Athletically, um, I played 4 years of basketball and anchored one end of the bench. Then, I was an academic disaster and nearly flunked out. And socially, I was totally inept. So, it was a brilliant career at Williams College. But then, I got— I'd always thought that I wanted to be a doctor. And it goes back— and I didn't want to be a doctor. I wanted to be a surgeon. And it goes back to when I was 10 years old, I saw A picture in a friend's house of he in the operating room in a mask, and I thought I'd look really good in a mask. So, and it looked very dramatic, and so that's what I always wanted to do. And so I, after a stellar career in college, I got into one of 13 medical schools I applied to. I wound up getting into the University of Virginia, and. That was a godsend. So, then I— the career from graduating from medical school, I bounced around. I spent a surgical internship and a first-year residency in Rochester, New York, at Strong Memorial, and then went to Vietnam for a year.

Wow.

And then back in the military for another year. And then, I talked my way into Mass General. They told me they weren't— they had a job opening, but they wouldn't give it to me. And so I called up the chief of surgery's office and I said, I'd like to come. I have not met him. I'd like to— I'm applying for residency. I'd like to come see him. And And I'd like to come see him on Thursday. I'm sorry, busy all day Thursday. How about Friday? Busy all day Friday. How about Monday? Busy all day Monday. How about I come and sit in his office until he's got 15 minutes for me? And they said— they called me back and said, he'll see you on Thursday. So I— so they took me for a year, and then when I finished my residency in general surgery, they didn't want me to be the chief resident in cardiac surgery. So, they took my then brother-in-law and promoted him ahead a year and got him out of the military and cast me off to Boston Children's Hospital. When I finished there, I was unemployed. All of a sudden, I got a letter from the Cleveland Clinic saying they would like to have me for— come for sort of a senior year, and if I was good enough, they'd keep me on. And so, Make a long story short, they kept me.

Yeah. Wow. That's pretty amazing. What do you think flipped? Was there a switch that flipped for you between your bachelor experience in college and medical school that where you became more focused?

Well, it wasn't a matter of focus. So turns out I'm dyslexic. And so trying to do the reading for a liberal arts degree was almost impossible and getting through French was nearly impossible. So, but so then medical school came along and it was academically so much easier for me than undergraduate school in liberal arts. So it was transformational. I thought I'd arrived.

No, that's awesome. It's a great, great story for many, many different reasons. So in all of that, well, I have a question about, you know, was there a single pivotal moment? But it sounds like there's many pivotal moments that fundamentally changed your trajectory. But when I ask that question, is there one in particular that stands out?

Well, you know, it was, I think the fact that I got into one medical school on 13 tries. And I don't know what they saw in me, but thank God they did.

Yeah. Isn't that nice when Someone believes in you, gives you that opportunity. Uh, no doubt about it. You mentioned when you were 10 years old, you see this picture, operating room mask. It's like, wow, something about that captured you. Um, and then you talked about how that kind of led you down this path. Tell us a little bit more about Vietnam. Like, as a flight surgeon in a whole year in, you know, in combat going on around in Vietnam, how did that shape you? Like, what, what did that do for you as a, as a person and as a clinician?

Well, that was sort of my first opportunity to lead. I was in charge of a, what's called a casualty staging flight. And the Air Force evacuated all these troops. And so at age 28, I was in charge of a 100-bed facility, 2 doctors and probably 20 nurses and a squadron of techs, corpsmen. Um, and we evacuated, uh, in the year that I ran it, 22,000 sick and wounded. I actually learned about war, learned about, um, Asia, um, and, um, learned a little bit about being in charge.

Yeah. And, and I'm sure you were exposed to many things that you didn't learn or were trained on in medical school, right? I mean, there's a combat Injuries. And did that help shape, like, you went on to become a surgeon, a heart surgeon, and doing a lot of inventions. And I imagine that must have helped kind of shape that direction.

Well, I think what you learned is that, well, first, one of the, I learned a couple of really important lessons that I subsequently applied to Cleveland Clinic. One is I learned about how they take care of casualties. I mean, you get hit in Vietnam, And you're taken to a tent hospital and they stop the bleeding and splint your wounds, and then you're moved to another hospital where they have the specialists, and then you're evacuated out of the United States. And we did the same thing. We set up a whole Air Force to move people from one place to another, and we've tried to get the person, the right person in the right hospital at the right time for the right care. And so we moved about 30,000 individuals a year around the Cleveland Clinic Health System. So that was one thing I learned. The second thing I learned is the importance of trying to get help that is not necessarily a doctor. When I was a resident, we had to take veins and close the wounds and pull the chest tubes and stuff. We— That's all tech work. And so we employed PAs and that was most, most of them were Vietnam veterans when I came to Cleveland Clinic and we just expanded that. It was really a good thing to do. So it was, it was a great learning experience for me.

I can imagine. Did you ever return in peacetime?

Yeah, I did.

And yeah, tell me about that.

I was in Da Nang. Which was sort of at the center of the war at the time. I remember when we were having, uh, down on the beach at an officers club having dinner, and we had a mortar attack. We all rolled off into the sand. Then I looked around this gorgeous beach and I thought, boy, this war's over, uh, this is going to be hotels along here. And then I went back to Da Nang and China Beach was filled with tourist hotels.

