The Transformation of Health and Health Care Delivery
The Transformation of Health and Health Care Delivery
“The Center approaches its work with a 'think big, start small and move fast' philosophy.”
Innovations Exchange: Why did Mayo Clinic create the Center for Innovation ?
Spurrier: Mayo Clinic launched the center in 2008 to transform the delivery and experience of health care. The transformation is rethinking what we know about the health care system and looking for opportunities for disruption and improvement. We also think a lot about health and well-being at the individual, community, and population level. Our goal is to deliver health care in ways that are accessible, affordable, and sustainable.
How does the center foster a culture of innovation?
We think of the center as a “giant incubator” where we nurture new ideas, and enable them to grow, mature, and evolve until they are ready for patients. We create multidisciplinary teams to think differently about challenges and help bring innovative ideas to life. These teams have project managers, design professionals, and specialists from a wide variety of disciplines, including information technology, health care, education, human factors engineering, and communication.
Because environments matter, we recently moved into a new facility that feels more like Silicon Valley than Mayo Clinic with a lot of open space for multidisciplinary teams to collaborate on projects. It also houses the Design Research Studio where researchers and designers come together to observe patients, interview families, conduct traditional consumer research, and visualize, model, prototype, and test possible health care delivery solutions.
We also developed an outpatient “living laboratory” to study how health care is experienced and delivered to patients. The lab is a clinical environment where providers can experiment with health care delivery methods, prototypes, and processes to discover new insights and address problems.
We also created and support the Healthy Aging and Independent Living Lab. Through a collaboration with the Robert and Arlene Kogod Center on Aging and Charter House , the center supports “aging in place,” helping seniors remain at home, healthy, and independent. The approximately 5,000-square-foot lab is a place for discussion groups, workshops, observations, and other research activities. There are two mockup apartments for in-lab experiments simulating a typical home experience that can be recorded with digital technology.
What is the center's approach to solving health care problems?
We connect people through internal and external partnerships, use design thinking, a creative, problem-solving approach to improving the consumer experience, and enable competency to flourish. This methodology called Connect, Design and Enable (CoDE) is a competitive funding mechanism that supports innovative ideas across Mayo by giving them access to our methods, team member's expertise, and help with implementation.
Another popular concept at Mayo is co-creation—it's very important to us that we connect with the users of the new care model or process of care as well as those delivering it. We also are deeply committed to human-centered design thinking, to understand the user's needs and involve them in the design and testing of new practice models. For example, patients participate in the outpatient lab and we go to a senior's home to understand more about aging in place. We use qualitative methods including ethnography and focus groups to generate insights throughout the process.
We also form strategic collaborations and partnerships with academia and health care and technology companies to leverage and accelerate our work. Partnering with universities enables us to access their talent. For example, a graduate MHA student at the University of Minnesota wanted to develop a mobile application for adolescents with asthma. Our programmers wrote the code and Verizon provided the smartphones that we tested. The application will enable adolescents to watch videos and connect to their care team for monitoring and treatment.
We also recently formed a consortium to support the “aging in place” initiative. Consortium members including Best Buy, General Mills and the Good Samaritan Society, pay membership fees and in return they receive benefits such as access to Mayo's clinical expertise in aging. By sharing expertise and resources, seniors benefit. Best Buy, for example, is thinking about how they can use the Geek Squad in the home, Good Samaritan has nursing homes in 240 communities, and General Mills, a Minnesota company, does amazing work with food, nutrition, and wellness.
Finally, we are also responsible for growing the culture and competency of innovation across Mayo Clinic. We want to connect with everyone across the organization so they have innovative tools to think differently about the challenges they are facing. We try to connect the organization with partners who are trying to design new ways of innovation.
How do you decide which problems to address in health care delivery?
We think about what is the smallest number of big ideas we can address that aligns with our strategic mission and what is going in health care and other industries. We express these ideas through four care delivery platforms to give our work focus: “Future works” allows us to think about things that we don't fully understand yet; Community Health Transformation and Care at a Distance challenges us to take the knowledge of 3,700 physicians and scientists at Mayo and deliver that knowledge in new ways to patients in their communities rather than in the doctor's office. Finally, Practice Redesign recognizes that the current outpatient practice model is unsustainable. That platform is very disruptive in that everything is on the table for review—how we interact with patients, the team composition, flow of patient care, and how technology enables and support processes of care.
Each platform has a portfolio of projects. Similar to an investment portfolio, some projects have a short-term return and others are more complex and have longer returns. Some projects have a financial return and others have more of a societal impact. We aim to strike an overall balance in what we try to accomplish for the organization. Each platform has a multidisciplinary team, internal and external collaborators, and a diverse portfolio of projects supported by a solid business model.
What goals and implementation targets have you established for your priority platforms?
- Practice Redesign: The goal is to reduce outpatient costs for Mayo Clinic by 30 percent while improving the patient experience and maintaining and enhancing quality outcomes.
