CHAPTER ONE

An Experience of Civility

I first came to Mayo Clinic in the summer of 2001 because I was wheezing doing a Prairie Home Companion show, getting on and off stage, because, as it turned out, I had sprung a leak in a mitral valve. So I came to Mayo, and it took the internist about five minutes to make the diagnosis, and the choice was fairly simple … uh, either Dr. Orsulak will operate and sew up your mitral valve, or else you will sit in a sunny corner of your kitchen and wait for God to harvest his flowers.

Right off, you may recognize the storyteller. It’s none other than Garrison Keillor, host of Minnesota Public Radio’s well-known show heard weekly for some 40 years on most National Public Radio affiliates. At the 2012 Mayo Clinic Center for Innovation TRANSFORM symposium, Keillor got a chance to tell us about his Mayo Clinic experiences. Pretty amazing stories these turned out to be, especially since the half-hour keynote was completely unscripted and unrehearsed. Experiences—memorable experiences these were—from the mind and from the heart. Let’s listen in:

The operation turned out well. … Besides repairing the mitral valve, it also gave me an experience. … It gave me a crucial experience … in the kindness of extremely competent people. You were brought into the operating room, you were naked, you’ve been shaved in embarrassing ways. You were wrapped in a sheet. You were lifted off the gurney onto this glass and steel table in this dim, very chilly room, strange lights, and masked people. … It’s out of a science fiction movie. You’re laid down there, and they adjust you, and in this unreal world, to have a human being touch you with some feeling … just put a hand on your bare shoulder … means the world, means that we are people. … You are a person, I am a person, and you recognize that I am. Someone asks you how you are doing and means it. … It means the world to you. The humanity … the humanity … and kindness … the way in which things are done. … And then you disappear into the fog … and the fog breaks hours later, and you find yourself in a recovery room, and these angelic beings appear out of the mist … and they speak with Minnesota accents … and they remove this 12-inch drainage pipe from your mouth, and they tell you that you’re alive … and you are grateful for that … and 11 years later, I still am.

This is an amazing experience for an adult person to have … to experience competence and kindness … all wrapped up in one piece. … It’s what I love about Mayo Clinic. … It has international expertise and small town manners in my own experience with the place.

When I came down to Mayo for my prostate biopsy, what those two men did for me (aside from telling me I don’t have prostate cancer) … I’ll never forget. It’s an embarrassing thing. It’s uncomfortable. As the doctor’s assistant said, it’s like having nine hornets up your butt …

But they went at it like a Vaudeville team, like an old time comedy team … the Russian urologist and his assistant … and … the jokes were almost funny … and the conversation and the bi-play. … And now we’ve got four more, and now we’ve got three more, and now two, and one, and now you’re done. And when you were done, you shook hands with them, and you said thank you, and you meant it. Aside from its medical value, this was such an experience of civility.

An experience of civility.

There’s a lot of meaning wrapped up in that phrase. And also in the phrase “international expertise with small town manners.” And, continuing, “to have a human being touch you with some feeling, … to put a hand on your bare shoulder.” And “great competence put at your service by people who recognize your humanity.”

You get the main idea. There’s something pretty special here. Excellence not just in health care but also in the health care experience. Excellence in an experience beyond the medical outcome, excellence that draws patients from around the world to Mayo, and has done so for 150 years.

So just what is Mayo Clinic? If you’re like most Americans and many around the world, you recognize the name and the brand, and you likely associate it with world-class medical care for some of the most challenging illnesses we might confront in our lives. But as you learned in the Introduction, our book isn’t just about health care, and it isn’t about the status quo. It’s about how to innovate in a complex environment. We use the way Mayo Clinic delivers health care today, and how that delivery will be transformed in the future, as a guiding example. The roots of the Mayo legacy—how our organization earned its renown, and how it goes about improving and achieving excellence every single time a patient comes in contact with Mayo, anytime and anywhere in the world—make up a key part of our story.

How did Mayo Clinic come to be such an “experience in civility”? As with any great organization, particularly a successful one like Mayo, its roots define its culture, and its culture defines its achievements. So a sketch, a glimpse, a short movie about just what Mayo Clinic is, its history, its culture, its values, its ethos, and how it all came to be a setting for today’s and tomorrow’s transformative innovation in health and health care—this is a logical place to start.