Wow. Yeah. And I imagine it was maybe a healing process too, after all the trauma and things that, that you had to have had experienced. Thank you for your service. And I, as I've shared with you before, my dad was next door in the Army base to where you were. Um, so you would have been taking care of, uh, uh, him who he was never injured, thankfully, but many of his troops were. So, um, Thank you very much. So you went back to Cleveland Clinic afterwards. Was that always the plan?

No. Um, I, I, I hadn't been at the Cleveland Clinic until I was through Vietnam and through my training and stuff. And I got that letter and I went out there and I said, this is for me. And I, uh, I went there and worked my buns off. It turned out okay.

So Toby, after all of these years, and it's probably hard to identify one person, so maybe a couple of people, but Who has served as your biggest inspiration and why? So along your whole journey, whether it's in the military or, or, you know, you mentioned your dad earlier in your life.

Well, I think probably the biggest is my parents, but then I think you, I, I believe that you learn from people as you go along. You see people do things that you like and are impressed by, and then you see people who do things that you just think are terrible. And so you become an amalgamation of lots of experiences about people along the way.

Now you're at the clinic and you've had this leadership experience thanks to the Air Force at age 28, and you're working your way as a surgeon and you're very inventive. Was there a time— when was the time when you thought, man, I might like to run this place someday?

Well, I never thought it was going to happen. I was, You know, chief of cardiac surgery, and I was 63, 64 years old. And I thought at that point, they'd asked me to start a venture capital company. And so I thought, did that. And then I thought, well, you know, it's getting time to hang up my spikes. And maybe I'll just go out to California and pursue a venture capital experience.

Yeah.

And, and all of a sudden, Fred Loop announced that he was going to retire and they asked me to throw my hat in the ring. And I thought, wow, maybe I can stay here and, you know, I won't have to move and this'll be interesting. So I went at it full tilt and happily I got the opportunity.

That's amazing. Yeah. And I'm, I'm glad it all worked out the same way. And again, your experience is so vast, so I feel Awkward just asking for one example, but maybe 2 or 3 examples, like your tenure at the Cleveland Clinic, amazing. You still serve as executive advisor. What are 2 or 3 things that you're most proud of?

Probably the thing that I did the best was to try and— I asked myself a couple, a few questions. I said, why do I get paid? Why do we have a hospital? Why do we have a clinic? Why are we all here? And the answer was for patients. And that's the only reason we're there. And so the— I made it our mantra for the Cleveland Clinic, that'd be patients first, and everything sort of flowed from that. And the second thing that I think was really important was we changed how we felt about what we called people. So there used to be doctors and janitors and nurses and— Bus drivers, and we decided we're gonna call everybody a caregiver. And that did 2 amazing things. That increased the patient satisfaction, went way up like that, and the employee engagement went up the same way. And, you know, I realize in retrospect, you know who sees more of a patient in the hospital than anybody else? It's the housekeeping group. And if you don't employ them and get them involved in the experience, it's really, it's a loss. And so I think those 2 things were probably the best things that I did for the Cleveland Clinic, and I'm really proud of them.

Yeah, I'll add 2 more. One is leaders replicate leaders. You've replicated so many leaders that today are Have some are still at the clinic leading, but others have left and gone to other fantastic institutions as CEOs. That's always a hallmark to me of a great leader, someone who can replicate themselves. And also the second thing is that I think you changed the world. Not only did you change Cleveland, but obviously Cleveland Clinic's reach is global. And you had the vision for that as you added hospitals throughout the world and the whole empathy, the whole culture that you created, like the examples you cited. Toby, have gone around the world.

You're very flattering. Thank you.

So how are you spending time today? What's your typical day?

Well, I got a portfolio of things I do. I'm on some public boards. I'm on a lot of startup boards. I'm coaching some CEOs of hospitals. And I'm working with McKinsey as a senior, senior, senior, senior, senior advisor.

And yeah, speaking and just sharing your wisdom is really great. What brings you the greatest amount of professional satisfaction? So obviously the things that you've already accomplished, but you're still in the game. So what—

Yeah, I really enjoy bringing new technologies into healthcare, and it's really hard to get them integrated. And, you know, I think one of the most amazing things that's happening in healthcare It's gonna solve a lot of problems and help an awful lot of people is the AI. And it's really slow to be up— taken up.

Yeah. Why do you think that is?

Well, if you, I mean, if you look at, there's, I see 3 major problems with healthcare right now. It's very expensive. And in fact, 40% of the hospitals are running in the red and it's too expensive for patients. Secondly, there's 2 million unfilled jobs in healthcare across the country. So there's a shortage of personnel. And 3, the explosion in knowledge. The total amount of knowledge in healthcare doubles every 73 days. Last year, there were 1.8 million medical articles written. Who the hell can keep up with that? Nobody can. So you've— So the AI is going to Allow physicians to, uh, and to patients, by the way, to democratize knowledge and shorten the length of time it takes from a proven technology until it becomes standard of care. It's going to allow, um, a lot of the work that goes into healthcare. For example, it's got 3,500 people putting out a bill. It's got 1,000 people in call centers. I mean, those, you know, if you're going to have people working in healthcare, they ought to be looking after people.

