How A World-Class Heart Surgeon Found The One Leadership Trait Many Businesses Are Missing

How could a decorated war surgeon and leader of the best cardiac care clinic in the country possibly have more to learn about leadership?

Ten years ago, right before he became CEO of the prestigious Cleveland Clinic, 65-year-old Dr. Toby Cosgrove had good reason to believe he’d already acquired all the knowledge and wisdom he needed to excel in his new role.

The man, who recently was President Obama’s first choice to take over the troubled Department of Veterans Affairs following the resignation of General Erik Shinseki, could not have been more qualified for the position. And few people in his field, moreover on the planet, had amassed a more stunning list of career achievements.

Dr. Cosgrove had earned a Bronze Star as a Vietnam surgeon. He’d performed 22,000 surgeries, patented 30 different medical inventions, created a highly profitable venture capital group, written 450 journal articles, and led the clinic’s cardiac care team that U.S. News & World News Report named best in the nation for 20 consecutive years.

But as Dr. Cosgrove shared with me recently, soon after he took on the job he painfully discovered there was one essential leadership lesson he’d yet to learn. And it was largely a result of this late-in-life epiphany that he was able to transform the Cleveland Clinic into one of the most admired, engaged, and profitable health care organizations in the world.

Lessons In Empathy

The Harvard Business School was so impressed with the decades-long success of the Clinic’s heart care program that they invited Dr. Cosgrove to participate in a case study at its Cambridge campus.

While standing on a stage in an auditorium filled with students and faculty, fielding questions in what should have been an entirely celebratory experience, he called on a woman who’d raised her hand.

"My father is a doctor too," she said, "and he has mitral valve disease. After doing research, we know you’ve done more of this kind of surgery than anybody else in the country. But we finally decided not to come to you because we heard you didn’t have any empathy. Dr. Cosgrove, do you teach empathy at the Cleveland Clinic?"

The student’s question left him shocked and momentarily speechless. But it was 10 days later, at the inauguration of the clinic’s new facility in Jeddah, Saudi Arabia, where yet another striking experience forced him to fully confront the question.

"The president of our new hospital went to the podium to make some remarks," Dr. Cosgrove told me, "and he told everyone in the audience, ‘This new clinic is dedicated to the body, and the soul, and the spirit of its patients.’"

When Dr. Cosgrove looked over at the hospital’s sponsors, he saw that both the Saudi King and Crown Prince were weeping. "What I understood in that very moment was that those tears were expressions of sheer gratitude—for the fact that we intended to care for much more than a patient’s physical body," he said.

The back-to-back experiences were so profoundly impactful that Cosgrove realized he was "missing something very important" that required him to take "a long, hard look in the mirror."

What he ultimately discerned was that he’d unconsciously subordinated his feelings—his heart—in the interest of becoming the best surgeon possible.

Recalling that heart-surgery-related deaths were in the double digits when he began his career and that he’d witnessed five children die on just one day during his medical residency, Dr. Cosgrove realized he’d unintentionally become a "cardiac surgical technician." He’d become a doctor who focused exclusively on the precision of his work, rather than on connecting more personally with patients and supporting their emotional needs.

"Cut well, sew well, do well" was the operating room motto.

Changing The Direction Of The Cleveland Clinic

Dr. Cosgrove wasted no time putting his new understanding to work and immediately began to bring elements of compassion, kindness, and empathy back into how his organization was led and managed:

In meetings held with all employees, he announced that the mission of the organization going forward was to make patient health and well-being its sole priority.

"I believe everybody wants to be associated with a higher calling," he told me. "Everyone wants to be a part of something bigger than they are, and I believe you have to give them that vision. And so this was the beginning of me trying to instill a soul in the organization. Then and there, we answered the essential question, ‘Why are we here?’"

Next, Cosgrove created the first ever chief experience officer position and directed the entire organization to work on greatly improving the patient’s emotional experience.

They hired famous designer, Dianne von Furstenberg, who created a new "wrap gown" to cover a patient’s formerly exposed backside (and restore a little human dignity in the process). They brought in architects who found clever ways to add more light and color to all 75 facilities. And they sent 43,000 employees to a half-day seminar that taught them how to most successfully support the emotional needs of other human beings.

"We also discovered that one of the biggest complaints patients have is with their doctor’s communication," Cosgrove told me. "So we mandated that all of our physicians be re-trained to be more attentive, caring, and thoughtful."

By digging into the details, the clinic discovered that 130 different people come in contact with a surgery patient from the time they arrive to when they go home. And in recognition that "any one person along the line could mess up the patient experience," Dr. Cosgrove decided that all employees in the institution would be called "caregivers."

"It didn’t make a difference if they worked on a loading dock, swept the floors, delivered the food, or were a neurosurgeon," he told me. "I wanted to ensure every person knew that they were important and part of the team. And almost immediately, our people began taking greater ownership and contributing at much higher levels."

In the decade Dr. Cosgrove has led the Cleveland Clinic, he’s nearly doubled its size, expanded it internationally, and ensured it continues to be recognized as the most innovative health care organization in the country.

But the reason President Obama was so vocal with his respect recently is because of its extraordinary standards of care. Last year, the average emergency room wait was just 11 minutes—and they fulfilled 98% of patient requests for same-day appointments.