“The Care Begins When You Arrive at the Door”

 

You walk down Third Avenue SW in Rochester, Minnesota, and look around. It’s a notably clean and traditional-looking town of about 110,000 residents approximately 90 minutes south of the Twin Cities of Minneapolis and St. Paul. Tallish buildings and parking garages surround you. People are looking for parking spaces, people are walking around the streets, and people are being pushed in wheelchairs. You stare straight ahead at the Gonda Building, the 20-story world headquarters, the integrated practice centerpiece of Mayo Clinic (Figure 1.1).

FIGURE 1.1. MAYO CLINIC GONDA BUILDING

You’re curious, and you walk inside. You see more people in wheelchairs, many being assisted by family members. You see the concerned looks on their faces. About a thousand patients come through these doors every day.

It’s a beautiful lobby with a pleasing, contemporary, tasteful design, like a fine hotel. All designed by world-renowned architect Cesar Pelli, who gave us the title quote for this section, and by Ellerbe Becket. It was funded in a large part by the family of Leslie Gonda, an American entrepreneur and Holocaust survivor. The lobby is adorned with a massive glass sculpture by Pacific Northwest artist Dale Chihuly—a sculpture beautiful in its own right but also indicative of the sorts of gifts given regularly to Mayo by grateful patients.

You walk through this attractive and calming space. And what’s that you hear? Piano music accompanying a small choir. Nice. You go out the back entrance—east—toward Second Avenue SW. There’s a small town square known as the Peace Plaza with attractive shops and—today—a street festival with fancy crafts, great food, and tasteful live music thanks to a collaboration known as Destination Medical Center, an economic development cooperative with Mayo Clinic, the city of Rochester, the state of Minnesota, and other partners. There are stately older buildings that were designed with great purpose in mind in the 1920s, on both sides of the square. We’ll return to those buildings shortly. The modern 18-story Mayo Building is attached to Gonda to the south. Mayo Clinic Hospital, Methodist campus flanks it to the north.

You see a young couple in an embrace—an embrace of all-out love and passion. She is standing gingerly on a leg prosthesis, with eyes closed, and is smiling intently as they hug. She is one of the thousands who come every year to Mayo Clinic for a definitive answer. She comes with the hope of receiving medical care that might save her life and salvage her connection with her loved ones. To think about what they have to deal with brings tears, even to the eyes of a stranger. But it’s perfectly clear that Mayo Clinic, the city of Rochester, and countless others are pulling out all the stops to make their visit as comforting, pleasant, and, really, joyful as possible—for that couple and any loved ones who might be with them.

It’s an experience in civility, and it happens every day.

Mayo Clinic: The Snapshot

 

Mayo Clinic is the first and largest integrated, not-for-profit medical group practice in the world. Today’s Mayo Clinic employs more than 4,000 physicians and medical scientists and 54,000 allied health staff.

Mayo Clinic is headquartered in Rochester, with additional full service facilities in Arizona and Florida. Mayo Clinic also operates a Mayo Clinic Health System network of about 70 hospitals and clinics across Minnesota, Wisconsin, and Iowa. More than three-quarters of the employees are located in Rochester and the surrounding health system, and the remainder are in Arizona and Florida. There are also about 3,400 students and residents associated with the Mayo Medical School, the Mayo Graduate School, and the Mayo School of Graduate Medical Education, which fulfill the education mission of Mayo Clinic.

Beyond these Mayo-owned facilities, a new Mayo Clinic Care Network has been formed that offers health care systems the benefits of Mayo Clinic knowledge and expertise without having to travel to a Mayo Clinic facility. Mayo Clinic provides these like-minded organizations care delivery offerings and information-sharing tools through a partnership agreement. The network recognizes that people prefer to get their health care as close to home as possible, and it serves to extend and expand the Mayo brand beyond the traditional Mayo geography and bricks-and-mortar facilities. Currently there are 29 such organizations in the network across the United States and beyond. The Mayo Clinic Care Network will most assuredly expand as the health care industry wrestles with accountable care, affordability, and access.

