Hello and welcome to the State of the Clinic. In this address, it is my honor to share Cleveland Clinic's optimism for leading healthcare. Cleveland Clinic's strength is in providing the most complex care as a team, through innovation and technology. It has been the source of our success in the past and a key ingredient to our future. Our mission remains timeless: Caring for life, Researching for health, Educating those who serve. Our vision is to be the best place to receive care and the best place to work in healthcare. To guide us, we have four priorities: Caring for patients, caregivers, communities, and Cleveland Clinic. We are motivated to impact as many lives as possible with Cleveland Clinic care. In our transition from the COVID pandemic, healthcare is fundamentally changing. Globally, there are not enough caregivers to serve the evolving needs of patients. Standalone hospitals are struggling to fund their mission due to rising costs. The delivery of care is shifting to more convenient settings.

And there is a race to personalize care with powerful technologies. Cleveland Clinic embraces this new reality. As a global, integrated health system, we continue to thrive. Cleveland Clinic is serving more patients, conducting more research, and educating more learners than ever before. Our family of 81,000 caregivers think and act as one. We are growing in communities around the world. Through digital tools, Cleveland Clinic is redesigning care delivery. Let us explore how far we have come, and where we are going. I am pleased to highlight some of our accomplishments in this 2023 year in review. ♪ Cleveland Clinic continues to get recognized on the world stage. Newsweek World ranks the Clinic at number two on the list of Best Hospitals of 2023. It's the number one hospital for cardiology, heart, and vascular surgery for the 29th year in a row. What an accomplishment! People come from all over the world to receive this world-class care. ♪ Cleveland Clinic has never before

been doing the amount of research that's going on now across the world. You have hospitals in London and Abu Dhabi. There is a whole hospital system in Florida. Cleveland Clinic and IBM have unveiled the first quantum computer in the world dedicated solely to healthcare research. A vaccine to protect against breast cancer is closer to becoming widely available. Researchers at the Cleveland Clinic say they've been working on this vaccine for one of the deadliest forms of the disease. In a phase one clinical trial, the Clinic found that deep brain stimulation is not only safe for stroke patients, it may also help them recover some function too. In the fight against Alzheimer's, today Cleveland Clinic Lou Ruvo Center for Brain Health administered the first infusion of Lecanemab. We have performed the first robotic kidney transplant in the UAE and in the Arab world. This is a major advancement in kidney transplant. Cleveland Clinic regaining its top spot as Ohio's largest employer. ♪ Diverse groups make faster progress

because they're bringing different perspectives to the table. ♪ Education is foundational to our mission. We educate doctors literally all over the world. Their goal is to get you involved and to have a presence here. A huge focus here is caring for the community, making healthcare more accessible for people in the neighborhood. We're working around communication, closing the gaps. What we are doing is not just for today; it's generational. I feel great that I'm in a safe home and I don't have to worry about my kids being affected by lead poisoning. Cleveland Clinic Akron General seeing so much success from its first food pantry; another location now open. We're very excited to have announced our commitment of $10.5 million to address food insecurity. ♪ The investment to enhance the footprint will increase our mission in developing therapies for patients. More growth for the Cleveland Clinic overseas. The healthcare network just opened a brand-new cancer facility in the United Arab Emirates. It's the Clinic's first hospital.

in Lake County that will provide inpatient and outpatient care. Mentor Hospital brings an innovative care model, not only in how the design was built, but also how it's going to deliver care. Here we are at Cleveland Clinic in Middleburg Heights, a brand-new facility, and the response has been incredible. 55 Moorgate is located directly in the heart of the city, and will be reaching a population of patients who haven't had that close access to Cleveland Clinic care. 100% of the money we raise goes back to research, patient care, innovation. The progress that we're able to make is incredible and inspiring. Giving keeps the Cleveland Clinic growing for us in so many ways. A small idea can really turn into a big idea, and with the grant, there really are no limits to what you can do. 100% of the dollars that the riders raise go directly to cancer research at Cleveland Clinic. I'm proud of the work that we do here. We work with some of the sickest of the sick patients.

