Cancer treatment at mayo clinic. Mayo Clinic Management Practice

Mann, Ivanov & Ferber has published a book on how a service culture and systems approach to organizing work leads to outstanding achievements in the field of medical services. The authors examined the practice of one of the most famous medical institutions in the world - the American Mayo Clinic.

With the kind permission of the publishing house "Mann, Ivanov and Ferber", the portal site publishes excerpts from the book.

Chapter 1. Brand with a century of history

About 140 years ago, in the small provincial town of Rochester, Minnesota, the first private hospital opened, which in the early 1900s became the Mayo Clinic. The most surprising thing is not that this clinic still exists, but that it has become one of the most influential and expensive brands in the service sector in the world. And the fact that this brand has been successfully supported, protected and developed throughout its long history is admirable. Mayo Clinic uses almost no advertising to market its medical services these days. Until 1986, there were no marketing specialists on its staff, and the marketing department, opened in the same year, until 1992, consisted of one person.

Since modern management is focused on everything new (concepts, theories, models, technologies, etc.), it was interesting for us to consider a world-famous organization that laid the foundation for its success in the early 1900s and continues to stand on this foundation already in XXI century. The Mayo Clinic demonstrates that once you have the right basic business concept, you can use it for many eras.

Mayo Clinic is a modern, traditional enterprise, skillfully combining profit strategy and maintaining corporate principles, innovation and tradition, talented professionals and their well-coordinated teamwork, science and art.

Mayo Clinic in numbers

The number of people coming in and out of Mayo Clinic each week is comparable to the population of a small town. The working day starts at five in the morning, and during the day 42 thousand employees, students and volunteers work within the walls of three campuses located in Minnesota, Arizona and Florida. Surgical patients start arriving at 5:30, and an average of 300 surgeries are performed here per day. The flow of patients increases at 6:45 am when laboratories open and blood tests are performed. By noon, more than 13,500 patients, most often accompanied by relatives, receive medical care. In total, 65 thousand people participate in the dramatic struggle for human life per day - medical and service personnel, students, patients and their relatives.

During the day, patients undergo more than 4600 procedures or diagnostic examinations, including X-rays, computed tomography or magnetic resonance imaging in the radiology department. The clinic employs 230 radiologists, each of whom processes the data of one patient and makes a report on them within 90 minutes. Two and a half thousand doctors on the staff of the Mayo Clinic conduct 9 thousand examinations or consultations per day. Around 350 patients receive emergency medical care on one of three campuses, and 1,300 inpatients stay in wards overnight.

Mayo Clinic is the world's first comprehensive non-profit medical group, one of the largest of its kind. Due to its versatility, it unites physicians of almost all existing specialties into a common system, who work together for the benefit of patients. In just over a century, Mayo Clinic has grown into a major medical institute... During 1912, more than 15 thousand patients were registered at the clinic. Twelve years later, when the Mayo brothers were at the peak of their careers, the clinic's doctors treated 60,000 patients annually and performed 23,600 surgeries. By this time, the clinic had 1,500 hospital beds and 27 operating rooms. By 1983, the volume of medical services increased 4.5 times compared with 1924 and amounted to 276,800 patients per year.

Until 1983, Mayo Clinic, as at the beginning of its history, was based in Rochester, Minnesota. But that year, a strategic decision was made that spurred the rapid growth of the organization, which continues to this day. In 1986, it included St. Mary's Hospital and Methodist Hospital, located in Rochester; at the same time, a campus was opened in Jacksonville, Florida, and in 1987, in Scottsdale, Arizona. Between 1983 and 2007, the number of patients almost doubled, and the number of doctors and researchers increased by more than 200%.

In 2007, total revenues were $ 7.3 billion (17 times more than in 1983), and total profits increased to 622.8 million dollars (which is ten times more than in 1983).

Throughout its history, Mayo Clinic has been renowned for the medical services it offers patients. However, it is written in its charter that this is the "organization of three shields." The central and largest shield in the Mayo Clinic logo symbolizes patient care. Adjacent to it are two other shields representing medical research and medical education. Brothers William and Charles Mayo defined this three-pronged mission, convinced that they are superior to many of their colleagues by studying the experiences of other doctors each year during their holidays. For example, Dr. Charles Mayo spent his honeymoon with his wife Edith, visiting hospitals and surgical clinics on the East Coast and Chicago. The Mayo brothers have inspired many medical professionals around the world with their scientific publications. They created an original financial foundation to support the clinic's educational and scientific medical programs. These programs are a significant addition to the main activity - clinical medicine.

Mayo Clinic is remarkable for being a large academic center with a medical school not affiliated with the university. The clinic's College of Medicine currently has five certified schools with about 3,200 trainees and students. Education is part of the Mayo Clinic's medical and philanthropic mission. In 2007, proceeds from charitable foundations and donations to educational programs clinics amounted to more than $ 166 million. This was a significant support for programs, which spent a total of $ 215 million. Opened in 1972, Mayo School of Medicine is a small educational institution, which is quite difficult to get into.

It has about 200 students who are undergoing programs to defend the degree of Doctor of Medicine and Doctor of Philosophy. Established in 1917, the Mayo Medical Master's Degree has 250 students who are taking biomedical sciences programs to defend their Master's and Ph.D. degrees. The Mayo Medical Graduate School, for resident physicians and fellows, has its origins in programs developed in 1915 in conjunction with the University of Minnesota. However, at present, the postgraduate study, in which more than 2,200 resident doctors and scientific researchers study in 280 programs of the clinic, are not associated with the university. Mayo Clinic has been providing academic education to healthcare professionals for nearly a century. Today, the School of Medical Sciences has about 600 students who are trained in 34 programs of various medical specializations. According to the plan, half of the school's graduates join the staff of the clinic. Every year at the School of Continuing medical education Mayo runs 170 different short-term courses, enrolling 15,000 doctors outside the clinic.

