Monday, 23 June 2014

Mayo Clinic: lessons on management and governance

The Mayo Clinic is a network of non-profit health services based in Rochester (Minnesota). Mayo is essentially a group medical practice that has 3,800 doctors, researchers and over 50,000 employees. There are two features that identify this group: integrated clinical practice (especially in addressing complex cases), and research. The Mayo Clinic has been top of the U.S. News magazine for 20 years in a row and is among the one hundred best companies to work for, according to Fortune magazine.

In 1892 a group of doctors, led by brothers Will and Charlie Mayo, created a group of clinical practices, that from the start, had the vision to grow whilst retaining the essence of a cooperative and integrated medical practice, which, together with an early willingness to do research and teach, has earned them the prestige that they deserve today. If we consider the history of the Mayo Clinic in context, we can see the value of having defended the concept of a top-level project of professional services as it has survived the aggressive, speculative market of private medicine in the U.S.

The spirit of the Clinic

Take note of the values ​​that the Mayo brothers entrenched in the DNA of the organisation over one hundred years ago:
  • Continuing pursuit of the ideal of service and not profit
  • Continued primary and sincere concern for the care and welfare of each patient individually
  • Continuing interest by every member of the staff in the professional progress of every other member
  • Continuing effort towards excellence in everything that is done
  • Continuing conduct of all affairs with absolute integrity

The Secrets of Governance

With this background, I was drawn to read the book by Leonard Berry and Kent Seltman "Management lessons from Mayo Clinic" to see if they discovered some of the secrets that have allowed such a complex organisation to remain independent with so much force as the Mayo Clinic has. Starting from the perspective of governance, the first thing I want to emphasise is that the organization is still, today, a group of clinical practices, and therefore the president is a doctor and the board is dominated by doctors.

These are 5 of the secrets that my pen highlighted while reading the book:

The internal genesis of leaders. The organisation supports the natural clinical leaders and promotes their rise to positions of responsibility, as long as they base their career on the spirit of the clinic. That is, doctors who want to thrive, can do so only if they are highly rated by their patients and admired by their peers. For these leaders, management training is considered a secondary issue.

The managers’ role. First of all they must know that they work in an organisation that is governed by physicians with principles based on professionalism and compassion. In this environment, managers tend to quickly align goals with clinical leaders and this ultimately is beneficial. What's good for one is good for others.

The committee as a working methodology. The Mayo professionals spend many hours working on committees. There are at least 80 on each campus, as well as countless internal committees in each department and division. There are committees for almost every little detail that you can imagine. In the book, one of the clinical leaders, Dr. Hugh Smith, paraphrases Winston Churchill’s quote on democracy: "The committees are the worst health management model, except all the others that have been tried." They themselves admit that it is often a difficult model of work, but it ensures that when an agreement is obtained, action is very fast and very effective, because everyone is very clear.

Economic compensations. Doctors are paid a salary but when promoted to a position of responsibility (e.g. Department chief) they receive compensation approximately 5-10% of their salary, the compensation is for life, regardless of the fact that these positions have an average rotation every 8-10 years. They say that this policy facilitates changes in the leadership of the clinical departments and organs of government and direction, because the professional, once the term is over, isn’t troubled by having to face a reduction in their income when relieved of the position.

The choice of professionals. Dr. Nina Schwenk, internist and Vice President of the Board of Directors, explains in the book the key role that medical school is playing in the selection of professionals. "College is where people grow and is where we will look for talent and obviously we strive to choose the students who have best understood the spirit of the clinic and that are technically good. And if these two aspects don’t end up married, we always prioritise the values ​​over the technique, because while it is possible to improve technically, if the values are not shared, experience tells us that things often don’t go well."

I thought it appropriate to discuss the lessons in the Mayo Clinic book, not to further idealise one of the best health organisations in the world, but to see if out of their experiences we could gain ideas, such as, for example, the policy of promoting leaders, the involvement of many professionals in decisions through a committee methodology (although many hours are lost), the effort to align goals between managers and doctors, the (non-traumatic) natural rotation of positions of responsibility every 8-10 years, selection based on professional values, etc. I think that what is found in this book are lessons, no more no less, that are coming from a group of health services that have done and are doing very well.

Jordi Varela


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