People come from all over the world because of the work that we do day-to-day. Cleveland Clinic has been at the forefront of care for more than a century. First, we anticipate what must change, and then we create a framework to lead. To prepare for the future, we have updated our operating model. Our clinical institutes, where we innovate care, now have worldwide responsibilities. Our geographic markets manage the delivery of patient care to serve our communities. And shared services are thoughtfully distributed for operational support. Nothing makes us prouder than serving patients as One Cleveland Clinic. We now care for patients at nearly 300 locations on three continents. Our aspiration is to care for each patient like we would for a family member, with consistently high standards. Last month, a grateful mother wrote to me about her baby boy's care in our children's hospital. She noticed our pediatrics team rounded twice daily as a single group. When her son's health improved, the team cheered for him,

and they planned his return home with excitement and compassion. His mother said, They didn't just care for my child's illness. They cared about my son like he was their own child, or grandchild. As caregivers, we are blessed to make such an impact on patients and families. It is why we strive to provide uniform excellence of care at every location. Cleveland Clinic offers patients the best chance of survival, regardless of medical condition. Every patient who returns home to their loved ones is validation of our effort. We have learned new tools to deliver highly reliable care. The core principles are communicating, speaking up, asking questions, and being accountable. Our ultimate goal is to prevent harm, and our primary tool is the Universal Protocol Safety Checklist. Using the checklist consistently can eliminate many serious safety events at Cleveland Clinic. This tool protects our patients, and it protects us. We must use it for every patient, every procedure, every time. Plan of care visits let patients and families know what to expect.

We strive to create a more consistent approach for holding daily plan of care visits in the hospital setting. Delivering consistent care for every patient is not easy, but it is possible if we share best practices with each other. Innovations are happening all around Cleveland Clinic. Mentor Hospital is teaching us how to use telehealth in every facet of care. South Pointe Hospital prevented central line infections, and serious safety events in the operating room for an entire year. Fairview Hospital, one of America's safest, shows that excellence can be maintained. Weston Hospital established a command center to make emergency care more available. And Marymount Hospital is leading a new model of care, which teams up nurses and Patient Care Nursing Assistants. By managing groups of patients, they reduced staffing needs, while improving patient satisfaction and caregiver engagement. We can learn from these examples and many others throughout Cleveland Clinic. Our caregivers are exceptionally creative and capable. When we empower each other, we can overcome any challenge.

In today's healthcare environment, no challenge is greater than the global shortage of nurses and other skilled caregivers. When we ask our teams for feedback, you tell us about your pride in Cleveland Clinic's mission and how much you enjoy making a difference for our patients. But you also say that we continue to be challenged by staffing, job stress, and perceptions of safety. Thank you for your honesty. Cleveland Clinic has a big family, with 81,000 caregivers around the world. Our ambition is to build a uniform caregiver experience that is the best in healthcare. One of our commitments is to create more opportunities for those who are new to healthcare. Take a look. ♪ You'll ask the patient to read on the chart. The Cleveland Clinic Apprenticeship Program is a program that offers learning and earning at the same time. It allows an opportunity to work here, have a career path, and be able to see themselves long term as caregivers for Cleveland Clinic. (bright music) ♪ Healthcare is experiencing a workforce shortage.

so the apprenticeship program has allowed us to create a pipeline and opportunities for our in-demand roles. Currently, we have four apprenticeship programs: one in pharmacy, two within neurology and epilepsy, and sleep, and then the last one is in ophthalmology. The only qualification is a high school diploma. You receive all your training while you're in the programs. Every apprentice goes through foundational skills training, along with classroom instruction. From there, you are off into your department, learning the role that you'll be placed into upon the completion of the program. Once they're ready to move into their position, they already understand our organization, our culture, and they've also had that certification that's required. ♪ We have found that once an apprentice goes through the program, the retention rates are extremely high. There's no better opportunity than to get paid to learn a new skill. You'll learn everything that you need. And everyone here is very supportive. The program has been absolutely wonderful.