The clinic's doctors and scientists, pioneered by the Mayo brothers themselves, use scientific research to improve the way patients are diagnosed and treated. In 1950, Mayo Clinic scientists Dr. Edward Kendall and Dr. Philip Hench were awarded Nobel Prize in medicine for the discovery of cortisone. In 2007, Mayo Clinic had an annual research budget of $ 495 million, including $ 179 million from charitable foundations and individuals. Scientific work includes a wide range of research - from laboratory to clinical, in which patients participate; in addition, population surveys (epidemiological) are carried out; the results of laboratory discoveries are applied in practice in the treatment of patients - according to the triune mission. About 80% of the doctors at Mayo Clinic are involved in scientific research, while more than 7,000 approved projects are being implemented here.

Medical Mecca

The Mayo brothers gained international recognition during their lifetime and made the clinic that now bears their name glorified, in large part due to their scientific contributions to medicine and innovations used in surgery. Their writings had a significant impact on theoretical and practical medicine for seven decades, until 1939, when their lives ended. Even now, their names can be seen in links to modern research... But the Mayo Brothers' greatest legacy is the enterprise they created and still lives today - the dynamic embodiment of their organizational genius. The systems and basic management structure they developed over the years of their careers, as well as the model of clinical treatment, exist to this day. The amazing vitality of the Mayo Brothers' creations is not due to a stubborn reverence for the past, but to brilliant clinical results, organizational effectiveness and multifunctional services that often anticipate patient expectations and ensure their loyalty.

In 1961, independent consumer research firm Social Research described the Mayo Clinic's image of first-time patients. Among the dominant statements were the following: "This is where you should turn if you are seriously ill" and "the court of last resort is the supreme court of medical decisions." People are convinced that Mayo Clinic makes the most accurate diagnoses and makes the right decisions. They are awaiting clarification and resolution at the same time. conflict situations associated with questionable opinions, diagnoses and treatments. The belief that the clinic is able to give an accurate answer is the most important component of its image.

In 1962, Social Research conducted a new study on the same topic, but this time among individuals who were not patients of the Mayo Clinic. Sociologists found that the respondents viewed the clinic as an important national institution, in connection with which a myth about the ideal quality was formed in their minds. Mayo Clinic is perceived by them as a symbol of the best in American medicine, which, from the point of view of some people, seems alarming, since others, even good clinics, are unlikely to revise or change Mayo's diagnosis.

Recent studies, which we will present later, argue that Mayo Clinic is still a medical Mecca (this metaphor was first proposed by Social Research in their 1961 study - A Study of Attitudes toward the Mayo Clinic. - P. 56.)

Today, the clinic uses modern tools in its work, but the human values, clinical and administrative models and fundamental philosophical principles of the Mayo brothers have not changed much, although the organization has adapted to the new requirements of medical science and public policy, to modern health care financing and changing patient expectations. The essence of medicine, which the Mayo brothers learned, still plays a major role in the management of the organization.

The spirit of the clinic

At the end of his life, Dr.William Mayo identified three conditions that, from his point of view, are necessary for the future success of the clinic:

1) continuous striving for the ideal quality of services and adherence to non-commercial principles;

2) a constant sincere desire to help every patient;

3) constant interest in the professional development of each employee.

In 1975, Dr. Emmerson Ward, then on the board of directors, proposed a fourth condition:

4) the desire to change in response to changing needs of society.

In 1984, Robert Resler, who retired after 37 years in the hospital's administration, added two more conditions that he believed were inherent in all the Mayo brothers' actions, but remained unspoken:

5) constant striving to achieve the highest results, no matter what you do;

6) absolute honesty in all actions.

Modern research confirms that in companies that depend on employees to serve customers for their well-being, there is a link between social benefit and financial profit. Organizations are socially beneficial when their activities provide the community with some “net benefit” beyond the supply of goods and services and job creation - essential conditions for financial success. The public good is the investment of financial and non-financial resources (eg knowledge) to improve the quality of life. Public benefit is a form of distribution of profit, when profit is expressed not only in financial terms, and distribution is not limited to the framework of the organization.

The public good depends on the nobility of the spirit. And, as the researchers found, the success of an organization is more related to such nobility than to financial investment, since it wins the hearts of all who are somehow involved in its activities (including those who are directly involved in the provision of services), and strengthens them. devotion. And if selfishness takes away human energy from service, then nobility gives the opposite effect.

Our book talks about amazing success service organization based on the rare nobility of the Mayo brothers and their desire to bring public benefit to their medical practice. Perhaps the exceptional nobility, more than other factors, was the spark that defined the spirit of the clinic. And her goals go far beyond monetary gain.

Chapter 3. Practice of team medicine

Mayo employees are specialists highly qualified, but the same qualifications are possessed by physicians working in other organizations. Teamwork, however, is the hallmark of Mayo Clinic's medical staff. And the clinic has achieved an advantage over many medical organizations in terms of the ability to find and unite talented professionals for the benefit of patients.

Mayo Clinic is dominated by a flexible collaboration that allows for the selection of a team of experts to treat people individually. Imagine a giant supermarket that sells literally everything and has a team of experts in every department to help customers. The Mayo Clinic, serving consumers of healthcare services, operates in the same way.

People do not just go to the doctor: they are treated by a team of specialists. It is not uncommon for patients to deal with several doctors. Typically, the first treating physician is responsible for drawing up a plan of interaction with other Mayo clinicians, as well as with the doctor who serves the person in his home. Most of the clinic's patients meet with only one doctor, who informally consults with other specialists when making a diagnosis and prescribing a course of treatment. Depending on the individual needs of the patient, the treatment team may include surgical nurses and technicians, specialty nurses, nutritionists, physical rehabilitation specialists, social workers, and others. By providing the necessary treatment, groups are transformed according to the needs of other patients.

