Citations

Agility has been adopted in the software development industry for decades and has been used in the business world for the past 10 years. In healthcare, however, agility has not been widely adopted or studied but is emerging as imperative for competitive advantage in a rapidly changing environment. Human-centred agility and change in the wake of the COVID-19 pandemic has become especially important. Change agility is composed of two aspects. While the first aspect is a mindset that embraces change, resiliency, flexibility and responsiveness to consumer needs, the second is an approach using collaborative efforts through self-organising teams. Healthcare organisations must adopt both aspects to leverage the collective value of change agility. To help staff embrace and develop a change agility mindset, healthcare organisations need to offer relevant educational courses and coaching; teach change agility principles and values by using case studies and real-life applications; and promote the right culture by building flexible systems, providing a safe learning environment and encouraging risk-taking. To grow and sustain change agility, healthcare organisations can benefit by using a continuous seven-step quest: examining the current state, defining the future state, assessing the gaps, developing strategies, executing the strategies, measuring progress and maintaining success. This paper addresses the strategy and iterative interventions developed by the Department of Management Engineering and Consulting (renamed the Strategy Department) at Mayo Clinic to prepare its professional staff to drive a business-focused, change agility mindset through benchmarking, education and experiential learning. The early experiences and lessons learned at Mayo Clinic in change agility are likely broadly transferable to other healthcare organisations.

Change management plays a crucial role in an organisation’s ability to adapt and thrive in today’s ever-evolving and fast-changing technologically enabled business landscape. Many organisations continue to struggle with effective change management, resulting in failed projects and missed opportunities for growth and development. This paper analyses the reasons why organisations frequently falter in change management efforts and provides insights into overcoming these barriers. The paper identifies a host of significant barriers to effective and successful change management. Each barrier is discussed in detail, explaining the negative effect it can have on change initiatives. Among these barriers are the lack of change management role accountability, a culture where change management is not embraced at all levels, a lack of change champions and leadership support, resistance to change, limited employee involvement, inadequate and poorly designed communications and a failure to properly integrate change management with other complementary approaches. The paper provides practical recommendations to overcome these barriers. It emphasises the crucial role of leadership in championing the change, communicating the vision and actively involving employees in the change process. It underscores the importance of a well-crafted, clear and consistent communication that can help build trust, ensure buy-in and reduce resistance. The paper also highlights the need for robust integration of change management with other complementary approaches. Furthermore, the paper underscores the significance of a centralised change management approach, incorporating tools, best practices and standardised change management practices, and setting realistic expectations to sustain change efforts over time. It stresses the need for organisations to provide the necessary resources, authority and support to staff to effectively fulfil their change management roles. In conclusion, this paper provides insights into overcoming the main barriers to successful change implementation. By implementing the suggested strategies, organisations can enhance their change management capabilities and increase their adaptability, thereby ensuring long-term success in a rapidly changing business landscape.

The COVID-19 pandemic challenged healthcare organisations in safely providing healthcare to patients while protecting employees and reducing the spread of the virus. This paper shows how the Mayo Clinic responded by implementing innovations, including screening, testing and tracing patients for COVID-19; expanding telehealth services; adjusting surgical and procedural operations and reallocating staffing and supplies. These changes were operationalised rapidly through the coordinated response from its leadership, partnership of experts across the organisation, prompt decision-making driven by data, redistribution of resources and expedited training. These innovations and methods of rapid implementation enabled Mayo Clinic to safely continue its mission of providing healing and hope to its patients worldwide, and quickly return to financial sustainability.

Mayo Clinic adopted one electronic health record (EHR) across all 70 locations in five different states in 2017 and 18. A post-implementation review addressed concerns, and new workflows, processes and functionalities were adjusted. A common issue raised by multiple departments related to difficulty in accessing the right referral orders. Referrals between departments at Mayo Clinic are orders driven; scheduling is dependent on accurate ordering. Mayo Clinic’s vast size and number of specialties resulted in a very large catalogue of referral orders mapping to appointment types specific to each specialty. Providers found ordering in the new system time-consuming and looking for specific orders tedious. Often, wrong orders were selected, resulting in scheduling errors, reordering, rescheduling and staff and patient dissatisfaction. To solve this problem, an innovative functionality, EZ Panels, was created, which uses a panel-within-panel approach to group orders by speciality, displaying a much shorter list to providers. This functionality improved ordering capabilities, making it easier for providers to access the correct orders and make referrals accurately and efficiently. All 70 practices built and implemented EZ Panels in less than one year. Our fast-paced build and implementation approach can be modified and used by any healthcare system experiencing similar issues.

Mayo Clinic’s Management Engineering and Internal Consulting Department has a comprehensive and integrated approach to knowledge management (KM). This enables the department to provide consistent delivery of services, reduce project duration and innovate and build from the collective and diverse expertise of their team members, who are in multiple health system locations in the United States. The KM and sharing programme consists of tools to manage content and best-practice methodologies as well as informal and formal approaches to sharing broad knowledge and expertise via project design forums, social networks (eg community of practice groups) and knowledge sharing and project libraries. Staff are encouraged to contribute to the stored knowledge to support future project needs and to extract data for best practices and lessons learned (including successes and failures) to assist current project efforts.

