Mayo Clinic: Design Thinking in Health Care – Case Study Synopsis & Teaching Objectives

Mayo Clinic: Design Thinking in Health Care case study is available here.

Case Background
In the early 2000s, Mayo Clinic physician Nicholas LaRusso asked himself a question: if we can test new drugs in clinical trials, can we in a similarly rigorous way test new kinds of doctor-patient interactions?

Although over the last 50 years there had been enormous advances in diagnosing and treating disease, the systems of delivering health care had changed little. In fact, new tests, treatments and procedures meant that the health care experience had become increasingly complex for provider and patient alike.

But what if there were better ways to provide care? As LaRusso reasoned, “New technology, new diagnostic tests, and new therapeutics will be most effective if we can improve the ways we deliver these enormous advances to patients.”

LaRusso had heard that design firms like IDEO were offering consulting services in the area of human-factors design, and he wondered if their work might be applicable in the health care setting. Mayo had a history of innovation in care delivery, starting with the invention of the patient medical record in the early 20th century, and the clinic was always looking for ways to improve both patient outcomes and the health care experience.

In 2002, in consultation with IDEO, LaRusso and colleague Dr. Michael Brennan opened a skunkworks outpatient lab called SPARC, where physicians and designers could work together to test hypotheses about ways in which providers and patients interact. They dealt with a number of challenges: recruiting busy physicians to a new and untested type of research, crossing the cultural divide between physicians and designers, doing experimentation with real patients, and gaining institutional support for their unusual endeavor.

Within six years, the lab grew from a small venture sponsored by a single department to an enterprise-wide Center for Innovation, a dedicated research and design-oriented institute that studies the processes of health care provision, from the initial phone call, to the clinic visit, to the diagnosis and treatment of the problem, to follow-up and preventive care.

In 2010, the CFI was a respected internal consultancy of Mayo Clinic. It had five platforms that encompassed various kinds of service redesign, and it had grown from two full-time employees to 32. It had undertaken projects to reorganize the work flows in a practice, test new strategies for patient education, use technology to improve physician consultations, and redesign the traditional exam room.

At the same time, CFI designers and physicians acknowledged that the innovations they had developed were small, and they spoke of the goal of “transformational” change. But in 2010 there were questions about how the CFI would achieve its stated aspirations. What would a major change in health care delivery look like? How should the CFI’s impact be measured? Were the center’s structure and processes appropriate for transformational change?

Teaching Objectives
The principal case question concerns the tension between incremental and transformational innovation within a service setting. It will be of particular interest in courses on innovation, design thinking, service design, and the health care industry.

The case also allows for discussion of ancillary topics, such as:

•    The risks and rewards of innovation in health care.
•    The role of innovation in developing a powerful service brand such as Mayo Clinic.
•    The need for improvements in health care delivery processes.
•    The evolution of an innovation project from skunkworks to institutionalized center.
•    The opportunities and challenges of integrating designers into the medical culture.
•    The challenge of measuring impact of innovation in health care delivery.
•    The challenge of diffusing innovation within Mayo and beyond.

Case Resources
The case study consists of a brief history of innovation at Mayo, an overview of current challenges in health care delivery, descriptions of particular projects, and a discussion of challenges faced by the CFI, including internal management, metrics, and strategies for bringing together designers and physicians. Development of the case was overseen by Rodrigo Canales, Assistant Professor of Organizational Behavior at the Yale School of Management and Andrea Smith, Project Editor at the Yale School of Management’s Case Study Research Department.

Besides text, the case study consists of 35 links to primary documents and 33 video clips featuring interviews with Mayo Clinic executives, physicians, administrators, and designers.

A highlight of the case is a set of mini-cases on five projects undertaken by the Center for Innovation:

•    Dermatology practice redesign: CFI designers worked with Mayo’s dermatology practice to enable each function to work at the top of their license; as a result, the practice increased its business from 35 to 65 patients a day.
•    Pediatric ENT practice redesign: The CFI helped the pediatric ENT unit to more effectively treat sick children by improving communication with their parents.
•    Diabetes education cards: Mayo’s endocrinology practice, in collaboration with the CFI, found that patients who used new diabetes education cards were more knowledgeable about the side effects of their medicines and more likely to be compliant with their treatment plans.
•    eConsults: A new electronic communication system helps physicians to communicate more efficiently with each other and with faraway patients.
•    Exam room redesign: A new exam room designed by the CFI enables patients to better retain information about their health records and exam results.

Discussion Topics

From Incremental to Transformational Innovation
The key challenge faced by the CFI in 2010 is the pressure to produce transformational change. Instructors can discuss the difference between incremental and transformational innovation and ask students to consider whether they are in tension. Do the two types of innovation need to be balanced? Should the CFI stick with incremental improvements, the same type of small changes that made Toyota the largest automaker in the world? Or should it attempt to foster a breakthrough innovation? What would such an innovation in health care delivery look like? And does the CFI have the structure to produce transformational innovation?

Innovation in the Health Care Setting
Mayo Clinic has a history of innovation in health care delivery, beginning with the invention of the patient medical record in the early 20th century. One hundred years later, there is a new need for innovations in the service of health care. Instructors can frame the problem by discussing the connection between advances in medical treatments and diagnosis and the increasing complexity of the health care experience. Doctors and patients alike are under pressure as they attempt navigate a highly specialized medical system. Instructors can also discuss the move toward “data-driven” methods for monitoring complex services so as to minimize errors. Consumers are expecting higher levels of quality in a variety of settings, and techniques are available to track effective and ineffective pieces of a complex system. With its Center for Innovation, Mayo Clinic is bringing to the health care setting the methods that transformed the New York Police Department and the Toyota Motor Corporation.

The SPARC Laboratory as a Skunk Works Operation
Mayo Clinic was one of the first medical organizations to open a laboratory to study the processes of health care delivery. Instructors can discuss the challenges of starting a new venture in any large establishment and the particular sensitivities of experimenting with service innovations in the health care setting. They can also consider the importance the credibility of Dr. Nicholas LaRusso as head of the new SPARC Laboratory: could such a new venture have been started without the leadership of a respected member of the existing institution?

Two Cultures: Design and Medicine
By the early 2000s “design thinking” had become a new method for improving various aspects of the consumer experience. When Mayo Clinic brought designers into the medical setting, it had to deal with communication challenges between physicians and designers. Instructors can discuss the “design thinking” movement and ask students to consider the role of designers in facilitating innovation in health care delivery. What do designers bring to the medical environment? In what ways do designers need to accommodate their style to the expectations of a medical clinic?

Institutionalizing Innovation
A key challenge faced by the CFI in 2010 is to expand its influence. The center has achieved substantial successes, but it has not always been able to diffuse them throughout the institution. How should the CFI measure its results? Once it has concrete results, how should it publicize them and persuade others to act on them? Which projects seem to be the most scalable, and which are the most difficult to bring to scale? What should the CFI do when projects such as the check-in kiosk receive positive feedback but nevertheless do not find acceptance in practice?