Establishing a Clinical Laboratory in a Tertiary/Quaternary Care Greenfield Hospital in the Middle East Recounting the Cleveland Clinic Abu Dhabi Experience Imran Mirza, MBBS, MS, FRCPC; Laila O. AbdelWareth, MBBCh, FRCPC; Muneezeh Liaqat, MBBS, FRCPath; Peter Anderson, BAPPSc, MBA; Bryson Palmer, MA; Andrew Turner, PhD; Fasila Pallinalakam, MSc; Helal Bin Ali, BSc; Eufe Tantia, BS, MSc, MT(ASCPi); Sara Lari, BSc; Therese Tiexiera, MBA; Paul Suchy, PhD; David Bosler, MD; Kandice Kottke-Marchant, MD, PhD  Context.—This review chronicles the establishment of a clinical laboratory in Cleveland Clinic Abu Dhabi, a greenfield tertiary/quaternary care hospital in the United Arab Emirates. It discusses the challenges faced, solutions sought, and lessons learned and shares insights and pitfalls that may be encountered in such an undertaking. Objectives.—To share our experience in building a clinical laboratory in a start-up, multispecialty hospital and how we provided support and managed people, processes, and technology for building and making operational the Cleveland Clinic Abu Dhabi. Data Sources.—The Medline (PubMed, National Center for Biotechnology Information, Bethesda, Maryland) data- base was used to review this topic as well as other journals, books, and Google (Mountain View, California) search engine. Conclusions.—To deliver on the promise of quality healthcare in a culturally appropriate setting close to home, Cleveland Clinic Abu Dhabi proved to be an unprecedented and ambitious project, jointly carried out by Mubadala Investment Corporation and the Cleveland Clinic Foundation. Cognizant of the scale of this task, hospital leadership engaged closely with staff and stake- holders through motivational techniques and effective communication. Excellent project planning and execution of complex tasks were required for initiation of services. Establishing the clinical laboratory served as an instructive model in fostering multidisciplinary teamwork by high- lighting ways to manage operational roadblocks and opportunities in the planning, commissioning, and activa- tion phases. Throughout the activation process, all efforts were directed to create a patient-safety culture within an intentional-learning organization. (Arch Pathol Lab Med. 2018;142:1023–1035; doi: 10.5858/arpa.2017-0518-RA) ‘‘I had many dreams. I dreamt of our land keeping pace with the growth of the modern world.’’ —Sheikh Zayed bin Sultan Al Nahyan 1 F ew organizations in the world are officially inaugurated by the leader of the nation, and fewer still can boast of the presence of leaders from 2 nations at their inauguration. This is possibly unprecedented in health care. In December 2015, Cleveland Clinic Abu Dhabi (CCAD) had the great fortune to have Sheikh Mohammed bin Zayed Al Nahyan, Crown Price of Abu Dhabi, and His Majesty King Mohammed VI of Morocco, grace its official opening on National Day of the United Arab Emirates (UAE), under- scoring the significance of the hospital to the country. 2 Proclaimed in 2006, CCAD was an effort to replicate the US- based Cleveland Clinic in Abu Dhabi, UAE, and remains a cornerstone of the Abu Dhabi Economic Vision 2030, which mandates a long-term, self-sustaining health care system. 3 CCAD is a unique and unparalleled extension of the Cleveland Clinic (Cleveland, Ohio) model of patient- centered care. It is designed to address a range of complex and critical care requirements specific to the Abu Dhabi and UAE populations. CCAD has 5 centers of excellence in the following institutes: (1) neurologic, (2) eye, (3) heart and vascular, (4) respiratory and critical care, and (5) digestive diseases. Other institutes include anesthesiology, emergen- cy medicine, medical subspecialties, surgical subspecialties, Accepted for publication February 28, 2018. From the Pathology & Laboratory Medicine Institute (Drs Mirza, AbdelWareth, Liaqat, and Turner; Messrs Anderson, Palmer, and Tantia; Mrs Pallinalakam; and Ms Lari); the Clinical Engineering Department (Mr Bin Ali); and the Clinical and Nursing Institute (Ms Tiexiera), Cleveland Clinic Abu Dhabi, United Arab Emirates; and the Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio (Drs Suchy, Bosler, and Kottke-Marchant). The authors have no relevant financial interest in the products or companies described in this article. Corresponding author: Imran Mirza, MBBS, MS, FRCPC, Pathology & Laboratory Medicine Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates (email: Mirzai@ClevelandClinicAbuDhabi.ae). Arch Pathol Lab Med—Vol 142, September 2018 Establishing a Clinical Laboratory—Mirza et al 1023