- Target: Develop new practice models by 2012 and implement them in Mayo Clinic's outpatient practice by the end of 2014.
- Community Health Transformation: The goals are to improve the population's health, enhance the patient experience, and reduce per capita cost of care.
- Target: Pilot a new “triple aim” model in the Mayo Clinic Health System's Central Region and Employee Community Health practice.
- Care at a Distance: The goal is to develop three sustainable models that extend specialty care from traditional clinic/hospital settings.
- Target: Pilot the model in three venues by mid-2012—an underserved area in the United States, an affiliated practice, and a patient's home.
Can you provide an example of a care delivery innovation that was scaled up and spread?
We are scaling the eConsult model we developed for the Care at a Distance platform to connect Mayo specialists with primary care providers who are in remote locations. Using, the concept of co-creation, we brought together primary care providers, patients, and the payer, which was Blue Cross/Blue Shield (BCBS) of Minnesota, to design a new kind of system. The result was a project that we tested in a remote community in northern Minnesota that didn't have advanced technology or electronic health records. Patients benefited from the eConsults by not having to fly to Rochester to see Mayo specialists and being diagnosed more quickly so they can move on with their treatment.
This pilot project informed the direction for the e-health platform, and we built infrastructure around it. We now have eConsults defined for 170 medical conditions that resulted from working with specialists. We're approaching our 9,000th eConsult and are scaling up this service across our entire organization. As we build out affiliate practice network across the country, we plan to offer this as a service to physician groups in remote locations and keep patients where they are.
In terms of payment, we use a subscription service, which began with BCBS of Minnesota who saw the value in this new practice model. We have now spread that service to new relationships, mainly this affiliated practice network that we are building. We also have a subscription service relationship with the Alaskan Native Health Consortium to reimburse us for eConsults for women at high risk of breast cancer. We also made eConsults free of charge for Mayo's 60,000 employees and their dependents through our insurance plan at Mayo.
What infrastructure is needed for the scale-up/spread phase?
We use a distributive network model in hiring people with the expertise we need. This helps us grow our ecosystem across Mayo, co-create, and build support for a project when it's ready to scale. Some projects can be scaled in 4 to 6 months while others, such as the medical home, community, and redesign, which are more complex, can take up to 2 years.
The leadership of Mayo is also very engaged in our work including helping us to craft the Future works platform and serving on our internal advisory council that includes patients. We also have an external advisory council with thought leaders in innovation from different industries.
The center receives funding from the Mayo Clinic where innovation is now a strategic requirement. Other funding sources include grants and the aging in place consortium through its membership fees. As we develop new products and services, there may be opportunities to partner with IT start-up companies, in which the center would have equity shares.
How do you disseminate or spread the center's products across Mayo and beyond?
We spread the work of our center across Mayo through our innovation curriculum and toolkit, and through workshops. We package all our products in creative ways and share them on the Mayo Intranet. For example, learning about the redesign of the emergency department could lead the urology department to consider how that will affect the patient experience, efficiency, productivity, and throughput.
We also have a monthly leadership newsletter in which we highlight specific innovation deliverables that we have completed, our strategic partnerships, and all the groups that are coming here. We also launched a new Webcast speaker series last year, Unexpected Conversations, which is available to all Mayo employees. We bring in big thinkers in innovation with different perspectives such as Tim Brown, chief executive officer of IDEO, who is on our advisory council. IDEO played a big role in the development of our outpatient lab.
What are some challenges and lessons learned since the center started in 2008?
We have faced several challenges. For example, the co-creation model requires that we connect to individuals and teams of individuals at the beginning of the process so everyone is working through all phases together. This is a change from creating and testing a model in a laboratory and then rolling it out for everyone to implement. We also have been challenged by developing a new care delivery model before the business model is fully established. We have learned that if we're meeting the needs of the patients, the business model will evolve.
Another challenge has been to change the perception that human-centered design thinking is only for design professionals and to find ways to include others. Design professionals also approach problems with a more qualitative risk-taking approach than physicians and scientists who want data to support the need for change. Lastly, we know that radical collaboration requires us to go outside our organization and tap into that energy, intelligence, and network to accelerate our approach and work.
About Barbara Spurrier, MHA: Ms. Spurrier, Administrative Director of Mayo Clinic's Center for Innovation, along with Nicholas LaRusso, MD, the Center's Medical Director, oversee all aspects of the center, including strategic partnerships, portfolio operations and execution, and business development. Ms. Spurrier joined Mayo Clinic in Rochester in 1997 and served as Operations Administrator for many clinical practices. She was named Vice Chair of the Department of Medicine in 2003 and in 2008, became Administrative Director of the newly launched Center for Innovation.
Disclosure Statement: Ms. Spurrier reported having no financial interests or business/professional affiliations relevant to the work described in this article.