Mayo (9): Quality strategy

Mayo Clinic has adopted a quality strategy based on three types of criteria: functional clues, mechanic clues, and humanic clues.

Functional clues are generally considered by Mayo Clinic customers as being achieved. This is clearly the most important criterion which established confidence in the institution. The expertise of physicians at the Mayo Clinic is based on the excellence of the treatment that has been dispensed for many years. But this excellence – the basis for its reputation – is not enough.

Mechanic clues, including the cleanliness of the premises, the dress of the personnel as well as the architecture, the furnishings, the green spaces, the catering: every detail counts at the Mayo Clinic, because they endeavour to be at the service of the patient, the needs of the patient come first. Because “nobody ever wants to go to hospital“, because one is always in a position of inferiority, sometimes in a state of extreme weakness and confusion, almost naked, almost incarcerated – for all these reasons, a great effort must be made to do everything that will help to restore the patient’s dignity, reduce the stress of his position and sooth the anguish aroused by his stay in hospital, with an obsessive attention to detail. The whole service industry often functions on the initial appearance perceived by the customer. A customer’s first impression of a restaurant that he does not know, whose first criteria are the quality of the food and the ambience, depends on details such as the curtains, the lighting, the presence of tablecloths and napkins, the cutlery, the way the personnel are dressed and the background music. The same applies to hotels and many other services. One example given by Berry and Seltman is that of the Starbuck chain whose success is due not just to the quality of its cafés but also to the ambiance created by the warm décor, the wooden tables with adequate space between them, round rather than square, as surveys show that a customer on his own is more at ease sitting at a round table rather than at a square table. The Mayo Clinic spends little on direct advertising but invests considerably in the elements that help to put patients at ease as soon as they enter its doors: vast, uncluttered entrance hall, decorated with artwork, ornamental plants, patios, pianos, large windows and lightwells. Noise is a major nuisance in hospitals: mobile phones, alarms, people talking, trolleys being wheeled along, doors banging – there are so many sources of noise. To deal with this problem the Mayo Clinic carried out surveys, with noise meters to measure the noise in its services. The highest noise measured was moving the mobile X-ray machine from room to room (a machine that was already very expensive to run and only too often useless, as shown by another survey carried out in the Tenon Hospital in Paris!). Moving the mobile X-ray machine in a Mayo Clinic service (98 dB) created the same amount of noise as that produced by a moped! Other measures relating to the design of the furniture were adopted in the paediatric services, with furniture with rounded wide ends to prevent children injuring themselves if they fell.

Humanic clues are those which go beyond the expectations of the patient. The patient does not expect a smile, reassurance, confidence, kindness or even humour. He hopes for a calming look, a kind word or a friendly gesture. He knows that he must not insist on them. The Mayo Clinic knows that its reputation can only be enhanced. “The cherry on the cake”, this shrine of modern medicine, of the most sophisticated technology, medicine and surgery, makes every effort to provide patients with physicians, nurses and administrative personnel who are gentle, calm, caring and attentive, responsive and unhurried. The decision that personnel should be salaried and not paid for each service provided (as in most private establishments in North America) has been a contributing factor, ever since the founders of the clinic themselves, the Mayo brothers – 100 years ago – opted for this form of remuneration. This arises from the Mayo Clinic’s values that put the “best interest of the patient” first. The personnel often make this a point of honour and are proud of it. The Mayo Clinic carried out a survey recently of a sample of 192 patients who had been discharged from the hospital, telephone interviews lasting 20 to 50 minutes, asking them what they had appreciated most and least in their relations with the care personnel at Mayo. The results showed clearly that patient satisfaction did not depend solely on the technical quality of the treatment – patients are often not in a position to judge the technical quality of the treatment given to them. It is not that they consider this quality to be unimportant – this may well be the main reason why they went to the Mayo Clinic or other medical centres of excellence – but they consider the patient-doctor relations, the caring attitude of the nursing personnel, the quality of surroundings and the catering service to be just as important, and much easier to judge.
If the managers of all hospitals organise their daily activities according to the three quality criteria adopted by the Mayo Clinic – competence, appearance and humanity – if they are able to excel in each and pay extreme attention to detail, they can hope to reap the benefits of their efforts with patients who will bear witness to their satisfaction.

The next post will be more marketing oriented. We will look at what produced an international brand such as the Mayo Clinic over one hundred years, the determinants of the success and how it remains at the top of the world ranking.