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Len Berry On Mayo's 'Soul Of Service'
By Russell C. Coile, Jr.

(Note: This essay first appeared in the April 2002 issue of Russ Coile's Health Trends newsletter.)

"Healthcare is America's most important service industry. One of the goals of my research at the Mayo Clinic is to define the ideal service experience, from the perspective of the patient, the physician and the allied health professional." -- Len Berry, author, The Soul of Service (1999).

The Mayo Clinic is the citadel of the best-of-the-best medicine. From around the world, patients bring their difficult diagnoses and complex conditions to Mayo's flagship facilities in Rochester, MN, and more recently to Mayo's new clinics in Scottsdale, AZ, and Jacksonville, FL. The Clinic's website, MayoClinic.com, is one of the top-ten most popular consumer health destinations on the Internet.

Mayo was recently recognized as the #2 hospital in America in U.S. News & World Report's annual listing of the "Best Hospitals in America," as well as the Report's "Honor Roll" of facilities with more than 6 or top-ranked clinical specialty centers. Mayo's reputation is based on the excellence of its clinical medicine. Less well understood - but perhaps just as important - is that Mayo's service excellence is what makes Mayo Clinic care a superior experience for its patients.

Best-selling customer service expert Berry, has just returned from a five-month research sojourn at the Mayo Clinic. As the Distinguished Professor of Marketing in the Lowry Mays College & Graduate School of Business at the Texas A&M University in College Station, TX, Berry devoted his sabbatical to an indepth assessment of Mayo's customer service strategies.

In the process, Mayo gave Berry unprecedented behind-the-scenes access to Clinic operations, from the business office to the transplant surgery suite. Berry spent a week with 14 specialty medicine centers, in Rochester and in Mayo's new hospital and clinic in Scottsdale. In the process, Berry and his research colleagues interviewed over 1,000 Mayo physicians, nurses, allied health professionals, and patients.

Mayo's superior service experience is not scripted. It is the result of processes and traditions built upon the values of the founding Mayo brothers. Maintaining a service culture based on Mayo values is central to insuring its high reputation with patients and referring physicians. The Clinic is challenged to train its rapidly expanding workforce. In Scottsdale, opening the new hospital has required doubling the staff. Like other high-growth organizations, Mayo works hard to maintain its special brand of medical and service quality.

Key components in Mayo's approach include: (Berry 2002)

• Integrated practice model - Mayo's roots run deep as a multispeciality medical group practice. Mayo's fundamental principle is the collaboration of specialists. Clinical teamwork is coordinated hundreds of time every day. Each patient has a team of specialists, who meet to discuss their patients every day, usually on-site, but also by telemedicine consults with Clinic specialists across its three locations.
• Technology - The integration of specialty care across Mayo's multiple locations is computer-based and Web-enabled. Mayo's new hospital in Scottsdale is "99% paperless and filmless." The digital transformation of Mayo's clinical and administrative process is highly advanced. Clinical work stations provide digital linkages for doctors, nurses and Mayo employees, with an electronic medical record, computerized physician-order entry, and universal patient registration. The World Wide Web has leveraged Mayo's international reputation. MayoClinic.com is a hugely popular Web site, and provides the Internet portal into the system for many self-referred Mayo patients.
• Staff quality - Mayo recruits and hires only those who "reflect the values of the Mayo brothers." The organization's values are published in the "Mayo Model of Care," which is the centerpiece of the orientation for every new Mayo physician and employee. Nursing quality is very high. Mayo operates with a 2:1 nurse-to-patient ratio, one of the highest in the nation. Staff loyalty is very high, and turnover low.
• Exceptional facilities - Mayo recognizes that the built environment provides "torrents of cues" about Mayo values to its patients, and reinforcing the Mayo culture for its physicians, nursing staff and employees. Mayo's design philosophy has distinct elements which are incorporated into all of its facilities, especially the newly-opened 20-story Gonda clinic in Rochester and Mayo's new clinics and hospitals in Scottsdale and Florida. Central ideas in Mayo's design vocabulary are stress reduction, creating positive distractions, quiet (noise reduction), art that is a physical reflection of patient care, family-centered furnishings and accomodations, and space plans that minimize impressions of crowding.

As a researcher as well as a management professor, Leonard Berry is looking at the Mayo Clinic through the prism of his non-health expertise in marketing and customer service. Service quality is intangible, especially for something as hard-to-define as "health." Delivering a consistent and satisfying patient care experience is highly technical and complex. Mayo recognizes that its facilities, processes, and ultimately, its people, must "manage the evidence" that tells the story that the intangible service can't tell itself.

Berry's research is still in an early stage, but he is already distilling lessons from his analysis customer service in the Mayo Clinic:

• Medicine is inherently a personal service, so impersonal service is unsatisfying.
• Excellent medicine requires thinking, not just doing.
• Patients receive better care in the long-term when they have a primary physician.
• All service employees are "volunteers" who exercise discretionary effort - maximum vs. minimun - based on their commitment to the values of the organization.
• Employ skilled professionals and utilize them at their highest level of expertise for as much of the day as possible. Substitute technology, deploy lesser-trained workers and grow the roles of mid-level providers.

As Berry has become immersed in studying customer service in one of the nation's leading medical care organizations, he has become intimately acquainted in the organizational and policy issues of the health field. Healthcare is one of the leading service industries, but somewhat insulated from other service sectors. The U.S. is spending $1.4 billion on healthcare expenditures, but more than 40 million Americans have no health insurance. Uninsured consumers don't fare well in today's system.

Berry is coming to believe that patients who can afford to pay for the full costs of healthcare should pay to subsidize those who cannot. Mayo does its share of uncompensated care, but these voluntary efforts can never fill the gap that Berry sees. Over the coming months and years, Berry will visit other hospitals and health systems, and distill his research on healthcare customer service into scholarly articles and books. The Mayo Clinic understands the "soul of service," and is a national model whose culture-based service strategy has made Mayo a household word for medical quality.

Russ Coile, Jr., is a healthcare futurist, industry consultant, and editor of Russ Coile's Health Trends. He is also a member of The Center's Board of Directors.