The Agenda - Total Teamwork

Once a decision is made, the Mayo organization executes it with the speed and effectiveness of a crack surgical team. But up to that point, Mayo operates in a way that reflects how physicians work and think: carefully, cautiously, and, above all, with a focus on getting things right the first time. "If you're a doctor and you come up with a great idea, do you go and try it out on a patient the next day? No," says John LaForgia, a spokesman for the foundation. "You have to make sure that it is ethical and effective and in the patient's best interest. That involves a scientific process and a lot of discussion with peers. We've extended that model to everything we do here."

At the same time, the clinic is acutely aware of the risks posed by such a deliberative style. A century-old organization with an outstanding track record is apt to feel little impetus to change -- and therefore it runs the risks of complacency, inflexibility, and obsolescence. So Mayo, in its calm and careful way, constantly looks for fresh ideas. It scouts out such nonmedical companies as AT&T, 3M, and Xerox, looking for innovative practices, and it constantly monitors competing health-care facilities.

Several years ago, for example, when other hospitals began opening up women's-health centers, Mayo formed a committee to consider starting a center of its own. "We made multiple site visits, evaluating the drivers behind other hospitals' decisions to open women's centers," recalls pediatrician and committee member Patty Simmons. "We looked at the components of these centers and at what they were able to accomplish."

After all that, Simmons says, Mayo concluded that creating a separate women's-health center might undermine women's ability to benefit from the resources of the entire clinic. The Mayo Clinic approach to assessing a new initiative: "You should recognize what you already have and are doing well," says Simmons. "One hundred years of acclaim ensures that any proposal for change undergoes very critical analysis." And very few proposals pass that test.

This is especially true when the clinic is entering a new area. When Mayo decided to create new information systems for its clinics, a physician-led committee oversaw the development of each component of each system. In acquiring new software for ordering medical tests, for example, doctors made sure that it was built around patient care, rather than around accounting practices. John Camoriano, 42, an oncologist and hematologist at the Scottsdale clinic, who led the IT effort, says, "We had a healthy, 'jaundiced' view of what software can and cannot do."

To ensure successful results, physicians insisted on a three-stage release. "With each successive release, we wanted to incorporate criticism and feedback about the unexpected ways that people react to and adapt to software," Camoriano says. "Intensive doctor input delayed the release significantly -- but that was worth it."

The Patient-Physician relationship

In the end, the true test of any new system or tool is its ability to enhance the primary element of the institution that it serves. At Mayo, the primary element is the doctor-patient relationship. New surgical techniques, new equipment, new drugs -- all of these are important. But the Mayo staff has long held that the quality of the doctor-patient interaction determines both the success of treatment and the quality of the "Mayo experience." All aspects of a patient's care flow from that primary relationship, and every system at Mayo is designed to support and nurture it.

Ultimately, patients need to feel confident that they can take part in their own treatment -- and that they can intervene when necessary, as Martha did when she objected to the proposed bilateral mastectomy. "Treating cancer is incredibly intense," says Hartmann. "It involves high emotions and life-threatening consequences, so there must be room for all opinions and for allowing patients the time and space that they need to find a practitioner with whom they feel completely safe."

Martha's surgery, which took place several months ago, appears to have been a success. Her chemotherapy is finished. "Her life is returning to normal," reports Hartmann. As it turns out, after continued discussion with Mayo doctors, Martha elected to have the second mastectomy, as a preventive measure. It was a hard decision, but in a more authoritarian setting, it would have been much harder.

To be sure, patients come to Mayo to receive superior treatment from a top-flight team of physicians. But what many patients are really looking for is an answer to the question "What's wrong with me?" "Patients know when something is wrong. That period of uncertainty is extremely difficult, and it requires a tremendous amount of energy -- both physical and psychological," Hartmann says. "Even when they are getting very difficult news, I have had many patients tell me, 'Thank you. At least now I know what I'm dealing with. Now I can get on with it.' "