Mayo Clinic treats more than 1 million unique patients each year. The vast majority, 85 percent, are treated on an outpatient basis, many staying in Rochester, Scottsdale, or Jacksonville for days or weeks of successive outpatient treatments. They take up residence at one of the many local hotels that offer special accommodations and weekly rates for patients and their families. Shuttle services ply the streets continuously between these accommodations, the outpatient center, and the two affiliated hospitals.

The physical presence of Mayo Clinic in Rochester is impressive, with a complex of downtown-style city buildings occupying several city blocks. In Rochester, Mayo Clinic occupies 30 buildings in all and some 15 million square feet, about 3.5 times the size of the gigantic Mall of America just south of the nearby Twin Cities.

Today’s Mayo Clinic operates primarily as a “destination” medical center, gathering in patients from across the United States and 150 countries across the globe for highly specialized treatments for a wide assortment of diseases. Increasingly, Mayo has broadened its footprint by expanding into more local and regional geographies, and as we’ll see, it is also reaching out in a big way through innovations and technologies that allow remote patient visits with diagnosis, treatment, and monitoring. Mayo has also moved squarely into health and wellness, embracing a holistic shift from just sickness or health care to helping people optimize their well-being over their lifespan—the difference between “health” and “health care” as noted in the Introduction. Increasingly, Mayo physicians collaborate with local physicians and staff to deliver health and health care, both in Mayo locations and, through partnerships, to non-Mayo locations. In this way, the Mayo brand is gradually growing beyond the idea of destination medicine.

Much goes on at Mayo Clinic beyond the medical practice itself. However, to quote John Noseworthy, M.D., Mayo Clinic president and CEO, “the practice is the main thing.” The three shields of Mayo, which have existed from the beginning, are Patient Care, Research, and Education (Figure 1.2).

FIGURE 1.2. THREE SHIELDS OF MAYO: PATIENT CARE, RESEARCH, AND EDUCATION

In addition to the patient care and education shields already described, Mayo Clinic under its research shield conducts extensive studies in clinical care, including new diagnostics, medications, devices, tools, and procedures. Almost 9,000 active research studies were conducted in 2012 by about 3,300 research-dedicated personnel on a budget of $633 million resulting in 4,000 publications. This does not include the patient experience research and innovation conducted by the Mayo Clinic Center for Innovation, the central subject of this book.

Interestingly, Mayo Clinic physicians are paid a fixed salary that is not linked to patient volume or income from fee-for-service payments. This model was put in place to ensure that the needs of the patient would always come first and to minimize any financial motivation to see patients in large numbers or perform unnecessary procedures. It adds an incentive to spend more quality time with individuals, as well as to devote more time to collaborate with other personnel for patient care and, importantly, for innovation.

Mayo Clinic: The History and the Heritage

 

As big and impressive as Mayo Clinic is today, both as a facility and as a brand, it is just as instructive to look at Mayo Clinic’s past. In that story we can find many historical and cultural clues descending directly from its founders to form its values, which have shaped today’s approach to medicine. That past has also shaped today’s approach to innovation and the patient experience.

Early Beginnings, and a Twister of Fate

It all started rather inconspicuously with the birth of William Worrall Mayo in northern England in 1819 to an English family of Flemish descent. As with many successful innovators, his parents, who were of modest means, insisted on a good education. Among other things, this led to private tutorage from none other than chemist John Dalton, considered a father of modern chemistry and physical science and one of the first to scientifically describe atoms and the periodic table. William Worrall Mayo’s passion for science was set for life by his exposure to Dalton. Not a bad place to begin.

Mayo immigrated to the United States in 1846 at age 27. And like many other immigrants, he migrated westward seeking opportunity where it could be found, gaining experience in many trades including pharmacy, tailoring, farming, publishing, and ultimately, medicine. He enrolled at the Indiana Medical College in La Porte, Indiana, and he graduated in 1850. He set up to practice medicine and pursue medical knowledge with a microscope, one of the first to do so in a medical practice. He kept detailed clinical notes, and he was known for the persistent comment, “Left open for further thought and research,” that accompanied many of his observations. For Dr. Mayo, status quo didn’t cut it.

