Create a plan Before Cosgrove could put a new plan in place, he surveyed the situation. “We went and looked at all of our physical facilities all over Northeast Ohio,” Cosgrove says. “Then we looked at what was good of our physical facilities, what was not so good of our physical facilities, and then we began to figure out what we needed to do.” In looking at the different facilities, Cosgrove discovered that some of them were OK, but he also realized some were getting older and needed investment in them to bring them up to current standards. He also found that some facilities were so old that it wasn’t worth investing in them anymore. Then he began to couple the physical facility needs with those of the patients. He looked at how the clinic could better meet patient needs with the facilities it currently had, and how, going forward, it could meet the needs of the community and its patients. “We spent a lot of time projecting out into the future what the population needs were and what the new technologies were going to be and how we could best serve those needs,” he says. While nobody has a crystal ball to see what the future holds, Cosgrove says you can still make educated assumptions by looking at as many sources as possible. “You have to get as many points of view and as much input as you possibly can and understand where your particular industry is going,” he says. “That includes understanding demographic changes, understanding, in our case, disease trends, but it would be trends in any industry, understanding population shifts in your particular area, and understanding what people are looking for in terms of the population’s desires and expectations.” From looking at all the data, Cosgrove and his team created a campus plan that looked at where the clinic wanted to be five and 10 years out, and they explored options for getting there. The team created one scenario, and then would try it out with multiple people in the organization, and then it tried another and another. “We just kept going back to it until we found a scenario that fit most people’s expectations,” he says. When it comes down to it, you have to rely on these other people, but combine it with your own ideas. “Obviously, you have a body of experience of things you’ve done yourself in the past, so you bring that to the table,” Cosgrove says. “Then you get a lot of input from other people.” Once Cosgrove had an idea of where he wanted to take the hospital, he then had to create a strategic plan, which encompassed that campus plan, to get there. When you’re creating a plan, you have to be grounded in reality of what you can do. “There’s any number of ways that you have to go and check the reality of what you’re capable of doing,” he says. “When you start down a road, it’s just constant checking — can you get to the end of that road? A journey of a thousand miles starts with a single step.” He knew a few things already: That the clinic’s main campus wasn’t leaving Cleveland, that it was going to be a very high-tech hospital, and that it had the highest acuity (a measure of the average severity of illness in patients) of any hospital in the country. “Now, all of those go to form part of the plan,” Cosgrove says. For example, he would need a lot of employees on-site, and that meant he’d have to accommodate them in terms of parking and seating and making the campus employee-friendly. “All of those came from the fact that we made the basic decision that we were staying here in a major hospital presence,” he says. “Each one of those was sort of a cascading decision.” He says that where you go all stems from basic decisions. “Look at where your industry is going, what your portion of the industry wants to be and what niche you want to fill,” he says. “I think every leader has multiple options and needs to decide the things we want to do and the things he doesn’t want to do.” For example, one of the things Cosgrove decided to do was to take obstetrics off of the main campus. He saw that the suburbs were where the majority of the babies were being born, so that’s where the specialty should primarily be located. He also decided to consolidate the clinic’s psychiatric services, and it was better for those services to also be off of the main campus. Additionally, he decided to change how care was organized. Instead of having the usual departments of medicine and surgery, he went to institutes built around organ and disease systems — a cardiovascular institute, a neurological institute and a urologic institute. This allowed the medical and surgical expertise to be in one location, and that also affected the buildings by bringing all the expertise into one physical location. In short, he made big changes. Cosgrove says, “There’s a lot of people here, so change is still always difficult.”
