Eric Klein, MD, on Leadership and the Urology Program with the Nation’s No. 1 Reputation

The metrics that matter, and how to become a top center for urology referrals

Since 2012, more U.S. urologists have said they’d refer their most complex urology cases to Cleveland Clinic than to any other medical center. This reputation, or Expert Opinion score, accounts for nearly 30% of a urology program’s overall rating based on U.S. News & World Report’s “Best Hospitals” survey. But it’s a lot more valuable to Eric Klein, MD, Chair of Cleveland Clinic’s Glickman Urological & Kidney Institute.

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“I think about this rating by considering the difference between character and reputation. Character is who you really are, and reputation is who people think you are,” says Dr. Klein, paraphrasing a favorite quote from winning UCLA men’s basketball coach John Wooden. “Much of our character at Glickman Urological & Kidney Institute is our patients-first attitude, and not being satisfied with the status quo for any condition we treat. That’s what pushes us to do innovative research and lead new medical and surgical approaches to move the urology specialty forward. This part of our character is closely reflected by our reputation, and I find it gratifying that our peers around the U.S. see us as we really are.”

In this Q&A, Dr. Klein, who has led Glickman Urological & Kidney Institute since 2008, explains more about the metrics that really matter, what’s gone into building such a notable reputation, and how the institute is ensuring that Cleveland Clinic’s status as a top center for urology referrals will continue.

What scores or metrics do you prioritize as you lead urology at Cleveland Clinic?

Dr. Klein: We have a whole set of objectives and key results that organize our practice. They’re categorized into five groups:

  1. Care for patients.
  2. Education.
  3. Care for caregivers — making Cleveland Clinic the best place to work in healthcare.
  4. Care for the organization — being responsible stewards of resources and being dedicated to growth in clinical practice.
  5. Care for the community — reducing barriers to access and giving back to our local neighborhoods with efforts like our Minority Men’s Health Fair and middle school mentoring.

We consider lots of specific metrics in each of these categories: avoidance of serious safety events; patient outcomes after surgeries and other interventions; achievements by our faculty, residents and fellows; not to mention all the business operations metrics, such as growth and reimbursement.

As a leader, how do you address so many measures at one time?

Dr. Klein: Leadership is mostly about communication and setting expectations. Vince Lombardi, legendary coach of the Green Bay Packers and another favorite leader of mine, observed that teams should strive for perfection in everything they do and recognize that they will rarely achieve it. But somewhere along the way, they’ll achieve excellence.

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That’s been my philosophy too, and that’s the expectation I’ve set for our institute. Every job, whether patient-facing or not, needs to operate at a level of excellence at all times.

When I was appointed Chair of the institute 12 years ago, I established a monthly meeting with all of the institute’s critical leaders, including department chairs and administrators, nursing directors and supervisors. It’s called the QEAA (Quality, Efficiency, Affordability and Access) council. Each month, we discuss all of the metrics that we track and discuss our expectations for excellence. It’s also an opportunity for people to report on their progress and have a cross-fertilization of ideas.

At that meeting, I get to hear what’s going on with appointment scheduling, nursing, finance, clinical care — all the functions that mesh together in our institute. I get to reinforce the importance of every function, and together we hold each other accountable for excellence in every position.

It’s a very positive feedback mechanism that helps us organize what we do and stay focused on the things that are important.

How do you define your leadership style?

Dr. Klein: Good leadership is informed by good values. As a leader, I’ve always said that it’s not about me, it’s really about everyone else getting the opportunity to do their job well.

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I think my leadership style is hands-off. First I get the right people on the team, with the right values, skill sets and diversity. Then I set high-level expectations and give the team members the resources they need to do their jobs well. Finally I get out of the way, but monitor what my colleagues are doing, so if they get off track I’m there to redirect them.

What factors do you believe have gone into building a urology program with such a high reputation?

Dr. Klein: Providing great patient service is where it starts — providing high-quality care and keeping patients safe. Then it requires communicating well with referring physicians and doing cutting-edge things that move the field forward, staying a little ahead of the curve with innovations like single-port robotic prostatectomy and kidney transplant; ambulatory urodynamic devices; and the new IsoPSA™ test for patients facing a decision on prostate biopsy. Our faculty and scientists are studying the effect of the microbiome on cancer, stone disease and infertility. We have the world’s largest experience with partial nephrectomy for kidney cancer.

Because of our culture at Cleveland Clinic, we enjoy these and other results of a multidisciplinary approach to complex medical problems.

What are you doing to maintain this leading reputation in urology?

Dr. Klein: We hire people with intellectual curiosity and an inherent drive to move the field forward. Our faculty and scientists collaborate effectively to devise new ways of understanding and treating a large variety of urologic diseases, and then translate the results into the clinic. In the end, the goal is to improve the lives of patients by reducing the burdens of diagnosis and treatment.