Healthcare Markets Talks to Cleveland Clinic London CEO Brian Donley, MD

Entering the London private market

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This article originally appeared in the March 2019 issue of the Healthcare Markets (HM) publication. It is republished here with permission.

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Cleveland Clinic sent seismic waves through London’s private hospital sector when it announced plans to enter the market back in 2016.

Increased competition, new models of care and a potentially new way of engaging consultants have dominated discussion and that is before the US not-for-profit has treated a single patient or opened a single bed at the six-storey hospital currently under construction in London’s Grosvenor Place.

However, there is a delicate balance between being the bearer of disruptive innovation and integrating into a new market, and this is something that Cleveland Clinic London CEO Brian Donley, MD, understands only too well as he presses the point that the US healthcare giant plans to be as much collaborator as it is competitor in the UK market.

“We’re here because we want to innovate and to learn and also make a contribution to healthcare provision in this country,” he tells HM.

“We want to bring the best of what we do to this market and integrate that with the best of UK healthcare. And that combination of the best in UK healthcare, which exists throughout all sectors of healthcare in the UK, and the best of Cleveland Clinic is what Cleveland Clinic London is about. As Cleveland Clinic London is different to what we have back in the US, that allows us to learn back in Cleveland how to be better for our patients and continue to be an evolving, learning organisation.”

The 185-bed London hospital is due to open in the first quarter of 2021. Equipped with the latest digital technology, including full electronic medical records and computerised medicine dispensing, it will be a full-service hospital but with a focus on specialties where Cleveland Clinic has particular expertise back in the States: cardiology and cardiac surgery, digestive diseases, orthopaedics and neuro-services.

In addition, it will provide cancer surgery and although there are no plans for a full oncology suite, it is looking to develop collaborations with medical and radiotherapy providers in the UK.

“We will absolutely look to collaborate and learn and innovate from some of the best healthcare that exists here in the UK,” says Donley.

Like many of the Cleveland Clinic’s executive team, Donley is a medical doctor. He joined the organisation as an orthopaedic surgeon in 1996 before taking a sabbatical to attend Harvard Business School and moving into leadership roles. In his previous role, as the Cleveland Clinic’s chief of staff, he was responsible for oversight of the organisation’s 3,500-strong team of physicians.

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“I was responsible for all clinical operations across North America, so I’ve got extensive understanding of where our focus has been over the last 25 to 50 years and over the life of the organisation. And there have always been two words that govern and guide everything we do – patients first.”

Clinician-led

Established in 1921 by a group of four clinicians who had returned from caring for soldiers in World War I, Cleveland Clinic prides itself on its physician-led model. As Donley puts it, it is “a medical group that runs a health system rather than a health system that employs doctors.”

“There are four core elements to our organisation. And the first of those is physician leadership,” he says. “So, in our governance at all layers of leadership is the physician voice. It influences everything we do, and we believe that’s important because that brings the patient perspective into decision-making.”

The organisation’s second core, says Donley, is its not-for-profit status.

“We have no shareholders that money is distributed out to, so all surplus goes back to fund the organisation’s mission of delivering high quality healthcare and some of that funds core three and four – research and education,” he explains.

In 2017, the Cleveland Clinic’s Lerner Research Institute alone had a research budget of $272 million.

It also provided 107 accredited training programmes at its Education Institute and enrolled 160 students on its tuition-free MD programme at the Lerner College of Medicine.

“We focus on research and education with great intentionality,” says Donley. “And we focus on it because our patients get better outcomes. Organisations that focus on research and education get better outcomes and that allows them to attract great talent. People want to be a part of organisations that are continuing to define and innovate the future. Our mission is to improve the lives of those we care for and we’re looking to extend that model across the globe.”

Striving to innovate

In the US, Cleveland Clinic runs health systems of gargantuan proportion. Its flagship hospital campus in Cleveland, Ohio has almost 1,400 beds and 101 operating theatres spread across 59 buildings on a 170-acre site.

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With centres in Florida and Las Vegas, as well as outside the US in Toronto and Abu Dhabi, the organisation has built a strong reputation for quality and outcomes. It ranks the number one in the US for heart surgery and urology and its hospital campus in Cleveland has the highest acuity of any hospital in North America.