The Mayo Clinic system of multi-specialist inpatient and outpatient care does not always work out as planned. But more often it does work, creating the most important competitive advantage for the clinic.

This chapter explains the meaning and practical application the most important for Mayo principle of cooperation of doctors associated with working in teams and logically following from the principle of "Patient's needs above all else" (see Chapter 2). The guidelines define the standards of care that were formulated by one of the clinic's founders, Dr. William J. Mayo, in his 1910 message to Rush Medical College.

In it, Dr. Mayo talked about how the best way to serve patients is to “join forces”. Here it is appropriate to quote from the above message: ≪The need has come to develop medicine as a science of cooperation; the clinician, specialist and laboratory technician team up for the benefit of the patient, and each contributes to the solution of the problem, each dependent on the support of the other≫.

Dr. Will formulated two basic principles of Mayo: what to strive for (for the benefit of the patient) and a practical principle (medicine as the science of cooperation). The clinic has not only lived, but also thrived for a century, as the principles formulated by its founders continue to inspire and guide employees. The clinic can be said to be an organization that is guided by its principles. And if she loses them, she will turn into an ordinary medical institution.

Teamwork is a must

“Teamwork Required,” reads the headline of an article about the Mayo Clinic in Fast Company magazine. And it is true.

Many excellent clinicians do not meet Mayo's demands, particularly those who choose to work independently, crave fame, or earn as much money as possible. The clinic is well known in medical academia for what it has and what it doesn't have. Self-selection determines who exactly works at Mayo. Gastroenterologist Jonathan Leighton says: ≪Mayo's culture attracts people who view medical practice as an integration of professionals working in a team. This is what we do best, and most of us love to do it. But the most inspiring cases are when success is achieved thanks to the work of a team of doctors from different specialties. The same joyful feeling arises when your favorite team scores a goal against the opponent≫.

The clinic is aggressively looking for team players. She recruits them and then fosters collaboration between them through significant investments in communications technology and medical equipment (see chapters 6 and 9). Cooperation is also stimulated by the principle of remuneration: an employee's salary does not depend on the number of patients whom he has examined or who has provided assistance. The doctors at the clinic have no financial reasons why they would seek to keep the patient with them and not send him for treatment to a colleague who is better able to meet the patient's needs. The same applies to the time spent consulting colleagues (see Chapter 5).

Mayo employees are introduced to teamwork on the first day they arrive at the clinic. Dr. James Lee, a specialist in allergies and infectious diseases, says: “In the 20 years that I have worked here, our corporate culture has not changed. I went through cultural assimilation in the first year of work, and over time it only strengthened≫. Perhaps the most remarkable achievement of the clinic is that, being a very complex organization, having recruited thousands of specialists over the years, it has managed to connect them with each other and with the organizational mission.

This is where I grew up professionally

Providing medical services is an unusually challenging job that is physically and emotionally demanding. The patient expects the doctor to know everything, never make a mistake (since the consequences can be catastrophic) and, if necessary, perform a miracle. Working at the Mayo Clinic is especially difficult because it attracts thousands of patients who suffer from severe complex diseases. Quite often doctors can hear from a patient who has come here for the first time: "You are my last hope."

Teamwork is driven not only by the corporate strategy of integrated multidisciplinary medicine, but also by the severity and complexity of patients' illnesses.

The collaborative spirit that dominates the clinic is a powerful learning mechanism. The professional level of doctors here increases over time, as they are faced with the need for their own development, without which they will not be able to work effectively in this system. Similarly, the professional development of the rest of the staff is observed. The clinic expects a lot from its employees, and teamwork helps them meet those expectations.

The clinic is a training organization in the traditional sense: it teaches new doctors. However, it also uses special techniques that are unique to Mayo. Employees instruct each other.

Dr. Kirk Rodisill, a specialty general practitioner, notes: “The clinical notes, tests, and prescriptions I write down every day are regularly read by experts in almost every field of medicine.

If something is wrong in my notes, they immediately call me and I learn something new. Perhaps the prescription I made, or the survey I conducted, is not up to date. And all this raises my professional level≫.

Dr. Nina Schwenk, also a therapist, was asked if she became a better doctor here compared to her other places of work. To which she replied: “Hundreds of times better thanks to the support system. This system is like an organism: in the absence of knowledge, you do not become an isolated cell. Not having deep knowledge of narrow problems, I have the opportunity to consult on any topic with the best specialists. Whatever disease interests me, whatever problem I have to face, I can call my colleagues and they will help me≫. Endocrinologist Dr. Robert Rizza adds: "I never feel lonely, even if no one is around."

I need your help

The culture of the clinic is great not only for providing employees with the opportunity to seek help, but also for encouraging them to do so. Failure to seek advice or assistance, if necessary, poses a threat to career growth. The employee is expected to ask for help. Elaine Gustetic, Transplant Social Worker, says: “I can call anyone at any time and ask them to do what the patient needs.”

Once gastroenterologist Dr. Russell Hay had to examine 13 patients in a day. He planned the work so as to take the seriously ill patients first. But almost all of them turned out to be difficult. The most difficult case was a 94-year-old female patient who, among other symptoms, had acute abdominal pain. Russell immediately consulted with two doctors, including a surgeon, who said: “This case worries me very much because the life of a 94-year-old patient is in danger. The only question is whether it will survive the operation≫. Dr. Hay and the surgeon were reluctant to start the operation until they had complete confidence in a successful outcome.

After seeing several other critically ill patients, Dr. Hay was asked how he made difficult decisions and how he managed to cope with stress. To which he replied: “I have wonderful colleagues, and they helped me a lot. In difficult situations, I turn to them. Specialists that I can turn to in difficult cases can improve the effectiveness of treatment≫.