Yeah.

And not just looking after bills. So, you know, there's tremendous opportunities to improve the efficiency and cut costs from that standpoint. So I think it can address— and then my heavens, think about what it's going to do in terms of the research capabilities. So, and finally, you know, I don't— one of the biggest things may be, and this is if you read the papers today, it's every patient now is going to OpenAI or ChatGPT or one of the others to learn about their disease. And so they, so they go to the doctor's office better prepared. They ask the appropriate questions. They may realize, and they may take better care of themselves. They may even realize, I don't have to go to the doctor at all.

Yeah.

Oh, that's good.

Yeah. That reminds me, Toby, I thought of another thing that I would say about you that you've helped, you know, in terms of accomplishments. And that is, you really did push tech forward for sure at your time at the clinic, both first as a surgeon and the innovations that you created in the in the medical space, but also in the tech for healthcare. You were always very progressive, one of the first to always, whether it was the EHR way back when with Epic or whatever, you've always been a strong proponent. That's what was so much fun working with you is to have a CEO like that.

Well, it's obvious an opportunity.

Yeah. All right. So, let's talk a little bit about leadership, which has kind of been running through everything we've discussed so far. Do you define success differently today than you might have, you know, half a generation ago?

Yeah. You know, I think success, you know, in the early days was all personal. You know, can I do this? Can I get to be a good surgeon? Can I get great results, et cetera? And then it became a team that you were leading. And then success became How successful was the organization and how did you lead the organization forward? So, and so very different for different phases of your life and maturity, I think.

So if you're speaking, Toby, right now to 2 audiences, so we'll take one at a time, but it's the same sort of question, like advice, like if you are currently mid-career, so let's just say you're a director, maybe a vice president in a larger organization, what advice would you have? Are there one or two things that you think will help people as they continue on in their career? And let's just say that they aspire to reach the C-suite.

Yeah, I think that two things that you have to do, I think an awful lot of people are interested in just maintaining their position and not taking opportunities. And I think you have to, A, demonstrate tremendous work, That's like, and B, you have to look for opportunities. And if those, those 2 things go with what is written by Angela Duckworth recently, she wrote about grit as a first book, and she's got a book coming out in September, which talks about putting yourself in the right situation. And you have to find the right situation for yourself to move up. And, you know, I was happy to find it at the Cleveland Clinic.

And would the advice be any different for someone who's, let's just say, more advanced in their career? So now, they are maybe right below the C-suite or in the C-suite, and they just want to be more effective generally. Like, are there any particular skills that you saw in your best performers versus your average?

Well, first of all, I think you have to learn to speak, to talk. And I remember one of the most painful things I did is I took myself to California one weekend and had a coach. And watch yourself is tremendously embarrassing. And I have worked at it and worked at it and worked at it. And so, the presentation capabilities and the public speaking capabilities, I think, are incredibly important. The other thing I would say is, I think particularly with AI coming along, I think you want to be widely diverse and learn lots of different things so that you can begin to apply human capital in the maximum way. And that's, you know, because it's going to be taking over technical jobs and just to be a techno isn't going to do it anymore.

Right. Yeah, no, sage advice. Toby, in the last almost 30 minutes, we covered a lot of ground. Everything from music, Lucky Man's going to be playing in my brain. We do have a Spotify playlist for Digital Voices. We're going to add that. I know it's not on there. We need to add it. We talked about leaving the world a better place, something that you learned from your parents back in growing up in New York, Watertown specifically. And then you shared a lot about just kind of growing up and you're a great inspirational testimony of of someone who had to deal with some adversity in your life and with dyslexia, and you overcame that. No one would even know until you actually say it yourself. So you're a great inspiration that way. You have this great career, you served in the military, and then you did these amazing things at the Cleveland Clinic. You identified a couple. I added 3 extra. I'm sure we could spend another 10 minutes and I could tell you some more things that you've done that were so wonderful. And I don't say that to just lift you up, but also to share with our audience, like, man, you can be, you can make a difference. You can be a difference maker like Dr. Toby Cosgrove. And so, we talked a lot of things that you're proud of and then a lot of advice for aspiring leaders and leaders that are leaders today and how you define success and how that's changed over time, which I think was beautifully shared. What did we miss? Or is there anything you want to double down on? I'll give you the last word.

Well, I think that healthcare is a tremendous area to work. And, you know, you will get a lot— make a lot more money in other places. But healthcare, you will get tremendous psychic return. And it's incredibly satisfying helping people. And there's always going to be a need for it. And the changes that are happening are so exciting that I'm sorry, I'm not going to be around another 100 years to enjoy them.

Yeah. Well, Toby Koskoff, thank you for sharing your heart and your experience with my audience, and we'll have to have you back really soon.

Thank you for listening to Digital Voices. We hope today's conversation sparked ideas, reflection, and connection. Subscribe on YouTube, Apple, and Spotify Podcasts so you don't miss an episode.