to Quality Improvement Mayo Clinic. Michael B. Wood, M.D

1
An Institutional Approachto Quality Improvement
Mayo Clinic

• Michael B. Wood, M.D.
• Juran Summit
• June 25, 2002

2
What Type of Organization is Mayo?

• Integrated multispecialty group practice --
  inpatient and outpatient
• Specialty and subspecialty practice
• Salaried physicians
• Not-for-profit
• Academic medical center -- major emphasis
  on research and education
• Physician-led
• National distribution -- 3 geographic locations
  with regional networks

3
How Mayo Has Changed
1983
2001

• Clinic operation

Clinics, hospitals, primary care clinics,
reference lab, health education for public, tech
transfer, TPA, health plans

• One location

Multiple locations

• 480M Total assets

5,606M Total assets

• 381M Revenue

4,135M Revenue

• 810 Staff physicians

2,725 Staff physicians

• 7,500 FTE employees/ students

38,000 FTE employees/ students
4
Major Periods of Growth and Development
Years
Highlights
5
Phase I Circa 1990Somebody Elses Problem

• Our core values are rock solid

• Look how we have changes and grown

6
Phase I

• Perennial first or second place winner in
  national polls

• Cost of healthcare per person at Mayo 22 below
  national average

7
Phase I
There may be something to the quality movement in
healthcare but it doesnt apply to us. Weve
always put quality first.
8
But...
Our insulation wore thin in a short period of
time
9
Phase II Circa 1992The Book of Revelation

• Early explorers of improvement in healthcare
  visited Mayo

• Mayo visits industry Baldrige winners

10
Phase II
Teachers
Lessons Learned

• ATT
• Eastman Chemical
• General Motors
• Xerox
• Ritz Carlton/Marriott
• Hewlett Packard

• Role of leadership in quality improvement
• Improvement in research
• Benchmarking
• Service
• Hoshin planning

11
Phase II -- Circa 1992

• Benchmark with the best --
• There may be something to this!

There are some good things others do that we
arent doing.
12
Phase III -- Circa 1994Goin from Preachin to
Meddlin

• Getting started --

13
Phase III

• Took low-key approach

• No hype
• Implemented eight pilot teams
• Results do the talking
• Leaders participated on teams
• Started centrally then disseminated

14
Phase IV Integration -- Circa 1995

• Integration

Making it the way we work
15
Phase IV

• Led by President of Mayo Foundation

• System-wide
• Focused workshops
• National speakers
• Annual conference on quality

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17
Phase V -- Circa 1998Converging Improvement on
Strategy

• Defining priorities through strategic planning

• Focusing collections of improvement activities on
  strategic objectives

18
Phase V
Strategic Imperatives (partial list)

• Improving patient care service
• Error reduction / patient safety
• Integration
• Information Systems
• Supply expense initiative

19
Physician/Hospital Traditional Perspective
Medical Outcome
gtgt Patient Service
Patient / Family Perspective
Medical Outcome
Service
Perceived Quality
20
Well-Known Service Shortcomings

• Waiting in Waiting Rooms

• Talking at you, not to you
• Bewildering billing systems

21
Linked
22
Improving ServiceInstitute for Healthcare
Improvement (IHI)
Improved Access and Efficiency in the Clinical
Office collaborative

• 20 discreet initiatives
• Mayo Clinic Rochester and Mayo Health System

23
Improving ServiceGrass Roots Initiatives

• Enhancing Patient Satisfaction in the Emergency
  Department Saint Marys Hospital, Rochester

• Improving Resolution of Patient Complaints Mayo
  Clinic Jacksonville

• Hospital Room Service Rochester Methodist
  Hospital, St. Lukes Hospital

24
Improving Patient Safety

• To Err is human

Institute of Medicine December 1999
25
Medical Error and Patient Safety
Prevention of Errors

• Automation and I.T.
• Improved information access
• Error proofing
• Print-out orders
• Standardization
• Work schedules to diminish fatigue

26
Improving Patient SafetyInstitute for Healthcare
Improvement (IHI)
Inpatient Medication Delivery Patient Safety
collaborative
20 Hospital sites

• 3 Mayo Clinic Rochester
• 15 Mayo Health System
• 1 Mayo Clinic Jacksonville
• 1 Mayo Clinic Scottsdale

27
Improving Patient SafetyGrass Roots Initiatives

• Bar-coding operating room inventory
• Blood-culture contamination reduction
• Eliminating patient falls

28

Importance of institutional culture to improve

• Patient Service
• Patient Safety

Primary Mayo Value
The needs of the patient come first
29
Research Problem
The Ideal Service Experience
Dr. Leonard Berry Texas A M University Dr.
Neeli Bendapudi Ohio State University
30
Methods
Interviews

• Personal interviews with individuals, groups
  (patients and Mayo staff)
• Telephone interviews with patients

Participant Observations

• Hospital rounds
• Exam-room observations
• Inpatient, outpatient experiences
• Mayo One
• Surgeries

31

• Excellent medicine requires thinking, not just
  doing unfortunately it is hard to get paid for
  just thinking

32

• Medical care is co-produced by patients,
  families, caregivers

There are opportunities for shaping patient
expectations and improving patient performance
33

• Fiscally sound healthcare requires using skilled
  professionals at the high end of their expertise
  rather than the low end

34

• Patient service begins before the episode of
  medical care and doesnt end after the episode
  of care

35

Quality Improvement at Mayo Foundation
More Phases Ahead
36
Mayo Lessons Learned

• Effective implementation depends on institutional
  culture

• Recalibration to meet changing objectives
• It is the way we work no end point

37

If we excel at anything, it is in our capacity
for translating idealism into action
Charles H. Mayo, MD
38

That which can be foreseen can be prevented
William J. Mayo, MD
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