Dr. Victor Trastek, CEO of the Arizona campus, consistently supports the “Teach but don't blame” principle. An employee's mistake is seen as a reason for learning and improving performance. Does constructive learning always eliminate responsibility for mistakes? No. However, Dr. Trastec advocates a principle that builds self-confidence in people, enhances their self-esteem, and fosters genuine collaboration.

This is what we do

Most of the specialties in the service sector involve the employee's actions at their own discretion. These actions are limited, on the one hand, by the maximum energy that a person can apply to provide a service, on the other hand, by the minimum effort required to avoid being punished (this can be a reprimand, a reduction in salary, or even dismissal). And the employee voluntarily chooses whether to invest maximum or minimum energy in his work. Truly successful service organizations get more voluntary return from their employees than any other organization. And this extra effort ensures their superiority.

The goodwill of the Mayo Clinic staff benefits patients. Making the extra effort to help patients or team members is the essence of corporate culture.

Most of Mayo's employees go to great lengths to show goodwill. Their daily “voluntarism” is not always dramatic, it is not always associated with saving lives, as in the story with which this chapter begins. But the extra effort that employees spend on a daily basis in a variety of ways makes teamwork strategy a reality of teamwork.

The power of respect

≪Mutual respect is very great importance says Bridget Jablonski, who leads the team of oncology and transplant nurses at Phoenix Hospital. - You are expected to show respect for every person you deal with, be it a patient, a nurse-colleague, a doctor, a service representative or anyone else. You should treat him like a member of your team. None of us can do our job without the help of other people ≫.

Mayo culture enhances its inherent power of respect. Showing respect is generally necessary in a work environment. If you are respected at work, it means they trust you, they listen to you carefully, involve you in the production process, appreciate your input and treat you honestly.

The activities of a team are unthinkable without mutual respect, and it also depends on the trust of partners, their ability to listen carefully to the interlocutor, and involvement in work. and contributing to it, treating colleagues honestly. All of this amounts to respect.

A corporate culture that promotes the principle of mutual respect emphasizes the value of people's work and fills them with a sense of self-worth.

Respect raises the spirit of a person, nourishes him with the energy necessary for the manifestation of good will. Respect for colleagues builds self-confidence, which motivates the employee and improves team communication.

The corporate culture of the clinic, which supports the principle of mutual respect, must be stable enough to overcome the boundaries of different positions, departments, campuses and bring together strangers. A colleague at Mayo Clinic means that even a stranger or new member of a team is perceived as a competent person with a voice.

Moreover, mutual respect should be equally expressed both vertically (for example, between doctors and nurses) and horizontally (for example, between medical colleagues).

Respect is one of the Mayo Clinic's strengths, but the organization must vigorously tackle disrespect at all hierarchical levels. Such cases do happen, but not often. The stakes are high, as the Mayo Clinic wouldn't be there if it wasn't for mutual respect. Teamwork depends on this.

Practical medicine in full view

From the very beginning of their practice, Doctors Will and Charlie kept medical records of patients' examinations and treatments. They were compiled by hand, and each one individually entered them into the thick registration books kept in his office. At first, such records were comprehensive, and they became the basis for many scientific articles published by the Mayo brothers. But the increase in the number of patients and the expansion of the staff revealed the shortcomings of such a system. Sometimes a return visit was recorded in the margins the sheet on which the previous visit was recorded, which complicated the study of chronology. In addition, if two or three doctors treated one patient, his medical history was broken up into scattered notes in several registration books stored in different offices.

Dr. Henry Plummer, shortly after joining the clinic in 1901, proposed changing the registration system. He referred to the fact that doctors made important decisions without having access to all the information about the patient, which was stored in scattered books.

With the support of the Mayo brothers, Henry Plummer created an improved system. Previously, he studied similar experience in other clinics, as well as in organizations in other industries. Plummer has developed a unified registration system so that all patient information, including information about previous treatments, diagnostic examinations and surgical procedures performed in and out of the clinic, is available when needed. This integrated patient registration system was introduced at the clinic in 1907 and is still in use today, albeit in a modern electronic format.

The main principle here is that the recordings are organized more by the patient than by the doctor. Each is assigned an individual identification number, which is a simple sequence starting with the number 1, which marked the first patient in 1907. Now their number has reached 7 million.

Registration books have been replaced with individual cards, which contain all the necessary information.

The current detailed medical records for each patient were a breakthrough a hundred years ago, they are now commonplace. But even today, combined outpatient and hospital records are rare, with the exception of the integrated healthcare facilities created by Mayo Clinic's “graduates”.

In the mid-1990s, the transition from paper to electronic format began, and now all records are stored electronically.

For many years, the registration card has maintained the high quality of medical care at the clinic. It reflects the vision of Henry Plummer and the Mayo brothers to improve diagnosis and treatment with better information. At the same time, the concept gave more positive results than its authors expected. It allows you to assess the quality of the medical services provided by the clinic. Dr. George Bartley, general manager of the Jacksonville campus, wrote in a 2004 address to employees: “Our overall registration system leaves little room for error.”

The combination of an integrated medical practice (where different specialists treat the same patient), integrated medical records (where all specialists have access to all the information they need), and the high reputation of Mayo Clinic puts pressure on employees from colleagues to improve the quality of medical services. The skills and knowledge of each doctor are constantly reflected on internal displays. The demands of colleagues to study or leave the clinic are real practice. In essence, medical records become both a tool (electronic textbook) and a stimulus to learning.

The group medicine model could not work effectively if the team members were not confident in their partners. Substantially modified, Dr. Plummer's idea reinforces this confidence. Dr. Sadosti says that from her perspective, what sets Mayo Clinic apart from other healthcare facilities is that the team members believe in her.

Lessons for managers

Mayo Clinic is notable for the consistency of its success and the principles that make this success possible. The world-renowned institution, which began its existence a century ago with the formulation of two principles on which it still relies, has a lot to learn.

The material in this chapter allows managers to learn the following lessons.

