Q. Most people would agree that healthcare is a fractured system. How is one of the world’s leading healthcare organizations tackling this issue?
To date, the system has been optimized to mitigate risk, not to create value—but that is beginning to change. The main issue is, as ironic as it sounds, healthcare has not been sufficiently patient-focused. The traditional model is more like a ‘conveyor-belt’, whereby a patient moves from one specialist to another, and he is the only constant: he might go from a cardiologist to a radiologist to an oncologist, and it’s up to him to preserve his ‘story’ throughout these encounters.
Mayo Clinic is unique because of our integrated practice model. This essentially means that all the services a patient might need— doctor visits, testing, surgery, hospital care—are integrated. The scheduling is done in a coordinated and efficient way, so what might take months to accomplish at a community hospital can be done in a matter of days here. Our approach also brings a range of ideas, knowledge and experience to bear on each case, ultimately providing better answers than any single physician could provide individually. So, rather than trying to ‘fix’ a broken model, we are working together to imagine an alternative future for our patients.
Q. Once an organization becomes highly successful, it sometimes just gets better and better at doing the same thing. How do you avoid this trap?
At Mayo, we have a dedicated Centre for Innovation, where our motto is, ‘Think big, start small, move fast’. We embrace Design Thinking, which has become a vital tool in fueling innovation across industries. Our team fuses design principles with scientific methods to uncover human needs in the healthcare environment, using empathy, creativity, systems thinking and a human-centered focus. Our methods include ethnographic and observational techniques, visualization, prototyping, sketching, brainstorming and more. Working directly with patients and providers allows for rapid prototyping, which leads to new insights and addresses problems in the current delivery system.
As any organization grows, it is increasingly difficult to be agile and spontaneous—and we have suffered from that at Mayo, too. As you scale up—and particularly in an industry like healthcare, which is so regulated—your energy naturally goes into stabilizing your existing model. Basically, you build this big battleship, and then your job becomes keeping it afloat. Unless you carve out a completely separate set of resources that are independent from the group keeping the thing afloat, your resources will be consumed maintaining the status quo.
Our Centre for Innovation is an example of the kind of investment an organization can make to ensure it doesn’t become immune to signals from the external environment. We’re in an extreme situation—we’re located in the middle of the cornfields in Rochester, Minnesota, so we have no competitors nearby. If you exist in an environment without competition, you are very likely going to lose your competitive edge; for us, it takes dedicated effort to remain on the leading edge.
Even the most innovative companies need to take proactive steps. Last summer, Google announced the creation of a parent company for itself, called Alphabet. Founders Larry Page and Sergey Brin realized that Google was consuming all of their creative energy, and they felt they were becoming too bureaucratic. So they shook things up, so they could re-focus their energy on innovation.
Q. Fostering innovation is a primary focus for most organizations today. Describe how you engage your employees in innovation.
One of the most efficient sources for gathering great ideas is enabling your employees to tap into their creativity. Innovative organizations find ways to provide employees with ‘thinking time’ —empowering them to work on projects that they are passionate about, outside of their normal work. Google and 3M were two of the first to do this.
Innovation in health care has never been more important. However, in an industry where days are carved up into time slots with patients and appointments, ‘free’ time is hard to come by. That’s why, in 2009, our Center for Innovation created an internal grant program that gives all Mayo employees an opportunity to apply for funding to pursue an idea they have developed. By setting specific parameters for this funding— such as completion timelines, working with Center design teams, having physician proponents and a representational team from many sites —we gave watched these funding dollars grow into successful new models for delivering care.
Q. Your main competition used to be other academic medical institutions, but your industry is being radically disrupted. Talk a bit about your new competitors.
The shift came when all U.S. medical organizations were forced to adopt electronic records. This was largely a legislative move to protect patients, and make sure that their information could be shared effectively. From that point on, every practice had to have a legitimate and robust system of encrypted medical records. Overnight, we became an industry less defined as a service industry to more of a knowledge industry. If healthcare is a machine, the fluid that’s moving around inside of it is information.
When this happened, companies that were already established in terms of managing information began to see the healthcare industry as overlapping with their competencies. They started talking to healthcare companies, saying, ’We already do 95 per cent of what you need to do—we just do it for banking and other industries.’
And it’s not just IT companies: on the most recent list of Fortune 50 companies, 24 named healthcare as their key growth area for the future. These retail, telecommunications and car companies are starting to see that they can develop niches in the health space—not in traditional healthcare, but in terms of maintaining and preserving health.
Q.Tell us a bit about how you deal with the complex emotions that your organization engenders in people.
In the design of any institution, there is an explicit goal of trying to prompt certain behaviours. For example, with urban planning and public spaces (like train stations or airports), the design itself sends cues to people about the most effective way to move through the space. These cues are often cultural, as well, and as a result, when people travel to different parts of the world, they often can’t interpret them. But over time, they are becoming more and universal.
The same is true of healthcare environments. Traditionally, there has been a certain look and feel to healthcare spaces in order to trigger role-playing and the establishment of trust. At Mayo, we’ve invested a lot in our built environment. It’s very pristine, but not too clinical, because our clinic is for outpatients. In an outpatient setting, there is less risk of infections and other issues that hospitals face. When people walk in here, the first thing they should experience is a strong sense of relief and a feeling of trust. People are completely in awe of the physical space here—they instantly feel like it’s the Mecca of healthcare. When your customers trust you, you don’t have to spend time establishing credibility, which means you can quickly get into a more meaningful conversation and begin to make progress for the customer. Our environment is really important in this respect.
Q. Why is human-centred design such a powerful tool in healthcare and other industries?
We define human-centred design as ‘a process of progressive inquiry whereby concepts and solutions emerge from a close collaboration with users’. This helps you understand the role of the user in your system. It also helps you understand your users’ capacity—and their limitations. In the end, we have found that this approach really helps to determine where resources will have their greatest impact.
Q. You have decried the ‘Wizard of Oz’ nature of healthcare, where so much is hidden from the patient. Please explain.
For most patients today, the system ‘behind the curtain’ is completely invisible, so a big part of their experience is a lack of understanding about what is going on. One of our designers recently observed an interaction between a patient, his caregiver and a resident. The resident left, to talk to a consultant, and she was gone for 45 minutes. Because the designer was in the room, she heard this narrative emerge, whereby the husband and wife described to each other what they imagined was happening. ‘Oh, they’re probably checking my medical records or looking at some other reports’. Within minutes, they had created this whole narrative about what was happening behind the scenes. There is such a curious tolerance in patients; in the absence of shared information, they have become accustomed to filling in the blanks themselves.
I actually think we hide too much from patients. For some reason, we’ve decided that it’s too messy or stressful to show them how the system really works. But in my experience, patients really want to see the machine in action. With the advent of tele-medicine and other technology-enabled practices, we won’t be able to continue hiding so much from people.
Other industries have embraced transparency in a variety of ways. For instance, many restaurants have open kitchen areas, showing their chefs making the food, and despite the chaos and mess, people love it. There is something about the authenticity of skill and craft, and being able to watch something happen organically. We believe patient experience initiatives should focus less on adding art to the walls and other common practices, and more on engaging patients in the process, de-mystifying things, and unveiling some of the ‘magic’ that is kept behind the scenes in healthcare.
Lorna Ross is Director of Design in the Center for Innovation at Mayo Clinic.
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[This article has been reprinted, with permission, from Rotman Management, the magazine of the University of Toronto's Rotman School of Management]