Monday, December 18, 2006

clinical innovations, the Mayo approach, Twenty Clnical Innovations to Build Patient-Doctor Trust: Fifth in a Series

Innovation by Design, the Mayo Approach

No better example of innovation by design exists than that practiced at the Mayo Clinic.

Since its founding in 1889, Mayo has passionately believed in design innovation offering patients a superior clinical experience. In 2002, Len Berry, PhD, and Neeli Bendapudi, PhD, marketing business school professors, after five months of study, wrote of the trust Mayo generates in patents who go there for care (“Clueing in Customers, Harvard Business Review, February 1, 2003.)

Berry and Bendapudi attributed the trust and loyalty engendered by Mayo to:

• An integrated practice model with the fundamental principle being collaboration of specialists.
• Technologies - Integration of specialty care across Mayo’s multiple locations with computer-based and Web-enabled technologies.
• Staff quality – Recruiting and hiring only those who "reflect the values of Mayo brothers." The organization's values are published in the “ Mayo Model of Care," the centerpiece of the orientation for every new Mayo physician and employee.
• Exceptional facilities – Mayo recognizes the building environment provides "torrents of cues" about Mayo values to its patients, and reinforcing the Mayo image.
• Economies – Repeated surveys show Mayo care – focusing on teamwork, instant chart retrieval, cross-referrals, and ambulatory care – costs 20 to 22 percent less than comparable care in the outside world.
• Constant innovation to continually improve care through constant staff meetings.

The professors concluded a passion for innovation by design” is part and parcel of the Mayo experience.I believe this. Some 25 years ago, I was looking at a position at Mayo as part of their department of laboratory medicine. In the interview process, I was taken to the blood drawing area. There I was told how the area was designed – from types of chairs used and their placement, to the ideal waiting time, to the trek to and from the reception desk, to the view from the chair. Nothing was left to chance.

Mayo trains itself and its employees to design everything from buildings, to exam rooms, to dress codes, to demeanors, to give patients visual and experiential clues to tell the compelling Mayo story.

Passion for Precision, Control, and Planning

A good example of the Mayo passion for control, planning, dress, design, and visual imagery is their new SPARC (for See, Plan, Act, Refine, and Communicate) innovation laboratory. This laboratory was developed to see how Mayo could best improve patient-doctor interaction by studying room architecture, furniture placement, body language, and behavior of both patients and doctors.
Mayo observers have concentrated on the “waiting experience.” They have compared patients sent to the registration versus those directed to a kiosk desk, like those at airline counter and have found kiosk waiting superior in all respects.

The idea is to observe how patients interact in waiting areas and exam rooms, and how doctors, nurses, and staff can best navigate the health care process. The Mayo team wants to create a basic template for facilitating service delivery innovation - a systematic process that includes how to brainstorm new ideas for using the space, rapidly prototype novel service delivery designs, and use customer observation and direct feedback to refine solutions.

The point of Mayo’s SPARC Innovation Program, according to the medical director of the program, Alan Duncan, MD, is to find ways to improve the patient experience. Says Duncan, “Everything we do is from the patient’s perspective.” He is quoted in The December 2006 issue of Minnesota Medicine as saying, “For a general internist, the relationship between the physician and patient is absolutely critical. I think it’s critical for any physician, but it’s really critical for the general internist, who often has a longitudinal relations with patients.”

Innovation, Above All Else

Innovation is in the Mayo organization’s DNA.

• When Doctor W.W, Mayo founded Mayo as an integrated health care group, built upon by his two doctor sons – still known at Dr. Charlie and Doctor Will; it was innovative.

• When the Mayo’s put multiple specialists in one building; it was innovative.

• When the Mayos hired Dr. Henry Plummer in the early 1900s to design their buildings, surgical and diagnostic instruments, examining room, record system, and pneumatic tube powered chart-delivery system; it was innovative.

• When Mayo developed a research division, culminating in two Mayo researchers, Dr. Edward Kendall and Dr. Philip Hench, sharing the 1950 Nobel Prize for their work on adrenal steroids; it was innovative.

• When Mayo founded Medical Innovations, Inc, in 1965; it has designed, patented, and marketed over 1000 medical devices; it was innovative.

• When Mayo took their diagnostic reference laboratories national in the 1970s; it was innovative.

• When Mayo collaborated with IBM to expand and refine its information technology system over the last 20 years, and then worked with IBM, GE, Siemens, and Phillips to build and market a better MRI machine in 8 months, rather than the usual 18 to 24 months, it was innovative.

• When Mayo developed their clinic trials service; it was innovative.

National Symposium on Health Care Reform

Now Mayo has undertaken its boldest reform innovation yet – to help design a national system based on Mayo thought and design.. On May 21 and May 23, 2006, Mayo hosted a national symposium on health reform. Before the symposium, Mayo CEO Denis Cortese, MD, and Mayo Administrative Director, Robert Smoldt, MBA, staked out the Mayo position on reform in the April issue of the Mayo Clinic Proceedings.

Cortese and Smoldt said, among other things, that the health system suffered from lack quality and safety, the uninsured, public unease, rising costs, misaligned payment incentives, and a looming baby boomer retirement.

Fixing the Problem

To fix the problem, Cortes and Smoldt argued, would require national learning organizations, led by physicians with shared visions, professionalism, information technology tools, and systems engineering management.

Cortes and Smoldt concluded,

“To achieve this vision of a new health system for America – one that functions as a vibrant, innovative learning organization – we propose a consumer-driven market-based model that delivers universal coverage to all Americans, a model similar to the Federal Employee Health Benefits Plan (FEHP) or the Universal Health Voucher Plan.”

To Mayo, systematic, organized and purposeful innovation has no limits --when it is designed from the patient’s point of view.

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