Building a Culture of Innovation at Mayo Clinic

IIT Institute of Design is hosting three executive education workshops in Minneapolis this fall and winter beginning with Building a Culture of Innovation on October 22. Ashley Lukasik, director of corporate relations, communications, and marketing, recently had a conversation with a team of innovators from Mayo Clinic, Caroline Chaffin, Allison Matthews, and Marnie Meylor, on the same subject. Their longevity with design methodology and experience tackling one of the society's biggest problems is an inspiration for other organizations looking to formalize their innovation programs.


Ashley Lukasik (Facilitator):  Hi, guys. I'm Ashley. I oversee corporate relations and communications at the Institute of Design.

Mayo historically has hired from the Institute of Design as well as worked on some projects with us. We've been most recently working with the Innovation Center to help share some ideas about best practices as it pertains to innovation and building a culture of innovation.

We're pleased that some representatives from the Mayo Clinic Innovation Center will participate in an upcoming panel on September 24th in Minneapolis at bswing that is part of a kickoff to an executive education module that's running at bswing on building a culture of innovation.

The panel discussion is going to be a public event the evening of September 24th and will also include Doug Beaudet from Honeywell and an individual from Room and Board talking about how they are trying to build a culture of innovation within their organizations.

Today I wanted to talk to you guys about, more generally, how you've managed to accomplish building a culture of innovation at Mayo.

Marnie Meylor:  I would say it's a work in progress. Every day is a new day, obviously, but one thing in particular that we do at CFI is we have a core platform of work that's dedicated to the promotion of innovation throughout the organization about enabling people within that.

One example of activities that we have and resources that we dedicate are we have a grant program called CoDE, which is Connect Design and Enable, which I'm sure Amber will be speaking to about.

It is basically funding that different groups and different people within Mayo can apply for. The idea behind it is it's not just about getting money to support their ideas. They're also paired with a team at CFI where they have retreats and workshops that they attend that are essentially deep dives where they're really exposed to the principles of design thinking and user centered design. That's one big activity within that space.

Allison Matthews:  Here at Mayo we have had a culture of innovation that has spanned the lifespan of the Mayo Clinic in that we were one of the first integrated practices. We're always looking to create new sciences and technologies.

The challenge that we face here is helping people understand that innovation is not just creating a new vaccine or a new tool to use in the clinic, but instead it's also about understanding how do you innovate along the service line of health care. How do you innovate along delivery? How do you use innovation to shift the culture to be a little bit more patient oriented?

We think that there are different ways that we are looking at innovation that way.

Facilitator:  Having been one of the first health care institutions, as an early adopter and embraced design as fundamental to your innovation strategy along with Kaiser Permanente and Memorial Sloan Kettering Cancer Center. How would you say things have evolved since you first took on that challenge or embraced innovation in that way?

MM:  Design has been at the core of the way that we've been innovating since we began, but it's also a challenge in that we work a lot with qualitative methods. We try to understand things not necessarily from as much of a quantitative side as the rest of the institution.

It's been something that we wrestle with constantly in a very positive way. How to demonstrate the value of design innovation to the rest of an institution that's very scientific. It's a very healthy struggle that we wrestle with. It allows us to constantly find value within design and understand exactly where it fits within the ecosystem of a large institution.

Facilitator:  That's interesting. Do you have examples that you can share of how you've been able to achieve that?

AM:  Hmm. Yes.

Participant 3:  I just wanted to add, also, because I come from Europe where service design is also struggling to be recognized. Then I come to the US where it's even struggling maybe a little more. It's having that shift from a product centered to a service centered...the shift in the economy is requiring us to convince people to think [inaudible 05:00] .

Mayo has come a long way trying to have people acquire those principles. I think that's one of the challenges, more the feel than all the subcategories that's growing within the design field.

AM:  An example of integrating service design and innovation within a health care system is something that we did with our community health platform where we began to redesign the care team and move that towards implementation.

As we began the project, we were tasked on the Center for Innovation side with coming up with ways to better care for our population of patients, which is a big ask. But then, when we would move into the clinic they would want things like, "Help us redesign our offices so that we can see patients better."

They wanted a really tangible outcome and we were looking for something that was a little bit more...a cultural shift, so it was our job to then, through experimentation and prototyping, to balance changing a tool or changing a space with pushing the culture to further embrace a patient‑centered model.

In that way, we really had to not only come up with evidence for why our ideas were good, so we would get a lot of things that said, "Sure, you can use your team model as soon as we can see that it works," and we said, "Well, you have to give it the option to try it out before we can show you that it works."

