Let's rewind to March 2020. Schools, restaurants, places of worship, and businesses are all closing their doors. The number of confirmed cases of Covid-19 is beginning to resemble a crisis, and hospitals are facing an uncertain and frenzied landscape. Two competing health systems that care for most of northern Ohio, take an unorthodox step to tackle the immense challenges of the incipient pandemic: their leaders pick up the phone and hatch a plan for their rival organizations to collaborate.

Recognizing the Covid-19 crisis represented a problem much bigger than their institutions could face alone, Cleveland Clinic and University Hospitals, whose flagship facilities are only separated by 1,500 feet, agreed to partner and share resources in order to ensure the best possible care for their community.

Advisory Board's Rae Woods recently spoke with Dr. Robert Wyllie, Chief of Medical Operations at Cleveland Clinic, and Dr. Eric Beck, Chief Operating Officer at University Hospitals, about bringing their two competing systems together.  Here's what struck us about their unique experience and the lessons they've learned along the way.

Lesson 1: The "power of relationships" is the lynchpin of successful cooperation

"That's the power of relationships and the power of cultivating those relationships, particularly when you're fighting a common cause." – Dr. Beck

One of the most striking features of the partnership between Cleveland Clinic and University Hospitals is the strength of its relationships at the individual human level. These relationships, they say, are rooted in mutual respect both for each other's organizations and for each other as individuals. The "power of relationships," as Dr. Beck refers to it, starts at the top-most levels of their organizations: for example, Dr. Wyllie and Dr. Beck cite daily phone calls throughout the pandemic, especially whenever a question or potential disagreement arose, as one of the reasons for the success of the partnership between their two organizations.

The duo role modeled this spirit of collaboration daily and set the tone for their teams, who likewise reflected the value of cultivating strong relationships to work together effectively. 

"There's a fondness for the teams that have come together – those relationships really flourished during the pandemic," says Dr. Wyllie.

Lesson 2: Collaborating with competitors requires the same competencies as building internal "systemness"

"We think about a system of care not being just within a single health system, but within a region or geography. The ability to leverage data and to pool the talent around that data are enduring examples of how collaboration is […] synergistic." – Dr. Beck

"Systemness" is the ability of a health system to overcome challenges and make progress because of its scale, not in spite of it. Getting different facilities within a system to begin pulling in the same direction with a common goal in mind requires adjusting entrenched habits, realigning communication routes, and building decision-making consensus. While simple in principle, the competencies required to build "systemness" can be challenging to achieve. And, as Cleveland Clinic and University Hospitals discovered, they are the same competencies that are required to effectively bring two competing systems together toward a common goal.

But like any journey toward "systemness," there were bound to be points of misalignment along the way. Dr. Wyllie and Dr. Beck occasionally found that there were some subjects on which they had to agree to disagree. In those moments they would bring their internal experts together and create an open, respectful dialogue between the teams, which they credit with enriching their decision-making.

It was also important for the two systems to recognize that they did not need every site, every physician, every team to operate in the exact same way. They allowed room for some variation and set guidelines to decide where it was and was not warranted, always maintaining focus on their common goal – improving the health of the people of northern Ohio.

Lesson 3: Pandemic response partnerships provide a template to tackle enduring public health challenges

"We want to maintain the structure and the communication that we have, not only with each other, but with [other organizations as well], so that we can continue to leverage those relationships and improve the health of Northern Ohio."– Dr. Wyllie

Cleveland Clinic and University Hospitals aren't letting their partnership fade in the post-pandemic landscape. They recognize that the advantages of sharing resources—and combining their data and analytic power—can be parlayed into addressing problems outside of Covid-19 as well.

"The ability to carry that same approach into long-standing, enduring public health issues in our region is really what we're committed to," noted Dr. Beck. Already, their organizations have discussed tackling the challenges of infant mortality and the burden of addiction in their community.

These are public health problems that exist outside the scale that can usually be addressed by a single system, or even by a single sector. In fact, both systems point to opportunities to extend their collaborative endeavors to organizations across the health care ecosystem, from start-up companies to health plans to public health agencies.

The unique partnership between Cleveland Clinic and University Hospitals provides an example of the value created when competition can be set aside in favor of collaboration—and the untapped potential benefit it can yield for society.

The lessons from their partnership can help other rival organizations team up to tackle the complex, structural challenges facing the U.S. health care system, such as infant mortality, racial disparities in care, opiate addiction, and the mounting behavioral health shortage.  Finding common ground among competitors remains uncharted territory for most health care leaders.  But it's a model worth emulating. 

Interested in learning more about the experience of Cleveland Clinic and University Hospitals?  Check out the full podcast episode here.

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