It's everything you could really ask for in wanting to learn and getting your feet wet in the hospital. Having this program really is a great start. A few months ago, one of my children, Maya, asked for work experience before she heads to college. It was the first time she expressed interest in healthcare. Maya shadowed in our Children's Institute to learn about nursing. Weeks later, she came to me and said, Dad, everybody loves working here. All of you who met Maya welcomed her as part of the team, and you showed her that you support one another. For me, it was another reminder that our culture is what makes Cleveland Clinic the best place to work. With input from our pulse surveys, we are designing the optimal work environment for all of us, which will be safe, engaging, rewarding, and inclusive. Cleveland Clinic must be the safest place to work. Violence against healthcare workers is a silent epidemic. Last year, our own caregivers reported 3,800 incidents.

of verbal and physical violence. Violence will never be accepted as a part of our job. Cleveland Clinic continues to enhance our police and security presence. We have installed magnetometers in every Emergency Department and confiscated 30,000 weapons brought in by patients and visitors last year. We are training caregivers to de-escalate difficult situations with patients and families. The work we do must be engaging. When I became CEO at 54, one of my first assignments was to honor your service anniversaries. I will never forget one caregiver who served 55 years at Cleveland Clinic. What more could I say, but thank you? It is humbling to know that so many caregivers love what they do and choose a lifetime of service. And now you know how old I am. All of us want to be part of a team, and our culture of teamwork is unsurpassed. Cleveland Clinic's turnover is four percent lower than the rest of healthcare. It is important to recognize caregivers who embody Cleveland Clinic values.

In a new program, we distributed more than 7,000 recognition coins. I truly enjoy awarding Legacy Coins to inspiring caregivers. The optimal workplace must be rewarding. Over the past two years, we have made significant investments in caregivers. Our compensation philosophy is to be fair, equitable, and competitive in every market. Our benefits package continues to be one of the most generous in healthcare. As an international health system, we offer unparalleled career growth and development opportunities. At Cleveland Clinic, 4 out of 5 leadership roles are filled internally. Diverse caregivers now make up a greater proportion of leadership. Cleveland Clinic must be inclusive. We respect differences and value every caregiver, regardless of race, age, ethnicity, creed, gender identity, or sexual orientation. Cleveland Clinic is home to all caregivers. As a founding member of OneTen, we are a leader in skills-first hiring. Cleveland Clinic removed unnecessary degree requirements from hundreds of job descriptions. With Cleveland Clinic's growth, our collective voice has become louder.

We are speaking up for our communities and local children who do not have a voice of their own. Long-standing issues such as lead poisoning, infant and maternal mortality, and hunger have not gone away. With our help, they can be solved. For children who live in poverty, lead poisoning is a common hazard. The damage from lead to a developing brain is both irreversible and preventable. Cleveland Clinic invested $55 million into the Lead Safe Cleveland Coalition. Already, 177 children are living in lead-safe homes, and more than 1,000 housing units will be remediated this year. Compared to all other developed countries, more children in America do not live to see their first birthday. In Cleveland Clinic's immediate neighborhoods, the mortality of Black infants is four times greater than the national average. Vulnerable families deserve better support before and after delivery. Through our Center for Infant and Maternal Health, we surround at-risk women with resources and the most compassionate team. Here is a brief story about a special group of caregivers.

who understand the needs of our patients. Hola, ¿cómo estás...? Our communities are hurting. And we can't sit by and allow our infant mortality rate to increase. Currently, we have a team of community health workers who follow moms throughout pregnancy and after delivery. A community health worker is a person that has boots on the ground with the community. Somebody that is hand-to-hand with them. It was the lady who sat on the porch and knew every resource. Did you set up your Pack 'n Play yet? For the safe sleep area? She is you, she's you. She's been in your shoes. You look like the people that you serve, like Brown and Black communities that are in desperate need of people that can help them. We help people with food, shelter, baby items. If they need help with getting their utilities back on, if they need help with childcare, even going to the welfare building to get applications. They have been here helping me

