Q & A: Eric Klein, chairman of Glickman Urological and Kidney Institute

The new chairman of the Cleveland Clinic’s Glickman Urological and Kidney Institute sees himself as an orchestra conductor.

“Each of the individual physicians in the institute is an instrument player,” said Dr. Eric Klein, who on Sunday moved into the chairman’s office on the 10th floor of Glickman Tower. “The department chairs and the center directors are the concert masters. And my job as institute chair is to pick the medical themes.

“So I see my job as a conductor: raising money, providing the structure around which individuals can follow their passions – which is playing their individual instruments or  practicing their particular specialties - and making each section sound good.”

Klein, 53, is a urological oncologist, researching, treating and teaching doctors about urological cancers in areas such as the prostate, bladder, testis and kidney. Though Klein has been a Clinic staff member since 1989, the institute he leads is only about a year old. Glickman Tower, the institute’s home, is even younger, opening in September.

Less than a month later, Klein, then vice chairman of the institute, became its interim chair following the untimely death of his mentor and the institute’s first chairman, Dr. Andrew Novick. Below are excerpts of an interview with Klein as he discussed his new post.

Q. What have been some of your career highlights at the Cleveland Clinic?
A. When I started here, there were six urologists on staff. Six. And now we have … probably 75 or 80 urologists. Back then, I was the second urological oncologist on the staff. Then the more senior urologist decided to leave the staff and go elsewhere.

So after a year on staff here, I was really the only urological oncologist doing bladder and prostate cancer for a few years.

That was exciting because we were starting to do new things. We were just starting to build new bladders out of intestines for patients with bladder cancer. Radical prostatectomy (prostate removal) had just become popular as a treatment for prostate cancer. PSA (now the standard blood test for prostate cancer) had just been discovered, and so clinically, things were very exciting.

Another highlight was having the opportunity to build the laboratory program that subsequently focused just on prostate cancer. At our peak a few years ago, the laboratory program in prostate cancer here had nine externally funded investigators and $16 million in funding. And in 2002, we won program of the year as the best translational research program at the Cleveland Clinic. So I was very proud of that.

Q. Have you had any career low-lights?
A. I would say early on, disappointments in not having patients do as well as they should, and that happens occasionally, disappointments in not having some grant applications funded or not having some manuscripts accepted, disappointments in not being picked for some opportunities in leadership positions that I wanted,  disappointments in some residents or staff people who have decided to … continue their training elsewhere.

Since I’ve become chair of the department, though, and I was acting chair for a few months, I would have to say there haven’t been any disappointments yet. There have been lots of challenges, but no disappointments.

Q. What are the challenges?
A. Well, I think the greatest challenge is trying to orchestrate all the four departments (urology, nephrology, regional urology and Florida urology) into a cohesive whole — operationally, academically, clinically, socially, all of those things.

Q. Knowing that Dr. Novick hired you and was your mentor, did you expect to follow in his footsteps as leader of this institute?
A. I didn’t expect it, but I certainly  hoped for it. I have to say my expectation was actually that … he would be chair of the institute when I retired, which will be in another 12 or 15  years. I say that because I think he enjoyed the job so much and was so good at it.

Q. What ground do you expect to break as the leader of the Glickman Institute?
A. Again, across the institution, I think the groundbreaking thing here is to organize our medical care differently… moving to the institute model.

We have guys … who are working on ways to improve the treatment of chronic kidney disease, come up with an artificial kidney. Our minimally invasive surgery team is recognized around the world for all the things that they do. The most recent has been single-port, laparoscopic surgery, which is pretty exciting for functional recovery.

[Another doctor] is doing some really outstanding work in minimally invasive surgery for the treatment of pelvic floor prolapse (for women).

One of the things that is innovative in this building, in terms of patient care, is the Versus System (a patient-tracking system). We’ve used it for a few months now, and it’s really terrific. We can tell… at a glance of a screen which patient is in which room, how long the patient’s been waiting, whether or not there’s another person on my team with the patient… It really helps me to know where to go next and keeps the patient wait-time short.

Q. Does the Versus System and other technology in Glickman Tower help reduce health care costs?
A. I think American society… always thinks that whatever the new toy on the block is [that] makes it the best. In fact, there have been few studies on what you might call Michael Porter’s definition of value, and that is what delivers the best outcomes for the least cost. So we have a number of initiatives there.

We are just starting the center for clinical and translational research, which is something that Dr. Novick asked me to develop… which is going to provide everybody in our institute the infrastructure, in terms of nurses and database managers and databases, and the opportunity to collect data to address those sorts of questions.

Q. So what types of work are you doing, these days?
A. My clinical practice is well-established. My research is well-established… I’m on the steep end of the learning curve in terms of personnel management and budgetary issues and the administrative sorts of things. I cut my surgical practice in half. I need to keep it no busier than that to have time for the rest of it. Trying to bring everybody together is what occupies most of my time now.

Q. Was it tough taking over for  Dr. Novick?
A. Dr. Novick’s death was a shock. I had  been vice-chair when that happened, and I stepped in as interim chair. It was tough at first. I really didn’t have a good compass to navigate by. There were days when I sat in my office and thought, “Gee, I wish Andy were here so I could ask him what to do.”

But with time, I grew more comfortable with that. My colleagues seem comfortable with me being in that position. And I really did learn to enjoy it. So in some ways, I’m happy I had the opportunity to do this for a few months as interim. I really got an idea what the job was like. And I decided it was what I want to do.