A century ago marked a critical time for Mayo Clinic. By every measure, the organization was successful. Yet William J. Mayo, M.D., was at a crossroads, with a mounting sense of pressure. He and his brother, Charles H. Mayo, M.D., faced a question that confronts many entrepreneurs: What will happen when I retire or die? The clinic's governing structure as a private practice was not sufficient for its long-term vitality or its humanitarian mission of education and research to advance patient care.
The demands of World War I exacerbated his concern. In alternating trips to Washington, D.C., the brothers helped mobilize medical support for American troops in Europe—and manage Mayo Clinic, where a staff depleted by enlistment served a record number of patients. The strain took a toll on Dr. William Mayo's health.
"In the late spring of 1918," recalled Harry Harwick, a Mayo Clinic administrator, "Dr. Will returned from Washington a sick man. With a surgeon's detachment, he told me he had either a temporary jaundice or cancer. Calmly, he said: 'I have things that I want seen to.'" He left no doubt that Harwick was the one to help him.
Today, whether it's the editorial staff of Harvard Business Review or benchmarking visitors from other medical centers, one aspect of Mayo Clinic that earns consistent praise is the model of physician-administrator collaboration.
The roots of this tradition go deep—to that time in 1918 and long drives through the countryside as Dr. William Mayo conversed with the young administrator, Harwick.
Almost every workday at 9 a.m., Harwick wrote, "Louis West [Dr. Will's chauffeur] would swing the Mayo car to the curb, and I would climb into the back seat. Sometimes, Dr. Will alone would greet me; sometimes, he was accompanied by Mrs. Mayo. The car would leave Rochester behind. . . . We would ride for hours, stop for lunch, drive on again. Though I had worked for him for 10 years, it was on these drives that I really got to know him, and he me. He would philosophize on the widest range of subjects, discussing not only the future of the Clinic and of medicine but a hundred other topics as well."
Harwick put in some long hours when he got back to his desk, but he described the experience as "an invaluable education." Dr. William Mayo got what he wanted when Harwick brought his administrative skills to a committee, which included the Mayos' investment manager and several well-known attorneys, "to bring this great purpose into legal reality."
Dr. William Mayo's malady turned out to be jaundice, and he returned to a full professional schedule. Now, Harwick said, he turned more and more of his attention to ways "that would safeguard the future of the institution."
It took several years to transform Mayo Clinic from a private practice into a not-for-profit organization with a salaried staff and a governance structure of committees that function under an independent board of trustees. But the concepts that Dr. William Mayo and Mr. Harwick discussed on their road trips set the course for Mayo Clinic for a century.
Harwick progressed in his career to a position that was equivalent to chief administrative officer. His professional stature and willingness to share his experience with others played a key role in establishing the profession of medical administration that is central to many health care organizations. His description of this unique role is equally relevant today: "The lay administrator of a medical institution, therefore, must be able to find a practical, harmonious balance between medical ideals on the one hand and . . . sound business methods on the other."
Today, John Noseworthy, M.D., President and CEO, Mayo Clinic, and Jeff Bolton, Vice President, Administration, Mayo Clinic, set the tone, which is emulated throughout the institution. At Mayo Clinic, medicine and business are complementary rather than competitive, uniting diverse perspectives for the shared goal of serving patients.