with setting up appointments and making sure I get to my appointments. I didn't know what WIC was. That helped me tremendously. We go to the patient's home. We go to the patient's appointment. So wherever that patient needs us, that's where we go. We also are working with them to make sure that their children are going to their well-child visits because we want to make sure that everybody has equitable access to healthcare. That every mom, every baby, every patient has the opportunity to thrive. It was very important for me because I was overwhelmed being pregnant, being a new mom. To see somebody become self-sufficient because you helped them, it's just a beautiful thing. You turn on a little spark, and believe me, this goes everywhere. You help one person, and that other person just goes to family, friends, and they're like, Listen, Cleveland Clinic is doing this for me. And they told me about this resource. So yeah, it's just massive. It's massive.

It's like a wildfire. ♪ Training for community health workers is supported by a generous gift from Jones Day and the Jones Day Foundation. One in five children in Ohio does not know where their next meal will come from. No child should ever be deprived of nutritious food. We worked closely with Meijer to bring a grocery market to Fairfax, which was a food desert for more than 50 years. Akron General opened two food pantries. Cleveland Clinic has already fed 13,000 children. We recently pledged more than $10 million over five years to address hunger. Our ambition is for children to have hope for a brighter future. Cleveland Clinic is grateful to stand with many partners and proudly say, We are building a healthy community together. One measure of Cleveland Clinic's impact is community benefit. In 2022, our community benefit totaled more than $1.4 billion. As a nonprofit, we sustain and advance Cleveland Clinic's mission by serving patients and managing our resources.

Positive operating margins allow us to reinvest in care, caregivers, and our facilities to grow and serve more patients. Last year, we provided a record amount of service, nearly 14 million patient encounters. We generated more than $14 billion in revenue, exceeding our plan. In the past, these results would assure a healthy financial foundation for Cleveland Clinic. But all hospitals, including us, are challenged by inflation. The rising cost of wages, supplies, and pharmaceuticals has greatly outpaced nominal increases in reimbursement. For 2023, we resulted in an operating margin of 0.4 percent, which is an improvement over 2022. Cleveland Clinic is a winning team. Our organization is stable, and we have always been good stewards. Today, we are more productive than ever. While other hospitals are closing services, we continue to offer services that our most vulnerable patients depend on, including pediatrics and mental health. Yet, we must also think differently about the care we provide.

It is possible to use fewer resources while touching more lives. Cleveland Clinic is committed to operational excellence. Each of us contributes to our sustainability by finding savings, such as using space to its full capacity, or standardizing pieces of equipment. Any caregiver can spot and influence these opportunities. In Florida, our caregivers designed a model of hospital care in patients' homes. Take a peek at what this new option has to offer. ♪ No one likes having to stay in the hospital. Because when it comes to feeling better, there's no place like home. That's why Cleveland Clinic is bringing the hospital to patients, with Hospital Care at Home. Even though the patient is not in the hospital, the entire care team is there every step of the way. In fact, a caregiver is there in person, or connected virtually 24 hours a day, seven days a week, available at just the push of a button. We provide and set up an easy-to-use tablet for video visits. A phone, connected directly to the care team.

A personal emergency response bracelet, vital sign monitoring, and even a backup power supply. You have immediate care via the telephone or the iPad. I thought that was nothing short of amazing. Acute hospital care within the home is a transformational way to deliver care and a better experience during their hospitalization. I couldn't ask for better care. I would definitely take advantage of this, no question. ♪ Hospital Care at Home is a wonderful example of creating the future of patient care. It is accessible, affordable, and digital, taking place in the right setting for the best outcome. As we advance care, Cleveland Clinic has four strategic focus areas enabled by technology. We will transform care to be consistent, continuous, and customized for patients. We will empower caregivers in a safe environment that rewards teamwork. We will uplift communities by preventing health challenges and offering solutions. And we will sustain Cleveland Clinic through controlled costs and smart growth. Our competitive advantage is providing high-quality, complex care as a global team of teams.

