“How is it that in the middle of a relatively small town of about 125,000 people in Minnesota, you’ve got the number-one-rated health care system probably in the world?”
The question was put to Jeffrey Bolton — the Mayo Clinic’s chief administrative officer — by Larry Jameson, executive vice president of the University of Pennsylvania Health System, during the recent Wharton Leadership Conference. Jameson, who was interviewing Bolton, said he wanted to understand “the Mayo magic.”
Founded more than a century ago by two brothers in the rural Midwest, the Mayo Clinic has built a world-renowned reputation as an exemplary network of clinics and hospitals that has become the preferred destination of patients with difficult-to-treat conditions. Today, the nonprofit health system cares for more than a million people annually from about 140 countries. It employs more than 63,000 people and brings in $12 billion in annual revenue. The Mayo Clinic was ranked number one in the 2018-2019 ‘Best Hospitals Honor Roll’ compiled by the U.S. News & World Report. Indeed, it regularly lands at or near the top of these rankings.
As lifespans lengthen and more money is spent on medical care, places like the Mayo Clinic, which prides itself as being a referral center for advanced and complex cases, will become even more essential. “As people live longer and have multiple different chronic diseases, the need for … advanced services will be ever greater,” Jameson said.
Patients Come First
Bolton said what differentiates the Mayo Clinic from many health care organizations is that the needs of the patient come first. While many medical centers claim the same thing, he said, the Mayo Clinic is actually structured to support it as a goal. The health system is organized to foster teamwork, not hierarchy.
Bolton traced the concept to the clinic’s beginnings in the late 1800s. Brother physicians William and Charles Mayo, along with a small group of other founders including Franciscan nuns, created a model of medical collaboration inspired by helping local victims of a tornado. Teams of specialists provided patient-centered care, although the term didn’t exist then.
An oft-repeated anecdote from the clinic’s early days reflects the organization’s focus on teamwork instead of position. Dr. Will Mayo was once asked by a patient, who was looking for the person in charge, “Are you the head doctor here?” He answered, “No, my brother’s the head doctor. I’m the belly doctor.”
The collaborative model is still alive and well in the organization, said Bolton. Indeed, he added, Mayo is one of the largest integrated group practices — not only within and across specialties but in administration, nursing and technology.
Jameson said he has seen the Mayo Clinic teamwork in action. “I want to underscore that [Jeffrey] is not just blowing smoke. This is the way it really works.” Patients come into the Mayo Clinic and see a doctor. If there’s a deeper problem involved, say with the gastroenterology system or another issue, the patient gets moved that day, or even that hour, to the next specialist, “so problems get solved. And this is what attracts people,” he said.
Bolton noted that part of Mayo’s philosophy has always been that “the wisdom of peers is greater than any individual.” It’s almost expected, he said, that if you see a patient with an issue you’re unsure about, “you pick up the phone and call a colleague — either within your specialty or another specialty — and seek out insight.” And now that Mayo Clinic has electronic medical records, that colleague can also pull up and view the patient’s information.
“[The] wisdom of peers is greater than any individual.” –Jeffrey Bolton
Indeed, Bolton said the Mayo Clinic was the first hospital to maintain standardized information on its patients, starting 110 years ago. Obviously these were on paper and traveled with the patient, but “every physician that saw that patient had the full record in front of them — the medications, the diagnoses.”
Salaried Doctors
Another feature that distinguishes the Mayo Clinic is that it’s a physician-led organization, which is fairly rare. Yet this model leads to better quality of care that routinely lands the clinic atop the lists of best hospitals. Bolton said the Mayo Clinic uses a “leadership dyad” model in which a physician leader is paired with an administrative partner. Bolton himself is the administrative partner to president and CEO John Noseworthy, a neurologist and multiple sclerosis specialist.
Putting doctors in charge of the organization is one way that the Mayo Clinic ensures that it provides the best care for patients. This approach is taken by the entire clinic, including its research and educational branches. “We are really very conscious about having our physicians and scientists co-lead,” Bolton said.
Even the way Mayo physicians are compensated reflects the institution’s collaborative philosophy. Bolton explained that all of Mayo’s specialists, sub-specialists and physician-scientists get a salary after five years on staff. This also is unusual in health care. He added that the salaries are consistent within specialties: All cardiologists are paid the same, all neurosurgeons are paid the same, and so forth. “So there’s no real incentive for driving volume within your practice,” Bolton said. “You’re really, again, focused on what the needs of the patient are.”
Jameson agreed that the salary arrangement removes “potentially perverse incentives that are based on volume.” American medicine is often criticized for being too profit-oriented, sometimes at the expense of optimal patient care.
“You have to come in with a certain mindset, and really focus on the mission.” –Jeffrey Bolton
With its adherence to close peer collaboration, a team approach to care and pre-set salaries, the Mayo Clinic’s foundational tenets go against the conventional image of the American doctor as a lone, brilliant individual who builds a reputation and gains wealth as patients flock to his or her practice. Would some physicians hesitate to work in this kind of environment? “I think you could imagine that the Mayo Clinic really isn’t the workplace for everyone,” said Bolton. “You have to come in with a certain mindset, and really focus on the mission.”
The Money and the Mission
The Mayo Clinic has its own set of challenges, however. A central one involves maintaining both financial sustainability and the quality of care that has made it world-famous.
“Every hospital system that has some Catholic roots has heard the phrase, ‘no money, no mission,’” said Bolton, referring to the Franciscan Sisters’ role in the clinic’s founding. “A lot of people forget, though, the other side of that: ‘No mission, no need for money.’” There are tensions at the clinic around balancing the business side and the humanitarian vision. Some staff members feel it is becoming too “corporate,” but Bolton said the clinic works to continually underscore the values upon which it is built.
