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Mayo's innovation team thinks big, moves fast to transform medical care

While covering important events in our civic and cultural life, journalists typically focus on facts, controversies, issues and their impact. They rarely look through the lens of understanding leaders and leadership: who is leading the causes and creating change, how those leaders were motivated to tackle tough problems and create opportunities for their communities, and how they worked through the challenges that arose.

In a yearlong series, MinnPost is profiling such leaders in order to provide new insights — and, we hope in some cases, inspiration — for our readers. Each profile is paired with comments from members of a panel of experienced leaders and scholars of leadership. The project is made possible by a grant from the Bush Foundation.

ROCHESTER, Minn. — Many a Minnesotan has exhausted treatment options with local doctors and traveled to the Mayo Clinic. Sure, they were grateful for the gold-standard care. Still, the trek to Rochester took time and money.

Now, hundreds of patients are seeing Mayo doctors without leaving home. They and/or their local doctors do so via video hookups or "eConsults" with Mayo care teams.

The eConsults are just one example of innovations developed by Dr. Nicholas LaRusso and his team in a bid to help break the national health-care crisis.

"We spend more money per capita on health care than any other country on the planet and our outcomes are not nearly as good," LaRusso said. "Everyone in the country who thinks about this recognizes that change is needed. We need better outcomes, and we need to reduce costs."

Dr. Nicholas LaRusso
MinnPost photo by Sharon Schmickle
Dr. Nicholas LaRusso

Designing to change mindsets
LaRusso heads a skunkworks project that is housed in Mayo's Rochester complex of conventional clinics and research labs. Step inside the Center for Innovation and you have to change mindsets — think Google generation, not staid country doctors.

There are few walls and no cubicles, offices or chemistry benches. Instead, there are rooms and corners with names like "Enabling Space" and "Future Works." Projects in the works in those spaces include personal security systems for senior citizens and a "pediatric distraction" chair (Kids give a blood sample, and the experience is so much fun they ask to do it again — in theory, at least.).

Someone has taken a blue marker and written "NOW WHAT?" on a window. People seem to think Post-It notes are wallpaper. A study of patients' impressions of dialysis treatment is outlined on one wall in the multicolored notes.

Another wall bears LaRusso's motto in a splash of green letters: THINK BIG, START SMALL, MOVE FAST.

Arguably more radical is the fact that designers claim rightful places alongside medical experts on the project teams. Yes, designers — as in furniture, clothing and graphics. The global design firm IDEO is an external partner to the Mayo center.

If health care truly is to be transformed, then every element from the waiting rooms to the billing offices has to be considered within the frame of design thinking, LaRusso maintains. It's an emerging, 21st-century approach that has been embraced by some leaders in engineering, academia and the corporate world.

Simply put, design thinking approaches challenges from the broad perspective of desired goals and values rather than the specifics of individual problems.

Video courtesy of Big Think. Visit their website here.

"Solution rush is what many of us as physicians are guilty of when we try to frame and solve problems," LaRusso said. "We are trained to get to an answer from a set of symptoms as quickly as possible, with the shortest number of steps, with the least amount of testing."

A problem as complex as the health-care delivery system calls for opening those sharply focused medical minds to different realms of thought.

New thinking for old systems
In theoretical terms, LaRusso's very ambitious challenge is to fuse design thinking with the scientific method that has driven medical discovery in the past.

"Scientific research will generate new cures, but his team had the sense nobody was paying enough attention to the overall delivery system, to the patient experience," said Steve Kelley, who directs the Center for Science, Technology and Public Policy at the University of Minnesota's Humphrey School of Public Affairs.

"Innovation in health care is not just about inventing new cures," Kelley said. "It also is about changing the delivery system."

Thanks to LaRusso and a few other leaders in his field, the impetus for such expansive thinking is spreading in health-care circles.

"That fact that an institution like Mayo with Dr. LaRusso's leadership is exploring this, has given confidence to other institutions to go down the same path," Kelly said.

Mayo for a new century
From a "30,000-foot perspective," LaRusso said his center's mission is to help Mayo make "the same transformational impact on health care at the beginning of the 21st century that our founders made at the beginning of the 20th century."

Mayo's founders are credited with developing the first teamwork approach to medical care. More than a century ago, the original doctors invited others to join them in an integrated group practice.

From that foundation of collected expertise, they solved the riddles of diseases that had stumped other doctors working solo. And their worldwide reputation for delivering top-notch care influenced the structure of medicine far beyond Rochester.

So LaRusso has set a very, very high bar for himself.

It isn't the first time he has done that.

