MANAGEMENT LESSONS FROM THE MAYO CLINIC


Mayo Clinic Model of Care 

Patient Care

  • Collegial, cooperative, staff teamwork with multispecialty integration.
  • A team of specialists is available and appropriately used.
  • An unhurried exam and time to listen to the patient.
  • A physician takes personal responsibility for directing patient care over time in a partnership with the local physician
  • Highest quality patient care provided with compassion and trust.
  • Respect for the patient, family and the patient’s local physician.
  • Comprehensive evaluation with timely, efficient assessment and treatment.
  • Availability of the most advanced, innovative diagnostic and therapeutic technologies and techniques.

The Mayo Environment

  • Highest quality staff, mentored in the culture of Mayo and valued for their contributions.
  • Valued professional allied health staff with a strong work ethic, special expertise, and devotion to Mayo.
  • A scholarly environment of research and education.
  • Physician leadership
  • Integrated medical record with common support services for all outpatients and inpatients.
  • Professional compensation that allows a focus on quality not quantity.
  • Unique professional dress, decorum and facilities.

The clinic has patient‐centric aspects in their scheduling system. Most importantly, it provides the physicians an opportunity to spend as much time as needed with each patient, a critical Mayo commitment.

The architectural intent has been to create a sense of substance that justifies patient confidence. “Patients immediately need to feel that they made a good choice in coming to Mayo Clinic.”

Further encouraging collaboration is an all‐salary compensation system with no incentive payments based on the number of patients seen or procedures performed. A Mayo physician has no economic reason to hold onto patients rather than referring them to colleagues. Nor does taking time to assist a
colleague result in lost personal income.

Dr. Trasek, CEO of Mayo, AZ, continually reinforces the principle of “teach don’t blame.” When something goes wrong, when a mistake occurs, it should be viewed as a teachable moment, an opportunity to get better.

Mayo Clinic and its patients benefit from a high level of volunteerism from the staff. Extra effort for the patients and the team is embedded in the essence of the culture. Most Mayo employees volunteer hard. “Mutual respect is important here,” asserts Bridget Jablonski, a nurse team leader for oncology. “ There is an expectation that you treat everyone with respect whether it’s your patient or colleague, physicians, housekeepers., everyone. You incorporate them as a member of the team. None of us could do our job without the contributions of others.”

Mayo Clinic’s two primary values‐“the needs of the patient come first” and “medicine should be practiced as a cooperative science” reign over all others.

After hearing comments about the unexpected efficiency of Mayo in patient focus groups, their marketing efforts added a question about efficiency in their patient satisfaction surveys. The results show that systems and processes that efficiently control the flow of the patient experience are as
important as the care provided to patients’ overall satisfaction.

Nothing is more important than finding the right individuals to lead, whether physicians or administrators. It is not enough to rely on the gifts of emerging leaders. “ The nurturing of physician leaders is extremely important.”

None of the Mayo four facilities has the traditional “hospital administration “ found in most hospitals. Rather, Mayo hospitals operate largely through a physician‐led hospital practice committee on each campus. The key members are the physician chair, the nursing chair and a designated hospital administrator. They serve as a triumvirate for day to day decisions within the hospital.

The Mayo management model uses many thousands of hours of the precious resource physician time. They have up to 80 committees to deal with issues across campuses. Much of the administrative work is accomplished through committees and task forces.

Mayo Clinic’s salary system is deeply rooted in the culture and the values that created this unique organization. The Mayo brothers were committed to paying all employees fairly and generously though not lavishly. Dr. William Mayo believed that the salaried physician was a crucial element in their practice model. It doesn’t matter whom they see, how long they spend, what they see, they just have do the best they can for the patient here.

Newly employed doctors earn a salary that will, with annual increases, max out in five years. Physicians earn more vacation time and academic rank but top off in income quickly. Financial incentives have not been necessary to motivate physicians who embrace the values and mission.

They evaluated their compensation system and concluded that a productivity‐based compensation system would not necessarily increase productivity significantly among physicians and, more importantly, could irreparably damage their culture. To sustain high productivity, the major management objective is “to foster an environment of unity and trust.”

The shared management structure at Mayo works well. “ The physicians have as much at stake as administrators do to ensure that the institution profits financially. Administrators have as much at stake as the physicians do to ensure that patients are well cared for.

Mayo thrives because a benevolent employer fosters a generous, giving spirit in its workforce. Those who need to bask in the starlight of personal recognition or wealth thrive elsewhere.

Most management decisions at Mayo are made by groups, not by individuals. The CEO is the spokesperson for the decisions.

The Mayo has continually nurtured the next generation of leaders who believe in its values. The term limits associated with most leadership ensures the rotation throughout the organization.

High performing organizations do deliberate hiring. They take the time necessary to find just the right employee. “ Mayo is not an easy place to get hired.” They have so many steps, so many people involved in screening and interviewing, even at entry‐level jobs. The people who survive really want to work there.

Panel interviews are standard across the organization. A panel may ask, “ Tell me about a time you had to disagree with your boss to make a mistake from being made.”

Candidates may be asked to describe a past project. Whether candidates use the word “I” or the word “we” is of particular interest to the panel.

Mayo focuses on values over skills. Skills can be trained and values cannot.

Mayo invests significantly in in‐service training. Many are a single session with several hours of education; others might extend over a few days.

They invest in their employees. In most cases, Mayo helps the employees who are failing or under performing find a niche that better fits who they are and the capabilities they offer.

Patients do not encounter physicians in casual attire . Unless they are in surgical scrubs. Mayo physicians wear business attire at work. “ The wearing of business attire rather than white coats is recognized by our patients as a unique dress code that projects an aura of expertise and respect for patients accompanied by warmth and friendliness.”

Mayo nurses wear white because research shows that is what hospital patients prefer. They require solid colored scrubs as well. Each unit needs to come to a consensus for the color from a list of approved colors.

No marketing textbooks or marketing consultants guided the founding of the brand. Mayo had a one person marketing staff from 1986‐1992. To this day, it uses little media advertising to promote clinical care.

The two primary sources of external brand communications are word‐of‐mouth –often conveyed via the Internet‐ and publicity, including reports in the news media.

Mayo Clinic is a benevolent employer. Because, Mayo Clinic takes good care of its employees, the employees are more likely to take good care of those they serve.

Mayo Clinic leads all other U.S. providers when you look at objective measures of outcomes, safety, service, preventable death, mortality rates adjusted to account for preexisting medical problems and health status, and adverse event with harm to the patients. The catalyst to change is transparency‐ there is open sharing of performance measures of the clinical groups.

Money matters at Mayo. The difference between Mayo and other organizations is that money doesn’t drive the bus. Mission does, and this is a key reason the Clinic can attract good staff members who do such good work.

The physician perspective wins out when there is a tie vote on decisions. Administrators are partners, but they are not equal partners, and this is purposeful.

Mayo is intolerant of prima donnas regardless of whether they are administrators, nurses, doctors or anyone else. You may find a few here and there, but they rarely hire these kind of people, and if they do, they don’t last long.