Pictured above: Will and Charlie Mayo with their father, William Worrall Mayo.
On the evening of Sept. 25, PBS will air another documentary by Ken Burns. Developed with long-time collaborators Erik and Christopher Ewers, its focus is Mayo Clinic. It is an extraordinary tribute to one of the world's truly extraordinary organizations.
Entitled "Faith – Hope – Science," those three values echo throughout the documentary: In "Faith," as patient Tom Brokaw speaks of a "secular temple" and "holy ground." In "Hope," as across more than a century patients and families make their way to Rochester, Minnesota. And in "Science," as Mayo physicians and scientists pioneer not only in medical breakthroughs but in organizational design and management.
Shared Purpose and Deep Trust
Several fundamental commitments catalyzed faith, hope and science into excellence, including the clinic's steadfast 150 year dedication to teamwork. This is captured in the opening minutes of the film with an African adage: "If you want to go fast, go alone. If you want to go far, go together."
Those first few minutes also reverberate with thunder and lightning. In August of 1883, one of the worst tornadoes in the history of Minnesota devastated the town of Rochester. There was only so much William Worrall (W.W.) Mayo and his two sons, Will and Charlie, could do as they stood alone, surrounded by death and destruction in the storm's aftermath. So they turned to Mother Alfred Moes, superior of a small order of teaching nuns, the Sisters of St. Francis. As Will Mayo would emphasize throughout his life, "a union of forces" was necessary. The Sisters of St. Francis were to become as essential to the creation of Mayo Clinic as W.W. and his sons.
Among the other essential commitments that shaped Mayo Clinic was resolve. Having looked at the list of the more than 200 people who had been killed or injured in the tornado, Mother Alfred received a vision from God: she should build a hospital and have the Mayos serve as its medical staff. It was a vision only reluctantly embraced by W.W. But Mother Alfred was resolved to do what most felt to be impossible, raise money and build a hospital in a small, remote farm town on the edges of what was still a wilderness.
In fulfillment of Mother Alfred's vision, St. Mary's Hospital opened in 1889. The Mayos became its physicians and the teaching nuns of St. Francis became its nurses. Unshakeable resolve would evidence itself not only in Mother Alfred but in the Mayos as well. At the onset, teamwork became non negotiable for everyone who joined the clinic, as did the requirement that "the best interest of the patient is the only interest to be considered." The Mayos resolved to integrate care around the whole patient.
In 1986, as Mayo Clinic, St. Mary's Hospital and Rochester Methodist moved through a merger, an attorney asked Sister Generose Gervais for a copy of the contracts between the sisters and Mayo Clinic. He was flummoxed when she said there weren't any. The sisters' partnership with Mayo had, for a century, been forged and maintained with handshakes, shared purpose and a deep trust that each would always do the right thing.
Even today, all Mayo employees, including its physicians, have no incentives beyond the best interest of the patient. Their teamwork takes sacrifice, for it requires trust and a degree of subordination of individuality to be sustainable. Mayo physicians recognize the necessity of such sacrifice and are selected on the basis of their willingness to embrace it. But they get something very valuable in return. As the clinic's physician CEO John Noseworthy observes, they are "never alone." They have more than 4,500 physician and scientist colleagues and 64,000 Mayo employees behind them.
Another fundamental commitment that shaped Mayo was learning. From its earliest days, the Mayo brothers reached out and learned from others. Every year, one of them would take an extended sabbatical to learn from other physicians and institutions. By 1920, they had visited with physicians in every town in America with a population greater than 100,000 and had made 30 crossings of the Atlantic. It was an extension of a habit developed when they were young and traveled with their father in a buggy as he made house calls. After each call, their father would ask them what they had observed and then pose hypothetical questions. W.W. raised his boys in a life of medicine like farm boys raised on a farm.
Not only did the Mayos travel to learn, they encouraged fellow physicians to come to Rochester. There was much to see. By 1905, St. Mary's was doing more surgeries than any other hospital in the country. As the Mayos shared their methods with others, they invited suggestions for improvement while giving credit to the physicians from whom they learned or adopted a technique.
Research and teaching are, at their heart, about learning. With their homes paid off and money from their expanding practice "piling up," the Mayo brothers created and funded a foundation dedicated to research and education in cooperation with the University of Minnesota. Toward those ends, Mayo Clinic pioneered graduate medical education in America. It also led the way in training physician scientists – men and women simultaneously active in the care of patients and in research.
Across many decades, the rural population Mayo served was more financially challenged than that found in urban centers. In response to this disparity, it would charge wealthier, typically urban patients who traveled to Rochester while reducing or forgiving the cost of care for those with fewer means. Like institutions throughout America, the Great Depression threatened Mayo's existence. In response, its employees took pay cuts, and the clinic issued "Mayo dollars" to help them through the hard times. It gave away care to the needy. Still, Mayo grew.
