In Innovation Projects, Mayo Physicians See Their Roles Anew

A series of remarkable, documentary-style video interviews, present five Mayo physicians describing the very individual but very similar personal journeys of physicians deeply trained in the science of medicine, who now are striving to master medicine as an art.

Created by the Yale School of Management as part of an online, multimedia case study of the Mayo Clinic Center for Innovation (CFI), the nation’s largest health care innovation center, the videos describes how the three-year-old center was launched, how it operates, and how its goals mesh with Mayo Clinic’s historical mission to innovate in medicine.

Mayo’s CEO, Dr. John Noseworthy, is interviewed on video, as are Dr. Nicholas LaRusso and Dr. Michael Brennan, two Mayo physicians who co-founded the Center for Innovation. Two prominent innovation consultants, Tim Brown of IDEO and Larry Keeley of Doblin, who have both advised Mayo on how to apply innovation disciplines to health care delivery, are also interviewed.

The multimedia case study also includes video interviews with CFI designers Lorna Ross and Maggie Breslin; project manager Dan O’Neil; Mayo historian Matthew Dacy; outpatient lab manager Naomi Woychick; Mayo internist Dr. John Paat; administrative director Barb Spurrier; Mayo hospitalist Dr. David Rosenman; Mayo gastroenterologist Gianrico Farrugia; Mayo dermatology nurse Donna Beyer; and Mayo patient Kathie Philo; and others.

In-Depth Views

At the core of the Yale case study is a series of video interviews with five physicians who each participated deeply in different Center for Innovation projects, since its founding in 2008. While the projects sometimes led to significant changes in the physicians’ practices, the interviews are in many ways most notable for the personal reflections of physicians who were challenged to rethink their relationships to patients, families and their own colleagues – even to rethink their definitions of health and healing.

Dr. Victor Montori, an endocrinologist specializing in diabetes treatment, describes a personal turning point during which he shifted perspective away from the data collected about a particular patient’s disease, towards empathetically understanding the patient’s life, of which the disease, diabetes, was just one part.

“Say you are a patient who has been struggling with a condition for a few years,” Dr. Montori said. “When you come in to the visit, the doctor doesn’t ask how your efforts have been going. He does not acknowledge that you have been partially successful in a few of these. Instead he only holds you accountable to the results of your blood test, and then tells you that your sugar control has not been good.

Education Cards

“Immediately, you feel labeled as a bad patient,” Dr. Montori says. “You feel you are at the principal’s office and are being scolded! Now, what if we were to rethink that visit and think about the patient as a complex individual, living in a complex setting, and we try to provide support and expert advice along the way?

“My personal journey was from being an evidence-based medicine person, trying to get science to inform practice, to becoming a person interested in how health care service can be sensitive to the needs of the patient.”

Armed with this new perspective, Dr. Montori developed a series of diabetes education cards. The cards, showing the risks and benefits of taking the medicine over a period of time, structure a patient-physician conversation in which – surprise! – the physician acknowledges uncertainty about whether a particular patient will enjoy the benefits, or suffer the risks, of taking a medication.

Rather than undermining trust, Dr. Montori said, the physician acknowledging uncertainty actually reinforced the patient-physician relationship.

Dr. Dana Thompson, a pediatric ear, nose and throat surgeon, asked the Center for Innovation to help her department address a complex of issues concerning overwork, work flow, and lingering personnel issues.

Minnesota Nice

“With the changes in health care, new regulations, documentation and insurance and all these things, the burden to deliver care in a high-rate fashion just exponentially stressed our group,” Dr. Thompson said. “That’s how we started to partner with the Center for Innovation, to look at new ways of how might we redistribute the work load? How might we meet the needs of our patients and yet improve our job satisfaction, and not stress our entire team out?”

The project was carried out through a series of intensive, candid discussions, guided by CFI staff embedded in Dr. Thompson’s unit, in which all employees were allowed to fully voice their concerns, no matter how sensitive they were, and not matter how long it took to air them. It took a while to get going.

“We have a culture here of Minnesota Nice,” Dr. Thompson said. At first “it was really difficult to get people to speak out. People were good at saying, ‘This is what I like about the practice.’ We had to break that ice, that culture, to get people to talk about what the touch points were. Once we started working through that, people really opened up and got excited about the process. We said ‘We’re going to make this work better, move the process forward.’ That’s been really good.” The upshot has been increased numbers of patients seen, as well as increased satisfaction about the work roles of the unit’s staff, Dr. Thompson said. A distinctive feature of the Center for Innovation’s method is the application of “design thinking” – a creativity discipline widely used in the manufacturing and retail service industries – to drive innovation in health care delivery. At the CFI, designers trained at the nation’s top design schools and consultancies partner with health care providers on projects, guiding the process of practice or product redesign through observation, brainstorming and prototyping phases.

Creative Terms

For Dr. Clark Otley, a dermatologist, and Dr. Terri Vrtiska, the radiologist, working with the CFI’s artistically-minded designers offered not only a refreshing, but a critically useful change in perspective from medicine’s scientific mindset.

“Designers talk in very creative terms,” Dr. Otley said. “They are not so bound by tradition. The Mayo Clinic has so many amazing elements to it that I deeply respect, but there’s a time and a place to challenge everything. And they were challenging to us. They challenged each of us to step out of our preconceptions of how things had to be. They were awesome at breaking old concepts, facilitating open discussion, bringing new ideas and a can-do attitude to the process.”

The dermatology innovation project focused on helping a community-based Mayo dermatology practice boost its daily patient load to more than 50 patients a day, while hopefully also increasing job satisfaction among the providers.

Partnering with the CFI’s designers and project managers, the dermatology staff brainstormed their practice from top to bottom. In many cases, they saw opportunities for staff who previously had little interaction with patients, to take on tasks that previously only physicians had done. Work roles were redefined and, after some experimentation, the practice was seeing 65 patients a day.

Magical Moments

Importantly, “job satisfaction increased,” Dr. Otley said. “Initially, it was viewed as a threat and more work. But suddenly it became, ‘This is kind of cool, I get to interact more with patients, I feel like I’m part of a team and I’m an important part of this medical institution.”

Dr. Terri Vrtiska, a Mayo radiologist who heads a CFI project to fund new medical innovations by Mayo Clinic employees, said working with the CFI’s designers introduced new perspectives that reinvigorated her medical practice.

“As a physician, you are used to being in control,” Dr. Vrtiska said. “I didn’t have the designer’s skill set, so you had to let this opportunity grow behind your own limited knowledge base. But that became the most exciting part of it.

“Every time I came up and worked with our designers, I felt refreshed and rejuvenated. It was like being cold and coming to a fire. So I would come and get my flame built and then I could go back into my regular work day.”

Dr. Montori also described a certain kind of letting go of control as a way, paradoxically, to more artfully handle the human equation in medicine.

“We have to make sure all the education we get doesn’t get in the way of being human,” he said. “At the end of the day it’s that magic that happens, that dance that happens between the patient and clinicians. The job of the innovation program is to create as many of those magical moments as we can.”

By Doug McGill