With Mayo

In the deli that is health care, we all deserve the special

By Ian Morrison

Last fall I was with Mayo. Not in the sandwich sense, but in the Rochester, Minn., folks at the Mayo Clinic sense. It was my second visit, this time to meet with the leaders of the Mayo Health System.

Mayo Health System is not the Rochester clinic but the network of 16 affiliated hospitals and clinics with 720 physicians spread over 250 miles where Minnesota, Wisconsin and Iowa meet. Mayo Health System is part of the consolidated financials of the Mayo Clinic (which in total has some $6 billion in revenue from all its sites). But from a governance perspective, Mayo Health System reports to the board of trustees of the Mayo Clinic Rochester. Got it?

Once-independent community hospitals and clinics have been absorbed into this network over the last 14 years. The progressive integration that has occurred under the able leadership of Dr. Peter Carryer, chair of the Mayo Health System board, and his colleagues has created a network that gets progressively more Mayo over time, exhibiting ever-more characteristics of the mission, values and behavior of the mother ship in Rochester. Actually, mother ship is the wrong term, more like mother fleet, because the whole of Rochester, with the exception of the giant Libby’s corn-on-the-cob water tower, seems to be part of the Mayo Clinic–from the myriad hospitals and clinic buildings to the fact that everyone on the regional jets flying into Rochester is going to the clinic to get treatment, to get training or to give a talk.

I came away, once again, from Mayo even more firmly of the belief that we all deserve to have the Mayo Clinic: not to all fly to Rochester, please understand–there isn’t room on the planes or in the Marriott next door–but to have our local health system deliver the Mayo.

Lessons from Mayo

What makes Mayo? My friend Len Berry, Ph.D., distinguished business professor at Texas A&M and an internationally recognized expert in service industries, spent a lengthy sabbatical studying Mayo in Scottsdale, Ariz., and Rochester, and I cannot even begin to do justice to his scholarly review of what makes Mayo so good. (You should it read for yourself. See, for example, “Clueing in Customers,” by Leonard L. Berry and Neeli Bendapudi, Harvard Business Review, 2003, Reprint R0302H.) But here are a few personal observations I would add to Len’s work about what factors distinguish Mayo from the pack.

Global brand. The Mayo Clinic is synonymous with quality. No, really, it is. It has a global brand that speaks of medical excellence in solving difficult diagnostic problems, of providing desperately sick patients with hope and offering path-breaking medical advances in research and treatment. That’s why patients come from all over the world to get care and why Mayo has more than 1,700 clinical fellows receiving training in graduate medical education. “I trained at Mayo” is a proud boast of many of the world’s greatest clinicians and medical scientists.

Saudi princes and a lot of locals. Despite Mayo’s globally recognized brand, it is important to know that only 3.5 percent of patients come from afar. I am sure these patients represent a bigger share of the bottom line, maybe 10 to 15 percent, but it always comes as a bit of a surprise to find that Mayo is a regional and local health system at its core. Mayo remains financially healthy because the local Blues plans pay a fairly high share of reasonable and customary charges. If these plans started to get difficult, Mayo might have a problem, but I can’t imagine why a payer would take them on; what’s not to like about getting the right care the first time around?

So, even at Mayo, health care is primarily a local good. Actually, this local-versus-national focus isn’t that much different from any of the national flagships like the Cleveland Clinic, M.D. Anderson, Stanford, Hopkins, Cedars-Sinai, Mass General and on and on. While these great institutions attract patients from all over the world and these (generally affluent) patients contribute a disproportionate share of the bottom line, they tend to account for less than 5 percent of volume. Funnily enough, just the other day, I landed in Cleveland and as we pulled into the gate, across the way was an Airbus emblazoned with the government of Kuwait colors. At first, I was shocked that there was a direct flight from Kuwait to Cleveland, and then I realized it was probably some ailing emir who commandeered the government jet to come and get a bypass at the Cleveland Clinic.

Values-based culture. In the early days of Mayo, one of the clinic’s founders, William J. Mayo, M.D., stated, “The best interest of the patient is the only interest to be considered.” Mayo is built on this simple premise that the founding Mayo brothers hammered into the DNA of the organization: “Put the patient first.” This is not a slogan. It is the credo that guides the organization and the people who work there. Len Berry’s research reveals a staff at Mayo Clinic highly committed to serving patients. From volunteers to world-class surgeons to the more than 70,000 individual benefactors, the people at Mayo are focused on the best interests of the patient.

Minnesota nice meets medical excellence. As Berry and Bendapudi’s research shows, Mayo carefully captures this will to serve and reinforces it through training, selection of staff and a structure of compensation (salaried physicians in particular) that rewards integration and teamwork to serve patients’ needs. It doesn’t hurt that Mayo is in the “nice” state of Minnesota, but these values and practices apparently extend to the Scottsdale and Jacksonville, Fla., campuses as well.

No jerks. In my limited exposure to Mayo, I would argue that one of the hallmarks is that they don’t hire jerks. This is not a place for brilliant but difficult prima donnas. The folks at Mayo say they may have the odd jerk, but they are the exception rather than the rule. When physicians and staff are recruited, they get the no-jerks-allowed message, so the people who are attracted to Mayo tend to be self-selected to this culture of getting along to serve patients.

Team is everything. Integrated, team-based care is the hallmark of the Mayo delivery model. If your doctor can’t figure out the problem, he or she will bring in colleagues to help, and there is no shame in drawing on others’ expertise. While this is how medicine is supposed to work, it doesn’t always turn out that way in many large, internally competitive, clinical settings that operate more like Survivor.

No empire building. Unlike many big, prestigious academic medical centers, there is remarkably little sense of departmental empire building at Mayo. Partly this is reinforced by the fact that important physician leadership roles (such as chairman of the board of trustees of the Mayo Clinic at Rochester) are for four-year terms, and while in some cases an exceptional incumbent may serve two terms, it is anticipated that they will return to full-time clinical practice or some other combination of duties after their leadership service concludes. (In the interests of full disclosure, my wife’s first cousin, Dr. Hugh C. Smith, a distinguished cardiologist, recently concluded two such terms as Rochester Clinic board chair and has now returned to a combination of clinical practice and development work on behalf of the clinic. So if my column seems uncharacteristically positive, you skeptics might attribute it to family-oriented bias.)

No expansion beyond two satellites. While Mayo has successful satellites in Arizona and Florida, it seems they have settled on the formula that they don’t have to be everywhere in America to serve patients. Indeed, by focusing locally they can sustain and enhance the model without having the values and vision corrupted by the pressures of competition in a whole bunch of different geographic markets with very different medical mind-sets.

Leading health and health care. Mayo has been a pioneer in public education on health and wellness; they play a key role in health promotion nationally; and it is no accident that Olmsted County, where Rochester is located, is among the healthiest in the nation. Thankfully, the Mayo Clinic is also committed to becoming more of a voice in the national health policy debate, as evidenced by the Mayo Clinic CEO, Dr. Denny Cortes, leading a National Health Policy Summit at Mayo Clinic earlier this year. We need their help.

We all deserve the Mayo Clinic. We all need truly integrated care, where the patient is put first; where the care is done right the first time; where the payer pays for value and outcomes, not low-cost units of service; and where staff are proud and happy to work, on behalf of patients. If that doesn’t sound like the frenetic zoo where you work, or where you get health care, then maybe you should get your care with Mayo.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. He is also a regular contributor to H&HN OnLine. This article 1st appeared on January 2, 2007 in HHN Magazine online site.