The Cleveland Clinic was established in 1921 as a group surgical-medical practice with its own dedicated hospital in Cleveland, in the U.S. state of Ohio.

Early beginnings Origins

The Cleveland Clinic had its roots in the Lakeside Unit,The Lakeside Unit: Cleveland Medicine in World War Ihttp://lakesideunit.com, retrieved August 29, 2015.George Crile, George Crile, An Autobiography, edited by Grace Crile, 2 Vol. (Philadelphia and New York: Lippincott, 1947),274-80. an American First World War medical-surgical unit consisting of volunteers from Cleveland's Western Reserve University Lakeside Hospital, (now part of the University Hospitals medical system), organized and led by George W. Crile, MD the hospital's chief of surgery. The Lakeside Unit, formally designated U.S. Army Base Hospital No. 4, was part of the American Expeditionary Forces and attached to the British Army Medical Hospital near Rouen. The Unit served the American sick and wounded throughout WWI. The experience of caring for patients as a group appealed to Crile and two of his partners, Frank E. Bunts, MD, and William E. Lower, MD. Lower later wrote of his admiration for the "teamwork and efficient organization" of military medicine.Surgery, Subspecialization and Science: A History of Urology at the Cleveland Clinic, 1921–2000, Mark D. Bowles and Virginia P. Dawson, Cleveland Clinic Foundation, History Enterprises, Inc., 2000, p. 19 The three began to explore the possibility of establishing a similar sort of practice together in Cleveland after their return from the war.Hospital Built Upon Service, Milwaukee Journal, May 16, 1929, page 2. Retrieved from https://news.google.com/newspapers?nid=1499&dat=19290516&id=H5pQAAAAIBAJ&sjid=wCEEAAAAIBAJ&pg=5944,1367390&hl=en , on August 26, 2015 Upon their return to Cleveland, Crile, Bunts and Lower asked a fourth Cleveland physician from Western Reserve Medical School, John Philips, MD, also a WWI veteran of the Army medical service, to join them in a group practice. Philips was an internist and a pediatrician and complemented the surgical expertise of the other three. The four of them together founded the Cleveland Clinic on February 5, 1921.Creating Cleveland Clinicby Brad Clifton and Jessica Carmosino, retrieved from http://clevelandhistorical.org/items/show/603, on August 7, 2019

Crile, Bunts, and Lower, already shared a surgical practice in Cleveland before they left to serve in the Lakeside Unit. Crile and Bunts started together as assistants in the surgical practice of Frank J. Weed, MD, at 16 Church Street on the near west side of Cleveland. When Weed died in 1891,Shock, Physiological Surgery and George Crile, Peter C. English, Greenwood Press, 1980, p. 62 Crile and Bunts purchased his practice. In 1892, they brought in Crile's cousin, William E. Lower, MD. In 1897, they moved their practice to the Osborn Building on Prospect Avenue in downtown Cleveland.Retrieved from http://www.whonamedit.com/doctor.cfm/1959.html, August 25, 2015

At the time of the founding of the Cleveland Clinic, there was a great deal of opposition to the whole idea of a comprehensive group medical practice, but Crile, Bunts and Lower were sufficiently well respected in Cleveland — all three were professors at one or more of Cleveland medical schools, and each of the three, at one time or other was elected president of the local Academy of Medicine — that they were able to bring their plans for the Clinic to fruition.

