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Cleveland Clinic

The Cleveland Clinic helps set Cleveland apart as a medical city.

Detroit is the latest metro area vying to become a medical destination. The hope is that its hospital systems can draw patients from outside its region, helping the local economy. In short, Detroit wants to be more like Cleveland. But Cleveland could be tough to copy.

In 1975, a young cardiologist arrived in Cleveland.

“I came here in a rented truck with a Vega on the back end because it was too sick to pull,” Toby Cosgrove said. Jump ahead 36 years and that newbie with a beater of a car is now CEO of the Cleveland Clinic. Cosgrove presides over a medical empire vastly larger than when he came to town hoping to get better at heart surgery.

“We were about 140-150 doctors. We’ve grown a bit since that time. We’re now about 3000,” he said.

Dan Bobkoff

Toby Cosgrove, the Cleveland Clinic's CEO, in his office.

The Clinic has become a centerpiece of an industry that employs roughly 70,000. That includes places like University Hospitals\ next door, and Summa Health in Akron.

Growth has been rapid. University Hospitals alone has added 4000 workers in the last few years. And, expansions have been pegged at about $3 billion in construction spending.

George Rouse is a nurse who made his own transition before the rest of the region.

“My friends were like: are you crazy? Are you nuts?” he recounts.

About 15 years ago, Rouse was working in IT for a manufacturing company.

“I had a very good living with that company but I’m like: what if this would ever end? What would I do next?” Rouse said.

His premonition was right. His former employer closed up shop a few years ago. No one thinks he’s crazy now.

“When I’m driving to work, the last two years, for all of us, you know, our houses have dwindled down to nothing, our 401ks have shrunk down,” he said. “I mean, all these pieces are crumbling.”

Dan Bobkoff

Nurse George Rouse prepares a patient for a pacemaker operation.

While it worked for Rouse, healthcare is no replacement for manufacturing. Health jobs make up about 11 percent of the workforce. In its heyday—say the 50s and 60s—manufacturing jobs employed 40 percent of Clevelanders.

“Healthcare became the big generator of jobs by accident,” said Chris Seper, founder of MedCityNews.

Cleveland’s hospitals have been growing for nearly a century. It’s only been in the last decade that healthcare has become the center of economic development.

“The healthcare system here and the life sciences industry here does as much as it possibly can. But there’s a limit to what they can do,” Seper said.

Cleveland never really set out to become a healthcare capital. Cleveland Clinic CEO Toby Cosgrove says it’s not like some politician stood at a podium many years ago.

“No, nobody raised their hand and said they’re going to push this organization to the front,” Cosgrove said.

The Clinic’s international reputation can be traced back to advances in heart care in the 50s and 60s. Now, patients arrive from around the country and world for heart procedures. Foreign patients often pay cash. Bringing patients in is the holy grail for cities like Detroit that want to be like Cleveland. But even at the Clinic, only one percent of its patients are international. Paul Ginsburg is president of the Center for Studying Health System Change.

“But when you really look at the numbers of some places that are really strong in medical tourism, it’s not that large a part,” Ginsburg said, adding that there are other reasons why healthcare may not be a good economic driver for regions.

For one, building more hospitals often means people consume more care, which means we all pay more in taxes and insurance. Whether any city can sustain this much expansion is a big question.

And, the industry is changing, shifting more to home care and so-called telemedicine. Already, smaller hospitals are outsourcing difficult diagnoses to places like the Cleveland Clinic. Chris Seper of MedCityNews says that will make it even harder for cities trying to embrace healthcare as their future.

“I think if you’re building healthcare systems and hospitals as an idea that they’re going to be your jobs growth engine, it’s a lose-lose situation,” Seper said.

Cosgrove of the Clinic says we may end up with nationwide chains, the way banks have consolidated over the years. So, if you’re trying to copy Cleveland, good luck.

The patient, Mr. Pointer, is recovering from abdominal surgery. Photo by Kate Davidson.

LANSING — The country is facing a nursing shortage. But schools in our region can’t keep up with the demand for nursing education.  As we reported in our first story, that’s partly because there are a limited number of clinical settings where student nurses can work with patients. So to augment the clinical experience, some nursing programs are enlisting the help of a newfangled dummy, wired with smart technology.

