Mayo Clinic Care Network—Cardiology Center of Excellence Summary

October 29-31, 2012

NCH participants: Drs. David Axline, Adam Frank, and Herman Spilker, along with Zach Bostock, Linda Cifani, Debbie Curry, Phil Dutcher, Kristin Miller, Mike Riley, Scott Wiley, and Allen Weiss.

Mayo Clinic participants (25) whose names/titles will be included in their specific areas of discussion. Dr. Stephen Lange and Mr. Bob Walters graciously shared the entire day and evening before at the Foundation House with us.

Dr. Ron Menaker, Ph.D., Administrator, Division of Cardiology set the foundation for the entire discussion around change management as related to access, employee engagement, physician engagement, and marketing. Heart failure was also included as a subject. Ron began by sharing Mayo’s mission, vision and value statements below:

Mission: To inspire hope, and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research.

Vision: Mayo Clinic will provide an unparalleled experience as the most trusted partner for health care.

Value: The needs of the patient come first.

An important core competency of Mayo Clinic is to create, connect, and apply integrated knowledge to deliver the best health care, health guidance, and health information. By sharing with the affiliated network systems such as NCH, everyone benefits and we all further the above goals in our own way. For NCH we are focused on clinical practice and aspire to include graduate medical education and research.

#1 Access

Tim Faber, Operations Manager, Office of Access, focused on the out-patient area sharing elements of the new scheduling system driven by demand and matched by supply. Building partnerships (which is a concept repeated though out our visit) between clinical and operations management is essential as the still phone based system migrates ultimately to on-line for healthcare as other industries have already done.

Mayo utilizes Bronze, Silver, and Gold for designations of operations manager competence whereas NCH had adapted Juran’s Yellow, Green, and Black. We need to rekindle our operations management discipline using Mayo’s model.

Carla Brunsvold, Operations Manager, Division of Cardiology visually highlighted the migration of fee-for-service to population health/bundled payment. The timeline is unknown presently but there will be change. How do we do this? One thought was to change physician compensation from primarily volume based to equal parts quality, efficiency (prudent use of limited resources), and productivity (e.g. wRVUs).

Dr. Steve Ommen, Vice-Chair, Cardiovascular Practice, Dr. Francisco Lopez-Jimerez, Consultant Division of Cardiology, Dr. Malcolm Bell, Director of Ischemic Heart Disease, Dr. Amir Lerman, Vice-Chair, Cardiovascular Research participated in the discussion about the following:

A survey of patients and care givers asked: What does the idea cardiovascular experience look like? Patients enjoy communication with the team including front office, nurse, and other care givers. Patients also desire continuity with the same team, and good document management, e.g. medical record availability. Interestingly and importantly, staff has the same goals, which is great.

The above directed focus on three goals: communication through a portal, using patients as drivers for change, e.g. patient focus groups composed of representative folks—care team model, and standardized processes for obtaining outside records, e.g. securing records before a visit and getting out a consultative letter within four days of the visit.

#2 Employee Engagement

Peter Taddy, Senior HR Service Partner, Kim Pollock, CNS Clinical Nursing Administrator, Sharon Prinsen, CNS Clinical Nursing Administrator discussed the results of their employee survey with an eye towards engagement and satisfaction. The presenters also focused on growing a just culture and integration.

After about one third of the presentation about half of the NCH team including me observed a quarterly Town Hall meeting which stressed open and frank communication. The audience was attentive and engaged which is similar to NCH.

The trilogy of a physician, nurse and administrator was again stressed as a model essential for results when employed as survey team monitors and facilitators. These professionals are chosen from other areas to facilitate honest and fair feedback.

Make your customer number two and place your employee first was introduced but is not where Mayo or NCH are currently. Employee engagement fosters greater satisfaction resulting in improved safety, retention, quality. Similarly physician engagement supports both patient and physician satisfaction. Mayo has the equivalent of a RAC committee.

