Cleveland Clinic implemented the institute model approximately 20 years ago.
Over the years, the health system has continued to evolve the model, which included various specialties such as cancer and digestive diseases.
In the past few years, as Cleveland Clinic has experienced significant growth, it began work on a new operating model that aimed to assure consistent, quality care for all patients and create a more uniform work environment for employees. Among other changes, this led to the development of a new institute structure, reducing it from 18 to 11, which includes the health system's Integrated Hospital Care Institute.
Raed Dweik, MD, chief of the Integrated Hospital Care Institute, told Becker's work on the operating model began before the pandemic but was not implemented until 2023, when Cleveland Clinic's new operating model structure began to roll out. He describes it as "Institutes 2.0."
"Everything we have learned in the last two decades about our existing institute model helped inform our new approach to delivering patient care," Dr. Dweik said.
Under the institute model, departments of related medical specialties collaborate as unified institutes, with the goal of improving patient outcomes and advancing medical knowledge.
The new IHI model is unique in healthcare in that it unifies hospital-based services, integrating five departments — pulmonary and critical care medicine, infectious disease, anesthesiology, emergency medicine and hospital medicine — along with their 12 divisions under one umbrella, as Dr. Dweik said in a LinkedIn post.
The IHI also has two centers (critical care and perioperative medicine) to organize clinical, education and research activities of these services across the health system.
Graduate medical education programs in the IHI include more than 150 residents and more than 100 fellows in 14 specialties and subspecialties, in addition to an APP-CRNA School and APP-ICU Fellowship. Research activities in IHI include 650 projects supported by more than 100 federal grants, 150 industry-sponsored trials, and various foundation awards.
Overall, the IHI, which has about 1,200 faculty members and 4,000 employees, has fostered a more team-focused, inclusive mentality, according to Dr. Dweik.
Still, he acknowledged there was reluctance about the IHI model in the beginning, such as challenges around how to determine which metrics to focus on. Now, the departments meet every week as a group to discuss collaborative opportunities and revisit processes that affect outcomes and patient experience.
Additionally, the transition of patients between departments has been smoother since the IHI rollout, according to Dr. Dweik. He gave the example of hospital physicians embedded in the emergency room, so they are familiar with a patient's status before they are taken to an inpatient room.
"With more insight into the patient before they arrive, the hospital specialists can seamlessly begin delivering care without delay," he said.
"Anecdotally, as there isn't yet data, this integration streamlined transitions and resulted in efficiencies and consistent care delivery," said Dr. Dweik, who is also a professor of medicine at Cleveland Clinic Lerner College of Medicine.
Dr. Dweik also noted that no additional investments were needed by Cleveland Clinic for the creation of and implementation of the new IHI structure. Instead, it involved reassigning resources and teams in a manner he believes will improve the patient journey.
He said he would have implemented the IHI model 10 years ago if that had been possible.
"Organizational change in healthcare is not easy," Dr. Dweik said. "Finding the right balance of accountability while advocating for your team has been key to managing our systemwide evolution."