We have a chicken‑and‑an‑egg argument often with some of these groups, so the moment that we get the opportunity to jump into a clinical space, try things out, we really try to get everything that we possibly can get out of it. We want to get quantitative metrics. We want qualitative metrics.

We want examples of stories that are really very compelling, and then we knit that all together, and when we talk to leadership, or when we talk to groups who are making decisions, we'd say, "Here's what you want in terms of cost savings. We have quantitative metrics on that.

Here's how people felt about this. We have these beautiful stories to tell you how this has transformed your case, and then we have just these qualitative measures that can fill it all out and make it a very rounded and compelling argument for moving forward with the process.

AM:  I would add to that we're also very fortunate with the robustness of just the size of Mayo and all that fits under its umbrella, that while we may be kind of on that fuzzy front end, a project where we might be re‑imagining a care delivery model, we have the center for the Science of Health Care who also we can partner with and will help us with the validation of a new model, or what have you, in a way that can take out...

That obviously with us being on the front end, we're a little bit biased, [laughs] , so really adding that level of validity to what we're doing, so it's really great to be able to work that way and have that available, basically.

Facilitator:  Right, so it strikes me that when you're working in a complex organization like Mayo that you have a little bit of an opportunity to establish a living lab, or several sort of living labs, where you can sort of quickly, I would think, lots of different concepts very early.

Can you talk about that a little bit, and then I'm also curious to hear about where there are maybe some barriers to being able to prototype when it comes to things like medical outcomes for real patients.

MM:  We have several lab spaces, some formal and some that become informal that we integrate into our projects, so we have an inpatient lab space that's very formally designated at that. We can bring in providers to see their patients there.

We can change how the space looks. We can change how the interaction feels. We can change the technology that they have available. We can change the team members. We can change really whatever we like and it's this incredibly flexible system that we can set up and then also record very robustly so we have gobs of data that comes out of it.

On the other hand, though, as we set up each project, as we're doing it, we tend to develop kind of an informal lab space, and that informal lab space may be centered around a certain provider, so I go with that provider to see every patient that they see for the next two weeks, so the lab space then moves around or it may be centered around a specific space.

I sit myself in a team room and I observe everything that happens in that team room or it might be centered around a process, so I might work with the groups who are charge of that process or curate the different technologies, and I understand how that works all the time.

We have one very formal space, but then we have kind of an infinite amount being embedded within the practice of informal lab spaces that we can use and take advantage of as well.

Caroline Chaffin:  You're wanting to know about barriers to being able to work this way?

Facilitator:  Right. Exactly.

CC:  I would say a lot of the barriers are probably say that any group would anticipate when working in the space of health care. A lot of the time, within this kind of living lab space we're working with, very often it involves the use of technology, and what inherently comes with that is we have to work with HIPAA just like everybody else does.

If we are falling under the category of research, obviously working through the bureaucracy of legal, and IRB, and all of that, it can be really challenging.

Another aspect that we have to be very careful of is that sometimes we can get a little carried away with ourselves, and be trying something in the practice, and we have to be absolutely, a hundred percent diligent the entire time that whoever our partners are absolutely, completely bought in, understand why we're doing what we're doing, that this is their idea too.

Otherwise you can create a situation where it's like the ants under the magnifying glass thing really quickly, so you have to be very, very careful of that just in terms of being sensitive and cognizant.

I don't know. [laughs] Should I go on?

Facilitator:  Sure. Is it fair to you've talked a lot about going along on the patient visits with doctors that you're working with, and the impression that I'm getting is that there's just this total immersion amongst all of the stakeholders.

It's interesting to hear you talk about that because I think sometimes people, just as you were saying earlier, sometimes people think about an innovation center as being a physical space, but they have trouble with some of the more ephemeral elements of having a sort of innovation center and what that might look like.

What I'm hearing you say is it's much more mobile and it's hitting every aspect of the organization. Is that fair?

AM:  Our innovation center, not including the lab, is really where we come to process what we learn out in the field, then the field being anything within Mayo or anywhere Mayo patients might be, so our innovation center is really where we come back to work together, to process our work, to come up with the insights, and the way that we will deliver them, and the story that we're going to tell.

Then the rest of the clinic is really where our lab space in that that's the place where we learn, and I think we're uniquely spoiled with the incredible access that we have and the willingness for really most people at Mayo to let us come in and see what they do.

