Taking the Jobs No One Wants: A Conversation with Dr. Tomislav Mihaljevic
by Sohini Mukherjee
In September 2017, Dr. Tomislav “Tom” Mihaljevic was named President and CEO of Cleveland Clinic, beginning his appointment this year and succeeding Dr. Toby Cosgrove. Nationally recognized as one of the top medical centers in the United States and the world, the Cleveland Clinic has long been famous for its technological and management systems and its cutting-edge cardiovascular treatments. While Dr. Mihaljevic’s achievement is impressive, his journey from Croatia as a refugee of war to becoming the head of one of America’s best hospitals is extraordinary. Growing up in Zagreb, Croatia, Dr. Mihaljevic had just graduated from medical school when an unthinkable war broke out in 1991. After continuing his training in cardiac surgery in Zurich, he came to the Brigham and Women’s Hospital in Boston in 1995. He then joined the Cleveland Clinic in 2004 as a cardiothoracic surgeon specializing in robotically assisted cardiac surgeries, building the Cleveland Clinic into the world’s largest robotic practice. In 2010, he opened Cleveland Clinic Abu Dhabi, and has served as its CEO since 2015.
Joining the Voices in Leadership Series, Dr. Mihaljevic shared his extraordinary story, recounting how he fled a war-torn country and became a leading medical expert, and his experiences in enhancing the patient experience and increasing access to clinical services, with his former chief resident Dr. Atul Gawande, Professor in the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health and now the newly appointed CEO of the as-yet unnamed Amazon-Berkshire Hathaway and Chase joint health venture.
Escaping War and Starting Over
As Dr. Mihaljevic described his journey from Croatia and Zurich, he highlighted the importance of looking for and going after opportunities, which eventually led him to the Brigham for a fellowship. Dr. Gawande, his chief resident, humorously recounted his own experiences working with “Tommy” who landed on his service, saying,
“This is a guy who is fully trained, relative to me, as a surgeon and cardiac surgeon…there’d be a gunshot wound downstairs and the cardiac folks would call up and say, hey, can Tommy come help us out? Yes, you can take my intern.”
Smiling while reminiscing over their residency days, Dr. Gawande commended him for never expressing any resentment for working his way up despite outpacing his peers in surgical knowledge and training. However, according to Dr. Mihaljevic, there was “nothing to complain about,” as he was only met with “graciousness and generosity,” saying,
“The uniqueness of the opportunity that was handed over here to me to Brigham, just to be at Harvard, was unthinkable for me. It’s something that I felt so blessed that I have just a chance to be here and learn from people around me that I never felt embarrassed or never felt any resentment, to the contrary. I just felt an immense amount of gratitude to be able to be trained here.”
After completing his cardiac surgical residency, Dr. Mihaljevic had a difficult choice to make — either stay at the Brigham or move on to other practices. As challenging as the decision was, he knew that the Cleveland Clinic, with the best team in cardiac surgery, had the mission and “very unique” environment which was a good personal fit. Describing the non-hierarchical, open environment, he said, “We do not have any titles at the Cleveland Clinic…We would like to say that we like people to be recognized by their name and their ability rather than the relative position in the organization. There is a kind of collective sense of the fact that we, together, are much more important than each individual for him or herself.”
Taking the Jobs No One Wants
Once again speaking of opportunities in every organization, Dr. Mihaljevic highlighted how building a career often means “taking on assignments that are immediately available but nobody else wants to do,” because either they are in “early stages” or they do not have the associated resources or recognition. For him, this meant first working in robotic surgery, which, although prominent now, was job that no one wanted a decade ago, given the level of complexity and risk. At the peak of his surgical career, he knew that a career of academic cardiac surgery would not be one he was enthusiastic about, and so accepted the task of creating the Cleveland Clinic in Abu Dhabi, which, as described by Dr. Gawande, was “the job no one wanted to take.”
The move was a bold one and the scale of the effort was enormous. Cleveland Clinic Abu Dhabi was the world’s largest international health project, with a building of 4 million square feet and with an internal volume exceeding the tallest building in the world, the Burj Khalifa in Abu Dhabi, making it the largest steel construction in the Arabian Gulf. In addition, Dr. Mihaljevic was in charge of bringing together over five thousand people from 80 countries, form teams to work cohesively in a 4 million-square-foot facility, and deliver the world famous Cleveland Clinic quality care in more than fifty service lines thousands of miles away from the original. However, Dr. Mihaljevic was determined to establish the hospital the right way, and keep the “Cleveland Clinic people, culture, processes, the quality of care”; it had to be “the real Cleveland Clinic.” He made it clear that, despite the pitfalls and challenges, the only way to accomplish something so large was with determination, motivation, and the right people. He made it a point to “recruit the best possible talent” in order to instill the right culture from the very beginning, saying,
“You can create a world-class team out of almost anyone as long as their hearts and minds are in it.”
Even with the right people, the task was daunting, but gratifying. In order for the culture to be taught to the teams, it was important to keep talking to each other, to know how to solve problems, and decide where they stood as an organization. According to Dr. Mihaljevic,
“Probably the most inspirational part of all of this was not the technical and medical, but it was really interesting to see how those values that we hold so dear and think unique, that are unique for Cleveland, Cleveland Clinic Ohio, transcend the geographical, cultural, ethnic, and religious boundaries.”
Envisioning a team health strategy for populations
While Dr. Mihaljevic and Dr. Gawande both discussed the Cleveland Clinic model as one of phenomenal specialty care, they both recognized that the future of health care still needed a population health strategy that came ahead of illness, rather than after. Dr. Mihaljevic noted that although people thought of population health and specialty care as two different businesses, his time at the Cleveland Clinic meant that he did not share that opinion. Caregivers in organizations are responsible for a “continuum of care,” as people who are labeled as specialty are usually being treated long term for chronic conditions, which will require the integration of speciality care into the primary care network. The next iteration of the organization that will meet the needs of patients will be focused primarily on teams, less so than individual providers.
Amongst all this, Dr. Mihaljevic also recognizes the need to strengthen systems of medical education, and discussed his plans collaborating with the medical school in Athens, Ohio, once again discussing how teams will feature in this vision,
“We’re integrating — you know, we’re bringing this new health education campus where, for the first time, we’re going to put, under the same roof, medical students, nursing students, dental students under the same roof. Because we firmly believe that people have to start…their professional journey with their educational journey as a team.”
Read an article by Dr. Tomislav Mihaljevic on his visit.
Story by Sohini Mukherjee, a second year student in the Master of Science program in Global Health and Population at the Harvard T.H. Chan School of Public Health, interested in gender equity, maternal health, and health policy and governance.