Management Lessons from Mayo Clinic

Mayo Clinic has enjoyed huge growth over the last five decades, and built further facilities in two other locations across the US in the nineteen-eighties. Since then, it's also developed a network of medical laboratories, health information, and integrated health systems that have the approval of the Mayo brand.

Both the authors are experts in healthcare marketing. Doctor Berry, who's written several other books on service quality, provides what he calls the "outsider's" perspective. He's a professor of Humanities in Medicine and holds a Chair in Marketing Leadership at a renowned business school in Texas. Doctor Seltman was Marketing Director at Mayo Clinic for 14 years, from the early 1990s on. He provides the "insider's" point of view.

So, who should read this book? Well, the authors say their goal is to show how Mayo's lessons can be applied to other service organizations, inside and outside of healthcare.

But is this a reasonable aim? The high credibility of Mayo Clinic, its glowing reputation with patients, and the fact that it's lasted for so long, means that a management book about this brand should be of interest to the business world. Although there's no other service organization that compares exactly, the authors argue that ideas from Mayo Clinic can be applied to other services, from power plants, to airlines to restaurants.

Here at Mind Tools, we think Management Lessons from Mayo Clinic will most appeal to people interested in the history, philosophy, and practice of healthcare – particularly in the United States. But it will also provide much food for thought for readers interested in the roles of benevolence and philanthropy, as combined with efficiency, growth and financial logistics. In other words, how should the market – and management – respond in a humane way to a "need", as healthcare is, compared to a "want", such as leisure services?

All the same, readers are warned that this is not a gripping or charismatic read, with strong characters or a powerful storyline. It starts to sound like an advertisement for Mayo Clinic at times, although the authors emphasize that while the Clinic co-operated with the book, and even encouraged staff and former patients to give interviews, its contents were not under the Clinic's control.

So, stay tuned if you want to know why you might need a consultation to show that you don't need a consultation; why Mayo Clinic culture is keen to have "reluctant leaders"; and why customers should be seen as detectives.

Management Lessons from Mayo Clinic is divided into ten chapters. Each chapter ends with a helpful section called "Lessons for Managers" and a summary. Although the authors insist that it's important to read the book in chapter order, the more interesting and insightful chapters are in the latter half of the book, starting with Chapter Five. So these concluding sections at the end of each chapter may be useful for readers who want to cut a few corners.

The first chapter of Management Lessons from Mayo Clinic is really an introduction to the so-called "Spirit of the Clinic." Research has shown that many Americans consider Mayo Clinic to be what the authors describe as "a court of last resort." That is, when patients are faced with a life-threatening illness, like cancer, they'll leave their home towns and travel hundreds, even thousands, of miles to get a diagnosis from Mayo Clinic.

Some remarks in this chapter may seem obvious, like the observation that Mayo inspires loyalty in the patients it helps. Others may seem a little pious. However, in order to understand the rest of the book, readers need to note the first three definitions of the Spirit of the Mayo Clinic, which came from Doctor William Mayo himself. These emphasize, firstly: service and not profit; secondly, a genuine concern for each patient; and lastly, staff interest in the progress of other staff members – in other words, team spirit.

This chapter also raises the issue of how, in service organizations, social profit can be linked to financial profit. Generosity is seen to be a key to success, and the point is made that long-term service organizations need to act young to avoid becoming ineffective.

The second chapter, called Preserving a Patient-First Legacy, explains the philosophy and core values of Mayo Clinic in detail. The authors make clear that putting patient needs first is much more than a marketing mantra for Mayo staff. It started more than a century ago, but has since enabled Mayo management to meet customer-service needs in a modern age of medical consumerism.

The origins of "Patients First" lie in the collaboration between Mayo doctors and the sisters of Saint Francis of Assisi in eighteen eighty-three. Both the Mayos and the nuns saw patients as human beings with physical and spiritual needs, and this shared belief gave their work direction.

This chapter shows how this patient-centered focus – the Mayo legacy – is maintained through what they call "acculturation." This involves heritage celebrations every October, and a program called "Plus One," which empowers workers in the clinic to consult someone above them in the hierarchy, at any time of day or night, to get what the patients need.

The authors give an example of an intern whose patient had to catch a plane, but was concerned about his vision and needed an eye test. Late on a Friday afternoon, the intern called the ophthalmologist, who took time out of his schedule to reassure the patient that his eye appointment could safely wait until a later visit. The patient's concerns were taken seriously enough for him to be given a consultation with an expert physician, who was able to set his mind at rest.

For practical purposes, the way that Patients First works is best explained in the diagram called Mayo Clinic Model of Care. Unfortunately, the book uses all too few diagrams and tables, making its lessons wordy and time-consuming to digest.

But the book does use a lot of anecdotes and long quotations from staff and patients, some of which work well.

The Lessons for Managers section at the end of Chapter Two is useful and to-the-point. The first two lessons are about values – that the true values of any organization are the values its employees actually live out, and that when a value is humane, it will win over the hearts and minds of employees, whatever their beliefs or traditions. The third lesson is that substance is more important than words. And lastly, although values themselves should not change, the way they're put into practice will inevitably change over time.

The third chapter is entitled Practicing Team Medicine and it's largely self explanatory. Mayo's focus is on teaching and not blaming, we're told. And the authors describe how the Clinic staff focus on co-operation and integrated care. Unfortunately, much of this chapter seems to be self-congratulation or justification rather than an actual lesson in management.

