Oversized hospitals

The latest issue of The Economist has an article about very big hospitals in mid-sized cities:

The most dramatic are Rochester, a medium-sized city where Mayo has long been a star business, and Cleveland, Ohio, a rustbelt city that has seen its hospitals boom and one, the Cleveland Clinic, become a new economic force. Each hospital is a behemoth: Mayo's revenues in 2006 totalled $6.3 billion, Cleveland's $4.4 billion.

Their success stems from medical innovations and excellent care. The Cleveland Clinic is America's best heart hospital; Mayo tops the rankings for neurology, digestive disorders and endocrinology. Cleveland and Mayo have also expanded through mergers with other hospitals to form regional health systems.

This is a very interesting topic: why is it generally assumed that a healthcare center has to be resource-constrained by the size of the place that hosts it? I mean, it's clear that from the point of view of providing easy access to quality healthcare for everyone in a region, healthcare centers should not be too far away and this access requirement goes against the idea of heavy concentration but as the cited examples prove, both approaches are perfectly compatible.

What is it that makes a mid-sized regional hospital grow and expand to become a world class mega-hospital? Is it management? Strategic Planning? Sheer luck? I had the opportunity to visit the Cleveland Clinic in 2006 (my fiancée was there as a visiting resident) and it really is an impressive place. The management quality and professional standards should serve as an example to everyone. The strive for improvement in every field that I saw there is not something usually found in your average hospital.