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July 23, 2014

Why Mayo Clinic's CEO wants to serve 200 million patients—and how he plans to do it

Daily Briefing

This interview of Dr. John Noseworthy, President and CEO of Mayo Clinic, was conducted by Eric Larsen, managing partner, and condensed by Dan Diamond, managing editor.

Question: I've read that before you joined the Mayo Clinic—and this was decades ago—one of your first encounters with the organization was when a physician was supposed to visit your hospital for a commemorative dinner…and he missed it. Can you talk a little bit about that?

John Noseworthy: It was one of the two or three most pivotal moments in my life.

You're right, he missed his flight—and it was because he was with a patient.

I was very young and I remember thinking, "who is this man who is so humble that he would put the needs of the patient ahead of his receiving  a distinguished recognition." And then I wondered what organization could retain and keep a person like that.

It was Mayo Clinic.

At the time, I didn't realize that I would end up working here. But that's the ethos and values of Mayo Clinic. It's very affirming to me—knowing that everyone has the same purpose here:  to do what's right for patients. And it’s exceptionally gratifying to be surrounded by people every day who believe in that purpose.

That's one reason why I'm here.

I'm glad you saw that story. That's every bit as true now as it was 30 years ago.

Mayo's strategy

Q: You've spoken about an ambitious goal—by 2020, to have Mayo serving 200 million patients. At the same time, you're not taking a traditional M&A approach to grow your footprint.

Noseworthy: We want to optimize what Mayo Clinic has done for years:  providing face-to-face care for people who are seeking hope and solutions. And in this very challenging environment, optimization on that level is no small order—we're focused like a laser on that.

We have 400 or more engineering projects in flight right now, many of which are conducted to improve the safety and quality of our care and reduce the cost of our care.

There's considerable focus on that—as you might imagine—being now well into our 150th year of operations in the modern era, being a leader in health care.

But at the same time, we want to extend our reach. There's both a humanitarian  and a business side to this major initiative .

Q: Can you talk about that balance you're trying to strike?

Noseworthy: We're a not-for-profit, humanitarian organization and we've often said, "How can Mayo share what we know with others"—our approach to patient-centered, salaried physicians, our underpinnings of research and education. And certainly our culture of team-based care.

There are many great organizations in the world that also provide team-based care. We're not saying for a moment that Mayo is alone, but we've been at it for a very long time.

We've been asked over and over again, can we open up health care operations in other states and in other countries? But it's hard to scale a culture of team-based care.

What we realized we had an opportunity to do instead was scale our knowledge through a knowledge delivery strategy and not a merger and acquisition strategy.

Q: How does 'scaling knowledge' fit into what Mayo already does?

Noseworthy: I'll give you an example. Every patient who comes to Mayo has a team. If more than one physician is needed—and 95% of the time, more than one is—the team focuses around that patient and shares their knowledge of how best to handle the problem.

Since this is at the heart of what we do every day, we decided to create countless delivery of care scenarios, gather input from the care teams that interfaced on that particular problem and then digitize that information so that it could be shared inside and outside the walls of Mayo Clinic.

This knowledge-content management system, which can be edited and updated daily, and shared with others that want to have Mayo Clinic “inside.” Mayo Clinic knowledge assures them in providing seamless, high-quality, team-based care.

Q: It sounds like you're describing the Mayo Clinic Care Network.

Noseworthy: We saw that as an alternative to an M&A strategy. And we think it's more patient-centered, because it's right at the bedside.

Every time we have an innovation in how we work, we can update the knowledge content and share it with others. And this allows patients to have access to Mayo knowledge, wherever they live in the world.

And providers who may not work in as much of a team-based model as we do [can] take advantage of what we know to provide higher-quality care to that patient, every day, wherever they live.

That's been the foundation of the Mayo Clinic Care Network.

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Q: Which our Daily Briefing has covered extensively. Can you describe, in your perspective, the core elements of the network?

Noseworthy: The network is our subscription-based model that has now been up and running for more than two-and-half-years.

And we now have 29 groups, 27 of which are in the U.S. and one in Mexico City and one in Puerto Rico. And they're subscribing to our knowledge—care process models, order sets, patient education materials, and FAQs around thousands of medical conditions. Clinicians are getting a tool right on their desktop.

That will allow specialists, or a couple of specialists in different specialties, working in a medium-sized group to say, "well, wait a minute. We need to bring others into the team. But Mayo's already done this." And they can use that desktop tool to provide better care and keep the patient right there in Chicago, or Pikeville, or San Diego, and so on.

If that's not enough to answer the questions around how the patient could be managed, it's very easy to determine which teams wrote the materials—to contact the teams at Mayo to learn more information.

