Gordon Blackburn, the program director of cardiac rehabilitation.
Renee Turner sees sick people every day. Some get well; others do not. As a member of the security staff at the Cleveland Clinic, she knows there is more than luck involved in who stays healthy and who doesn't. Having survived cancer twice, Turner is very aware that there are things you can do to take control. That's something she is learning every day from the physicians, patients and staff at the clinic, a 1,100-bed hospital that is testing ideas on its own staff and now might just be the future of American medicine.
Take weight loss. Turner is considered morbidly obese — you don't have to work in a hospital to know that's bad. That's why she's on a diet; in fact, her entire department is on a diet. Turner and a few of her co-workers are enrolled in the hospital's Lifestyle 180 program, an innovative approach to good health that uses cooking classes, exercise sessions and yoga to educate patients who are obese or who have high cholesterol, high blood pressure, diabetes or multiple sclerosis about how to eat better, become more physically active, manage stress and, ultimately, prevent what doctors call a major health event.
"It's what we talk about all day: changing what we eat," Turner says. Halfway into the 48 hours of sessions, spanning six weeks, she has lost 9 lb., and the good-health philosophy is changing her everyday behavior. She parks farther away when she goes to work or visits a mall. She looks at food labels and thinks before she eats. As an employee of the Cleveland Clinic, Turner is luckier than most: the hospital is covering the cost of her participation in the program. She even gets a "tool kit," complete with yoga mat, recipe book and tips for navigating the food aisles. All Turner and the others have to do is show up. (See pictures of the Cleveland Clinic.)
And that, argues the Cleveland Clinic's CEO, Dr. Delos Cosgrove, is how a health-care system should work. Patients like Turner who want to live healthier lives should be encouraged — and supported, both financially and emotionally — to do so. In fact, we soon may have no other choice.
As the cost of health care continues to climb (60% of U.S. bankruptcies in 2007 were due to medical costs), the health of our nation is not getting any better. Heart disease remains the No. 1 killer of Americans (as it has been for all but a few years since 1900), our collective waistline continues to bulge, diabetes rates march ever higher, and after steadily declining in recent decades, the smoking rate among high schoolers is leveling off. The U.S. boasts the best cutting-edge medicine in the world, yet 75% of our health-care costs are attributable to chronic, preventable diseases. In all, about 40% of premature deaths in the U.S. are caused by lifestyle choices — smoking, poor eating and inactivity.
But while prevention — intervening in patients' lives before they get sick — has long been part of the medical lexicon, programs to educate and encourage patients to adopt healthy behaviors have never truly been embraced. Ours is a system that rewards pills and procedures and nurtures a clinical culture in which the goal is primarily to fix what goes wrong. "I never saw a well patient in my life," says Cosgrove of the years he spent as a heart surgeon. "They were all sick. We are in the sickness business. We need to get into the health business." This idea is at the heart of how President Obama wants to reform health care in America; he argued that the U.S. medical system is designed to provide disease care rather than health care. In a letter to Senators drafting health-care-reform legislation, Obama cited the clinic as a model: "We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country," he wrote.
Exactly what are those model behaviors? The Cleveland Clinic and its 10 sister hospitals employ 40,000 people in Ohio, Florida, Canada and the United Arab Emirates. Cosgrove's idea is to turn those campuses into living laboratories, where healthy behavior is rewarded (with cash incentives if necessary) and people start thinking about health as an investment and a responsibility. In a demonstration of this commitment, Cosgrove even created new executive positions, including chief wellness officer, chief empathy officer (now changed to chief experience officer) and arts-program curator. These are not titles you're likely to find in any other organization.