By Leonard Berry and Kent Seltman
According to President Barack Obama, the Mayo and Cleveland clinics represent models for meeting the three main goals of the ongoing healthcare reform debate:
- Insurance for the uninsured;
- Improved quality;
- Reduced cost.
“We should learn from their successes and promote the best practices, not the most expensive ones,” the president said, after reading Dr. Atul Gawande’s New Yorker article, which laid out the details:
“Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country — $6,688 per enrollee in 2006.”
Two pivotal lessons from our recent in-depth study of Mayo Clinic demonstrate cost efficiency and clinical effectiveness.
Patient-first medicine. Throughout its 140-year history, Mayo Clinic has never put money first, instead living its primary value: The needs of the patient come first.
Mayo doctors (indeed, all employees) are on salary. No doctor earns more by ordering an extra test or procedure. No doctor earns less by referring a patient to another Mayo physician with more expertise.
Core values guide organizational behavior and Mayo Clinic’s patient-first core value guides its more than 43,000 employees. For example, the head of transfusion medicine noticed a day-shift technician working at 2:00 a.m. as he dealt with an emergency. The technician explained that she was redoing a test to correct an earlier mistake.
“Why not repeat it the next day?” she was asked. She replied, “I can’t have patients at Mayo Clinic waiting an extra day in the hospital because I fouled up a test.”
Dr. Robert Waller, who retired as Mayo Clinic CEO in 1999, remembers a conversation with a cardiologist whose patient needed a pacemaker.
Option A was a Medicare-approved model requiring relatively involved surgery and several days of postoperative hospitalization. Option B was a new model that could be implanted more simply with only one day of hospitalization. Option B was not yet Medicare-approved and meant no reimbursement for Mayo.
“This was a no-brainer,” Dr. Waller recalls. “Use the pacemaker that is best for the patient.”
Healthcare is a sacred service. Patients’ quality of life — and often their lives themselves — are at stake. The needs of the patient must be at the center of healthcare reform. This will require, among other steps, revamping doctors’ compensation to encourage efficient and effective care that truly serves patients. Until we pay doctors for better care, rather than for more care, we cannot successfully reform healthcare.
Team medicine. Mayo Clinic does not have a monopoly on highly capable doctors and nurses, but it has a competitive advantage because its highly capable clinicians pool their knowledge. When clinicians truly work together the result is more efficiency, less duplication of effort and a greater likelihood of correctly diagnosing and effectively treating a patient earlier in the process.
Medical care in America is highly fragmented, impeding both efficiency and effectiveness. Patients with multiple or complex illnesses are often treated by physicians from different practices who may not communicate with one another. Not so at Mayo Clinic, which functions as a medical department store, with staff experts for each medical specialty. Working in an organizational culture that demands teamwork and using such tools as electronic medical records and a sophisticated communication system, Mayo clinicians collaborate to provide the specific expertise needed by the individual patient.
Consider the case of “Don,” who endured an undiagnosed tumor on the base of his tongue for two years. Both his dentist and an ear, nose and throat physician told him the discomfort in his mouth was not clinically significant. When another ENT doctor diagnosed cancer and recommended immediate surgery (which would have ended Don’s ability to speak), he contacted Mayo Clinic. Two weeks later he met his Mayo team of three physicians (ENT, medical oncology and radiation oncology specialists). The team dismissed surgery and recommended radiation and chemotherapy instead.
Today, five years after Don’s initial diagnosis, he is cancer-free and living a normal life. He still sees his team of physicians at twice-yearly check-ups. Don’s story illustrates Mayo Clinic at its best.
Teamwork is vital to improving medical efficiency and effectiveness. Healthcare reform must include bold investments to encourage and enable it. Encouraging medical practices, financially and otherwise, to coordinate a patient’s care over time (called “patient-centered medical homes”) should be in the healthcare reform blueprint. So should the transformation from proprietary paper medical records to universal electronic records available as needed by treating clinicians.
Few organizations survive for more than 100 years, much less thrive as Mayo Clinic has. It’s not perfect. Its integrated, multi-specialty medical model works wonderfully — most of the time. Stories like Don’s happen every day at Mayo, but the clinic cannot help every patient. Nor is it the only medical institution that merits consideration in healthcare reform discussions.
But the way Mayo conducts its business, governs itself and sustains its focus on the core values of patient-first needs and collaborative medicine is deeply instructive. Never have such lessons been more important to our nation’s healthcare system.
Leonard Berry and Kent Seltman are authors of “Management Lessons from Mayo Clinic,” (McGraw Hill, 2008). Berry holds the M.B. Zale Chair in Retailing and Marketing Leadership in the Mays Business School, Texas A&M University. Seltman retired from Mayo Clinic in 2008 after serving as director of marketing from 1992 through 2006.