Innovation Across the Pond

Podcast Transcript

Will Morris, MD:  Hi, this is Will Morris host of Health Amplified, a Cleveland clinic podcast. And with us as always is Dr. Akhil Saklecha, managing partner Cleveland Clinic Ventures. And today we have a special guest all the way across the pond. Our CEO of Cleveland clinic London, Dr. Brian Donley. Brian is an orthopedic surgeon and previously served as the chief of staff of Cleveland Clinic. And in subsequent has transitioned to his role as CEO of our new enterprise Cleveland clinic London in February of 2018. Brian, is an absolute pleasure to have you here.

Brian Donley, MD: Well, Akhil and Will it's great to be here. Thanks actually for the opportunity.

Will Morris, MD:  Great. Well, I'll kick off with an open-ended question as a lifelong innovator, stateside orthopedic surgeon you experienced the culture of both US healthcare innovation, certainly at the Cleveland Clinic. What has been your experience now two years plus in the ecosystems of London?

Brian Donley, MD: Well, Will, experience in two years has been on many levels, just a phenomenal experience. And in many ways it makes me think about the experiences I had at the Cleveland Clinic. I think the experiences that many of us have at the Cleveland Clinic. When I say many all 70,000 of us as caregivers. I think about what I enjoyed being in Cleveland and the history of the Cleveland Clinic, I always remember and think about it being two things. One about a passion to learn and about a spirit of innovation. And so when I think of those two things, then come over here to London with us building Cleveland Clinic London. I can tell you my experience has been nothing but just enriched around the passion to continue to learn and about the spirit of innovation and in many ways, as you know and Akhil knows those are really tied together. So it's really been a great growing experience to be over here for me, for our team. And I think overall for Cleveland Clinic, as we continue to learn, as we go across the globe for many different areas.

Akhil Saklecha, MD: How you viewed ... coming from the U S and then going into a totally new health system. Going from fee for service and the value based care, but now going to the UK where the NHS is in some ways, even more advanced in delivering care for the US or for the UK population, how did you look at that transition and how did you learn and figure out how to navigate there?

Brian Donley, MD: Yeah, I think Akhil, I go back to think about the reasons why we decided as an organization to come to London. And the reasons we made that decision were to continue to learn and innovate as an organization. That's the number one reason we're here in London, not in a three to five-year plan, we're here in a 25 to 50 year plan. The other reason we came here is to build brand. Despite COVID, despite Brexit, London has been, is now and will always be a city to the world. And so when I think of those two reasons, you come in here with a lot of some of our values of the Cleveland Clinic. You come in here with humility, you come in here with eagerness, with curiosity. And so when you look at the National Health Service and for maybe the listeners that don't fully know about the National Health Service, that is free healthcare for every person in the United Kingdom free at the point of service, paid for by the government.

Brian Donley, MD: And I'm sure that's controversial to hear that and think about that compared to our US system, but from your question and the thought of how we continue to learn and innovate, it's a remarkable experience to dwell and look at some of the great aspects of that, and then how we can take some of those aspects of the Cleveland Clinic. What we've said in our approach of our team here, we're a little over 200 people now in London. We're on timeline now to open the outpatient clinic in September 14th of 2021. Not that I'm counting, but that's 51 weeks and five days, and we'll open a hospital in 72 weeks. And what we talk about a lot is we're not bringing the Cleveland Clinic to London, we're bringing the best of what we do in Cleveland and we're integrating with the best of UK healthcare. And we specifically chose to come to London because we think there's great healthcare in London. And I can tell you in my two years here, that's exactly what I've seen.

Will Morris, MD: Yeah. I think what at least listening gets me so excited. You mentioned two things. One is the city of the world, and you imagine the diversity, the unbelievable differences of thoughts, challenging status quo, different perspective, the uniqueness, I think that is such a fertile environment to grow, learn, and foster. And that also you are coming with ears open, mouth closed and a degree of humility. How has your presence been welcomed by the NHS? Is it ... I don't want to say adversarial, but was it questioned at first and how can perhaps innovation be or a branch if you will, to create better synergies and collaboration and partnership?