Lesson 1. An organization should operate like a small business, even if it is large. Mayo Clinic is a large enterprise that is small at its best. The large size of the organization has competitive advantages: a more complete range of services provided, a wide distribution network, a strong supporting infrastructure. But there are also opposite effects: bureaucracy, ineffective internal communication, poor coordination, service devoid of individualization. The challenge for large organizations is to maximize the benefits of their size while minimizing its disadvantages. Despite the clinic's inherent bureaucracy (see the discussion of the clinic's committee system in Chapter 5), it is able to operate both as a large and as a small business, reaping the benefits of this - a great example for other organizations.

Serving customers like a small business means acting quickly, efficiently, responsibly, flexibly, individually. This means finding ways to meet unusual consumer needs, as the Mayo Clinic demonstrates, by forming unique teams that meet the needs of patients through the use of a variety of professional knowledge and skills. It means taking extra effort, exercising creativity and “strive to get the job done, not watch the clock”.

Treating employees like a small business means bringing them together, creating a common vision, maintaining a collaborative spirit. This means establishing personal and collective responsibility and fostering a culture that fosters mutual trust, mutual assistance and a sense of belonging.

Of course, the size of “true” small businesses does more than just benefit them. The peculiarities of their activities are reflected in the psychological attitudes and forms of behavior of employees, which are supported by corporate principles formulated in special statements of the organization. Mayo Clinic has learned this lesson. Its main principle (“Patient needs above all else”) makes services individualized, even if 13 thousand patients are admitted per day. Another principle ("Medicine as a science of cooperation") allows you to form a team specifically for an individual patient. The team becomes business card clinics are a small company within a large one. Supporting the work of the teams, the clinic spends financial resources on tools, technologies, systems for the delivery of high-quality individual services, where integrated medical records play an important role. Large, efficient companies, acting on the principles of small, are equally close to consumers and high-tech systems, as exemplified by the Mayo Clinic.

Lesson 2. Stimulating a culture of limitlessness. Mayo's story reveals the positive effect of infinity (a term coined by former General Electric CEO Jack Welch). Stimulating infinity is the encouragement of employees in accordance with the principles of corporate culture, aimed at ensuring that they go beyond the organizational structure and, while doing their work, contact specialists from other parts of the organization, whose knowledge can help solve the problem that has arisen. While ‘isolation’ relies on strictly defined roles and powers and a strict division of functions in the organization of work, limitlessness presupposes the destruction of artificial barriers for the purpose of cooperation, the manifestation of interest in the opinions of various specialists, the use of technology that allows the collection of dispersed information, and the formation of special groups. (such as teams, operations and research teams).

Infinity makes the organization open and allows it to free up its powers and resources to use them in best goals... Infinity creates an opportunity for a team to work regardless of the framework of organizational structures. Mayo Clinic proves the value of this work. In this giant organization, comparable to a “supermarket” of medical services, a variety of specialists and different expertise are available to use when needed.

Infinity means breaking the boundaries of the “supermarket” departments so that specialists and knowledge can be used in the place where it is most needed. Many larger organizations in other industries also have a supermarket-like structure, and they also have specialists who are not limited to their workplace. But the potential of the working groups is not fully realized here, since in the process of solving problems, the opportunity for mutual training of specialists from different departments is not sufficiently used.

At Mayo Clinic, employees are encouraged to seek help from their peers, which is seen as a sign of weakness in other organizations. One of the most important achievements of the clinic's corporate culture is that seeking help is regarded here as the norm and the expected form of behavior.

According to Professor Noel Teachy, Mayo's culture prepared the organization for the "rugby game". “This is a very dynamic sport,” the professor explains. “At first glance, it is chaotic, but it requires very close communication, constant assessment of the uncertain external environment, and problem solving without relying on hierarchy.”

Lesson 3. The how principle is not the same as the what principle.

The two main principles of Mayo Clinic (“The needs of the patient are above all” and “Medicine must work on the principles of cooperation”) from the very beginning to the present, determine all other principles, including what and how to strive. It's inspiring and exemplary. We hope that managers in other organizations will learn from the multidimensional structure of Mayo's core principles.

In business, it is generally accepted that the main principles of the company remain unshakable, while its tactics and strategy change over time. However, the Mayo Clinic example proves that it is possible to have one or more strategies that are so important to the value system, so significant to those who use them that they grow to the level of a fundamental principle. A pool of talented professionals shows how Mayo meets the needs of patients.

This is both the main principle and the main strategy. The sustained success of the clinic is based not only on the invariability of the main principle, but also on its constant practical application. From the beginning and for centuries, Mayo Clinic has defined the way it wants to do business, and this definition remains relevant, although over time it has evolved into a modern medical organization.

Summary

Collaboration, cooperation and coordination are the three forces that support the group medicine practice at Mayo Clinic. These three forces determine the individual principles of treatment for each patient, although several thousand are served here every day.

Individuals - from doctors to cleaning ladies - become active players in the team to meet the needs of patients, as complex diseases require the expertise and skills of different specialists, as well as a supportive infrastructure. Being on the staff at Mayo Clinic means working as a team. For all its areas, the organization clearly defines not only what what does, but also how she does it. Mayo's model demonstrates principles and practices worthy of emulation in business within and outside healthcare.

Haven't seen each other for a long time, friends. I'll start with a short introduction, if you will allow me, my hands were itching to write a fresh article and there are a lot of ideas, but I was sorely lacking time and finally it appeared.

In our country, medicine is treated as something due and free, it is not considered a service, it is rather considered a duty. And this has its own truth. But there is also another approach. Today I want to tell you about a clinic that has turned medical services provided within its walls into a brand, guided by very light and correct principles, while looking at its work as one of the types of services. Good or bad - not for us to judge. We'll just see what it has become and what it has led to. Here is the world famous Mayo Clinic.

