Stephen J Swensen: the Mayo Clinic model of care


Mayo Clinic is 150 years old, about the age
of the King’s Fund. Mayo Clinic is a $10 billion not-for-profit. We see over a million
unique patients from 152 different countries. We’re the first and largest Integrated Group
Practice in the world. We’re designed for short itineraries, for someone come in with
an undifferentiated problem, have the initial encounter where it’s 45 to 60 minutes with
a Physician. An unhurried visit is part of the Mayo Clinic model of care and then the
itinerary is set up by… We have a team of over 300 Industrial Engineers and their job
is to help us in the reliability of our care and the integration of our Group Practice
so that you can come for your hour visit with an Internist, have a CT scan, have an MRI
scan, have a Consultation with Neurology and then have your surgery by Wednesday and home
by Friday. It’s a pure salary system, so Physicians don’t have a financial conflict
of interest to patients and the departments don’t have a conflict of interest. Anything
that’s left over, we redistribute that meritoriously based on the needs of the departments to serve
the needs of the patients. We aspire to have Mayo Clinic function as
a single organisation, not as holding companies. So we have the Anatomy, the Physiology and
the Ecology of bringing together these 61,000 people with 255 Committees and 41 Speciality
Councils so that we can be a learning organisation. If Orthopaedics has a lower cost structure
in Florida for replaying hip, we know that and can spread that. The Social Capital that
we build intentionally helps us in the collegiality and the spread of best practice. So Social Capital is, beyond our brand, our
most valuable asset; it’s much more valuable than the bricks and mortar of scanners and
OR suites and proton beams. All 41,000 Physicians are working hard but it’s not because we’re
paying them on a production model, it’s because of peer pressure and the culture of
the organisation to deliver our three shield deliverable which is not just clinical care
but education and research that support the care of patients. We’re a Consensus-driven organisation. Like
I said we have 255 Committees; sounds like a lot of bureaucracy but it helps us not just
make decisions better, it helps us in communication, it helps us in leadership development and
it helps us in change management. So if we have Physicians with Administrative Colleagues
and Nurses and Pharmacists and Social Workers on Committees together, not only do we build
Social Capital but we also build… Do the first steps of change management because it’s
not us versus them. The answers come from us making decisions together. So how can you have a bunch of Doctors without
MBAs leading a $10 billion not-for-profit organisation? Well we partner with Administrators.
So we have a dyadic relation or a triad relationship with Nurses to lead the organisation. A Physician
cannot be in a leadership position for more than eight years. He or she then rotates back
in the Practice or to another leadership position and maintaining patient care practice allows
that to happen smoothly. At the end of the first year, every Physician
undergoes emotional intelligence assessment. At the end of the second year, every Physician
that we’re about to make a permanent commitment to undergoes a 360 so we hear about Nurses
and other Doctors and Students and Administrator’s thoughts about how her or she works as a team
member. These aren’t past fail assessments but they allow that person to reflect. We
have over 100 internal Executive Coaches, Doctors and Administrators that have been
trained up as Coaching, and we pair up these Physicians who are about to become formal
consultants at Mayo with a Coach to reflect on their emotional intelligence and their
360s. Medicine is a team sport and no matter how
technically good you are, if you don’t relate well to others, to Nurses, to Students, to
Pharmacists you’re not going to be safe and we don’t want you on our staff and we
know it works. We know that a huge driver of the engagement of our staff relates to
the effectiveness of that Leader. If you would ask any one of our 61,000 Colleagues
across Mayo Clinic what we’re about, it’s about the needs of the patient come first.
Those seven words. If you walk past a gum wrapper or a tissue on the floor, then that’s
a standard you accept. If you walk by a Physician being disrespectful to a Nurse or a Social
Worker, then that’s a standard you accept. Another part of our culture is the expectation
that we have two jobs at Mayo Clinic. One is to do our work and the other is to improve
our work. After Len Barry spent a sabbatical year at Mayo, he’s a Marketing Professor
at Texas A & M. His conclusion about the distinguishing feature of Mayo in our culture was this discretionary
effort, the volunteerism and his observation was if everybody just did their job description
at Mayo, we wouldn’t exist. It’s that discretionary effort to work together as a
team, to do something more than your job description that distinguishes us and so that engagement
is part of this Social Capital culture that helps us deliver what we need to do for our
Mayo Clinic model of care. So thank you.

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