The Agenda - Total Teamwork

The Culture of Care

For all of its prowess in science and technology, the Mayo Clinic owes much of its success to its culture. From the most senior surgeons to the greeters in the patient-waiting areas, everyone appears animated by the medical equivalent of high-school spirit: They all seem to take enormous pride in Mayo's greatness and to derive personal satisfaction from maintaining its stature.

How does Mayo maintain such a tight culture? By growing it. While Mayo does occasionally recruit doctors, much of its talent is homegrown -- trained in its own highly selective medical school and in its residency programs. Last year, the medical school accepted only 42 new students and only about 5% of those who applied for a residency or a fellowship. From these highly selective programs, Mayo hires about 45 new physicians each year. The result: Mayo gets not only the most talented physicians but also the most "Mayo-ized" physicians -- doctors who are fully acculturated to the Mayo system.

For Robert Brown, a 37-year-old neurologist, "Mayo-ization" began early. In his first year at the Mayo Medical School, Brown was already on a clinical rotation: With one or two other medical students, Brown teamed up with a Mayo physician. The students visited patients and reviewed one another's examinations and diagnoses. "From the start, you learn that amiable sharing drives the Mayo system of patient care," Brown says. "It's ingrained."

After four years of medical school, Brown entered the Mayo residency program in neurology. He and his fellow residents found themselves spending more than 100 hours a week in on-the-job training. That regimen involved engaging in education and research, serving on governing committees -- and, above all, learning the Mayo approach to patient care. "The adage here is 'The needs of the patient come first,' and as a resident, you see that principle in action every day," Brown says. "You see the consultants and senior residents promoting it, even though they're extremely busy. Pretty soon, you start believing it yourself." So completely did Brown take to the Mayo-ization process that his department offered him a staff position -- even before he had finished his residency.

But not everyone adapts so well. According to Mayo old-timers, the process is so exacting, and the culture so distinctive, that it usually becomes clear right away whether a trainee has the right attitude. "You can tell early on," says Brown, who now helps with Mayo's hiring process, "by how they interact with patients, by their enthusiasm for seeing extra patients, by their drive to find answers to puzzling clinical questions. You watch people, day in and day out, and you can quickly tell who has the attitude as well as the aptitude that Mayo requires."

Physician, Lead Thyself!

Medicine isn't the only team sport at Mayo. From the clinic's earliest years, nearly every element of its operation -- from lobby decor and patient billing to surgical practice and market expansion -- has been handled by committees of doctors. "We're a very horizontal organization," says Dr. Robert Waller, 62, an ophthalmologist who served as president and CEO of the Mayo Foundation until early this year. "We seek input broadly, and while that may cause us to take more time to reach a decision, it has served us well in the long term."

Almost from their first day at Mayo, many physicians have a seat on one or more governing committee. This early participation begins their training in Mayo's collaborative style. Committees also guide the clinic's promotion process -- overseeing the appointment and advancement of managerially gifted doctors. That process is pivotal, since Mayo offers no tenure, and committees choose new chairs each year. (Even so, effective leaders tend to stay put: Waller was president and CEO for 12 years, and his two predecessors each served terms of roughly the same length.)

The consequences of this physician-directed, committee-style leadership can be significant. For example, while Mayo physician-administrators rely heavily on "lay" administrators for business expertise, doctors -- people whose primary focus is on medicine -- make all final decisions. Predictably, such consensus-driven management isn't very fast. Several years ago, says Waller, the foundation wanted to determine the ideal rate of growth for Mayo's various clinics. A task force was formed, and its members visited each clinic, holding exhaustive interviews with everyone from division heads and department chairs to individual staff members -- a painstaking process that took months.

Yet as slow and frustrating as this style can be, it is widely acknowledged that Mayo could operate in no other way. Current business theory may insist that companies should be able to change quickly -- or die -- but Mayo clearly thrives by moving into new areas slowly and cautiously, balancing the need for new ideas with the bedrock requirements of safety and stability.