Along the way, the authors mention how Mayo employees attend memorial services for patients who die, and they tell the story of an impromptu wedding that was organized for a patient who was found to have a terminal illness.

The first lesson for managers here is the home truth of "Act small even if big," because everyone likes personal service and hopes not to be swallowed up in a bureaucracy. The second lesson is to encourage what has been termed "boundary-less-ness." This is when workers break down strict definitions of work roles and authority functions, to remove barriers to closer collaboration.

What does this lead to in practice? Well, teams, committees, and study groups that bring multiple perspectives to shaping solutions, tend to foresee future problems and can therefore stop them from happening. By holding an early consultation together, they avoid having to have many more later on.

Mayo Clinic is an icon of what's known as "destination medicine," which is explained in Chapter Four. Destination medicine serves patients and families traveling long distances, as well as those living nearby.

Every year, more than a hundred and forty thousand patients travel from far and wide to Mayo Clinic. For this to happen, Mayo works with the patients' local doctors and has a system in place to ensure efficient care, with speedy attendance, lab test results, diagnosis, and analysis.

The lessons here are that a service organization should solve the customer's total problem, and that technology should be used for this purpose and not just to save money.

As you heard earlier, Chapter Five, called Partnering for Leadership, is the point at which this book becomes a good read, because it addresses the nitty-gritty issues of leadership, and how to form partnerships and gradually democratize. It traces the history of the legal separation of the clinic's assets from its limited partnership, with a deed of gift, or Trust, in nineteen-nineteen.

This is engrossing because it uncovers the historic efforts by the two Mayo brothers to transform control of the clinic into what the authors call "a co-operative science." While a little dry as a narrative, the concepts of employee leadership and partnerships show a creative and practical attitude toward management and decision-making on the part of Mayo Clinic, as well as a respectful attitude toward staff.

We learn that Mayo trustees are not paid to serve on the board, and that the company has a firmly entrenched tradition of rotational leadership. In fact, it seeks out what the authors call "reluctant leaders," because individuals who are ambitious for leadership may not put the patients' needs first.

The most important management lessons cover how to focus on a humane idea, so that staff seek more than financial gain. The messages here are moral arguments about the success of old-fashioned values. They're very different from the structured, step-by-step guidelines more typical of the business manual.

Between Chapters Five and Six there are six pages of black and white photographs and illustrations that bring to life the Mayo Clinic, its founders, and patients. Readers who have trouble getting their teeth into this book would be advised to sneak a look at these early on.

Chapter Six, on Hiring for Values and Talent, is one of the most lively, thanks to the interesting quotations from Mayo patients and staff. Anecdotes work well here, with the observation that service is performance: When hiring, you should think of yourself as casting a Broadway show. The metaphor of a caring organization as a "family" could come across as a cliché in other contexts, but it works well here. We see that Mayo Clinic tries to accommodate its more eccentric employees and doesn't let go of staff easily.

At the beginning of Chapter Seven we learn why customers should be seen as detectives. Appearances matter, and in the case of Mayo, clues such as dirty shoelaces display a glitch in staff commitment to their patients and visitors. The authors show that, in service organizations, customers are constantly absorbing clues – emotionally and rationally.

Chapter Eight introduces Mayo's current marketing and growth strategy – with the surprising information that the clinic uses very little advertising and it only had a one-person marketing team between 1986 and 1992. And despite past qualms about being a brand, Mayo is now moving into four different brand extensions.

The lessons drawn from Mayo on this topic will awaken readers' curiosity. Firstly, managers are urged to focus on the performers, that's to say the employees, and secondly, they're advised to play defense as well as offense. By this the authors mean that Mayo's historically cautious, and publicity-shy, approach that favors consistency over growth has been essential to make it last for so long. And by turning customers into marketers, Mayo Clinic has not had to invest in other forms of publicity.

The ninth chapter, on Investing in Tomorrow's Organization, touches on the tricky question of cutting costs in healthcare. It raises the idea that the entire American healthcare industry could move toward the Mayo vision. Regrettably, once again some parts of this chapter and the next frankly read like advertising – this time for the Mayo Clinic's glorious version of the future.

The last chapter is about Realizing Human Potential and focuses a good deal on care while patients are dying. Amid this highly charged and emotional topic, the authors discuss Mayo as an enduring and unique global brand and hint that Mayo's future may lie in the prevention of illness. "Healthcare needs the Mayo Clinic," is one of the authors' conclusions. Somewhat shamelessly, the book ends with a tear-jerking anecdote of a young nurse praying with a dying patient and his wife at his bedside.

Management Lessons from Mayo Clinic does not come across as an impartial book, nor as a book driven by a coherent management ethos. As a piece of writing, it's not very accessible, with long paragraphs, few diagrams, and hardly any tables. But what this book does offer is the story behind a great institution, and for that, it's of value.

One of the reasons why many non-Americans may not have heard much about Mayo is that free national healthcare is the norm in many Western countries. In parts of Europe, for example, private healthcare has only recently become part of the landscape. This book shows how traditional service ethics, home truths, and tried-and-tested values can survive and flourish in contemporary organizations – in the healthcare sector and elsewhere.

Management Lessons from Mayo Clinic: Inside One of the World's Most Admired Service Organizations is published in hardback by McGraw Hill.

That's the end of this episode of Book Insights.