As Donley puts it,that means it takes care of ‘the sickest of the sick’ from across the country.

“Where our organisation has been a success, it’s because we have always had a relentless focus on quality, safety and the patient experience of care, centred on a foundation of transparency to make us better,” he says.

According to Donley, it is this culture of continually striving to learn and innovate that led to Cleveland Clinic’s decision to launch in the UK.

“Why we are here and why we made this decision was that we want to continue being an innovative and learning organisation and we feel that we have a thread of innovation and continuous improvement knowing that we constantly want to be better for our patients. And it’s that thread and that spirit that led us to this decision and the reason we chose London is because there is great healthcare that happens in London,” he says.

Donley is no stranger to the UK. Ten years ago, he was selected for a travelling fellowship where he spent time working at NHS trusts across the country, from Southampton to Edinburgh. What he saw, he tells HM, convinced him that there is excellent healthcare, delivered by excellent clinicians, in the UK.

“There are lots of opportunities for us to learn here. There are fantastic examples of clinical care, fantastic examples of safety programmes, there are excellent examples of providing care in more cost-effective ways using digital technology. There are many examples where we will collaborate with organisations here in the UK – both providers and industry – to combine the best of what Cleveland does with the best in the UK,” he says.

Consultant engagement

In the US, all Cleveland Clinic consultants are employed on a salaried model and like fellow new market entrant Schoen Clinic, this is something the organisation plans to offer doctors in the UK, alongside more traditional routes such as practicing privileges.

However, regardless of how they are engaged, the organisation wants its UK consultants – even its Institute Chairs – to continue their NHS practice.

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“One thing is that we expect and encourage our physicians at Cleveland Clinic London to continue their time in the NHS. There are excellent things that happen in the NHS, and we expect our physicians to continue with the practice in the NHS and then participate in the private care with us,” says Donley.

All consultants at the London hospital will also be expected to work as part of multi-disciplinary teams alongside nurses and other healthcare professionals, such as pharmacists.

“We’ve had an overwhelming expression of interest from physicians wanting to work with us. I think that physicians want to provide the best for their patients, and they want to find the best environment and the best place where that can occur,” says Donley.

Although still two years away from its opening date, Cleveland Clinic London has already recruited leads for all its service lines and has embarked on the recruitment of Institute and Department chairs.

Donley is acutely aware of the difficulties recruiting nursing staff in the UK but says Cleveland Clinic is confident it can attract the right people and it is looking to recruit internationally and domestically, as well as bring staff over from the US.

“We think that there will be many challenges ahead with the metrics of success that we are defining, but we think we can work through those and so certainly staffing is a focus for us and we’re very happy that we’ve had great enthusiasm from consultants wanting to be a part of our model of care,” he says.

And, according to Donley, it all comes back again to those two words: patients first.

“I think physicians, nurses and all employees in the health system participate in an ethos of wanting what’s best for the patient and what healthcare workers want – everyone wants meaning and purpose in their working life – and health professionals get their meaning and purpose by improving the lives of others. In a clinician-led model, when those people who define their meaning and purpose by improving the lives of the others are in the centre of decision-making, they are bringing that patient perspective,” he says.

The private healthcare market has become an increasingly challenging environment in recent years, and in London some of the major providers have reported a decline in revenue as international patient numbers dwindle while PMI revenue remains, at best, static.

Add political turmoil and continued uncertainty over Brexit into the mix, and it has to beg the question of whether Cleveland Clinic would make the same decision to enter the market today?

“We continue to be as committed and positive about our decision as when we initially made it before the Brexit vote,” Donley concludes.

“We chose London because we want to innovate and learn, and we can do that by collaborating and learning from some of the great things that happen in healthcare here in the UK. And that’s from a clinical delivery perspective, that’s from a research standpoint, and that’s from an education standpoint. London is a city of the world and it will continue to be a city of the world. As we are successful in London, it allows us to be successful in our model of care for the world.”

Republished with permission from HM, by LaingBuisson Ltd.

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