A day after announcing he will step down as Mayo Clinic's president and CEO at the end of 2018, John Noseworthy spoke with American Health Line's Josh Zeitlin about his 9-year tenure as chief executive, his approach to leading through change, and his advice for the Clinic's next leader.
Question: Dr. Noseworthy, you just announced yesterday that you will retire as president and CEO of Mayo Clinic at the end of 2018. How are you feeling now, just a few hours later—and what have the past 24 hours been like?
Noseworthy: I feel good! This is a good decision for Mayo Clinic. I feel very confident in our future, and I'm very proud of our staff and our leadership team. It's a good feeling. I think Mayo Clinic is in a very strong position.
Q: Why have you decided to step down now, after nine years as CEO and 28 years with Mayo?
Noseworthy: Mayo has a tradition of rotating leaders every four to eight years in all the medical departments, and the CEO is renewed annually and generally serves for seven to 10 years. We think that's a good way to do it.
So number one, this is the beginning of my ninth year. Number two, we're in a very strong position in our quality, safety, education, research activities, and our financial performance and our financial foundation. So the organization is rock solid. We have a very clear strategy for our performance going forward and alignment around the leadership tables with our external board and our internal group. And I have developed a strong bench of tested physician executives who would be well-suited to seamlessly step into this role if selected.
The table is well set for this.
Q: Could you speak more to the philosophy of why Mayo rotates its leaders at those regular intervals?
Noseworthy: Mayo believes in servant leadership: that essentially the leader is there to serve the organization, serve the staff.
As you know, Mayo is physician-led. The broad philosophy across Mayo is that every major division and department has a physician-administrator partner. So we pair a physician leader with an able administrator, and together they lead the departments, divisions, the major committees, the major sections of Mayo.
That's how Mayo works. We rotate our administrators every six to eight years so they gain a broad knowledge of the organization, and we rotate the physician leaders in each of these roles. We just believe it's the best way to bring fresh ideas and innovation across the organization.
It's similar with the CEO, but it's a formal, annual renewable process—a very formal process, a rigorous process—and then we recommend that person stay for another year. But there's a sense when you're doing well that the CEO will rotate somewhere in that seven to 10 year timeframe.
Q: So what's next for you?
Noseworthy: I have 11 months to be a very active president and CEO of the Mayo Clinic, and I'm looking forward to that and focused very much on maintaining our performance as a center for excellence for serious and complex illness, on driving quality and efficiency, on driving down the cost of care and improving our outcomes, and on supporting Mayo from a cultural standpoint broadly and in the public space as a thought leader. And opportunities for me are coming in as you might expect, and I'm looking at those for what do to in January.
Q: What accomplishments are you are most proud of from your tenure thus far?
Noseworthy: The thing I'm most proud of is that every day, every member of the staff puts the patients first. That's our culture.
Also, we basically had to do a major structural reorganization of Mayo that we started the first day I came into this role. We were a holding company—in Florida, Arizona, and the upper Midwest—and we said no, we're going to come together as a single operating company with a single strategic plan, a single operating plan, a single budget, and our values and culture.
That had huge business implications for the back office, revenue cycle, supply chain, HR, legal, public affairs, all that kind of thing. We had to streamline our work and basically perform as one organization in multiple markets.
That's unquestionably what underpins our strong success these last 8 years. Arizona, Florida, and the Upper Midwest are all performing extremely well. The three of them are in the 98th percentile in quality and safety, and it's allowed us to be successful as well in our research, education, and finances. It's the power of acting as an organization as a single organization as a national player. That's probably what's led to our strong success and our very strong physicians in a very changing marketplace.
Q: Are there other highlights from your time as CEO that spring to mind?
Noseworthy: I think another big step we've done is in this world of mergers and acquisitions, Mayo Clinic decided not to do that. Instead, we created the Mayo Clinic Care Network, which now has 46 sites around the world, most of them in the United States, which basically share Mayo's knowledge on a subscription basis for patients who don't have a fully integrated practice.
That's been very successful. It's our answer to mergers and acquisitions, and we've pretty well blanketed the United States and have five international sites. The cool thing about that is that more than 80% of the patients who we interface with don't need to travel to get a Mayo Clinic opinion. Most of those patients can be managed at home, which is good for them, good for the local provider, and good for the cost of health care.
Q: With so many other organizations going through identify crises with their scale and mission scope, what lessons do you take from wearing the many hats that Mayo Clinic has donned?
Noseworthy: If an organization knows who they are, and they develop and execute on that culture, they can be successful. If they don't, and they don't have a shared purpose and a shared mission and shared values, they will struggle. And that's been the source of our success.
We've had a common mission for 154 years, but in the last eight years we've come together literally as one Mayo Clinic, and that has allowed us to navigate some pretty choppy water.
Q: To step back and talk a bit about leadership—a lot of leaders admire you. Who do you admire?
Noseworthy: I admire our staff. We have the most committed staff—nurses, physicians, scientists—who come every day to work to help other people.
The medical profession is rife with that everywhere; I understand that. But I've never seen the level of commitment to service that I've seen at the Mayo Clinic, and that's why I've had 28 blissful years at the Mayo Clinic and not a bad day. I'm just surrounded by these people who are servants for the patients. It's unbelievable.
Q: What would you say is your advice for the next Mayo Clinic CEO?
Noseworthy: Remember who we are. Remember how we work. Be open to change, and then become a change leader. There's a lot of change, and we're going to have to make more changes going forward. We are we believe a Center of Excellence for serious and complex illness, and we should be open to partnerships with other academic medical centers, with life sciences companies, device companies, pharma, but also with other sectors: transportation, education, nutrition, all that stuff.
We all together need to work on, "How do we create a strong system to provide high quality, sustainable care in the country?" And we don't have that right now. We have a series of systems, but it's broken, and there's lots of opportunity for innovation.
And as you've written about, there are folks who want to invest in health care, and we welcome that investment and that partnership. So the next person again is basically leading change for what I think is a great organization, and it's extremely rewarding work.
Q: You've talked about engaging in these uncertain times. What would you say should be a health care leader's role in engaging in policy conversations, as someone who's been outspoken about policy yourself?
Noseworthy: I may sound like a broken record, but the patient has to be at the center of the solution. It isn't about the insurance company, it isn't about the academic medical center, and it isn't about the medical device company—it's about the patients.
We all have to come together and say, "What does a sustainable, high-quality health care system look like to serve our citizens, our patients, and their families?" If we do that, if we have that singular focus, then we're capable of great things.
Q: You mentioned that the next Mayo leader will need to excel at leading through change. What's your advice to leaders for excelling at that?
Noseworthy: I think really good leaders are really good listeners. They're also really good at surrounding themselves with very capable people from diverse backgrounds and with diversity of thought. They communicate the answers to key questions, such as "why do we need to change?" and "what does the future look like?" And if you can tie that to the values of a health care professional—that we went into this profession for the benefit of others—you really can't go wrong.
Whenever there's a controversy or an uncertain solution, at Mayo at least, we always just say, "Wait a minute: What's best for the patient and their families?" That breaks a lot of ice around the table. We don't have to do it much at Mayo, because I'm surrounded by people who believe that. But when the patient is at the center, the solutions emerge.
So that's why I would say: Surround yourself with really smart people and listen, listen, listen.