To celebrate the centennial of Cleveland Clinic’s founding, doctors Will Morris and Akhil Saklecha spoke with Chris Coburn, the founding executive director of Cleveland Clinic Innovations and chief innovation officer at Mass General Brigham, about the establishment of the enterprise’s commercialisation arm, the deep-seated culture of innovation at Cleveland Clinic and his efforts at Mass General Brigham.
Will Morris: Well, I think what we’d like to do is a little throwback and take us back to those founding days. There wasn’t a lot of innovation offices within hospital systems and walk us through what was the genesis, what were those barriers? And certainly now 20 years ahead, what do you reflect on doing right?
Chris Coburn: Well, thanks. I would say the genesis of innovation at the clinic really was a combination of several factors. One, you had Toby Cosgrove. Dr Cosgrove as chair of cardiac surgery, taking an ever larger role in the leadership of the system, ultimately becoming CEO in 2003. So, it was his activity working with Dr Joe Hahn, who was chair of surgery and I think the combination of those things, looking to leverage the historic commitment to innovation of the institution going back to 1921. So, it was the right time and I think the right combination of people.
Akhil Saklecha: So when you first got involved and you saw the landscape of what Cleveland Clinic had, the leadership, the innovators, how did you get your arms around all of this and feel that something could be started and how it would get started?
CC: I would say that first of all, looking over the landscape, the community within the clinic, there’s in my view been kind of an unbroken focus on innovation since the founding. The question was really an organisational one. How do we direct ourselves in a way to push that ever further? And again, the blessing of having the most prolific inventor in the history of the clinic at that time, chair of cardiac surgery, and then headed to be CEO, certainly made a big difference. But from my standpoint, the challenge was heavily on the organisation side was connecting, building the team, trying to tie together the enormous reservoir of capability that was resident in the system and then trying to direct it more towards the commercial market.
WM: In the 20 years, you kind of look back, I imagine early on, as you mentioned, you had two surgeons at the helm, it was heavy in the devices. What has been the kind of evolution from your purview of kind of those core areas and what do you think is the future white-hot space?
CC: Obviously devices have been central to the world of improved care, improved diagnostics, and I think they will stay that way. I think devices have already become intelligent. The combination, obviously with the digital capabilities makes a huge difference. I think, as we look towards the future, several things, one, obviously the role of digital in care transformation and the kind of recreation of the US model of the delivery of care was basically demonstrated full force when the pandemic arrived. So, we won’t back away from that and I think that will be an ongoing element of what defines care. Additionally, I think you’ll see the application of digital, but also other new technologies, whether they’re genetic sequencing or across that romp in fields like behavioural health.
So, some people see that as the second largest area of expense in all of healthcare and really not efficiently addressed. So, a lot of room for growth there. And then in the area of therapies, of therapeutics, gene and cell therapy, clearly is a rocket ship. Both have been around, you can say cell therapy has been around for more than 100 years, but they’ve arrived and arrived together. And the power of those technologies is stunning. And obviously a lot of great work going on at the clinic also for us at Mass General Brigham.
AS: When you go back and maybe to add on to Will’s question, now devices was certainly a big area at the Cleveland Clinic and innovation. And when you were here and setting things up, I’m curious as to some of the challenges that you faced, because starting something new in an environment like this, although innovative, but it’s a very large organisation. And so, when you go back to that time, obviously change management and building something new is always difficult, but in your mind, what were some of the big challenges you faced in starting innovations and then as you kind of grew that group?
CC: Well, I think in any large organisation, the need is always present to gain the trust and confidence of the people that you have to work with. So for us, the great benefit to have someone like Hahn so revered throughout the organisation and also so visible as someone that was a kind of ever-present element of what we were trying to do. So, I think that establishing those relationships and then maintaining them was very important. I think also a key from my perspective is the fact that no hospital, no university is set up for, per se, is founded to create commercial outcomes. So you always need to keep in mind that these activities are at times running counter to the more classic outputs and aspirations for the hospital, for the system. So there’s a need to, in a sense, almost over-communicate.
So at least for me, that meant continuous rounding where you just drop by and call him, the chair of cardiology and talk about what’s occurring in his department. What were the needs and what were the issues? And I started a programme there and continued it in Boston, where I call on every department chair, every clinical and research leader, at least once a year and ask them face to face, “How are we doing? Can we do better? What our success has been?” So, that idea that you need to over-engage and really live from the perspective of what is the role of our team within this broader environment where patients’ lives and larger economic decisions are getting made every day?
WM: I love that commentary kind of, the simple act, but very, very profound act of engagement being authentic and transparent in seeking the advice and guidance. I’m curious either at the clinic experience or at Mass General, the opportunity for innovation going the other way, right? Industry or startups having something, but they have a solution looking for a problem and they need the clinical input or operational input – your thoughts on that approach? How does that kind of balance out from traditional tech transfer and growing stuff as opposed to kind of out-in-out?
CC: And that has always been a big priority from my standpoint, which is the market realities, the measure, the work of these functions is in the commercial realm. So, being able to interpret and act on what their priorities are is key. So, kind of that constant engagement. In Boston and also in Cleveland, we used a very active external board. In Boston, we now call it the innovation growth board, some of the top venture funds and most innovative companies are represented on there. And from my standpoint, it’s almost a lifeline from this area where we need to be able to discern and then act on these commercial dynamics. And that requirement runs across the board and I think once industry sees you as a part, a real partner, collaborative innovation can take place. They need to be able to count on the things that define academic medicine. These insights, the ability to establish group of biology, or to do an implementation on a digital technology, things that have to occur in the laboratory and the care environment of a big system where patients and the related insights and data are available. Companies will always need that. And so capitalising on that, I think is driven by their ability to see you as an effective partner.