Clinic history

Mayo Clinic is a non-profit organization (an organization that does not have profit as the main goal of its activity and does not distribute the profit among the participants), one of the largest private medical and research centers in the world.

Dr. William Worrell Mayo (1819-1911) was assigned to Rochester in 1863 to practice medicine. The population of Rochester was then 5,000. William Worrell traveled a lot to the largest clinics in the United States, where he "absorbed" not only surgical techniques, but also paid attention to the organization of the structure of institutions, adopting the most effective models. After a quarter of a century of medical practice, donations from the convent of St. Francis, grateful to him and his sons for their help in eliminating the consequences of a devastating hurricane, he opened a clinic in 1889 - one of the first private clinics in the world (!!!).

From 1911 to 1939, the clinic was headed by his two sons, William James and Charles Horace. Guided by high moral values, the brothers manage to create an effective corporate culture and investment infrastructure that supports it. At that time, the clinic was already a large center, and rumors about it went far beyond the state of Minnesota.

The marketing department appears in 1986. Until 1992. the marketing department consisted of one person! The main rate was made on word of mouth, because even Dr. William Mayo said:

"If you do something better than your neighbors, then the path to your house will not overgrow, even if you live in the forest."

The clinic exists to this day. On the this moment has 3 campuses located in Minnesota, Arizona and Florida. The clinic employs 42 thousand people. The number of patients per year reaches the population of a small town. The hospital, along with clinical activities, is actively involved in educational and scientific fields. The clinic's revenue in 2012 exceeded $ 8.8 billion; about $ 500 million is allocated for Scientific research... The annual revenue of the clinic in 2013, according to Forbes, was $ 3.74 billion.

So what's the secret of the Mayo Brothers Clinic?

Principle of operation

The Mayo Center is not just a clinic name, it is a brand in the world of medicine, both clinical and scientific. A brand that, like all brands, has a clear development strategy. This development is based on 3 fundamental principles.

1. The needs of the patient come first

In this clinic, this is the first principle of work, from which everything else follows. And it's not just words. This principle is imbued with the heads of all participants in the process: from the nurse to the doctor and, which is very important, the administrators of the clinic. Everyone moves in a single impulse - to make the patient's stay when visiting a hospital or an outpatient clinic as comfortable as possible.

Nurses need to be sympathetic to the process. Doctors, not only need to be involved in the latest trends in their industry, constantly improve their level of specialists, passing trainings, including in the field of communication with patients. Research is being carried out on the topic: what color of the uniform has the best effect on the patient's recovery; the noise level in the premises is measured and everything possible is done to reduce it as much as possible; the territory of the hospital was ennobled in order to ensure a pleasant pastime for patients and for meetings with relatives who visit patients; the clinic regularly organizes music concerts for patients. In general, everything is done so that the patient is distracted from his illness and feels the support of a team of professionals.

As for medical services, everything is aimed at the efficiency and consistency of their implementation. An appointment with a doctor lasts about an hour, so that the patient can ask all the questions that interest him regarding his condition and the method of treatment. If you come to the appointment and you need an MRI, then you will have it done on the same day, and with the result of the MRI they will be recorded as quickly as possible for a second consultation, possibly right on the same day. If surgery is required, then it will be done immediately after the necessary additional examination. The administration understands that most of the patients have come from other cities and do not have time to "swing". This principle applies to the treatment of all patients in this clinic.

2. Teamwork

The work of the clinic is arranged in such a way that the scope of functional responsibilities is defined for each group. At the same time, the departments are very actively interacting with each other. Consultation with a specialist of a different profile will be received in a matter of minutes, if the situation requires it. The consultation will be assembled within 30 minutes, and the doctors do not need the presence of the clinic administrators at the consultation. The policy of the hospital is such that the involvement of related specialists is encouraged, since the hospital adheres to the principle of holistic medicine, which will be discussed below. All this gives a quick solution to many controversial issues and a prompt correction of therapy.

3. Holistic medicine

A very important principle that implies the fact that a doctor must treat a person with all his concomitant diseases. I very often heard at the institute, "You must treat not a disease, but a person," which meant: I must look at concomitant diseases and treat them as well. In practice, I have seen very few places where this principle is followed. At Mayo Clinic, this principle is elevated to a cult.

It would seem that I did not name anything unusual, all the principles are clear, and it seems to everyone that every doctor and every clinic should follow them, but alas. And here it is sometimes even a manic instillation of these principles to their employees. There are also a number of organizational features in the work of the clinic. We will talk about these features further.

Doctor-administrator liaison

Doctors in the clinic have complete freedom precisely in terms of clinical approaches. Doctors are gathered in departments, which are supervised by the heads. Heads are replaceable and are selected from the doctors of the department. An administrator (a person with specialized education) is assigned to such a manager, helping him to solve bureaucratic, analytical and economic problems. As a result, we have a department that is profitable and has fewer problems with emerging issues in which a doctor may not be competent due to the specifics of medical education.

Staff recruitment

At the clinic, when hiring a candidate, up to 8 people are interviewed, and this can happen in 2 stages. During the interview, attention will be directed not only to the level of knowledge and experience of the applicant, but also to how he can work in a team. The clinic employs not the doctors of the star, but the whole constellations. And of course the clinic cannot afford to underestimate the level of its employees. The institution allocates a huge share of the budget for the continuous improvement of doctors, administrators and nurses.

Well, and the most important part is creating quality marks. After all, the patient, turning to the clinic, has experience in receiving medical services and compares precisely the signs of quality when choosing a place in which he will be provided with the service. In the clinic, there are three groups of signs.

Functional features are the technical quality of services, namely, how the main service is rendered - treatment. Quality should be in everything: what drugs will be used, what endoprosthesis is installed during the operation, and on what machine is the MRI performed.
External signs are the atmosphere created in the clinic: cleanliness of floors, color of premises, renovation, decoration, building facade and territory. Agree that you pay attention to this when you drive up to the consultation at the hospital.
Interactive - the behavior and appearance of the service personnel: the manner of holding oneself and speaking, the manner of dressing, and so on.