Actually, calling these high tech mannequins “dummies” might be a bit insulting.

Forget those passive plastic torsos you’ve seen in CPR demonstrations. We’re talking about high fidelity mannequins, remotely operated by IT guys with headsets and laptops. Larissa Miller runs the nursing simulation program at Lansing Community College. She can wax poetic about the virtues of the school’s simulated man.

Boxes of skin, spare legs. Larissa Miller runs the nursing simulation program at Lansing Community College. Photo by Kate Davidson.

“Our mannequin can shake,” she said, “which is great, we make him have a seizure right in the bed. He can sweat and it starts pouring down his face. He blinks, he breathes, he has pulses…”

He talks. And his female counterpart can even give birth. Miller has been a nurse for 19 years and she says the technology is exploding.

“Simulation is absolutely one of the fastest paced things I’ve ever watched in education,” she said.

It’s estimated there are more than a thousand places across the country that use medical simulation of some kind – including schools and hospitals in Lansing, Cleveland and Chicago. Miller says that, just like pilots learning to fly, student nurses should do some of their high stakes training in a place where no one can get hurt. In fact, proponents of simulation training in nursing often point to its success in aviation and the military.

To see simulation in action, I join Larissa Miller in a dimly lit control room. We hover behind a two-way mirror like a couple of cops. But instead of a lineup, we’re observing a fake patient, in a fake hospital room, surrounded by real students. They know that Mr. Pointer, aka the mannequin, is recovering from abdominal surgery. His only complaint is a mild headache. But Larissa Miller has more in store for the students – and their patient.

“He’s actually going to have a massive … stroke right before their eyes,” she said.


A stroke, caused by a clot that travels to the patient’s brain. The clues are all there – in Mr. Pointer’s heart rhythm, his rising blood pressure, and his worsening headache.

The scenario is being videotaped with a timestamp. Later on, when the students debrief with their instructor, they’ll see exactly how long it takes them to perform crucial tasks. So, will they call for help in time?

Dean Margie Clark is a booster of simulation training. But she says working with real patients is "priceless." Photo by Kate Davidson.

We’ll find out in a minute. But first, can a mannequin really take the place of a live patient? Margie Clark is the Dean of Health and Human Services at Lansing Community College. She says no.

“The value of going into a facility and working with patients is priceless,” she said. “It would never replace it. But it is a key component for the experience of our students when they get into the clinical, that they can make every minute count.”

That’s because student nurses are often intimidated when they start clinical rotations. Clark says that simulation builds confidence, which helps students hit the ground running. She adds that gains in efficiency could eventually pave the way for shorter rotations, creating room for more nursing students.

Lansing Community College serves students in the state capital. But simulation also holds promise for students at small rural hospitals who might not get to see a live birth or observe children in acute care without traveling for hours.

Still, the technology is expensive. LCC has several mannequins. The one undergoing a massive stroke costs about $70,000. Larissa Miller says the whole lab ran close to $2 million.

Back in the fake hospital room, the student nurses eventually decide to call for help, in the form of a rapid response team. Second year student Travis Pierce emerges full of adrenaline.

“This is fantastic,” he exclaimed. “I feel that the sim labs actually help us better than the actual clinical settings. Because they can simulate these things. And on top of that, you don’t have to worry about someone dying if you don’t figure it out right away.”

The debate is on within the medical community about how big a role simulation should play in training nurses. The answer could be informed by a major study on the effectiveness of simulation, which begins across the country this fall. Meanwhile, in our region, where jobs are so needed, nursing faculty say that any competitive tool can help.

Second year nursing students Travis Pierce, Shelby Feldpausch, Staci Pierson (kneeling), Jennifer Meaton, Ashley Neybert and Jamie Hill. And of course, Mr. Pointer, center. Photo by Kate Davidson.

CORRECTION: In an earlier version of this story, the stroke the patient experiences was described as a “hemorraghic” stroke.  It should have been referred to as an “ischemic” stroke.