A political prescription from the Mayo Clinic

The discreet sign reads, “If you have been here for more than 20 minutes, please inform check-in.” It takes a while for the penny to drop. You have never seen this sign in any Canadian hospital!

Behind the sign sits a commitment to performance measurement and outcomes that are far from a priority in Canadian public institutions.

For the 1.3 million patients to whom the Mayo Clinic provides treatment each year, the experience could not be more different than what we are used to in our hospitals. “Patient first” is not a marketing slogan, it is the foundational value of the world’s most successful medical institution. It is lived daily by the 63,000 employees of this non-profit foundation.

On my fifth visit over more than a decade, I am still stunned by the difference that an organization built on teamwork, constant improvement and innovation, exceptional patient care and outcomes can deliver.

To the cheerful receptionist I hesitantly ask, “What would happen if several patients complained that they had been left waiting?”

I am met with a puzzled look, “Well, there would be changes, wouldn’t there!?”

When the then-newly-arrived CEO of the clinic discovered a wide range in resources consumed, length of stay and, crucially, outcomes among their heart patients, he announced a multi-year inquiry.

The world-famous Mayo cardiac surgeons were not pleased. After sever- al years, the study revealed the consistent best performers — and the others. CEO John Noseworthy, a Cape Breton native, made changes.

Never a follower of fashion, the original doctor Mayo was roundly excoriated by the Chicago Medical Society when he presented a paper on surgical followup and long-term-outcome assessment.

Then, as now, his peers were not keen to be judged on how patients fared beyond the operating theatre.

More recently, when too many doctors fell for the seduction of the opioid pedlars — and touched off our continuing tragedy — the Mayo Clinic did not.

It expanded its opioid withdrawal and drug-free pain-management programs.

“Always look forward, not back,” was among William Mayo’s favourite aphorisms.

He overbuilt facilities for patients that would only come later, invested in people and equipment before a capacity crisis demanded them, mortgaged his own house to buy an early medical microscope, knowing that it would have a huge impact on better diagnosis.

Better diagnostics was another of his innovations.

The best diagnosis required more than one set of eyes, getting diagnosis right was far more important than intervention, he believed. Followup and outcome measurement were more important than either.

Imagine if our public institutions were so managed?

If governments devoted more work to analysis and deep understanding before policy change and new spending.

If universities’ grants were based on a third-party assessment of the academic growth of their graduates.

If surgeons’ successful treatment of patients was judged by a panel of their peers.

If teams of Canada Revenue Agency call-centre workers got recognition — or even a bonus! — for reducing the number of taxpayers given bad advice, as opposed to today’s response to the perennial increase in dumb counsel — a dismissive shrug.

Mayo cultural values are not foreign, most of us try to live by them in our own lives: trying hard is important, getting the best outcome even more so; teams of colleagues with a shared commitment to success and to each other deliver better outcomes. Fads are not innovation.

Imagine if governments taxed and invested today in tomorrow’s housing, health and education needs — instead of going into deeper debt to finance yesterday’s policy failures.

A1-per-cent hike in interest rates means $300 million more dollars of our money goes, every year, to bond holders.

That would build a lot of new housing and better schools in Ontario.

Why do these damaging behaviours become the norm?

Because it is easier to borrow than to defend a tax increase; easier to ignore wait times than to make the behaviour changes required to shrink them.

Genuine commitment to better outcomes requires work more than money, shared commitment not just more spending. Working toward better outcomes is hard, yet we demand it of ourselves. Why do we not demand the same of our political leaders?