Brian Donley, MD: Yeah, I think that's a great question, Will and really great to recognize what position you're in when you come into a completely new environment like this. I would say that we're cautiously welcomed as you would welcome anyone and not until ... and I'm not sure that has anything to do with healthcare in general, but just from a human psychology standpoint, not until you really build trust in one another, can you then move forward to collaboration. So we have worked hard to build trust with a lot of the different communities of healthcare. And that's not just providers. And I think as we've done that over these two years, and in this coming time, it's allowed us really to work on some strong collaborations with parts of the National Health Service, and also with other private providers. On Monday, we had a press release come out that we announced a cancer partnership with the London Clinic. That's a private provider. We will share IT, we'll share our patient information. And together we will provide a seamless care pathway that's in the best interest of patients and their families. That takes a lot of trust. We learned from them, they learn from us and together we're better for our patients. In a similar way where we have several partnerships already established with NHS partners. One's around sterilization and you might not think of this as an innovation, but maybe this is an example and what you can learn going to a new environment. Real estate in London is extremely expensive. So it's hard for a hospital to have sterilization in the hospital. Certainly hard for us. Our hospital is right behind Buckingham Palace. It's 184 beds, 29 ICU beds. And we don't have the capacity of essential sterilization in the hospital as other places don't.

So we have an NHS partner where we will outsource our sterilization. That takes a lot of trust, but that's somewhat, I think of innovation because in America, and certainly in Cleveland, we would never outsource central sterilization. Every hospital has that in the hospital, not possible here. So you realize, "Hey, you can do things in a new way." And it's learnings like that, where I can go after example, example. I think always, if I can just say one other point about your question, Will. The two things that are core to the Cleveland Clinic are research and education. And when you said the word, all the branch note, that's an area where everyone can come together.

And there's an incredible research community in London. Some of the top universities in the world are here in London and having the opportunity to work with them around research and education has been a great opportunity and us to be able to go back with the 4,000 physicians, 70,000 caregivers in Cleveland, and bringing that to London is a great collaborative effort where I think we're making advancements. Again, always at the core advancements to better the lives of our patients and their families.

Akhil Saklecha, MD: I would agree with that comment. I think we always have a belief that we're not in a while ... we are pioneers certainly in innovation and in clinical care and are amongst the best in the world. We can learn so much from others. Are there examples that you found within the time that you've been in London where we're able to actually take some of the things and practices or processes that you're doing in there and bring them back here?

Brian Donley, MD: Well, that's a great question, Akhil. When you think about that we don't open yet. We only see our first patient for a year, but I think there already are. There's some actually across health care is a broad area. And so some of the things are construction. There's some construction practices that we actually have taken out of London and that we're bringing back to the US to think of a new way. This is really specific, but again, it's partly because of the density in London, they have to [inaudible 00:11:07] all the steps and then just drop those into a building. I guess we never thought of that in Cleveland, but that actually can cut the timeframe down and building a building. That's a very specific example. That's one example. We see instances in human resources, we've learned different things in human resources that we're doing different, that we're bringing back to Cleveland and some practices there.

There's a lot of areas already. And I think it's really exciting then as we move into the clinical areas. We've already hired all of our clinical Institute chairs and department chairs and they're well integrated with our Cleveland team and working together to spread different practices, different ways to do things and different ways to look at things.

Akhil Saklecha, MD: So, when we were in London, one of the things that struck me was how we were hiring the clinical physicians. And I recall that they weren't necessarily 100% with the clinic. They were shared with the NHS in some way or with their current practice. And was that intentional to make sure that we deliver that sense of trust, or is that something that the clinicians were wanting because they were unsure?

Brian Donley, MD: Wow, Akhil and will you guys have done your homework, you have good questions and I'm actually really appreciative of you bringing that point out, Akhil. That was done with intentionality on our part and it really goes back ... I know it sounds like redundant, but we work off just some simple principles and we always aligned to them. And going back to learning and innovating, being our principal, and having great healthcare here, we know a lot of that is in the NHS. And so when we came here, we wanted to hire our doctors for their time that they spend in private care. But the best doctors are the ones who are in the National Health Service, and we want them to continue their work in the National Health Service for several reasons.

One, there's phenomenal health care there. One, I think there's an obligation to the citizens of the country so that all citizens can be provided. It will create a little challenge and though uniqueness to what we're used to in Cleveland at our main campus where our employed physicians are 100% of the time. So it's a little cultural complexity, but with a lot of attention to detail, we're finding that the culture is really growing and going well with a lot of intentional interaction and infusion of Cleveland Clinic culture. Pre-COVID, it was with travel to London. Now it's filled with a lot of virtual aspect.

Akhil Saklecha, MD: Will, if I could give a follow on question on that. So specifically around hiring, I know that when we look at physicians for Cleveland Clinic, we're always asking about their thinking around innovation and how much they view innovation as a part of what they want to do. How do you look at that in the hiring of the physicians you've hired and going forward as you build Cleveland Clinic London?