First years of operation

The four purchased land at the corner of Euclid Avenue and E. 93rd St in Cleveland and constructed a four-story building with facilities for outpatient clinics and inpatient hospitalization, along with a medical laboratory. The building, which still stands and is still used as part of the Clinic's mission, was dedicated at a private ceremony on February 26, 1921.Retrieved from http://blog.cleveland.com/medical/2008/09/07CGCLINICTIME.pdf , August 26, 2015 William James Mayo, MD, of the Mayo Clinic, delivered the main address. On February 28, 1921, Cleveland Clinic opened its doors to the public and registered 42 patients. In April 1921, Cleveland Clinic had 60 employees, including 14 physicians, four nurses, a telephone operator, six cleaners, 22 clerical workers, an art department, and an unknown number of laboratory technicians. In 1922, the founders purchased four private homes nearby used for hospitalization, radiation treatment, and administration.The Cleveland Clinic Foundation, by Amy Rowland, William Feather, 1938 A fifth house was acquired as a residence for patients with diabetes receiving insulin treatments.Ohio Memory, Madeleine Bebout and the Nurses at Oxley Homes Photograph, caption. Retrieved from https://server16007.contentdm.oclc.org/cdm4/item_viewer.php?CISOROOT=/p267401coll36&CISOPTR=14140&CISOBOX=1&REC=2, on August 26, 2015 To meet rising patient volume, a 184-bed hospital was built in 1924, located at East 90th Street and Carnegie Avenue.Encyclopedia of Cleveland History, http://ech.cwru.edu/ech-cgi/article.pl?id=CCF1, accessed August 25, 2015. A power plant, laundry, and ice plant were also built.Pathfinders of the Heart, the History of Cardiology at Cleveland Clinic, William C. Sheldon, Xlibris, 2008, p.60 A research laboratory was constructed in 1928.Cleveland: The Making of a City, William Ganson Rose, 1950, Kent State University Press, p.1011

Disaster and recovery

On May 15, 1929, nitrocellulose x-ray films stored in the basement of the outpatient building ignited.The Repository (Canton)A Deadly Combo; X-ray films burn noxious fumes at Cleveland Clinic, July 14, 2014They Died Crawling: And other Tales of Cleveland Woe, John Stark Bellamy III, Gray & Company, 1995, pp218-232Time Magazine, May 27, 1929, pp. 15-16 An explosion sent a cloud of toxic oxides of nitrogen and carbon though the building. One hundred and twenty-three people lost their lives, and ninety-two others were injured. Among the dead were forty-three Clinic employees, including co-founder John Phillips, many of whom died from smoke inhalation after heroic efforts to save the lives of their patients.Encyclopedia of Cleveland History, http://case.edu/ech/articles/c/cleveland-clinic-disaster, accessed August 7, 2019. A dozen investigating agencies were not able to determine a single cause for the Cleveland Clinic fire of 1929. Cleveland Clinic's own inquiry narrowed the possible causes down to three: spontaneous combustion caused by heat; a discarded cigarette or match; contact with an extension cord light hung over a stack of films.

Philanthropist Samuel Livingston Mather II formed a committee of 36 community leaders to help Cleveland Clinic reestablish itself in temporary quarters across the street.Plain Dealer123 Die in Clinic Disaster; Poison Gas Seeps into System; Explosion Rocks Building, August 23, 1998Reading Times, May 17, 1929, p2 Patient care services resumed five days later. The 1921 building was completely renovated, and a new three story clinic building, with a new main entrance, was added in 1931. All debts were repaid by 1941.

Growth of specialization Leadership

Crile and Lower relinquished their administrative duties in 1941. In 1942 Cleveland Clinic's Naval Reserve Unit, which included George Crile, Jr., MD, son of one of the founders, established a mobile hospital in New Zealand to treat wounded from the Guadalcanal Campaign.The Way it Was. 1907–1987, Sex, Surgery, Treasure & Travel, George Crile, Jr., Kent State University Press, 1992, p.222

In 1954 Cleveland Clinic formally adopted governance by a physician-led Board of Governors. The nine physician governors are elected by the physician staff. They work with the CEO and lay administrators to formulate and carry out policy, overseen by a board of directors and board of trusteesSpecialty Care in the Era of Managed Care, John A. Kastor, MD, The Johns Hopkins University Press, 2005, p.2 This is a list of the chairman of the Board of Governors, and their terms of office:

