The Agenda - Total Teamwork

Each afternoon, in a tiny workroom on the 12th floor of the Mayo Clinic, the battle against cancer begins with an argument. At 1 p.m., support staffers at the world-famous clinic in Rochester, Minnesota line the walls of the room with X-rays and cat scans from the current caseload. The space fills with a small crowd of cancer specialists, surgeons, residents, and nurses. For the next three hours, this talented team will debate the condition and treatment of the day's patients.

Today, for example, Dr. Lynn Hartmann, a medical oncologist, reviews the tests of a 65-year-old man with a possible kidney tumor. Hartmann is leaning toward conducting a relatively simple surgical procedure. But, as is typical of Mayo's century-old team approach, she asks fellow oncologists John Edmonson, 64, and Harry Long, 52, for their opinions. Joined by a nurse and a resident, these three physicians painstakingly trace the ghostly shapes on the X-rays, attempting to distinguish abnormal tissue from healthy tissue. Then, in a collegial but direct point-counterpoint exchange, all five of them debate the evidence. Their conclusion: The case requires a more complex treatment than the one that Hartmann initially favored. "I'll go talk to the family," says Hartmann, unruffled by her colleagues' having, in effect, overruled her opinion. As she heads for the door, a nurse checks the surgery schedule for an opening.

Every weekday, scenes like this are repeated all day long at the Mayo Clinic. They help to explain the institution's reputation for excellence in the world of medicine. At many top-ranked hospitals, a patient may spend weeks going from one specialist to another, receiving separate diagnoses and maddeningly divergent advice -- only to wait even longer for surgery. At Mayo, specialists don't just visit the patient; they swarm the patient as an integrated team, diagnosing a complex problem, proposing treatment -- and often slotting the patient for surgery within 24 hours of the diagnosis. "Many of our patients come from hundreds or even thousands of miles away," says Hartmann, an articulate midwesterner who came to the Mayo Clinic in 1986 for a fellowship and never left. "They can't afford to wait around."

Teamwork and speed aren't the only things that make Mayo different -- or that account for its fame. (According to the clinic, the Mayo name is so famous that it's recognized by 85% of Americans.) Patients who walk into the Mayo Clinic in Rochester enter an environment of comfort and tradition that is worlds apart from the institutional atmosphere of many modern hospitals. Fine art hangs on walls throughout the clinic. In the waiting areas of each medical department, professional greeters ease new patients through the admission process, reassuring them in homey upper-midwestern accents. They greet returning patients by name. Doctors see patients in private offices -- cozy spaces decorated with personal items -- rather than in sterile white-and-chrome exam rooms.

The overall effect is one of orderliness, function, and, above all, vigor. Indeed, at a time when many other medical enterprises are either suffering a fiscal crisis (cutting staff and reducing services), or struggling with an identity crisis (wondering what is expected of a modern health-care unit), Mayo is the very picture of a robust organization. Today, nearly a century and a half after the Mayo family arrived in Minnesota, the nonprofit Mayo Foundation has revenues of $2.9 billion and a staff of roughly 30,500. There are seven Mayo facilities -- including one in Scottsdale, Arizona; one in Jacksonville, Florida; and a brand-new state-of-the-art hospital in Phoenix -- and each year, more than 400,000 patients visit one of them. The Mayo residency and fellowship programs are among the most sought-after in the world. Last year, nearly 7,000 people applied for slightly more than 360 positions.

How has Mayo been so successful? Having top-notch talent doesn't hurt. Mayo's medical staff is widely regarded as being among the best in the world. Mayo's administrators have invented (and reinvented) the business side of medicine. It was Mayo, for example, that developed one of the world's first systems of centralized patient records -- a landmark organizational effort that is now evolving into a paperless data system that digitally stores records, lab results, and X-rays. Such efficiency-promoting innovations help explain how Mayo can keep costs low enough to admit patients from all income levels. In fact, while Mayo may have gained recognition as the clinic of the international elite -- before his death early this year, for example, Jordan's King Hussein received treatment there -- 97% of Mayo's patients are from the United States, and 35% are on Medicare. Notes Dr. Gerald Gau, 60, a cardiovascular expert in his 31st year at Mayo: "Medicare has been here twice now, trying to figure out how we can be so fast and efficient, yet treat our patients so well."