AS: Now, when you were either here at the clinic or where you are now at Mass General Brigham, have you ever taken kind of the wide spaces that are out there, or the problems that are needing to be solved and go back to the inventors and say, “Can you work in these areas that we’ve identified as problems,” as opposed to waiting for their eureka moments and bringing things towards you?
CC: Well, Akhil, thanks for that question. That exactly characterises some of the work we’re doing now in behavioural health. So, if you look at our three hospitals, Mass General Psychiatry, McLean Hospital, and Brigham And Women’s, the combination of the psychiatric talent in those three institutions, the aggregate of that has to be the largest in the US, I can’t imagine anything being bigger. So, on the clinical side, we have an awesome resource trying to better adopt with dynamics in the investment and the commercial world is a project we have currently underway. So we’ve assembled a group of leaders from the industry side, very large, very recognisable companies, investors, and entrepreneurs, to be part of an iterative dialogue with our clinician leadership around areas that I think can represent common ground and then ideally drive some of that back even to the discovery realm and whether it’s companies contributing their own insights, their own libraries, where our people are sharing what they see as shortcomings in the realm of commercial products. Ideally
that will bring us to new outcomes that might not have happened on their own.
CC: So, that’s an example. I think we subscribed to that concept that you can look at unmet needs, a model that we follow a number of times, and there’s been good government support for this. I think the State of Ohio has been a great partner with the clinic on programmes to be able to drive recognition and ideation around unmet needs and areas of future growth. And as both of you know better than me, there are plenty of fields that are still underserved in terms of the… let’s call it the state of technology for whatever reasons, whether it’s investment trends or just kind of historical perspectives around a given field. And in my view, those are ripe for this kind of intervention, if you will, around the ability to determine and prioritise around those needs.
WM: You brought up the second kind of quiet pandemic, which is behavioural health coming out of covid. I’m curious how covid played and impacted you and your team in either surfacing unmet needs or pain points that we didn’t know we didn’t know until the system was under duress and stress to: we have a new need. I’m just curious as you reflect back in the past 10 months during these pandemic times, what are the unintended positive things that you could say, “Gosh, you know what? We were able to do amazing things and look at this space.”
CC: Yeah. Well, first and fortunately for us, we had just adopted a large digital enterprise data and digital health initiative – about a $500 million investment – in the year before the pandemic hit. So, that had shifted, let’s call it, the organisational capability to respond. We brought in our first-ever digital health officer and those things combined, I think positioned us and accelerated across a broad spectrum of implementations of technology. And then the numbers for us – I’m sure similar in Cleveland – where we went from something like less than 2,000 remote visits to over 250,000 in just a matter of weeks. So that broad scale disruption, again, tested a lot of concepts and validated a number of technologies and our team, obviously, part of that, part of our giant enterprise of 80,000 people. So we were kind of working within that context.
And so really heartening to see how people were able to drive things through to outcomes, to test assumptions, to better understand the environment that we were operating in. And one of the things that’s come out of this is we now have a digital investment fund, $30 million, just in the process of making our first investment on that. And so much of what’s been learned over the last year is being reflected in the management of that fund and the creation of the portfolio. So I give that as an example, plenty of other things, but again, our team like everyone else in healthcare in the US and I think around the world, we did have to redefine how we worked. I remember being at the office, I think it was like 12 March and kind of saying goodbye to our team. Really, “Great working with you. I hope we’ll be together at some point in the not too distant future.” And now a year has gone by.
And I think realistically we’re not going to be together until middle of the summer at best, could be a little bit later. So, that’s been a challenge for everyone, but it’s remarkable how resilient people are and the tools that have emerged to promote resiliency, just an example of kind of the overall response.
AS: If you go back to your time here in Cleveland, what is your biggest success? It doesn’t have to be economic, but the biggest accomplishment that you’re proud of during your time here at Cleveland Clinic.
CC: Well, again, everything happens as part of a team at the clinic. So, I don’t want to have my name associated with this, but I think at the time in 2000 and 1999, prior to that when we started the discussion, I’d like to think the view of innovation and commercial outcome was incidental. There’s a small team, two and a half people. They were part of another department and then went to being something where it was top of mind, I like to believe for leadership across the board. People were either prioritising it in their area, or at least appreciating the significance of it. A lot of really good people came to the clinic and became part of the team. Many younger clinicians joined where they saw this right off the bat and truth be told, I guess it was 2007 and 2006.
No, excuse me. It was before that, it’s more like 2003 when Toby was still chair of cardiac surgery, he asked if I would help support a recruitment for a young cardiac surgeon from Brigham, Dr Tomislav Mihaljevic, because he was an innovator and I had a chance to spend time with Tom before he ever committed to the clinic. And so, the beautiful thing from at least looking back on it now, 21 years later, is just the embrace of the commitment and the understanding that there needs to be a strong team to pursue this and getting the right people into those positions is so key.
WM: Well, Chris, first of all, thank you for your time, but more importantly, your candid and personal remarks as we reflect back on our 100 years, it is about team. It takes a pandemic to realise that even though, perhaps in one world Cleveland Clinic and Mass General and others can compete against, at the end of the day, we all serve one mission, which is to serve patients. And there is more commonality, more partnership, more collaborations. So you are always part of the clinic family. And the degree of reciprocity I think between Boston and Cleveland is rich, but going forward, I think for ourselves and for those listening, it does take a village, it does require this unbelievable opportunity to people to kind of lean in and participate. So, I just wish to thank you. Innovation is alive and well, certainly at the clinic and certainly a part of you and owes you a debt of gratitude.
Adapted from a Health Amplified podcast