Our ethical imperative is to grow, and our relevance in the world is counted by the number of lives we touch with Cleveland Clinic care. Since 2018, we have increased our services to patients by 53%. Here are recent examples of Cleveland Clinic's growth. Mentor Hospital is designed to be efficient and modular. Demand for care has exceeded our expectations, and we have room for future expansions. The renovation and addition of space at Cole Eye Institute will be complete by the end of 2025. The Neurological Hospital opens in 2026. It will be customized to the needs of patients with neurological conditions, their loved ones, and our clinicians. Cleveland Clinic Florida grew to serve seven percent more patients last year. Our five Florida hospitals are now fully integrated. The Lou Ruvo Center for Brain Health is one of America's largest clinical trial sites for Alzheimer's disease. We are helping to study if the new drug, Lecanemab, can prevent or delay symptoms of Alzheimer's.

In Canada, we expanded virtual care into new residential buildings. Patients can receive a medical exam using remote diagnostic tools. Cleveland Clinic London is using the latest technology to improve patient outcomes. As the leading provider of private healthcare, we were named Hospital of the Year. In Abu Dhabi, we opened the Fatima bint Mubarak Center, a global destination for cancer care. It combines everything we know about treating cancer with emerging therapies. Today's digital tools offer the best look into tomorrow's care. At Cleveland Clinic, we are developing a concrete vision to digitally enable care, caregiving, and our operations through artificial intelligence and strategic partnerships. For patients, Cleveland Clinic is developing an AI companion. It will guide patients on their health between visits and provide continuity of care. Our partnership with Bayesian Health will further improve sepsis prediction. For caregivers, we will release an AI scribe, powered by Nuance, to assist with summaries of patient interactions. Caregivers will spend more time doing what we enjoy.

which is caring for patients, and less time typing notes. A scribe in Epic will draft replies to routine in-basket messages. To support our operations, we have partnered with Palantir to predict staffing needs in real-time and assist with hospital throughput. In collaboration with Zipline, we are laying the groundwork for home delivery pharmacy using drones. The service will begin next year. And, through automation, we will support our back-office teams to be more efficient and reduce costs. We invent tomorrow's care through research, innovation, and education. Cleveland Clinic uses more than $500 million annually to support these areas of our mission. Our research space on the main campus is doubling in size. Last year, we opened 45,000 square feet of renovated laboratories. This year, construction begins on two new research buildings, which are part of the Innovation District. In Ohio and Florida, we lead cutting-edge research on pathogens and cancer immunotherapy. The United Arab Emirates made a transformational gift to support this work.

Healthcare is exploding, with clinical, genomic, and demographic data. To benefit from this knowledge, we need the best computational tools. Cleveland Clinic is home to the Discovery Accelerator, which has the first IBM quantum computer in medicine. Quantum technology will make finding cures swift and efficient. With the help of donors, we can move even faster. In 2022, the Mandel Foundation endowed a CEO fund for innovation. One of the first quantum computing projects to receive a grant sounds like science fiction. Cleveland Clinic is investigating how to detect lung cancer with a blood test. Listen in. ♪ The outcome of lung cancer is better if we can find it early in its course before it's spread. Oftentimes, there are no symptoms or signs of lung cancer. And so it's very hard to detect. If we had an easy-to-use, accurate, inexpensive molecular biomarker, a blood test, the number of lives saved every year would be 50,000 in the US alone.

♪ We've been very fortunate to be the clinical research lead of a couple of blood test studies for early lung cancer detection. The first is a fragmentomics-based assay. In the blood, the DNA gets digested into little pieces, or fragments. There may be more highly variable fragment lengths if it came from a cancer cell than from a healthy normal cell. The second study is looking at methylation of genes, attachment of a certain chemical to specific locations within the gene can affect gene signaling. There's been an association between some of those methylation changes and the risk of developing cancer, including lung cancer. These tests are developed with a huge number of molecular features. It's very difficult for classical computing, classical machine learning algorithms to handle that large number of different features. With this partnership with IBM, we'll be able to evaluate whether quantum computing, quantum machine learning algorithms are able to find patterns amongst all of these variables more accurately than the traditional approaches can. ♪ This is the future and it builds on everything.