The COVID-19 pandemic has created unique logistical challenges for vaccine transportation, inventory management, allocation and distribution at multiple levels — the federal government, states and healthcare institutions. Unpredictable weekly vaccine allocation from state health departments, changing population priorities, stringent vaccine requirements for ultracold storage, transportation, reconstitution and 2-dose administration intervals have presented challenges never seen before in the history of mass vaccination programmes, including those at Mayo Clinic. To meet the challenges, an efficient system of allocation and administration for COVID-19 vaccines was developed through collaboration with process engineering. To understand the challenges, ten health systems engineers from the Department of Management Engineering & Consulting at Mayo Clinic facilitated the institution-wide COVID-19 vaccine project, collaborating closely with diverse multidisciplinary teams that included physicians, nurses, pharmacists, administrative services, information technology, human resources, scheduling operations and public affairs. The internal consultants designed tools and solutions based on systems and process engineering methodologies to solve a myriad of complex problems, including identifying priority populations, using resources efficiently and minimising vaccine waste. Tools designed included a vaccine resource playbook; dynamic staffing models based on vaccine allocation, storage, inventory and distribution processes using a hub-andspoke model; workflows and staffing models for face-to-face and drive-through vaccine administration sites; and end-of-day workflows to reduce vaccine waste. Through the collaboration, modelling and engineering, multiple sites across Mayo Clinic have implemented successful COVID-19 vaccination programmes that are efficient in resource utilisation and have minimal waste. In this paper, we share what we have learned to help other healthcare organisations prepare for future mass vaccination scenarios.

As modern medicine offers novel surgical therapies for conditions simple and complex, the proper resource allocation of operating rooms, surgical staff and supporting services is becoming increasingly important for healthcare organisations. Surgical services are one of the most essential parts of any healthcare system, substantially influencing patient choice of healthcare services. These services are typically the centre for revenue but also impart considerable costs. Given the complexity of surgical schedule planning, expectations of high reliability and demand on resources, many healthcare organisations have resorted to using a static block schedule based on historic utilisation patterns. This is based on the dogma that surgical schedules are not predictable, surgical blocks are stable, and surgical yield has no direct correlation with outpatient schedules. Here we share our two-year experience with a Surgical Predictor Tool using our surgical practice management principles and the cost-effective use of these means to meet the needs of patients and our surgical staff in an integrated community health system.

The value of a shared service organisation (SSO) is recognised in transactional functions across manufacturing, technology and finance. Successful application of an SSO in healthcare is limited, particularly in professional, non-transactional functions. This article explores the application, effectiveness and challenges of creating an SSO in a fast-paced, dynamic environment. The Department of Management Engineering & Internal Consulting (ME&IC), a team of engineering and consulting staff at Mayo Clinic, completed its SSO journey by leveraging lessons from Mayo Clinic and various industries. Methods to implement a successful SSO included a literature review, customer and leadership interviews, and cross-industry benchmarking. ME&IC converged and streamlined its services, expenses, infrastructure and service delivery; realised economies of scale; translated best practices; and optimised staff talent. The SSO enabled customer responsiveness and performance excellence by integrating talent, processes and technologies. An effective SSO supports policy standardisation, agile decision-making, strong change management, consolidation of shadow groups, resource alignment with strategic priorities and more accurate measurement and benefits realisation. To achieve success, SSO models must be adapted to organisation culture, leadership commitment and service delivery expectations. The systematic transition to an SSO and lessons learned by ME&IC are broadly transferable to professional groups across industries.

The COVID-19 pandemic caused a transformation in healthcare delivery at a pace never before experienced, including by the child psychiatry practice at Mayo Clinic Health System in Mankato, Minnesota. The aim of this study was to describe the outcomes of that practice’s transition from in-person to virtual care. This retrospective study comprised two groups of patients who received care in the child psychiatry practice at our institution: before COVID-19, 1 March 2019 to 28 February 2020; and after COVID-19, 1 March 2020 to 28 February 2021. We extracted data related to patient visits from the electronic health record and satisfaction data from a Medical Practice Survey given to patients after visits. Virtual visits increased by 306 per cent within a month of transitioning to virtual care and remain the main visit type for established patients. Findings from patient surveys showed substantial overall improvements in patient experiences with virtual visits, and no-show appointments decreased substantially (from up to 23 per cent to 1 per cent). This study provided data for an overview of how the COVID-19 pandemic affected a child psychiatry practice and of the positive outcomes of transitioning from 100 per cent in-person visits before the pandemic to more than 80 per cent virtual visits. The quick transition to virtual care delivery in the child psychiatry practice was a positive change for patients, families and the care team. We believe that other healthcare systems can learn from our experience.

The demand for telehealth services in the United States saw an unprecedented increase following the 2020 COVID-19 pandemic. Prior to the pandemic, intake and virtual rooming functions for scheduled, synchronous video appointments at Mayo Clinic were supported by a small centralised team of virtual agents within its Center for Connected Care (Connected Care). In response to the pandemic-generated demand, Connected Care leveraged its existing model and the support of temporary staff to rapidly scale support for the increased video visit demand across the enterprise. Once demand stabilised in the summer of 2020, Mayo Clinic’s destination medical centres in Minnesota, Florida and Arizona, and Mayo Clinic Health System’s sites in the Midwest, launched pilots to evaluate alternative telehealth delivery models. The goal of these pilots was to test the flexibility of alternative intake models for supporting long-term scalability and growth. Through these pilots, each site developed unique workflows and staffing plans with the overall intake function remaining standardised across all locations. The workflows delineated responsibilities between clinical departments and virtual agents, leveraged current infrastructure and maximised best practices from the original model. This paper outlines the models implemented, and presents lessons learned and best practices garnered from each implementation.