Stephen J Swensen: the Mayo Clinic model of care

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  • Posted:Friday 08 May 2015

Stephen J Swensen, Medical Director at the Mayo Clinic's Office of Leadership and Organization Development, talks about delivering high-quality, compassionate medical care in a multispecialty, integrated academic institution.


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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