Teaching Note
Journey to Perfect: Mayo Clinic and the Path to Quality
Abridged Version
Case Summary
Long-regarded as one of the best healthcare organizations in the world, the Mayo Clinic has not been
Learning Objectives
• Demonstrate the efficacy of using quality as a strategic driver to the transformation of an organ-
ization
• Manage major change within an organization
• Utilize the various theories and approaches to design a quality system that will work with an or-
Case Study Components
Written Case Study:
Part I of the case study is the situation analysis and poses the challenges that the Mayo Clinic faced in
their transformation efforts. Part II of the case study details some of the deployment activities that
Mayo Clinic undertook in its journey to quality.
1. The first half is a presentation to the Masters of Engineering Management (MEM) Program
2. The second half is a question and answer session with Swenson, Dilling and the student audi-
ence. Approximately 40 minutes
The video is available online from the American Society for Quality at:
http://www.youtube.com/watch?v=PNTXk-
2dXTc&list=UU2M3UlM_gu5NT2FT_SyUVPQ&index=1&feature=plcp
Student Discussion Questions
1. Why would a world-renowned organization, Mayo Clinic, already known for quality embark on a
quality improvement journey?
2. What were challenges facing Mayo and the role of leadership?
3. All organizations have a culture. Why is it important to align the organization’s culture with its
larger goals?
4. What was the role of standardization in improving quality?
5. What purpose does the Quality Academy at the Mayo Clinic serve? Who should participate in
the Academy and how should they encourage or require participation?
6. How should quality improvement be measured and knowledge disseminated?
Analysis of Discussion Questions
1. Why would a world-renowned organization, Mayo Clinic, already known for quality
embark on a quality improvement journey?
3
Mayo has always emphasized quality primarily through hiring top notch physicians and using their clini-
cal system for treating patients. The clinical system involves assigning a patient to a consulting physician
and then routing the patient through various tests and other specialists as needed in the same clinic and
2. What were the challenges facing Mayo and the role of leadership?
According to the case, Mayo faced several challenges. They needed to improve the entire health care
system to adopt standardized best practices across all their clinics and hospitals. This would require
changing the culture of the physicians who tended to use their individual approaches to patient care,
4
Of course, all of this derived from the Mayo’s unique approach. Mayo called this the Quality Construct
(see Figure below) where the four aspects of infrastructure, culture, engineering and execution are
aligned with the vision to provide the best care to every patient every day through integrated clinical
practice, education and research.
3. Why is it important to align the organization’s culture with its larger goals?
As you look at the Mayo Quality Construct you will see that culture holds a predominate role. To attain
standardization and transparency – and even to assure the most accurate data is collected for meas-
urement, an organization’s culture is central to success. Mayo chose to look at three cultural aspects to
5
After implementing the Fair and Just program, the case describes that an operating room nurse brought
a potential problem in the O.R. to the attention of a very experienced and respected surgeon. Frankly,
4. What was the role of standardization in improving Quality?
In one instance after another, the leaders of Mayo have decided to standardize a process with two ideas
in mind:
• The standardization would prevent harm, eliminate waste (and thus cost) or both.
• The standardized process would, as it was widely adopted, move Mayo toward perfect out-
nurses are required to sanitize their hands during rounds between patient’s rooms.
5. What purpose does the Quality Academy serve and how should it operate?
Mayo demonstrated across a range of clinical targets and around several Mayo locations that they knew
how to make important improvements; improvement which reduced harm and saved money.
they had learned to other medical facilities across the nation. Two of these efforts were the Quality
Academy and the Medical Information and Reporting System.
The intent and design of the Quality Academy can be grasped by asking some simple questions.
6. How should quality improvement be measured and knowledge disseminated?
As the case describes, there are numerous dimensions to measuring and reporting results of quality ini-
tiatives at Mayo. Initially core measures focused on patient satisfaction, infection prevention and con-
trol protocols and mortality. Of course they adjusted and continued measuring financial and operational
data.
To sustain transformation, however, takes an on-going understanding that the collection of data for bet-
ter patient outcomes is clearly mandated. If you can show improved patient outcomes — such as fewer
Concluding
As the case notes: “We started to think about are we as good as we could be? If you did nothing
Key Lessons
1. Quality initiatives are most successful and produce the greatest outcomes when they are a stra-
tegic imperative tied to the organization mission.
But that new technology is what may give the organization the market advantage.