Great institutional cultures can accomplish great things. But in some ways, that’s a problem for the rest of us. It’s natural to want to emulate the achievements of Cleveland Clinic in our policies. But you can’t make a culture out of rules. Culture is an organic outgrowth of an organization’s history, it’s people, its successes and failures. It cannot be ordered from the top, or nurtured by simply altering the financial incentives. Cosgrove speaks of maintaining the institution’s culture in much the way that he talks of maintaining their electronic health records system: a constant process of checking in, re-evaluating, and upgrading.
We can salary doctors and order them to care as much as the Cleveland Clinic doctors and administrators do about continual improvement. We can mandate checklists and appointment follow ups and staffing levels. But we can’t make them be the Cleveland Clinic.
More from Megan McArdle on Cleveland Clinic’s salaried physicians.