Sustaining their advanced capabilities in methods and technology also required sacrifice. There were costs – personal, professional and financial – associated with moving beyond the status quo. For example, W.W. had studied under the great British scientist John Dalton and, as a result, had committed himself early to the power of the scientific method. With the support of his wife, Louise, he mortgaged his home to purchase what was at the time a very expensive piece of technology – a $6,000 microscope.
As Will and Charlie became more involved in the practice, they brought enthusiastic support for controversial medical methods, including those advocated by Joseph Lister related to sterile surgery. Despite widespread skepticism, they persevered and designed their procedures and facilities in accordance with Lister's principles.
Later, Will would challenge the clinic's pathologist, Louis Wilson, to figure out a way to determine whether a specimen was cancerous while the patient was still on the operating table. This he did by freezing the specimen and returning a result in minutes. In fulfillment of Mayo's commitment to make the patient consideration the only consideration, Wilson would insist that his pathology lab be located right next to the operating rooms.
Today, Mayo Clinic still has its pathology labs located next to where surgeries are being conducted. This proximity allows surgeons to know almost immediately whether the margins around a cancer are clear and has led to a fourfold reduction in re admittance for follow up surgeries. Just as importantly, it has greatly reduced the stress for patients who otherwise might agonize as they waited for their pathology results.
Mayo physician, Henry Plummer, pioneered the use of iodine to treat thyroids. But he also invented the uniform medical record that has become the accepted standard worldwide. He engineered a network of conveyor belts and pneumatic tubes to integrate care so the same patient information would be readily available to physicians throughout the clinic and St. Mary's.
Further, Plummer delivered on the promise of teamwork by putting multiple specialists under the roof of a remarkable building designed exclusively for the integration of care. He pushed the clinic beyond surgery towards comprehensiveness by embracing the then emerging field of internal medicine. In the film, when Pulitzer Prize winning author and oncologist Siddhartha Mukherjee comments on what distinguishes Mayo Clinic, he points to the engineered excellence of its integrated care.
Despite its accomplishments and international reputation, Mayo internist, Deborah Rhodes, reminds viewers that sometimes "the body is unexplainable" and that Mayo must always guard against the "illusion of greatness." Instead, it must re earn its greatness every day.
Looking to the Past and Future
Because this is a documentary directed by Ken Burns, it shouldn't be surprising that it gives great emphasis to history. Mayo has always given much attention to its history. It is through the example of its founders, and of those who followed them, that Mayo values were imbued with authenticity and integrity. By looking back, those who today comprise the Mayo Clinic can see its values lived out.
Mayo combined the power of its historical legacy with transformative vision. There was Mother Alfred's vision of a hospital. There was the Mayo brothers' vision of integrated care delivered by salaried physicians in a multispecialty group practice. There was Plummer's vision of a uniform medical record. There was a shared vision of ever-expanding capabilities in Rochester. And there was a broader vision of the Mayo model operating in Florida and Arizona.
Mayo not only looked back, but forward. As Will, near the end of his life, commented, "I look through a half opened door into the future, full of interest…." But he went on to emphasize that it would be left to others to continue to open that door. In 1919, when the Mayo brothers transferred their personal savings, all the assets of their clinic and all its future earnings into what would become a nonprofit foundation, they let go of their control of the institution they had created.
Two decades later, 1939 would prove to be a fateful year. Sister Mary Joseph, who had run St. Mary's Hospital for four decades, died. In May, Charlie passed away, and then in July, Will died of stomach cancer. Many thought Mayo Clinic would fade away with the loss of its leaders. It didn't. It continued to grow as it drew on the values imbedded in its past and its optimism for its future.
In the black and white photos of Charlie and Will's funeral processions, nurses form a seemingly endless white line along the road side. Somehow you know they never doubted their clinic would carry on.
As surgeon Mark Truty comments in the film, "We need Mayo Clinic." By "we," he means all of us. We need teamwork focused to the whole patient – integrated with resolve, sacrifice, history and vision; these are the things that turned faith, hope and science into something so remarkable. In an era often characterized by skepticism and cynicism, the Mayos, the sisters and the clinic they built together remain powerful symbols of the full potential of American health care. In September, PBS viewers will find that this beautifully crafted documentary conveys that potential in compelling fashion.
Author’s note: An excellent companion to the Mayo documentary is Management Lessons from Mayo Clinic, a book by Len Berry, University Distinguished Professor at Texas A&M University and an internationally recognized expert on service excellence, as well as a Senior Fellow at the Institute for Healthcare Improvement. In 2008, Professor Berry spent several months on sabbatical at Mayo Clinic in Rochester and Scottsdale. The result was a business bestseller (coauthored with Kent Seltman).
Dan Beckham is president of The Beckham Company, a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to AHA Today.