Dr. Tomislav Mihaljevic recognizes the incredible responsibility that comes with being a cardiothoracic surgeon. It’s a profession in which his patients quite literally put their lives in his hands. But after performing roughly 4,000 surgeries in his career, Mihaljevic has learned that the mind is perhaps an even more powerful instrument than a surgeon’s hands.
“People always think about cardiac surgery as an exercise in dexterity,” says the Croatian-born graduate of the University of Zagreb. “And yes, the technical aspects of surgery are fascinating. One has to have a certain degree of talent. But I would say that is greatly overplayed.”
As Mihaljevic explains his cerebral approach to being a surgeon, it becomes easy to see why the Clinic chose him to succeed Dr. Delos “Toby” Cosgrove as its new president and CEO. All at once, he conveys a sense of the calm, the strength, the wisdom and the leadership he will need to lead this $8.5 billion global health care enterprise.
“What differentiates a good heart surgeon and a great heart surgeon is primarily the ability to make the right decision, not necessarily the ability to make the right move in the operating room,” Mihaljevic says. “The decision on when to operate or not operate, what to focus on and what is important versus not important. That ultimately determines the success or failure of the surgery.”
Mihaljevic succeeded Cosgrove on Jan. 1, coming to Cleveland after serving as CEO at Cleveland Clinic Abu Dhabi. Days before traveling to Cleveland last year for what he expected to be the final interview before he was formally hired into his new role, Mihaljevic had a moment of pause in the operating room.
“I was about to finish the surgery and I realized toward the end, if I happen to get this job, this may be the last operation I’ll ever do,” Mihaljevic says.
While he had the time to be both a CEO and a surgeon in Abu Dhabi, that simply would not be possible leading the Clinic and its more than 52,000 employees.
“You cannot be a good part-time surgeon,” Mihaljevic says. “I would never walk into an operating room knowing that I’m not as good as I could be. This is the type of work one has to do all day, every day in order to perform it at the level that patients deserve. So, I made the decision not to do surgery any longer.”
Instead, he will focus on getting to know his large and diverse team at the Clinic and the challenges they will face together in the years ahead.
Confront difficult problems
Mihaljevic has been with Cleveland Clinic since 2004, when he arrived as a specialist in minimally-invasive and robotically-assisted cardiac surgeries. He helped build the clinic into the world’s largest robotic practice. He is the author or co-author of more than 145 articles in medical and peer-reviewed scientific journals and in 2005, he received a patent for a novel cardioscopy system for minimally invasive cardiac surgery.
His skill as an innovator will be put to the test as he confronts a number of significant health care threats that continue to worsen.
“Certainly, the most profound health care issue is the opioid crisis,” Mihaljevic says.
“That is a serious, serious problem that has taken tens of thousands of lives every year in the United States. Because of the widespread nature of the problem that is tied not only to the medical community, but the community as a whole, I don’t think that we will be able to solve it without a very coordinated, collaborative effort between all stakeholders. What I mean by that is health care providers, regulators, law enforcement, social services — I think we’ll all have to put a concerted and coordinated effort into tackling the opioid crisis.”
Next on the list of burning health care issues for Mihaljevic is infant mortality, particularly in Northeast Ohio.
“We lose many of the youngest members of our community prematurely,” he says. “It is at the top of our agenda as an organization to tackle to whatever extent possible. That problem as well is not just a reflection of health care delivery issues. It’s truly a much broader reflection of social determinants of health — education, poverty and social services. I believe the opioid epidemic and infant mortality are the two most acute and burning issues for health care in Cleveland and in the state of Ohio.”
Robert E. Rich Jr., chair of the clinic’s board of directors, is confident Mihaljevic is up to the challenge of leading the organization into the future.
“Dr. Mihaljevic brings a depth of experience, first as an innovative, world-class surgeon and more recently as a hospital executive focused on health care quality and safety, patient experience and business strategy,” Rich says.
“By nearly every measure — quality, accessibility, finances, innovation, reputation — Cleveland Clinic has made unprecedented strides since Dr. Cosgrove became CEO and president in 2004. Following in his footsteps would be challenging for anybody, but Dr. Mihaljevic has the background, skills and vision to move Cleveland Clinic forward to even greater heights.”