Dr. Cosgrove insists that deeply caring about people—patients and employees alike—is at the root of all their success (and the nearly $1 billion the clinic earned last year).

But he doesn’t seem to realize how uncommon and enlightened his leadership philosophy is in business. "I’m not brilliant," he insisted. "I just responded to the cues."

[Image: Flickr user Helge V. Keitel]

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  • The notion that empathy is an important characteristic of successful workplace leadership is still not widely embraced in business. That Dr. Cosgrove chose to make it important to himself and to his organization upon becoming CEO ten years ago is not just admirable, it's clearly had an influence on it's performance and reputation in the market. When I asked the CEO at Gallup recently to identify the top CEOs in all of business recently, Dr. Cosgrove was the second name he gave me.

  • Al Winston

    Cute. Fails to mention how they jam 30% more patient visits into a clinician's day and yet spend enough time being 'empathic'. Fails to mention how behavioral problem patients are kept satisfied (simple stat: identify them and exclude them from the data analysis). Sounds like a load of marketing double talk.

  • Ronald Harris

    Dr. Cogrove did not give any examples of how he handles his and patients' feelings to show that he is more empathetic. He looks like he is trying to develop empathy in his clinics like he developed his clinics, technically. He has to learn to be and then be more caring and that will flow and direct his handling of staff in the workplace and also knowing what to look for in the hiring process to get quality, qualified caring employees on board. When he shows that he cares more, they will be more caring. I didn't see, no I did not FEEL any of that in this article. something he did not know for 40 years now he wants to TEACH others. He is still a student. You CAN'T TEACH WHAT YOU DON'T KNOW. YOU CAN'T LEAD WHERE YOU DON'T GO! My advice: Continue to work on self and caring and empathy will come through without trying. If you have to try you are not there.

  • Ronald Harris

    Better late than never to learn the necessity of empathy. I am a physician also and it is kind of sad that a person could go through 40 years of treating patients without real empathy. But more scary than this is that "he wasted little time putting this new found understanding to work". There is mentioned a lot of technical and facade type changes and half day similar for staff and retraining for physicians. But having or developing a heart for people, after "all your life not doing so" takes more than sending staff to a half day seminar or retraining doctors. Just like sensitivity training for police has not stopped brutality against a certain segment of the population. These changes are good but if he is sincere, about changing his heart I believe he would be more. No, these changes seem more about generating more business than about caring. He doesn't know empathy and doesn't say how he is working on his. But what he has done to get others to develop empathy.

  • ckcaviglia

    Maybe it was his duty to become the best at what he does first; to be so exacting ("Cut well, sew well, do well"). Maybe something like that is needed in the army when the wounded outnumber the beds, efficiency is a must. You might argue quality over quantity but maybe he would not have written as many (450) journal articles or made as many patents over his career had he been struck with empathy sooner. . . I think it happened at a good time for him, at the right time. Do you think if he had as much success as he did that he would have had as much influence? His successes caused him to lead the Clevland Clinic, gave him enough power to have an impact, which is ultimately why we just read about him. Now we know. Great article!

  • These are fantastic questions! Here's my conclusion: While heart-care patients most certainly would have been made to feel better had Dr. Cosgrove been more attentive/caring following their surgeries, his surgical expertise dwarfed the overall importance of that. But as a leader -- especially as a CEO -- that lack of balance between efficiency & care, mind & heart -- inevitably would have become an Achilles heel for him were he not to have remedied it.

    That the Harvard student stunned him when she did does seem like amazing timing. But Dr. Cosgrove also had the ability & willingness to make the essential changes to how we would go on to lead and manage -- remarkable noting he was 65 years old and presumably set in his ways.

    What Dr. Cosgrove iproves is that sheer intelligence is insufficient as a qualifier for leadership and management excellence today. His success as CEO is equivalently owed to his willingness to care for the emotional needs of others.

  • Sharon Spano

    As someone who has spent endless hours in and out of hospitals with my own son, I greatly appreciate this perspective. I was one of many who fought for family-centered care legislation many years ago, and I know that Cleveland Clinic has taken this concept to an entirely new level.

    Thanks for writing such a great article and sharing the candid expressions of Dr. Cosgrove. Courageous Leadership at its best.

  • Thank you, Sharon! As a CEO, Dr. Cosgrove possesses a great mind for business in addition to an authentic concern for the well-being of his clients (patients) and employees. The latter part of this combination remains uncommon in the C-Suite, of course. But CEOs everywhere will be wise to follow his example if they want their organizations to thrive going forward.

  • Toby AndJihad

    Toby Cosgrove has no shame. He is well aware of the staggering number of injuries inflicted upon his patients by uncredentialed and unqualified staff and residents. Avoidable medical error and hospital acquired infections kill 440,000 patients each year in US hospitals, the third greatest cause of death in the US after cancer and heart disease. USNews ratings of Cleveland Clinic are contradicted by other independent and government reviews. Modern Healthcare cover story 8 June 2014 ( disclosed "stonewalling" by Cleveland Clinic officials in the CMS investigation of patient harm, patient rights violations, informed consent violations, alleged double billing, fraudulent credentials, operating room fires injuring patients ( ) and other egregious violations. Mr. Cosgrove was personally cited by CMS for his failures. Two of nine CMS investigations found that Cleveland Clinic Urology Department did not have proper credentialing or privileging of staff