Cleveland Clinic's London Calling

Glance at 33 Grosvenor Place, an eight-story building in Belgravia situated near Buckingham Palace, and you might assume it is one of London’s landmarks. And it is, in a way—the city’s newest, and most technologically advanced, private hospital. A robot in the hospital’s pharmacy creates individual bar codes for every dose it doles out; an intraoperative MRI machine provides neurosurgeons with real-time images of the brain during surgery.

But the hospital’s most cutting-edge innovation might not be found in its technology but rather its culture—specifically in its absence of “employees.” All 1,400 people who work at the hospital in London, and all 77,000 people who work at Cleveland Clinic locations around the world, are called “caregivers.”

That includes Dr. Jamanda Haddock, a highly regarded radiologist who serves as Chief of Staff and Chair of Diagnostic Services for Cleveland Clinic London. We spoke with Dr. Haddock recently at the cutting-edge hospital she helps lead—the first privately owned hospital to open in central London in four decades, an opening which increased the number of surgical theatres in the city by almost 10% and the number of intensive-care beds by almost 30%. And it did so at a time when the strain on the country’s public healthcare system was mounting, as was the demand for private healthcare.

Cleveland Clinic London looks to meet that growing demand with a distinctive brand of care, one that can be glimpsed in seemingly minor details—like calling everyone a “caregiver.”

“At first, I thought it was just a word from American healthcare that I wasn’t familiar with, but I’ve come to understand it represents a belief system,” says Dr. Haddock. “And that belief is: Everybody working at Cleveland Clinic contributes to the well-being of the patient.”

When Dr. Haddock says “everybody,” she isn’t exaggerating. “As a patient, you obviously want a top-notch doctor—that’s what you’re here for,” she says. “But around that experience so much else matters. If the front-of-house person smiles, welcomes you, leads you to your room, you feel a little bit better. If the floor’s sparkling clean, you know you’re less likely to get an infection. If the nurses are kind, the person delivering your meal chats with you, the radiographers, the porters—they all contribute to how you feel. That’s so well-understood at Cleveland Clinic. That engagement is palpable here.”

Since every hospital in the world would crave that kind of engagement, the question is how the US-headquartered Cleveland Clinic, a “nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education,” actually manages to create it.

“Culture,” Dr. Haddock says without hesitation. “Everybody’s clear about the vision: to be the best place to receive health care and the best place to work in healthcare. Our values get talked about every day. Performance is measured against them. I’ve worked in places with a similar-sounding list of values, but it’s this day-to-day involvement, the way they’re implemented from the board to the ward, that’s so different.”

One of the ways that Cleveland’s culture manifests is in the tiered-huddles that happen, every day, in every one of its clinics (there are more than 270 worldwide) and hospitals (there are 23—London is the newest).

Tier-one huddles happen on the hospital floor—“an operational problem-solving huddle,” as Dr. Haddock describes them. Key challenges then get “filtered up” through the different tiers. Tier-three huddles, for instance, have all the senior management from a hospital—nursing, estates, IT, doctors, physios, occupational therapists—run through a set agenda in 15 minutes. The highest level is tier six, where Cleveland Clinic’s most senior leaders meet daily to discuss key quality or safety metrics. “If there’s been, for instance, a central line-associated bacterial infection, it gets reported to tier six,” says Dr. Haddock. “And our CEO, who’s a cardio-thoracic surgeon, might ask the President of that particular hospital: ‘How long was the line in? Who put the line in?’ That our most senior leaders take the time to do this every day, that they get involved like that … it sends a powerful message about what values like ‘quality and safety’ and ‘teamwork’ really mean.”

We ask Dr. Haddock about teamwork because the word comes up repeatedly in our conversation; she often refers to a “team of teams” approach. Most organizations would say they encourage working together, yet Cleveland Clinic’s approach seems genuinely different—particularly in the UK, where top doctors often work in their own private practice. “It’s a physician-led, team-based model with an emphasis on empathy,” says Dr. Haddock. “Collaborating with other doctors, as we all do here at Cleveland Clinic, isn’t common.”

That means a patient visiting Cleveland Clinic London doesn’t have to coordinate visits with separate specialists; they simply show up to the hospital and all the specialists come to them. “There was one patient here who’d been having lots of odd symptoms that didn’t seem to fit together. They’d seen a number of specialists but hadn’t been able to get to the bottom of it, so they were referred to us. After multiple investigations here, the patient was diagnosed with subacute bacterial endocarditis. That diagnosis, and being able to then begin treatment immediately—I think that’s an utter triumph for the team-based approach.”

We ask Dr. Haddock about the hospital’s approach to education, because Cleveland Clinic London is the first private hospital in the city to train students in medicine, nursing, and physiology. “We’re in the position we are today, with our knowledge base in healthcare, because people in the past pushed boundaries,” she says. “We need to keep doing that. Being involved in education and research are good for the future of medicine, and it’s good for Cleveland Clinic—that involvements attracts top-quality doctors and nurses.”

Invariably, talking about research and the future of medicine today means also talking about artificial intelligence.

“There’s a long history here at Cleveland Clinic of being at the frontier of medicine, so this is another way to push that frontier,” Dr. Haddock says. The organization’s frontier-expanding advances to which Dr. Haddock refers span a century’s worth of breakthroughs in fields ranging from cardiac surgery to dialysis. Cleveland Clinic also boasted the world’s first quantum computer uniquely dedicated to healthcare research.

“My view is that AI in healthcare is incredibly exciting, and that it’s going to help both the people working in healthcare and the patients,” she says, quickly diving into examples.

“AI can help with caregiver companions, patient companions, so that people can get answers more quickly. We can streamline some of our processes, make them easier for people to access.

“Then you think of interpreting diagnostics—AI is already helping with chest X-rays, mammography, but going forward we’ll be looking at that for echo, R and others. These diagnostics have such an important role to play in preventative medicine; they can tell you if you need to start treatment. The demand for these diagnostics is going to increase massively, and AI will enable us to meet that demand because there isn’t the workforce to support it.

“And then there’s integrating all the information we have already about a patient to produce more personalized care. We already use remote reporting—you can have experts read ECGs at a distance, monitor patients to see their progress. Being able to weave that in with AI could make a big difference.”

After our conversation with Dr. Haddock ends, we find ourselves outside of 33 Grovesnor Place once more, our time inside the building having reinforced the impression you get by standing outside it: This isn’t quite like any other hospital.

Additional reporting by Kathleen Lang, an Associate in Brunswick’s London office.