Prescription for Change

How Mayo Clinic standardized care across 22 emergency departments

by Elizabeth Trandel

Organizations pursuing an M&A strategy while trying to achieve clinical standardization face a unique set of challenges. The piecemeal addition of facilities often results in sites with dissimilar cultures and conflicting approaches to clinical operations.

This is problematic for two reasons. First, as one member recently told us: "Unless we create very clear, succinct operational efficiency to deliver high quality, we're going to lose money." Second, variation between sites poses opportunity costs in terms of quality, when best practice clinical standards are not being consistently applied.

Mayo raises the bar for quality and reduces costs through standardization

In 2012, Mayo Clinic Health System recognized the financial and quality opportunities of standardizing the clinical operations of their emergency departments. So, they tasked a physician-administrator dyad with an ambitious goal: harmonize the clinical operations of all 22 of Mayo's emergency departments in Minnesota. The facilities ranged from Mayo's flagship academic medical center ED to several small critical-access sites; in aggregate, the facilities saw over 350,000 patients annually.

While all Mayo facilities, the sites had different cultures, bylaws, physician compensation, and leadership structures. Adding to their challenge, many sites were paying below market-level salaries, and several were relying heavily on locum tenens physicians. With these challenges in mind, Dr. Christopher Russi, the chair of community emergency medicine, and Aaron Keenan, an operations administrator, forged ahead on their herculean task.

How they did it

Dr. Russi and Mr. Keenan executed four critical steps:

1. Reorganizing the 22 academic and community EDs under a singular leadership structure
Previously, the sites were divided into four regions, but had no standardized leadership structure. The Mayo team created steering committees at the regional level led by physician-nurse-administrator triad leadership teams.

2. Standardizing physician salaries across the EDs and creating a centralized recruitment process
Creating one centralized physician recruitment effort across the system increased efficiency and eliminated duplicative work.

3. Creating new, more appealing rotational roles for both physicians and physician leaders
At the smaller facilities, physicians spend 20% of their time practicing at the flagship AMC in Rochester. Physicians value this opportunity, and it facilitates cross-pollination of ideas and dissemination of standardized care practices between the flagship and outlying facilities.

See all the Physician Executive Council's resources on performance improvement

Community site physician leaders also have 80/20 roles: they practice at the AMC 20% of the time, and spend the remaining 80% of their time at the community site, doing both administrative and clinical work.

4. Standardizing nursing education and protocols across facilities
Previously, disparate nursing protocols across sites proved difficult for physicians to navigate when transitioning between facilities. Implementing standardized, best practice nursing protocols throughout the system not only improved care, but also allowed physicians practicing at multiple sites to transition smoothly.

In-person visits critical to getting buy-in and driving change

Of course, these changes did not happen overnight, or without some resistance. To ease the transition, Dr. Russi and Mr. Keenan drove to each facility to speak with its leaders. They view this face-to-face communication as critical to success. To get the most out of these conversations, the dyad partners came equipped with three basic questions to ask the community leaders:

  • What is burdening you?
  • What is your biggest hurdle?
  • What are you concerned about with integration?

These simple questions had a big impact. They alleviated leaders' fears about the Rochester flagship trying to seize authority from afar, and secured buy-in for the integration plans. As Dr. Russi told us, "If you demonstrate that you care and that you're willing to help, and then follow through with those promises, you gain serious credibility." Gaining this credibility directly gave way to the program's success.

The results

Dr. Russi and Mr. Keenan started these efforts in January 2013. Within a year they saw remarkable results: reduced transfer rates, dropped service line write-offs, improved billing and coding, rising HCAHPS scores, and increased success with hiring and retention, reducing the need for locum tenens physicians and saving $75,000 annually for each terminated locum contract. The improvements are ongoing and continue to gain momentum.

Learn more about dyad leadership

Join us for the last session of our 2014-2015 national meeting series to get a closer look at Mayo's integration process and tools for developing effective physician leadership teams.


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