Op-Ed: Healthcare Reform Lessons From Mayo Clinic

Mayo_MN_Gonda_3884cp Three goals underscore our nation’s ongoing healthcare reform debate:1) insurance for the uninsured, 2) improved quality, and 3) reduced cost.  Mayo Clinic serves as a model for higher quality healthcare at a lower cost.President Obama, after referencing Mayo Clinic and Cleveland Clinic, advised, “We should learn from their successes and promote the best practices, not the most expensive ones.”

Atul Gawande writes in The New Yorker, “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.

1. Patient-first medicine.  Throughout its 140-year history, Mayo Clinic has never put money first but lives its primary value:  the needs of the patient come first.  Mayo doctors, as 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 the more than 43,000 employees.

For instance, 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: a Medicare-approved model requiring relatively involved surgery and several days of postoperative hospitalization.  Option B: a new model that could be implanted more simply with only one day of hospitalization.

Option B was not yet Medicare-approved and meant noreimbursement to Mayo.  Dr. Waller recalls:  “This was a no-brainer – use the pacemaker that is best for the patient.”Healthcare is a sacred service.  The patient’s quality of life – and life itself – is 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.

2. 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, as at Mayo, 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 medical practices who may not communicate with one another.  Not so at Mayo Clinic, which functions like a medical department store with staff experts for each medical specialty.  Working in an organizational culture that demands teamwork and using tools such as an electronic medical record 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 ENT physician told him the discomfort in his mouth was not clinically significant.  When another ENT doctor diagnosed cancer and recommended immediate surgery (that would end Don’s ability to speak), Don 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 cancer diagnosis, he is cancer-free and living a normal life.  He still sees his initial physician team at six-month’s check-ups. Don’s story illustrates Mayo Clinic at its best.  Teamwork is vital to improving medical efficiency and effectiveness, and health reform must include bold investments that encourage and enable it.  Encouraging medical practices, financially and otherwise, to coordinate a patient’s healthcare over time (called “patient-centered medical homes”) should be in the health reform blueprint.  So should the transformation from proprietary paper medical records to universal electronic records available as needed by treating clinicians.

A time to learn.  Few organizations survive for more than 100 years, much less thrive like Mayo Clinic. Mayo Clinic is not perfect.  Its integrated, multispecialty medical model works wonderfully — most of the time.  Stories like Don’s occur each day at Mayo, but the Clinic cannot help every patient.  Nor is Mayo Clinic the only medical institution that merits consideration in healthcare reform discussions.Yet, the way Mayo conducts its business, governs itself, and sustains focus on its core values of patient-first needs and collaborative medicine is deeply instructive.  Never have such lessons been more important to our nation’s healthcare.

Leonard L. Berry and Kent D. Seltman, 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.

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