The clinic pays attention to this and tries to exceed the expectations of patients.

Conclusion

I am amazed at the attention to detail that executives at Mayo Clinic have, amazed at the foresight and understanding of the need to invest in staff development.

At the dawn of this clinic, the Mayo brothers could already boast of a serious income, but they independently limited themselves to wages, and the remaining money was used to raise the level of certain services.

Such a beautiful blade with its own management and approach to management appeared in 1889. Its position is only getting stronger, despite the incredible competition in the United States, proving to us the viability of the system they have chosen. But the main secret is a sincere desire to help people, to do what you love and to know that your work will be appreciated.

Mayo Clinic Management Practice. Lessons from the world's best service organization Leonard Berry, Kent Seltman

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Title: Management Practice Mayo Clinic. Lessons from the world's best service organization
By Leonard Berry, Kent Seltman
Year: 2013
Genre: Medicine, Management, recruiting, Industry publications, Popular about business, Foreign business literature, Foreign educational literature

About the book “The Practice of Management Mayo Clinic. Lessons from the World's Best Service Organization "Leonard Berry, Kent Seltman

Mayo Clinic is a nonprofit medical center ranked in the Top 100 American Companies. For many years, Mayo Clinic has been considered the best medical institution in the United States, and thousands of patients from all over the world come to be treated there. What's so special about her?

Leonard Berry and Kent Seltman examined the management of the Mayo Clinic and concluded that the reason lies in the special approach to service and to each patient. The culture of service and a systematic approach to organizing the work of the clinic have led to outstanding results in the provision of medical services.

Mayo Clinic is one of the best books on modern, customer-centric service. The tips presented in it are universal for any service company seeking to apply global best practice.

On our site about books, you can download the site for free without registration or read the online book “Practice of Mayo Clinic Management. Lessons from the world's best service organization ”Leonard Berry, Kent Seltman in epub, fb2, txt, rtf, pdf formats for iPad, iPhone, Android and Kindle. The book will give you a lot of pleasant moments and real pleasure from reading. Buy full version you can contact our partner. Also, here you will find the latest news from the literary world, find out the biography of your favorite authors. For novice writers, there is a separate section with useful tips and tricks, interesting articles, thanks to which you yourself can try your hand at literary skill.

Quotes from the book "The Practice of Management of the Mayo Clinic. Lessons from the world's best service organization "Leonard Berry, Kent Seltman

We will show the specifics of these partnerships using the example of the cardiology department, although this model is applicable to any field of medicine. The head of the department, cardiologist, maintains a partnership with the administrator. The head is responsible for adhering to the general concept and strategic direction of the department's work, as well as for the professional activities of doctors, including the treatment of outpatients, cardiological diagnostics: echocardiogram recording, cardiac catheterization, as well as hospital practice. He is also responsible for each cardiologist individually: for his career growth, research, practice, work results.

A hallmark of the Mayo Clinic is the structure that makes doctors responsible for everything that happens at the institute. And if the institute fails, doctors can only blame themselves. This feature has a positive effect on the behavior of the Mayo Clinic doctors. They must constantly be mindful of the interests of the institution, as these interests are linked to their own.

By the early 1920s, clinical medicine as a "science of cooperation" had developed significantly in the organization created by the Mayo brothers. The most powerful unifying factor that strengthens the partnership is Henry Plummer's proposed integrated medical records that doctors and nurses maintain for inpatients and outpatients. Dr. Plummer also took part in the design of the new clinic building, built in 1914.

The data for the report is recorded primarily in standard terms selected from the drop-down menu, which is stored in an electronic format designed for this purpose. Within five minutes after the examination is completed, its results are recorded in electronic medical records (EMR). For comparison: in most echocardiography laboratories, test results are only available to the cardiologist at the end of the day. At Mayo Clinic, other cardiac exams (such as a standard ECG or exercise ECG) are also read by the cardiologists on duty throughout the day. The results, as a rule, are recorded in the EMZ within an hour and, extremely rarely, for more than two.

In the 1990s, Mayo Clinic began to move from paper-based to electronic management. This transition is the most complex and expensive engineering project of the clinic in its entire history. The practice of electronic records was introduced first in Jacksonville and Arizona, then in Rochester. Now the medical history should go to the doctor before the patient. In the era of paper records, even with the use of lifting and lowering devices, patients had to wait up to four and a half hours for the doctor to be sure that the medical history was delivered to him. Published EMRs are constantly available throughout the clinic. Thus, the appointment schedule is formed based on how long it will take for the patient to get to the doctor (independently or with the help of the attendants).

The group medicine model could not work effectively if the team members were not confident in their partners. Substantially modified, Dr. Plummer's idea reinforces this confidence. Dr. Sadosti says that from her perspective, what sets Mayo Clinic apart from other healthcare facilities is that the team members believe in her.

Respect is one of Mayo Clinic's strengths, but the organization must vigorously tackle disrespect at all hierarchical levels. Such cases do happen, but not often. The stakes are high, as the Mayo Clinic wouldn't be there if it wasn't for mutual respect. Teamwork depends on this.

The corporate culture of the clinic, which supports the principle of mutual respect, must be stable enough to overcome the boundaries of different positions, departments, campuses and bring together strangers. A colleague at Mayo Clinic means that even a stranger or new member of the team is perceived as a competent person with a voice. Moreover, mutual respect should be equally expressed both vertically (for example, between doctors and nurses) and horizontally (for example, between medical colleagues).

They were compiled by hand, and each one individually entered them into the thick registration books kept in his office.