Profound lessons learned from failure
In high school, LaRusso won the position of quarterback and captain of his football team despite his slight frame. Then he kept climbing rungs in the achievement ladder: graduated magna cum laude from Boston College and rose through a distinguished medical career to chair the Department of Medicine at Mayo. On the national level he was editor of a medical journal and president of two professional organizations. His many honors include a Merit Award from the National Institutes of Health.

Those are just the highlights.

But his achievement was not defined by a steady upward curve. When I asked him what in his early life might explain his capacity for leadership, he talked about profound lessons he learned from failure.

As a 6th-grader in the New York City public schools, LaRusso set his sights on a program under which a student who scored high enough on an IQ test could complete 7th through 9th grades in two years.

"I took the test, and my score was one point short of the cutoff," LaRusso recalled. "As a result I didn't get into the Rapid Advancement Program."

Instead of sitting back at that point, LaRusso dug in, determined that he would succeed nevertheless.

Failure prompted LaRusso to dig in again when he was a freshman at Boston College, where he chose a premed major because "if I didn't like it, it would be easier to switch to my second choice, which was English, than if I did it the other way around."

Here's LaRusso's account of the humbling experience in his first science class:

"There was a guy named Professor Vincent, who taught first year. He taught botany in the first semester and zoology in the second semester. So you were stuck with him for a year. ... The final exam in botany was a blue book exam, an essay exam. The way he marked it, he would stop if he found a mistake. I made a mistake on the second page and I got an 11 on the exam — 11 out of 100. So I got a C-minus for the course. He called me in and said to me, ‘You have no scientific aptitude.  You will never be a doctor. Find something else to do.' ... Mentally, I said, ‘Go F yourself! I'm going to prove I can do this.' The next semester I got an A- in his botany course."

Family, Jesuits and football
So failure spurred the young LaRusso. But what gave him the drive and resilience to fight back where others might have folded?

For starters, LaRusso credits his Italian-American family. He grew up in Brooklyn the oldest of five kids. Neither of his parents had college education, but they had high aspirations for their children. Nicholas would be a priest or a doctor, they insisted. He quickly rejected the prospect of priesthood, but he admired the family physician.

So there was one of the first high bars.

Another influence was a demanding education in Jesuit schools — Brooklyn Prep for high school and then Boston College. His classmates were the scrappy kids of Polish, Irish and Italian immigrants. Competition was fierce.

"There was an expectation of excellence," LaRusso said. "The concept was noblesse oblige, which meant that because you have been given so much you have a responsibility to give back. It was rigorous academically.  In four years of high school I took four years of Latin, three years of Greek and two years of French. We were expected to study every night, and I did. ... Nobody went home at 2 o'clock. Everybody had to be involved in something, whether it was sports, theater, the newspaper."

In football practice, LaRusso felt driven to be the first player running laps and to run them hard because he was the quarterback and the team captain.

"You had to set an example," he said.

‘I can outwork anybody'
Maybe the best explanation for LaRusso's drive is that it came naturally, from something deep within him.

"I think leadership can be taught, and I think it can be refined and nurtured," LaRusso said. "But I think some people more naturally gravitate to it. I was the head monitor in the 6th grade. I was president of most of my classes in high school.  I ran for president of the student body. I lost, but I was always involved at that level."

And then, the early failures taught him that a winning equation was hard work added to whatever talent he had.

"One of the things I learned, particularly when my IQ was one point below what they wanted, was that I might not be as smart as other people — and I'll tell you I am not the smartest, just judging from IQ — but I can outwork anybody," he said.

"Hard work ultimately is what makes the difference," he said. "One of my roommates in medical school had a photographic memory. I would have to spend two hours trying to memorize stuff that he could learn in five minutes. My attitude was, ‘Well it's too bad I don't have that. But if this what it takes, this is what I'm going to do.' "

Concrete results
Now, brilliant innovators across Minnesota — indeed, across America — are working hard to make health care more affordable, more available, more effective and more responsive to the basic human needs of the sick and the dying.

After three years, the Center for Innovation already has contributed to that cause.

Center for Innovation at the Mayo Clinic
Photo courtesy Center for Innovation, Mayo Clinic
Center for Innovation at the Mayo Clinic

The eConsults are one contribution. Mayo has identified some 170 conditions for which Mayo physicians, patients and their local doctors can save time and money by taking advantage of virtual visits. Instead of shuttling around for face-to-face meetings, doctors send a patient's information to specialists and discuss the case via a video conference.

And some patients save travel expenses by making follow-up visits to Mayo doctors from their living rooms, using Skype or similar software applications.

After three years of design and testing, Mayo now has done nearly 8,000 eConsults in its Rochester clinics and hospitals. And it relies on the innovation for at least 10 percent of its internal consultations.

A related innovation is "distance care," the expansion of electronic medicine to places where specialized advice is simply out of reach. Mayo breast-cancer experts are providing consultations to women in remote locations in Alaska.

