<p>Toby Cosgrove</p>

Courtesy of The Cleveland Clinic

Bill Gates once said that if business in the 1980s was about quality and in the 1990s it was about reengineering, then in the 2000s it will be about velocity. The rate of change is brutal. Obsolescence doesn't creep anymore, it leaps. The situation is best expressed in the Latin phrase absolutum obsoletum: If it works, it's out of date. In terms of shelf life, any technology at the peak of its adoption curve has passed its expiration date. You need to foster innovation and continually relaunch proprietary technology, or prepare for diminishing returns.

What precisely does "innovation" mean in the context of health care? It's not just good ideas, as the world is full of ideas that go nowhere. An innovation is an idea that has been put to work. Having an idea doesn't make you an innovator any more than...



Courtesy of Stephen Travarca/The Cleveland Clinic

The modern academic medical center is one of the most powerful engines of innovation in the world today.

If you travel around enough, you know that the world is filled with monuments and historical markers. From Phoenix to Philadelphia, plaques recognize everything from the first airplane flight to the first soda fountain. But the great innovators of medicine often go unrecognized.

Let me give you an example. F. Mason Sones discovered moving cine-coronary angiography at the Cleveland Clinic in the mid-1950s. For the first time, it was possible to see into the coronary arteries, and understand the role of arterial stenosis in the etiology of angina and heart attacks. Sones' discovery enabled his colleague Rene Favaloro to perform the world's first published coronary artery bypass at the Cleveland Clinic in 1967. Even though these two innovations saved or improved countless millions of lives, no historical markers commemorate them. In my opinion, Sones should have won a Nobel Prize for his discovery.

If an institution is to foster innovation, it must have a high tolerance for renegades, the kind of creative people who are dissatisfied with the status quo and always looking for better ways of doing things. Institutions must also allow room for failure. It is an astonishing fact that Sones realized coronary angiography through an error. As the story goes, he was injecting contrast solution near the opening of the coronary artery. The catheter slipped, and dye was injected into the coronary artery itself. It was believed at that time, that if you injected dye solution directly into the coronary arteries, the heart would stop and the patient would die. To everyone's surprise, the consequences weren't fatal. Sones went on to make small, deliberate injections of contrast material into the coronary arteries, resulting in clear, real-time X-ray pictures of the coronary arteries, and a new era in cardiac care.


Innovation can be spurred in several ways, but the enemies of innovation seem numberless. They include, ironically, success. If something isn't broken, why fix it? For centuries, medicine was one of the most tradition-bound professions. Precedent overruled observation. Generation after generation performed procedures such as bloodletting without bothering to find out if they actually worked. In our own time, I've worked in hospitals where outmoded practices were defended by saying: "That's the way we do it." Or, "That's the way our founders did it." It used to drive me crazy. Some people will always be terrified of change.

Education can be another enemy of innovation. Medical schools demand that students accumulate a massive quantity of facts. Too often, these are learned for the purpose of regurgitation, not application. Residents are encouraged to imitate, and are rewarded for becoming junior versions of the reigning technical and intellectual stars. I can remember being told (and telling others), "No improvements please. Today, we'll do it my way."

The pressure to reduce costs has also taken its toll on innovation in health care. It has actually brought about a paradigm shift in the way we apportion care. In the past, we took it for granted that we would do everything humanly possible to help a patient. Today, we must weigh the cost of treatment against the potential benefit.

We need to remind our constituency that cost alone tells us nothing. Quality also needs to be factored in. Technology that increases the cost of medicine also increases its quality. Eighty years ago, the average life expectancy was 54 years. The innovations of the past half century have helped to extend life expectancy to 76 years. Global improvements in health and hygiene assure that those extra years are as vital and productive as any that came before. As the quality of life has surged ahead, people are working longer, paying more taxes, and contributing more to the general weal. Does anyone care to turn back the clock? No. Yet the public discussion of health care continues to emphasize cost over value.

The ability of modern medicine to enhance the condition of any given patient exceeds society's current willingness to pay. This fact is at the bottom of every healthcare issue today. Some see this fact as a menace. I see it as another opportunity for innovation. Economist Elizabeth Teisberg wrote, "Innovation is the only long-term solution to high-quality, affordable health care."

Indeed, our national medical innovation summit (Oct. 18–20) is focused on the challenges of cardiovascular medicine, including rising healthcare costs. It will bring together Fortune 500 CEOs and top economists to discuss new technologies, new research, and ways to make these technologies available to patients.

We all know the dangers of innovation. Nothing is more difficult than planning a new order of things. Your enemies attack with the fervor of partisans. Your defenders will be sluggish. You'll get a belly full of griping and a back full of arrows. But the greatest risk is taking no risk at all. From all this, we must conclude that chance favors not only the prepared mind, but also the institution that is prepared to capitalize upon it. Innovations will succeed based on their own merits, and the only failure will be to stifle invention. Our first task is to get out of the way.

Toby Cosgrove is the new president and chief executive officer of the Cleveland Clinic and a cardiac surgeon at the Cleveland Clinic Heart Center, ranked No. 1 in the United States by U.S. News &World Report. His interests include the surgical treatment of thoracic and cardiovascular diseases, mitral and aortic valve repairs, and innovations in minimally invasive heart-valve surgery. He has 18 patents filed for medical and clinical products used in surgical environments.

He can be contacted at (cosgrod@ccf.org)

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