Fay Lefevre, MD, 1954–1968 Carle E. Wasmuth, MD, 1968–1973 William S. Kiser, MD, 1973–1989 Floyd D. Loop, MD, 1989–2004 Delos M. Cosgrove, MD, 2004–2017.Med City News, The 50 Best Cleveland Clinic Doctors. Ever., December 24, 2011, retrieved from http://medcitynews.com/2011/12/the-50-best-cleveland-clinic-doctors-ever/, on September 11, 2015 Tomislav "Tom" Mihaljevic, MD, 2018–present

Organization Until 2007 Cleveland Clinic's largest organizational unit was the division: division > department > section. There was a Division of Medicine, Division of Surgery, Division of Anesthesiology, etc. Within each division were departments (Department of Infectious Disease, Department of Cell Biology, etc.). Within each department were sections, (Section of Headache and Facial Pain, Section of Metastatic Disease, etc.). Divisions and departments were led by chairs, and section were led by heads. In 2007, Cleveland Clinic reorganized patient care services around disease and organ-system-based institutes.Harvard Business School, Cleveland Clinic:Growth Strategy 2014, Michael Porter and Elizabeth Teisberg, December 29, 2014, pp.4-5, retrieved from, on August 26, 2015Crain’s Cleveland Business, In name of streamlined care, Clinic forms 26 institutes, November 05, 2007, retrieved from http://www.crainscleveland.com/print/article/20071105/FREE/311050037/in-name-of-streamlined-care-clinic-forms-26-institutes, August 26, 2015Newsweek, What Health Reform can Learn from Cleveland Clinic, November 26, 2009, retrieved from http://www.newsweek.com/what-health-reform-can-learn-cleveland-clinic-76971, on August 26, 2015

Growing facilities

Cleveland Clinic built new operating rooms in the early 1970s to accommodate the growth of cardiac surgery. The Martha Holding Jennings Education Building opened in 1964, with an auditorium named for Bunts. A new hospital building (currently home to Cleveland Clinic Children's) was opened in 1966, and a new research building went up in 1974 (demolished in 2007). A pathology and laboratory medicine building was constructed on Carnegie Avenue in 1980. Kiser led the development of a strategic plan to accommodate growing patient volumes in the late 1970s. This resulted in a group of buildings known as the Century Project. Completed in 1985, the Century Project including a 14-story outpatient building (now known as the Crile Building), designed by architect Cesar Pelli, .retrieved from http://pcparch.com/project/crile-clinic , on August 26, 2015

Becoming a system

Loop was appointed chairman of the Board of Governors in 1989. In the late 1990s, Cleveland Clinic merged with nine regional hospitals: Marymount Hospital, Lakewood Hospital, Fairview Hospital, Lutheran Hospital, South Pointe Hospital, Euclid Hospital, Health Hill Hospital, and Ashtabula County Medical Center (an affiliate hospital). (Medina Hospital joined the system in 2009; Akron General Hospital became an affiliate in 2015.) Center for Studying Health System Change, retrieved from http://www.hschange.com/CONTENT/214/clev-04.html?PRINT=1 , on August 28, 2015Note, Can Cleveland Clinic Health System Be Trusted: Whether a Proposed Merger or Acquisition by Cleveland Clinic Health System Will Substantially Impair the Competitive Health Care Market in Northeast Ohio Resulting in a Violation of Federal Antitrust Statutes, 17 J.L. & Health 137 (2002–2003), p. 159, retrieved from http://engagedscholarship.csuohio.edu/cgi/viewcontent.cgi?article=1135&context=jlh, on August 28, 2015retrieved from http://www.cleveland.com/healthfit/index.ssf/2014/08/cleveland_clinic_to_put_100_mi.html, on August 28, 1015retrieved from, http://www.ohio.com/lifestyle/powell/akron-general-cleveland-clinic-ceos-say-affiliation-better-than-expected-1.586407, on August 28, 2015