CC:  And also the patients too, that they' explain to them what you're trying to do, and more often than not they're just like, "Yes, please. How can I help?" That's been the most wonderful and rewarding thing, but also you almost forget how wonderful it is to work in that kind of situation.

Facilitator:  Do you credit that to Mayo having such a strong and branded presence as a state‑of‑the‑art research system and organization?

AM:  I think that and that we're seen as a learning center. They come here to get answers, and they come here to get really reliable answers very quickly, but they also come here in a place where they're willing to let other people learn from their experience and are very excited to share their experience with others, I'd say, for the most part.

In the four years that I've been here, maybe one or two patients have ever told me that they really prefer that I not spend some time with them, and that's with me trying to make it as easy as I possibly can for them to tell me to get out of the room.

Facilitator:  How important would you say the Mayo's leadership is in terms of being sort of being brought into the idea that what you're doing is important?

AM:  I almost think that it's important. I think that absolutely having leadership support for our existence, having very engaged leaders at the center level, is very critically important, but the things that we talk about at the Center for Innovation and the things that we advocate for really aren't difficult for high‑level leadership to say, "Yes, that's the right thing."

We're saying, "This is good for the business. This is good for taking care of patients. This is the direction that we should be going," and that's not that hard for leadership to agree to.

What's really challenging is when you get down to where the rubber meets the road and people who are living within one culture, and we're asking them to simulate another one or to imagine changes within their lives. That's where it gets really hard.

That's where we're saying, "We want you to stop doing this thing that you've done for your entire career and do this completely different thing that you've been told never to do." That's where it gets really hard. At a leadership level, you can make pretty strong arguments for the innovations that we're pushing forward.

Facilitator:  Can you talk a little bit about the parts of the organization that get messy, or I guess I should say the parts of the industry that can get messy and potentially introduce roadblocks to what you're trying to do? I'm imagining insurance and some of the systems in place around patient privacy could get a bit complex.

MM:  Yeah, absolutely. I think we do...obviously a lot of our work is really about the patient experience, and it's very easy for people to really focus at the individual provider level, and the behaviors, and the communication, and the touch points, and all that, which is important, but then you can't forget that for every interaction, there are 17 layers underneath it that you are possibly influencing.

We'll have a project that'll be around designing a new care models, and the layers really are...if you can't work out that finance piece, if you can't get the insurance companies...if you can't work out that payment piece, if you can't work out the logistics, we have probably one of the most complex scheduling systems basically. I don't even know.

In my mind it's like known to man, [laughs] , but I don't want to be that arrogant, obviously, but it's just...any time you touch that, you have to really acknowledge and recognize that the ripple effects are going to be crazy. Yeah, it's the scheduling. It's the billing. It's the legal aspects.

AM:  There are very few systems in health care, at least this scale of an institution, that are simple. If they look simple on the face of it, it's because we've built them on top of eight other systems to make it look simple. It's very rare that you find something that is [inaudible 16:55]

CC:  Yeah, but on the bright side of things, if you can explain what you're doing and you're proactive about it, a lot of the time...I think a lot of what CFI is, it's more of a network, and you start to figure out who the change makers are and who are the people who have influence in this ever‑complicated area of X, Y, Z.

Through experience you start to understand when to start burning those people to the table, and you explain what you're doing, and more often than not we all want the same things, so the challenge is there, but on the other hand we're really fortunate to have a lot of partners who can help us cut through the infinite weeds everywhere. [laughs] I don't know.

Facilitator:  Are there some areas that you just haven't been able to penetrate or new initiatives that you just haven't been able to get through?

AM:  Recently we avoided the hospital, the inpatient setting. That's primarily because, in my opinion, we're a physician‑led organization, and the Center for Innovation is physician‑led, but interestingly, a hospital is really practically led by nursing, so the culture was very different, so it's just recently that we've gotten into that.

We've had a hard time being able to run experimentation where we can change the kind of payment model even on a prototype basis. We've pitched it to a few payers and a few insurance companies to see if they'd be willing to run a one‑year pilot with us, and that seems something that's just been a little too complex to get us able to do, a lot of times because they negotiate contracts years out so you can't do anything in a very agile manner.

MM:  We all would die to be able to really take a real, hard look at that issue, and we have a couple projects that are really starting to scratch the surface, but really being able to look at that whole piece of the experience and figure out how we create a more transparent and compassionate system around that, I think a lot of us are like, "Whoa. Where do you even begin?"