In 1851 he married Louise Abigail Wright, who would become his devoted spouse and medical companion for the next 60 years.

As a consequence of malaria and related fevers, common at this time, he went west by riverboat to the fresher climes of Minnesota, and he settled there and started practicing medicine. Louise eventually followed.

When the Civil War broke out, he applied to become an army surgeon for a Minnesota regiment, but for reasons unknown, his application was denied. In hindsight, that was fortuitous, for shortly thereafter he landed a position as the examining surgeon supporting federal troops involved in the nearby Indian wars, still quite active at the time. The headquarters of the conscription board was in Rochester.

New job in hand, Dr. Mayo (“Worrall,” or “W.W.,” as he is fondly called by Mayo employees) and Louise settled down in 1864 and had four children—two girls and two boys. And not surprisingly, Dr. Mayo took his two sons, William (“Will”) and Charles (“Charlie”), under his wing to teach them science at a very early age. They went on his rounds, helped in the office, sometimes even with surgery, and read a lot of good books like Gray’s Anatomy and Paget’s Lectures on Surgical Pathology. There was lots of encouragement from Mom too. Many years later Charlie described her as “a real good doctor herself.”

And not surprisingly, both boys went to medical school—William to the University of Michigan, Charlie to Northwestern University. Both graduated in the 1880s.

Meanwhile, on a hot August afternoon in 1883, a massive tornado leveled a good part of Rochester, killing 24 and seriously injuring 40. Dr. W. W. Mayo, his sons, who were home for the summer, and other volunteers set up a makeshift hospital. Needing more help, Dr. Mayo called on Mother Alfred Moes and her Sisters of St. Francis, who were teachers, not nurses, to assist in round-the-clock patient care.

A partnership was formed, and eventually from it a new permanent hospital, Saint Marys, opened in 1887, now called Mayo Clinic Hospital Rochester, Saint Marys campus. It has been in operation ever since. It is one of the earliest examples of collaboration between doctors and administrative staff on the design and operation of a medical facility.

The two boys formally joined the practice in 1889. By now all three Mayos were gaining a reputation for surgical accomplishments at Saint Marys.

My Brother and I

In the late 1800s, the practice of medicine was still in its early stages. Most medical practices were simple storefronts staffed by an individual physician with varying degrees of professional training. That physician learned and delivered all forms of medicine. There were no “specialists” to call on. Physicians learned by reading, by doing, and by watching each other perform. The age of science-based, research-based medicine was just at its beginnings.

The Mayo brothers and their father continued to practice together, an unusual construct in those days. They traveled extensively, in the United States and abroad, to acquire new knowledge. They shared their observations and knowledge, and they were dedicated to a “team” approach to delivering better patient care and, in so doing, advancing medical science. Soon, other doctors started arriving from long distances to observe their practice—and patients began coming from afar as well.

The teamwork became a guiding mantra. As Dr. W. W. Mayo put it: “No one is big enough to be independent of others.” They shared medical knowledge, took interest in each other’s professional growth, and even shared a bank account. In later years, Drs. Will and Charlie would simply refer to themselves collectively as “my brother and I” when giving talks, accepting awards, or discussing matters with a patient.

Teamwork—mutual respect and the sharing of diverse skills for a common good—is the essence of Mayo Clinic. Biographer Helen Clapesattle later called it a “spirit of cooperative individualism.”

The Needs of the Patient Come First

The Mayo founders believed that the combined wisdom of one’s peers is greater than that of any one person. They went out of their way to be inclusive, way before “crowdsourcing” became a popular term. An integrated team of compassionate, multidisciplinary physicians, scientists, and allied health professionals who are focused on the needs of patients is a core principle and value of today’s Mayo Clinic. At the time the clinic was founded, however, it was a revolutionary idea and way to practice medicine.

Dr. William Mayo put it quite clearly in a 1910 commencement address:

As we grow in learning, we more justly appreciate our dependence upon each other. The sum-total of medical knowledge is now so great and wide-spreading that it would be futile for one man to attempt to acquire, or for any one man to assume that he has, even a good working knowledge of any large part of the whole. The very necessities of the case are driving practitioners into cooperation. The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary.