Be a credible leader
Mihaljevic’s ascension to the CEO role maintains the Clinic’s strategy of having a medical professional at the top of the organization. His predecessor, Cosgrove, spent 30 years as a cardiac surgeon and performed 22,000 operations prior to becoming CEO in 2004.
“We firmly believe it’s much easier for a physician or person with a medical background to learn about the business side of the job than it is for a business person to understand the complexities of contemporary health care,” Mihaljevic says.
“That’s one belief we have. The other belief is that, particularly in our culture, you cannot be an effective leader unless you have credibility among the people you lead. Historically, we have always sought to keep a person in the leadership position who has a track record as a physician, as a researcher and as an educator. Those are three components of Cleveland Clinic’s mission that we care about.”
Leading the Clinic is indeed a unique challenge, Cosgrove says.
“No place else functions quite like Cleveland Clinic, with its physician-driven, patient-centered ethos that encourages clinical excellence, medical education, research and innovation. I look forward to working with Dr. Mihaljevic in any way that I can to further the Cleveland Clinic mission,” Cosgrove says.
The office from which Mihaljevic will work is bright and airy, with a beautiful view of the courtyard below the Clinic’s executive offices. His desk is very clean and it’s clear this is not a man eager to sit in a chair combing through the day’s mail or a stack of paperwork. He likes to be around other people and begins most workdays before the sun comes up, often going out for a run with other Clinic personnel.
“I’m an early bird, so I do all of this before my day starts,” Mihaljevic says. “Yesterday we had another run with the CEO, a group of caregivers who have a similar passion for being physically active. We ran together at 5 o’clock in the morning and got that out of the way by 5:30.”
Show your humanity
When you have more than 50,000 people looking to you as their leader, it would be quite understandable to feel overwhelmed by the scope of the job.
The Clinic has a 165-acre main campus near downtown Cleveland, more than 150 outpatient locations in northern Ohio, along with facilities in Las Vegas, Toronto, London and Abu Dhabi. Overall, the clinic had 7.6 million outpatient visits in 2017. Mihaljevic recognizes his responsibility, but he takes a measured approach to his work.
“There is an opportunity to build relationships in every conversation and every interaction that you have with every person,” Mihaljevic says. “There is also an opportunity to build that relationship through simple and consistent messaging.”
He says this messaging is constructed around a simple framework.
“I always share with our caregivers that what we have to do is think of every patient as our family member,” he says.
“Every single member of our organization is a member of our family. And this organization is our home. As we use the simple framework that equates family and home in the decisions we make in our own work environment, we are always going to come to the right decision. We are always going to come to the right answer. That is a framework that connects us all and connects me with the entire organization.”
Beyond that, it comes down to modeling the right behavior for others to follow.
“I believe you have to stay true to who you are,” Mihaljevic says. “I suggest to every one of our caregivers simple advice about how to become approachable. It’s not so complicated. Smile. Behavior is contagious, both good and bad behavior. To smile, say hello to everyone when you walk by them, ask them how they are doing and just try to get to know people in the organization.”
Another regular piece of advice he shares revolves around what to do when it’s time for lunch. It’s a simple act, but one that can go a long way toward shaping a more positive, collaborative workplace culture.
“Whenever you’re in the cafeteria having your lunch or your break, you should never eat your meal alone and you should never eat it with someone who you know,” he says. “That’s the way we build our community. Our community is very important, because health care is a team sport.”
There is no better man to build that community than Mihaljevic, says Umberto P. Fedeli, president and CEO at The Fedeli Group and a member of the Clinic’s board of directors.
“Dr. Mihaljevic is an incredible visionary leader with impeccable character and a compassionate commitment to lead the world-class Cleveland Clinic,” Fedeli says.
“His boundless energy for always looking for ways to improve is unparalleled. His commitment is to make the Cleveland Clinic not only the employer of choice, but also the leader in the world in health care.”
Whatever new challenges the Clinic confronts and whatever new accolades are bestowed upon this iconic health care organization, it will never forget its roots in the city of Cleveland, Mihaljevic says.
“We have a phenomenal social impact through the care that we provide and through the jobs that we offer, but also a huge economic impact by bringing all these resources to the city of Cleveland,” Mihaljevic says.
“We’re firmly committed to Cleveland and the vast majority of everything we do happens in Northeast Ohio. We are growing in other parts of the country and internationally, but ultimately all the fruits of our labor come back to Cleveland.” ●