Antoine Flahault’s blog

Berry and Seltman help us to understand how an independent teaching hospital created a hundred years ago and of great international renown (2 Nobel prizes, scientific papers of unrivalled quality and attracting patients and doctors from all over the world), has succeeded in staying at the top of the rankings without break. It has become a brand of excellence, a standard. It might have been thought that the determining factors were research, medicine and leading edge technology, or an aggressive policy of attracting skills but, surprisingly, the driving force behind the success was the core principle established by the founder, Dr William Mayo – that the needs of the patient come first. This could be the slogan for any service-oriented organisation: “The students come first” for the EHESP, “the users come first” for regional health agencies, “the customers come first” for Orange.

A patient-oriented policy cannot remain unchanged for a whole century. A hundred years of in-depth changes have clearly left their mark – not on the basic principle but on how it is implemented. For example, at the time of Dr William Mayo, patients were summoned to see the doctor – “appointment with Dr So-and-so at 2 o’clock in the afternoon” – and this practice was continued by his two sons who succeeded him. Satisfaction surveys have changed all that. Patients now have other claims on their time that have to be taken into account. An effort is made to find a time that will be suitable for the patients, that will be more convenient, depending of course on the urgency and the timetable of the doctor available. The Mayo Clinic does not claim to be doing anything out of the ordinary. But the needs of the patient come first, that’s all, it’s simple.

There are no special courses on the policy, no university degree, no great fuss about it. Berry and Seltman set out certain key factors that show that, even though it may sound simple, ensuring that the organisation is centred on the patient is not intuitive but must be based on a deep-seated culture. The fact that 62% of the staff are trained at the Mayo Clinic is a great help. It helps the human resource managers, too: recruitment interviews last for several years! For other members of staff, initial courses are dedicated essentially to the “patients first” culture.

The empowerment of personnel is one of the most important conditions for implementing this culture. It enables everybody, at all levels within the structure of the Mayo Clinic, to take the initiative if they see that patient is unwell or that his condition looks to be deteriorating. The Joint Commission (the equivalent of the Haute Autorité de Santé (HAS) in France) which is responsible for hospital accreditation in the USA, reported that communication problems were the main cause of avoidable iatrogenic incidents, and set “the improvement of effective communication between care personnel” among the top priorities for patient safety in 2007. We are, therefore, not in the realm of the politically correct or high-flown sentiments of US culture, this is clearly a matter of looking for solutions to provide real improvement in the quality of care.

Putting the needs of the patient first is a global approach to patients. A patient is not just a body to be cared for, fed and lodged. A patient is also someone who has other needs, perhaps even more than ever: the need for an environment, a system specific to his particular case or the need for care for his soul and his mind. Cesar Pelli, the architect who designed one of the most recent buildings in 2001, said that he “wanted to create a building where the process of healing starts as soon as the patient crosses the threshold.” The generosity of Mayo benefactors has endowed the clinic with chandeliers, sculptures and other ornamental features that have no functional purpose but are very beautiful.

The next post will discuss how a factor in the success of the Mayo Clinic is also its capacity to ensure that the care personnel work as a team.