And if that's not enough, let's do an e-consult.

All of that is done without any charges being passed on to the patient, which is fabulous because it's part of a subscription model.

And then if they say we'd like to send the patient outside of our system, that's where the connection with Mayo could be useful.

Q: That's a useful picture of how the network operates—how you're scaling through knowledge.

Noseworthy: Yes, and as you were alluding to earlier, this knowledge content management system—we call it "knowledge as an integrator"—is an alternative to an M&A strategy.

Hopefully there will be some good integrated care that will come from it. But this is right at the heart of what we do every day, with teams of cardiologists, infectious disease surgeons, sharing their expertise.

That's an important innovation for us. And it gets at one of the two key drivers we think can be managed as a medical profession: unsustainable rising spending in health care.

Some of that deals with the fragmentation of care and the accompanying over-utilization of services — especially in places that don't have a system in place to really have a team-based model of care.

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Q: So that's the first driver of unsustainable costs. What's the second?

Noseworthy: The second key driver of unsustainable health care costs that we can manage as a profession is the uneven quality of care. And there are many, many, many wonderful doctors and small systems.

But most of us would say that uneven quality of care is responsible for a huge part of unnecessary health care spending. If you get the diagnosis late or wrong, patients suffer and get inappropriate care.

And that gets to the second transformative innovation that Mayo Clinic is doing in this space—the Optum Labs innovation that we put forward a year and a half ago in Massachusetts. Our investment in a new center for health care delivery supported in part by our commitment as the founding medical partner in Optum Labs.

Here's why that's so striking: The field is moving ahead with great alacrity. And all of us in health care are proud that quality, safety, and transparency of results is really part of the norm now in how we practice medicine. That's been a huge advance. We can compete now on quality metrics, safety metrics, in public and we can learn from each other.

But we've been unable to get our hands around the cost of care. What is the cost of care…what is the spending over an episode of care? No one has been able to get to that. This relationship with Optum will give us data on 150 million patients over a couple of decades, and what they spent their money on in health care.

Think of what that data could tell us. It could help us get to who had the best outcomes, and who had the worst outcomes. What was the spending? What are we doing in the medical profession? What contributes to that outcome, what works?

And once we've found what innovations really matter, we can share that data with other providers, and patients, and their families.

So who has the safest care at the lowest cost over time? You let market forces drive the safest care.

Q: And you think Mayo Clinic can play a key role in spreading this knowledge.

Noseworthy: It gets back to our idea of "knowledge as an integrator."

In this digital world, we can work to one day to have a meaningfully interaction with 20 million people per year.

Yes, we're being bold. But by no means do we think we have the only answer.

On Mayo's culture

Q: I read an excerpt of something that Dr. William Mayo said in 1910—"We are animated only and exclusively by what is good for the patient." How is that sort of animating principle manifested in 2014?

Noseworthy: That's right. And he further said, It takes a “union of forces” to do that. Meaning, other professionals and other technologies—it takes all of this to make it happen.

Those principles, the purpose of our work, have never been more fundamental to us in order to realize the potential here.

We couldn't do it without our staff. And we're lucky—we have 60,000 staff members who are motivated by just one thing. They're motivated by what's good for patients.

We think Mayo Clinic is the most trusted name in health care, but for our mission to continue for another 150 years, we need to be affordable. People want high-quality care that they can afford. Trusted and affordable. That’s the value equation—essentially outstanding results, better outcomes, better safety, better service, overall better quality but at a lower cost.

That’s what motivates our doctors to work in teams.

Q: But getting back to your earlier points about sharing information, it sounds like Mayo's culture is built on learning from other organizations. That you're open to best practices from across the industry.

Noseworthy: We're championing a transparent data-driven marketplace. We know we can learn from our colleagues at other great centers in the country. Maybe their value is higher than ours for a certain procedure, a certain process.

We want to find out so we can do it here.

The principles of team-based care and people helping each other, that's what is most important.

Leadership lessons

Q: You're a physician who's become CEO of one of the most prominent organizations in health care. What advice do you have for others who might aspire to a similar path?

Noseworthy: There are people out there who are being promoted into tough leadership roles. So I'll speak to that.

And they should know that there are a lot of people who have been in those positions who have learned from their experiences and have those experiences to share.

My advice is you should ask for help from them the same way that you ask for help from your colleagues in medicine.

That's been very helpful for me to reach out to others—to say "this is a tough one; what would you do?"

It sounds so naïve but as a physician…it seems like many physicians still tend to feel that they still have to solve problems on their own. That they can solve these leadership challenges by themselves.

So if you've been asked to be a department chair or a dean or a provost—you should realize that you're not alone out there. There are people within your organization, or even outside, who can help you take the step into leadership.

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