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The wellness philosophy that begins in the hospital, Cosgrove hopes, can then seed the community, then the state and the nation. Such an ambitious idea could not have found a better place to start than Cleveland, where smoking rates are above the national average, nearly 28% of the population is obese, and exercise and good nutrition are luxuries. If it can work in Cleveland, it can work anywhere.
Clearing the Air
Health consciousness doesn't come naturally to the average CEO nor should it be expected to. Paying for smoking-cessation programs or gym memberships makes sense only if a company is reaping some return on its investment. The Cleveland Clinic, as the city's largest employer, has to be more mindful of that fact than most are. Improve employee health and you cut sick days and boost productivity. Most important, you keep insurance premiums under control. And the up-front costs can be minimal.
"There are things organizations can do that send a real message but cost very little," says Cosgrove. "It doesn't cost anything to have a walking program. It doesn't cost anything to tell people to take the stairs instead of the elevator. And it costs nothing to say that you can't smoke here."
Well, almost nothing. In 2007, Cosgrove took the controversial step of deciding not to hire any more smokers. As a high-tech hospital rooted in one of Cleveland's more wanting neighborhoods, the clinic was already viewed as an élitist institution with little compassion for the community from which it draws its workforce. The no-smokers policy would cement this perception. "I had to fight everybody, including human resources," says Cosgrove. "But this sends a message. It's perfectly legal. It's as much symbolic for the community as for the organization."
Since the rule went into effect, smoking rates in Cuyahoga County, which includes the city of Cleveland, have dropped from 21% to 18%. Rates have been declining since 2003, but it didn't hurt that the clinic also spent $30,000 to support antismoking efforts throughout Ohio, culminating in a 2006 statewide ban on smoking at work and in public places.
That's just the sort of scaling up Cosgrove hopes for. But while the clinic was successfully sending a message about tobacco, it was failing miserably as a model of nutritious eating. Dr. Michael Roizen, an anesthesiologist and now the clinic's chief wellness officer, knew something had to change when he heard about a patient's recent dining experience in the hospital's emergency room. The patient arrived with chest pains and was put into a holding area with his family while doctors ran tests. They ended up waiting for several hours, so well-intentioned staff members offered to bring everyone some food. An orderly went out and came back with Kentucky Fried Chicken. "Can you believe it?" asks Roizen. "That was quickly corrected."
The cafeteria's new, varied menu particularly with its ban on trans fats was one response. Roizen is now working with chefs to inject more flavor and excitement into patient meals while keeping the food low in fat, salt and sugar. So far, they have redesigned 36 of the 55 meal offerings, substituting thickeners for fat, citrus flavors for salt, and peppery, spicy ingredients for sugar.
But as innovative as these efforts are, what happens when patients walk out the door and leave the bubble of the clinic? Keeping them motivated and committed to staying healthy, eating right and getting physically active is another issue Cosgrove is addressing this time with the help of technology.