In these words you can clearly identify the teamwork approach. But another guiding light shone down from this address, to become the core philosophy and value of Mayo Clinic: “The best interest of the patient is the only interest to be considered.”

Over the years, the wording has been consolidated into Mayo Clinic’s primary value, heard daily from any employee across the organization: “The needs of the patient come first.”

Practice Makes Perfect: The Integrated Practice Comes Together

 

The practice grew. In the early 1890s Drs. Will and Charlie began inviting more partners to provide services to complement their own surgical practice. In 1892, Dr. Augustus Stinchfield, a well-known Minnesota practitioner, joined the Mayos as their first partner. At about that time, Dr. W. W. Mayo, now 73, retired. Two years later, Dr. Christopher Graham, a brother-in-law and recent medical graduate, joined the growing practice as the second partner. By 1908, eight more professionals—four physicians, a medical illustrator, a professional administrator, a medical librarian, and a secretary—had joined the practice.

The Mayo brothers were building a true interdisciplinary team, recognizing the value of nonphysicians as core members of the team, on equal footing to physicians. We will come back to this point in Chapter 3, when we describe the approach taken in building the Center for Innovation. In 1894, the brothers made a decision to dedicate half their income in perpetuity in the “service of humanity” to what ultimately became the Mayo Foundation. “We try to take up the medical surgical education of selected and promising men where the state leaves off. My interest and my brother’s interest is in the service of humanity. … If I can train 50 or 500 pairs of hands, I have helped hand the torch.”

Dr. W. W. Mayo passed away in 1911, and by then, the practice had continued to grow both in size and in reputation. The Mayo “Red” Building was built in 1914 to house it, adjacent to what is now the Peace Plaza. It was subsequently torn down in 1989 to make room for the Harold W. Siebens Medical Education Building. As with many other Mayo buildings, many important artifacts from the original site were preserved.

In 1919, the original founders decided to convert the Mayo practice to a not-for-profit entity dedicated not only to medical practice but also to research and education. That entity came to be known as Mayo Clinic. And with that, the foundation was laid not only for Mayo’s reputation for excellence but also for it to be an innovation-focused enterprise that would be driven to advance the science and the delivery of health care. That enterprise was integrated and staffed by professionals of broad disciplines and skills, a theme we will see again and again as we explore the mission and approach of the Center for Innovation.

Early Innovations and the Birth of the Modern Medical Practice

 

All eight new partners to join the Mayo practice between 1892 and 1908 made notable contributions to research and diagnostics, as well as to the administration of a collaborative, patient-oriented practice. The Mayo brothers were primarily surgeons, but they could see that these other areas were also important. Two of these new partners deserve special mention in Mayo’s journey to become—and really, define—the modern medical practice: Dr. Henry Plummer and Harry Harwick.

Dr. Henry Plummer

Dr. Henry Stanley Plummer became a full practice partner in 1901, and he was a primary driver of Mayo Clinic’s early success. He designed many of the systems that are now used universally around the world today, such as a shared, individual dossier-style medical record and an interconnecting telephone system.

Up until that time, medical records were kept by the physician for that physician’s own personal use; they were not shared among physicians, nor was there any kind of common format. Medical records were physician centered, not patient centered, until this new innovation appeared.

Dr. Plummer was also the first to adopt, understand, and use an X-ray machine in the practice, then a new technology. He created new diagnostic procedures, and he devised new ways for physicians and other personnel to interact and to share medical information. He was the first to truly incorporate medical specialization into what became known as the integrated group practice.

Later, he was the chief design collaborator with architect Franklin Ellerbe in the design of a then-modern medical building that would eventually become known as the Plummer Building. The Plummer Building, a Gothic-inspired structure that would look quite at home on Manhattan’s Fifth Avenue, was completed in 1927. At the time the tallest building in the state, it has been preserved largely as a museum and monument to the early Mayo practice, innovation, and culture. It is one of the two stately older buildings found just east of the Gonda Building on Second Avenue (the other is the Kahler Grand Hotel, an elegant grand lady completed in 1921 and surviving to this day mainly for the convenience of Mayo patients). The Plummer Building is topped by a distinctive tower that contains a 56-bell carillon dedicated, as Dr. Will said, “to the American soldier, in grateful memory of heroic actions on land and sea to which America owes her liberty, peace, and prosperity.” Music is played from it several times a week, which can be heard throughout downtown.

