Q&A: Meet Mayo Clinic's next CEO, Gianrico Farrugia—and the 3 challenges Noseworthy says he'll face

Topics: Providers, Hospitals, Care Delivery

by Thomas Seay, editor-in-chief, and Jackie Kimmell, senior analyst

On Friday, Mayo Clinic announced that Gianrico Farrugia will take over as the organization's president and CEO beginning in January 2019. Shortly after the announcement, Farrugia and Mayo's current president and CEO, John Noseworthy, spoke with American Health Line about why Mayo remains committed to physician leadership, its strategy for growth, and the three biggest challenges Farrugia will take on when he takes the reins as CEO.

This interview has been lightly edited for length and clarity.

Question: Dr. Farrugia, you're clearly stepping into some big shoes. How are you feeling at the moment?

Gianrico Farrugia: They are very big shoes—figuratively and literally. He's probably a foot taller than I am.

First of all, I'm honored to have this opportunity to serve this iconic institution and to serve our staff and patients. And with that comes feelings of humility, obviously, and of excitement. Mayo Clinic has never been in as strong of a position as it is in currently, both in terms of the number of patients we serve and in terms of our outcomes.

So there's the excitement of knowing that we're in a very strong place, that John Noseworthy brought us here, and that now it's my job to make sure that we continue to show ingenuity, innovation, fresh ways of looking to [genetic] testing. We want to make sure that we do what Mayo Clinic is best at: offering hope and healing for the patients with the most complex and serious diseases.

Q: For our readers who aren't familiar with your background, what's one thing they should know about you?

Farrugia: They should know that I follow a long series of Mayo Clinic leaders who are physicians. Mayo Clinic is physician-led and we've all practiced medicine before we got to this role. That's something we're very proud of, being part of a team of people that looks after patients.

Q: Dr. Noseworthy, you're still Mayo's CEO through the end of the year. What's on your priority list for the next several months?

John Noseworthy: As the president and CEO through the end of the year, my job is to continue to deliver the work that we're doing—to continue to provide outstanding care, safe care; continue to invest in research and innovation; and continue to have excellent educational work. So, to do the work. We have to execute on our plan, as we've done every year, to provide the best and safest care to our patients.

The other thing is that we are three-quarters of the way through a very large install of a new electronic health system for our health records and revenue cycle—the EPIC system. We're about to do that in October in Florida and Arizona. So that's a big lift for the organization. We've just finished installing the system in Rochester and we've done our Mayo Clinic Health System. So that's one of the big things on my plate for the rest of the year.

Q: Dr. Noseworthy, if you were identifying for Dr. Farrugia the three biggest challenges he'll face as CEO, what would you say?

Noseworthy: The first is that it's very important, especially if you're going to be a physician leader at Mayo Clinic, to connect with Mayo Clinic. Connect with the staff and build your team. At Mayo Clinic, it's all about teamwork, and in the present CEO role, it's all about understanding how the organization is doing, where the areas of excitement are, and where the pain points are. The team has to be trusted. That will happen quite quickly with Dr. Farrugia; he's been here 30 years and he's quite well-known. But it is a different role to be the president and CEO. 

Number two, we have a very clear strategy, which he has been part of building. We'll be asking him to lead the refresh of the strategy which has brought us nearly to 2020. He'll be leading that discussion about the path to 2030 with all of the opportunities and challenges that will entail.

The third thing in this role is leading the execution of the strategy—because with that comes better patient outcomes and sustainability for the organization. One of Dr. Farrugia's strengths is his inherent curiosity and his proven track record at innovation, research, invention, and creating new businesses.

It's the perfect time to have that energy and expertise in our physician leader, because Mayo Clinic is placing great importance on partnering not just within the health care sector but across all sectors broadly, and that kind of partnership is important for solving some of the most vexing problems in health care. If we simply try to fix those problems as physicians, or if the insurance company tries to do it, or the government tries to do it, the solution won't be sustainable. So his natural innovation and his style of collaboration will be perfect for this organization.

Q: Dr. Farrugia, some of those challenges sound pretty daunting. Any thoughts on how you'll address those challenges? What strikes you as the most difficult task in front of you?