Bolton also talked about the complexity of running a hospital system today, including the massive capital demands of health care. “It’s a people-intensive industry, something like the airlines, if you think about capital and people,” he said. Mayo does a lot of charity care and subsidizes a great deal of Medicaid and Medicare business, but needs a certain amount of commercial business to balance that out and generate a profit even though it’s a non-profit. Mayo’s business model needs continued investment and reinvestment to stay at the leading edge, he said.
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4 Comments So Far
ambrosia merolize
I was diagnosed with Multiple Sclerosis (MS) in October 2011, at the age of 55. I woke up one morning with numbness in my lower back and legs, I couldn’t feel my feet touching the floor. I saw my doctor and had an MRI to see if I had a disc problem, it was negative and she told me she feared MS. I was sent to a neurologist, had two more MRIs, and was told that night that I have four lesions on my spine MS. I tried every shots available but nothing worked. In 2015, my neurologist and I decided to go with natural treatment and was introduced to Natural Herbal Gardens natural organic MS Herbal formula, i had a total decline of symptoms with this treatment, the numbness, terrible back pains, stiffness, body weakness, double vision, depression and others has subsided. Visit Natural Herbal Gardens official website ww w. naturalherbalgardens. com. This treatment is a breakthrough for all suffering from Multiple sclerosis, i am strong again!
Renee Herman
Growing up in Minnesota, we were frequent visitors to the small town of Rochester to see exhibits and partake of education offerings at the then small (and only) Mayo Clinic. Early on, I learned a great deal from their health education experiences and because Mayo Clinic valued teaching all ages (and in all modalities), it has become a foundational principle in my life to learn and to share healthcare knowledge with others.
I’m so appreciative for Mayo Clinic and their ongoing organizational commitment to bring hope and healing to patients around the world, which continuing to meet the needs of the many communities they now serve.
I’ve been a Registered Nurse for 30+ years now, and 50+ years of staying connected to Mayo Clinic. I hold fast to the healthcare values they instilled through their community education program, appreciating their programs such as the Shared Decision Making model and forward thinking approach to health care education to enrich patient experience and learning.
Mayo Clinic left an imprint on my life as a child and it has grown to be legacy of how I care for and share with others. So many lives have been touched by simple values of two brothers who knew what it truly meant to put the needs of the patient first. We can all learn from Mayo Clinic’s commitment to uphold their mission and values (no matter how large their footprint grows), and daily be inspired to grow as health professionals, care givers, patients and community members to be more like them. I know I have!
Katie Gillet
I was diagnosed with multiple sclerosis 1 month after I turned 45. My grandma is 96 and had it since she was in her 20s. I have been on Copaxone, the first year was daily and now I am on 40 mg, 3 times a week. It made a tremendous difference for me. Although the fatigue is what really gets to me. When I do too much, I do start to feel weak. My MS got significantly worse and unbearable Last year, a family friend told me about Organic Herbal clinic and their successful MS TREATMENT, I visited their website ww w . organicherbalclinic. co m and ordered their MS Formula, i am happy to report the treatment effectively treated and reversed my Multiple Sclerosis(MS)), most of the symptoms stopped, I’m able to walk and eat well, sleep well and exercise regularly., I’m pretty active now and my attitude is extremely positive.
P M
Not the same anymore!! I was here when they were just as the article said, 15 years ago. I came back because of the way they put the patient first and would keep going to solve the problem. Now, in 2021, they are no longer practicing this. No department will talk to another. You have a problem, can’t get to the department needed, even when the problem might have been caused during their surgery. ENT is ridiculous. Have lessions on tongue, & pain in gland and ear, that could be cancer, or infection, after just having another cancer surgery at Mayo, and no one will see me at ENT/Head Neck Throat. They don’t call back and when I call in, they read notes from head of department telling me to go home and check it out back home, without them ever looking at my mouth here, and I’m here for a month and half with surgery and my son’s surgery as well. While something is growing in my mouth and bumps spreading and hurting.
They do not care about the patient anymore. It is treating me like when I had an HMO years ago with doctors back home, and almost lost my life. I have the best PPO from BCBS, and they are treating me like back home with an HMO.
The OBGYN department and Dermatology were good, but again, couldn’t get in unless another specific person referred to each department. They stopped giving you a Primary Care Physician unless you live within 20 miles of Mayo. No Internal Medicine assigned either with the same rules. Yet, they say to see a doctor you need internal medicine PCP to get in to each department. They are a mess now and am so aggravated. No one talking to each other like they used to. No one helping you get answers. They are like any other medical place now and treat everything like an HMO. You have a massive pain in the head, if you get yourself in somehow, they do one test, don’t find in one year, tell you to go somewhere else on your own to look for the problem back home.
Again, I had a great OBGYN doctor and team here, and my son, a good Dermatology team, after we fought on our own to get doctors back home to refer each time to each doctor specialty here. But beyond that, not the Mayo philosophy that was implemented years ago anymore. New head in charge and Board Of Directors that have no connection with the medical field, only money, bottom line. Mayo will kill their business this way and more people will start to go to UIC, Northwestern, Sienei, Massachusetts, unless they change back to the philosophy of health and wellness and the patient first, or die.
Very sad that after all these years of building up a reputation, that it is changed and gone instantly with the wrong people mindset moving in. Even a nurse told me all the nursing students come here to intern and they don’t know why ALL of them leave now and go to Chicago to continue. She said that never used to be. Well, this is why.