Mayo survey results and feedback were shared. Involving everyone in problem solving is important for progress. The five behaviors of safety were also reviewed: attention to detail, clear communication, receptive listening, safe hand offs, and full support of colleagues. Colleagues are hired for behavior and fit. Initial interviews include peer group interviews and psychometrics.

#3 Heart Failure discussions

Chest pain triage for false positives and negatives and how best to set up a chest pain triage and testing protocol for exercise and pharmacological stress tests ensued.

During the discussion and slightly off topic but of importance was NorthShore University Health System’s excellent experience with a public educational event with an invited Mayo speaker.

CHF care should be preemptive and educational with a coming technology revolution of telemonitoring from patient’s homes.

Also mentioned was the Mall of America experience which has not engaged as well as anticipated.

#4 Physician Engagement

Drs. Charanjit Rihal, Chair Division of Cardiology and Robert Simari, Vice-Chair of Cardiology joined Dr. Ommen discussing the similarities and differences of models.

Mayo physician leadership starts early with education and psychometrics. Those with interest and potential are encouraged to proceed with further leadership training.

Change is both painful and a process. Staying disciplined and diligent while creating a sense of urgency is beneficial.

One Mayo with 239 cardiologists creating a safe and secure environment with similar care throughout is a goal. Having centralized direction and not chaos across an entire continuum of care is a new goal. Regenerative medicine, personalize medicine, and consultative medicine are Mayo projects for the next five years.

Using “Ask Mayo Expert,” measuring its use and sharing feedback are excellent processes to advance change. Avoiding regression to the mean is a constant threat.

Sustaining teams, avoiding silos and having everyone row in the same direction is an awesome experience for everyone. Examples include the new interventions in cath lab, e.g. percutaneous aortic valves which need a functional team.

Having end users to buy in, creating non agenda type meetings and moving in the right directions all matter.

Again administrative pairing with MD leader and operations managers was stressed. Research administrator and ops managers paired similarly. Nursing administration is separate. “Mayo's physicians all boss each other” as they push decisions down as close to the folks doing the work.

Mayo is making decisions to be number one in country. Why would patients come here to Mayo? We all are concerned about our future. One response in cardiology has recently been that clinical research is available here and per cutaneous valves are a big volume driver.

There is also top down strategic planning to get to greater good when there is a need to come up with the solution to a problem which is cost effective. In this instance a small executive team of under 10 manages more than 150. There are always answers in the team.

1,200 physicians utilize “Ask Mayo Expert” which is the pithy expert to share information. This is not meant as an Up to Date. Target audiences include other generalists.

#5 Marketing:

Nicole Engler, Specialist, Public Affairs, Julie McAdams, Operations Manager, Division of Cardiology, and Evelyn Molloy Henkemeyer, Marketing Manager, Public Affairs discussed the following:

Word of mouth is first mover of patient flow followed by US News and World Report. Also YouTube videos are taking off (YouTube content increased over 300%). Mayo uses data to drive strategy including Google analytics, referral areas (patient vs. physician) and post event evaluations.

Social media presence as an additional service recently is growing. Mayo blog helps word of mouth using content and patient stories. Differentiators are key for success. Keeping brand fidelity is of the utmost importance. Differential or Die by Trout was mentioned as a resource.

#6 Change management:

Awareness, desire, lack of dissatisfaction, vision and first steps need to be bigger than resistance in order to have change. Being transparent and need are necessary but not sufficient.

Visions need to be inspirational and galvanizing but again, are necessary but not sufficient. Using SBARS for communication is also good but not enough.

Vision, execution, discipline, and work the plan. Need art and sensitivity. Every beginning is the signal for a loss. Figure out what you can agree with that are satisfiers.

Professionalism values, leadership competencies, need a process on how to get there. Need mutual respect and live the values. How to develop leadership skills for folks was discussed. We both have teams which work synergistically. Everyone going in the same direction is breath taking. 


Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.