"My belief is that it is going to be an important model for the future in this country because there is a physician shortage," LaRusso said. "We are not the only one doing this. What's different about us is that we have an integrated system here, so that if the breast-cancer specialist needs a surgeon, the surgeon can show up at the same time.

This thrust into electronic medicine also is prodding reform at the payment end of the system.

"The ability to get reimbursed for the kind of remote consultations that I described to you is limited right now," LaRusso said. "Most of the reimbursement is based on the face-to-face model. You come to my office. I spend 15 minutes with you. Medicare pays me this much money."

Persistent demonstration that the innovations can improve cost and quality will pressure policymakers to change the reimbursement system, he predicted.

"Five to 10 years from now there will be payment models for remote consultations," LaRusso said. "The next 15 years are going to see dramatic changes in how health care is delivered, what the payments models are for the new delivery models and, hopefully, a shift toward paying for value rather than paying for volume."

Senior safety and care for caregivers
Another thrust at the Center for Innovation is helping senior citizens live at home with better health and safety. Think of it as a home security system — guarding against health threats, not burglars.

The Center created a living laboratory in the Charter House, an assisted-living facility for some 400 people in Rochester. New devices help track whether residents have taken their medicine. Motion sensors watch for signs someone is at risk of falling. Other gadgets monitor blood pressure and overall fitness. Best Buy is collaborating on the creation of some devices.

Yet another initiative aims to better support those who help care for loved ones with chronic conditions such as Alzheimer's disease.

And ready for market is a Center-developed product designed to help small medical practices move their record systems online.

Moving the institution
Some of the Center's most important innovations are less tangible. And they start at home, at the Mayo Clinic where more than 1 million people are treated every year.

"I think maybe our initial impact has been broader than the concrete projects," LaRusso said. "We have a number of projects that are starting to mature and to actually influence the way the institution does things."

Failure is not something you want your doctor to risk. And so the medical mindset properly is risk-averse. Even outside of medicine, large institutions often change at a snail's pace — if they change at all. But with support from Mayo's top management, the Center is spreading innovation fever throughout that large institution.      

"We have emphasized the value of reaching outside of the organization and even outside of health care," LaRusso said. "So if you look at our external advisory council there is not one physician on there. These are people from different industries, public relations, design innovation, a furniture company."

Don't some Mayo doctors think what you are doing here is a bit offbeat, I asked LaRusso.

"Yes, but I think that is less the case now," he said. "One of the goals we set three years ago was to establish a degree of internal credibility and acceptance. I think we've accomplished that."

More and more Mayo experts are coming to the Center to work on ideas.

"Our group when we started in July 2008 had maybe 10 people," LaRusso said. "By the end of this year we will be approaching 60. ... We are now at the point where we have many more people interested in using us than we are in a position to accommodate."

Beyond Mayo, the Center's innovative thinking is spreading in small steps that could add up to big savings and better care, said Kelley at the Humphrey School.     

"This concept is spreading to other institutions in the state, and the fact that there is this resource of thinking and exploration at the Mayo Clinic is an important part of that," Kelley said.

You have to be there
Even before the Center was created, Mayo had begun to push outside its institutional walls for change in the larger health-care system. Its Health Policy Center has worked and lobbied inside and outside health care circles for system reforms including a call for guaranteed, portable health insurance for all individuals.

LaRusso's Center for Innovation lends support to that effort by providing models for change — talking points, if you will, about change that can improve outcomes while also reducing costs.

"We give them stories to tell," said Francesca Dickson, a spokeswoman for the Center.

At the same time, LaRusso himself struggled to express the essence of the Center's reach for change.

"It's easier to appreciate how this works when you experience it rather than when someone tries to explain it to you," he said.

"The analogy I give is if you are a downhill skier and you try to explain to someone the joy and sensation that you get by downhill skiing. That's not the same thing as actually being out there on a beautiful sunny day when you are going down the hill and you are feeling like you are in control," he said. "So you have to come here and experience what it's like to be involved in a brainstorming session."

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Comments (1)

..."We spend more money per capita on health care than any other country on the planet and our outcomes are not nearly as good"...

And the main thrust of his research?

Limit actual physical contact time with patients while increasing reimbursement for that limited contact.

Somehow, that doesn't seem quite on target.

The biggest elephant in the room that isn't mentioned is the amount of money eaten up in the fragmented public/private insurance model of medical payments which eats up a very large portion of health care spending and does not improve outcomes one whit.

Also, it seems to me that there are many medical conditions that are discovered in a serendipitous fashion when the patient and doctor are actually in the same room. The dynamics of video chat are significantly different than a physical meeting, and the potential result would be that there would be a increasing tendency to medicate symptoms rather than treat underlying conditions.