In the early 2000s, Mayo Clinic physician Nicholas LaRusso asked himself a question: If we can test new drugs in clinical trials, couldn't we also test new kinds of doctor-patient interactions. The Mayo Clinic Center for Innovation was soon born. Lorna Ross heads up its Design Group
The Mayo Clinic Center for Innovation’s projects are focused around three areas: Redesigning Practice, Community Health Transformation and Care-at-a-Distance. Which currently contains the greatest challenges?
All three hold uniquely different challenges, but I would say Redesigning the Practice has the greatest amount of scrutiny around it. That’s because there is an existing practice model in place and everyone who works here is highly invested in it. As you can imagine, any group that has been tasked with possibly undoing some of that is going attract a lot of attention. As a result the process risks becoming ‘design by consensus’, so it’s been quite challenging to foster the divergent exploration from which we hope the disruptive model may emerge.
The Community Health Platform is something Mayo has less precedent in -- though we do currently care for the local Rochester community in addition to almost 60,000 employees and their dependents. Historically, Mayo has operated very much as a ‘destination medical centre for specialist and sub-specialist care’: people come to us and we are able to micro-manage and control the environment that they come into. Some have said it’s like getting onto a spaceship, and in many people’s minds, that’s why Mayo is so hyper-efficient -- because we manage every aspect of each patient’s experience once they get here.
Many groups within Mayo have been driving towards efficiency for years, adopting principles or standardized practices like Six Sigma and Lean, but the problem is, health care is extremely unpredictable. You can never standardize something that is so personal and has so many moving parts. Add to these complications our sheer size and the fact that our physicians practice according to a more individualized practice model that often defies standardization (which is both good and bad). So we are dealing with this infinite combination of variables, within an industry driving towards standardization.
Then there is Care at a Distance, which to me, feels like the least complicated platform, because it really comes down to creating physical tools to deliver on the exciting potential and well overdue promises of ‘telemedicine’. If you ask 10 different people what the quintessential Mayo experience is, you’ll get 10 different answers. Yet we’ve been trying to package some of Mayo’s services so that they can be effectively delivered at a distance via computers and video technology that recreate the experience in different locations. Of course, some of the dynamics that work for an experience in the downtown Rochester setting – which is a huge clinic -- would be really inappropriate in a smaller clinic, so we have to take that into consideration. The challenges here lie in matching the experience to the environment and the context.
Much of the work you do entails getting stubborn humans to behave differently. What have you found to be the best approach to this age-old challenge?
Like the word innovation, the term co-creation gets overused these days. But whenever you’re working with a group of people, there is real value in figuring out a role for each of them to play in the process. The alternative is simply handing something that you’ve created over to them and trying to convince them of its merits. If people have a hand in crafting something, it’s much easier for them to embrace a new model. It’s also more respectful of the inherent complexity of the work everyone does here every day; we would never even imagine that one isolated group, such as ours, could have a complete and comprehensive understanding of everything that they do.
While the idea of engaging people in the creation process is great in theory, it often doesn’t always work out as planned, because particularly in our environment, people simply don’t have the time. Taking up a surgeon’s time is extremely expensive -- especially for something that is seen as a non-essential activity (one that doesn’t deal directly with patient care). So we have to be very careful in terms of how we use peoples’ time. We tend to do a lot of workshopping with groups and ‘low-touch moments’, where we’ll sit in on their meetings and support them in being more effective together. As much as possible, we try not to do the work for them. People often ask us to do some work for them, but we always say, ‘How about we do the work together?’ Doing it ourselves would likely be much faster, but that’s a trade-off we’re willing to make, because we realize we’re investing in long-term relationships and smooth hand-offs.
One key learning for us has been to invoke the patient as the voice of reason whenever possible. I’ve been here two years now, and every single person I’ve met is completely focused on our patients. As a result, they are strongly drawn to any idea that will improve patient experience and outcomes. If we can show a positive benefit for a patient, people will put their assumptions and needs aside and listen.
Lorna Ross (far left) with the OCADU team that won the Rotman Design Challenge.