Question

CASE STUDY

The Mayo clinic is one of the most respected names in medicine world. Founded in the 1880s in Rochester, Minnesota, the Mayo clinic embraced innovation from the beginning. It is believed to be America’s first integrated group practice as it employed the concept of coordinated, specialized care and sought out the best expertise.

At the core of the Mayo culture, from its inception to today, is a team approach and physician decision making rooted in shared responsibility and consensus building. Mayo holds a strong tradition of being a physician-led organization that champions exceptional patient care and medical research it is world renowned for its quality of care.

Today, the Mayo clinic is determined to set a new standard in health care by eliminating waste and improving efficacy. It has already succeeded in providing safer care that cots significantly less than the U.S. average. As the organization has grown and society has changed, a custom blend of quality tools and approaches has helped achieve a systemwide transformation, positioning Mayo to achieve its objective delivering the best health care, bar none.

As health care changed in the 1990s, Mayo began to approach quality with increasing rigor, measuring more thoroughly the results of its efforts with the help of the Juran institute, Mayo launched a full-fledged quality improvement program. Various leaders pursued six sigma training and shared their expertise with the organization. These efforts brought some improvements and helped develop future key leaders. But a conflict between efficiency and effectiveness felt by many organizations unfolded at Mayo the perceived cost of quality improvement clashed with improved results whether needed or not. the program was dropped.

The Mayo’s strategic advantage of being the “best of best” was tested. In 1999 the institute of medicine issued a pivotal report, building a safer health system. Which challenged health care providers to reduce preventable medical errors by 50 percent over the following five years. Crossing the quality chasm: a new health system for the 21^st century and several other influential reports followed.

The IOM reports were catalyst for Mayo to learn how it measured up in patient safety and care. Around this time, clinic personnel recognized some preventable errors occurred which put a human face on the report data and helped Mato leadership realize that all organizations-whether good or bad-need improvement.

Mayo also fae the challenge of being a destination provider as most patients travelled long distances and expected to complete their care in four to five days. Mayo examined its strategic advantages that brought patients hundreds and thousands of miles for care.

Under the leadership of then CEO Dr. Denis Cortese, Mayo initiated a number of steps toward quality that included.

• Taking s serious look at the gaps between its high aspirations and its good but far from perfect results.
• Paying greater attention to sentinel events which are instances of clearly avoidable major patient har. Such events were now regarded as system failures, not just accidents or bad luck.
• Learning from the achievements of other health care organizations such as the institute for health care improvement’s bundled practices research protocols and its 100,000 lives campaign.
• Appointing a chief quality officer Dr. Stephen Swensen, a physician who would partner with James Dilling and engineer by education, on administrative improvement.

Mayo resumed its journey by exploring quality theories including continuous improvement, Toyota;s production system the Baldrige criteria for performance excellence, six sigma, and lean as well as benchmarking companies that underwent successful transformations. The organization found the companies that used a blend of these methodologies as a basis for developing their own unique approach to quality had the most successful and lasting outcomes.

Understanding that one approach across its vast organization would garner the best results, Mayo developed its value creation system which blends the best aspects of numerous quality theories into a unique model.

As a first step Mayo pinpointed where the organization stood in terms of systems alignment and readiness against the Baldrige criteria for performance excellence.

Mayo also needed to look beyond improving individual clinic and focus on improving the entire system. Its doctors were leading experts who worked as craftsmen to address unique patient problems. Physicians were very independent and tended to practice what they knew best leading to many different ways to approach the same medical problem. How could the organization promote standardized best practices across more than 50 locations? Mayo was known for handling complex medical cases but how could it give its highest quality of care to all patients while reducing costs? Its culture valued physician interdependence, but it needed a culture that upheld both physician and support staff interdependence.

As Mayo leaders reflected on the organization’s values and mission, they realized that Mayo provided care and modeled health care on a national basis. The system needed strategic transformation while preserving what made it successful. It needed fundamental changes to its approach toward customers, workforce, operaction, and information, and knowledge management. Mayo used the seven parts of the Baldrige criteria to provide the following insight.

LEADERSHIP AND STRATEGIC PLANNING

Mayo made improvement and transformation and organizational priority. Initially, the transformation was seen as giving the best of Mayo to every patient. That approach evolved into an idea that patient-centered care is a win for financial outcome. Quality was not simply continuous improvement; it was the vision and mission of the organization. To Mayo, quality provides hope for the patient and it helps staff provide excellence in all they do.

