The Cleveland Clinic's Cosgrove era comes to a close

Dr. Delos "Toby" Cosgrove has always been in search of a better way to do things — for patients, for Cleveland Clinic, for its caregivers.

In his near 30-year career as a cardiac surgeon, he would look at every step of the process, every stitch and think, "How can we do this better?" according to those who've worked alongside him in the operating room.

The first time he addressed staff during his tenure as CEO, Cosgrove handed out buttons with a simple phrase: Patients First, the mantra that would come to define the Clinic and guide all that the system does.

With a respected voice and platform in the national health care debate, he's pushed for cost control, wellness and patient responsibility.

His colleagues past and present use many words to describe the influential leader — consistent, powerful, compassionate, tenacious, genuine, direct — but perhaps what best captures Cosgrove is "innovator."

"He was and might still be the most prolific innovator in the history of the Clinic," said Chris Coburn, the former head of Cleveland Clinic Innovations who is now the chief innovations officer at Partners HealthCare in the Boston area. "His creativity was not limited to what he might invent as a surgeon. He brought and really embraced a willingness to envision a different way to do things."

Cosgrove, who joined the Clinic in 1975, will step down as CEO of the Clinic at the end of the year. Dr. Tomislav "Tom" Mihaljevic, now CEO of Cleveland Clinic Abu Dhabi and one of the Clinic's prized cardiothoracic surgeons, will take over Jan. 1.

Cosgrove ushered in a new era for the health system, propelling it from a regional system to an international brand. His list of accomplishments and accolades is long, but what he says he's most proud of is the people of the Clinic.

"The Cleveland Clinic is not a bunch of buildings. It's a bunch of people who really have done a tremendous job," he said. "They work very hard. They're very capable and they really pour their hearts and souls into their work here."

The operating room with Cosgrove was a "magical place," said Dr. Nicholas Smedira, a heart surgeon at the Clinic. Cosgrove was a fast, efficient "master surgeon," with a great sense of humor. Smedira learned from him to think creatively and always question how to do things better.

"I'm one of the hundreds if not thousands of surgeons he's trained that have gone out around the community, the nation and around the world in literally dozens and dozens of countries that have changed how cardiac care is delivered to patients in every country," he said.

A surgeon in the U.S. Air Force, Cosgrove served in Da Nang, Republic of Vietnam, as the Chief of U.S. Air Force Casualty Staging Flight and was awarded the Bronze Star and the Republic of Vietnam Commendation Medal.

In his near 30-year career as a cardiac surgeon at the Clinic, Cosgrove performed 22,000 operations. He's a "workaholic," said Dr. Joe Hahn, the Clinic's former chief of staff, who has known Cosgrove since the two attended the University of Virginia School of Medicine in Charlottesville, where he received his medical degree.

He completed his undergraduate work at Williams College in Williamstown, Mass., and his clinical training at Massachusetts General Hospital, Boston Children's Hospital and Brook General Hospital in London.

Many people see Cosgrove as a "hard-charging" thoracic surgeon, a successful CEO running an $8 billion business, said Larry Pollack, a member of the Clinic's board of directors.

"They don't see Toby as a surgeon who moved here when he was right out of training and slept in his car the first night," he said. "They don't see Toby when he was doing some training in pediatrics in Boston, running through the halls shooting his squirt gun at kids to get them to smile."

In his time in the operating room, he developed dozens of ideas that led to new technology innovations and patents, said Bob Rich, chairman of the board of directors for the Clinic, who has known Cosgrove since 1959.

Cosgrove was named chairman of the Department of Thoracic and Cardiovascular surgery in 1989.

In 2004, he was named president and CEO of the Clinic, pushing the heart surgeon into the national spotlight as he stood holding the reins of one of the country's most well-known health care institutions.

"I was never a public figure before this," Cosgrove said. "I used to go to a party and I would be introduced as Anita Cosgrove's husband, because no one knew me because I was locked up in the operating room. And all of the sudden, I became a very public figure in a matter of about three weeks."

To the C-suite, Cosgrove brought his sense of curiosity and desire to do things right.

He led the Clinic as it grew within the region, solidified its reach across the nation and stretched around the world. Between 2004 and 2016, revenues more than doubled from $3.7 billion to $8.5 billion, and total visits grew from 2.8 million to 7.1 million.

In that time, the Clinic bolstered its research efforts, with research funding growing from $121 million to $260 million and the number of physician-scientists increasing from 1,800 to 3,400.

The Clinic opened new buildings, most recently a hospital in Avon and the Taussig Cancer Center on its main campus, and shuttered some as well. In his tenure, the Clinic closed both Lakewood and Huron hospitals, decisions that were met with backlash from their communities. Cosgrove stands by the decision, saying that the Clinic did the right thing for both facilities, which were underutilized.

"We put in their place an outpatient facility that was specifically tailored to that community," he said. "Health care is changing. There's less inpatient requirements and more outpatient, and that's what we tried to do."

The squabbles over hospital closures weren't the only tumultuous periods during his tenure. In 2007, the Clinic stopped hiring smokers, a point of contention for many. In 2015, he closed the McDonald's on the Clinic's main campus after an almost decade-long crusade to rid the campus of the fast food restaurant.

And in the spotlight, he has made a few off-kilter statements. Several years ago, he told The New York Times that, if it were legal, he wouldn't hire obese people. He ultimately apologized for those remarks, but told employees that there's still "much more we could do to prevent chronic diseases if we take measures to eat healthier, exercise and quit smoking."