Primarily for his creation of the modern medical record and his collaboration on the design of the model collaborative medical practice facility, Dr. Plummer is widely held by today’s physicians to be the architect of the modern medical practice. He was an innovator before the term came into common use, and he established the pattern for much that was yet to come in today’s Mayo Clinic and its Center for Innovation.

Harry Harwick

From the first days after his 21st birthday in 1908 to his retirement as chief executive officer of the Mayo board in 1952, Harry Harwick was dedicated to developing the administrative foundation of the Mayo Clinic practice. He and Dr. William Mayo conceived the idea of the not-for-profit Mayo Clinic years before it was formed. Like everything else, from specialized medicine to medical records to X-rays, dedicated administration was a new thing to modern American medical practice. Harwick introduced new accounting systems, and he generally worked “to free the physician from the daily burdens of business affairs.” These efforts were modeled in a wide variety of professions beyond medicine, and they became a model for integrating sound business methods with professional practice. Again, this became an important part of Mayo’s DNA.

The 150-Year-Old Brand: Growing into Today’s Mayo Clinic

 

The deaths of brothers Drs. William and Charlie Mayo occurred within two months of each other in 1939. But Mayo Clinic continued to flourish through the years because by then, the rich heritage and core values were already well established in the organization. The size, reputation, brand image, and quest for innovation have continued to grow through the present.

A Growing List of Innovations

Starting in the early days of Dr. W. W. Mayo’s quest for new and better ideas back in the 1850s, Mayo Clinic has become recognized for a long list of innovations shaping clinical medicine and medical practice. Some of the leading-edge medical practice innovations, like common medical records, have already been noted, and they have been developed further since. Among the thousands of other innovations since the early days, the more recognizable ones include these:

            1905: First method of freezing tissue during surgery as a means of diagnosing cancer

            1915: First program in graduate medical education

            1919: First not-for-profit practice aligned with medical education and research

            1920: First index to grade tumors

            1935: First hospital-based blood bank

            1940s: First aero-medical unit to transform aviation

            1950: Nobel Prize for discovery of cortisone

            1955: First series of operations with heart-lung bypass machine

            1969: First FDA-approved hip joint replacement

            1973: First CT scanner in North America

            2001: In response to the September 11 terrorist attacks, development of a rapid diagnosis procedure to detect anthrax poisoning

            2002: First multisite comprehensive cancer center in the United States

Mayo Clinic’s 150-year history is beautifully shared in this short film, which is narrated by Tom Brokaw, noted journalist and member of the Mayo Clinic Board of Trustees: http://www.youtube.com/watch?v=3w6z7IbeJj4.

The Footprint Expands

Through the 1980s and 1990s, Mayo Clinic took the idea of “healing body, mind, and spirit” on the road through an expansion campaign. The following facilities were built or integrated during this period:

        Saint Marys and Rochester Methodist Hospitals—1986. The first step was right at home in Rochester. These two hospitals had operated for a long time under a close partnership. In 1986 they were formally absorbed into the Mayo Foundation and Mayo system. They now operate as one with their outpatient facilities and clinical staff, and in 2014 they were respectively renamed as Mayo Clinic Hospital, Saint Marys and Methodist campuses to highlight their integration.

        Mayo Clinic Jacksonville—1986. A new facility was built in 1986 on 140 acres of Florida woodlands. Today there are five buildings used by over 90,000 patients annually.

        Mayo Clinic Scottsdale—1987. A second new practice was established in this Phoenix suburb. Today it hosts 100,000 patients a year, and it is tied to two new research facilities and a second Mayo campus in Phoenix.

        Mayo Clinic Health System local clinics—1992. Mayo Clinic expanded beyond its traditional destination medical center role by buying or building a network of 70 smaller clinics and hospitals, which are located mainly in the upper Midwest.

        Gonda Building—2001. Built as a state-of-the-art facility, the Gonda Building taken together with the interconnected Mayo and Charlton Buildings is the largest medical facility of its kind in the world. The impressive structure is designed for the kind of teamwork and collaborative practice Mayo specializes in, and it is home to the Mayo Clinic Center for Innovation.