AM:  I know, but I think for the most part, though, we've penetrated most of what the clinic does.

Facilitator:  Interesting. It's funny that you say the cross‑transparency thing because it's such a big issue for patients, and I remember working with some of our partners at Memorial Sloan Kettering who had managed to bring two of the different billing departments together so that patients are getting one bill and one invoice.

As simple as that sounds and as such an obvious benefit to patients, the way they described, it was just this massive undertaking.

MM:  Oh, huge.

AM:  Yeah.

Facilitator:  Can we walk through an example or a story that you all are proud of, of the success that you've had in terms of building a culture of innovation at Mayo or moving a very new concept through the organization and seeing it take hold?

CC:  One that's just starting to get a little bit of traction is a project called OB Nest. This is a project that was a started a few years ago, where we took a look at our low‑risk, prenatal care service line, and really wanted to look at, "How do we rethink this?"

Recognizing the fact that know, Mayo being a top medical institution, but were treating women in a very medical way who aren't sick. [laughs]

With that, we partnered with the Department of Obstetrics and Gynecology, and we really worked together to create a re‑imagined model, looking at how do we re‑think this whole pregnancy experience in a way that re‑positions the women and their families within that experience so that they're...that we're thinking about how do we enable them to be more confident in their pregnancies?

How do we really empower them and activate their support people and communities...

Facilitator:  Deliver value.

CC:  Yeah, throughout that experience. With that, it became kind of this service that really integrates mutuals in technology, re‑imagines the care pathway, looks at the kind of pacing and expectations set around the visits, and non‑visit care, and all that. Right now that is being run within the OB department, and from what I hear, it's going well.

AM:  Marnie ran these beautiful experiments that helped to understand the true value that expecting mothers were finding within the system and where health care thought that there was value but there wasn't any for the patient, so it matched up where the mothers wanted value and where health care knew that value needed to be, and created a system that these mothers could really take advantage of.

Facilitator:  I have an eight‑month‑old son, so what you're saying [laughs] feels very relevant to what I just experienced, having gone through pregnancy, and going in for those visits, and they're telling you that you're measuring like this, and all this stuff that just feels very medical but feels very separate from your experience as a pregnant woman, so I can appreciate what you're saying.

Have you thought about, or is there some work being done to, extend any of Mayo's services into the home like they do in a lot of European countries?

CC:  Just picking on that model a little bit, a lot of the idea is that through the tools that the women have, most recognize that most of the care, a huge component of their care is what they do for themselves, so empowering them in their self‑care, so giving them access to tools and technologies.

One example is women who participate in this program will get access to a fetal Doppler that is basically theirs throughout the experience so that they're not waiting until that next appointment to hear the baby's heartbeat.

Again, these are commercially‑available devices that anybody can buy, but really incorporating that within their program of care and allowing them to get the answers they need at home, in a more relaxed setting, and being able to bring in the people they care about on their time.

Because it's in their space, in their time, being able to give them the kind of tools and empowerment to be able to tell us when something's wrong rather than vice versa, which is more typical within a medical model, so that's one component.

AM:  We've done a lot of work around video visits where you could call in and talk to your provider from home, especially if it's a return visit. We created an exam room in a backpack that allows primary care providers to go see chronic care patients in their homes and do entire appointments while they're there, so we've looked...we're looking definitely outside of the walls.

Facilitator:  That's great. Just further going on that example, what would be some of the more medical or quantitative measures that you would use to evaluate the success of the program?

CC:  Some of the things they're looking at...obviously they're tracking outcomes, but I know they're looking at patient satisfaction. They're looking at cost. Yeah, I think they're looking at pre‑term births.

Again, I'm not exactly sure because it's 300 women that are participating in the current pilot, so I'm not exactly sure what they can expect to see within the cohort in terms of results, but those are just some of the ones that come into my mind.

At least a sample of the women who are participating are being interviewed and really looked at for how this was for them, and hopefully not just from a satisfaction standpoint but also really getting to the nuts and bolts of how things can be improved and how we can continue to grow and move forward in the model.

MM:  It's an interesting case study because it was already sitting in a bundled payment model, so there was an advantage for Mayo Clinic to further streamline the care and find value, but there was also for the patient in that they're paying us this lump sum of money and they can know exactly what to expect from us in terms of value rather than find out piecemeal as you go forward, and it empowers the patient to demonstrate what is valuable rather than the clinic dictating to them what's valuable.

