Cleveland Clinic’s Lou Ruvo Brain Institute © Kirk Gittings

A decade ago, James Young, a genial British-born doctor, had one of the most prestigious jobs possible at an American hospital. His title was “Head of Medicine” at Cleveland Clinic, one of the biggest hospitals in the world; and since western medicine has traditionally been split into two branches—namely “medicine” and “surgery”—James was thus overseeing half the hospital.

But in 2007, James was sucked into an extraordinary experiment. Toby Cosgrove, a heart thorassic surgeon who runs Cleveland Clinic, declared that he was abolishing the Department of Medicine, to blend surgery and medicine into a single unit. Some doctors might have howled in protest.

But James did not. “I could see the sense of that,” he recalls, with a smile. These days Cleveland Clinic has turned the usual organisational map of medicine upside down. Instead of splitting its operations between “medicine” and “surgery”, it organises itself according to different body parts or ailments.

Instead of a “neurosurgeon” department that keeps itself apart from “neurology” and “neuro-radiology” and “psychiatry,” it has a single “brain” institute instead. The core goal is to structure the hospital around the way that consumers (that is, patients) experience medicine—rather than how providers (that is, doctors) have been trained. “A patient doesn’t go into a hospital and say ‘I want to see a cardiothorassic surgeon’—they just say ‘I have a chest pain’ or ‘my head hurts,’” as Cosgrove explains.

Welcome to a curious little experiment that British doctors and policy makers ought to watch. In recent years politicians and policy makers have fretted endlessly about the state of the National Health Service (NHS); there is concern about underfunding, inefficient processes and falling standards. But there is also another problem that does not get nearly enough debate: the problem of silos, or the way that medicine is organised into fragmented units, and specialist medical experts (or quasi tribes).

As medical bureaucracies keep swelling in scale, they are not just becoming more impersonal; they are also fragmenting people too. Similarly, as NHS hospitals embrace a policy of outsourcing and hyper streamlined efficiency, this tends to breed a world where people are only incentivised to care about what is directly under their nose. And this in turn can leave healthcare professionals operating with rigid labels and boundaries which are ill suited…

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