Transformative Innovation?

In 2010, the CFI was hoping to go even further than "small changes for big impact." Most of its projects had a timeline of six months, but it was also working on some longer-term, large-scale innovations.

For example, Austin Medical Home was a major initiative to study and improve health care in rural communities. In 2009 the CFI had sent two designers to live for several months in the town of Austin, Minnesota, in order to conduct extensive surveys of residents’ access to health care. The researchers had found that although there were ample medical and social service resources available in the town, there were problems with communication both among the providers and between patients and providers. In 2010 the CFI was pondering how to respond to these needs.

In another major project, the high reliability operating room, designers spent 12 weeks examining in detail the processes and interactions in the operating room with the goal of developing a better set of procedures for preventing and recovering from errors. A third project was a new model of mini-clinics, similar to small banking offices in a supermarket. The Minute Clinic was a proposed Mayo extension at the Mall of America, where consumers could get minor illnesses treated in a convenient location for a published, fixed fee.

But all of these projects were still in the planning stages, and the challenge remained to implement them, both within the Mayo system and in the larger health care industry in general. 

In addition, some completed projects that appeared to be successful were still waiting to be applied in the actual practice of the clinic. For example, the CFI had experimented with check-in kiosks in clinic waiting rooms, similar to an airport check-in system. The CFI had received positive responses from both patients and providers, but in spite of this success, no departments within Mayo had adopted a check-in kiosk. This raised the question of whether a large-scale innovation could find acceptance, not just in theory but also in practice.

Another question as the CFI came of age was whether the designers who came to Mayo would continue to find their work suitable. Maggie Breslin acknowledged, “I think you have to be pretty humble to do this type of work. It's not a place for a more ego-driven designer, because the nature of the work is that you put it out into the world and other people take it and run with it. So if you want it to still be attached to you, this isn't really the right place for you.” Although designers who came to Mayo were dedicated to improving the health care experience, it was not clear whether they would be satisfied in the long run with incremental innovations.

In 2010 the industry's problems with Medicare reimbursements were becoming more acute. In 2009 Mayo Clinic lost $840 million on Medicare patients, which forced the organization to stop accepting these patients at one of its primary care clinics in Arizona beginning in 2010. On top of this challenge, the health care industry was facing the prospect of new government regulations and their attendant administrative burdens. This made it all the more urgent for Mayo Clinic to find new ways to streamline care delivery, while maintaining its core commitment to the needs of the patient.