Facilitator:  It strikes me that the role that the three of you are in, you are constantly shifting between the language of the different departments as well as the languages of physician speak and what patients want to be communicated to, which is likely more personal.

Can you speak a little bit about that and how important the role of communication is in achieving success?

CC:  It's something that we look at very frequently, and it's not something that just you have to negotiate, but something we see patients being forced to negotiate, especially when we were looking at the inpatient setting.

The patients...almost everything that people say in the inpatient setting is clinical, especially from the provider side, and there wasn't even a recognition that their language is changing from one situation to the next.

As designers we figure out pretty quickly how to communicate within each group, but even more importantly, what it is is kind of shining a light on the challenges that these different languages, and different ways of communicating, and the burden that it's placing on patients.

MM:  I would add to that because Caroline's a little bit newer, but Allison and I have been here four‑and‑a‑half, five years, and it's really easy to become desensitized to over‑medicalized language, and it's something we try to be aware of, and definitely you start to forget how much you're switching gears and switching languages depending on who you talk to.

One thing that I really love that we hired, maybe a year ago, we have an illustrator that we hired and he has been a really wonderful asset, yeah, to our team because he comes in and he'll illustrate different patients' stories in this very real and raw way that can really crystallize, in a really beautiful way, what's happening in a situation.

A lot of times they're not...well, they're beautiful, but they're not pretty. They can highlight really dark areas and experiences that people are having with their condition or with the health care system, and I think the capturing of that for us, it's a really wonderful reminder and I think it just...again, it's been a really wonderful tool to continue to communicate across different roles.

It just takes the words out from just being words in thin air.

Facilitator:  Tell me a little bit more about that. Is the illustrator having conversations patients or he's working with the innovation center, going on these patient visits with physicians, capturing this stuff and then producing drawings that then get shared out with stakeholders would be making decisions strategically about where to go next?

MM:  He does multiple things. He works kind of integrated within our team, so sometimes it's that he's going off patient visits and really understanding what's going on.

It can also work that another designer has done a lot of the work and needs to put together a report that really can crystallize the story that they're trying to tell, so we might come to him and say, "Here's what I saw. Here's what I'm trying to convey," and he's a master at putting those together.

Or it can just be something where we tell a story that we've had, historically, that it hasn't come through very clearly yet and we need him to help us be more convincing when we tell this story, and he can do that.

He can work on the ground level, or in the middle on the team when you get to the nitty‑gritty report writing, or at the top, high level, how do you clarify something?

Facilitator:  Aside from illustration, can you think of other specific tools that have been really crucial to your process?

CC:  Oh, gosh. I would say something I use a lot, especially during the research process, is we do a ton of card sort activities, and visualization activities, and things like that to really be able to enable articulation around what does the patient value, do they value this more than that, in what ways for what...

I would say, for me, that's something that I always go back to, and just in terms of being able to draw out a different type of conversation, and also recognizing that a lot of the time, while we have a lot of access to patients, depending on the project, if it's a rare condition, you don't have unlimited access or unlimited time, so it's like really drawing out...helping people think. [laughs]

That's one tool that I really like to go to.

AM:  We also have, just in terms of this information, we have an embedded IT team who can help [inaudible 30:00] different interfaces that you want to try out or new systems of connecting different pieces of technology, and another one that's an invaluable asset that we have here is our innovation coordinators who...

I know Amber will be at your panel, but they really know how to navigate Mayo Clinic politically, how to make friends, how to talk to different groups, and then they have a lifetime's worth of favors that they're willing to call in for us, so if I say, "I'd really love to see a heart transplant tomorrow," chances are they can get me into a heart transplant tomorrow.

Or I want 20 people to talk to by Friday for this type of interview. You can pretty much bet that there will be 20 people ready to go.

Facilitator:  That's awesome. One quick question about data. You described what you were collecting as gobs of data, and I just was curious about what are you doing with all of that and how are you making it actionable for either your team or for other stakeholders within Mayo?

MM:  That's one of the challenges that we face. We try to always distill it into insights and reports that are actionable for the specific stakeholders that were putting it together, but I think one of the ongoing challenges we have is once a project wraps up, how can you best take all of that data and those insights that were put together for that one particular reason and make them meaningful to other projects?

We've done it different ways. We tell stories, we make personas, we create different system maps, but I think we have yet to perfect how to make it so that our data can slide back and forth between projects.

Facilitator:  All right, guys. This has been really fantastic. I really appreciate your time. Thank you so much. I'm looking forward to meeting you on the 24th and 25th of September.