The next strategic challenge was to make a truly great organization better, though the culture already encouraged the belief that Mayo was the best. This required a game changer. Leadership asked departments and units to display their performance data. Virtually every department or unit could report an imperfect situation. Although most of these events had no patient impact, there was still significant room for improvement. For Mayo, the challenge became “ are we as good as we can be?”

CUSTOMERS

Traditionally, Mayo viewed the patient as its customer. Certainly, the individual, immediate patient was Mayo’s primary customers, but it also needed to develop best practices to help all stakeholders and society. This led to fundamental questions, such as:

How should Mayo obtain information from stakeholders?

How does Mayo keep stakeholders engaged?

How does mayo determine its health care offerings to support stakeholders need?

WORKFORCE

Mayo prized physician excellence, and few would disagree that its physicians are some of the best the world. But what capabilities would the entire workforce need to overcome the new challenges in health care? To address this, Mayo developed cross-functional teams. The process improvements needed were greater than the staff engineers could handle, and the task needed contributions from all employees.

PROCESSES MANAGEMENT

Certain Mayo units developed excellent work systems, but these successes proved to be difficult to adopt systemwide. New approaches to design, improve, and control processes on an ongoing basis were needed. Mayo created a system to identify which processes to improve, the tools and methods needed to make improvements, and how to sustain the change in a cost-effective manner.

INFORMATION AND KNOWLEDGE MANAGEMENT

Information and knowledge management was a big challenge for Mayo. Like many other health care organizations, Mayo dealt with antiquated software not designed to measure patient outcomes. Not only did Mayo need to capture valid and reliable data, it needed to codify and share those data across the organization. Mayo also needed to roll operational level data up to the executive level, so that thinking and doing were connected in shorter learning cycles in real time.

Mayo leaders realized that they would need to carefully develop a deployment plan so these different components would act in concert. In addition, it was imperative that the Mayo founders’ original intent-to create excellence in health care-be maintained. The challenge was to preserve the core of what made Mayo clinic excellent and be ready to change everything else.

THE CHALLENGE

As Mayo leadership contemplated the enormous task ahead there were many issues to consider: The Mayo mission of care for patients, the culture of health care in the U.S. and at Mayo, change management in a complex organization, and how to begin this vast effort. The challenge was to translate these strategic issues into a workable deployment plan-one that would be not simply accepted but embraced by employees.

PART II

QUALITY DEPLOYEMENT AT MAYO

Change, especially transformational change, is daunting for any organization. Mayo leaders faced all of the archetypical challenges inherent with change of this scale-cultural sensitivities, technological upgrades, and vast organization to shift to NEW THINKING well-prepared for this change through its exposure to six sigma training, lean and the Baldrige criteria, Mayo leaders conducted a self-examination that brought the entire organization on board. Leaders asked questions and identified what caused barriers between desired outcomes and what actually happened on a day-to-day basis.

What distinguished this effort was a bottom-up approach, the idea that real quality care must characterize the frontline relationship between provider and patient. Only then could Mayo understand what it would take to achieve consistent, stellar results.

CULTURE CHANGE:Culture predominates in the construct, as it is the key to standardization and transparency and to assuring that the most accurate data are collected for measurement. One of the first FAIR AND JUST CULTURE, where every member of the medical team is encouraged to report anything that does not seem quite right, without rear of reprisal. After Mayo implemented the fair and just culture, an operating room nurse brought a potential problem to the attention of an experienced and respected surgeon. In a traditional medical setting, a surgeon is rarely questioned or challenged. The physician, rather than being peeved, thanked the nurse. These professionals now appear in an in-house training video demonstrating that a fair and just culture delivers superior results and better patient outcome

STANDARDIZING TOWARD EXCELLENCE: Another key element of Mayo’s construct is engineering. The organization had employed system engineers since the 1940s, but the quality construct spread engineering principles across all functions and taught staff to identify process flow, eliminate waste, and use duplication and measurement controls.