Farrugia: They're daunting challenges, but they're really daunting for us as a nation as well as locally. I actually think the Mayo Clinic is really in a much better place to deal with them. We already have the best things when it comes to biomedical research, education, and patient care.

I fully expect that by harnessing these things, and then by using all of partnerships we've built over the years—both within and outside out health care system—that we'll actually come up with better ways at doing what we've always done, which is to provide care for patients with the most complex and serious disease.

We need to innovate as a county to stay ahead and to offer the latest in health care. At the same time, we need to continue to innovate to make sure that what we know works can be diffused across the country though methods which are affordable for most people. And, in fact, that's one of the tenets of the Mayo Clinic Network: We don't acquire other health care systems, but rather partner with them and diffuse our knowledge so that they too can provide a better level of care.

Q: Dr. Farrugia, in the book you co-wrote about the Mayo Clinic Center for Innovation, you talk about "Project Mars"—which was basically an effort to ask, "What would the ideal medical practice look like if started from scratch on Planet Mars?" I wonder: What would your own "Project Mars" health system look like? And is that a direction you want to take Mayo?

Farrugia: What was very interesting about Project Mars was to get input from patients, from relatives, from people that were not only experiencing health care at that moment, but who thought about health care from a broad lens and compared it to other sectors. We learned a lot. Specifically, the big thing we learned is that it's not just one thing; you don't just fix health care by going after one aspect of health care. Really, you don't just fix health care by fixing health care, but you have to fix the whole system around it, from education, to government to regulation.

What we will be doing moving forward is co-creating the next version of our strategic plan which outlines the way we want to do things, and then we'll work on testing them with our partners so that we can do what we do best—making sure that we have the scientific knowledge to know what works rather than assuming it does.

Q: One of the biggest concerns we've heard about from hospital and health system CEOs is their future growth path, especially at a time when inpatient services aren't growing as fast as they have in the past. How do the two of you see Mayo Clinic approaching growth? Are you worried about competing with ever-growing systems in the future?

Noseworthy: Mayo Clinic has a growth strategy, and it's a strategic growth strategy based on the areas that we do very well in, areas where we believe that we add value to patients and make it worthwhile for them to travel the distance. That would include cancer, transplants, neurosciences, and cardiovascular disease, as well as diagnostic evaluations.

So we have a strategic growth plan there, and we know that if those patients come to Mayo—and they have come forever and they seem to still want to come—because of our efficient team-based care, we will get the diagnosis correct more quickly than anywhere else on the planet and we will have done more of the procedures (if they need them) and we will bring new treatments to patients who have exhausted treatments that they've had elsewhere.

And so focusing on growth in areas of serious and complex illness is essentially our strategic plan for growth, and it's working, so we're investing heavily in our facilities to accommodate the growth of the patients from all over the world.

Q: A final wrap-up question for each of you: Dr. Noseworthy, what's next for you beyond January?

Noseworthy: A boring answer: My job is to lead the Mayo Clinic until the end of the year and then decide how I'll be leaving. I won't be going back into practice as a neurologist, and I won't be working at the Mayo Clinic; that's not our tradition. I'll be taking some time to think about how I can best serve society with the expertise that I've learned at this point.

Q: Dr. Farrugia, let's flash forward to the point in the future when, at the end of your tenure, you're having this same conversation about your time as CEO. What do you hope you will have accomplished? How will you measure your success?

Farrugia: Dr. Noseworthy is handing over, at the end of the year, an organization that has never been stronger, and I want to make sure that I am also going to hand over an organization that has also never been stronger.

Number two, Mayo Clinic is always about the people. We do a lot of technology, we innovate, but patients very much need the relationship with that provider. Therefore, it will be very important to build a diverse workforce that will meet the needs of our patients.

And thirdly, I'd like to hand over to my successor a group of staff who are not only finding meaning at work but are finding joy in their work. I hope that joy spills over into every part of their life, which means that my successor is able to rely on that joy, and that spirit of collaboration, to build an even better Mayo Clinic.