The corporate culture of the clinic, which supports the principle of mutual respect, must be stable enough to overcome the boundaries of different positions, departments, campuses and bring together strangers. A colleague at Mayo Clinic means that even a stranger or new member of the team is perceived as a competent person with a voice. Moreover, mutual respect.

The Mayo Clinic is the world's largest community of multidisciplinary community clinics and research institutes and laboratories located in three states - Minnesota, Arizona and Florida. Mayo is a unified system of providing the most modern medical care... The clinic is accredited by JCI as the most competent institution in all traditional medical fields and interdisciplinary medical specialties of the 21st century.

Mayo employs over 3,300 doctors and 46,000 specialized staff. Each year, more than 500,000 patients receive treatment at Mayo at the best world standards, using innovative high technologies and new concepts of personalized medicine.

The largest medical center in the world is the Mayo-complex in Minnesota - Saint Marys Hospital and Rochester Methodist Hospital, which serve more than 350 thousand inpatients per year and 1.5 million outpatients. In just one working day, 205 operations, 41,000 laboratory tests, 700 X-rays, 3800 radiological and 250 MRI examinations, 650 CT scans, 200 blood transfusions, and 5800 consultations are performed.

Mayo Clinic is a large scientific center. In the state of Arizona, the Mayo system includes the largest complex of research institutes - Samuel C. Johnson Medical Research Buildings and the Mayo Clinic Collaborative Research Building. It develops and implements research programs in the field of molecular genetics and biology, in many other relevant areas of biomedicine in close cooperation with clinicians. Clinical trials of the latest drugs are conducted at Mayo Clinics, and patients have access to the latest developments in the field of pharmacology.

The Mayo Clinic in Florida is a multidisciplinary hospital complex specializing in 43 medical, primarily surgical, areas ranging from ophthalmology to orthopedics. Major achievements are noted in oncology, neurology and neurosurgery, organ and cell transplantation. In 22 operating rooms of Mayo Clinic Hospital, all types of surgical interventions are performed - from minimally invasive manipulations to the most complex operations with the participation of several surgeons of various specialties and the use of robotic systems, using MRI scans during the operation. The department of transplantation performs the largest number of liver transplants in the United States, kidney, heart, lungs, pancreas, and bone marrow transplants. The stroke treatment program at the specialized center is carried out by a multifunctional team, which includes resuscitation doctors, neurosurgeons, neurologists, radiologists, nurses, psychologists, and social workers.

Mayo Clinics are great training base for many medical colleges and universities, for the specialization of doctors and nurses.

Mayo conducts a tremendous educational work both among the population of the United States and around the world, widely informing users of its website about its own achievements in practical medicine and scientific work... Such work is an important part of preventive medicine and early diagnosis of diseases.

Mayo patients in the United States and many other countries can rest assured that they are receiving the best medical care in the world.

Leonard Berry, Kent Seltman

Mayo Clinic Management Practice. Lessons from the world's best service organization

All rights reserved. No part of the electronic version of this book may be reproduced in any form or by any means, including posting on the Internet and corporate networks, for private and public use without the written permission of the copyright holder.

Legal support of the publishing house is provided by the law firm "Vegas-Lex".

This book is well complemented by:

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Kevin Cruz and Rudy Karsan

Lean Six Sigma in Services

Michael George

Customers for life

Carl Sewell

Five vices of the team

Patrick Lencioni

War for talent

Ed Michaels, Helen Handfield-Jones and Beth Excelrod

Publishing partner's foreword

The correct book ...

The uniqueness of this book lies in the fact that it is very simple language talks about the cornerstone principles of building a customer-oriented organization, in which service and attitude towards its customers (in this case, the patients of a network of clinics) is set to the highest level. The authors constantly use live and concrete examples, using cases from the daily practice of the clinic's employees, and show how one of the most important principles of the clinic - “the patient's needs above all else” - is actually implemented.

The centuries-old experience of the legendary Mayo Clinic shows that the ability to listen is one of the most important conditions in building the "right" business, what success can be achieved if the goal of "making the world a better place" is put at the forefront. It is even more striking that people were able to create from this a whole culture that has lived for a century and is resistant to social change. And all the more I would like the book to find its readers in Russia and similar clinics began to appear in our country.

Medlinesoft team

To do full research and then write this book, we had to be in the role of both students and teachers. Before becoming teachers, we had to study an outstanding healthcare organization ourselves, and now we can tell you what lessons it has taught us. It was a fun and exciting journey.

We started our project with the conviction that we understand Mayo Clinic and what makes it great. We really knew a lot. However, now, when we write words of gratitude to the people who helped us, we understand how much new we have managed to learn. It takes careful research and analysis to write a good book. This is a truly effective way of learning. We carefully studied the material, trying to see what we had not paid attention to before, in order to discover new patterns and relationships. But it is one thing to think about ideas and quite another to turn them into words: this activity requires a clearer and deeper understanding. When your words have a long life in print, you want them to reflect reality.

We tried to find words that would describe Mayo Clinic as accurately as possible, convey the history of the services provided as frankly as possible, and talk about the lessons it teaches. We are grateful to many people who helped us on this exciting journey; his final destination was the completion of the manuscript. We were inspired to write this book by Carlton Ryder, who had a distinguished career with Mayo and retired in 2007. He was the first chief administrator of the clinic's new campus to open in Jacksonville.

There are many works devoted to the history of Mayo Clinic, but there have not yet been books on its service culture, strategy, management and systems approach to work organization. Ryder was convinced that such a publication would be useful not only to "outside" readers representing various corporations, commercial and non-profit organizations, as well as managers working in healthcare, but also to "internal" readers, that is, those who are directly related to the clinic Mayo. Thousands of new employees are added to the organization every year, and our book on the unique features of Mayo Clinic may be useful to them. Telling about the history of the clinic's services, this work is able to help many patients (and more than half a million of them come to the clinic a year) to understand why interaction with this organization makes such a strong positive impression on them.