JOINGT REPLACEMENT: Like other health care providers, Mayo is encountering more aging patients with arthritis-caused joint deterioration. Hips, knees, and shoulders are being replaced by mechanical, artificial joint implants at a rapidly growing rate across the Unites States. A standardized process involving elements from various surgical teas was designed and proposed. After further refinement and approval, the new process was adopted as the standard of care for Mayo system, resulting in improved patient outcomes for all teams.

QUALITY ACADEMY: Mayo considered the following in its decision to launch the academy.

ROLE OF A QUALITY ACADEMY. The academy would make core knowledge used for decades in quality improvement, including six sigma, lean, re-engineering, and other related approaches, accessible to staff. It would ensure the widespread application of this knowledge across all locations and staff.

PURPOSES SERVED BY AN ACADEMY. The academy would prepare staff to reduce defects, reduce harm, reduce cost and create value using proven methods.

DELIVERY OF KNOWLEDGE. Though basic quality knowledge is widespread and is arguably generic, it was important to Mayo for staff to learn in a respected health care setting and apply their newly acquired skills in that culturally unique setting.

KNOWLEDGE AND INFORMATION SYSTEMS

AS ONE Mayo physician explained, each Mayo employee has two jobs; one in providing care or service, and the other in assisting in quality improvement, capturing and disseminating knowledge throughout the organization has been monumental task.

Read Case Study "Journey to perfect: Mayo Clinic and the Path to Quality" at the end of the course textbook.

Answer the following Discussion Questions:

1. Why would a world-renowned organization, Mayo Clinic, already known for quality embark on a quality improvement journey?

2. What were the challenges facing Mayo and the role of leadership?

3. Why is it important to align the organization's culture with its larger goals?

4. What was the role of standardization in improving quality?

Include on the last page of your paper a half-page paragraph about:

1. what surprised you as you read about business operations at Mayo Clinic?

2 one or two quality-related assumptions you had about a large health care facility such as Mayo that were either confirmed or disconfirmed in the narrative of the case. Please explain.

3. any other thoughts you have about the challenges of Operations at Mayo.

Bibliography:

SCHROEDER. OPERATIONS MANAGEMENT IN THE SUPPLY CHAIN: Decisions and Cases. MCGRAW-HILL EDUCATION, 2017.

Answer 1

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(1) Mayo is determined to set a new standard in healthcare by eliminating waste and improving efficacy. As the healthcare changed in the 1990s, Mayo began to approach quality with increasing rigor, measuring more thoroughly the results of its efforts. Though the organizational priority for Mayo was improvement and transformation, the approach was patient centric which resulted in good financial outcomes. However, Mayo wanted to provide hope for the patients and help staff provide excellence in all they do. Mayo’s strategic advantage of being the “best of best” was tested in 1999, the institute of Medicine (IOM) issued a pivotal report which challenged the healthcare providers to reduce the preventable medical errors by 50% over the following five years. The IOM reports were a catalyst for Mayo to learn how it measured in patient safety and health care. By then, the clinic personnel recognized that some preventable errors occurs in Mayo, put a human face on the report data and helped the management realize that all organizations needed improvement.

(2) The challenges are:

The leadership approach was patient centric which resulted in good financial outcomes. However, Mayo wanted to provide hope for the patients and help staff provide excellence in all they do.

The next strategic challenge was to make a truly great organization better, though the culture already encountered the belief that Mayo was the best.

Mayo considered their patients as their customers however, they now felt the need to develop best practices to help all stakeholders and the society

The process improvements needed were greater than the staff engineers could handle and the task needed contributions from all employees.

Information and knowledge management were a big challenge for Mayo.

Mayo’s leadership faced the enormous tasks like Mayo mission care for the patients, maintain the culture of healthcare in the U.S., and how to begin change management in a complex work environment.

(3) Mayo leadership believed that the quality of culture is based on
a. Design (the right treatment for the right patient at the right time)
b. execution (really doing things right every time to achieve the best outcomes) and
c. cost overtime. Hence, Mayo developed a quality construct which illustrates how the three components of infrastructure –culture, engineering and execution- align with its vision to provide the best care to every patient, everyday through integrated clinical practice, education and research.

(4) Mayo’s leadership felt that standardization would prevent harm, eliminate waste or both. Also, the widely adopted standardization would move Mayo toward nearly perfect outcomes- results that reflected the current best practice or the theoretical limit.

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