that's led up to now. Doing these sorts of projects, it's very exciting. Bringing together all this expertise in a quantum computer with people who really know how to use that quantum computer, and all be part of a team, that's where we can see progress accelerate the fastest. ♪ One in six people worldwide lives with a neurological disorder, such as Alzheimer's disease or Multiple Sclerosis. By the time of their diagnosis, it is already too late for a cure. Cleveland Clinic's Brain Study is the largest prospective study of neurodegenerative disorders. It gives future generations hope for prevention. We aim to discover the biomarkers of brain disease before it appears. Each participant in the study will give billions of data points over 20 years. With every promising tool or treatment, caregivers need to learn to use them. Cleveland Clinic educates the continuum of healthcare workers, from young students to lifelong learners. Our education program is among the largest in the United States.

Recently, I read an article about the difficulties facing healthcare. It is noted that patients were becoming sicker, that it was harder to recruit talent, and that the most important medical discoveries had already been made. Surprisingly, that article was published in the early 1950s. Back then, people harbored the same sentiments about healthcare that many hold today. And yet, medicine continued to progress. The times in which we live will always push healthcare to evolve. Since the founding of Cleveland Clinic, we have been there to lead the way, for the patients of today, and the patients of tomorrow. Our reasons to be confident have not changed. As we begin 2024, every aspect of our mission is thriving. From clinical care to research and education. Our caregiver family is engaged. We have clear priorities for serving our communities. And we are performing well in a demanding financial environment. With the most advanced therapies and technologies readily available to us, I can think of no better time to serve in healthcare.

And there is no other place I would rather be than right here with our caregivers. By following our shared mission, we remain a beacon of hope to our patients. Here is a story about a patient who had almost given up, and how Cleveland Clinic restored his life. My father is the best. He brings joy to everyone. To have a father like that is a wonderful thing. Once he was sick, it was stressful for my family. I knew that there was a possibility that I could lose him. ♪ I realized our life will change overnight. The minute that I found out that I need to do dialysis, we applied for kidney transplant. We waited about probably one and a half, two years, but no sign of kidney. So I started putting some sign in front of yards in the whole Columbus. I was deteriorating so bad, they didn't expect me to live much longer. The pain is 10 out of 10. And many times, when I was by myself.

I asked God to just take me away. ♪ I heard about Cleveland Clinic before, that they would do things that other hospital they cannot do. We are one of the shortest waiting times, out of getting a transplant, here in the United States. Our expectations were not high, but they make us feel positive and have hope again. ♪ They said, This came from somebody that had overdose. It was offered to other hospital in Midwest, but they didn't take it. Nobody wanted that kidney. The beauty of our institution is we work as a team. So when you get an offer like this, we talked to our nephrologist, we talked to our renal pathologists. These are all second looks, that we put on the time and effort, and that gives us the confidence that we can move forward, and we know that all of us are all on the same page. You should find every reason to say yes. That's what we do here. We make it happen. ♪

Thank you for taking care of me so well. You're welcome, you're welcome. You gave me another chance at life. When people are sick, when people are vulnerable, you want to be with someone you can trust. It's our experience, and it's our care. That's what makes us different. For sure, I love Cleveland Clinic. So when I go to Cleveland, I always go to the shop. I think I'm going to get a black one, because I have a blue one. I buy hats, I buy cups. I wake up in the morning. I want my coffee with Cleveland Clinic. I did trust them, and I'm glad I did. Without them, I wouldn't see my kids growing. They gave me the chance to live, so it means a lot. ♪ Robert, thank you for believing in us and spreading your message of gratitude. Finding a way to say yes to our patients is what sets Cleveland Clinic apart. To our caregivers and friends, thank you for watching.

and for giving your support throughout the past year. Have a wonderful day.

CEO Annual Address | State of the Clinic 2024

Cleveland Clinic is a nonprofit multispecialty academic medical center. Founded in 1921, it is dedicated to providing quality specialized care and includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education division and a research institute.