Brian Donley, MD: Yeah. There's one slide that guides everything we do. Every meeting we have, it starts with, that's our executive team, that's where the executive teams, and that's where the teams below that. Everyone starts with one slide. And at the foundation of that slide, which we recite every meeting, our six Cleveland clinic values, and so we hire towards those values and we talk about the fact that it's not just those values, it's the behaviors that we model. And as you know, our six values are quality and safety, empathy, teamwork, integrity, inclusion, and our sixth is innovation. So it is a part of the entire process that we speak about innovation and it's a constant theme. And so it's, I can tell you, it's an attraction of why we've been able to get such great talent. We've already signed approximately 155 doctors through COVID, we've seen the demand even accelerate to want to be a part of our model. And I think it's that ability to have your innovative spirit valued that is an attraction. It's a big part of our success in recruitment right now.

Will Morris, MD: We would be remiss not to address COVID, but my take on COVID and the question is really how the pandemic is hoisted that this is a global effort, both in the management but certainly how we all come together for vaccines and purpose of curing this. I'm curious, what is your perspective of this physical hospital as a conduit for [inaudible 00:17:08] outside of the the UK, how do you see Cleveland Clinic London in the bigger sphere, whether it be the EU for innovators?

Brian Donley, MD: Yeah, I think COVID is a great example. Certainly around the world, not just in healthcare, we've seen an incredible acceleration of innovation from this pandemic. And I think it's a great example to Cleveland Clinic London and to our system. And what I mean by that is as that was rolling out, we were very fortunate to have a global healthcare system so that we had Abu Dhabi, we had their experiences, we certainly had Cleveland and the experiences in Cleveland around the treatment of COVID. And then in London, we're not open, but with our doctors being in the NHS, so we did have experience through the NHS and we were able to tie together those three experiences as we continue to develop our plans. When you think back in March, April things were accelerating fast, and I thought it was very ... it was a comfort, source of comfort to be able to see those three experiences, have the database of the national health system, phenomenal advantage of a national health system to have a database of all patients in the country.

I think that shows you some of the power of global innovation. And Will and Akhil, you guys have tremendous experience with innovation more than I do, but when you think of different areas, if you're in Ohio, it's great to get into different areas of Ohio and hit innovation. Whereas in a global situation, that's just on steroids to have the access into England, United Kingdom and close to Europe. So I think it's been a real benefit for our system. And back again, ultimately, who is that a benefit for? That's for our patients.

Akhil Saklecha, MD: Brian, looking at what we did here, there was a strong partnership between the Cleveland Clinic and the state of Ohio, Florida and even nationally, we obviously are in a very early position in the UK, but are there tangible examples that you found of how we interacted with the government and contributed to the fight against [inaudible 00:19:50]?

Brian Donley, MD: Yeah I was really proud of our Cleveland Clinic London caregivers. I can tell you the one thing we did is we put all of the doctors and nurses back into the national health system to help with the fight of COVID during that time. Some tangible examples would be around education. We had developed some great programs in Cleveland, and there were some phenomenal programs around health education, England, and looking to retrain healthcare providers early in the pandemic when it was unsure what the demand on the system was going to be. And we were fortunate to come together with health education, England, along with our educators in Cleveland, to help each other enhance the systems for education around that. And I know that in Cleveland, we certainly benefited from that. We were fortunate for the learner, we were fortunate here in London with the support of the Learner Research Institute to reach out with ... get involved with some of the European research councils that were popping up very quickly around COVID.

I think that was a great advantage for our organization. And I think also our organization was likely beneficial to some of those councils. Those are two examples that I think of. Maybe the other one that kills I sit here is, we have a critical, we're going to have 29 ICU beds in this hospital, which is a phenomenal amount of ICU care in private healthcare here in London. Actually, when we opened, there'll be 26% of the capacity of private ICU care. With our leadership team being in the AHS, I know that I would be connecting them with our respiratory leadership in Cleveland talking about what was being seen here in London, because it was coming through London a little earlier and having some of those experiences I think were helpful.

Will Morris, MD: Yeah. I think, again, it just makes so much sense that these conduits for best practices, for education, for research, for data, this is ... healthcare is global and shame on us if we do not listen and do understand, and then shamelessly share best practices and also share when things don't work. So, I applaud you're not just obviously opening up a physical instantiation of a hospital, it is a conduit of bi-directional best practices it sounds, that is really, really exciting. What has-

Brian Donley, MD: I'm sorry Will. I think the other thing too, as you say that, and I started to be interested in hearing your input, if you think differently, it also improves the diversity. We all know how important diversity is, but it's about diversity of thought. It's about diversity in your research databases, all to get better answers. And I think I see a lot of benefit to the improvement of the diversity of the research databases and obviously the diversity of thought.