The Spirit of the Clinic

 

In a 1919 address to the Mayo Alumni Association, Dr. William Mayo, ever the spokesman for the actions, visions, and values of Mayo Clinic, offered his views of what made Mayo Clinic successful:

In view of the large number of sick who come here to be cared for, it would be natural to attribute the cause of their coming to work well done, but since good work is being done everywhere, there must be another and deeper reason. Perhaps this other reason may be best summed up in one phrase, “the Spirit of the Clinic,” which incorporates the desire to aid those who are suffering, the desire to advance in medical education by research, by diligent observation, and by the application of knowledge gained from others, and, most important of all, the desire to pass on to others the scientific candle this spirit has lighted.

Later that same year, he articulated four conditions he felt were essential to the future of Mayo Clinic:

       1. Continuing pursuit of the ideal of service and not profit

       2. Continuing primary and sincere concern for the care and welfare of each individual patient

       3. Continuing interest by every member of the staff in the professional progress of every other member

       4. Continuing the advancement of the science and delivery of medicine

You can clearly appreciate these values in the early evolution of the clinic as well as in its activities and “vibe” today. But in 1978, Dr. Emmerson Ward, the chair of the Mayo Clinic Board of Governors, added another tenet that ultimately gave rise to the spirit of this book:

       5. A willingness to change in response to the changing needs of society

Later, in 1984, two more conditions were added by administrator Robert Roesler:

       6. Continuing effort toward excellence in everything that is done

       7. Continuing conduct of all affairs with absolute integrity

Focus on the customer (the patient), teamwork, service, integrity, excellence, and market-directed change—this captures the spirit of Mayo Clinic, and it describes a unique environment in which patient-centered, transformative innovation is a natural consequence.

Today’s Mayo Experience

 

Leonard Berry and Kent Seltman summed up what Mayo Clinic has become in their 2008 book Management Lessons from Mayo Clinic : it has evolved to become a “‘modern-traditional’ enterprise that aligns strategy with value, innovation with tradition, talent with teamwork, and science with art.”

If you talked to anyone at today’s Mayo Clinic, including the patients who have been under its care, you would probably hear the Mayo experience and its delivery summed up something like this:

Mayo physicians understand that medicine is far too complex for any one person to know; therefore, a collaborative, team approach works better. Care is overseen by a single physician team leader who manages the patient experience from start to finish—no handoffs, no delays, no confusion or miscommunication. That physician is paid on a salary and is guided by a commitment to the highest professional standards, so there is no incentive to see larger numbers of patients; quality supersedes quantity. On the other hand, modern systems and processes allow patients to have multiple medical evaluations and tests on the same day; it is often possible to have same or next day surgery or other procedures. Our destination facilities are designed for comfort and efficiency, to “heal body, mind and spirit”; that said, when possible, consultations, updates, and evaluations are done remotely. In short, the needs of the patient come first, but we also don’t forget about the families. It is a holistic experience consistently delivered with the utmost respect and compassion.

As Keillor’s keynote story suggested, it broadly qualifies as an “experience of civility.”

The Value of Deep Values

 

They’ve been in place for 150 years, but without doubt the basic values, structures, and systems put in place by the Mayo brothers, their father, and other early contributors are still highly relevant today. Customer focus, teamwork, service, integrity, excellence, and patient- and market-directed change are all still very much part of Mayo Clinic. Employees are loyal, hardworking, open to change, and driven by values, and they do what’s right when they see something that needs to be done.

The deep personal and universal commitment to the organization’s values appears consistently throughout Mayo Clinic; it is “woven into the fabric.” As former CEO Dr. Glenn Forbes put it: “If you’ve communicated a value but you haven’t driven it into the policy, into the decision making, into the allocation of resources, and ultimately into the culture of the organization, then it’s just words.” Put another way, core values are core values, not just training items.

When these values put the customer first and embrace collaboration and a “willingness to change,” you have the right ingredients for transformative innovation. You have the right “innovation DNA” as innovation guru, president, and cofounder of Doblin and director at Deloitte Consulting LLP Larry Keeley would put it.

