Book excerpt: Tracing the history of the Cleveland Clinic from its start as a small not-for-profit group practice to being the world's second largest private academic medical center, this medical history tells one of the most dramatic stories in modern medicine. Starting on the battlefield hospitals of World War I, this details how the clinic achieved medical firsts, such as the discovery of coronary angiography and the world's first successful larynx transplant, improved hospital safety, and met the challenges of the 21st century to be ranked among the top five hospitals in America. This text not only recounts the history of the clinic but presents a model for other not-for-profit organizations on how to endure and thrive.