Will Morris, MD: Yeah, I would agree. I think the diversity of thought challenges the status quo. And the US and I will say, I suffer from the, I call it the NIH phenomenon or not invented here. And that is a barrier I perceive when we don't challenge status quo and even something like shared services, like shirt sterilization, laundry, IT, these are all things that, yes, we have done them for years, but should we continue? And how do we continue to afford to innovate on the edge, but not be encumbered by the past?

Brian Donley, MD: Yeah. I agree with you.

Akhil Saklecha, MD: And I want to actually build off that acronym that we'll use,` NIH. So one of the things that struck me when looking at some of the startups in the UK and Europe is, we're actually in a position to really work with some of this cutting edge innovation and startup culture that's in the UK and Europe in general. But you're not quite there as a physical facility that's open. So how do startups actually engage with CCF London? And then how do we look at how those startups actually can come to us? So, have you thought about a process of how to interact with startups because that NIH concept that Will brought up, it's actually really important because there's so many unique things that are going on in London with startups that are really innovating on ideas and concepts that we may not be familiar with and we certainly don't want to miss out on.

Brian Donley, MD: Yeah, I think Akhil, the key is back to the point, we're not bringing the entire Cleveland Clinic in Portland and in London, but we're bringing the best of what we do. And so in many ways, this 184 bed hospital, 29 ICU rooms, a focus on digestive disease on neurosciences, orthopedics and heart vascular and thoracic is a place where we rely and have the backing of the entire Cleveland Clinic. And so, we are an academic medical center in center of London with our academic base based across the ocean but directly connected to us. And in the last six months, I think we've all seen it's a lot easier to be connected than we ever thought.

And so, your question about how you access, I think getting into our system exposed with our people and us at Cleveland Clinic London, getting out there in the community. We're really aggressive and spending a lot of time to get into the community of healthcare in all aspects. And that allows us to get in to see the different innovation pathways, the different startups, and then getting all of you involved. We're not going to recreate what we have in Cleveland with the expertise that two of you represent. And so it's about bringing that together and bringing your resources, your experience, and your expertise to the table to work with that.

Will Morris, MD: Brian, we're coming up on time, and I know you are laser focused to what happens in 51 weeks and five days. But beyond that focus point that day, what is your vision for Cleveland Clinic London?

Brian Donley, MD: I can tell you Will, it's not my vision, but I think it's our vision. And it's our vision right now of 200 plus Cleveland Clinic London caregivers and I think our vision of Cleveland Clinic. And in Cleveland Clinic London, we have nine words that anchor who we are and what our purpose is. And what we say is we're actually not here to build a hospital. And I know that people might think like, well, what is that? Why would you not be there? And what we say is if you join our team and you want to come be a part of Cleveland Clinic London, our purpose is that we're compassionate caregivers, transforming health and care for the world. And if you want it, if that sounds like something you're interested in, then that's what you want to be ... then you want to be at Cleveland Clinic London.

I'm going to say that again. If that's something you're interested in, then you want to join Cleveland Clinic London, because that's what we're about. And so what our vision is, is to truly transform health and care for the world. We actually want to improve the lives for all the citizens of London and UK, by developing a model of care that sets a standard of care with an integration of NHS best practices, Cleveland best practices, and everyone in the United Kingdom and beyond can benefit from that. And we're excited that we're already seeing examples of that.

Will Morris, MD: Well, I think you can count on both Akhil and I and the entire team of innovations and ventures to be at your side as willing participants in this exciting chapter and a book that is not yet written, but we are truly appreciative and thankful for the work that you and your team of 200 are doing. And certainly for the citizens of the UK for being such welcoming guests, if you will, in acclimating and inviting us into that ecosystem.

Akhil Saklecha, MD: And I will just add Will, just based on what you said I think I'm ready to sign up. We are coming to CCF Monday and I just need to persuade my wife.

Brian Donley, MD: Hey, Will, it's really nice of both of you to have me. And I just assure you, we can't do this without you. So looking really forward to the interactions and collaboration as we grow together.

Will Morris, MD: Well, in the spirit of collaboration, we have our virtual medical innovation summit. So one need not travel across the pond to experience our medical innovation summit this October 6th. A link will be included in the podcast, but we again, hope that one day in the stantiation of years of experience of innovation. But Brian, you can count on us that the conduit is open and we look forward to many collaborations, many conversations, and the success of your patients.