Moving into the 21st Century

 

In the sidebar that follows are the Mayo principles that have collectively come to be known as the Mayo Model of Care. This set of articulated principles has been evolving since the end of the 19th century. As forces of the present and the future coalesce, it is more important than ever that Mayo transforms the model into a 21st century version. That is the overriding mission and vision of today’s Mayo Clinic, and it is the specific mission and task of the Mayo Clinic Center for Innovation.

For starters, in this century we must move beyond the long-standing “The care starts when you walk in the front door” model. That model has served us well, but the present and future demand more. The delivery model of the 21st century starts before the front door; it starts with the patients’ health and wellness. It starts before the front door in the patients’ interactions with their primary care providers and in their remote interactions with their community and their local care providers. It continues during the care event and, when needed, through the treatment of complex diseases. It continues after the care event to ensure healing and care plan progress.

“Health” and “health care” mean you’re always connected to help and care—always in health as well as in sickness. The “experience of civility” is continuous. It is continuously connected. It really is Connected Care. Mayo Clinic of the future will serve individual and family health and health care needs here, there, and everywhere, through both bricks-and-mortar and virtual delivery assets and protocols. All of this will become the Mayo model of care of the 21st century: “Health and health care, here, there, and everywhere, continuously connected.” This will happen, as we will describe in the next chapter, against a backdrop of change and as part of the new cost consciousness. As the Mayo Clinic Center for Innovation leads the way to define this model and turn it into reality, you can follow along to understand the challenges and how the Center for Innovation has risen to the task to define the pieces and put them together into the 21st century vision and model of care.

Finding Your Organization’s Innovative Spirit

 

Why did we share this sketch? How can you use this discussion to generate, stimulate, and steward transformative innovation in your organization?

Clearly, your organization isn’t the same as ours. You don’t have the same founders; you may not have the same issues that confront us in the health care industry. But regardless of your enterprise, regardless of your enterprise model, you probably do share the challenge of how to innovate in a complex environment. A visit to the “model of care” you deploy for your customers will likely nourish the mission and deployment of your innovation enterprise especially if viewed in the light of the Mayo Model of Care.

Innovation the Mayo Clinic Way: Developing Your Own Model of Care

 

The goal is not only to innovate but to innovate faster. The more aligned you are with your roots, your vision, and your culture—your own model of care, of the past and for the present and the future—the more likely it is that you will make progress:

        Find your cultural hooks. What was it about your history, your founding, your original products or services, and the delivery methods for those products or services that was unique and distinctive in your early days? What themes, slogans, or philosophies guided the early formation of your enterprise and your brand? “A car in every garage,” “Think different,” “We bring good things to life,” and “Better living through chemistry” are examples. What did your organization say about itself? What would it have said about itself in its early days? Can you capture the essence of your culture in a statement or short paragraph?

        Look for other historical clues. Slogans and visible marketing messages are useful, but you can also look back at unique and formative decisions that were made about your products, how they were positioned, and how they were delivered to customers. Mayo Clinic has always emphasized innovation, both on the clinical side and in the delivery of care. We invented the integrated destination medical practice, and we made the investments to make it more successful. Likewise, your organization made early choices about what it would be and how it would get there. The exercise here is to observe how those choices were made, what innovations were involved and how they came about, and how that formula might be applied today.

        What made your founders tick? Every organization has founders, and all founders had visions and methods for getting things done—methods that may have been watered down, changed, or evolved as the organization grew and matured. Going back to what those original founders thought and did—and why—is an important exercise. The Mayo founders’ footprints are quite clear in this regard, and they established a clear pattern for the future. What about yours?

        What makes your organization tick today? Just as your founders had a vision, how does your organization see itself today? What do you (or your leaders) really think drives success today? Innovative products? Lowest cost? Best customer relationships? At Mayo, we see ourselves driving a transformation in health care through the innovative optimization of the care experience—that’s what makes us tick.

        Apply these hooks and clues to your innovation effort. Your history, your vision, your guiding purpose, and your culture will drive the kinds of innovation you strive for, and they will help define how you will get there. Innovation that doesn’t support your vision, and that isn’t in turn supported by your culture, is indentiikely to succeed.